Parallel tablets are a complex medicine that affects the body in several directions. The effectiveness of treating hypertension increases by combining several active ingredients with different properties. For this purpose, the drug “Paralel” was developed. The effectiveness of this medication in the treatment of hypertension is high.
Side effect
Adverse reactions are usually transient and mild, so interruption of the course of treatment is not required.
By organ system and frequency of occurrence, adverse reactions are classified as: very common (≥ 10%), common (≥ 1% - < 10%), uncommon (≥ 0.1% - < 1%), rare (≥ 0.01 % - <0.1%), very rare (<0.01%). From the circulatory and lymphatic systems:
very rarely - bone marrow suppression, agranulocytosis, leukopenia, neutropenia, thrombocytopenia, anemia (including hemolytic), lymphadenopathy.
From the side of the central nervous system:
often – headache, dizziness, drowsiness; sometimes - vertigo, parasthesia, hypesthesia, taste disturbance, syncope, tremor; very rarely - confusion, depression, fainting, peripheral neuropathy.
From the mental side:
rarely - mood lability, sleep disturbance, insomnia, fainting; rarely – mental disorders, irritability.
From the cardiovascular system and blood:
often – tachycardia, orthostatic hypotension, facial flushing; rarely - myocardial infarction, tachycardia, palpitations, stroke, Raynaud's phenomenon, arterial hypotension; very rarely - arrhythmia (including ventricular tachycardia and atrial fibrillation), vasculitis.
From the respiratory system:
often – cough, sometimes – rhinitis, shortness of breath; very rarely - bronchospasm, allergic alveolitis / eosinophilic pneumonia, sinusitis.
From the digestive tract and metabolism:
often – nausea, vomiting, abdominal pain, diarrhea; rarely – upset stomach, dyspepsia, impaired intestinal function, dry mouth; very rarely - pancreatitis, intestinal angioedema, gastritis, gingival hyperplasia, hyper- and hypoglycemia.
From the digestive system:
very rarely - liver failure, hepatitis, jaundice (including cholestatic), cholestasis.
From the skin and immune system:
rarely - hypersensitivity, rash, itching, angioedema (of the face, limbs, lips, tongue or larynx), alopecia, hemorrhagic rash, change in skin color, sweating; rarely – psoriasis, urticaria; very rarely - toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, pemphigus, cutaneous lymphocytoma, autoimmune disorders.
Syndromes may include one or more of the following: fever, vasculitis, myalgia, arthralgia/arthritis, positive ANC (nucleic acid antibodies), increased ESR, eosinophilia or leukocytosis, rash, photosensitivity or other manifestations.
From the musculoskeletal system:
rarely – arthralgia, myalgia, convulsions, back pain.
From the kidneys and urinary system:
often – renal dysfunction; sometimes – dysuria, nocturia, increased frequency of urination; rarely – acute renal failure, uremia; very rarely – oliguria/anuria.
General violations:
often - peripheral edema, fatigue; rarely - asthenia, chest pain, discomfort, deterioration of health, leukopenia.
Other:
rarely - visual impairment, tinnitus, impotence, gynecomastia.
Laboratory indicators:
rarely - increased levels of urea, creatinine and liver enzymes, hyperkalemia, changes in body weight; rarely - decreased hemoglobin and hematocrit levels, increased bilirubin levels in the blood serum, hyponatremia.
Paracitolgin
- ibuprofen - paracetamol
Composition and release form of the drug
◊ Film-coated tablets
white or almost white, oval, biconvex; roughness of the surface of the tablets is allowed; on a cross section, the core is white or almost white.
| 1 tab. | |
| paracetamol | 325 mg |
| ibuprofen | 400 mg |
Excipients: microcrystalline cellulose M102 - 76 mg, corn starch - 65.25 mg, glycerol - 3 mg, sodium carboxymethyl starch - 14.25 mg, colloidal silicon dioxide - 38 mg, talc - 19 mg, magnesium stearate - 9.5 mg.
Shell composition:
hypromellose - 12.9 mg, macrogol-4000 - 3.2 mg, titanium dioxide - 2.3 mg, propylene glycol - 1.6 mg.
5 pieces. - contour cellular packaging - cardboard packs. 5 pcs. — contour cell packaging (2) — cardboard packs. 5 pcs. — contour cell packaging (4) — cardboard packs. 10 pcs. - cans - cardboard packs. 10 pcs. — contour cellular packaging — cardboard packs. 10 pcs.
— contour cell packaging (2) — cardboard packs. 10 pcs. — contour cell packaging (4) — cardboard packs. 20 pcs. - cans - cardboard packs. 20 pcs. — contour cellular packaging — cardboard packs, 20 pcs. — contour cell packaging (2) — cardboard packs.
20 pcs.
— contour cell packaging (4) — cardboard packs.
pharmachologic effect
A combination medicine containing ibuprofen (NSAID) and paracetamol (analgesic-antipyretic).
Ibuprofen
has an analgesic, anti-inflammatory, antipyretic effect. By inhibiting COX-1 and COX-2, it disrupts the metabolism of arachidonic acid, reduces the amount of prostaglandins (mediators of pain, inflammation and hyperthermic reaction), both in the site of inflammation and in healthy tissues, suppresses the exudative and proliferative phases of inflammation.
Paracetamol
indiscriminately blocks COX, mainly in the central nervous system, has little effect on water-salt metabolism and the gastrointestinal mucosa. Has an analgesic and antipyretic effect. In inflamed tissues, peroxidases neutralize the effect of paracetamol on COX-1 and COX-2, which explains the low anti-inflammatory effect.
Pharmacokinetics
Ibuprofen.
Absorption is high. Cmax in plasma is achieved 1-2 hours after administration. Plasma protein binding - 90%. T1/2 - 2 hours.
Slowly penetrates into the joint cavity, lingers in the synovial tissue, creating higher concentrations in it than in plasma. After absorption, about 60% of the pharmacologically inactive R-form is slowly transformed into the active S-form.
Metabolized. It is excreted by the kidneys (no more than 1% unchanged) and, to a lesser extent, with bile.
Paracetamol.
Absorption is high. Cmax in plasma is achieved 0.5-2 hours after administration. Plasma protein binding - 15%. Penetrates through the BBB.
Metabolized in the liver (90-95%): 80% enters into conjugation reactions with glucuronic acid and sulfates to form inactive metabolites; 17% undergoes hydroxylation to form 8 active metabolites, which conjugate with glutathione to form inactive metabolites.
With a lack of glutathione, these metabolites can block the enzyme systems of hepatocytes and cause their necrosis. The CYP2E1 isoenzyme is also involved in the metabolism of the drug. T1/2 - 1-4 hours. Excreted by the kidneys in the form of metabolites, mainly conjugates. Less than 5% is excreted unchanged. T1/2 is 4-5 hours.
Indications
For adults: pain of moderate intensity; traumatic inflammation of soft tissues and the musculoskeletal system (incl.
bruises, sprains, dislocations, fractures); postoperative period; algodismenorrhea; toothache; neuralgia; myalgia; lumbago; fibrositis; tenosynovitis; headache; febrile syndrome; articular syndrome (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gouty arthritis); sinusitis; tonsillitis.
For children (as an auxiliary drug): tonsillitis; acute infectious and inflammatory diseases of the upper respiratory tract (pharyngitis, tracheitis, laryngitis).
Dosage
Inside. The dose, frequency of administration and duration of use depend on the indications and the age of the patient.
From the digestive system:
NSAID gastropathy - nausea, vomiting, heartburn, anorexia, discomfort or pain in the epigastrium, diarrhea, flatulence; rarely - erosive and ulcerative lesions, bleeding; liver dysfunction, hepatitis, pancreatitis; irritation or dryness in the mouth, pain in the mouth, ulceration of the gum mucosa, aphthous stomatitis; constipation.
From the nervous system:
headache, dizziness, insomnia, anxiety, nervousness, irritability, agitation, drowsiness, depression, confusion, hallucinations; rarely - aseptic meningitis (more often in patients with autoimmune diseases).
From the senses:
hearing loss, tinnitus, visual impairment, toxic damage to the optic nerve, blurred vision or double vision, scotoma, amblyopia.
From the cardiovascular system:
heart failure, increased blood pressure, tachycardia.
From the hematopoietic organs:
anemia (including hemolytic and aplastic), thrombocytopenia, thrombocytopenic purpura, agranulocytosis, leukopenia.
From the respiratory system:
shortness of breath, bronchospasm.
From the urinary system:
allergic nephritis, acute renal failure, nephrotic syndrome, edema, polyuria, cystitis.
Allergic reactions:
skin rash, itching, urticaria, Quincke's edema, bronchospasm, dyspnea, allergic rhinitis, dry and irritated eyes, swelling of the conjunctiva and eyelids, eosinophilia, fever, anaphylactic shock, erythema multiforme exudative (Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome ).
Laboratory indicators:
decreased serum glucose concentration, decreased hematocrit and hemoglobin, increased bleeding time, increased serum creatinine concentration, increased liver transaminase activity.
Other:
increased sweating.
With long-term use in high doses:
ulceration of the gastrointestinal mucosa, bleeding (gastrointestinal, gingival, uterine, hemorrhoidal), visual impairment (impaired color vision, scotoma, amblyopia).
Drug interactions
When used simultaneously with acetylsalicylic acid
ibuprofen reduces its anti-inflammatory and antiplatelet effect (there may be an increase in the incidence of acute coronary insufficiency in patients receiving small doses of acetylsalicylic acid as an antiplatelet agent after starting treatment).
Combination with ethanol, GCS
increases the risk of erosive and ulcerative lesions of the gastrointestinal tract.
Ibuprofen enhances the effect of direct (heparin) and indirect (coumarin and indanedione derivatives) anticoagulants
,
thrombolytic agents (alteplase, anistreplase, streptokinase, urokinase), antiplatelet agents, colchicine
- the risk of developing hemorrhagic complications increases.
This combination enhances the hypoglycemic effect of insulin and oral hypoglycemic drugs.
Reduces the effects of antihypertensive drugs and diuretics
(due to inhibition of renal prostaglandin synthesis).
Increases blood concentrations of digoxin, lithium and methotrexate
.
Caffeine
enhances the analgesic effect of ibuprofen.
When using this combination simultaneously with cyclosporine, gold preparations
nephrotoxicity increases.
With simultaneous use of this combination with cefamandole, cefoperazone, cefotetan, valproic acid, plicamycin
the incidence of hypoprothrombinemia increases.
Antacids and cholestyramine
reduce the absorption of the ibuprofen + paracetamol combination.
Myelotoxic
drugs contribute to the manifestation of hematotoxicity of the ibuprofen + paracetamol combination.
Pregnancy and lactation
In the first and second trimesters of pregnancy, use is possible only as prescribed by a doctor in cases where the potential benefit outweighs the possible risk to the mother and the potential risk to the fetus. The use of this combination in the third trimester of pregnancy is contraindicated.
If necessary, use during lactation should stop breastfeeding.
Use in childhood
Use is contraindicated in children under 2 years of age.
For impaired renal function
Contraindicated in renal failure.
For liver dysfunction
Contraindicated in liver failure.
The description of the drug Paracitolgin is based on officially approved instructions for use and approved by the manufacturer.
The information provided on drug prices does not constitute an offer to sell or purchase goods. The information is intended solely for comparing prices in stationary pharmacies operating in accordance with Article 55 of the Federal Law “On the Circulation of Medicines”.
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Overdose
Symptoms:
severe peripheral vasodilation, which is accompanied by an excessive decrease in blood pressure, cardiovascular shock, electrolyte imbalance, renal failure, hyperventilation, tachycardia, bradycardia, dizziness, anxiety and cough.
Treatment is symptomatic:
it is necessary to provide the patient with a horizontal position, monitor heart function, blood pressure, indicators of electrolyte metabolism and water exchange, and also correct these indicators if necessary. In case of severe arterial hypotension, the patient should be placed in a horizontal position, his lower limbs elevated, and intravenous infusion solutions should be prescribed. If this therapy is ineffective, it is necessary to prescribe vasoconstrictors (vasopressors) of peripheral action, unless their use is contraindicated. Calcium gluconate can be administered to interrupt the blockage of calcium channels.
Since the absorption of amlodipine is prolonged, gastric lavage may be effective.
Lisinopril can be removed from the body by hemodialysis, but amlodipine, due to its greater ability to bind to protein, is not subject to hemodialysis.
Interaction with other drugs
Interactions associated with lisinopril:
Substances that increase potassium levels: potassium-sparing diuretics, potassium supplements, or substitutes that may increase potassium levels. Heparin in combination with ACE inhibitors can lead to hyperkalemia, especially in patients with renal failure;
diuretics: a sharp decrease in blood pressure may be observed;
other antihypertensive drugs: additive effect;
non-steroidal anti-inflammatory drugs: may reduce the antihypertensive effect;
lithium salt: the degree of lithium excretion may decrease, so the level of lithium in the blood plasma must be regularly monitored;
narcotic drugs, anesthetics in combination with lisinopril enhance the hypotensive effect.
Lisinopril inhibits potassium excretion when used simultaneously with diuretics.
Lisinopril increases the manifestations of alcohol intoxication.
Interactions associated with amlodipine:
CYP3A4 inhibitors: studies in elderly patients have shown that diltiazem inhibits the metabolism of amlodipine, probably through CYP3A4 (plasma concentration increases by 50% and the effect of amlodipine increases), which is also possible with the use of other CYP3A4 inhibitors
Caution is required when used together with amlodipine; . CYP3A4 inducers: combined use with anticonvulsants (for example, carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone), rifampicin, drugs containing St. John's wort / Hypericum perforatum may lead to a decrease in the concentration of amlodipine in the blood plasma;
CYP3A4 inducers: combined use with anticonvulsants (for example, carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone), rifampicin, drugs containing St. John's wort / Hypericum perforatum may lead to a decrease in the concentration of amlodipine in the blood plasma;
amlodipine does not significantly affect the pharmacokinetics of cyclosporine and atorvastatin.
Sildenafil did not affect the pharmacokinetics of amlodipine, but with the combined use of amlodipine and sildenafil, each drug independently exhibited a hypotensive effect. The use of amlodipine as monotherapy is safe in combination with thiazide diuretics, beta blockers, ACE inhibitors, nitrates, sublingual nitroglycerin preparations, digoxin, warfarin, atorvastatin, sildenafil, antacids (aluminum, magnesium hydroxide, dimethicone), cimetidine, NSAIDs, antibiotics and oral hypoglycemic agents.
Dual blockade of the renin-angiotensin-aldosterone system
Based on the available data, dual blockade of the RAAS with ACEI, ARB II, or Aliskiren cannot be recommended in any patient, especially in patients with diabetic nephropathy.
In patients with diabetes mellitus or moderate/severe renal impairment (GFR < 60 ml/min/1.73 m2), the simultaneous use of Aliskiren with an ACE inhibitor or ARB II is contraindicated.
In some cases, when the combined use of ACE inhibitors and ARB II is absolutely indicated, careful supervision by a specialist and mandatory monitoring of renal function, water and electrolyte balance, and blood pressure are necessary.
Precautionary measures
Significant symptomatic hypotension may occur in patients with hyponatremia and/or hypovolemia. Before starting a course of therapy, it is necessary to correct hyponatremia or hypovolemia, and when using the first doses of the drug, it is necessary to monitor its effect on blood pressure.
For cerebrovascular diseases and coronary heart disease
It should be noted that a significant decrease in blood pressure can lead to cerebral stroke or myocardial infarction. In case of mitral aortic stenosis or obstructive hypertrophic cardiomyopathy, Parallel should be used with caution.
For renal artery stenosis
(especially if it is bilateral or there is only one kidney and there is a narrowing of the mouth of the renal artery), in the presence of hyponatremia and/or hypovolemia, as well as in case of insufficient blood supply, lisinopril can lead to decreased renal function, acute renal failure, which after interruption of therapy is reversible.
For liver failure
The release of amlodipine from the body may be delayed. There is no exact dose, but such patients should take the drug with caution.
When taking ACE inhibitors, in particular lisinopril, angioedema may occur with swelling of the face, extremities, lips, epiglottis and larynx. In this case, it is necessary to immediately discontinue the drug, the patient should be under the supervision of a physician until the symptoms completely disappear. If swelling develops on the face, lips and limbs, it usually goes away spontaneously, but the use of antihistamines can help reduce the intensity of its symptoms. Angioedema with laryngeal edema can be fatal. Swelling of the tongue, epiglottis and larynx can lead to blockage of the airways, so immediate adoption of the following therapeutic measures is necessary: inject subcutaneously a 0.1% solution of adrenaline in a dose of 0.3 - 0.5 ml (0.3 - 0.5 mg) or 0.1 ml (0.1 mg) slowly intravenously, after which a glucocorticoid and an antihistamine should be administered while monitoring the patient's vital functions.
Possible anaphylactic reactions
during hemodialysis using a membrane with polyacrylic nitrile (AN 69), during apheresis of low-density lipoproteins and during desensitization to hymenoptera insects (bee and wasp venom).
For liver damage
The half-life of amlodipine increases, so the drug should be used with caution. Patients who develop jaundice or have elevated liver enzymes should stop taking the drug and seek medical attention.
The drug should be used with caution in patients with collagen vascular disease, those receiving immunosuppressive therapy, treatment with allopurinol or procainamide, or a combination of these complicating factors, especially if impaired renal function already exists. Due to the fact that the possibility of agranulocytosis cannot be excluded, it is necessary to periodically monitor the blood picture.
During major surgical procedures
or when using anesthetic agents
that cause hypotension, lisinopril inhibits the compensatory release of angiotensin II. Arterial hypotension, which is observed in this case, can be eliminated by administering saline sodium chloride solution.
When using the standard dose, higher plasma levels of active substances were observed in elderly patients, so the dose in these patients should be set with caution, although no significant difference in effectiveness was observed in young and elderly patients.
Dual blockade of the renin-angiotensin-aldosterone system
Dual blockade of the renin-angiotensin-aldosterone system is associated with an increased risk of hypotension, hyperkalemia and renal dysfunction (including acute renal failure) compared with monotherapy. Dual blockade of the RAAS using an ACEI, ARB II, or Aliskiren cannot be recommended in any patient, especially in patients with diabetic nephropathy.
In some cases, when the combined use of ACE inhibitors and ARB II is absolutely indicated, careful supervision by a specialist and mandatory monitoring of renal function, water and electrolyte balance, and blood pressure are necessary. This applies to the use of candesartan or valsartan as adjunctive therapy to ACE inhibitors in patients with chronic heart failure. Carrying out double blockade of the RAAS under the careful supervision of a specialist and mandatory monitoring of renal function, water-electrolyte balance and blood pressure is possible in patients with chronic heart failure with intolerance to aldosterone antagonists (spironolactone), who have persistence of symptoms of chronic heart failure, despite other measures adequate therapy.
Children.
Due to the lack of data, the use of the drug in children is contraindicated.
Impact on the ability to drive vehicles and other potentially dangerous mechanisms.
The drug may affect the ability to drive a car or operate machinery with an increased risk of injury (especially at the beginning of use), so it is necessary to individually determine at what dose one should not drive a car or work in conditions of increased injury.
Pharmacokinetics
The rate and degree of absorption (bioavailability) of amlodipine and lisinopril when taking the drug Parallel did not differ from that when taking amlodipine and lisinopril tablets simultaneously.
Amlodipine.
When taken orally, absorption is slow, does not depend on food intake, is about 90%, bioavailability is 60-65%. The maximum concentration in plasma when taken orally is achieved within 6-12 hours. With continuous use, the equilibrium concentration of Css is created after 7-8 days. Volume of distribution - 21 l/kg. Bonding with plasma proteins is 90-97%. Passes through the blood-brain barrier and is secreted into breast milk. Intensively (90%) is metabolized in the liver with the formation of inactive metabolites, has a “first pass” effect through the liver, on average - 35 hours. Total clearance - 500 ml/min. T1/2 in patients with arterial hypertension is 48 hours, in elderly patients it increases to 65 hours, in case of liver failure - up to 60 hours, similar parameters for the increase in T1/2 are observed in severe CHF, and in cases of impaired renal function it does not change. It is not removed by hemodialysis. Excreted by the kidneys - 60% in the form of metabolites, 10% unchanged; with bile and through the intestines - 20-25% in the form of metabolites, as well as with breast milk.
Lisinopril
. Absorption - 30% (6-60%); bioavailability - 25%. Weakly binds to plasma proteins. Permeability through the blood-brain and placental barriers is low. Cmax is about 90 ng/ml, time to reach Cmax is 7 hours. It is practically not metabolized and is excreted unchanged by the kidneys. The half-life (T1/2) is 12 hours.
Compatibility
| Compatibility with other active ingredients | |
| Substance | Reactions |
| Drugs that increase potassium levels | Hyperkalemia |
| Diuretics | A sharp decrease in blood pressure, inhibition of potassium excretion |
| Non-steroidal anti-inflammatory drugs | Reduced antihypertensive effect |
| Lithium salts | Lithium excretion level decreases |
| Narcotic drugs, anesthetics | Increases hypotensive effect |
| Alcohol | Increase alcohol intoxication |
| CYP3A4 inhibitors | Increases the effect of amlodipine, must be used with caution |
| Anticonvulsants | Reduce the concentration of amlodipine |
Directions for use and doses
The drug is prescribed when it is not possible to achieve the desired level of blood pressure with monotherapy with one of the components of the drug.
Dose for adults (for monotherapy) – 1 tablet per day, regardless of meals. Depending on individual sensitivity, the dose can be increased to 2 tablets per day.
For patients who have previously taken diuretics, it is recommended to stop the diuretic two to three days before starting therapy. If this is not possible, the initial dose is ½ tablet per day. In this case, after taking the first dose of the drug, the patient's condition should be monitored, since symptomatic hypotension may occur.
For renal failure
the initial dose should be reduced (lisinopril is excreted by the kidneys) and determined individually, depending on the response to the drug and with sufficiently frequent monitoring of renal function parameters and the level of potassium and sodium in the blood serum.
In case of liver failure, the drug is taken with caution (the elimination of amlodipine may be delayed). There is no exact dosage. . For elderly patients (>65 years), dose titration is individual and depends on the response to the drug
The optimal maintenance dose is 1 tablet per day (10 mg lisinopril / 5 mg amlodipine).
For elderly patients (>65 years)
Dose titration is individual and depends on the response to the drug. The optimal maintenance dose is 1 tablet per day (10 mg lisinopril / 5 mg amlodipine).
Advantages
Treatment with Almag has many advantages. The most important of them:
- ease of use - to conduct a session, you do not need to have special knowledge and skills;
- the ability to influence not only the skin, but also the internal organs of a person - this is achieved due to the fact that the magnetic field can penetrate 6-8 cm inside the human body;
- safety of the device - subject to the basic precautions indicated above, it can be used by elderly people, as well as people in a weakened state;
- good tolerance of the magnetic field by patients for whom other physiotherapeutic procedures are contraindicated;
- complete absence of any dependence or addiction, as well as side effects - you can calmly stop the procedures at any time;
- Almag treatment can be done at home, so you don’t have to periodically visit the treatment room, wait in line, or arrange an appointment time6;
- the ability to cover various problem areas in one course;
- long-term use - the average lifespan of the device is 5 years, but it can serve you longer.
The main advantage of the Almag 01 device is, of course, its high efficiency. It is confirmed by clinical studies conducted, in particular, at the Russian Scientific Center for Restorative Medicine and Balneology of the Ministry of Health of the Russian Federation and the Moscow City Clinical Hospital No. 1 named after N. I. Pirogov.
Contraindications
Absolute:
- cardiogenic shock;
- severe arterial hypotension (systolic blood pressure below 90 mm Hg);
- unstable angina (except Prinzmetal's angina);
- acute myocardial infarction (during the first 28 days);
- hypertrophic obstructive cardiomyopathy or hemodynamically significant aortic/mitral valve stenosis;
- indications in the anamnesis of angioedema, including that associated with therapy with other ACE inhibitors;
- idiopathic and/or hereditary angioedema;
- age under 18 years;
- pregnancy and lactation;
- glucose-galactose malabsorption, lactase deficiency and lactose intolerance;
- hypersensitivity to any component of the drug or to other dihydropyridine derivatives or other ACE inhibitors.
Relative (Equacard tablets should be taken with extreme caution):
- coronary insufficiency, coronary heart disease (CHD);
- arterial hypotension;
- heart failure in the stage of decompensation;
- CHF of non-ischemic etiology of functional class III and IV according to the classification of the New York Heart Association (NYHA);
- sick sinus syndrome (severe tachycardia, bradycardia);
- acute myocardial infarction (period after the first 28 days);
- aortic/mitral stenosis;
- cerebrovascular lesions (including cerebrovascular insufficiency);
- inhibition of bone marrow hematopoiesis;
- systemic connective tissue diseases (including scleroderma, systemic lupus erythematosus);
- renal and/or liver failure;
- bilateral renal artery stenosis or stenosis of the artery of a single kidney with worsening azotemia;
- condition after kidney transplantation;
- hemodialysis using high-flow dialysis membranes (AN69) (with concomitant treatment with ACE inhibitors, anaphylactoid reactions were recorded; in such cases, a different type of dialysis membrane or another antihypertensive agent should be used);
- azotemia;
- hyperkalemia;
- primary hyperaldosteronism;
- conditions that lead to a decrease in circulating blood volume (CBV) (including diarrhea, vomiting);
- elderly age;
- following a diet with reduced salt intake.
Who should not use it?
This medicine is contraindicated for people with individual intolerance to the components. It is prohibited to use Parallel during pregnancy and breastfeeding. Also, the drug should not be taken in case of arterial hypotension, unstable angina, or heart pathologies. In the first month after a heart attack, you should not take this medicine. Before the prescription, the body is diagnosed, a biochemical blood test is taken, and if a lack of sodium is detected, the medication is not prescribed.
pharmachologic effect
Antihypertensive combination drug. It has a hypotensive and antianginal effect due to the properties of the components included in the drug.
Lisinopril
- ACE inhibitor, reduces the formation of angiotensin II, aldosterone, while increasing the formation of bradykinin (a vasodilator mediator). Affects tissue RAAS. Reduces total peripheral vascular resistance, blood pressure, preload and afterload, pressure in the pulmonary capillaries, does not affect heart rate, while it is possible to increase the minute volume of blood and increase blood flow in the kidneys. Arteries dilate to a greater extent than veins. Improves blood supply to ischemic myocardium. With long-term use, it reduces hypertrophy of the myocardium and the walls of resistant arteries. Slows the progression of left ventricular dysfunction after myocardial infarction not complicated by heart failure. Effective for arterial hypertension with low renin activity, reduces albuminuria (by reducing blood pressure, changing the hemodynamics of the glomerular apparatus). Does not affect blood glucose concentrations in patients with diabetes. The hypotensive effect develops 1 hour after administration, the maximum effect is after 6 hours, the duration of action is 24 hours. When treatment is stopped, there is no withdrawal syndrome (a sharp increase in blood pressure).
When should you take Parallel?
You should not take pills if you have high blood pressure, unless they are recommended by your doctor; there are contraindications. Only a specialist will indicate when and how much to receive the drug.
A large dose can cause a sharp drop in blood pressure and unnecessarily reduce the sodium content in the blood. And this can provoke the development of stroke and myocardial infarction. Therefore, the doctor will conduct an examination and, if necessary, recommend taking these pills.
And it is usually prescribed for:
- ineffective monotherapy;
- hypertension with angina pectoris;
- elevated blood pressure after myocardial infarction.
It is important to know! Despite its high effectiveness, Parallel causes side effects. It should not be taken for certain diseases. Therefore, never self-prescribe medication.
Drug interactions
Interaction reactions that are possible when lisinopril is used in combination with other drugs/drugs:
- potassium-sparing diuretics (triamterene, spironolactone, eplerenone, amiloride), cyclosporine, potassium preparations, salt substitutes containing potassium: the risk of hyperkalemia increases, especially in cases of renal impairment; these combinations are possible only as prescribed by a doctor and with regular monitoring of renal function and serum potassium concentration;
- diuretics and other antihypertensive drugs: the antihypertensive effect is potentiated;
- non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase-2 (COX-2) inhibitors; sympathomimetics, estrogens: the hypotensive effect is weakened;
- NSAIDs (including COX-2), ACE inhibitors: the level of potassium in the blood serum increases, renal function may deteriorate (impairments are usually reversible);
- lithium preparations: the elimination of lithium slows down, which leads to an increase in its plasma concentration (reversible) and aggravates the threat of adverse events; Serum lithium levels must be regularly monitored;
- antacids, cholestyramine: absorption of lisinopril from the gastrointestinal tract is reduced;
- barbiturates, vasodilators, tricyclic antidepressants, antipsychotics (neuroleptics), beta-blockers, BMCC: the antihypertensive effect is enhanced;
- ethanol: potentiates the effect of lisinopril;
- insulin and oral antidiabetic agents: the risk of hypoglycemia increases;
- procainamide, allopurinol, cytostatics: leukopenia may occur;
- gold preparations with intravenous administration (sodium aurothiomalate): a symptom complex may develop, including facial flushing, vomiting, nausea and decreased blood pressure, when combined with ACE inhibitors.
Interaction reactions that may occur when amlodipine is used in combination with other drugs/drugs:
- beta-blockers: possible exacerbation of CHF;
- ACE inhibitors, alpha-blockers, thiazide diuretics: no negative effects noted;
- NSAIDs (including indomethacin): no clinically significant interaction observed;
- ACE inhibitors, nitrates, thiazide and loop diuretics: antianginal and hypotensive effects are enhanced;
- alpha1-blockers, antipsychotics, isoflurane: antihypertensive effect increases;
- antiretroviral drugs (ritonavir): plasma concentrations of amlodipine increase;
- sildenafil (single dose 100 mg), aluminum- or magnesium-containing antacids, cimetidine, grapefruit juice: there is no significant effect on the pharmacokinetic parameters of amlodipine in patients with arterial hypertension;
- erythromycin: Cmax of amlodipine increases by 22% in young patients and by 50% in elderly;
- antiarrhythmic drugs that cause prolongation of the QT interval (amiodarone, quinidine): the severity of the negative inotropic effect of these drugs may increase when combined with certain BMCCs;
- ethanol-containing drinks: there is no recorded effect on the pharmacokinetics of ethanol with single/repeated use of amlodipine at a dose of 10 mg;
- atorvastatin (at a dose of 80 mg): no significant changes in the pharmacokinetics of this substance are observed when combined with amlodipine at a dose of 10 mg;
- cyclosporine: its pharmacokinetics do not change;
- calcium supplements: the effect of BMCC may be reduced;
- isoflurane, neuroleptics: the hypotensive effect of dihydropyridine derivatives is enhanced;
- lithium preparations: aggravation of neurotoxicity manifestations (diarrhea, vomiting, nausea, ataxia, tinnitus, tremor) may be observed;
- digoxin: no effect on the serum concentration of this substance and its renal clearance is observed;
- warfarin: there is no significant effect on the effect of this substance (prothrombin time);
- warfarin, phenytoin, digoxin, indomethacin: in vitro, the binding of these substances to plasma proteins does not change under the influence of amlodipine.
Do you still think that it is difficult to cure hypertension?
Judging by the fact that you are reading these lines now, victory in the fight against pressure is not yet on your side.
The consequences of high blood pressure are known to everyone: these are irreversible damage to various organs (heart, brain, kidneys, blood vessels, fundus of the eye). In later stages, coordination is impaired, weakness appears in the arms and legs, vision deteriorates, memory and intelligence are significantly reduced, and a stroke can be triggered.
In order to avoid complications and operations, Oleg Tabakov recommends a proven method. Read more about the method >>
Parallel tablets are a Belarusian-made drug that is successfully used to treat and alleviate the condition of people suffering from hypertension.
In practice, it is this medicine or its analogues that have the most effective effect on the problem of high blood pressure.
The drug is available in the form of small white tablets. One package may contain 10 or 20 tablets. The medicine is sold in pharmacies only with a doctor's prescription.
Adverse reactions
“Parallel” is well tolerated. Side effects are often mild and resolve quickly. For this reason, the therapeutic course is usually not interrupted. The body's reactions and the frequency of their expression from the perspective of different organs are shown in the table. Side effects from taking pills are classified according to the following scheme:
- more than 10% - very often;
- 1-10% - common;
- 0.1-1% - uncommon;
- 0.01-0.1% - rare;
- less than 0.01% is very rare.
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Reactions from organ systems
| Side effects | |
| Systems, organs | Reactions |
| Blood and lymph |
|
| CNS |
|
| Psyche |
|
| Hematopoietic |
|
| Respiratory |
|
| Digestive |
|
| Immunity and skin |
|
| Musculoskeletal system |
|
| Urinary |
|
| Disorders of general origin |
|
| Other changes |
|
| Analyzes |
|
Side effects
Equacard also has side effects that are caused by its components.
| The cardiovascular system | often - orthostatic hypotension, marked decrease in blood pressure; uncommon - Raynaud's syndrome, acute myocardial infarction, palpitations; rarely – chest pain, dysfunction of atrioventricular conduction, tachycardia. |
| CNS | often - dizziness; uncommon – stroke, sleep disturbances, paresthesia, mood lability; rarely - drowsiness, cramps of the lips and limbs, asthenic syndrome, confusion. |
| lymphatic system, hematopoietic systems | rarely – a drop in hematocrit and hemoglobin levels; very rarely - autoimmune diseases, lymphadenopathy, hemolytic anemia, erythropenia, eosinophilia, thrombocytopenia, agranulocytosis, neutropenia, leukopenia. |
| respiratory system | often – cough; very rarely - shortness of breath, eosinophilic pneumonia/allergic alveolitis, bronchospasm, sinusitis. |
| digestive system | often – vomiting, diarrhea; uncommon – abdominal pain, taste changes, dyspepsia; rarely - dry mouth; very rarely - pancreatitis, jaundice, anorexia, interstitial edema, liver failure, hepatitis. |
| skin | not very often - rash, itching, rarely - psoriasis, alopecia, urticaria, angioedema of the larynx, tongue, face, lips, limbs; very rarely - Lyell's syndrome, photosensitivity, pemphigus, vasculitis, sweating. |
| urinary system | often – renal dysfunction, infrequently – acute form of renal failure, uremia; very good rarely – proteinuria, oliguria, anuria |
| reproductive system | rarely - gynecomastia, infrequently - impotence |
| metabolic processes | very good rarely - hypoglycemia |
| musculoskeletal system | rarely – myalgia, arthralgia/arthritis. |
During pregnancy
Equacard is not recommended for use during pregnancy and therapy should be discontinued immediately upon diagnosis of this condition.
The use of ACE inhibitors in the 2nd and 3rd trimesters may have an adverse effect on the unborn child (hypoplasia of the skull bones, hyperkalemia, renal failure, decreased blood pressure, intrauterine death).
There is no information about the negative effects on the fetus during treatment in the 1st trimester.
Infants and newborns exposed to ACE inhibitors during development require careful monitoring, which will allow timely detection of hyperkalemia, oliguria, and decreased blood pressure.
During breastfeeding, Equacard therapy should be abandoned; if treatment cannot be avoided, feeding should be discontinued.
special instructions
Equacard therapy can be started only after correction of hyponatremia and restoration of blood volume.
Due to the possible significant decrease in blood pressure and the development of symptomatic arterial hypotension after the first dose of the drug, careful monitoring of blood pressure is required.
If arterial hypotension occurs, the patient should be placed in a horizontal position and, if necessary, given an intravenous infusion of sodium chloride solution to replenish the volume of circulating fluid. When using the drug in patients with cerebrovascular insufficiency, coronary artery disease, in whom a sharp decrease in blood pressure increases the risk of developing myocardial infarction or stroke, you should also adhere to similar rules.
During treatment, you need to control your body weight and salt intake by following an appropriate diet. Periodic monitoring of peripheral blood is also necessary due to the risk of agranulocytosis.
It is required to maintain oral hygiene and be observed by a dentist in order to prevent bleeding, soreness and gum hyperplasia.
While taking Equacard, swelling of the tongue, larynx or epiglottis may occur, leading to airway obstruction; therefore, if this phenomenon develops, it is necessary to urgently administer a subcutaneous solution of epinephrine/adrenaline (1:1000 at a dose of 0.3–0.5 ml) and/or or carry out measures to ensure airway patency. If the swelling is localized only on the face and lips, antihistamines may be prescribed.
Before surgery (including dental surgery), the surgeon/anesthesiologist must be informed about the use of ACE inhibitors. During major surgical operations or when prescribing general anesthesia agents that have an antihypertensive effect, lisinopril may inhibit the formation of angiotensin II associated with the compensatory release of renin. With arterial hypotension, in this case, blood pressure is normalized by increasing blood volume.
Impact on the ability to drive vehicles and complex mechanisms
Patients driving vehicles and other complex machinery should be careful when using the drug due to the risk of drowsiness, dizziness and hypotension. .
Video on the topic
What groups of medications are prescribed for hypertension? Which ones are the most effective? Answers in the video:
Reviews about Parallel tablets for blood pressure are mostly positive (not counting cases of violation of the rules for taking the drug). Parallel is currently one of the most effective means to combat hypertension. Doctors prefer these tablets because of their comprehensive effect, which allows them to quickly achieve positive results in treatment. But as this review shows, caution is key when using the medicine. The drug can be a real salvation for you in the fight against hypertension; it is only important not to neglect the doctor’s recommendations.
