Instruction for use: Dihydroergocristine + Clopamide + Reserpine (Dihydroergocristinum+ Clopamidum+ Reserpinum)

Methyl (3beta, 16beta, 17alpha, 18beta, 20alfa) -11,17-dimethoxy-18- [(3,4,5-trimethoxybenzoyl) oxy] yohimban-16-carboxylic acid

Pharmacotherapeutic group:

Diuretics in combination

Sympatholytics in combinations

The nosological classification (ICD-10)

I10 Essential (primary) hypertension

Hypertension, Arterial hypertension, Arterial hypertension crisis course, Essential Hypertension

Primary hypertension, Arterial hypertension, complications of diabetes, hypertension, The sudden increase in blood pressure, Hypertensive disorders of blood circulation, hypertensive condition, hypertensive crises, hypertension, arterial Hypertension, malignant Hypertension, Hypertonic disease, Hypertensive crisis, Hypertension, accelerated hypertension, malignant hypertension, The aggravation of hypertensive disease, Transient hypertension, Isolated systolic hypertension

I15 Secondary hypertension

Arterial hypertension, complications of diabetes, hypertension, The sudden rise in blood pressure, Hypertensive disorders of blood circulation, hypertensive condition, hypertensive crises, hypertension, arterial hypertension, malignant hypertension, Hypertensive crisis, Hypertension, accelerated hypertension, malignant hypertension, hypertensive crisis, The aggravation of hypertensive disease, Transient hypertension, hypertension, Arterial hypertension, Arterial hypertension crisis course, renovascular hypertension, symptomatic hypertension, renal hypertension, Renovascular hypertension, Symptomatic hypertension

Pharmacological action

Combined preparation. Reserpine - sympatholytic, penetrating into the presynaptic terminals postganglionic fibers releases norepinephrine from vesicles with the simultaneous violation of its reverse transport and increased MAO inactivation process. It is a neurotransmitter depletion of stocks and sustained reduction in blood pressure. It helps reduce the concentration in the neurons dopamine, serotonin, and others. Neurotransmitters, exerting antipsychotic effect. Weakens the influence of sympathetic innervation in the cardiovascular system, reduce heart rate and total peripheral vascular resistance; retains activity of the parasympathetic nervous system; It deepens and strengthens the physiological sleep, inhibits reflexes interoretseptivnye. Improves gastrointestinal peristalsis, increases the production of stomach HCl; slows metabolic processes in the body; slows and deepens breathing movements, causes miosis, hypothermia; reduces the intensity of metabolism. It has a positive effect on lipid and protein metabolism in patients with hypertension and coronary atherosclerosis; increases renal blood flow, increases the glomerular filtration. Klopamid - netiazidny sulfanilamide diuretic average potency, blocks the reabsorption of Na + at the level of the cortical segment of the loop of Henle, removes Na +, K +, Cl- and water. Dihydroergocristine mesylate - dihydrogenated ergot alkaloid blocks the alpha-adrenergic receptors causes vasodilation, reduced peripheral vascular resistance. The hypotensive effect of the drug exceeds the hypotensive effect of each component separately and to do any combination of the two components; onset of action - for 4-7 days, stable hypotensive effect is achieved in 1-4 weeks.

Indications

Arterial hypertension.

Contraindications

Hypersensitivity, hypokalemia, hyponatremia, hyposalemia, hepatic failure, renal failure, Addison's disease, nephritis, hypotension, uremia, chronic heart failure, atherosclerosis, nephrosclerosis, concomitant treatment with MAO inhibitors, subacute phase of myocardial infarction, epilepsy, Parkinson's disease, depression, peptic ulcer and 12 duodenal ulcer (in the acute phase), erosive gastritis, ulcerative colitis, asthma, pheochromocytoma, angle-closure glaucoma, bradycardia, AV block, intraventricular block, electroconvulsive therapy, blood diseases, pregnancy, lactation.

Precautions

Diabetes mellitus, gout.

Dosing

Inside (not liquid, squeezed small amount of liquid), the initial dose - 1 tablet per day (in the morning); with insufficient expression of the hypotensive effect - 2 tablets per day in 2 divided doses; maintenance dose - 1 tablet every day or every other day; with severe hypertension - 2-3 pills a day.

Side effect

Headache, dizziness, weakness, drowsiness, insomnia, anxiety, decreased ability to concentrate; dyspepsia, nausea, vomiting, diarrhea, abdominal pain, loss of appetite; torakalgiya; dryness of mucous membranes, nasal congestion; allergic reactions, itching, redness of the mucous membranes of the eyes; hypokalemia, hyponatremia, hyperuricemia, hyperglycemia, orthostatic hypotension, myasthenia gravis, asthenia, thrombocytopenia. With prolonged use at high doses - paresthesias, reduced potency and / or libido, gynecomastia, urination disorders, spasm of accommodation.

Overdose

Symptoms: "nightmarish" dream, parkinsonism, angina pectoris; bradycardia, arrhythmia, depression, hyporeflexia, confusion, coma.

Treatment: gastric lavage, activated charcoal inside; symptomatic treatment, aimed at maintaining cardiovascular function, correction of fluid and electrolyte balance.

Interaction

It reduces the effectiveness of oral hypoglycemic drugs, tricyclic antidepressants, anticoagulants; increases the concentration of Li + plasma (slowing its excretion); reduces the effect of antiepileptic drugs and levodopa, anticholinergics, reduce the analgesic effect of morphine; It enhances the effect of barbiturates, ethanol, drugs for inhalation anesthesia, antihistamine drugs. Barbiturates, ethanol, beta-blockers, peripheral vasodilators enhance the hypotensive effect; Corticosteroids, NSAIDs, laxatives, drugs reduce the diuretic, hypotensive effects, increase the risk of hypokalemia. The treatment MAO inhibitors - increased inhibitory effect on the central nervous system; against the background of treatment with MAO inhibitors cause moderate or severe hypertension, hyperpyrexia.

Special instructions

7 days before the start of electroconvulsive therapy, elective surgery should eliminate the drug; in the case of emergency operations - preliminary enter atropine.

During treatment should monitor the concentration of electrolytes and uric acid in the blood serum, the mental state of patients (possible development of depression), renal function, blood glucose concentration (diabetic patients).

With prolonged use it is recommended diet with high content of K + (fruits, vegetables, low-fat cheese, fish) or additional prescriptions K +.

With the lack of severity of the hypotensive effect with monotherapy it can be combined with beta-blockers or vasodilators.

During the period of treatment must be careful when driving and other lesson. Potentially hazardous activities that require high concentration and psychomotor speed reactions (possibility of orthostatic hypotension, dizziness, somnolence, decreased ability to concentrate).