Lercamen Duo tabs 10mg + 10mg #28

Instruction for Lercamen Duo

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Release form, composition and packaging

The drug Lercamen Duo is produced by the Italian company Recordati Group, in the form of round, convex tablets covered with a protective film coating. The color of the tablets varies from bright yellow at the shell, to pale yellow at the core of the drug. The tablets are packed in standard polymer blisters with contoured cells, which, in turn, are stacked in white cardboard boxes with a yellow-red pattern in the lower right corner. The number of tablets in a blister and blisters in a pack may differ. In our pharmacy, you can buy a pack containing 28 tablets, as well as other packaging of the drug Lercamen Duo, which differ in price. The availability of tablets Lercamen Duo 10mg + 10mg 28pcs is confirmed by the reviews of our customers. Each pack of medicine contains an official instruction detailing all aspects of the drug's use. It should be carefully examined before starting the course of treatment. In addition, taking the medicine Lercamen Duo should be agreed with a cardiologist. Please note that the description. Posted on the website of our pharmacy is an unofficial, edited version of the annotation, and is posted only for general information about the features of the drug. This is the description. And also reviews of the drug Lercamen Duo on the Internet cannot serve as a sufficient justification for the diagnosis and self-prescription of the drug to oneself. Remember - self-medication can cause irreparable harm to health.

Composition

The preparation contains two main active components - lercanidipine hydrochloride and enalapril maleate. The concentration of the first substance in 1 tablet is 10 mg. The content of enalapril maleate differs from the release form - it can be 10 or 20 milligrams per tablet. In order to make it easier for the consumer to determine the content of enalapril, the manufacturer began to cover the tablets with a film shell of different colors - yellow (in the case of a tablet containing 10 + 20 mg of active substances), and white (for tablets containing 10 + 10 mg of active components.) The composition of the drug Lercamen Duo also includes auxiliary substances: • Milk sugar; • Microcrystals of cellulose; • Sodium salt of carboxymethyl starch; • Povidone; • Bicarbonate of soda; • Salts of magnesium and stearic acid. The mass content of each excipient in 1 tablet of Medicmen Duo is indicated in the official instructions. A modern Opadry II film former is used to create a film casing. It includes: • Methyloxypropyl cellulose; • Titanium white; • Talc; • Macrogol 6000; • Dyes.

Pharmachologic effect

Speaking about the pharmacological action and pharmacokinetics of the drug Lercamen Duo, one should take into account the presence of two active substances in it at once, each of which has its own effect, and therefore requires a separate description.

Lercanidipine

Lercanidipine is a calcium antagonist with the ability to selectively bind to specific receptors. In fact, lercanidipine is a racemate - a mixture of two pairs of sterioisomers - substances with the same chemical formula, but located in space in a mirror image, which explains the difference in their properties. Once in the body, this substance selectively blocks ion channels through which calcium ions pass through cell membranes into smooth muscle cells, which provide contraction and tone of blood vessels, and into heart muscle cells. As a result, the tone of the walls of blood vessels, including the coronary arteries, decreases, the total vascular resistance decreases, and the patient's blood pressure decreases. The drug acts mainly on the blood vessels, without exerting a pronounced effect on the work of the heart, and without reducing the heart rate. The vasodilating effect occurs gradually, due to which cases of tachycardia in a patient who has taken the medicine are extremely rare. An increase in cardiac output in patients was also not recorded. Lercanidipine is completely absorbed by the walls of the gastrointestinal tract. To achieve the maximum concentration of the drug in the blood plasma after a single dose, it takes, depending on the individual characteristics of the patient, from 1.5 to 3 hours. During the first passage through the liver, the drug is actively metabolized with the participation of 3A4 isoenzymes of the cytochrome system, which explains its relatively low bioavailability. It should be borne in mind that the joint administration of drugs containing lercanidipine, together with food, increases its bioavailability. An increase in the dose of the active substance also increases its bioavailability. Most of the metabolites formed during the passage of the substance through the liver do not have pronounced pharmacological activity. The elimination of the drug from the body occurs in two practically equivalent ways - with feces and urine. Due to this, the active substance can be safely prescribed to people suffering from a mild form of renal or hepatic insufficiency, without making adjustments to the dosage. The active substance has a therapeutic effect throughout the day after taking the drug, due to the ability to establish stable bonds with lipid membranes.

Enalapril

The peculiarity of the second active substance, enalapril, is that after entering the body, it enters into a chemical reaction with water, as a result of which the active metabolite enalaprilat is formed, which has the ability to suppress the action of the angiotensin-converting enzyme. This enzyme is responsible for the formation in the body of a hormone responsible for vasoconstriction. In addition, it blocks bradykinin, a peptide responsible for vasodilation. A decrease in the activity of the angiotensin-converting enzyme corrects the work of the renin-angiotensin-aldosterone system, due to which the patient has a pronounced effect of lowering blood pressure. After a single dose of the drug, the maximum concentration of the active metabolite is reached within 4 hours. About 60 percent of enalaprilat formed in the body forms stable bonds with the protein components of the blood plasma. Enalapril is not subject to any other metabolic transformations besides the formation of enalaprilat. The excretion of this substance and its active metabolite occurs mainly through the kidneys. In patients with renal insufficiency, the half-life of enalapril is significantly increased, therefore, such patients may need to adjust the dose of the drug.

Indications

The reason to order Lercamen Duo 10mg + 10mg 28 tablets is that the patient has a diagnosed prolonged and persistent increase in blood pressure, both at the time of contractions and during the relaxation of the heart muscle. The drug Lercamen Duo is prescribed if analogues containing only one active substance demonstrate insufficient effectiveness.

Contraindications

The use of Lercamen Duo tablets is contraindicated if the patient has: • Hypersensitivity to any of the ingredients that make up the drug; • A tendency to edema of the deep layers of the skin and subcutaneous tissue, the presence of such edema in the patient's history; • Narrowing of the renal arteries; • Clinical condition after kidney transplant; • Narrowing of the arterial and mitral valves, causing significant disturbances in blood flow; • Hypertrophic thickening of the walls of the left ventricle; • Increased production of aldosterone by the adrenal cortex; • Dysfunctions of the kidneys and liver; • Chronically low blood pressure; • Increased content of potassium in the body; • Minor age; • Pregnancy; • Breastfeeding period; • Sick sinus syndrome; • Chronic heart failure; • The recovery period after a heart attack. Representatives of the Negroid race should take Lercamen Duo with caution, do not exceed the recommended dosage, and regularly undergo examinations - this is due to their inherent physiological characteristics of the body. For children under 18 years of age, the drug is not prescribed, since its safety and efficacy for this category of patients has not been confirmed. During pregnancy, the drug is not prescribed, since Enalaprin and its metabolite have a pronounced toxic effect on the fetus. This can lead to a decrease in the amount of amniotic fluid, a disruption in the normal development of the kidneys, a slowdown in the formation of ossification nuclei, and other problems of fetal development, as well as provoke an excess of calcium, low blood pressure and impaired renal function in a newborn. Before starting the course of treatment, a woman is recommended to undergo a pregnancy test and use reliable contraceptives while taking the drug. If pregnancy nevertheless has come - taking Lercamen Duo should be interrupted. It is also not recommended to take the drug at the same time as breastfeeding. A complete list of contraindications can be found in the official instructions for the drug. Before buying Lercamen Duo, you should consult with a cardiologist, if necessary, undergo a medical examination aimed at identifying possible contraindications. If they are found, an experienced physician will be able to recommend analogs of tablets Lercamen Duo 10mg + 10mg 28pcs more suitable for the patient. Only a specialist will be able to determine whether the contraindication found in the patient is absolute, or whether the use of the drug is permissible with an appropriate dose reduction and other precautions.

Method of administration and dosage

The drug is taken orally. 1 per day. The tablet is swallowed whole and washed down. It is best to drink Lercamen Duo 15 minutes before a meal - this way you can ensure the optimal absorption of lercanidipine. The drug is recommended to be taken at the same time. If the patient misses the appointment, the dose is not doubled the next day. The recommended initial dose of the drug is 10 mg of lercanidipine and 10 mg of enalapril per day. If necessary, the dose of enalapril is increased to 20 mg. The dosage and duration of the course of treatment can only be determined by a cardiologist who has sufficient experience in drug treatment of arterial hypotension. The daily dose of the drug is prescribed based on the diagnosis of the patient, his condition, and other factors. The decision to transfer the patient to another form of the drug is also made only by a specialist. Be sure to consult your doctor before ordering Lercamen Duo.

Side effects

The manufacturer describes the likelihood of side effects using the classification proposed by the International Health Organization. According to the graduation organization proposed by specialists, side effects are: • Very frequent - observed in more than 10% of people who took the drug; • Frequent - occurs in less than 10, but more than 1% of patients; • Uncommon - observed in 0.1-1% of patients; • Rare - observed in 0.01 - 0.1% of patients; • Very rare - recorded in less than 0.01% of patients who received this drug. The drug Lercamen Duo contains two active ingredients, each of which has its own list of possible side effects. Each of these lists should be considered separately.

Side effects of lercanidipine

According to the results of clinical studies, lercanidipine is well accepted by the body of the majority of patients, rarely and extremely rarely causing any side effects. The manufacturer declares the possibility of such consequences of taking the drug: • Hypersensitivity reactions; • Drowsiness; • Vertigo; • Headaches; • Increased heart rate; • Flushing of the face and redness of the skin; • Pain in the chest area; • Exacerbation of symptoms during attacks of angina pectoris; • Development of syncope; • Stomach ache; • Nausea; • Vomiting; • Diarrhea; • Disorder of the digestive function; • Skin rashes; • muscle pain; • Increased urination; • Syndrome of increased fatigue; • Swelling. In medical practice, there is a mention of single cases of side effects such as: • Heart attack; • Pathological proliferation of gum tissue; • Increase in the activity of alanine aminotransferase and aspartate aminotransferase, which is reversible; • Frequent urge to urinate; Information about these symptoms is fragmentary, so it is impossible to say with certainty with what frequency they occur, and whether the use of lercanidipine is the root cause of their occurrence.

Side effects of enalapril

Enalapril and its active metabolite have a large number of side effects on the body compared to lercanidipine. The most common side effects include: • Development of edema of the deep layers of the skin and subcutaneous tissue of the face, hands, mouth and larynx, including life-threatening ones; • Depressive state; • Dizziness; • Headaches; • Decreased vision clarity; • chest pain; • Various violations of the heart rate; • Heart attack; • A sharp drop in blood pressure; • Orthostatic collapses; • Fainting conditions; • Brain hemorrhages. • Pain when swallowing; • Cough; • Hoarseness; • Shortness of breath; • Spasm of the bronchi; • Nausea; • Diarrhea; • Abdominal pain; • Increased gas production in the intestines; • Inadequate perception of taste; • Skin rashes; • Asthenia; • Fast fatiguability; • Increase in the concentration of potassium in the body • Increase in the content of creatinine in the blood. In more rare cases, the following side effects have been described: • Drop in blood glucose concentration; • Syndrome of inappropriate secretion of antidiuretic hormone; • Dysfunction of hematopoiesis of the bone marrow; • Dysfunctions of the immune system; • Drop in the concentration of leukocytes in the blood; • Swollen lymph nodes; • Sleep disorders; • Pathological dreams; • Clouding of consciousness; • Spontaneous tingling of the skin; • Noise in ears; • Dizziness; • Violations of the blood supply to the tissues of the extremities due to spasms of peripheral vessels; • Feeling of "rushes" of blood to the skin of the face; • Development of asthma; • Pulmonary eosinophilia; • Inflammation of the mucous membranes of the nasal cavity; • Hypersensitive interstitial pneumonitis; • Accumulation of eosinophils in the pulmonary alveoli; • Intestinal obstruction; • Inflammation of the pancreas; • Vomiting; • Anorexia; • Ulcerative lesions of the intestines and stomach; • Stomatitis; • Inflammation of the tongue; • Allergic intestinal edema; • Problems with potency; • Hypertrophy of the mammary glands; • impaired renal function; • Appearance of protein in the urine; • Weakening of urine formation; • Falling sodium levels in the body; • Increased blood urea levels; • Increase in the level of bilirubin in the blood; • Erythema multiforme; • Severe forms of dermatitis.

Side effects from the joint intake of active substances

Clinical studies have shown that when taking Lercamen Duo, the following side symptoms may occur: • Lack of platelets in the blood; • Falling hemoglobin levels; • Swelling of an angioedema; • Increase in the content of triglycerides in blood plasma; • Increased anxiety; • Vertigo; • Headaches; • Dizziness; • Drop in blood pressure; • Increased heart rate; • Decompensation of chronic forms of heart failure; • Acute vascular insufficiency; • Cough; • Pain in the larynx; • Dryness of the mucous membranes in the oral cavity; • Inflammation of the tongue; • Nausea; • Constipation; • Digestive disorders; • Pain in the abdominal cavity; • • Dermatitis; • Occurrence of edema; • Joint pain; • Increased frequency of urination, especially at night; • Increased urine production; • Problems with potency; • Increased fatigue; • Drop in vitality; • Increased activity of alanine aminotransferase and aspartate aminotransferase. The appearance of any side effects is a reason for a prompt referral to the attending physician. Only a specialist can adequately assess the severity of the complications that have arisen, give a prognosis, and decide whether to reduce the dose of the drug, or stop taking it, replacing it with analogues.

Overdose

There were no cases of overdose with the complex drug Lercamen Duo. It is assumed that the symptoms of an overdose will be similar to the symptoms of an overdose with one of the active substances in its composition, but it cannot be ruled out that additional symptoms occur due to the complex effect of the two active substances on the body. In case of an overdose of pure lercanidipine, the patient has the following symptoms: • Decreased tone of peripheral blood vessels; • Drop in blood pressure up to collapse; • Increased heart rate; • Strengthening the symptoms of angina pectoris; • Heart attack. Enalapril poisoning leads to: • A drop in blood pressure up to collapse; • Heart attack; • Stroke; • Thromboembolism; • Convulsions; • State of stupor. Focusing on the methodology of providing assistance in case of poisoning with individual components of the drug, the victim is recommended to take absorbents, gastric lavage. Further assistance is symptomatic. It is possible to administer plasma substitutes to the patient, antiarrhythmic drugs, cardiotonic drugs. The patient can be injected intravenously with saline, apply atropine. You should also take into account the complexity of the situation caused by the presence of two active components, and the associated risks of occurrence of previously undescribed interactions and a mirror increase in some symptoms of poisoning. The victim should be placed under medical supervision as soon as possible, in a medical institution whose specialists have a sufficient level of experience and have the necessary medicines and equipment.

Drug interactions

Speaking about drug interactions, it should be noted that lercanidipine and enalapril during clinical trials did not demonstrate any adverse reactions when taken together. At the same time, each of the ingredients is capable of entering into specific reactions with other medications.

Lercanidipine interactions

It is known that some beta-adrenergic receptor blockers can reduce the bioavailability of lercanidipine by almost 2 times, which may require a dose adjustment of the drug. Metabolism of lercanidipine is carried out by means of cytochrome isoforms, primarily the CYP3A4 isoenzyme. It is not recommended to take the drug together with drugs that block or stimulate the activity of each of these cytoenzymes, as this can affect the concentration of lercanidipine in the body and lead to undesirable consequences. Undesirable combinations include, in particular, cyclosporine and grapefruit juice. It is also not recommended to mix lercanidipine with alcohol, as ethanol can significantly enhance the effect of lowering blood pressure.

Enalapril interactions

Enalapril is able to provoke an increase in the concentration of potassium in the blood in a patient, especially when taken simultaneously with potassium-containing drugs, diuretics, heparin, and some other drugs. AT1 receptor blockers, when taken together, can also cause an excess of potassium concentration, and lead to the development of hypotension. The danger can be posed by the joint reception of Lercamen Duo with substances containing lithium, since there is a risk of developing lithium intoxication accompanied by nausea, muscle twitching, confusion, heart failure, and other dangerous symptoms, up to coma and death. Blockers of beta-adrenergic receptors and other drugs that have the property of lowering blood pressure, if taken together with enalapril, can enhance the effect, up to the occurrence of persistent hypotension. When taken together, the dosage should be carefully calculated, and the patient's pressure indicators should be regularly monitored. Non-steroidal anti-inflammatory substances weaken the effect of treatment with drugs containing enalapril, as well as lead to disruption of the normal functioning of the kidneys, therefore, such drugs are not recommended to be combined unless absolutely necessary. Co-administration with insulin can enhance the effect of the latter, leading to a dangerous drop in blood sugar levels.

Special instructions

Patients suffering from impaired renal function, the drug should be prescribed with extreme caution, since there are known cases of worsening problems after taking Lercamen Duo. It is recommended to constantly monitor the level of creatinine, as this indicator will allow you to detect the danger in time. When taking the drug, there were isolated cases of jaundice, flowing into liver necrosis. This syndrome can lead to death, therefore, during the course of treatment, the indicators of the patient's liver should be regularly monitored. If there is a suspicion of jaundice, or an increase in the activity of liver enzymes, taking Lercamen Duo, the patient is discontinued and appropriate treatment is prescribed. The simultaneous administration of Lercamen Duo tablets with drugs that suppress immunity increases the risk of developing viral infections, in the treatment of which antibiotics show insufficient effectiveness. You should refuse to take such drugs together, or carefully monitor the level of leukocytes in the patient's blood. Enalapril, in combination with bee venom, can cause severe edema in individuals who are allergic to hymenoptera venom. Edema can block the airways, and lead to death from hypoxia, therefore, during the course of treatment, any measures aimed at desensitizing this allergen should be interrupted. It should be noted that representatives of the Negroid race are more prone to the occurrence of Quincke's edema. Given the ability of drugs that suppress the action of an angiotensin-converting enzyme, to cause such edema, special care should be taken when prescribing Lercamen Duo to Negroid patients. The patient should be warned in advance about the possible risk, his relatives should also be informed about the methods of first aid in such situations.

The effect of the drug on the ability to drive a car

Clinical studies have shown that Lercamen Duo can cause side effects in the patient that worsen the reaction speed and decision time. The patient should be notified of this possibility so that he can take appropriate safety measures. The risk of side effects increases with an increase in the dose of the drug taken, as well as at the beginning of the treatment course, so during these periods you should be careful and, if possible, refuse to drive and other activities that require a quick reaction.

Terms and conditions of storage

Lercamen Duo tablets are stored at room temperature without losing their properties. It is important to make sure that the place where the medicine is stored is protected from children. The shelf life of the drug is 24 months from the date indicated on the package.

Terms of sell

You don't need a prescription to buy Lercamen Duo.