Normatens is a combination antihypertensive drug, containing in its composition three components complementing each other.Anadrol for salesympatholytic, penetrating into the presynaptic terminals postganglionic fibers releases norepinephrine from vesicles with the simultaneous violation of its reverse transport and strengthening the process of inactivation of monoamine oxidase (MAO).
It is a neurotransmitter depletion of stocks and sustained reduction in blood pressure (BP). It helps reduce the concentration in the neurons dopamine, serotonin and other neurotransmitters, exerting antipsychotic effect.
It weakens the influence of sympathetic innervation of the cardiovascular system, reduces heart rate (HR) and total peripheral vascular resistance; retains activity of the parasympathetic nervous system; It deepens and strengthens the physiological sleep, inhibits reflexes interoretseptivnye. Increases motility of the gastrointestinal tract, increases the production of hydrochloric acid in the stomach; 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 – “loop” sulfanilamide diuretic average potency, blocks the reabsorption of sodium ions at the level of the cortical segment of the loop of Henle, removes sodium, potassium, chloride and water.
Dihydroergocristine – dihydrogenated ergot alkaloid blocks the alpha-adrenergic receptors causes vasodilation, reduces the total 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 after 1-4 weeks.
Pharmacokinetics Absorption The individual components Normatensa absorbed after oral administration as follows: reserpine about 30-40%, clopamide – about 90% and dihydroergocristine – less than 25%.Maximum plasma concentration is achieved respectively for -1-3 hours reserpine, clopamide for – about 2 hours, to dihydroergocristine – about 1 hour.
reserpine and dihydroergocristine extensively metabolized in the liver to inactive metabolites. Clopamide not significantly metabolized in the liver.
half-life (T 1/2) Normatensa is long due to the presence of reserpine, 1/2 T for which is in the first phase – 4.5 hours, and the second – about 271 hours. The path removal is different for the individual components: reserpine and dihydroergocristine – inactive metabolites are excreted in urine and feces, clopamide, mainly kidneys.
- hypersensitivity to any component of the drug.
- depression, Parkinson’s disease, epilepsy, concurrent electroconvulsive therapy;
- pheochromocytoma, concomitant treatment with monoamine oxidase inhibitors (MAOIs);
- gastric ulcer and duodenal ulcer exacerbation, erosive gastritis, ulcerative colitis;
- angina pectoris, recent myocardial anadrol for sale infarction, congestive heart failure, bradycardia, atrioventricular block, intraventricular block;
- severe renal insufficiency (creatinine clearance below 30 ml / min), nephritis, uremia, nephrosclerosis;
- hypotension, pronounced cerebral atherosclerosis;
- severe liver function;
- Addison’s disease;
- hypokalemia, hyponatremia, chloropenia;
- hyperuricemia with clinical manifestations;
- angle-closure glaucoma;
- pregnancy and lactation;
- bronchial asthma;
- age of 18 years (effectiveness and safety have not been established).
Precautions: diabetes mellitus, gout, old age.
Pregnancy and lactation
Since reserpine has teratogenic, Normatens use the drug is not recommended during pregnancy.
Furthermore, reserpine can cause dangerous to the fetus hypotension, bradycardia. In infants reserpine may contribute to edema, rhinorrhea, and nasal mucosa, leading to difficulty breathing and cyanosis.Klopamid can cause thrombocytopenia in the fetus.
The drug should not be used during lactation. This is due, mainly, to the penetration into the milk and reserpine dihydroergocristine. Dihydroergocristine can cause symptoms in infants, resembling ergot poisoning, and brake / weaken lactation in mothers.
Dosing and Administration
Inside, during or immediately after a meal, not liquid, squeezed small amounts of liquid.
Dose set individually. It is recommended to start treatment with 1 tablet 1 time a day, if necessary (the absence of a satisfactory therapeutic effect), you can increase the dose to 2 times a day (every 12 hours): 1 tablet, and only in exceptional cases – up to 3 times per day (every 8 hours) for one tablet. The maximum daily dose is 3 tablets.
In connection with the mechanism of drug action, possible lack of efficacy can not say sooner than 2 weeks after the beginning of reception, therefore not necessary to increase the initial dose without the need for this period. Prolonged treatment, in the case of a satisfactory therapeutic effect, it is recommended intake of 1 tablet once a day 1, and in some patients the dose can be reduced to 1 tablet every other day I. Each reduction of the dose necessary to control blood pressure.
During the maintenance anadrol for sale therapy dose should not exceed – 2 tablets per day.
From the digestive system: diarrhea, dry mouth, abdominal pain, nausea, vomiting, exacerbation of peptic ulcer disease, decreased appetite. Rarely – ulceration of the mucosa of the stomach and duodenum, gastrointestinal hemorrhage associated with reserpine at a dose higher than 1 mg day (the amount contained of 10 tablets Normatensa);
Since the cardiovascular system: bradycardia, decreased blood pressure, cerebrovascular disorders, orthostatic hypotension;
On the part of the central nervous system: headache, dizziness, drowsiness, weakness, anxiety, impaired concentration, insomnia, extrapyramidal disorders (tremor, stupor, Parkinson syndrome). Since the product contains reserpine, should be aware of the possibility of occurrence of depressive reactions (including tendencies to suicide) and depressive syndrome; such symptoms are rare, and only in cases where large doses of reserpine (greater than 1 mg / day, which corresponds to the content of reserpine more than 10 tablets Normatensa).
The respiratory system: redness and swelling of the nasal mucosa. Reserpine may cause symptoms of bronchospasm, but this effect appears rarely, and usually in patients with asthma or BOS syndrome.
Allergic reactions: skin rash, pruritus.
From the side of hematopoiesis: thrombocytopenia with symptoms of hemorrhagic diathesis.
Laboratory findings: hypokalemia, hypomagnesemia, hypocalcemia, metabolic alkalosis, hyperuricemia, hyperglycemia, a slight increase in triglycerides, cholesterol.
With prolonged use at high doses – paresthesias, decreased libido, reduced potency, gynecomastia, impaired urination, accommodation spasm, conjunctival hyperemia, hypothermia.
Symptoms: nausea, vomiting, diarrhea, muscle weakness, dizziness, headache, bradycardia, marked reduction in blood pressure, arrhythmia, depression, hyporeflexia, confusion and coma.
Treatment: The first aid if the patient is conscious, induce vomiting, gastric lavage and give activated charcoal. Symptomatic therapy aimed at maintaining cardiovascular function, electrolyte balance correction. Reserpine, which is part of anadrol for sale not excreted from the body by dialysis.
Interaction with other drugs
reduces the effectiveness of oral hypoglycemic drugs, tricyclic antidepressants, anticoagulants.
Increases in plasma concentration of lithium (slowing its excretion).
It weakens the effect of antiepileptic drugs and levodopa, anticholinergics, reduce the analgesic effect of morphine.
It enhances the effect of barbiturates, ethanol, drugs for inhalation anesthetic, antihistamine drugs.
It enhances the effect of agonists.
Barbiturates, ethanol, beta-blockers, peripheral vasodilators enhance the hypotensive effect.
Glucocorticoids, nonsteroidal anti-inflammatory drugs, laxatives drugs reduce the diuretic, hypotensive effects, increase the risk of hypokalemia.
The treatment of MAO inhibitors – increased inhibitory action on the central nervous system.
Against the background of treatment with MAO inhibitors cause moderate or severe hypertension, hyperreflexia.
Antiarrhythmic agents – in the case of hypokalemia, which can accompany treatment, increases the risk of toxic action of amiodarone, disopyramide, quinidine; hypokalemia weakens the effect of lidocaine, mexiletine.
We do not recommend the combination with dopamine (gain vasoconstrictive reaction). In a joint application with digoxin – increase the risk of bradycardia; in the case of hypokalemia, which can accompany treatment, increased risk of intensifying adverse reactions of digoxin.
Since the effect Normatensa develops relatively slowly, the dosage should not be increased more often than 1 time per week, due to the possibility of occurrence of significant decrease in blood pressure;Special care is needed in case of a joint application with other antihypertensive agents; periodically during treatment to monitor blood pressure levels to determine the optimal dosing regimen. During treatment, may increase the level of glucose and uric acid in the serum, it is recommended to carry out periodic monitoring of these parameters, especially in patients with impaired glucose tolerance and hyperuricaemia. Requires monitoring of renal function, especially in patients with chronic renal failure.
In the event of bradycardia during treatment, the dose should be reduced or stop the drug. During treatment requires monitoring of potassium in the blood serum. In most patients, additional drugs potassium destination is not required, provided that a diet contains sufficient potassium rich foods (fruits, vegetables, fish, cheese and low-fat, etc.).
Caution must be exercised in patients with bronchial asthma or bronchospasm, in the case of acute need to stop taking Normatensa, no less than 2 weeks before planned surgery, you should stop taking the drug and to replace it with another antihypertensive agent. During treatment should not drink alcoholic beverages.
It is appropriate to modify the dose Normatensa in case of simultaneous use of other, interacting with them medicines. 7 days before the start of electroconvulsive therapy should be discontinued Normatens.
Effects on ability to drive vehicles and use machines
Normatens may interfere with the patient’s capacity for rapid responses, especially at the beginning of treatment. The treatment should not drive vehicles and to engage in any activities that require high concentration and speed of psychomotor reactions.