Dalneva from high blood pressure: instructions for use

Dalneva is a combined drug used in the treatment of hypertension.

In its composition there are at once 2 active components from different pharmacological groups: a calcium antagonist and an ACE inhibitor. This combination of substances can significantly increase the hypotensive effect of the drug. The preparation of Dahlnev is made by the well-known international pharmaceutical company KRKA, which is the guarantee of its high quality.

On this page you will find all the information about Dalnev: full instructions for use for this medication, average prices in pharmacies, complete and incomplete analogs of the drug, as well as reviews of people who have already used Dalnev. Want to leave your opinion? Please write in the comments.

Clinical and pharmacological group

Combined antihypertensive and antianginal drug.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much is Dalnev? The average cost of the drug Dalnev in Moscow is:

Dalneva tablets 10mg + 4mg 30 pcs. - 450-500 rub.

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Dalneva tablets 10mg + 8mg 30 pcs. - 500-550 rubles.
Dalneva tablets 5mg + 4mg 30 pcs. - 400-450 rub.
Dalneva tablets 5mg + 8mg 30 pcs. - 500-550 rubles.

Form of issue and composition

Dalneva is produced in the form of coated tablets, packed in contoured plastic cells. The main characteristics of the tablets are white, convex round shape. In pharmacies this preparation is presented in several variants, differing in the level of its active components (amlodipine and perindopril): 5 + 4 mg, 10 + 4 mg; 5 + 8 mg, 10 + 8 mg.

The composition of one tablet includes:

The main substances: amlodipine besylate (amlodipine besylate), perindopril erbumine (perindopril erbumine).

Additional constituents: MCC (microcrystalline cellulose), sodium hydrogen carbonate (Sodium hydrogen carbonate), starch (pregelatinized), sodium carboxymethyl starch, silicon dioxide (colloidal), magnesium stearate (Magnesium stearate, E 572).

Pharmacological effect

Antihypertensive drug with a combination of active ingredients:

Amlodipinehas antihypertensive and antianginal effect. Antianginal action is manifested in the expansion of peripheral and coronary arterioles and arteries. Also, amlodipine increases the intake of oxygen into the myocardium, depresses the spasm of the coronary arteries, and helps reduce the incidence of angina attacks. The hypotensive effect of amlodipine is long. A single application of the drug significantly lowers blood pressure in hypertension and maintains a therapeutic effect throughout the day (standing and lying).
Perindopril- Active ACE inhibitor, which converts angiotensin I into angiotensin II, which has a pronounced vasoconstrictive effect. Also, ACE has a disruptive effect on bradykinin, which has a vasodilating effect. Inhibition of ACE increases the activity of the kallikrein-kinin system. The hypotensive effect is maximum manifested 4-6 hours after taking perindopril and persists throughout the day. Reduction of blood pressure is rapid, and the pronounced therapeutic effect occurs 3-4 weeks after the start of the drug and is not accompanied by tachycardia. There is no withdrawal syndrome. In addition to vasodilating action. Perindopril reduces hypertrophy of the left ventricle and restores the elasticity and structure of the blood vessels.

Indications for use

What helps? The main indications for the use of Dalnev are arterial hypertension and / or IHD: stable angina in patients who require perindopril and amlodipine therapy.

Dalnev and Ko-Dalnev - what's the difference?

A variant of the drug is the drug Ko-Dalnev. It is an enhanced form of the drug due to the introduction of the third active ingredient, indapamide, which exhibits a diuretic effect. Co-Dalnev is produced in 5 different dosages, which facilitates the selection of the most suitable means. Ko-Dalnev is also taken once a day.

Because of the three-component composition, Ko-Dalnev has more contraindications, restrictions on use and possible side effects.

It is not recommended to replace one drug with another independently.

Contraindications

The instructions for use with the preparation of Dalnev contain a lot of contraindications and cautions. This is due to the presence of 2 active components in the composition of different pharmacological groups. After all, each of them has its own contraindications, which are combined in a combination medicine, and there are more of them.

It is forbidden to use Dalnev when:

hypotension;
narrowing of the aorta lumen;
unstable angina;
pregnancy;
renal failure;
breastfeeding;
under the age of 18;
individual intolerance to the components of the drug;
heart failure, unstable type, which arose against a background of a heart attack;
angioedema (including previous and hereditary).

Special attention of the doctor requires the use of medication in the therapy of patients with concomitant:

hepatic insufficiency;
stenosis (aortic and mitral);
diabetes mellitus;
a decrease in the volume of circulating blood;
atherosclerosis;
cerebrovascular diseases;
chronic heart failure;
narrowing of the renal arteries;
systemic connective tissue diseases.

In addition, the use of the drug with a number of other drugs is limited (for more details, see the section on drug interactions). in the conduct of desensitizing therapy with allergens, hemodialysis, anesthesia, and after kidney transplantation.

Application in pregnancy and lactation

Dalnev and Co-Dalnev are contraindicated in pregnancy.

When planning a pregnancy or the possibility of its onset, you should immediately stop using it medication and consult a physician for the selection of a safe means to reduce blood pressure. It is believed that in the first trimester the drug does not cause a teratogenic effect, but such a probability is not excluded.

The action of perindopril on the developing fetus in the second half of pregnancy can disrupt its development. This is manifested in the violation of the kidneys, low water, slowing the ossification of the skull. A newborn can experience a decrease in blood pressure, an increase in the concentration of potassium in the blood, and kidney failure.

If it is known that a woman still received these drugs or their analogs during pregnancy, ultrasound examination of the fetus should be performed to assess the condition of his kidneys and skull. Newborns should be under the supervision of doctors, as they have a high risk of hyperkalemia, a decrease in the volume of excreted urine and a decrease in blood pressure.

During breastfeeding, Dalnev and Co-Dalnev should not be used, as there is no evidence of their safety for the child.

Instructions for use

In the instructions for use indicated that Dalnev is taken internally, 1 tab. 1 time / day, preferably in the morning before eating. The dose of the drug is selected after previous titration of the doses of individual components of the drug: perindopril and amlodipine in patients with arterial hypertension and stable angina.

If necessary, the dose of the drug Dalnev can be changed, based on individual selection of individual component doses: (amlodipine 5 mg + perindopril 4 mg) or (amlodipine 10 mg + perindopril 4 mg) or (amlodipine 5 mg + perindopril 8 mg) or (amlodipine 10 mg + perindopril 8 mg).
The maximum daily dose: amlodipine 10 mg + perindopril 8 mg.

Care should be taken when using the drug Dalnev in patients with hepatic insufficiency, t. There are no recommendations on the doses of the drug in such patients.

The drug Dalneva can be prescribed to patients with QC more than 60 ml / min. The drug Dalnev is contraindicated for use in patients with KK less than 60 ml / min. Such patients are recommended individual selection of doses of perindopril and amlodipine. The change in the concentration of amlodipine in the blood plasma does not correlate with the degree of renal insufficiency.

Side effects

The list of "pobochek" is quite large, but do not get scared. Such negative effects are not observed in all patients taking the drug. The most typical side effects are:

The immune system: urticaria;
Reproductive system: gynecomastia, impotence;
Sense organs: tinnitus, visual impairment;
Exchange processes: increase or decrease in weight, hypo- or hyperglycemia;
Musculoskeletal system: pain in the joints, back and muscles, muscle spasms;
Respiratory system: cough, rhinitis, eosinophilic pneumonia, dyspnea, bronchospasm;
Lesions of skin: rash, erythema multiforme, pruritus, Stevens-Johnson syndrome;
The cardiovascular system: "Tides" of blood to the skin of the face, fainting, stenocardia, arrhythmias, palpitation, marked decrease in blood pressure, chest pain, myocardial infarction, stroke;
urinary system: nocturia, renal failure, impaired urination, frequent urination;
Blood System: decrease in the number of granulocytes, neutrophils, leukocytes and platelets, hemolytic anemia, pancytopenia, decrease in hematocrit and hemoglobin concentration;
Nervous system: dizziness, paresthesia, insomnia, sleep disturbance, hypoesthesia, confusion, drowsiness, headaches, vertigo, mood lability, tremor, peripheral neuropathy;
Digestive system: nausea, indigestion, constipation, eating disorders, pancreatitis, gastritis, cholestatic jaundice, abdominal pain, vomiting, diarrhea, dryness of the oral mucosa, changes in the rhythm of defecation, gingival hyperplasia, hepatitis, including cholestatic or cytolytic;
Laboratory results: increased activity of hepatic transaminases, bilirubin, creatinine and urea;
Other: asthenia, malaise, peripheral edema, increased fatigue.

special instructions

The intake of tablets is recommended to be accompanied by regular control of the level of leukocytes in the blood plasma.
Perhaps the appearance of dry, unproductive cough associated with the presence of an ACE inhibitor and after the drug is withdrawn.
Since the use of ACE inhibitors may develop intestinal angioedema, this should be taken into account in the differential diagnosis in patients with abdominal pain and use in diagnostic imaging of the abdominal cavity or ultrasound. After the drug is discontinued, the symptoms disappear.
When there are symptoms of angioedema development of the larynx and / or vocal cords, lips, tongue, face application Dalnev should be discontinued immediately and monitor the patient's condition until the symptoms of edema disappear completely. If necessary (swelling of the tongue or larynx), antihistamine therapy is required, since there is a high risk of airway obstruction and death.
When using high-flow membranes for hemodialysis, the risk of anaphylactoid reactions increases, so it is recommended to use membranes of a different type.
To prevent the development of anaphylactoid reactions during the desensitizing procedure, the venom of Hymenoptera insects or apheresis of lipoproteins low density with dextran sulfate, the patient must stop taking the tablets 24 hours before the beginning of each procedure.
When there is a high body temperature, sore throat or other symptoms of an infectious disease, the patient should consult a doctor.
In patients with impaired liver function should regularly monitor the activity of liver enzymes, if it increases or the development of jaundice requires immediate withdrawal of the drug.
The presence of perindopril in the composition causes a blockade of the renin-aldosterone-angiotensin system, so the use the drug may contribute to a sharp decrease in blood pressure and / or an increase in the concentration of creatinine in the blood plasma. This usually occurs with the first dose or within two weeks after the start of therapy.
It is recommended to avoid the simultaneous administration of perindopril and potassium-sparing diuretics, potassium preparations and potassium-containing substitutes for table salt. If necessary concomitant therapy with potassium-sparing diuretics or potassium preparations in patients with confirmed hypokalemia should regularly monitor the parameters of electrocardiography and the level of potassium in the blood plasma.
A prerequisite for the treatment of patients with impaired renal function is regular monitoring of the concentration of creatinine and potassium in the blood plasma.
In patients with chronic cardiac insufficiency III and IV functional classes according to the NYHA classification (New York Heart Association) against the backdrop of the use of Dalneva, the development of pulmonary edema is possible.
Care must be taken when driving vehicles and machinery, as dizziness and other side effects that affect the speed of psychomotor reactions and concentration of attention.
With extensive surgery or the use of general anesthesia with hypotensive effect in patients taking Dahlnev, there may be a marked decrease in blood pressure. Therefore, with a scheduled operation, it is recommended that the drug be discontinued 24 hours before the onset of general anesthesia.

Drug Interactions

The emergence of special effects from the combination of various medicinal substances relate to both individual perindopril and amlodipine, and their combination. With the interaction of Dalneva and baclofen, the hypotensive effect intensifies.

Due to the presence of perindopril in the ACE inhibitor, the combination with potassium-sparing diuretics is not recommended, since it is possible to develop hyperkalemia. Interaction with estramustine increases the risk of angioedema.
Care should be taken when combined with vasodilators, nitroglycerin, mineralocorticosteroids and glucocorticoids, prazosin, terazosin, amifostine.
Serious disturbances in the rhythm of the ventricles are possible with the combination of amlodipine and dantrolene, which can lead to serious hemodynamic disturbances. This pathology is associated with a significant increase in the concentration of potassium in the blood plasma, the poet should carefully apply potassium preparations and potassium-sparing diuretics.
NSAIDs decrease the effectiveness of the Dalnev, diuretics and sympathomimetic agents may unnecessarily reduce blood pressure. The risk of leukemia appears with the interaction of perindopril and cytostatics, allopurinol and systemic GCS.
When combined with rifampicin, phenobarbital and primidone, dosage adjustment of amlodipine may be required. Interaction with bisoprolol, carvedilol increases the risk of hypotension. There are no significant effects from the joint use of Dalneva with atorvastatin, digoxin, warfarin and cyclosporine.

Reviews

We picked up some responses from people about the drug Dalnev:

Julia. The pressure normalizes, only take initially from a small dose to understand how it works on your body.
Tatyana. I drink Dalnev (10 + 8) replaced instead of the substance for more than one year... the pressure keeps well but for 3 days the noise in my head I can not understand what the felts from weather toli it's time to replace the medicine.... or something else... ..will observe ....
Lyudmila. Such pills my mom has been drinking for several years. There were no pills. Pressure is always OK!
Svetlana. Hypertensive with a 20-year experience (56 years) Ko-Dalnev I drink 1.5 years 1 time in the morning. The drug helped immediately, BUT... for these eighteen months I gained 12 kg extra, constant bitterness in the mouth, a change in the blood composition. The doctor had to additionally write out HOPITOL. Probably have to ask for a cheaper analog, with a minimal pobochko.

Analogues

Analogues of Dalnev on the shelves of pharmacies are represented by drugs:

Prestan;
Amlopress;
Parnavel Amlo.

Before using analogues, consult your doctor.

Storage conditions and shelf life

The drug should be stored at a temperature of 25 ° C in a place inaccessible to young children. The medicine can be used within 3 years from the moment of its release.