Dalneva for high blood pressure: instructions for use

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Published: 02/17/2020

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• 1 General description of the drug
• 2 Existing contraindications 2.1 Perindopril
• 2.2 Amlodipine
• 2.3 Dalneva drug

Release forms and composition of the drug

The product can be purchased at various pharmacies in the form of biconvex white tablets, which are packaged in special standard plastic foil blisters of 10 pieces. The tablets are round and have a standard size, the plates are placed in boxes made of cardboard in 3 or 9 pieces.

Each package comes with instructions that describe in detail the features of use, nuances of therapy and possible contraindications. The tablets do not have a specific aroma, but have a bitter taste. The medicine contains two active components - amlodipine and perindopril. They have the main pronounced therapeutic effect.

The tablets also contain excipients:

• Silica.
• Magnesium stearate.
• Sodium in the form of bicarbonate.
• Talc.
• Starch.

Excipients do not have medicinal properties. The amount of amlodipine per tablet is 10 mg, the dosage of perindopril is 8 mg.

Analogues of Dalnev

Analogs are prescribed for treatment:

1. Amlodipine + Perindopril;
2. Amlopress;
3. Ko-Dalneva;
4. Parnavel Amlo;
5. Adelphan Esidrex;
6. Accupro;
7. Amlodipine;
8. Amprilan;
9. Anaprilin;
10. Atenolol;
11. Berlipril;
12. Betalok;
13. Bisoprolol;
14. Valz N;
15. Verapamil;
16. Veroshpiron;
17. Hypothiazide;
18. Diltiazem;
19. Diroton;
20. Zokardis;
21. Indap;
22. Indapamide;
23. Captopril;
24. Carvedilol;
25. Clonidine;
26. Concor;
27. Corvitol;
28. Cordaflex;
29. Cordipin;
30. Corinfar;
31. Lisinopril;
32. Lozap;
33. Losartan;
34. Lorista;
35. Metoprolol;
36. Nebilet;
37. Nifedipine;
38. Noliprel;
39. Noliprel forte;
40. Norvasc;
41. Obzidan;
42. Prestance;
43. Prestarium;
44. Ramipril;
45. Raunatin;
46. Renitek;
47. Spironolactone;
48. Stamlo;
49. Physiotens;
50. Phosicard;
51. Furosemide;
52. Egilok;
53. Equator;
54. Exforge;
55. Enalapril;
56. Enam;
57. Enap;
58. Enap N;
59. Enzix;
60. Estekor.

Pharmacological properties

Dalneva (reviews of the drug can be positive or negative, depending on the characteristics of the patient’s body) has quite pronounced antihypertensive properties, that is, it helps to reduce diastolic and systolic blood pressure.

The drug affects the process of converting angiotensin type 1 into angiotensin type 2, which has pronounced vasoconstrictor properties. As a result of the suppression of this component, the vessels dilate, and blood pressure decreases.

The drug also helps to significantly and quickly improve the condition of patients, eliminates tachycardia and some other manifestations of diseases of the cardiovascular system.

Composition and action

Dalneva tablets are used to lower high blood pressure (treat arterial hypertension). The formula of the drug allows you to block the transition of calcium ions, relax the walls of blood vessels (smooth muscle), reduces cardiac load and dilates peripheral arterioles and coronary arteries. Strengthens diuresis by lowering the concentration of sodium, chlorine, potassium and magnesium ions in the kidneys. Improves large arteries, making them more elastic. Increases the effectiveness of renin in the body and increases blood flow in muscle areas.

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The drug includes a complex of action of 4 components:

• perindopril
• erbumine
• indapamide.
• amlodipine.

Active ingredients, each of which performs its own function in reducing blood pressure and improving the functioning of the cardiovascular system. The formula of the product also includes additional elements, the number of which depends on the distribution of the number of active components. Below is a table listing these elements.

The described composition determines the quantities of components with amplombine 5 mg, indapamide - 0.625 mg, erbumine - 2 mg in one tablet.

Pharmacodynamics and pharmacokinetics

The drug has a pronounced effect quite quickly after the tablet penetrates the systemic bloodstream. It enters the blood and has a vasodilatory effect by blocking the conversion of angiotensin. As a result, the patient's condition improves significantly, the heart rate normalizes and the heart rate decreases slightly.

Amlodipine is a slow calcium channel blocker and has not only hypotensive but also antianginal properties. This allows you to improve the condition of various patients with chronic angina. Perindopril also lowers blood pressure but does not have a significant effect on heart rate.

The drug also has other effects on the body:

• Helps control blood pressure numbers, preventing their critical increase. As a result, the risk of developing a hypertensive crisis is significantly reduced, as well as a constant increase in indicators.
• It expands not only peripheral, but also coronary vessels, which improves myocardial nutrition and reduces its need for oxygen. The condition of patients with angina pectoris improves, the frequency of attacks decreases.
• Prevents spasm of coronary vessels, thereby reducing the likelihood of the formation of an ischemic area on the myocardium.
• Increases the patient's resistance to physical activity, which makes him more resilient, reduces the severity of shortness of breath when performing physical work or exercise.

The drug also helps reduce the patient's need for Nitroglycerin during exacerbation of angina pectoris. It does not affect lipid levels in the body and can be used for patients with gout, atherosclerosis and diabetes.

The maximum pronounced therapeutic effect develops within 3-6 hours after taking the prescribed dose, but it continues on average for 24 hours after the start of administration. The drug is well absorbed in the small intestine and quickly distributed throughout the body. When eating, the bioavailability of the active components decreases slightly.

The drug does not accumulate in tissues, so it requires constant use to maintain the therapeutic effect. The breakdown products of active substances after processing in the liver are excreted primarily through the kidneys. In patients with pathologies of the paired organ, there may be a slowdown in excretion and a slight accumulation of substances in the body.

Effect on blood pressure

The blood pressure drug Ko-Dalneva has a complex, combined effect. Amlodipine is characterized by the presence of pronounced antihypertensive properties due to its ability to relax the smooth muscle cellular structures of the vascular walls. It has an antianginal effect, dilating peripheral and coronary arteries. reducing the load on the heart and the quantitative need of the myocardium for oxygen.

Perindopril acts as an ACE inhibitor, suppressing the production of angiotensin, which increases blood pressure. Has vasodilating properties. Promotes accelerated destruction of bradycardin. Has a beneficial effect on the condition and functioning of the heart and blood vessels, with prolonged regular use.

Indapamide is a thiazide diuretic. Activates urination processes, effectively fights swelling and congestion.

It has a good effect on the condition of patients suffering from heart failure due to its ability to increase cardiac output, improve the processes of peripheral blood flow, blood circulation and microcirculation, and reduce the level of pressure in the area of ​​the right and left cardiac ventricles.

Ko-Dalneva is a complex drug for lowering blood pressure

Indications for use

Dalneva is prescribed to patients with various heart disorders.

Patient reviews of the drug confirm the relative safety and effectiveness for the following disorders:

• Arterial hypertension in acute and subacute stages. The drug can be used as a main method or in combination with auxiliary medications.
• Cardiac ischemia. The medicine helps reduce the risk of rapid progression of the pathology.
• Angina pectoris in acute and chronic form with severe disturbances and frequent attacks.
• Mild heart failure, accompanied by a persistent, regular, prolonged increase in numbers.

The drug can be used to treat various patients who have suffered a myocardial infarction and ischemic stroke in the past, and also suffer from hypertension.

Analogues and substitutes

On the modern pharmaceutical market you can find and purchase the following analogues of Co-Dalneva:

• Prestilol;
• Noliprel Bi-Forte;
• Kaptopres;
• Ramipril;
• Noliprel;
• Capozide;
• Enzix Duo;
• Enalozide;
• Noliprel Arginine;
• Ramizes Kom;
• Liprazid;
• Hartil-N;
• Co Amlessa;
• Nedipin;
• Bisoprolol;
• Metoprolol;
• Arifon Retard;
• Anaprilin;
• Trifas.

It is important to note that the medications listed above are not absolute analogues of Ko-Dalnev tablets. Therefore, if there is a need to select a substitute, it is better to entrust this task to a qualified medical specialist! https://www.youtube.com/embed/DZMdXTRRMgs

Contraindications

The drug is contraindicated in cases of acute or subacute intolerance to the main or auxiliary components of the composition.

There are other contraindications for pill therapy:

• Acute severe form of renal failure, accompanied by acute urination disorders and other disorders.
• Identifying signs of liver failure.
• Internal bleeding due to damage to the mucous membranes of the digestive tract.
• Acute period during myocardial infarction or ischemic stroke.
• The period of gestation and lactation, when the medicine can provoke serious complications.
• Chronic advanced form of heart failure, accompanied by a persistent decrease in blood pressure.
• Persistent hypotension.
• Severe bradycardia.
• Stenosis of the mitral or aortic valve of the heart.

With caution, an effective medicine is prescribed to patients with diabetes mellitus, psoriasis, and systemic lupus erythematosus. For patients with diagnosed atherosclerosis and scleroderma, the drug is also prescribed with caution and in a minimal dosage.

Indications for Dalneva®

Co-Dalneva is a combination drug that is used to treat hypertension.
It contains an angiotensin-converting enzyme inhibitor - perindopril erbumine, a calcium channel blocker - amlodipine and a thiazide-like diuretic - indapamine. Tablets 5 mg 4 mg: round, slightly biconvex, chamfered, white or almost white.

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Tablets 10 mg 4 mg: capsule-shaped, biconvex, scored on one side, white or almost white.

Tablets 5 mg 8 mg: round, biconvex, chamfered, white or almost white.

Tablets 10 mg 8 mg: round, biconvex, with a bevel and a score on one side, white or almost white.

Arterial hypertension and/or coronary heart disease: stable angina pectoris in patients who require therapy with perindopril and amlodipine.

At a temperature not exceeding 25 °C, in the original packaging.

Keep out of the reach of children.

3 years.

Do not use after the expiration date stated on the package.

Instructions for use, dosage

The tablets are taken orally in the dose prescribed by the specialized doctor. The daily dose for patients is usually 1 tablet. Take the drug in the morning, which helps control diastolic and systolic indicators throughout the day.

Treatment can last 2-4 weeks, but is often used on an ongoing basis. In this case, the patient is regularly sent to see a doctor, who can increase the dosage or discontinue the drug if there is no need to use it. Since the bioavailability of the drug decreases when eating, take the tablet 1 hour before or 2 hours after meals.

For arterial hypertension

When diagnosing arterial hypertension at varying degrees of neglect, the drug is taken 1 time per day. The daily dosage is ½ or 1 tablet, depending on the severity of the manifestations.

Take the drug in the morning, wash it down with plenty of water. Be sure to use the product separately from food to ensure maximum effectiveness. The medication is taken on an ongoing basis or for several weeks, depending on the severity of the disease.

For coronary heart disease

The drug for diagnosing coronary heart disease is also taken in the morning in the amount of 1 tablet. If the patient additionally has arterial hypertension, the drug can be used on an ongoing basis or in courses of 2-4 weeks.

Dalneva

The drug helps improve the condition and reduces the risk of rapid progression of the disease. When taking, you should take the tablets with plenty of water. Specialists can prescribe the patient the minimum effective dosage of ½ tablet. An increase in the daily norm is carried out only by a doctor.

Pharmacological effects

The drug is mainly used to control blood pressure in hypertension.

It does not increase the pulse, does not affect the number of contractions of the heart muscle, has a weak diuretic effect and removes excess sodium from the body.

When taken once, the effect lasts throughout the day. If there is a need to urgently stop taking the medication, this can be done without consequences for the body, since there is no withdrawal syndrome.

Side effects

Dalneva (reviews about the drug can be negative, which in most cases is associated with violation of the instructions or intolerance to the components of the composition) can provoke acute negative reactions, especially if the rules of use are not followed.

Adverse reactions are often accompanied by peripheral edema, severe weakness and even loss of consciousness. In this case, it is important to stop using the medication and consult a doctor who will prescribe medications to quickly improve the condition.

Side effects

Dalneva can cause negative side effects, like other medications. The list of “side effects” is quite large, but don’t be alarmed. Such negative effects are not observed in all patients taking the drug. The most common side effects are:

• excessive drop in blood pressure;
• dizziness;
• feeling of heartbeat;
• sleep disorders;
• cough;
• vertigo;
• nausea;
• paresthesia;
• epigastric pain;
• visual impairment;
• muscle spasms;
• headache;
• dyspepsia;
• dyspnea;
• tides;
• constipation;
• skin rash;
• swelling of the legs;
• diarrhea;
• constant feeling of fatigue.

Much less likely to develop:

• soreness of muscles, back, joints;
• potency disorders;
• hives;
• change in body weight (increase or decrease);
• blood disorders;
• hyper- or hypoglycemia;
• disturbances of consciousness;
• chest pain;
• tremor;
• peripheral neuropathy;
• fainting;
• vasculitis;
• bronchospasm;
• stroke;
• eosinophilic pneumonia;
• arrhythmias;
• myocardial infarction;
• dry mouth;
• general malaise;
• alopecia;
• violation of taste perception;
• cholestatic hepatitis;
• angioedema;
• pancreatitis;
• photosensitivity;
• erythema multiforme;
• gum hyperplasia;
• increased sweating;
• urinary disorders;
• Quincke's edema;
• gynecomastia;
• increase in urea level.

Overdose

Experts have not recorded cases of drug overdose. But this possibility cannot be excluded when taking large doses of the medication. In case of an overdose, all negative reactions appear more pronounced, which leads to a significant deterioration in the general condition and the development of other disorders.

• The condition may be accompanied by convulsions, loss of consciousness and repeated vomiting throughout the day.
• Patients talk about stool upset, pain in the stomach and intestines.
• The condition rapidly worsens with the addition of headaches and severe dizziness.
• If the patient experiences a critical, persistent decrease in blood pressure, a state of shock may develop.
• Consciousness is impaired, the skin becomes pale and cold to the touch, there is a decrease in heart rate and a decrease in circulating blood volume.

Overdose requires immediate discontinuation of therapy and receipt of care in a hospital setting. Help involves removing the remaining tablets from the stomach by lavage, followed by prescribing medications to eliminate symptoms.

Side effects

Such a strong drug as Ko-Dalneva can cause many side effects, which you also need to be aware of. In many cases, symptoms go away quickly, but any manifestations should be reported to your doctor.

Possible reactions:

• shortness of breath, cough;
• nausea, vomiting;
• itching, rashes;
• severe fatigue;
• dizziness;
• headache;
• swelling;
• hearing or vision problems;
• convulsions;
• a sharp drop in pressure;
• difficulty urinating.

In addition, “Co-Dalneva” can provoke unpleasant changes in the body’s condition, which are difficult to correct if ignored. The main ones from this list:

• Leukopenia is a decrease in the level of leukocytes.
• Pancytopenia is a decrease in blood elements that form its composition.
• Thrombocytopenia is a decrease in the number of platelets.
• Drop in hemoglobin level.
• Angina pectoris.

special instructions

The medicine should be used only for its intended purpose, since independent use can provoke a variety of complications and even death. During the period of therapy, it is important to monitor the symptoms, which will allow you to note deterioration or improvement. It is recommended to measure them at least once a day, preferably in the evening.

In most cases, it is recommended to use the drug in the morning, but if the indicators increase in the evening, doctors prescribe an appointment at this time. Depending on the individual characteristics of the patient’s body, the dosage and duration of use may differ, but it is prohibited to independently adjust the dose and course without prescription.

The opinion of patients and doctors about the action of the drug is predominantly positive, but this is not considered a reason for uncontrolled use without prior examination.

Special conditions

If symptoms of angioedema of the larynx and/or vocal folds, lips, tongue, or face appear, the use of Dalneva should be stopped immediately and the patient’s condition should be monitored until signs of edema completely disappear. If necessary (swelling of the tongue or larynx), antihistamine therapy is required, since there is a high risk of airway obstruction and death.

Since intestinal angioedema may develop during the use of ACE inhibitors, this should be taken into account when making a differential diagnosis in patients with abdominal pain and abdominal computed tomography or ultrasound should be used in diagnosis. After discontinuation of the drug, the symptoms disappear.

To prevent the development of anaphylactoid reactions during a desensitizing procedure with hymenoptera venom or low-density lipoprotein apheresis with dextran sulfate, the patient must stop taking the tablets 24 hours before the start of each procedure.

When using high-flow membranes for hemodialysis, the risk of developing anaphylactoid reactions increases, so it is recommended to use a different type of membrane.

It is recommended to accompany the intake of tablets with regular monitoring of the level of leukocytes in the blood plasma.

If a high body temperature, sore throat or other symptoms of an infectious disease appear, the patient should consult a doctor.

In patients with impaired liver function, the activity of liver enzymes should be regularly monitored; if it increases or jaundice develops, immediate discontinuation of the drug is required.

Drug interactions

The drug is not prescribed simultaneously with drugs that have the same properties or contain the same active ingredient. Use in combination with non-steroidal anti-inflammatory drugs may enhance the hypotensive effect.

Corticosteroids can reduce the effectiveness of the drug. Some antidepressants, tranquilizers, and antipsychotics enhance the hypotensive effect of the drug. If you need to use any medication frequently, you should consult your doctor first.

Pharmacological groups

Analogs

The drug has analogues that can be used if necessary.

The most popular and effective substitutes:

• Prestance contains the same active components, therefore it has a pronounced hypotensive effect. Tablets are prescribed for hypertension, coronary artery disease and other diseases of the cardiovascular system. They are considered quite effective. Available in different dosages, which allows you to choose for each patient.
• Kalchek is a product in tablet form that contains amlodipine as the main active ingredient. It has a pronounced hypotensive effect, helps maintain levels at the same level and prevents their critical increase. Take the medicine on an ongoing basis or for a short period of time, depending on the characteristics of the disease.
• Duplecor also contains amlodipine as well as atorvastatin. The second component helps reduce the level of harmful lipids in the blood, which has a beneficial effect on the condition of blood vessels in atherosclerosis. The drug is not always allowed to be taken, as it acts quite aggressively, but is considered quite effective.
• Amzaar is a tablet with antihypertensive properties that also contains amlodipine, but its effect is enhanced by the presence of losartan. The drug is used for severe heart failure, angina pectoris and hypertension. The pattern of its use may differ depending on the pathological condition and the stage of its development.

Analogues of the product should not be used without prior examination by a doctor.

Drug compatibility

It is better not to use it simultaneously with Dantrolene; this combination can be harmful to health. "Verapamil" can cause ventricular fibrillation and death of the patient. Interaction with medications containing thiazide diuretics or lithium increases the concentration of the latter in the blood, which increases intoxication of the body. Interaction with Baclofen can greatly reduce blood pressure and kidney function.

The same effect is observed when using Co Dalneva together with antihypertensive drugs, Amifostine and Nitroglycerin. Corticosteroids and tetracosactides worsen the effect of the drug. Orthostatic hypotension can be caused by interaction with Prazosin, Alfuzosin, Doxazosin, Tamsulosin, Terazosin. If treatment is necessary together with other substances, the doctor may prescribe analogues of the drug "Co Dalneva" to reduce the risk of adverse reactions.

Use during pregnancy

The use of Dalneva® is contraindicated during pregnancy. Dalneva® should not be used in the first trimester of pregnancy. If pregnancy is planned or occurs while using Dalneva®, it is necessary to stop taking the drug as soon as possible and prescribe another antihypertensive therapy approved for use during pregnancy.

Appropriate controlled studies of the use of ACE inhibitors in pregnant women have not been conducted. The limited available data on the effects of the drug on the fetus in the first trimester of pregnancy indicate that the use of ACE inhibitors does not lead to fetal malformations, but an increased risk of their occurrence cannot be excluded.

It is known that the effect of ACE inhibitors on the fetus in the second and third trimesters of pregnancy can lead to disruption of its development (decreased renal function, oligohydramnios, delayed ossification of the skull bones) and the development of complications in the newborn (renal failure, arterial hypotension, hyperkalemia).

Newborns whose mothers received ACE inhibitors during pregnancy should be under close medical supervision due to the risk of hypotension, oliguria and hyperkalemia.

It is not recommended to use Dalneva® during lactation, because There is no relevant clinical experience with the use of amlodipine and perindopril, either in monotherapy or as part of combination therapy. If it is necessary to use Dalneva® during lactation, breastfeeding should be discontinued.

The medication is not prescribed to pregnant women. If there is a need to use the product during lactation, breastfeeding should be interrupted.

Pharmacokinetics

The magnitude of absorption of amlodipine and perindopril when using the drug Dalneva® does not differ significantly from that when using single drugs.

Perindopril

After oral administration, perindopril is rapidly absorbed and reaches Cmax in blood plasma within 1 hour. T1/2 of perindopril from blood plasma is approximately 1 hour.

Perindopril has no pharmacological activity and is a prodrug. Approximately 27% of the total amount of perindopril taken orally enters the bloodstream in the form of an active metabolite, perindoprilate. In addition to perindoprilate, 5 more metabolites are formed that do not have pharmacological activity.

Cmax of perindoprilate in blood plasma is achieved 3–4 hours after oral administration.

Eating reduces the bioavailability of perindopril, so the drug should be taken once a day, in the morning, before meals. There is a linear dependence of the concentration of perindopril in the blood plasma on the size of its dose.

The Vd of free perindoprilate is approximately 0.2 l/kg. The binding of perindoprilate to plasma proteins (mainly ACE) is 20% and depends on its concentration. Perindoprilat is excreted by the kidneys, T1/2 of the unbound fraction is approximately 17 hours, so Css is achieved within 4 days after oral administration.

The elimination of perindoprilate is slowed in elderly patients and patients with cardiac and renal failure, so monitoring of such patients should include regular monitoring of plasma creatinine and potassium concentrations.

The dialysis clearance of perindoprilate is 70 ml/min.

The pharmacokinetics of perindopril is changed in patients with liver cirrhosis: hepatic clearance is reduced by 2 times, but the amount of perindoprilate formed does not decrease, so dose adjustment is not required.

Amlodipine

It is well absorbed when taken orally in therapeutic doses and reaches Cmax in blood plasma after 6–12 hours. Absolute bioavailability is 64–80%. Vd - approximately 21 l/kg. Food intake does not affect the bioavailability of amlodipine. In vitro studies have shown that approximately 97.5% of circulating amlodipine is bound to plasma proteins.

The final T1/2 from blood plasma is 35–50 hours, which allows you to take the drug once a day. Amlodipine is metabolized in the liver to form inactive metabolites. Approximately 60% of the dose taken is excreted by the kidneys, 10% unchanged.

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Elderly patients. Tmax in blood plasma is the same in elderly and young patients. There is a tendency for amlodipine clearance to decrease in elderly patients, which is accompanied by an increase in AUC. The recommended dosage regimen for elderly patients is the same as for younger patients, although dose increases should be made with caution.

Hepatic impairment: T1/2 of amlodipine is prolonged in patients with impaired liver function.

Dalneva

Description of the dosage form

Description

Tablets 5 mg + 4 mg:
round, slightly biconvex, bevelled, white or almost white.

Tablets 10 mg + 4 mg:

capsule-shaped, biconvex, with a notch on one side, white or almost white.

Tablets 5 mg + 8 mg:

round, biconvex, chamfered, white or almost white.

Tablets 10 mg + 8 mg:

round, biconvex, with a chamfer and a notch on one side, white or almost white.

Drug interactions

Perindopril

Concomitant use is not recommended

Potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes:

Despite the fact that serum potassium levels remain within normal limits, hyperkalemia may occur in some patients when using perindopril. Potassium-sparing diuretics (for example, spironolactone, triamterene or amiloride), potassium supplements or potassium-containing salt substitutes can lead to a significant increase in plasma potassium levels, so their use simultaneously with ACE inhibitors is not recommended. If simultaneous therapy is necessary (in case of confirmed hypokalemia), caution should be exercised and regular monitoring of plasma potassium levels and ECG parameters should be carried out.

Lithium preparations:

with the simultaneous use of lithium preparations and ACE inhibitors, cases of reversible increases in the concentration of lithium in the blood serum and associated toxic effects have been reported. Simultaneous therapy with perindopril and lithium preparations is not recommended. If such combination therapy is necessary, it should be carried out under regular monitoring of the concentration of lithium in the blood plasma.

Estramustine:

simultaneous use is accompanied by an increased risk of developing angioedema.

Concomitant use requiring special caution

NSAIDs, incl. COX-2 inhibitors, acetylsalicylic acid in high doses (more than 3 g/day) and non-selective NSAIDs:

the use of NSAIDs can lead to a decrease in the diuretic, natriuretic and hypotensive effects of ACE inhibitors. The simultaneous use of ACE inhibitors and NSAIDs may lead to deterioration of renal function, including the development of acute renal failure and an increase in serum potassium, especially in patients with reduced renal function. Caution should be exercised when using this combination, especially in elderly patients. In this case, patients need to compensate for fluid loss and carefully monitor kidney function, both at the beginning and during treatment.

Hypoglycemic drugs (oral hypoglycemic agents and/or insulin):

the use of ACE inhibitors may enhance the hypoglycemic effect of insulin or sulfonylurea derivatives in patients with diabetes mellitus.

The development of episodes of hypoglycemia was observed very rarely (there may be an increase in glucose tolerance, leading to a decrease in the need for insulin).

Concomitant use requiring attention

Diuretics (thiazide and loop):

In patients taking diuretics, especially with excessive fluid and/or electrolyte excretion, a significant decrease in blood pressure may be observed when starting to use ACE inhibitors. The risk of developing arterial hypotension can be reduced by discontinuing the diuretic, increasing fluid and/or sodium intake before starting therapy, starting therapy with low doses of perindopril and then gradually increasing them.

Sympathomimetics:

Sympathomimetics may reduce the hypotensive effect of ACE inhibitors.

Gold preparations:

In patients receiving simultaneous injection therapy with gold preparations (sodium aurothiomalate) and ACE inhibitors, including perindopril, nitrate-like reactions (“flushes” of blood to the facial skin, nausea, vomiting, and decreased blood pressure) are rarely observed.

Allopurinol, cytostatic and immunosuppressive agents, GCS (for systemic use) and procainamide:

simultaneous use with ACE inhibitors may be accompanied by an increased risk of leukopenia.

Agents for general anesthesia:

simultaneous use of ACE inhibitors and general anesthesia may lead to increased hypotensive effect.

Amlodipine

Concomitant use is not recommended

Dantrolene (intravenous administration):

In animal experiments, cases of fatal ventricular fibrillation and cardiovascular failure associated with hyperkalemia were observed after the administration of verapamil and dantrolene (iv). Given the risk of hyperkalemia, simultaneous use of amlodipine and dantrolene should be avoided.

Concomitant use requiring special caution

CYP3A4 inducers (rifampicin, St. John's wort preparations, anticonvulsants such as carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone):

a decrease in the plasma concentration of amlodipine is possible due to increased metabolism in the liver. Caution should be exercised when using amlodipine and inducers of microsomal oxidation simultaneously and, if necessary, adjust the dose of amlodipine.

Strong and moderate inhibitors of the CYP3A4 isoenzyme (protease inhibitors, azole antifungals (itraconazole and ketoconazole), macrolides such as erythromycin and clarithromycin, verapamil and diltiazem):

it is possible to increase the plasma concentration of amlodipine and increase the risk of side effects, especially in elderly patients. Caution should be exercised during simultaneous use and the dose of amlodipine should be adjusted if necessary.

Concomitant use requiring attention

Simultaneous use of β-blockers (bisoprolol, metoprolol) and the α- and β-blocker carvedilol, used for CHF:

increases the risk of developing arterial hypotension and worsening the course of CHF in patients with uncontrolled or latent CHF (increased negative inotropic effect). In addition, β-blockers can reduce reflex cardiac sympathetic activation against the background of concomitant CHF.

There is no interaction of the following drugs with amlodipine:

— with simultaneous use of amlodipine and cimetidine, the pharmacokinetic parameters of amlodipine did not change;

— with the simultaneous use of amlodipine and sildenafil, there was no increase in the hypotensive effect of either drug.

Grapefruit juice: Taking 240 ml of grapefruit juice with a single dose of amlodipine (10 mg orally) did not have a significant effect on the pharmacokinetics of amlodipine.

Amlodipine does not affect the pharmacokinetics of the following drugs:

- atorvastatin: taking repeated doses of amlodipine 10 mg in combination with atorvastatin at a dose of 80 mg does not lead to a significant change in the equilibrium pharmacokinetic parameters of atorvastatin;

- digoxin: simultaneous use of amlodipine and digoxin is not accompanied by changes in the concentration of digoxin in the blood serum and the renal clearance of digoxin in healthy volunteers;

- warfarin: in healthy male volunteers taking warfarin, the addition of amlodipine does not have a significant effect on the change in PT due to warfarin;

- cyclosporine: amlodipine does not have a significant effect on the pharmacokinetic parameters of cyclosporine.

Dalneva

Concomitant use requiring special attention

Baclofen:

Potentiation of the hypotensive effect is possible. Monitoring of blood pressure and renal function is necessary, as well as dose adjustment of amlodipine.

Concomitant use requiring attention

Antihypertensives (eg beta-blockers) and vasodilators:

the hypotensive effect of perindopril and amlodipine may be enhanced.
Caution should be exercised when used concomitantly with nitroglycerin, other nitrates or other vasodilators
, since an additional decrease in blood pressure is possible.

Corticosteroids (mineralocorticosteroids and corticosteroids), tetracosactide:

decreased hypotensive effect (retention of fluid and sodium ions as a result of the action of corticosteroids).

α-blockers (prazosin, alfuzosin, doxazosin, tamsulosin, terazosin):

increased hypotensive effect and increased risk of orthostatic hypotension.

Amifostine:

may potentiate the hypotensive effect of amlodipine.

Tricyclic antidepressants/neuroleptics/general anesthesia:

increased hypotensive effect and increased risk of orthostatic hypotension.

Composition and release form

Composition and release form

Table

Pharmacological properties

Pharmacokinetics

The magnitude of absorption of amlodipine and perindopril when using the drug Dalneva does not differ significantly from that when using single drugs.

Perindopril

After oral administration, perindopril is rapidly absorbed and reaches Cmax in blood plasma within 1 hour. T1/2 of perindopril from blood plasma is approximately 1 hour.

Perindopril has no pharmacological activity and is a prodrug. Approximately 27% of the total amount of perindopril taken orally enters the bloodstream in the form of an active metabolite, perindoprilate. In addition to perindoprilate, 5 more metabolites are formed that do not have pharmacological activity.

Cmax of perindoprilate in blood plasma is achieved 3–4 hours after oral administration.

Eating reduces the bioavailability of perindopril, so the drug should be taken once a day, in the morning, before meals. There is a linear dependence of the concentration of perindopril in the blood plasma on the size of its dose.

The Vd of free perindoprilate is approximately 0.2 l/kg. The binding of perindoprilate to plasma proteins (mainly ACE) is 20% and depends on its concentration. Perindoprilat is excreted by the kidneys, T1/2 of the unbound fraction is approximately 17 hours, so Css is achieved within 4 days after oral administration.

The elimination of perindoprilate is slowed in elderly patients and patients with cardiac and renal failure, so monitoring of such patients should include regular monitoring of plasma creatinine and potassium concentrations.

The dialysis clearance of perindoprilate is 70 ml/min.

The pharmacokinetics of perindopril is changed in patients with liver cirrhosis: hepatic clearance is reduced by 2 times, but the amount of perindoprilate formed does not decrease, so dose adjustment is not required.

Amlodipine

It is well absorbed when taken orally in therapeutic doses and reaches Cmax in blood plasma after 6–12 hours. Absolute bioavailability is 64–80%. Vd - approximately 21 l/kg. Food intake does not affect the bioavailability of amlodipine. In vitro studies

showed that approximately 97.5% of circulating amlodipine is bound to plasma proteins.

The final T1/2 from blood plasma is 35–50 hours, which allows you to take the drug once a day. Amlodipine is metabolized in the liver to form inactive metabolites. Approximately 60% of the dose taken is excreted by the kidneys, 10% unchanged.

Elderly patients.

Tmax in blood plasma is the same in elderly and young patients. There is a tendency for amlodipine clearance to decrease in elderly patients, which is accompanied by an increase in AUC. The recommended dosage regimen for elderly patients is the same as for younger patients, although dose increases should be made with caution.

Liver failure.

T1/2 of amlodipine is prolonged in patients with impaired liver function.

Pharmacodynamics

Perindopril

ACE inhibitor. ACE or kininase II is an exopeptidase that converts angiotensin I into a vasoconstrictor substance - angiotensin II, in addition, ACE destroys bradykinin, which has a vasodilator effect, into an inactive hectapeptide. Suppression of ACE activity leads to a decrease in angiotensin II, an increase in renin activity in the blood plasma and a weakening of aldosterone secretion. Since ACE also destroys bradykinin, suppression of ACE also leads to increased activity of the kallikrein-kinin system.

Perindopril acts through its active metabolite, perindoprilate. Other metabolites do not have an ACE inhibitory effect in vitro

. Perindopril has a therapeutic effect for any degree of arterial hypertension (AH), reducing SBP and DBP in the “lying” and “standing” positions.

Reduces peripheral vascular resistance, resulting in increased peripheral blood flow without changes in heart rate.

Renal blood flow usually increases, while the glomerular filtration rate (GFR) does not change.

The hypotensive effect reaches its maximum 4–6 hours after a single oral dose of perindopril and persists for 24 hours. The hypotensive effect 24 hours after a single oral dose is about 87–100% of the maximum hypotensive effect.

The decrease in blood pressure develops quickly. The therapeutic effect occurs in less than 1 month from the start of therapy and is not accompanied by tachycardia.

Discontinuation of therapy does not lead to the development of withdrawal syndrome.

Perindopril has a vasodilating effect, helps restore the elasticity of large arteries and the structure of the vascular wall of small arteries, and also reduces left ventricular hypertrophy.

Amlodipine

A dihydropyridine derivative, BCP, has antianginal and hypotensive effects. Blocks calcium channels, reduces the transmembrane transition of calcium ions into the cell (to a greater extent into vascular smooth muscle cells than into cardiomyocytes).

The antianginal effect is due to the expansion of the coronary and peripheral arteries and arterioles: in case of angina pectoris, it reduces the severity of myocardial ischemia; expanding peripheral arterioles, reduces peripheral vascular resistance, reduces afterload on the myocardium, reduces myocardial oxygen demand, expanding coronary arteries and arterioles in unchanged and ischemic areas of the myocardium, increases the supply of oxygen to the myocardium (especially with vasospastic angina); prevents spasm of the coronary arteries (including those caused by smoking). In patients with stable angina, a single daily dose increases exercise tolerance, the time before the onset of an angina attack and ischemic depression of the ST segment on the ECG, reduces the frequency of angina attacks and the consumption of nitroglycerin and other nitrates.

It has a long-term dose-dependent hypotensive effect. The hypotensive effect is due to a direct vasodilating effect on vascular smooth muscle. For arterial hypertension, a single dose provides a clinically significant reduction in blood pressure over 24 hours (in the patient’s “lying” and “standing” position). Orthostatic hypotension when prescribing amlodipine is quite rare. Does not cause a decrease in left ventricular ejection fraction.

Reduces the degree of left ventricular myocardial hypertrophy. It does not affect myocardial contractility and conductivity, does not cause a reflex increase in heart rate, inhibits platelet aggregation, increases glomerular filtration rate, and has a weak natriuretic effect. In diabetic nephropathy, it does not increase the severity of microalbuminuria. It does not have any adverse effect on metabolism and plasma lipid concentrations and can be used in the treatment of patients with bronchial asthma, diabetes mellitus and gout. A significant decrease in blood pressure is observed after 6–10 hours, the duration of the effect is 24 hours.

Indications

Indications

Arterial hypertension and/or coronary heart disease (stable angina pectoris (if necessary, combination therapy with perindopril and amlodipine).

Contraindications

Contraindications

Perindopril

hypersensitivity to perindopril or other ACE inhibitors;

history of angioedema (Quincke's edema) (including while taking other ACE inhibitors);

hereditary/idiopathic angioedema;

age under 18 years (efficacy and safety have not been established).

Amlodipine

hypersensitivity to amlodipine or other dihydropyridine derivatives;

severe arterial hypotension (sBP less than 90 mm Hg), shock, including cardiogenic;

obstruction of the left ventricular outflow tract (including severe aortic stenosis);

unstable angina (with the exception of Prinzmetal angina);

hemodynamically unstable heart failure after acute myocardial infarction;

age under 18 years (efficacy and safety have not been established).

Dalneva

hypersensitivity to the excipients included in the drug;

renal failure (creatinine Cl less than 60 ml/min);

age under 18 years (efficacy and safety have not been established).

Carefully:

liver failure; chronic heart failure (CHF); arterial hypotension; aortic and/or mitral stenosis; hypertrophic obstructive cardiomyopathy (HOCM); elderly age; bilateral renal artery stenosis; stenosis of the artery of the only functioning kidney; renal failure (creatinine Cl less than 60 ml/min); systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), therapy with immunosuppressants, allopurinol, procainamide (risk of developing neutropenia, agranulocytosis), reduced blood volume (taking diuretics, diet with limited salt, vomiting, diarrhea), atherosclerosis, cerebrovascular diseases, renovascular hypertension, diabetes mellitus, use of dantrolene, estramustine, potassium-sparing diuretics, potassium supplements, potassium-containing substitutes for table salt and lithium preparations, hyperkalemia; surgery/general anesthesia; black patients; hemodialysis using high-flow polyacrylonitrile membranes - the risk of developing anaphylactoid reactions; before the LDL apheresis procedure using dextran sulfate, simultaneous desensitizing therapy with allergens (for example, Hymenoptera venom), condition after kidney transplantation (lack of clinical data).

The use of Dalneva is contraindicated during pregnancy. Dalneva should not be used in the first trimester of pregnancy. If pregnancy is planned or occurs while using Dalneva, you must stop taking the drug as soon as possible and prescribe another antihypertensive therapy approved for use during pregnancy. Appropriate controlled studies of the use of ACE inhibitors in pregnant women have not been conducted. The limited available data on the effects of the drug on the fetus in the first trimester of pregnancy indicate that the use of ACE inhibitors does not lead to fetal malformations, but an increased risk of their occurrence cannot be excluded. It is known that the effect of ACE inhibitors on the fetus in the second and third trimesters of pregnancy can lead to disruption of its development (decreased renal function, oligohydramnios, delayed ossification of the skull bones) and the development of complications in the newborn (renal failure, arterial hypotension, hyperkalemia). If the patient received ACE inhibitors in the second or third trimesters of pregnancy, it is recommended to perform an ultrasound to assess the condition of the skull bones and fetal renal function.

Newborns whose mothers received ACE inhibitors during pregnancy should be under close medical supervision due to the risk of hypotension, oliguria and hyperkalemia.

It is not recommended to use Dalneva during lactation, because There is no relevant clinical experience with the use of amlodipine and perindopril, either in monotherapy or as part of combination therapy. If it is necessary to use Dalneva during lactation, breastfeeding should be discontinued.

Directions for use and doses

Directions for use and doses

.
Inside,

one tablet once a day, preferably in the morning before meals. Dalneva in fixed doses is not intended for initiation of antihypertensive therapy.

The dose of Dalneva is selected after previously titrated doses of individual components of the drug - perindopril and amlodipine - in patients with arterial hypertension and stable angina.

If necessary, the dose of Dalneva can be changed based on individual selection of doses of individual components: (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 is amlodipine 10 mg + perindopril 8 mg.

Renal dysfunction.

Dalneva can be used in patients with creatinine Cl more than 60 ml/min. Dalneva is contraindicated for use in patients with creatinine Cl less than 60 ml/min.

In such patients, individual selection of doses of perindopril and amlodipine is recommended. Changes in the concentration of amlodipine in blood plasma do not correlate with the severity of renal failure.

Liver failure.

Caution must be exercised when using Dalneva in patients with liver failure, because There are no recommendations for dosage of the drug in such patients.

Elderly patients.

When using Dalneva in elderly patients, no dose adjustment is required.

Children and teenagers.

Dalneva should not be prescribed to children and adolescents under 18 years of age. because There are no data on the effectiveness and safety of the use of perindopril and amlodipine in these groups of patients, both in monotherapy and as part of combination therapy.

Side effects

Side effects

WHO classification of the incidence of side effects: very often - ≥1/10; often - from ≥1/100 to <1/10; uncommon - from ≥1/1000 to <1/100; rarely - from ≥1/10000 to <1/1000; very rarely - from <1/10000; frequency unknown—cannot be estimated from available data.

Within each group, adverse effects are presented in order of decreasing severity.

From the circulatory and lymphatic system:

very rarely - leukopenia/neutropenia, agranulocytosis, pancytopenia, thrombocytopenia, hemolytic anemia in patients with congenital deficiency of glucose-6-phosphate dehydrogenase, decreased hemoglobin concentration and hematocrit.

From the immune system:

infrequently - urticaria.

Metabolic disorders:

uncommon - weight gain, weight loss; very rarely - hyperglycemia; frequency unknown - hypoglycemia.

From the nervous system:

often - drowsiness, dizziness, headache, paresthesia, vertigo; infrequently - insomnia, mood lability, sleep disturbance, tremor, hypoesthesia; very rarely - peripheral neuropathy, confusion.

From the senses:

often - visual impairment, tinnitus.

From the SSS side:

often - a feeling of palpitations, “flushes” of blood to the skin of the face, a pronounced decrease in blood pressure; infrequently - fainting; rarely - chest pain; very rarely - angina pectoris, myocardial infarction, possibly due to an excessive decrease in blood pressure in patients at high risk, arrhythmias (including bradycardia, ventricular tachycardia and atrial fibrillation), stroke, possibly due to an excessive decrease in blood pressure in patients at high risk risk, vasculitis.

From the respiratory system:

often - shortness of breath, cough; uncommon - rhinitis, bronchospasm; very rarely - eosinophilic pneumonia.

From the digestive system:

often - abdominal pain, nausea, vomiting, dyspepsia, diarrhea, constipation; infrequently - dryness of the oral mucosa, impaired taste perception, change in the rhythm of bowel movements; very rarely - pancreatitis, gingival hyperplasia, gastritis, hepatitis, cholestatic jaundice, cytolytic or cholestatic hepatitis.

From the skin:

often - skin itching, skin rash; uncommon - angioedema of the face, extremities, lips, mucous membranes, tongue, vocal folds and/or larynx, alopecia, hemorrhagic rash, photosensitivity, increased sweating; very rarely - Quincke's edema, erythema multiforme, Stevens-Johnson syndrome.

From the musculoskeletal system:

often - muscle spasms; infrequently - arthralgia, myalgia, back pain.

From the urinary system:

uncommon - urinary disturbances, nocturia, frequent urination, renal failure; very rarely - acute renal failure.

From the reproductive system:

infrequently - impotence, gynecomastia.

Other:

often - peripheral edema, asthenia, increased fatigue; infrequently - chest pain, malaise.

Laboratory indicators:

rarely - increased bilirubin concentration; very rarely - increased activity of liver transaminases (AST, ALT) (most often - in combination with cholestasis); frequency unknown - increased concentrations of urea and creatinine in the blood serum.

Additional data on amlodipine:

Isolated cases of extrapyramidal syndrome have been reported with the use of CCBs.

Overdose

There is no information on overdose of Dalneva.

Perindopril

Data on perindopril overdose are limited.

Symptoms:

marked decrease in blood pressure, shock, water and electrolyte imbalance, renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety and cough.

Treatment:

Emergency measures are limited to removing the drug from the body - gastric lavage and/or administration of activated charcoal, followed by restoration of bcc.

If there is a pronounced decrease in blood pressure, the patient should be transferred to the “lying” position on his back with his legs elevated, and if necessary, take measures to restore blood volume (for example, intravenous infusion of 0.9% sodium chloride solution). It is also possible to administer catecholamines intravenously. Hemodialysis can remove perindopril from the systemic circulation. For bradycardia that is resistant to therapy, an artificial pacemaker may be required. Dynamic monitoring of the general condition, concentration of creatinine and electrolytes in the blood plasma is necessary.

Amlodipine

Information on amlodipine overdose is limited.

Symptoms:

a pronounced decrease in blood pressure with the possible development of reflex tachycardia and excessive peripheral vasodilation (risk of developing severe and persistent arterial hypotension, including the development of shock and death).

Treatment:

gastric lavage, administration of activated charcoal (especially in the first 2 hours after an overdose), maintenance of cardiovascular function, elevated position of the lower extremities, control of blood volume and diuresis, symptomatic and supportive therapy. To restore vascular tone, use vasoconstrictors (in the absence of contraindications to their use); to eliminate the consequences of calcium channel blockade - intravenous administration of calcium gluconate solution. Hemodialysis is ineffective.

Indications

Dalneva tablets are used for high blood pressure and ischemic heart disease (angina pectoris).

Hypertension is diagnosed when blood pressure is persistently above 140/90 mmHg. Art. An episodic increase in blood pressure under the influence of emotional and physical stress, when the pressure independently returns to its original values ​​after some time, is not considered a disease. In case of hypertension, this requires taking antihypertensive drugs.

Target organs

Symptoms depend on the stage of the disease and the degree of damage to the target organs (brain, heart, blood vessels, eyes, kidneys).

IHD often goes hand in hand with hypertension. It is diagnosed when the blood supply to the myocardium is disrupted due to partial or complete occlusion of the coronary vessels. Has two forms:

• spicy;
• chronic.

The acute form manifests itself in the form of a heart attack, the chronic form – angina pectoris.

Angina pectoris

Angina pectoris occurs during emotional or physical stress, when the heart needs a greater flow of oxygen.

Manifests itself in the form of attacks of embossing, pain in the chest area. The man lacks air, he stops, his face takes on a pained expression, his hand reflexively presses against the left side of his chest.

Pharmacodynamics

1. Perindopril is part of the group of angiotensin-converting enzyme (ACE) inhibitors. What does this mean? The kidneys, in response to a decrease in blood pressure, secrete the hormone renin, which in the blood reacts with the protein angiothesinogen. As a result, inactive angiotensin I is formed. It, in turn, under the influence of ACE, is converted into the active hormone angiotensin II. It constricts blood vessels, increases blood pressure, the strength and frequency of heart contractions. In addition, angiotensin II stimulates the secretion of the hormone aldosterone, which increases the retention of water and sodium in the body, which also raises blood pressure. Perindopril, or rather its active metabolite perindoprilat, suppresses the activity of ACE, which leads to disruption of this chain, which works to increase blood pressure.

1. Amlodipine is a medicine of a different type of action. It is from the group of calcium channel blockers. Amlodipine reduces the flow of calcium into the muscle cells of blood vessels and the heart through these channels. As a result, their tone decreases, the force of myocardial contractions decreases, and the vessels dilate.

Interactions

Both active elements of Dalnevy interact with many drugs. Therefore, self-medication is prohibited. The doctor must be informed about all medications used and existing diseases. A detailed list of all unwanted effects when used together is provided in the instructions from the manufacturer. It must be read carefully.

Alcohol consumption is prohibited during the therapeutic course.

"Equator" is one of the analogues

Dalneva price, where to buy

The price of Dalnev tablets 5 mg + 4 mg No. 30 varies between 385 - 590 rubles per pack. You can buy Dalnev without difficulty in most pharmacies in Moscow and other cities.

• Online pharmacies in RussiaRussia

ZdravCity

• KO-Dalneva tablets 5mg+0.625mg+2mg 30 pcs. Krka-Rus LLC
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• Dalneva tablets 10mg+ 8mg 30 pcs. Krka-Rus LLC

  RUR 491 order

• Dalneva tablets 5mg+ 8mg 30 pcs. Krka-Rus LLC

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• Dalneva tablets 5mg+ 4mg 30 pcs. Krka-Rus LLC

  RUB 376 order

• KO-Dalneva tablets 5mg+2.5mg+8mg 30 pcs. Krka-Rus LLC

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Pharmacy Dialogue

• Ko-Dalneva (tab.5mg+1.25mg+4mg No. 30) KRKA-RUS

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• Dalneva (tab. 10 mg + 8 mg No. 30) KRKA-RUS

  RUR 534 order

• Dalneva (tablet 5 mg + 4 mg No. 30) KRKA-RUS

  407 rub. order

• Ko-Dalneva (tab.10mg+2.5mg+8mg No. 30) KRKA-RUS

  RUR 725 order

• Ko-Dalneva (tab.5mg+2.5mg+8mg No. 30) KRKA-RUS

  RUB 651 order

Reviews about Dalneva

There are not many reviews about the use of Dalneva; the positive effect of the drug on blood pressure and its rapid normalization are often mentioned:

• “The blood pressure has returned to normal.”
• “I used this drug. Blood pressure dropped to 110..."

Negative points that buyers indicate are too sharp a decrease in blood pressure, frequent side effects, heart pain:

• “It lowers the blood pressure, but the heart hurts. And how can you produce a medicine where a side effect could be a heart attack or stroke?”

Reviews

Vasily Ivanovich, 67 years old

I have angina and blood pressure. Previously I was treated with various medications. It wasn't very convenient. I always mixed up my medications and forgot to take one or the other. Then he switched to Dalneva. Comfortable. I took a pill in the morning and everything was fine.

Elena, 59 years old.

The drug is good. I've been taking it for three weeks now. Angina attacks have disappeared. The pressure has dropped. I feel much better than before.

Dalneva has a reputation as an effective drug. However, you should not rely only on medications. A healthy lifestyle plays an important role in leveling the negative consequences of coronary artery disease and hypertension, as well as in the prevention of these pathologies. In order for the blood vessels and heart to be normal, you should not abuse alcohol and rich food, you need to quit smoking and exercise regularly.

For more information about hypertension, watch the video.

You can learn more about angina from the video.