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Vazario H 80 / 12.5 mg (30 film-coated tablets)




The instruction for medical use of VAZAR medicine H the Trade name Vazar of N the International unlicensed name Is not present the Dosage form of the Tablet, film coated 80mg/12.5mg, 160mg/12.5mg and 160mg/25mg Structure One tablet contains active agents: valsartan 80 mg / Hydrochlorthiazidum of 12.5 mg valsartan 160 mg / Hydrochlorthiazidum of 12.5 mg valsartan 160 mg / Hydrochlorthiazidum of 25 mg, excipients: microcrystalline cellulose, lactoses monohydrate, sodium of a kroskarmelloz, K29-K32 povidone, talc, magnesium stearate, silicon dioxide colloidal anhydrous, structure of a cover: 8012.5 Opadray of II 85G34642 Pink (polyvinyl alcohol, talc, titan E171 dioxide, macrogoal 3350, E322 lecithin, ferrous oxide red E172, ferrous oxide yellow E172, ferrous oxide black E172) 16012.5 Opadray of II 85G25455 Red (polyvinyl alcohol, talc, macrogoal 3350, titan E171 dioxide, ferrous oxide red E172, decline yellow FCF aluminum varnish (FD&C Yellow #6) E110, E322 lecithin)) 160/25mg Opadray of II 85G23675 Orange (polyvinyl alcohol, talc, titan E171 dioxide, macrogoal 3350, ferrous oxide yellow E172, E322 lecithin, ferrous oxide red E172, ferrous oxide black E172). 025mg the Description of the Tablet of an oval form, with a biconvex surface, film coated pink color, with an engraving of V on one party and N on other party. Length is 11 mm, width is 5.8 mm (for a dosage of 80/12.5 mg). Tablets of an oval form, with a biconvex surface, film coated red color, with an engraving of V on one party and N on other party. Length is 15 mm, width is 6 mm (for a dosage of 160/12.5 mg). Tablets of an oval form, with a biconvex surface, film coated orange color, with an engraving of V on one party and N on other party. Length is 15 mm, width is 6 mm (for a dosage of 160/25 mg). Pharmacotherapeutic group the Drugs influencing a system renin-angiotensin. Angiotensin II antagonists in a combination with other drugs. Angiotensin II antagonists in a combination with diuretics. Valsartan in a combination with diuretics ATH C09 DA03 Code the Pharmacological Pharmacokinetics of Valsartan properties / Hydrochlorthiazidum At combined use with valsartany system bioavailability of Hydrochlorthiazidum decreases approximately by 30%. Hydrochlorthiazidum co-administration, in return, has no significant effect on kinetics of a valsartan. Noted interaction does not influence efficiency of the combined use of a valsartan and Hydrochlorthiazidum. The distinct antihypertensive effect of this combination which exceeds effect of each of components separately is revealed. Valsartan Vsasyvaniye After reception of a valsartan inside the maximum concentration (Cmax) is reached within 2-4 hours. The average absolute bioavailability is 23%. When assigning with AUC food (the area under a curve concentration time) Cmax approximately for 50%, however, later after reception decreases 8 hours approximately by 40%, concentration of a valsartan in blood becomes identical at the patients taking the drug with food and at those who received drug separately. Decrease in AUC is not followed by clinically significant decrease in therapeutic effect of drug therefore valsartan it is possible to accept irrespective of meal. Distribution the Equilibrium volume of distribution of a valsartan makes about 17 l that demonstrates to what valsartan actively does not get into fabrics. Valsartan contacts serum proteins for 94-97%, generally albumine. Valsartan’s metabolism is not exposed to active biotransformation, only 20% break up to metabolites. In blood plasma the inactive hydroxymetabolite in low concentration (less than 10% of AUC of a valsartan) is found pharmacological. Removal the Pharmacokinetic curve of disintegration of a valsartan has multiexponentsionalny character (t½α & lt, 1 h and t½ß oklo 9 h). Valsartan is brought mainly with a stake (about 83% of a dose) and urine (about the 13th dose), generally in an invariable look. After intravenous administration the plasma clearance is about 2 l/h, and renal clearance – 0.62 l/h (about 30% of the general clearance). Elimination half-life of a valsartan makes 6 h. Hydrochlorthiazidum Absorption After intake absorption of Hydrochlorthiazidum occurs quickly (tmax about 2 h). Increase in average AUC value has character linear and proportional to a dose when using therapeutic dosages. Influence of food on Hydrochlorthiazidum absorption, has no special clinical importance. The absolute bioavailability of Hydrochlorthiazidum after intake is 70%. Distribution Pharmacokinetics of distribution and removal of Hydrochlorthiazidum can generally be described function of biexponentsialny disintegration. The volume of distribution is 4-8 l/kg. Hydrochlorthiazidum contacts serum proteins (40-70%), mainly albumine. Hydrochlorthiazidum also kumulirutsya in erythrocytes in concentration which is about 1.8 times higher, than concentration of Hydrochlorthiazidum in plasma. Removal More than 95% of Hydrochlorthiazidum is mainly removed in an invariable look, with urine. Plasma elimination half-life makes from 6 to 15 hours in a phase of final removal. Repeated dosing does not change Hydrochlorthiazidum kinetics, cumulation is minimum at administration of drug once a day. The pharmacokinetics at separate groups of patients Patients of advanced age At some patients of advanced age of AUC of a valsartan was slightly higher, than at healthy patients of young age, however it is not clinically significant. Not numerous data allow to assume that at elderly people (both healthy, and having arterial hypertension) the system clearance of Hydrochlorthiazidum is lower, than young people. The renal failure When using of the recommended dosages valsartana / Hydrochlorthiazidum dose adjustment is not required to patients with clearance of creatinine of 30-70 ml/min. Data on use valsartana / Hydrochlorthiazidum patients with a heavy renal failure (clearance of creatinine & lt, 30 ml/min.) and the patients receiving dialysis no. Valsartan actively contacts proteins of plasma and is not brought by means of dialysis, unlike Hydrochlorthiazidum. In case of a renal failure the average maximum plasma concentration and AUC values of Hydrochlorthiazidum are increased, and excretion speed with urine is lowered. At patients with a renal failure of light and moderate severity the 3-fold increase in AUC Hydrochlorthiazidum, and at patients with a heavy renal failure – 8-fold was observed. A liver failure In a pharmacokinetic research of patients with easy (n=6) and the liver failure moderated (n=5) exposure of a valsartan doubled approximately in comparison with healthy volunteers. Data on use of a valsartan by patients with a heavy liver failure are absent. Diseases of a liver do not influence substantially Hydrochlorthiazidum pharmacokinetics. A pharmacodynamics Valsartan / Vazar Hydrochlorthiazidum H – antihypertensive drug which part are the antagonist of receptors of angiotensin II and thiazide diuretic. The system renin-angiotensin-aldosteronovoy (SRAA) is active hormone angiotensin II which is formed of angiotensin I with the participation of the angiotensin-converting enzyme (ACE). Angiotensin II contacts the specific receptors located on cellular membranes in various fabrics. It has a wide range of the physiological effects including first of all both the direct, and mediated participation in regulation of arterial blood pressure. Being powerful vasoconstrictive substance, angiotensin II causes the direct pressor answer. Besides, it stimulates secretion of Aldosteronum and promotes a delay of Valsartan Valsartan sodium – the active and specific antagonist of receptors of angiotensin II intended for intake. It affects selectively AT1 subtype receptors which are responsible for the known effects of angiotensin II. The increased serumal levels of angiotensin II owing to blockade of AT1 receptors valsartany can stimulate free AT2 receptors that counterbalances effect of AT1 receptors. However valsartan does not render the significant agonistic activity concerning receptors of AT1 subtype. The affinity of a valsartan to AT1 receptors is about 20,000 times higher, than to AT2 receptors. Valsartan does not enter interaction and does not block the receptors of other hormones or ion channels which are important for regulation of functions of a cardiovascular system. Valsartan does not inhibit APF known also under the name of a kininaza II which turns angiotensin I into angiotensin II and destroys bradykinin. Frequency of development of dry cough is lower at the patients receiving valsartan than at the patients receiving APF inhibitor. At treatment valsartany patients with arterial hypertension the lowering of arterial pressure (ABP) which is not followed by change of heart rate is noted. After intake of drug in a single dose at most of patients the beginning of hypotensive action is noted within 2 h, and the maximum decrease in the ABP is reached within 4-6 h. After administration of drug the hypotensive action remains more than 24 h. At repeated prescribing of drug the maximum decrease in the ABP, regardless of the accepted dose, is usually reached within 2-4 weeks and supported at the reached level during long therapy. At combination with Hydrochlorthiazidum the reliable additional decrease in the ABP is reached. Valsartan has high extent of linking with proteins of plasma and is not brought at a hemodialysis. Hydrochlorthiazidum, on the contrary, is removed from an organism at a hemodialysis. At the sharp termination of reception of a valsartan there is no ricochet hypertensia or any other undesirable reactions. Hydrochlorthiazidum the Point of application of effect of thiazide diuretics is cortical department of distal wavy renal tubules where receptors, highly sensitive to effect of diuretics, are located and where there is a suppression of transport of ions of sodium and chlorine. The mechanism of action of tiazid is connected with suppression of the pump Na+Cl-that, apparently, occurs due to the competition for places of Cl-transport. As a result of it excretion of ions of sodium and chlorine increases approximately to the same extent. As a result of diuretic action the reduction of volume of the circulating plasma is observed owing to what the activity of renin, secretion of Aldosteronum, removal with urine of potassium and, therefore, decrease in potassium concentration in serum increases. The interrelation between renin and Aldosteronum is mediated by angiotensin II therefore appointment of the antagonist of receptors of angiotensin II will reduce losses of potassium in comparison with monotherapy by Hydrochlorthiazidum. Hydrochlorthiazidum removal by kidneys happens by passive filtration and active secretion in a gleam of renal tubules. The condition of function of kidneys plays a large role in Hydrochlorthiazidum pharmacokinetics that is quite clear, considering that this drug is removed only by kidneys Indications – essential hypertensia, including, for treatment of those patients with essential hypertensia at whom it is not possible to reach adequate control of arterial blood pressure at monotherapy valsartany or Hydrochlorthiazidum the Route of administration and doses the Dosage the Recommended Vazar’s dose of N – on 1 tablet once a day daily, irrespective of meal, washing down with water. If necessary the dose can be increased up to 160 mg of a valsartan and 12.5 mg of Hydrochlorthiazidum, or up to 160 mg of a valsartan and 25 mg of Hydrochlorthiazidum, but not above the maximum dose valsartana / Hydrochlorthiazidum – 320 mg / 25 mg. It is recommended to titrate a dose of separate components. The steady hypotensive effect occurs within 2 weeks. At most of patients the maximum effect is observed within 4 weeks of therapy. However, for some patients can be required of 4-8 weeks of administration of drug. It should be considered in time titration of a dose. The maximum daily dose makes 320 mg / 25 mg. The renal failure For patients with a renal failure of light and moderate severity (the glomerular filtration rate (GFR) ≥ 30 ml/min.) dose adjustment is not required. An abnormal liver function At patients with a liver failure of easy and moderate weight without cholestasia the dose of a valsartan should not exceed 80 mg. Dose adjustment of Hydrochlorthiazidum for patients with a liver failure of easy and moderate weight is not required. Patients of advanced age At treatment of patients of advanced age of dose adjustment it is not required. Side effects At assessment of frequency of emergence of side reactions were used such gradation: ‘very often’ – & gt, 1/10, is ‘frequent’ – from & gt, 1/100 to & lt, 1/10, ‘sometimes’ – from & gt, 1/1000 to & lt, 1/100, is ‘rare’ – from & gt, 1/10000 to & lt, 1/1000, is ‘very rare’ – & lt, 1/10000. Frequency of side effects at Vazar’s reception of N it is rare – dehydration – paresthesia – a disorder of vision – sonitus – hypotension – cough – myalgia – fatigue Very seldom – dizziness – diarrhea – the arthralgia Frequency is not established – a syncope – not cardiogenic fluid lungs, sinusitis, bronchitis – a renal failure – increase in level of uric acid, bilirubin and creatinine in blood serum, the hypopotassemia, a hyponatremia, increase in level of urea nitrogen in blood, a neutropenia Additional information on separate components of drug Undesirable reactions about which it was reported in connection with use of separate components of drug earlier, potentially can also be side effects of therapy Vazary N even if they were not observed during clinical trials or during the post-registration period. Frequency of side effects at reception of a valsartan Sometimes – dizziness – an abdominal pain Frequency is not established – decrease in level of hemoglobin, a hematocrit, thrombocytopenia – other reactions of hypersensitivity / allergic reactions, including orrhoreaction – increase in level of potassium in blood plasma, a hyponatremia – a vasculitis – increase in level of hepatic tests – a Quincke’s disease, an itching, rash – a renal failure the Frequency of side effects at intake of Hydrochlorthiazidum Very often – a hypopotassemia, increase in level of lipids in blood (generally at reception of high doses) Is frequent – a giponariyemiya, a hypomagnesiemia, a hyperuricemia – postural hypotension – loss of appetite, slight feeling of nausea, vomiting – urticaria and different forms of its manifestation – impotence Seldom – thrombocytopenia sometimes with a purpura – a hypercalcemia, a hyperglycemia, a glucosuria and deterioration in the diabetic metabolic status – a depression, a sleep disorder – a headache, dizziness, paresthesia – a disorder of vision – an abdominal pain – arrhythmia – discomfort of digestive tract, a constipation, diarrhea – an intra hepatic cholestasia or jaundice – reactions of photosensitivity Is very rare – a gipokhloremichesky alkalosis – an agranulocytosis, a leukopenia, hemolytic anemia, suppression of activity of marrow – reaction of hypersensitivity – a respiratory distress a syndrome, including pneumonia and a fluid lungs, – the necrotizing vasculitis and a toxic epidermal necrolysis, skin reactions reminding a system lupus erythematosus, aggravation of skin manifestations of a system lupus erythematosus – pancreatitis – allergic reactions – a hypochloraemia, an alkalosis Frequency is not established – decrease in hemoglobin, decrease in a hematocrit, thrombocytopenia. – aplastic anemia – closed-angle glaucoma – a multiformny erythema – muscular spasms – a renal failure, an acute renal failure – a pyrexia, an asthenia – hypersensitivity, allergic reactions, including a serum disease – increase in potassium in blood serum, a hyponatremia – a vasculitis – Increase in values of function of a liver – the Quincke’s edema, dermatitis violent, an itching, Contraindication rash – hypersensitivity to one of Vazara components H, other sulfanamide drugs, soy oil, peanut butter or any of drug excipients – heavy abnormal liver functions, biliary cirrhosis and a cholestasia – an anury, heavy renal failures (clearance of creatinine & lt, 30 ml/min.) – a resistant hypopotassemia, a hyponatremia, a hypercalcemia and a symptomatic hyperuricemia – primary hyper aldosteronism – gout – a galactosemia, deficiency of Lappa lactase or with
ndry glucose galactose malabsorption – the combined use of Vazar of N with the drugs containing aliskiren including valsartan or APF inhibitors with aliskireny – pregnancy and the period of a lactation – children’s and teenage age up to 18 years the Medicinal interactions of Interaction connected with valsartanom / Hydrochlorthiazidum is not recommended to patients with diabetes or a renal failure (SKF & lt, 60 ml/min. / 1.73 sq.m) simultaneous use: Lithium It was reported about reversible increases in serumal concentration of lithium and toxicity when sharing APF inhibitors and tiazid, including Hydrochlorthiazidum. Considering lack of experience in area of the combined use of a valsartan and lithium, this combination of drugs is not recommended. In case of need uses of this combination, it is necessary to carry out careful monitoring of level of lithium in blood serum. The simultaneous use demanding care: Other Vazar antihypertensives H can enhance effects of other drugs with hypotensive properties (for example, guanetidin, Methyldopum, vasodilators, beta-blockers, IAPF, BRA, blockers of calcium channels and inhibitors of the return capture of a dopamine). Pressor amines (for example, noradrenaline, adrenaline) decrease in the answer to pressor amines is possible. The clinical importance of this effect is not clear and is not sufficient to forbid use of pressor amines. Non-steroidal anti-inflammatory drugs (NPVS), including selection TsOG-2 inhibitors, acetylsalicylic acid & gt, 3 g/days) and non-selective NPVS NPVS can reduce hypotensive effect both antagonists of receptors of angiotensin II, and Hydrochlorthiazidum, at the combined use. Besides, sharing valsartana / Hydrochlorthiazidum and NPVS can lead to depression of function of kidneys and increase in levels of potassium in serum. For this reason, at the beginning of therapy it is recommended to carry out control of function of kidneys and also adequate hydration of the patient. The interactions connected with valsartany Double blockade the system renin-angiotensin-aldosteronovy (SRAA) by means of APAII, APF inhibitors or an aliskiren Imeyutya data that double blockade the system renin-angiotensin-aldosteronovy (SRAA) by means of the combined use of APF inhibitors, blockers of receptors of angiotensin II or an aliskiren is connected with the increased frequency of the undesirable phenomena, including hypotension, a hyperpotassemia and depression of function of kidneys (including an acute renal failure) in comparison with use of one drug operating on RAAS. The combined use is not recommended the Potassium-preserving diuretics, potassium additives, the salt substitutes containing potassium, and other substances capable to increase potassium levels If joint with valsartany use of the medicine influencing potassium levels it is recommended to control potassium levels in plasma. Conveyors indicate Data of the researches in vitro what valsartan is substrate of the conveyor of hepatic capture OATP1B1/OATP1B3 and the conveyor of hepatic outflow of MRP2. Joint intake of inhibitors of the conveyor of capture (rifampicin, cyclosporine, etc.) or the outflow conveyor (ritonavir, etc.) and the valsartana can increase system influence of the last. At the beginning and completion of therapy by such drugs it is necessary to observe necessary precautionary measures. The lack of interaction is not revealed clinically significant interaction of a valsartan with the following substances: Cimetidinum, warfarin, furosemide, digoxin, atenolol, indometacin, Hydrochlorthiazidum, amlodipiny, glibenclamide. Digoxin and indometacin can enter interaction with Hydrochlorthiazidum which is a part of the drug N. Vazar Vzaimodeystviya, connected with Hydrochlorthiazidum To use of the following combinations it is necessary to approach with care the Medicines influencing serumal levels of potassium Gipokaliyemichesky effect of Hydrochlorthiazidum can increase at its combined use with potassiumuretic diuretics, corticosteroids, depletive, the AKTG adrenocorticotropic hormone, Amphotericinum, karbenoksolony, penicillin G, salicylic acid and its derivatives. If the specified drugs are appointed by the doctor for use in a combination with Vazary N, it is recommended to control potassium level in blood serum. The medicines capable to cause bidirectional ventricular tachycardia • Antiarrhytmic drugs of the class Ia (for example, quinidine, hydroquinidine, Disopyramidum) • Antiarrhytmic drugs of class III (for example, Amiodaronum, sotalol, dofetilid, ibutilid) • Some neuroleptics (for example, thioridazine, Chlorpromazinum, levomepromazinum, trifluopirazin, tsiamemazin, sulpirid, sultoprid, amisulprid, tiaprid, Pimozidum, haloperidol, Droperidolum) • Other drugs (for example, bepridit, tsisaprid, difemanit, eritromidin (in / c), galofantrin, ketanserin, mizolastin, pentamidine, sparfloksatsin, terfenadin, Vincaminum (in / c)) Considering risk of development of a hypopotassemia, Hydrochlorthiazidum should be applied in common with care with the drugs capable to cause bidirectional ventricular tachycardia. The medicines influencing sodium level in serum Giponatriyemichesky effect of diuretics can amplify at simultaneous use of antidepressants, antipsychotic means, anti-epileptic means, including carbamazepine. It is necessary to be careful at prolonged use of these drugs. Glycosides of a foxglove development of the tiazid-induced hypopotassemia which can lead to cardiac arrhythmia against the background of administration of drugs of a foxglove is possible. Salts of calcium and vitamin D Intake of thiazide diuretics, including Hydrochlorthiazidum, together with vitamin D or salts of calcium can strengthen increase in levels of calcium in serum. The combined use of thiazide diuretics and salts of calcium can cause a hypercalcemia in patients with predisposition to it (for example, in the patients having the hyperparathyreosis, malignant tumors or diseases connected with inadequate levels of vitamin D) due to increase in a canalicular reabsorption of calcium. Antidiabetic means (oral drugs and insulin) Reception of tiazid can affect tolerance to glucose. Correction of doses of antidiabetic drugs can be required. Metformin should be applied with care, considering risk of the laktatsidoz caused by the possible renal failure connected with intake of Hydrochlorthiazidum. Beta-blockers and diazoxide the Combined use of thiazide diuretics, including Hydrochlorthiazidum and beta-blockers, can increase risk of development of a hyperglycemia. Thiazide diuretics, including Hydrochlorthiazidum, can enhance hyper glycemic effect of diazoxide. The medicines used for treatment of gout (probenetsid, Sulfinpyrazonum and Allopyrinolum) correction of doses of the drugs promoting removal of uric acid as Hydrochlorthiazidum is capable to increase serumal levels of uric acid Can be necessary. Increase in a dose of a probenetsid or Sulfinpyrazonum can be required. Combined use with thiazide diuretics, including Hydrochlorthiazidum, can increase the frequency of development of reactions of hypersensitivity to Allopyrinolum. The anticholinergics and other drugs influencing a stomach vermicular movement Anticholinergic drugs (for example, atropine, Biperidinum) can increase bioavailability of thiazide diuretics that is connected with decrease in a vermicular movement of digestive tract and clearance rate of gastric contents. It is supposed that prokinetics, for example, tsizaprid, on the contrary, reduce bioavailability of thiazide diuretics. Amantadin Tiazida, including Hydrochlorthiazidum, can increase risk of the side effects caused amantadiny. Holestiramin ion-exchange resins and kolestipol slow down absorption of thiazide diuretics, including Hydrochlorthiazidum. This can be connected with subtherapeutic effects of thiazide diuretics. However, the consecutive scheme of intake of Hydrochlorthiazidum and ion-exchange resin (Hydrochlorthiazidum is accepted at least in 4 hours prior to or in 4-6 hours after pitch) can minimize risk of such interaction. Cytotoxic drugs of Tiazida, including Hydrochlorthiazidum, can reduce renal removal of cytotoxic drugs (for example, cyclophosphamide and a methotrexate) and to strengthen their myelosuppressive action. Ne the depolarizing relaxants of skeletal muscles (for example, tubocurarine) Tiazida, including Hydrochlorthiazidum, enhance effect of relaxants of skeletal muscles, such as derivative curares. Cyclosporine Combined use with cyclosporine can increase risk of a hyperuricemia and subagrosimilar complications. Alcohol, barbiturates and drugs the Concomitant use of thiazide diuretics and substances which also render hypotensive effect (for example, reduce activity of a sympathetic part of the central nervous system or have direct vasodilating effect), can strengthen orthostatic hypotension. Methyldopum It was reported about separate cases of hemolytic anemia at the patients who were in common receiving to Methyldopum and hydrokhlrtiazid. Carbamazepine At the patients who are at the same time accepting Hydrochlorthiazidum and carbamazepine can develop a hyponatremia. Therefore such patients should be informed on possible giponatriyemichesky reactions and to exercise necessary control of them. The contrast environment with iodine content in the presence of dehydration caused by intake of diuretics raises risk of an acute renal failure, especially when using high doses of iodinated drugs. Before therapy the patients need to carry out rehydration. Special indications of Change of balance of electrolytes of Valsartan Ne serum combined use of Vazar of N with potassium salts, kaliysberegayushchy diuretics, kaliysoderzhashchy substitutes of edible salt and also with medicines which can cause increase in potassium concentration in blood is recommended (for example, heparin). As required it is necessary to exercise control of potassium level in blood. Hydrochlorthiazidum there Are messages about development of a hypopotassemia at treatment by thiazide diuretics, including Hydrochlorthiazidum. Regular control of potassium concentration in blood serum is recommended. Connection of use of thiazide diuretics, including Hydrochlorthiazidum, was established with a hyponatremia and a gipokhloremichesky alkalosis. Tiazida cause increase in excretion with magnesium urine that can lead to a hypomagnesiemia. As well as for all patients receiving treatment by diuretics it is necessary to carry out the analysis of levels of serumal electrolytes regularly. Deficit in an organism of sodium and/or volume or liquid in an organism the Patients receiving thiazide diuretics, including Hydrochlorthiazidum, have to be observed regarding emergence of clinical symptoms of disturbance of water-salt balance. At patients with the significant deficit in an organism is sodium and/or liquid in an organism, for example, the diuretics receiving high doses, in rare instances in an initiation of treatment Vazary N there can be arterial hypotension. Before an initiation of treatment Vazary N it is necessary to carry out correction of content of sodium and electrolytes in an organism. Patients with chronic heart failure or other diseases against the background of stimulation system renin-angiotensin-aldosteronovoy At patients whose function of kidneys, depends on activity system renin-angiotensin-aldosteronovoy (for example, at patients with heavy stagnant heart failure) the therapy connection by inhibitors of angiotensin-converting enzyme (APF) was established with an oliguria and/or the progressing azotemia, and in rare instances – with an acute renal failure and/or a lethal outcome. Inspection of patients with heart failure or a postinfarction syndrome always has to include assessment of function of kidneys. Vazar’s use N by patients with heavy chronic heart failure was not studied therefore it is not recommended to use drugs with this combination of active agents at this group of patients. Vazar of N patients are not recommended to appoint a renal artery stenosis with a unilateral/bilateral renal artery stenosis or a stenosis of an artery of the only kidney as it can bring to p
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