Exforge HCT

Per 5/160/12.5 mg Amlodipine besylate 5 mg, valsartan 160 mg, hydrochlorothiazide 12.5 mg. Per 10/160/12.5 mg Amlodipine besylate 10 mg, valsartan 160 mg, hydrochlorothiazide 12.5 mg. Per 10/160/25 mg Amlodipine besylate 10 mg, valsartan 160 mg, hydrochlorothiazide 25 mg

Essential HTN.

Adult 1 tab daily, may be increased after 2 wk. Max: 10/320/25 mg daily.

May be taken with or without food: Taken w/ water.

Hypersensitivity to amlodipine, valsartan, hydrochlorothiazide or other sulfonamide derivatives. Refractory hypokalaemia; hyponatremia; hypercalcemia; symptomatic hyperuricemia. Concomitant use w/ aliskiren in diabetic type 2 patients. Severe hepatic & renal (CrCl <30 mL/min) impairment, biliary cirrhosis, cholestasis, anuria, dialysis patients. Pregnancy.

Discontinue immediately & not to be re-administered if angioedema develops. Not indicated as initial therapy. Not to be administered to patients who previously experienced acute resp distress syndrome. Allergy or asthma; history of sulfonamide or penicillin allergy. Unilateral or bilateral renal artery stenosis, stenosis to solitary kidney; recent kidney transplantation; serious CHF (NYHA class III-IV); worsening angina pectoris, acute MI, severe obstructive CAD; aortic or mitral stenosis or obstructive hypertrophic cardiomyopathy; conditions involving enhanced K loss; SLE; hypercalcemia; acute angle-closure glaucoma. Increased risk of non-melanoma skin cancer, basal & squamous cell carcinoma. Altered glucose tolerance & raised serum cholesterol, triglycerides & uric acid levels. Correct Na &/or vol depletion, hypokalemia & any coexisting hypomagnesemia prior to initiation. Periodically check K, Mg & Na serum conc. Regularly check skin for new lesions; limit sunlight & UV rays exposure. Concomitant use w/ K supplements, K-sparing diuretics, K-containing salt substitutes or other drugs increasing K levels (eg, heparin); ACE inhibitors or aliskiren. Not suitable in mild to moderate hepatic impairment w/o cholestasis. Avoid use w/ aliskiren in severe renal impairment. Not to be used in women of childbearing potential, during pregnancy & lactation. Not recommended in ped patients <18 yr.

Amlodipine: Headache, somnolence, dizziness; palpitations; flushing; abdominal pain, nausea; oedema, fatigue. Valsartan: Insomnia, decreased libido, pharyngitis, rhinitis, sinusitis, URTI, viral infections. Hydrochlorothiazide: Hypokalemia, increased blood lipids. Hyponatremia, hypomagnesaemia, hyperuricemia, decreased appetite; orthostatic hypotension; mild nausea & vomiting; urticaria & other forms of rash; erectile dysfunction.

Reversible increased serum lithium conc & toxicity. Amlodipine: Increased exposure to simvastatin. Increased plasma conc w/ ketoconazole, itraconazole, ritonavir; grapefruit juice. Concomitant use w/ CYP3A4 inducers eg, rifampicin, Hypericum perforatum. Valsartan: Increased incidence of hypotension, hyperkalemia & renal function changes w/ ACE inhibitors, aliskiren. Increased K levels w/ K-sparing diuretics, K supplements, K-containing salt substitutes or drugs increasing K levels eg, heparin. Attenuated antihypertensive effects w/ NSAIDs including COX-2 inhibitors. Increased systemic exposure w/ rifampin, ciclosporin, ritonavir. Hydrochlorothiazide: Potentiated antihypertensive action of other antihypertensives eg, guanethidine, methyldopa, β-blockers, vasodilators, Ca-channel blockers, ACE & direct renin inhibitors, ARBs. Potentiated action of skeletal muscle relaxants. Increased hypokalemic effect w/ kaliuretic diuretics, corticosteroids, ACTH, amphotericin, carbenoxolone, penicillin G, salicylic acid derivatives, antiarrhythmics. Intensified hyponatremic effect w/ antidepressants, antipsychotics, antiepileptics. Altered glucose tolerance of insulin, oral antidiabetics. Thiazide-induced hypokalemia or hypomagnesemia w/ digitalis glycosides. Weakened diuretic & antihypertensive activity w/ NSAIDs, selective COX-2 inhibitors. Increased hypersensitivity reactions to allopurinol. Increased risk of adverse effects by amantadine. Reduced renal excretion & enhanced myelosuppressive effects of antineoplastics. Increased bioavailability w/ anticholinergics. Decreased bioavailability w/ prokinetic drugs. Decreased absorption w/ cholestyramine or colestipol. Potentiated rise in serum Ca w/ vit D or Ca salts. Increased risk of hyperuricemia & gout-type complications w/ ciclosporin. Enhanced hyperglycemic effect of diazoxide. Hemolytic anemia w/ methyldopa. Potentiated orthostatic hypotension w/ alcohol, barbiturates, narcotics. Reduced response to pressor amines.

Angiotensin II Antagonists / Calcium Antagonists / Diuretics

C09DX01 - valsartan, amlodipine and hydrochlorothiazide ; Belongs to the class of angiotensin II receptor blockers (ARBs), other combinations. Used in the treatment of cardiovascular disease.

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