Adelfan: domestic and imported analogues and substitutes. Why is Adelfan not on sale?

International name

Reserpine+Dihydralazine+Hydrochlorothiazide

Group affiliation

Antihypertensive combination drug

Dosage form

Pills

pharmachologic effect

Combination drug. Reserpine, a sympatholytic, penetrating into the presynaptic endings of postganglionic sympathetic fibers, releases norepinephrine from vesicles while simultaneously disrupting its reverse neuronal uptake and enhancing the process of MAO inactivation. Causes depletion of neurotransmitter reserves and a persistent decrease in blood pressure. Helps reduce the concentration of dopamine, serotonin and other neurotransmitters in neurons, providing an antipsychotic effect. Weakens the influence of sympathetic innervation on the cardiovascular system, reduces heart rate and peripheral vascular resistance; maintains parasympathetic activity nervous system; deepens and enhances physiological sleep, inhibits interoceptive reflexes. Increases gastrointestinal motility, increases the production of HCl in the stomach; slows down metabolic processes in the body; cuts and deepens breathing movements, causes miosis, hypothermia; reduces metabolic rate. Renders positive influence to lipid and protein metabolism in patients with arterial hypertension and coronary atherosclerosis; increases renal blood flow, enhances glomerular filtration.

Dihydralazine is an arterial vasodilator, reduces resistance in the vessels of the heart, brain, kidneys (to a lesser extent - skin and skeletal muscles), does not affect renal blood flow; hypotensive effect not accompanied by orthostatic hypotension.

Hydrochlorothiazide is a thiazide diuretic that acts at the level of the cortical segment of the loop of Henle, enhances the excretion of Na+, K+, Mg2+, Cl- and water, increases the reabsorption of Ca2+; maximum diuretic effect is after 6 hours, duration of action is 12 hours.

The drug does not cause reflex tachycardia, characteristic of dihydralazine and hydrochlorothiazide (elimination by reserpine), and fluid retention, characteristic of reserpine and dihydralazine (elimination of hydrochlorothiazide).

Indications

Arterial hypertension.

Contraindications

Hypersensitivity; depression (including a history), Parkinson's disease, epilepsy, electroconvulsive therapy, pheochromocytoma, concomitant or recent treatment with MAO inhibitors, gastric and duodenal ulcers (in the acute phase), nonspecific ulcerative colitis, SLE, recent myocardial infarction, severe tachycardia, heart failure due to high cardiac output(including thyrotoxicosis) or due to mechanical obstruction (aortic, mitral stenosis, constrictive pericarditis), isolated right ventricular failure due to pulmonary hypertension(“pulmonary” heart); anuria, severe chronic renal failure (creatinine clearance less than 30 ml/min), liver failure; refractory hypokalemia, hyponatremia, hypercalcemia; hyperuricemia with clinical manifestations; pregnancy, lactation period, age up to 18 years. With caution. CHF, bradycardia, slow AV and intraventricular conduction, recent myocardial infarction, cerebral and coronary atherosclerosis, diabetes, peptic ulcer of the stomach and duodenum (history), erosive gastritis, calculous cholecystitis.

Side effects

From the outside digestive system: diarrhea, dry mouth, hypersecretion of gastric juice, hypersalivation, nausea, vomiting, bulimia, gastrointestinal bleeding, jaundice, increased activity of “liver” transaminases, hepatitis.

From the cardiovascular system: decreased blood pressure, rhythm disturbances, angina pectoris, “flushes” of blood to the skin of the face, cerebrovascular disorders.

From the nervous system: dizziness, depression, irritability, nightmares, increased fatigue, extrapyramidal disorders (including parkinsonism), headache, state of anxiety, decreased ability to concentrate, stupor, disorientation; extremely rarely - cerebral edema.

From the outside respiratory system: swelling of the nasal mucosa, shortness of breath, nosebleeds.

From the outside genitourinary system: decreased potency and/or libido, impaired ejaculation, dysuria, glomerulonephritis.

From the outside endocrine system: weight gain, hyperprolactinemia, galactorrhea, gynecomastia.

From the senses: blurred visual perception, conjunctival hyperemia, lacrimation, hearing loss.

Allergic reactions: eczema, skin rash, itching, lupus-like syndrome, photosensitivity, fever, purpura.

From the hematopoietic organs: anemia, leukopenia, thrombocytopenia.

Laboratory indicators: hypokalemia, hyperlipidemia, hyponatremia, hypomagnesemia, hyperuricemia, hypercalcemia, hyperglycemia, glycosuria, increased metabolic disorders in diabetes mellitus, hypochloremic alkalosis.

Other: swelling of the mammary glands.

Application and dosage

Inside. The initial dose is 1 tablet per day, with a gradual increase to 3 tablets; maximum daily dose– 3 tablets; maintenance therapy – minimal effective dose. In case of hepatic or renal failure (creatinine clearance 30 ml/min or serum creatinine 2.5 mg/100 ml = 221 µmol/l), increase the interval between doses or reduce the dose.

special instructions

7 days before the start of electroconvulsive therapy or planned surgery, the drug should be discontinued; when emergency surgery– pre-administer atropine.

Elderly patients and patients suffering from chronic diseases and cirrhosis of the liver need to regularly monitor the concentration of blood electrolytes; in patients suffering from hyperlipidemia, the concentration of lipids in the blood serum.

If signs of depression or arthralgia appear, the drug is immediately discontinued.

MAO inhibitors should be discontinued no later than 2 weeks before starting treatment with the drug.

When prescribed to patients with diabetes mellitus receiving insulin or other hypoglycemic drugs, adjustment of the dosage regimen of these drugs may be required.

Care must be taken when using eye drops, nasal drops and other drugs that contain alpha-adrenergic stimulants.

During the treatment period, care must be taken when driving vehicles and engaging in other potentially dangerous species activities that require increased concentration and speed of psychomotor reactions.

Interaction

Enhances the neurotoxicity of salicylates, weakens the effect of oral hypoglycemic drugs, norepinephrine, epinephrine, antiepileptic drugs and levodopa, anticholinergic drugs, drugs that reduce concentration uric acid; reduces the analgesic effect of morphine; enhances the effects (including side effects) of cardiac glycosides, the cardiotoxic and neurotoxic effects of Li+ drugs, the effectiveness of non-depolarizing muscle relaxants, reduces the excretion of quinidine; enhances the central effect of barbiturates, ethanol, drugs for inhalation anesthesia, antihistamines, tricyclic antidepressants.

Increases the risk of developing allergic reactions to allopurinol, amantadine; reduces the excretion of cytotoxic drugs by the kidneys and enhances their myelosuppressive effect.

Methyldopa increases the risk of developing depressive states, tricyclic antidepressants weaken the hypotensive effect; MAO inhibitors increase the risk of developing hyperreactivity, arterial hypertension; GCS, ACTH, amphotericin, carbenoxolone, laxatives - hypokalemia; NSAIDs weaken the diuretic and hypotensive effects; cholestyramine reduces absorption.

Guanethidine, methyldopa, beta-blockers, vasodilators, BMCC, ACE inhibitors enhance the hypotensive effect.

Vitamin D, Ca2+ preparations increase the risk of developing hypercalcemia, cyclosporine – hyperuricemia, gout.

Reviews of the drug Adelfan-Ezidrex: 7

Nadezhda, December 6, 2015, age: 59

I took Adelfan only to reduce blood pressure during a crisis. I take Liprazit-10 daily. Adelfan is a great help. Only now it is not available in pharmacies - it is a shame that the purchase of such a good drug was canceled.

Olga, 08/05/2016, age: 45

Resume purchasing Adelfan! To say that it is outdated is a utopia! For some reason, all vaccinations for children and adults are not outdated, but they are much older!

Olga, December 22, 2016, age: 66

I have been taking half a tablet only during crises for many years. Great help! None side effects was not observed, and I am allergic to many medications. I can’t imagine how I’ll be without it now during attacks. Resume supplies of Adelfan-Ezidrex!

Sasha, 01/08/2017, age: 50

Tell me where or how I can buy Adelfan?

Marina, 01/08/2017, age: 56

Adelfan was always on hand in case of a “jump” in blood pressure, half a tablet was enough - and that’s it, here’s your 125/80! And no side effects (where will it come from in one dose!) What is the point of taking something in a course (with side effects on three sheets) if the pressure jumps every 2-3 months? And what to do now that Adelfan has disappeared? How to reduce high blood pressure? As for analogues - empty chatter, all the listed drugs are COURSE! And now there is no emergency. This is such bullshit. Sad.

Victor, 04/27/2017, age: 57

I took it when my blood pressure was high and it helped tremendously. Now, in the wake of the fight against truly effective medications, he was banned. The question is, what should those who have neither the means nor the strength to escape from this country do? Die? I am sure that this is exactly what they are trying to achieve.

Sergey, December 7, 2017, age: 76

Whoever banned its purchase is not a fool, but a bastard! The only question is why does he need this?

Write your review

Do you use Adelfan-Ezidrex as an analogue or vice versa its analogues?

It’s not for nothing that high blood pressure is called a silent killer, because hypertension is to blame for 70% of all deaths in the world. It is possible and necessary to reduce the pressure, but with what? Previously, adelfan was very popular among hypertensive patients, but today it cannot be found in pharmacies. What analogues and substitutes have appeared for this medicine?

Adelfan is well known to experienced hypertensive patients. He is combined agent, the effect of which is to relax the walls blood vessels, lowering blood pressure, lowering heart rate. The medicine contains two active ingredients - reserpine and dihydrapazine. With long-term use of Adelfan, the pressure stabilizes after 2-3 weeks.

The medicine is indicated for mild hypertension and medium degree. Its use is justified in cases where it is impossible to establish the causes of blood pressure surges. At the beginning of therapy, you need to take 1 tablet. once a day, then - 1 tablet. three times a day. When the pressure returns to normal, the daily dose is reduced to 1 tablet.

Although the drug has proven itself well as an antihypertensive drug, doctors consider it outdated: it has been found to have a large number of contraindications and serious side effects. Therefore, it is better to use improved analogues and substitutes for Adelfan. What drugs can compete with it?

An effective “descendant” of an outdated drug

Adelfan was replaced by a medicine whose name is similar to the name of its predecessor - Adelfan-Ezidrex. It is produced in India. This is a direct “descendant” of Adelfan - its analogue in composition. It contains the same two components (reserpine and dihydralazine), but hydrochlorothiazide has been added to them, which eliminates the adverse effects of its use. After active substances will end up in the body and produce the necessary effect, without having time to harm other systems and organs, they will be eliminated naturally within one day.

Taking Adelfan-Ezidrex is not accompanied by such unpleasant phenomena as anemia, a feeling of dry mouth, flushing of the face and upset stool. This tool quickly normalizes blood pressure and keeps it within the prescribed limits for a long time. It is well tolerated even by elderly and debilitated patients. To achieve a lasting “antihypertensive” effect, sometimes just 1 tablet is enough. per day (taken in the morning).

Important! This potent remedy. It is not suitable for self-treatment and must be prescribed by a doctor.

There is no Adelfan, but what in return?

What else can replace Adelfan? Here are the most famous foreign analogues drug:

• Captopril (Ukraine), Capoten (USA). These are drugs based on captopril. Treatment of hypertension begins with these drugs; they act gently and effectively;
• Nifedipine (Bulgaria), Adalat (Germany). Contains nifedipine. They not only lower blood pressure levels, but also protect internal organs, have a positive effect on kidney function, and improve the condition of the retina;
• Enalapril Hexal (Germany) - in addition to the hypotensive effect, reduces vascular tone and stress on the heart muscle. A single dose of the drug is effective for up to 6 hours after administration. But to get a lasting clinical effect, you will have to drink it for at least six months.

Unlike Adelfan, they have an evidence base and prolonged action. And Captopril and Enalapril have a cardioprotective effect - they protect the heart from the destructive influence hypertension.

Russian analogues: we gain in price, do not lose in efficiency

Adelfan can be substituted domestic analogue. Here are the two most prescribed blood pressure medications:

• Cordaflex. Indicated for hypertension, coronary heart disease, Raynaud's syndrome. The main active ingredient is nifedipine. The medicine has a prolonged effect. The effect is detected after 20 minutes. and lasts up to 12-24 hours. Method of administration - 1 tablet. 3 r. per day. Adverse reactions provokes extremely rarely;
• Verapamil. It is produced both in Russia and in other countries: Croatia, Macedonia, Germany, India, Hungary. It is quite often prescribed for high blood pressure and angina. Contains verapamil hydrochloride. It has the lowest bioavailability of other calcium antagonist drugs (not higher than 20%). Usually it is taken 1 tablet. 2 r. in a day. Already from the first week of use, patients feel a positive effect, the pressure completely returns to normal by 3-4 weeks.

Their difference from Adelfan, according to doctors, is that they treat and do not lower blood pressure.

There are no side effects! Herbal medicines against hypertension

If your blood pressure rises from time to time and not too much, then it is better to try to correct the situation with the help of drugs based on medicinal plants or dietary supplements. Moreover, among them there were many that were similar in action to Adelfan:

• Coramin. Dietary supplement It is often called an analogue of Adelfan. The composition is very specific: it includes the heart muscle of pigs or large cattle. Adults should take 1-3 tablets. from 2 to 3 r. in a day;
• Atherophyton is a herbal preparation (dietary supplement). Allowed from 12 years of age. It is recommended to drink 2 tablets. 2 r. per day;
• Nephrox. Contains natural ingredients: extracts of anise, lespedeza, linseed oil. Standard daily dose - 2-3 times;
• Crystal. Aqueous-alcoholic tincture, which contains exclusively plant components: corn silk, sage, lingonberry, birch leaves and others. Normalizes blood circulation and gently lowers blood pressure. It is recommended to take 30-40 drops, diluted in 50-100 ml of water. Does not cause unwanted reactions;
• Cardiofit. Alcohol infusion medicinal herbs. Prescribed for hypertension in the following dosages: 1 tsp. 2-3 r. per day after meals.

So, Adelfan only had one “double” with the same composition. Other drugs that are considered its analogues still differ in their active ingredients, and therefore in the effect they produce. Regarding accusations of the ability to provoke side effects, then new drugs also have an impressive list of possible adverse reactions. But the doctors’ opinion is clear: “you won’t go far with Adelfan,” the pressure needs to be treated.

In this article you can find instructions for use medicinal product Adelfan. Feedback from site visitors - consumers - is presented of this medicine, as well as the opinions of specialist doctors on the use of Adelfan in their practice. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Adelfan in the presence of existing structural analogues. Use for the treatment of arterial hypertension and blood pressure reduction in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.

Adelfan- is a combination of antihypertensive components having various points application of their action and mutually complementary antihypertensive effects of each other.

Reserpine causes depletion of catecholamine depots in the endings of postganglionic sympathetic nerves and in the central nervous system. As a result, the ability to deposit catecholamines is impaired for a fairly long period of time. Depletion of catecholamine reserves leads to disruption of impulse transmission in the endings of the sympathetic nerves, which, in turn, leads to a decrease in the tone of the sympathetic nervous system (while the activity of the parasympathetic nervous system does not change). Thus, reserpine reduces elevated blood pressure and heart rate. In addition, reserpine causes a sedative effect. Reserpine also depletes the reserves of other neurotransmitters, incl. serotonin, dopamine, neuropeptides and adrenaline in central and peripheral neurons. These effects of reserpine may play a role in its implementation pharmacological effects and antihypertensive action.

After reserpine is taken orally, its antihypertensive effect develops slowly; the maximum effect is achieved only after 2-3 weeks and is maintained for a long time.

Dihydralazine sulfate is an arterial vasodilator, reduces smooth muscle tone arterial vessels(mainly arterioles) and reduces peripheral vascular resistance. The mechanism of this action at the cellular level remains unclear. To a greater extent, vascular resistance decreases in the vessels of the heart, brain, kidneys and others internal organs and to a lesser extent - in the vessels of the skin and skeletal muscles. If the decrease in blood pressure is not pronounced, the blood flow in the dilated bloodstream generally increases. The preferential expansion of arterioles, rather than venules, reduces the severity of orthostatic hypotension and increases cardiac output.

Vasodilation, leading to a decrease in blood pressure (more diastolic than systolic), is accompanied by a reflex increase in heart rate, stroke volume and cardiac output. The reflex increase in heart rate and cardiac output can be neutralized by combining dihydralazine with reserpine, which suppresses the sympathetic nervous system.

Hydrochlorothiazide, a thiazide diuretic, acts in the cortical segment of the loop of Henle and the distal renal tubules. Inhibits the reabsorption of chlorine and sodium ions (due to antagonistic interaction with the NaCl transport enzyme) and enhances the reabsorption of calcium ions (the mechanism is unknown). An increase in the amount and/or rate of entry of sodium and water ions into the cortical segment of the collecting ducts leads to an increase in the secretion and excretion of potassium and hydrogen ions.

In patients with normal function kidneys, an increase in diuresis is observed after a single use of hydrochlorothiazide at a dose of 12.5 mg. An increase in urinary excretion of sodium and chlorine and a slightly less pronounced increase in kaliuresis depend on the dose of hydrochlorothiazide. After taking the drug orally, diuretic and natriuretic effects begin within 1-2 hours, reach a maximum after 4-6 hours and continue for 10-12 hours. Diuresis caused by thiazides initially leads to a decrease in circulating plasma volume, cardiac output and systemic blood pressure. Activation of the renin-angiotensin-aldosterone system is possible. At long-term use hydrochlorothiazide, the maintenance of the hypotensive effect is ensured, probably, by reducing the peripheral vascular resistance. Cardiac output returns to initial values, a slight decrease in plasma volume and an increase in plasma renin activity persist.

Compound

Reserpine + Dihydralazine sulfate (hydrated) + Excipients.

Reserpine + Dihydralazine sulfate (hydrated) + Hydrochlorothiazide + excipients (Adelfan Ezidrex).

Pharmacokinetics

Reserpine is rapidly absorbed after oral administration.

Dihydralazine is rapidly absorbed after oral administration. In blood plasma, dihydralazine is found predominantly in the form of unchanged dihydralazine and hydrazone substances formed as a result of metabolism of the main substance. Approximately 10% of dihydralazine is found in the blood plasma in the form of hydralazine.

Hydrochlorothiazide after oral administration is absorbed by 60-80%. Changes in absorption due to food intake are not clinically significant.

Hydrochlorothiazide accumulates in red blood cells.

Reserpine is metabolized in the intestines and liver. The main metabolites are methyl reserpate and trimethoxybenzoic acid. Dihydralazine is metabolized largely by oxidation (to form hydrazones) and acetylation. Hydrochlorothiazide is metabolized to highly small degree. Its only metabolite found in trace amounts is 2-amino-4-chloro-M-benzene disulfonamide.

During the first 96 hours after oral administration, 8% of the dose of reserpine is excreted by the kidneys, mainly in the form of metabolites, and 62% through the intestines, mainly unchanged.

After oral administration about 46% dose taken dihydralazine are excreted within 24 hours, mainly in the form of metabolites, mainly through the intestines. About 0.5% of the dose taken is found in the urine as unchanged substance.

In patients with normal renal function, hydrochlorothiazide is eliminated almost exclusively by the kidneys. In general, 50-75% of an oral dose is excreted unchanged in the urine.

Indications

• arterial hypertension.

Release forms

Pills.

Instructions for use and dosage regimen

The drug is taken with meals and washed down with water.

The dose of the drug should be selected individually. Treatment begins with a minimum dose, which can be gradually (no more than every 2-3 weeks) increased, depending on the patient’s response to treatment. The daily dose is usually 1-3 tablets. The maximum daily dose is 3 tablets. The frequency of taking the drug is 2-3 times a day.

If adequate blood pressure control cannot be achieved, treatment should be reconsidered and possibly switched to a different drug. pharmacological group(beta blocker, slow calcium channel blocker, ACE inhibitor).

In elderly patients, as well as in patients with impaired liver function, a single dose of the drug or the interval between its prescriptions should be set with caution, taking into account the required clinical response to treatment and tolerability.

Side effect

• dry mouth;
• increased secretion of gastric juice;
• increased salivation;
• nausea, vomiting;
• diarrhea;
• increased appetite;
• ulceration;
• gastrointestinal bleeding;
• sinus bradycardia;
• swelling;
• arrhythmias;
• pain in the chest, suggesting angina pectoris;
• orthostatic hypotension;
• flushing of the face;
• fainting;
• heart failure;
• cerebrovascular accidents;
• swelling of the nasal mucosa;
• dyspnea;
• nose bleed;
• dizziness;
• depression;
• irritability;
• nightmares;
• increased fatigue;
• extrapyramidal disorders (including parkinsonism);
• headache;
• state of anxiety;
• impaired concentration;
• stupor;
• disorientation;
• cerebral edema;
• violation of potency and ejaculation;
• dysuria;
• glomerulonephritis;
• weight gain;
• weight loss;
• increased secretion of prolactin;
• galactorrhea;
• gynecomastia;
• swelling of the mammary glands;
• blurred vision;
• conjunctival hyperemia;
• lacrimation;
• hearing impairment;
• eczema;
• decreased libido;
• anemia, thrombocytopenia.

Contraindications

• depression (current or history);
• Parkinson's disease;
• epilepsy;
• electroconvulsive therapy;
• stomach ulcer and duodenum in the acute phase;
• ulcerative colitis;
• pheochromocytoma;
• concomitant or recent treatment with MAO inhibitors;
• systemic lupus erythematosus (idiopathic);
• severe tachycardia and heart failure against the background of high cardiac output (including with thyrotoxicosis);
• heart failure due to mechanical obstruction (including the presence of aortic or mitral stenosis or constrictive pericarditis);
• isolated right ventricular failure due to pulmonary hypertension (“pulmonary” heart);
• anuria, severe renal failure(creatinine clearance less than 30 ml/min);
• liver failure;
• refractory hypokalemia, hyponatremia, hypercalcemia;
• hyperuricemia with clinical manifestations;
• pregnancy;
• children under 18 years of age (efficacy and safety have not been established);
• hypersensitivity to reserpine and related substances, dihydralazine or other hydrazinophthalazines, hydrochlorothiazide or other sulfonamide derivatives.

Use during pregnancy and breastfeeding

Adelfan is contraindicated during pregnancy for the following reasons.

Reserpine, if prescribed before childbirth, can cause severe drowsiness, swelling of the nasal mucosa and anorexia in the newborn. The effects of thiazide diuretics, incl. hydrochlorothiazide, led to thrombocytopenia in the fetus and newborn. Since thiazide diuretics do not prevent the occurrence or in any way affect the severity of toxicosis in pregnancy (edema, proteinuria, hypertension), they should not be prescribed for this indication.

Reserpine, dihydralazine and hydrochlorothiazide penetrate into breast milk. In a newborn baby, reserpine can cause the reactions described above. Hydrochlorothiazide may suppress lactation. It is not recommended to use Adelfan during lactation.

No studies have been conducted to study the effect of Adelfan on reproduction in animals.

special instructions

Patients who have had a myocardial infarction should not be prescribed dihydralazine until the stabilization period after suffered a heart attack myocardium. As in the case of prescribing any antihypertensive drugs with a pronounced hypotensive effect, special care should be taken when prescribing Adelfan to patients with coronary and cerebral atherosclerosis. In these cases, a sharp decrease in blood pressure should be avoided, because this can lead to decreased blood flow. The precautions outlined below apply not only to each component individually, but also to Adelfan as a whole.

Since reserpine increases motility and secretion in the gastrointestinal tract, caution should be exercised when using it in patients with peptic ulcer stomach and duodenum in history, as well as in patients erosive gastritis And cholelithiasis. Caution should also be exercised in patients with heart failure, sinus bradycardia, conduction disorders, as well as in patients who have recently suffered a myocardial infarction.

Caution should be exercised in patients with suspected ischemic heart disease. Dihydralazine-induced tachycardia can lead to an attack of angina and ECG changes indicating myocardial ischemia. In some cases, a connection between myocardial infarction and the use of dihydralazine could not be excluded.

Avoid prescribing Adelfan (especially if it is used in conjunction with potassium supplements or potassium-sparing diuretics) to patients taking ACE inhibitors. As with other thiazide diuretics, caution should be exercised in patients with diabetes mellitus and gout.

If signs of depression appear, the drug should be discontinued immediately, as there is a risk of suicidal actions. Depression provoked by reserpine (especially in cases of use of the drug Adelfan in high doses), may be severe enough to provoke suicidal behavior. It may persist for several months after discontinuation of the drug.

The use of dihydralazine can lead to sodium and water retention in the body and, consequently, to the development of edema and decreased diuresis.

It is required to systematically monitor the condition of patients with impaired liver function, taking into account the possibility of rare but serious side effects of dihydralazine from the liver. It should also be taken into account that even minor disturbances in water and electrolyte balance caused by a thiazide diuretic can provoke hepatic coma, especially in patients with liver cirrhosis. Currently, there are a small number of case reports of lupus-like syndrome associated with dihydralazine. Mild forms of this syndrome are manifested by arthralgia, sometimes accompanied by fever and skin rashes; When the drug is discontinued, these symptoms go away on their own. In more severe cases the clinical picture is similar to the manifestations of systemic lupus erythematosus; complete disappearance of symptoms can only be achieved with long-term treatment GCS. The incidence of this syndrome is directly dependent on the dose and duration of treatment. In this regard, for long-term maintenance therapy it is recommended to use the minimum effective doses.

During treatment with dihydralazine, it seems advisable to determine antinuclear factor in blood plasma every 6 months. If an antinuclear factor is detected, its titers should be systematically determined. If they develop clinical manifestations lupus-like syndrome, the drug should be discontinued immediately. Reserpine should be discontinued at least 7 days before electroconvulsive therapy.

Discontinuation of reserpine before surgery does not guarantee that hemodynamic instability will not occur during surgery. It is important to warn the anesthesiologist that the patient is taking reserpine and take this into account when managing the patient. There are known cases of decreased blood pressure in patients receiving rauwolfia drugs. During surgical intervention in patients receiving dihydralazine, a marked decrease in blood pressure may be observed.

Hypokalemia develops with the use of hydrochlorothiazide. Hypokalemia may sensitize the myocardium or enhance the cardiac response to the toxic effects of digitalis drugs. The risk of hypokalemia is increased with liver cirrhosis, rapidly developing increased diuresis, insufficient intake of potassium from food, concomitant therapy with corticosteroids, beta2-adrenergic receptor stimulants or ACTH. For the purpose of timely detection possible violations electrolyte balance it is necessary to determine the content of electrolytes in plasma at the beginning of treatment and at certain intervals during treatment.

Nonspecific manifestations of electrolyte imbalance observed in a number of cases were dry mouth, thirst, weakness, drowsiness, restlessness, muscle pain and cramps, muscle weakness, decreased blood pressure, oliguria, tachycardia, nausea.

Thiazide diuretics cause a decrease in calcium excretion. In several patients who received thiazide diuretics for a long time, pathological changes in the parathyroid gland were detected, accompanied by hypercalcemia and hypophosphatemia. If hypercalcemia is detected, it is necessary to carry out additional examinations in order to clarify the diagnosis. There were no complications that are usually associated with hyperparathyroidism, such as kidney stones, bone resorption, or peptic ulcers.

Thiazide diuretics cause increased urinary excretion of magnesium, which can lead to hypomagnesemia.

When used in high doses, thiazide diuretics can cause a decrease in glucose tolerance and lead to increased plasma concentrations of cholesterol, triglycerides and uric acid.

The use of reserpine affects the results of determination of 17-ketosteroids and 17-hydroxycorticosteroids in urine by the colorimetric method, leading to an underestimation of these results.

Impact on the ability to drive vehicles and operate machinery

Adelfan may impair the patient's ability to quick reactions, especially at the beginning of treatment. As with other antihypertensive drugs, patients taking vehicles and mechanisms, should be warned about the possibility of a decrease in the speed of psychomotor reactions, and exercise caution.

Drug interactions

The hypotensive effect of Adelfan increases with simultaneous administration other antihypertensive drugs: guanethidine, alpha-methyldopa, beta-blockers, vasodilators, slow calcium channel blockers, ACE inhibitors.

A number of interactions associated with individual components of the drug are also possible.

Reserpine

It is necessary to discontinue MAO inhibitors at least 14 days before starting reserpine therapy. If it is necessary to prescribe MAO inhibitors to a patient receiving reserpine, MAO inhibitors should be prescribed no less than 14 days after discontinuation of reserpine. With the simultaneous use of reserpine and MAO inhibitors, hyperactivity and hypertensive crisis are possible.

Reserpine enhances the depressant effect on the central nervous system of alcohol, general anesthesia, and some antihistamines, barbiturates and tricyclic antidepressants. Reserpine weakens the effect of levodopa. Concomitant use of reserpine and tricyclic antidepressants may weaken the hypotensive effect of reserpine.

Reserpine should be discontinued several days before elective surgery to avoid an excessive decrease in blood pressure during general anesthesia. Prescribing reserpine in combination with antiarrhythmic drugs or digitalis drugs can lead to sinus bradycardia.

Reserpine may enhance the effects of epinephrine (adrenaline) or other sympathomimetic substances (caution should be exercised when used concomitantly with antitussives, nasal drops, eye drops).

Dihydralazine sulfate

The simultaneous use of tricyclic antidepressants, antipsychotics, and ethanol-containing drugs (as well as alcohol) may enhance the hypotensive effect of dihydralazine. Administration of dihydralazine shortly before or shortly after administration of diazoxide may cause a marked decrease in blood pressure.

Hydrochlorothiazide

With the simultaneous use of hydrochlorothiazide and lithium preparations, an increase in the concentration of lithium in the blood is possible, therefore, in this case, systematic monitoring of the level of lithium in the blood is necessary. In cases where lithium preparations cause polyuria, hydrochlorothiazide may cause a paradoxical antidiuretic effect. Hydrochlorothiazide may enhance the effects of non-depolarizing muscle relaxants.

The hypokalemic effect caused by diuretics may be enhanced by the simultaneous use of GCS, ACTH, amphotericin, carbenoxolone. Hypokalemia and hypomagnesemia ( unwanted effects thiazide diuretics) may contribute to the development of disorders heart rate in patients receiving cardiac glycosides.

When using hydrochlorothiazide in patients with diabetes mellitus, dose adjustment of insulin and oral hypoglycemic drugs may be required.

Co-administration of NSAIDs (including indomethacin) may weaken the diuretic, natriuretic and antihypertensive effects of hydrochlorothiazide. There are isolated reports of deterioration of renal function in predisposed patients.

The absorption of hydrochlorothiazide is impaired in the presence of anion exchange resins. Absorption of hydrochlorothiazide from the gastrointestinal tract with simultaneous single use of cholestyramine and colestipol is reduced by 85% and 43%, respectively, due to binding to these compounds.

Concomitant use of thiazide diuretics (including hydrochlorothiazide) may increase the risk of reactions. hypersensitivity on allopurinol, increase the risk of side effects of amantadine, enhance the hyperglycemic effect of diazoxide, reduce the renal excretion of cytotoxic drugs (including cyclophosphamide, methotrexate) and enhance their myelosuppressive effect.

Anticholinergic drugs (including atropine, biperiden) can increase the bioavailability of hydrochlorothiazide, which is associated with a decrease in gastrointestinal motility and the rate of gastric emptying.

Concomitant use of hydrochlorothiazide with vitamin D or calcium supplements may lead to increased calcium levels in the blood.

With simultaneous use of hydrochlorothiazide and cyclosporine, the risk of developing hyperuricemia and gout increases.

There are reports of development hemolytic anemia while taking hydrochlorothiazide and methyldopa drugs.

Analogues of the drug Adelfan

Structural analogues according to active substance:

• Adelphan Esidrex.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

As statistics from the World Health Organization show, more than 47% of the total population of the planet over the age of 40 suffers from it.

Such disappointing indicators tell us that every second adult suffers from severe headaches, weakness, shortness of breath and frequent headaches that occur as a result of the development of this disease. Well-known pharmacists, knowing about the insidiousness of hypertension, annually produce new, more improved drugs to combat this disease.

In recent years, Adelfan has been considered the most effective. The components included in this medicine have positive impact to almost all receptors that are involved in the narrowing of the lumen of blood arteries and vessels.

The instructions for use that accompany Adelfan accurately describe at what pressure to use it - at elevated pressures. Due to the fact that this medicine contains reserpine and dihydralazine, they contribute to the gradual normalization of parameters.

The main indications for taking a therapeutic course with Adelfan are:

• essential hypertension;
• hypertensive pathology of the middle and;
• hypertension with an unknown underlying cause of sudden fluctuations in blood pressure parameters.

Self-diagnosis of the disease and taking medications can harm your health and cause a deterioration in the overall clinical picture.

Select the most suitable antihypertensive therapy should only be done by a specialist.

Compound

In one tablet medicine Adelfan contains:

• reserpine (0.1 mg);
• dihydralazine (10 mg);
• hydrochlorothiazide (10 mg).

The drug also contains auxiliary components: mannitol, disodium edetate, magnesium stearate, talc, corn starch.

Release form and packaging

The drug Adelfan is available in the form of flat tablets, white. The tablet is marked on one side with the letters AF, and on the other side with the letters CIBA.

Adelfan-Ezidrex tablets

The drug is packaged in blasters of 10 pieces. One package can contain 2, 3, 5 or even 25 blasters.

Instructions for use

The medicine must be taken exclusively with meals, with big amount clean, still water.

The dosage of the drug, depending on the initial clinical picture, is selected individually.

The therapeutic course begins with a minimum dose, which, depending on the patient’s condition, can be gradually increased (no more than once every 2-3 weeks). In most cases daily dosage is 1 or 2 tablets.

According to the instructions, patients are strictly prohibited from taking more than 3 tablets per day. If the patient fails to achieve stable normalization of blood pressure, then the course of treatment needs to be reconsidered and switched to another, more suitable medicine.

Adelfan is best taken at the same time, 2 times a day.

For patients who have impaired kidney or liver function, as well as for older people, the dosage of the drug should be selected extremely carefully. Experts must carefully study all clinical picture and determine whether the patient is allergic to Adelfan components.

Contraindications

According to the instructions, Adelfan is strictly prohibited from being taken by patients who have individual intolerance to individual components of the drug.

There are also a number of other contraindications in which patients cannot undergo a therapeutic course of treatment with antihypertensive drugs:

• advanced forms of arrhythmia, angina pectoris;
• severe depression;
• anuria;
• previous stroke or myocardial infarction;
• Parkinson's disease;
• epilepsy;
• advanced form of renal failure;
• lactation period;
• severe form of tachycardia;
• third trimester of pregnancy;
• pheochromocytoma;
• severe pathology of liver functioning;
• damage to the duodenum or stomach by peptic ulcer, nonspecific colitis, which arose against the background of these pathologies;
• hyperuricemia.

Patients who have been diagnosed with a cerebral or coronary type of atherosclerotic lesion should be especially careful.

In addition, Adelfan is not recommended for use by persons who have not reached the age of majority. Patients whose type of activity is related to high speed reactions and constant concentration of attention, the medicine is not prescribed.

Side effects

Components included in general composition Adelfan can cause a number of side effects.

Reserpine can cause dry mouth, diarrhea, nausea, excessive secretion of gastric juice and vomiting in the patient.

In addition, there may be an increase in appetite, as well as the formation of ulcers on the surface of the mucous membrane of the digestive system. In quite rare cases, the medicine provokes sudden changes in heart rate (arrhythmia), cerebrovascular disorders, sinus bradycardia, orthostatic hypotension and sudden flushing of the facial skin.

In isolated cases it may occur and nasal cavity, glomerulonephritis, decreased sexual activity, increased total body weight and impaired ejaculation.

In some cases, side effects can cause serious damage to the reproductive system. Adelfan can provoke swelling of the mammary glands, the development of gynecomastia or galactorrhea, and also increase the production of prolactin.

When the medication is discontinued, all side effects are eliminated.

Dihydralazine in rare cases provokes hypotension and tachycardia. The patient may experience an allergic reaction in the form of rashes on skin and severe itching. In this case, a feverish state and sudden loss weight.

Price and where to buy

Many patients ask the question: “Why was such a high-quality medicine Adelfan removed from mass production?” But the whole point is that this drug was included in the category of outdated medicines.

Today, you can purchase the improved and effective drug Adelfan-Ezidrex in specialized pharmacies.

The price of Adelfan blood pressure pills varies depending on the region of residence. On average, a package of 30 tablets costs 170 rubles, but a package of 250 tablets will cost 1,200 rubles. The drug is commercially available; you can buy Adelfan-Ezidrex blood pressure tablets without a doctor's prescription.

Analogs

Sometimes situations arise when the patient’s body does not tolerate the components of the drug, reacting to them with all sorts of side effects and allergic reactions. In such cases, experts recommend choosing the most suitable analogue a certain spectrum of action.

The most popular analogues of the drug Adelfan include:

• . The medicine works well with high blood pressure, and also eliminates unpleasant and even painful symptoms caused by vascular diseases;
• Adelfan-Ezidrex. Numerous positive reviews patients and doctors, as well as indications for use indicate that this is one of the most effective drugs. It belongs to the combined antihypertensive medications, which have sympatholytic, arteriodialatatory and diuretic effects;
• Tririzide. A combined drug containing diuretics and rauwolfia alkaloids. This is an analogue of Adelfan, which quickly lowers blood pressure;
• . One of the most inexpensive drugs, which is distinguished by its safety and milder blood pressure reduction. The main component of the medicine is the plant Rauwolfia terrestrial, which is of natural origin.

Enap tablets

Adelfan can also be replaced with foreign analogues:

• Amprilan Nl;
• Accusid;
• Atacand Plus;
• Apo-Triazide.

Before taking any drug, you should consult a specialist.

Adelfan is a drug that can quickly lower blood pressure for a long time.

However, today this tool is considered obsolete.

That's why it's being used more and more often modern analogue, the main advantage of which is fewer side effects.

Features of using the drug

In the past, Adelfan was one of the most common drugs used for arterial hypertension. He provides complex action, since it contains two active components - dihydralysine and reserpine.

These substances have a relaxing effect on the walls of blood vessels, affecting the central nervous system and reducing the number of heart contractions.

However, such properties have an adverse effect on the body. But in cases where the factors for the development of hypertension have not been established, the use of Adelfan allows you to quickly normalize blood pressure levels.

However, the consequences after taking this drug are very negative:

1. headache;
2. depressed state;
3. spasms and cramps;
4. development of depression;
5. angina pectoris, heart failure and myocardial infarction;
6. feeling of anxiety;
7. irritability.

In case of overdose with Adelfan, unpleasant symptoms. For example, inhibition of speech and motor functions, drowsiness and dizziness.

In addition, these pills are strictly prohibited during pregnancy. They should also not be taken by patients under 18 years of age and by people suffering from epilepsy, liver, heart and kidney diseases.

Therefore, pharmacists developed structural analogue Adelfana, also rapidly reducing arterial pressure, but not having such strong and numerous side effects. This is how the improved drug Adelfan-Ezidrex appeared, containing not only the components of its predecessor, but also substances that reduce their negative impact on the body.

It is worth noting that the new analogue of Adelfan is adopted according to a completely different scheme. The optimal daily dose for an adult is no more than two tablets. But often, to achieve a lasting antihypertensive effect, one tablet is enough, which is taken in the morning with clean water.

After this, you should not eat food for half an hour. Thus, if you regularly use the modern analogue of Adelfan, you can achieve rapid decline pressure for a long time.

Popular analogues of Adelfan

Coramine is a well-known analogue of Adelfan, which is prescribed to speed up the process of restoring myocardial performance in coronary artery disease, including heart attack. The drug is also indicated for arterial hypertension and intense physical activity on the body.

In addition, Coramine is prescribed to elderly patients to maintain myocardial function. To enhance the effectiveness of the drug, it is taken together with Vasalamine.

Nephrox is another popular analogue of Adelfan, which is used for preventive and therapeutic purposes in the following cases:

• diabetic nephropathy;
• hyperazotemic nephritis (chronic and acute);
• high blood pressure;
• azotemia;
• atherosclerosis;
• renal failure;
• inflammation of the urinary tract.

Cordaflex is also used for hypertension of varying severity, stable angina and coronary artery disease. In addition, this drug successfully stops a hypertensive crisis.

Crystal is prescribed for preventive and medicinal purposes with arterial hypertension, ischemic heart disease, atherosclerosis, discirculatory encephalopathies and obliterating endarteritis. The product can also be used as part of complex therapy for osteoporosis, arthrosis or osteochondrosis.

Verapamil is a well-known analogue of Adelfan, which is also prescribed for hypertension, angina pectoris and coronary artery disease. In addition, these tablets are indicated for atrial flutter and fibrillation and paroxysmal supraventricular tachycardia.

Verapamil in the form of an injection solution is prescribed to relieve a hypertensive crisis. It is also effective for acute coronary insufficiency ventricular extrasystole and other similar conditions.

Atherophyton – effective analogue Adelphan, which is a source biologically active ingredients, normalizing the concentration of cholesterol in the blood and improving the condition vascular walls. This drug prevents atherosclerotic damage to blood vessels by mobilizing cholesterol from their walls. It is also used as a prophylaxis for atherosclerosis, symptomatic hypertension, coronary artery disease, hypertension, heart failure, thrombophlebitis and varicose veins.

Ebrantil is a good alternative to Adelfan. Available in the form of a solution intended for parenteral use in hypertensive crisis, severe and reflex hypertension.

The solution can also be used to monitor the process of reducing blood pressure during or after surgery. And Ebrantil tablets are taken for mild or moderate forms of hypertension.

AngiOmega Complex is biologically active additive, which contains niacin, policosanol, vitamin E, oleuropein, fatty and unsaturated acids omega-3,6,9. The drug is prescribed for preventive and therapeutic purposes as part of complex therapy for atherosclerosis of the blood vessels of the legs (unpleasant painful sensations in the legs when moving, chilliness of the limbs), coronary vessels(heart pain, ischemic heart disease, angina) and cerebral vessels (forgetfulness, cerebral atherosclerosis, deterioration of attention and memory).

In addition, AngiOmega Complex is indicated in the following cases:

1. violation metabolic processes- diabetes, excess weight, metabolic syndrome;
2. women and men after 30-35 for the prevention of atherosclerosis;
3. hypertension;
4. genetic predisposition to diseases of the cardiovascular system;
5. following a diet with a minimum amount of fat;
6. prolonged or constant psycho-emotional stress, nervous and stressful conditions;
7. reduced immunity;
8. prevention of stroke, heart attack and rehabilitation after vascular accidents.

An equally well-known replacement for Adelfan is Captopril, which is indicated for essential, renovascular, resistant, etc. The video in this article is intended to answer the question of what to do to reduce blood pressure.

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