Essential arterial hypertension in adults. Replacement therapy for patients with adequate blood pressure control while taking lisinopril and amlodipine at the specified doses.
active ingredients: lisinopril, amlodipine;
1 tablet contains lisinopril 20 mg (as 21.76 mg lisinopril dihydrate) and amlodipine 5 mg (as 6.94 mg amlodipine besylate)
auxiliary substances: microcrystalline cellulose (type 101), microcrystalline cellulose (type 12), sodium starch (type A), magnesium stearate.
Ecvator Dosage form
Basic physical and chemical properties: white or almost white, round, biconvex, with “CF2” engraving on one side, the other side without engraving.
Ecvator Pharmacotherapeutic group
ACE inhibitors (ACE) in combination with calcium channel blockers. ATX code C09B B03.
Equator is a combined preparation with a fixed dose combination of the active ingredients lisinopril and amlodipine.
Lisinopril is an inhibitor of the enzyme peptidyldipeptidase. It inhibits the angiotensin converting enzyme (ACE), which catalyzes the conversion of angiotensin I to the vasoconstrictor peptide angiotensin II. Angiotensin II also stimulates the secretion of aldosterone by the adrenal cortex. Inhibition of ACE leads to a decrease in the concentration of angiotensin II, as a result of which vasopressor activity decreases and the secretion of aldosterone decreases. A decrease in the latter can lead to an increase in serum potassium.
Since the mechanism by which lisinopril lowers blood pressure is based on inhibition of renin-angiotensin-, lisinopril lowers blood pressure even in hypertensive patients with low renin levels. ACE is identical to kininase II – an enzyme that leads to the degradation of bradykinin. Elevated concentrations of bradykinin, a potent vasodilator peptide, play a role in the therapeutic effects of lisinopril has not yet been elucidated.
Amlodipine is a dihydropyridine inhibitor of calcium ion entry (slow calcium channel blocker or calcium ion antagonist), which blocks their entry through the membranes into the muscle cells of the myocardium and blood vessels.
The mechanism of the hypotensive action of amlodipine is due to a direct relaxing effect on vascular smooth muscle.
At the moment, the exact reasons for the positive effect of amlodipine in angina pectoris are not known; however, it is known that a decrease in the total ischemic load occurs due to the following two mechanisms:
Amlodipine causes expansion of peripheral arterioles and thus reduces the total peripheral vascular resistance that the heart overcomes (afterload). Since the heart rate remains stable, unloading the heart leads to a decrease in myocardial energy consumption and myocardial oxygen demand.
The mechanism of action of amlodipine also possibly involves the expansion of the main coronary arteries and arterioles, both normal and located in the ischemic zone. This leads to an increase in the level of oxygen supply to the myocardium in patients with vasospastic angina (Prinzmetal’s angina or variant angina).
The use of amlodipine 1 time per day daily leads to a clinically significant decrease in blood pressure in patients with arterial hypertension, both in an upright and in a horizontal position for 24 hours. Due to the slow onset of action, a rapid hypotensive effect does not occur.
In patients with angina pectoris, a single daily dose of amlodipine increases exercise tolerance, increases the duration of the interval before an angina attack, delays the development of ST segment depression (by 1 mm), and also reduces the frequency of angina attacks and the frequency of taking nitroglycerin.
Amlodipine does not show any adverse effect on metabolism or plasma lipid concentration and can be used in the treatment of patients with bronchial asthma, type II diabetes mellitus and gout.
Essential arterial hypertension in adults.
Substitution therapy for patients with adequate blood pressure control while taking lisinopril and amlodipine at the indicated doses.
Associated with lisinopril:
hypersensitivity to lisinopril or to any other ACE inhibitor;
a history of angioedema associated with the use of an ACE inhibitor;
hereditary or idiopathic angioedema;
pregnancy or the period of planning pregnancy, the period of lactation (see section “Use during pregnancy or lactation”);
simultaneous use of Equator with medicinal products containing aliskiren is contraindicated in patients with diabetes mellitus or renal failure (glomerular filtration rate <60 ml / min / 1.73 m2) (see Section “Interaction with other medicinal products and other types of interactions”) ;
simultaneous use with sacubitril / valsartan; It is not recommended to start taking Equator earlier than 36 hours after taking the last dose of sacubitrilau / valsartan (see sections “Interaction with other medicinal products and other types of interactions” and “Peculiarities of use”).
hypersensitivity to amlodipine or to any other dihydropyridine derivatives;
severe arterial hypotension;
shock (including cardiogenic);
obstruction of the left ventricular outflow tract (severe aortic valve stenosis);
hemodynamically unstable heart failure after acute myocardial infarction.
all of the above contraindications associated with the use of individual components also apply to the combined preparation Equator;
hypersensitivity to any of the excipients of the drug Equator (see Section “Composition”).