Cadex

• Doxazosin (as mesylate, which is doxazosin salt - Doxazosin mesylate)

The medication is available in tablet form with different dosages:

• 1 mg

• 2 mg

• 4 mg

This range of doses allows the doctor to flexibly tailor the treatment regimen to the patient - both for hypertension and BPH symptoms.

Cadex is prescribed in two main cases:

• Arterial hypertension (high blood pressure) - the drug dilates blood vessels, reducing total peripheral resistance and pressure

• Benign prostatic hyperplasia (BPH) - helps reduce symptoms such as:

• Difficult or intermittent urination

• Frequent urges, especially at night

• Feeling of incomplete emptying of the bladder

Important: Before starting BPH therapy, prostate cancer must be ruled out - symptoms may be similar but require a different approach.

Cadex is taken orally, once daily - morning or evening, as agreed with the doctor. Food can be disregarded - it has almost no effect on absorption.

Recommendations for arterial hypertension:

• Starting dose - 1 mg once daily

• The dose can later be increased to 2, 4, or 8 mg

• The dose can be increased no more often than once every 1-2 weeks

• Maximum allowable dose - 16 mg per day

For BPH:

• Also start with 1 mg per day

• If necessary, the dose is increased in the same way: 2 mg → 4 mg → maximum 8 mg

For elderly patients - especially at the start - it is preferable to use minimal doses to reduce the risk of a sharp drop in blood pressure.

Advice for patients: It is better to take the first tablet before bedtime, especially if alpha-blockers have not been taken previously - this reduces the risk of dizziness and fainting when getting up quickly.

The drug is contraindicated in situations where its use may be harmful - due to the risk of a sharp drop in pressure or worsening of the condition. The doctor must take this into account before starting therapy.

Cadex is not used for:

• Allergy to doxazosin, other alpha-blockers (e.g., prazosin, terazosin) or excipients of the drug

• Orthostatic hypotension - tendency to sharp decrease in pressure when standing up

• BPH if there is:

• Obstruction of the upper urinary tract

• Chronic urinary tract infection

• Bladder stones

• Urinary incontinence with a full bladder

• Anuria - absence of urination

• Breastfeeding - the drug is contraindicated during this period

• Pronounced hypotension - especially with clinical manifestations

If there have already been episodes of orthostatic hypotension in the medical history - this is a reason to choose another treatment or start with extreme caution.

Cadex is usually well tolerated, but at the start of therapy, reactions associated with a sharp decrease in pressure are possible. Some conditions require special attention from the doctor.

The drug should be used with caution in patients with:

• Cardiovascular diseases (coronary heart disease, heart failure)

• Liver or kidney dysfunction

• Diabetes mellitus (especially while taking antihypertensive drugs)

• Advanced age

Special situations to pay attention to:

• The first dose may cause a "first dose effect": a sharp drop in blood pressure, especially in sensitive patients. It is recommended to take the first tablet before bedtime.

• Dizziness, weakness, drowsiness are possible - especially when getting up quickly

• Before cataract surgery, it is necessary to inform the ophthalmologist that the patient is taking doxazosin - intraoperative floppy iris syndrome may develop during surgery

• Co-administration with PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) requires caution - may enhance the hypotensive effect

Some drugs may enhance or weaken the effect of doxazosin, and in combination - increase the risk of adverse reactions.

It is not recommended to combine Cadex with:

• PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) - possible sharp drop in pressure

• Other antihypertensive agents - especially if the regimen is not adjusted

• CYP3A4 enzyme inducers (rifampicin, phenytoin, carbamazepine, phenobarbital) - reduce doxazosin blood levels

• CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, clarithromycin) - conversely, increase its concentration

• Alcohol - enhances the hypotensive effect and may provoke dizziness

When prescribing a new drug, it is important to tell your doctor that you are taking Cadex - this will help avoid dangerous combinations.

During pregnancy: Cadex can be used only if the expected benefit to the mother outweighs the potential risk to the fetus. Ideally - avoid, especially in the first trimester.

During breastfeeding: The use of the drug is contraindicated. It is unknown whether doxazosin is excreted in breast milk, so if treatment is necessary, lactation should be suspended.

Fertility: Data on the effect on reproductive function in men and women are currently not available.

While taking Cadex, some patients may experience dizziness, drowsiness, or visual disturbances - especially at the initial stage or when increasing the dose.

Recommendations:

• Drivers and equipment operators should exercise caution, especially in the first week of use

• If the described symptoms occur - temporarily refrain from driving

• With a stable dose and good well-being - restrictions are minimal, but the decision is made individually

Like any medication, Cadex can cause adverse reactions. Most of them develop at the beginning of treatment and decrease in severity or pass over time. However, some require monitoring or discontinuation of the drug.

Very common side effects (≥ 1/10):

• Dizziness - associated with vasodilation and drop in pressure

• Headache

• Orthostatic hypotension - decrease in pressure when standing up

• General weakness

These effects are most often observed after the first dose or with a sharp increase in dosage.

Common (≥ 1/100 to < 1/10):

• Drowsiness

• Visual disturbance

• Nasal congestion - may be associated with dilation of mucosal blood vessels

• Nausea

• Edema of extremities

• Increased heart rate (tachycardia)

Uncommon (≥ 1/1,000 to < 1/100):

• Anxiety, insomnia

• Dry mouth

• Abdominal pain, diarrhea, constipation

• Skin reactions - itching, rash

Rare (≥ 1/10,000 to < 1/1,000):

• Fainting

• Stroke

• Myocardial infarction

• Hepatitis, jaundice

Very rare but serious side effect:

• Priapism - prolonged and painful erection requiring urgent medical attention

When to see a doctor: If fainting, severe edema, pronounced weakness, or signs of liver dysfunction (yellowing of the skin, darkening of urine) appear - it is necessary to immediately stop taking and consult a doctor.

Cadex overdose is most often associated with a sharp decrease in blood pressure and requires immediate measures.

Main symptoms:

• Severe hypotension (low blood pressure)

• Dizziness, up to fainting

• Tachycardia - compensatory increased heart rate

• Coordination disorders

What to do in case of overdose:

• Place the patient on their back, legs elevated (this will improve blood flow to the brain)

• Administer saline solution intravenously to increase circulating blood volume

• For severe hypotension - vasopressors (as prescribed by a doctor)

• Mandatory monitoring of blood pressure, pulse, breathing, and consciousness

Important: There is no specific antidote. Treatment is symptomatic, under medical supervision.

How doxazosin works: Doxazosin blocks alpha1-adrenoreceptors, which are located in:

• Vascular smooth muscle

• Prostate gland

• Bladder neck

This leads to:

• Vasodilation and reduction of blood pressure

• Improved urine outflow and reduction of BPH symptoms

With regular use, the drug lowers both systolic and diastolic pressure without causing reflex tachycardia. It has also been proven that doxazosin favorably affects the lipid profile (reduces total cholesterol and LDL levels), which is beneficial for concomitant metabolic syndrome.

Understanding pharmacokinetics helps to properly prescribe the drug, especially in liver disease and in the elderly.

Absorption:

• After oral administration, it is quickly and almost completely absorbed

• Bioavailability is about 65%

• Maximum blood concentration is reached after 2-3 hours

Distribution:

• Doxazosin is well distributed in tissues

• Binds to plasma proteins by approximately 98%

Metabolism:

• Predominantly metabolized in the liver

• Main pathways: O-demethylation and hydroxylation

• The resulting metabolites are pharmacologically less active

Elimination:

• Excreted mainly in feces as metabolites

• Half-life - from 19 to 22 hours, which allows it to be taken once a day

• Alpha-adrenoblockers.

In addition to the active ingredient - doxazosin, each Cadex tablet contains excipients that do not have a therapeutic effect but provide form, stability, and bioavailability of the drug.

Main excipients:

• Lactose monohydrate - filler

• Microcrystalline cellulose - structure-forming component

• Sodium carboxymethyl starch - promotes tablet disintegration in the stomach

• Povidone - stabilizer

• Magnesium stearate - lubricant, facilitates tablet compression

• Sodium lauryl sulfate - helps uniform distribution of the active ingredient

Important notes:

• The composition of excipients may slightly differ depending on the manufacturer

• For patients with lactose intolerance, it is important to check for lactose in the composition

• The complete list is specified in the instructions for the specific package

The shelf life of Cadex is indicated on the original packaging and depends on the manufacturer, but typically ranges from two to three years from the date of manufacture.

After this period, it is not recommended to use the drug - even if the tablet looks normal, its effectiveness and safety are no longer guaranteed.

To protect against external influences, it is best to store the tablets in the original packaging - blister or vial, as it additionally protects the drug from moisture, light, and temperature fluctuations.

To preserve the properties and effectiveness of Cadex, it is important to maintain the temperature and light storage conditions. The drug should be kept at a temperature not exceeding 25°C, away from heat sources and direct sunlight.

Freezing or sharp temperature fluctuations are also not allowed. Cadex should be stored in a dry place, protected from moisture, out of reach of children - especially if there are young children or elderly patients in the house who need to avoid accidental intake of the wrong medications.

Cadex is available in the form of tablets, packed either in blisters or plastic bottles. The packaging format is selected taking into account the duration of treatment and patient convenience.

Packaging options may include:

• Blisters with tablets (from 5 to 30 pieces)

• Plastic bottles (from 10 to 100 tablets)

• Cardboard packs with mandatory instructions

The packaging always indicates: dosage, total number of tablets, shelf life, and manufacturer's name. Before starting use, it is worth ensuring the integrity of the packaging and the current storage period.

Medicines should not be thrown away with regular trash - they can contaminate water, soil, and enter the bodies of animals or humans. It is better to hand over the remains of the drug for disposal.

What can be done:

• Return the drug to the pharmacy if there is a collection point for medications

• Consult a pharmacist about safe disposal

• Avoid getting the drug into sewage or toilet

Such simple actions help protect nature and prevent accidental consumption of expired or unnecessary medicines.

• Cadex is registered and manufactured in Israel, and is also exported to some countries.

• Dexcel Ltd (Israel)

• Cadex is dispensed by prescription and is not suitable for self-medication.

For the use of Cadex to be safe and effective, the patient should follow a number of recommendations. This is especially important at the beginning of treatment and when changing the dosage.

What to pay attention to:

• Take the drug strictly as prescribed

• Avoid sudden movements, especially in the morning

• Inform your doctor about all other medications

• Monitor blood pressure during treatment

• With side effects - do not delay a visit to the doctor

Cadex is a drug with which you need to be attentive to details. But if all the rules are followed, it gives a stable and predictable result.

• C02CA04 - Doxazosin

The drug can be used in the treatment of infectious diseases corresponding to the following codes of the International Classification of Diseases (ICD-10):

• I10 Essential [primary] hypertension

• N40 Hyperplasia of prostate