Моксонидин Канон

Моксонидин Канон is indicated in adults for treatment of mild to moderate essential hypertension.

Моксонидин Канонидин Канонidine is indicated in adults for treatment of mild to moderate essential hypertension.

Posology

Adults

Treatment must be instituted with the lowest dosage of Моксонидин Канон. This means a daily dose of 0.2 mg Моксонидин Канон in the morning. If the therapeutic effect is insufficient, the dose can be increased after three weeks to 0.4 mg. This dose can be given as a single dose (to be taken in the morning) or as a divided daily dose (morning and evening). If the results are still insufficient after a further three weeks, the dosage can be increased further to a maximum of 0.6 mg given divided in the morning and evening. A single dose of 0.4 mg Моксонидин Канон and a daily dose of 0.6 mg Моксонидин Канон should not be exceeded.

Special populations

Elderly

Provided that renal function is not impaired, dosage recommendation is the same as for adults.

Paediatric population

Моксонидин Канон should not be given to children and adolescents under 18 years of age as insufficient safety and therapeutic data are available for this.

Method of administration

As concomitant ingestion of food does not affect the pharmacokinetics of Моксонидин Канон, Моксонидин Канон can be taken before, during or after meals. The tablets should be taken with sufficient fluid.

Posology

Adults

Treatment must be instituted with the lowest dosage of Моксонидин Канонидин Канонidine. This means a daily dose of 0.2 mg Моксонидин Канонидин Канонidine in the morning. If the therapeutic effect is insufficient, the dose can be increased after three weeks to 0.4 mg. This dose can be given as a single dose (to be taken in the morning) or as a divided daily dose (morning and evening). If the results are still insufficient after a further three weeks, the dosage can be increased further to a maximum of 0.6 mg given divided in the morning and evening. A single dose of 0.4 mg Моксонидин Канонидин Канонidine and a daily dose of 0.6 mg Моксонидин Канонидин Канонidine should not be exceeded.

Special populations

Elderly

Provided that renal function is not impaired, dosage recommendation is the same as for adults.

Paediatric population

Моксонидин Канонидин Канонidine should not be given to children and adolescents under 18 years of age as insufficient safety and therapeutic data are available for this.

Method of administration

As concomitant ingestion of food does not affect the pharmacokinetics of Моксонидин Канонидин Канонidine, Моксонидин Канонидин Канонidine can be taken before, during or after meals. The tablets should be taken with sufficient fluid.

Моксонидин Канон is contraindicated in patients with:

- sick sinus syndrome

- bradycardia (resting HR <50 beats/minute)

- 2nd or 3rd degree atrioventricular block

- cardiac insufficiency

Моксонидин Канонидин Канонidine is contraindicated in patients with:

- sick sinus syndrome

- bradycardia (resting HR <50 beats/minute)

- 2nd or 3rd degree atrioventricular block

- cardiac insufficiency

Cases of varying degrees of AV block have been reported in the post-marketing setting in patients undergoing Моксонидин Канон treatment. Based on these case reports, the causative role of Моксонидин Канон in delaying atrioventricular conduction cannot be completely ruled out. Therefore, caution is recommended when treating patients with a possible predisposition to developing an AV block.

When Моксонидин Канон is used in patients with 1^st degree AV block special care should be exercised to avoid bradycardia. Моксонидин Канон must not be used in higher degree AV blocks.

When Моксонидин Канон is used in patients with severe coronary artery disease or unstable angina pectoris special care should be exercised due to the fact that there is limited experience in this patient population.

Due to lack of clinical evidence supporting safe use in patients with co-existing moderate cardiac insufficiency, Моксонидин Канон should be administered with caution in these patients.

Caution is advised in the administration of Моксонидин Канон to patients with renal impairment as Моксонидин Канон is excreted primarily via the kidneys. In these patients careful titration of the dose is recommended, especially at the start of therapy. Dosing should be initiated with 0.2 mg daily and can be increased to a maximum of 0.4 mg daily for patients with moderate renal impairment (GFR>30 ml/min but < 60 ml/min) and to a maximum of 0.3 mg daily for patients with severe renal impairment (GFR<30 ml/min) if clinically indicated and well tolerated.

If Моксонидин Канон is used in combination with a β-blocker, and both treatments have to be discontinued the β-blocker should be discontinued first, and, then Моксонидин Канон after a few days.

So far, no rebound effect on blood pressure has been observed after the discontinuation of treatment with Моксонидин Канон. However, it is advisable not to stop taking Моксонидин Канон abruptly, but to reduce it gradually over a period of two weeks.

The elderly population may be more susceptible to the CV effects of blood pressure lowering drugs. Therefore therapy should be started with the lowest dose and dose increments should be introduced with caution to prevent the serious consequences these reactions may lead to.

Моксонидин Канон contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

Cases of varying degrees of AV block have been reported in the post-marketing setting in patients undergoing Моксонидин Канонидин Канонidine treatment. Based on these case reports, the causative role of Моксонидин Канонидин Канонidine in delaying atrioventricular conduction cannot be completely ruled out. Therefore, caution is recommended when treating patients with a possible predisposition to developing an AV block.

When Моксонидин Канонидин Канонidine is used in patients with 1^st degree AV block special care should be exercised to avoid bradycardia. Моксонидин Канонидин Канонidine must not be used in higher degree AV blocks.

When Моксонидин Канонидин Канонidine is used in patients with severe coronary artery disease or unstable angina pectoris special care should be exercised due to the fact that there is limited experience in this patient population.

Due to lack of clinical evidence supporting safe use in patients with co-existing moderate cardiac insufficiency, Моксонидин Канонидин Канонidine should be administered with caution in these patients.

Caution is advised in the administration of Моксонидин Канонидин Канонidine to patients with renal impairment as Моксонидин Канонидин Канонidine is excreted primarily via the kidneys. In these patients careful titration of the dose is recommended, especially at the start of therapy. Dosing should be initiated with 0.2 mg daily and can be increased to a maximum of 0.4 mg daily for patients with moderate renal impairment (GFR>30 ml/min but < 60 ml/min) and to a maximum of 0.3 mg daily for patients with severe renal impairment (GFR<30 ml/min) if clinically indicated and well tolerated.

If Моксонидин Канонидин Канонidine is used in combination with a β-blocker, and both treatments have to be discontinued the β-blocker should be discontinued first, and, then Моксонидин Канонидин Канонidine after a few days.

So far, no rebound effect on blood pressure has been observed after the discontinuation of treatment with Моксонидин Канонидин Канонidine. However, it is advisable not to stop taking Моксонидин Канонидин Канонidine abruptly, but to reduce it gradually over a period of two weeks.

The elderly population may be more susceptible to the CV effects of blood pressure lowering drugs. Therefore therapy should be started with the lowest dose and dose increments should be introduced with caution to prevent the serious consequences these reactions may lead to.

Моксонидин Канонидин Канонidine contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

Most frequent side effects reported by those taking Моксонидин Канон include dry mouth, dizziness, asthenia and somnolence. These symptoms often decrease after the first few weeks of treatment. Undesirable Effects by System Organ Class (observed during placebo-controlled clinical trials with n=886 patients exposed to Моксонидин Канон resulted in frequencies below):

*there was no increase in frequency compared to placebo

*there was no increase in frequency compared to placebo

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

Most frequent side effects reported by those taking Моксонидин Канонидин Канонidine include dry mouth, dizziness, asthenia and somnolence. These symptoms often decrease after the first few weeks of treatment. Undesirable Effects by System Organ Class (observed during placebo-controlled clinical trials with n=886 patients exposed to Моксонидин Канонидин Канонidine resulted in frequencies below):

*there was no increase in frequency compared to placebo

*there was no increase in frequency compared to placebo

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

Symptoms of overdose

In the few cases of overdose that have been reported, a dose of 19.6 mg was ingested acutely without fatality. Signs and symptoms reported included: headache, sedation, somnolence, hypotension, dizziness, asthenia, bradycardia, dry mouth, vomiting, fatigue and upper abdominal pain. Based on the pharmacodynamic properties of Моксонидин Канон, the following reactions may be expected in adults: headache, sedation, somnolence, hypotension, orthostatic dysregulation, dizziness, asthenia, bradycardia, dry mouth, fatigue and upper abdominal pain. In rare cases, emesis and a transient paradoxical increase in blood pressure can occur. In case of a severe overdose close monitoring of especially consciousness disturbances and respiratory depression is recommended.

In addition, based on a few high dose studies in animals, transient hypertension, tachycardia and hyperglycaemia may also occur.

Treatment of overdose

In the case of a severe overdose, in particular the observation of disorders of consciousness and respiratory depression is advisable. Treatment consists of absorption-reducing measures such as gastric lavage (if shortly after ingestion), administration of activated charcoal and laxatives, and otherwise is symptomatic.

No specific antidote is known.

In case of hypotension, circulatory support such as fluids and dopamine administration may be considered. Bradycardia may be treated with atropine. Alpha-receptor antagonists may diminish or abolish the paradoxical hypertensive effects of a Моксонидин Канон overdose.

Paediatric population

The following case of inadvertent overdose in a 2-year old child has been described:

The child ingested an unknown quantity of Моксонидин Канон. The maximum dose that could have been taken was 14 mg. The child exhibited the following symptoms: Sedation, coma hypotension, miosis and dyspnoea. Gastric lavage, glucose infusions, mechanical ventilation and rest resulted in the symptoms completely disappearing over the course of 11 hours.

Symptoms of overdose

In the few cases of overdose that have been reported, a dose of 19.6 mg was ingested acutely without fatality. Signs and symptoms reported included: headache, sedation, somnolence, hypotension, dizziness, asthenia, bradycardia, dry mouth, vomiting, fatigue and upper abdominal pain. Based on the pharmacodynamic properties of Моксонидин Канонидин Канонidine, the following reactions may be expected in adults: headache, sedation, somnolence, hypotension, orthostatic dysregulation, dizziness, asthenia, bradycardia, dry mouth, fatigue and upper abdominal pain. In rare cases, emesis and a transient paradoxical increase in blood pressure can occur. In case of a severe overdose close monitoring of especially consciousness disturbances and respiratory depression is recommended.

In addition, based on a few high dose studies in animals, transient hypertension, tachycardia and hyperglycaemia may also occur.

Treatment of overdose

In the case of a severe overdose, in particular the observation of disorders of consciousness and respiratory depression is advisable. Treatment consists of absorption-reducing measures such as gastric lavage (if shortly after ingestion), administration of activated charcoal and laxatives, and otherwise is symptomatic.

No specific antidote is known.

In case of hypotension, circulatory support such as fluids and dopamine administration may be considered. Bradycardia may be treated with atropine. Alpha-receptor antagonists may diminish or abolish the paradoxical hypertensive effects of a Моксонидин Канонидин Канонidine overdose.

Paediatric population

The following case of inadvertent overdose in a 2-year old child has been described:

The child ingested an unknown quantity of Моксонидин Канонидин Канонidine. The maximum dose that could have been taken was 14 mg. The child exhibited the following symptoms: Sedation, coma hypotension, miosis and dyspnoea. Gastric lavage, glucose infusions, mechanical ventilation and rest resulted in the symptoms completely disappearing over the course of 11 hours.

Pharmacotherapeutic group: Antihypertensives, antiadrenergic agents, centrally acting

ATC code: C02AC05

In various animal models it has been shown that Моксонидин Канон has a strongly hypotensive effect. Available experimental data indicate that the site of action of Моксонидин Канон is located in the central nervous system (CNS).

In the brain stem, Моксонидин Канон binds selectively to I₁-imidazoline receptors. These imidazoline-sensitive receptors are predominantly found in the rostral ventrolateral medulla, an area which plays an important role in central control of the sympathetic nervous system. The effect of this interaction with these I₁-imidazoline receptors appears to be a reduction in the activity of the sympathetic nerves. This has been demonstrated for cardiac, splanchnic and renal sympathetic nerves.

Моксонидин Канон differs from other centrally acting antihypertensives in the fact that it has only a weak affinity for the central α₂-adrenergic receptors compared to the affinity for I₁-imidazoline receptors. Alpha₂-adrenergic receptors are considered to be the intermediate pathway that causes sedation and dry mouth, the most commonly observed undesirable effects of centrally acting antihypertensives.

Mean systolic and diastolic blood pressure is reduced both at rest and during exercise. The effects of Моксонидин Канон on mortality and cardiovascular morbidity are currently unknown.

In humans, Моксонидин Канон leads to a reduction of systemic vascular resistance and consequently in arterial blood pressure.

Pharmacotherapeutic group: Antihypertensives, antiadrenergic agents, centrally acting

ATC code: C02AC05

In various animal models it has been shown that Моксонидин Канонидин Канонidine has a strongly hypotensive effect. Available experimental data indicate that the site of action of Моксонидин Канонидин Канонidine is located in the central nervous system (CNS).

In the brain stem, Моксонидин Канонидин Канонidine binds selectively to I₁-imidazoline receptors. These imidazoline-sensitive receptors are predominantly found in the rostral ventrolateral medulla, an area which plays an important role in central control of the sympathetic nervous system. The effect of this interaction with these I₁-imidazoline receptors appears to be a reduction in the activity of the sympathetic nerves. This has been demonstrated for cardiac, splanchnic and renal sympathetic nerves.

Моксонидин Канонидин Канонidine differs from other centrally acting antihypertensives in the fact that it has only a weak affinity for the central α₂-adrenergic receptors compared to the affinity for I₁-imidazoline receptors. Alpha₂-adrenergic receptors are considered to be the intermediate pathway that causes sedation and dry mouth, the most commonly observed undesirable effects of centrally acting antihypertensives.

Mean systolic and diastolic blood pressure is reduced both at rest and during exercise. The effects of Моксонидин Канонидин Канонidine on mortality and cardiovascular morbidity are currently unknown.

In humans, Моксонидин Канонидин Канонidine leads to a reduction of systemic vascular resistance and consequently in arterial blood pressure.

Absorption

Моксонидин Канон is rapidly absorbed after oral administration. In humans, approximately 90% of an oral dose is absorbed. Ingestion of food has no effect on the pharmacokinetics of Моксонидин Канон. There is no first-pass metabolism and bioavailability is 88 %.

Distribution

Only about 7% of Моксонидин Канон is bound to human plasma proteins (Vd_ss = 1.8 ± 0.4 l/kg). Peak plasma levels of Моксонидин Канон are reached 30-180 minutes after administration of a film-coated tablet.

Biotransformation

Моксонидин Канон is 10-20% metabolised, predominantly to 4,5-dehydroМоксонидин Канон and to an aminomethanamidine derivative by opening of the imidazoline ring. The hypotensive effect of 4,5-dehydroМоксонидин Канон is only 1/10, and that of the aminomethanamidine derivative less than 1/100, of that of Моксонидин Канон.

Elimination

Моксонидин Канон and its metabolites are almost entirely eliminated via the kidney. More than 90% of the dose is eliminated in the first 24 hours via the kidney, while approximately 1% is eliminated in the faeces. The cumulative excretion of unchanged Моксонидин Канон is approximately 50-75%. The mean plasma elimination half-life is 2.2-2.3 hours and the renal half-life 2.6-2.8 hours.

Characteristics in patients with renal impairment

In patients with moderately impaired renal function (GFR 30 - 60 ml/min), the AUC increased by 85% and the clearance decreased by 52%. In such patients the hypotensive effect of Моксонидин Канон should be closely monitored, especially at the start of treatment. The dose must be adapted in these patients so that the maximum daily dose is not more than 0.4 mg and the maximum single dose is 0.2 mg.

In patients with severely impaired renal function (GFR < 30 ml/min) the clearance is reduced by 68 % and the elimination half live is prolonged up to 7 hours. In these patients Моксонидин Канон dosing should be initiated with 0.2 mg daily and can be increased to a maximum of 0.3 mg daily, if clinically indicated and well tolerated. In such patients the hypotensive effect of Моксонидин Канон should be closely monitored, especially at the start of treatment.

Paediatric population

No pharmacokinetic studies in children have been performed.

Absorption

Моксонидин Канонидин Канонidine is rapidly absorbed after oral administration. In humans, approximately 90% of an oral dose is absorbed. Ingestion of food has no effect on the pharmacokinetics of Моксонидин Канонидин Канонidine. There is no first-pass metabolism and bioavailability is 88 %.

Distribution

Only about 7% of Моксонидин Канонидин Канонidine is bound to human plasma proteins (Vd_ss = 1.8 ± 0.4 l/kg). Peak plasma levels of Моксонидин Канонидин Канонidine are reached 30-180 minutes after administration of a film-coated tablet.

Biotransformation

Моксонидин Канонидин Канонidine is 10-20% metabolised, predominantly to 4,5-dehydroМоксонидин Канонидин Канонidine and to an aminomethanamidine derivative by opening of the imidazoline ring. The hypotensive effect of 4,5-dehydroМоксонидин Канонидин Канонidine is only 1/10, and that of the aminomethanamidine derivative less than 1/100, of that of Моксонидин Канонидин Канонidine.

Elimination

Моксонидин Канонидин Канонidine and its metabolites are almost entirely eliminated via the kidney. More than 90% of the dose is eliminated in the first 24 hours via the kidney, while approximately 1% is eliminated in the faeces. The cumulative excretion of unchanged Моксонидин Канонидин Канонidine is approximately 50-75%. The mean plasma elimination half-life is 2.2-2.3 hours and the renal half-life 2.6-2.8 hours.

Characteristics in patients with renal impairment

In patients with moderately impaired renal function (GFR 30 - 60 ml/min), the AUC increased by 85% and the clearance decreased by 52%. In such patients the hypotensive effect of Моксонидин Канонидин Канонidine should be closely monitored, especially at the start of treatment. The dose must be adapted in these patients so that the maximum daily dose is not more than 0.4 mg and the maximum single dose is 0.2 mg.

In patients with severely impaired renal function (GFR < 30 ml/min) the clearance is reduced by 68 % and the elimination half live is prolonged up to 7 hours. In these patients Моксонидин Канонидин Канонidine dosing should be initiated with 0.2 mg daily and can be increased to a maximum of 0.3 mg daily, if clinically indicated and well tolerated. In such patients the hypotensive effect of Моксонидин Канонидин Канонidine should be closely monitored, especially at the start of treatment.

Paediatric population

No pharmacokinetic studies in children have been performed.