Tarka 240 mg. / 4 mg. 28 capsules

Tarka WHAT IS AND WHAT IS USED?
Tarka is a medicament comprising a combination of two active substances in different ways to lower blood pressure. Tarka use in essential hypertension in patients whose blood pressure has been normalized with the individual active substances at the same dosage.



WHAT YOU SHOULD KNOW BEFORE YOU TAKE Tarka?
You should not take Tarka:
- With hypersensitivity (allergy) to trandolapril or any other ACE inhibitor and / or verapamil or to any of the excipients
- If you have swelling of the skin: and subcutaneous tissue (angioneurotic edema), where previous treatment with an ACE inhibitor;
- Hereditary angioedema or one without a known cause;
- Cardiovascular shock;
- A recent heart attack with complications;
- Severe conduction disorders of the heart (AV-blokII. Sh or degree) and not wearing a pacemaker;
- If you have a breach in the conductivity of the left atrial (SA-block);
- If you have a breach in the origin of the cardiac impulse in the left atrium (syndrome sick sinus) and not wearing a pacemaker;
- Congestive heart failure;
- Atrial flutter / fibrillation in association with an accessory pathway (eg. WPW- syndrome); - severe renal impairment (creatinine clearance <10 ml / min);
- If you are on hemodialysis;
- Severe hepatic impairment (liver cirrhosis) the collection of fluid in the abdomen (ascites);
- Narrowing of certain heart valve (mitral or aortna-);
- Thickening of the muscle sadechniya with difficulty pushing blood (obstructive hypertrophic cardiomyopathy);
- Overproduction of the hormone aldosterone from the adrenal cortex (primary aldosteronism);
- Pregnancy; -laktatsiya;
- Use in children and adolescents (<18 years); Take special care with Tarka
- When stimulated renin-angiotensin-aldosterone system (eg. Water or salt deficiency due to the use of diuretics, low-sodium diet, dialysis, diarrhea or vomiting; left ventricular failure, renovascular hypertension);
- With renal impairment or congestive heart failure, as this can cause acute worsening of renal function with increasing levels of potassium in the blood;
- Increased elimination of normal discharges urine protein (proteinuria);
- Severely impaired liver function, because there is not enough experience;
- If you develop swelling of the face, tongue, nasopharynx or extremities (angioneurotic edema), should stop using the product and seek medical attention; with ACE inhibitors was observed higher incidence of angioneurotic edema in non-white patients than in Caucasian patients;
- A degree of renal impairment, in particular when it is associated with connective tissue disease, e. systemic lupus erythematosus, scleroderma, and in the treatment simunosupresivni products;
- During treatment with an ACE inhibitor may occur dry or nonproductive cough, which resolved after the withdrawal of the medicinal product;
- In surgery requiring general anesthesia, because ACE inhibitors may cause hypotension;
- In a minor breach of the conductivity of the heart;
- In slow heartbeat (less than 50 beats / min);
- Diseases where impaired neuromuscular conduction is (myasthenia gravis syndrome, Lambert-Eaton, advanced muscular dystrophy Duchenne);
- Hemodialysis patients;
- When LDL-apheresis is administered concomitantly with ACE-inhibitors due to the likelihood of life-threatening reactions;

Children and adolescents
Children and adolescents (<18 years) should not take Tarka.


Elderly
Tagka been studied only a limited number of elderly patients with hypertension. Available data indicate that plasma concentrations of Tagka are higher in elderly patients compared with younger patients. In some elderly patients the fall in blood pressure may be more pronounced, in comparison with the other. It is recommended that evaluation of renal function at the beginning of treatment.

Pregnancy and lactation
Tagka should not be taken during pregnancy and lactation.


Effects on ability to drive and use machines
Although no effect on ability to drive and use machines may not even be ruled deterioration of attention since Tarka may cause dizziness and fatigue. This is particularly true during concomitant use with alcohol.

special attention
Tarka contains lactose, which is why you should tell your doctor if you have an intolerance to zahar.Edna Tarka tablet contains 1.12 mmol (25.76 mg) of sodium. If wall-sodium diet, you should keep in mind.


Interactions with other medicinal products
Please tell your doctor or pharmacist if you are taking other medicines or have recently taken any, although they were not subject to prescription. With concomitant use with the following medicinal products Tarka may affect their action:
Potassium-sparing diuretics or potassium supplements: should be avoided due to concomitant administration may increase the potassium level in the blood, especially in patients with renal impairment.
Dantrolene: not recommended.
Medications to lower blood: potentiate the hypotensive action of Tagka. Diuretics, may experience excessive reduction in blood pressure, particularly in patients with salt and / or water deficit;
Lithium: amplification and weakening of lithium; may decrease the excretion of lithium.
Anesthetics, may increase the blood pressure lowering effect of some anesthetics. Narcotic drugs / antisihotitsi: possible hypotension upon standing (orthostatic hypertension).
Allopurinol (for gout), cytotoxic (cancer), immunosuppressants (to suppress the immune system), certain hormones (systemic corticosteroids), procainamide (medicines against cardiac arrhythmias) can lead to a decrease in white blood cells.
Medicines for heart (eg. Beta-blockers, antiarrhythmics, inhalation anesthetics) may occur additional adverse effects.
Quinidine (antiarrhythmic drugs) in a few cases in patients with thickening of the heart muscle (hypertrophic cardiomyopathy) during concomitant use of verapamil (a component of Tarka) was observed hypotension.
Digoxin: possible 50-75% increase in plasma digoxin concentrations requiring dose reduction of digoxin.
Mgyurelaksanti: the effect of muscle relaxants may be enhanced. Tranquilizers / antidepressants: when combining products containing imipramine increased risk of hypotension upon standing.
NSAIDs, may reduce the antihypertensive effect of Tarka, increase the potassium level in the blood and impair kidney function.
Antacids: decrease the bioavailability of trandolapril (one of the ingredients of Tarka). Sympathomimetics: may reduce the antihypertensive effect of Tarka.
Carbamazepine (for epilepsy), ciclosporin (to suppress the immune system) and theophylline (for asthma) may increase the levels of these medicines.
Rifampicin (for tuberculosis), phenytoin and phenobarbital (for epilepsy) reduce the effect of Tarka.
Cimetidine (a medicine for lowering the acidity of the stomach): increases the effect of Tarka.
Antidiabetic: enhanced low blood sugar.


Concomitant use of Tarka with food and drink
During the use of Tarka should not drink alcohol because of increased hypotensive effect of Tarka.
Tarka should not be taken with grapefruit juice, because verapamil (one of the active ingredients of Tarka) can increase its effect under the influence of geypfrut.
Food intake leads to delayed absorption of verapamil (one of the active ingredients of Tarka), so Tarka should be taken half an hour before breakfast.


3. HOW TO TAKE Tarka?
Always take Tarka according to the doctor's instructions. Please ask your doctor or pharmacist if you are unsure.
Tarka tablets modified release should be swallowed whole with sufficient liquid (preferably with a glass of water).
Unless otherwise prescribed the usual dose is:
1 tablet Tarka modified-release, once daily in the morning, 1/2 hour before breakfast. Tarka tablets should be swallowed tseli.Molya tell your doctor or pharmacist if you think the effect of Tarka is too strong or too weak.


If you take a large amount of Tarka:
The highest tested in clinical trials for trandolapril dose is 16 mg. This dose does not cause symptoms of intolerance. Generally, overdose should lead to a lowering of blood pressure.
Signs of an overdose of verapamil depend on its effect on the cardiovascular system. These are lowering of blood pressure, heart failure and cardiac arrhythmias. A suspected overdose, seek medical attention!

If you forget to take Tarka:
Do not take a double dose if you forgot the previous one.

Interrupting the use of Tarka:
With the exception of emergencies such as angioneurotic edema, Tarka should not be interrupted arbitrarily. Please talk before this with your doctor.


4. WHAT SIDE EFFECTS ARE POSSIBLE?
As with all medicines, Tarka can cause side effects.
In assessing the adverse effects the following definitions:
Very common: more than 1 in every 10 treated
Common: less than 1 in 10 and more than 1 100 people
Not often: less than 1 in 100 and more than 1 in 1,000
Rarely: less than 1 in 1000 and more than 1 in 10 000 treated
Very rarely: less than 1 in 10,000, including isolated cases

The following side effects have been observed during treatment with Tarka:
Common: Headache, constipation, flushing, cough, dizziness, vertigo;
Uncommon: allergic reactions, increased blood lipids, drowsiness, tremor, extending the transmission time of the cardiac impulse (AV-block I. rate), palpitations, stomach pain, diarrhea, gastrointestinal complaints, nausea, swelling of the face, itching, hives, sweating, frequent urination, pain in the chest, changes in liver function tests;
Rare: anorexia, seizures, hair loss, igniter is caused by herpes viruses manifestation of skin disease, rise in bilirubin in the blood;
Very rare: decreased number of white blood cells, decreased number of all blood cells, decreased number of blood platelets, aggressive behavior, anxiety, depression, nevrnost, body weight disorders, insomnia, hypersensitivity, tingling, numbness, cold extremities, loss of consciousness or acute circulatory shock with loss of consciousness, change in taste, weakness, abnormal / blurred vision, angina, atrial fibrillation, severe conduction disorders (AV-block II. and III. degree), slow pulse, cardiac arrest, brain bleeding, swelling around the ankles, flushing, heart failure, sudden decrease in blood pressure when standing up, increased heart rate, asthma, bronchitis, shortness of breath, nasal sinuses, dry mouth, inflammation of the pancreas, vomiting, obstruction of the bile tract, inflammation of the liver, increase of some enzymes (lipase, gamma-GT, LDH), jaundice, angioneurotic edema, severe skin disease with serious general reactions (erythema multiforme), skin inflammation, psoriasis, urticaria, joint pain, muscle weakness, muscle ache, acute renal failure, breast enlargement in men, impotence, increased potassium levels in the blood increase of certain enzymes in the blood (transaminases, alkaline phosphatase);

5. HOW TO STORE Tarka?
Keep in places out of sight and reach of children.
Do not use after expiration of the markings on the package shelf life.
Store in the original container.
Store at temperatures below 25 ° C.