Cardival Plus

Cardival Plus is indicated for the treatment of hypertension.

Hypertension
: A patient whose blood pressure is not controlled with Valsartan and Hydrochlorothiazide monotherapy, should switch to Valsartan and Hydrochlorothiazide combination once daily. Highest allowed dose of Valsartan should not be greater than 320 mg in combination with hydrochlorothiazide 25 mg.
For Elderly
: No initial dosage adjustment is necessary for elderly patients.
Pediatric use
: Safety and effectiveness in pediatric patients have not been established.

The combination of Valsartan and Hydrochlorothiazide is generally well tolerated and side effects are rare. The most common side effects include headache, dizziness, fatigue, abdominal pain, cough, diarrhea and nausea. Patient may also experience hyperkalemia, impotency, reduced renal function, allergic reactions, dyspnea, constipation, back pain, muscle cramps, rash, anxiety, insomnia and vertigo. Hypotension may also occur.

Impaired Hepatic Function
: As the majority of Valsartan is eliminated in the bile, care should be exercised in patients with mild to moderate hepatic impairment including biliary obstructive disorder.
Impaired Renal Function
: Dosage reduction or discontinuation may be required with patients having pre-existing renal impairment because thiazides may precipitate azotemia.
Heart Failure and Myocardial Infarction
: Caution should be observed when initiating therapy in patients with heart failure and post-myocardial infarction patients.

Valsartan
is an oral medication that belongs to a class of drugs called angiotensin receptor blockers (ARBs). It is orally active and specific angiotensin II antagonist acting on the AT1 subtype. Angiotensin's attachment to the receptors cause the blood vessels to narrow (vasoconstrict) which leads to an increase in blood pressure (hypertension). Valsartan blocks the angiotensin II receptor. By blocking the action of angiotensin, Valsartan dilates blood vessels and reduces blood pressure without affecting pulse rate. Valsartan has much greater affinity (about 20,000-fold) for the AT1 receptor than for the AT2 receptor. It does not bind or block other hormone receptors or ion channels known to be important in cardiovascular regulation.
Hydrochlorothiazide
is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly increasing excretion of sodium and chloride in approximately equivalent amounts. Indirectly, the diuretic action of Hydrochlorothiazide reduces plasma volume, with consequent increases in plasma renin activity, increases in aldosterone secretion, increases in urinary potassium loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so co-administration of anangiotensin converting enzyme (ACE) inhibitor tends to reverse the potassium loss associated with these diuretics.