{"id":51975,"date":"2023-09-20T09:27:33","date_gmt":"2023-09-20T09:27:33","guid":{"rendered":"https:\/\/medsname.com\/olmesar-a\/"},"modified":"2026-05-01T10:49:12","modified_gmt":"2026-05-01T10:49:12","slug":"olmesar-a","status":"publish","type":"product","link":"https:\/\/medsbase.com\/ro\/product\/olmesar-a\/","title":{"rendered":"Olmesar A"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:18px 22px;margin:0 0 24px 0;border-radius:4px;\">\n<h3 class=\"wp-block-heading\" style=\"margin:0 0 8px 0;font-size:16px;font-weight:700;\">\u26a1 R\u0103spuns rapid \u2014 Ce este Olmesar A?<\/h3>\n<p style=\"margin:0;\"><strong>Olmesar A<\/strong> este un <strong>20\/5 mg comprimat cu doz\u0103 fix\u0103<\/strong> de <strong>olmesartan 20 mg<\/strong> (un blocant al receptorilor de angiotensin\u0103-II) \u0219i <strong>amlodipin\u0103 5 mg<\/strong> (un blocant al canalelor de calciu dihidropiridinic) de la Cipla. ARB + CCB este una dintre cele <strong>trei combina\u021bii de dou\u0103 medicamente bazate pe dovezi<\/strong> pentru hipertensiune (al\u0103turi de ARB+tiazidic\u0103 \u0219i CCB+tiazidic\u0103) \u0219i a fost bra\u021bul c\u00e2\u0219tig\u0103tor al <strong>studiu ACCOMPLISH (2008)<\/strong>, care a demonstrat o reducere de 20% a evenimentelor cardiovasculare \u00een compara\u021bie cu benazepril+HCTZ la pacien\u021bii hipertensivi cu risc ridicat. Cele dou\u0103 componente ac\u021bioneaz\u0103 prin <strong>mecanisme complementare<\/strong>: olmesartan blocheaz\u0103 receptorul AT<sub>1<\/sub> (vasoconstric\u021bie, aldosteron, stimulare simpatic\u0103); amlodipina blocheaz\u0103 canalele de calciu de tip L \u00een mu\u0219chiul neted vascular (dilatare arteriolar\u0103). \u00cen mod unic printre combina\u021biile existente, <strong>ad\u0103ugarea olmesartanului la amlodipin\u0103 reduce rata de edem la nivelul gleznelor cauzat de amlodipin\u0103 cu aproximativ 50%<\/strong> \u2014 efectul venos al ARB-ului reechilibreaz\u0103 dilatarea arteriolar\u0103 a amlodipinei, \u00eembun\u0103t\u0103\u021bind presiunea hidrostatic\u0103 capilar\u0103. Dozaj tipic: o tablet\u0103 o dat\u0103 pe zi. <strong>Contraindica\u021bie absolut\u0103 \u00een sarcin\u0103<\/strong> (olmesartan), hipotensiune simptomatic\u0103 sever\u0103, stenoz\u0103 aortic\u0103 sever\u0103 \u0219i cardiomiopatie obstructiv\u0103. Monitoriza\u021bi potasiul, creatinina \u0219i umflarea gleznelor.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f8fb;border:1px solid #d8e3eb;padding:12px 16px;margin:16px 0;border-radius:4px;font-size:14px;\">\n<strong>Ce beneficii ofer\u0103 MedsBase:<\/strong> Produc\u0103tor certificat WHO-GMP \u00b7 Ambalaj discret \u00b7 Livrare la nivel mondial \u00b7 Peste 1.400 de recenzii verificate <a href=\"https:\/\/medsbase.com\/ro\/reviews\/\">ale clien\u021bilor<\/a>\n<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 Fiecare comand\u0103 este acoperit\u0103 de politica noastr\u0103 de <a href=\"https:\/\/medsbase.com\/ro\/medsbase-re-shipment-assurance-policy\/\"><strong>Politica noastr\u0103 de Reexpediere Garantat\u0103<\/strong><\/a> \u2014 dac\u0103 coletul dumneavoastr\u0103 nu sose\u0219te \u00een 20 de zile lucr\u0103toare, \u00eel relivr\u0103m.<\/p>\n<h3>De ce s\u0103 comanzi de la MedsBase<\/h3>\n<p>Medicamentele noastre generice sunt procurate de la produc\u0103tori certifica\u021bi WHO-GMP \u0219i expediate la nivel mondial \u00een ambalaje discrete \u0219i simple \u2014 f\u0103r\u0103 denumirea medicamentului pe exteriorul coletului. Pl\u0103\u021bile cu cardul sunt procesate printr-un procesor reglementat (descrierile de pe extrasul de cont includ un procesor de pl\u0103\u021bi cu card reglementat \u2014 niciodat\u0103 \u201cMedsBase\u201d sau numele vreunui medicament). Accept\u0103m \u0219i criptomonede \u0219i transferuri bancare SEPA. Fiecare comand\u0103 este sus\u021binut\u0103 de Politica noastr\u0103 de Asigurare pentru Relivrare.<\/p>\n<h2 class=\"wp-block-heading\">Ce este Olmesar A?<\/h2>\n<p>Olmesar A este un comprimat cu doz\u0103 fix\u0103 combinat\u0103 pentru administrare oral\u0103 care con\u021bine <strong>olmesartan 20 mg<\/strong> (olmesartan medoxomil) \u0219i <strong>amlodipin\u0103 5 mg<\/strong> (amlodipin besilat) \u00eentr-o singur\u0103 tablet\u0103. Produs de Cipla, disponibil \u00een cutii de 30-180 comprimate.<\/p>\n<p>Olmesartanul este un blocant al receptorilor de angiotensin-II (ARB) introdus de Daiichi-Sankyo \u00een 2002 sub denumirile Benicar\/Olmetec; timp de \u00eenjum\u0103t\u0103\u021bire de 13 ore; printre cele mai potente ARB-uri pe miligram. Amlodipina este un blocant al canalelor de calciu dihidropiridinic cu ac\u021biune prelungit\u0103, introdus\u0103 de Pfizer \u00een 1990 sub denumirea Norvasc; timp de \u00eenjum\u0103t\u0103\u021bire de 30-50 ore, oferind o acoperire excep\u021bional de uniform\u0103 a tensiunii arteriale pe 24 de ore.<\/p>\n<h2 class=\"wp-block-heading\">De ce s\u0103 combina\u021bi un ARB cu un blocant al canalelor de calciu?<\/h2>\n<p>ARB + blocant al canalelor de calciu dihidropiridinic este o combina\u021bie de dou\u0103 medicamente recomandat\u0103 de ghiduri pentru hipertensiune. Ra\u021biunea:<\/p>\n<ul>\n<li><strong>Mecanisme complementare.<\/strong> Olmesartanul blocheaz\u0103 mecanismul de vasoconstric\u021bie \u0219i secre\u021bie de aldosteron determinat de angiotensin-II; amlodipina blocheaz\u0103 mecanismul de contrac\u021bie a mu\u0219chiului neted vascular determinat de calciu. \u00cempreun\u0103 produc o reducere aditiv\u0103 a tensiunii arteriale sistolice cu 10-15 mmHg peste cea ob\u021binut\u0103 cu monoterapia fiec\u0103ruia.<\/li>\n<li><strong>Neutralitate metabolic\u0103.<\/strong> Spre deosebire de combina\u021biile bazate pe tiazide, ARB+CCB <strong>nu agraveaz\u0103 toleran\u021ba la glucoz\u0103, profilul lipidic sau nivelul de urat seric. Acest lucru face combina\u021bia deosebit de potrivit\u0103 pentru pacien\u021bii cu sindrom metabolic, diabet sau gut\u0103.<\/strong>. Contrareglarea edemului de glezn\u0103 indus de amlodipin\u0103.<\/li>\n<li><strong>Amlodipina dilateaz\u0103 preferen\u021bial arteriolele precapilare, cresc\u00e2nd presiunea hidrostatic\u0103 capilar\u0103 \u0219i determin\u00e2nd transferul de lichid \u00een spa\u021biile tisulare \u2014 manifestare clinic\u0103 sub form\u0103 de edem de glezn\u0103 la 10-20% dintre pacien\u021bi. ARB-urile contrabalanseaz\u0103 acest efect prin dilatarea patului venos postcapilar, reduc\u00e2nd presiunea hidrostatic\u0103 capilar\u0103.<\/strong> Ad\u0103ugarea unui ARB la amlodipin\u0103 reduce aproximativ la jum\u0103tate rata de edem de glezn\u0103. <strong>Acesta este cel mai puternic argument clinic pentru utilizarea ARB+CCB \u00een locul fiec\u0103rui agent luat separat.<\/strong> Vasodilata\u021bia indus\u0103 de amlodipin\u0103 activeaz\u0103 reflex sistemul renin\u0103-angiotensin\u0103; ARB-ul blocheaz\u0103 acest r\u0103spuns compensatoriu, debloc\u00e2nd efectul complet antihipertensiv al amlodipinei f\u0103r\u0103 tahicardia simpatic\u0103 observat\u0103 la unele CCB-uri cu ac\u021biune scurt\u0103.<\/li>\n<li><strong>Contrareglarea RAAS.<\/strong> Baza de dovezi:.<\/li>\n<\/ul>\n<p><strong>Evidence base:<\/strong><\/p>\n<ul>\n<li><strong>studiu ACCOMPLISH (2008)<\/strong> \u2014 benazepril+amlodipine a redus evenimentele cardiovasculare cu 20% fa\u021b\u0103 de benazepril+HCTZ la pacien\u021bii hipertensivi cu risc ridicat. Extrapolat pe scar\u0103 larg\u0103 la combina\u021biile ARB+amlodipine.<\/li>\n<li><strong>ASCOT-BPLA (2005)<\/strong> \u2014 regimul bazat pe amlodipin\u0103 (adesea cu perindopril ad\u0103ugat) a dep\u0103\u0219it regimul bazat pe atenolol \u00een ceea ce prive\u0219te rezultatele cardiovasculare \u0219i accidentele vasculare cerebrale.<\/li>\n<li><strong>Studiul COACH (2010)<\/strong> \u2014 combina\u021biile fixe de olmesartan\/amlodipin\u0103 au atins \u021bintele de tensiune arterial\u0103 la 60-70% din pacien\u021bi fa\u021b\u0103 de 35-50% pe monoterapie.<\/li>\n<li><strong>Meta-analize<\/strong> arat\u0103 \u00een mod constant c\u0103 combina\u021bia ARB+CCB produce mai pu\u021bine evenimente cardiovasculare pe mmHg de reducere a tensiunii arteriale dec\u00e2t ARB+tiazid\u0103.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Doza \u0219i titrare<\/h2>\n<p><strong>Doza standard:<\/strong> un comprimat de 20\/5 mg o dat\u0103 pe zi. Momentul zilei nu conteaz\u0103 din punct de vedere clinic; lua\u021bi la aceea\u0219i or\u0103 \u00een fiecare zi.<\/p>\n<p><strong>C\u00e2nd s\u0103 \u00eencepe\u021bi Olmesar A:<\/strong><\/p>\n<ul>\n<li>TA necontrolat\u0103 la <a href=\"https:\/\/medsbase.com\/ro\/olmesar\/\">olmesartan<\/a> sau <a href=\"https:\/\/medsbase.com\/ro\/amlode\/\">amlodipine<\/a> monoterapie la doza \u021bint\u0103 timp de 4-6 s\u0103pt\u0103m\u00e2ni<\/li>\n<li>Hipertensiunea \u00een stadiul 2 (\u2265160\/100) ca combina\u021bie ini\u021bial\u0103 de dou\u0103 medicamente conform preferin\u021belor AHA\/ACC<\/li>\n<li>Trecerea la urm\u0103torul nivel c\u00e2nd monoterapia cu amlodipin\u0103 a provocat edem de glezn\u0103 intolerabil \u2014 ad\u0103ugarea ARB reduce adesea edemul la jum\u0103tate, \u00eembun\u0103t\u0103\u021bind \u00een acela\u0219i timp TA<\/li>\n<li>Pacien\u021bii cu sindrom metabolic, diabet sau gut\u0103 unde ARB+CCB este preferat metabolic fa\u021b\u0103 de ARB+tiazid\u0103<\/li>\n<\/ul>\n<p><strong>Titrarea:<\/strong> majoritatea produc\u0103torilor ofer\u0103 doze de 20\/5, 40\/5, 20\/10 \u0219i 40\/10 mg. \u00cencepe\u021bi cu 20\/5; cre\u0219te\u021bi la 40\/5 dac\u0103 TA r\u0103spunde bine dar \u021binta nu este atins\u0103; cre\u0219te\u021bi la 40\/10 pentru efectul maxim \u00eentr-un singur comprimat. Dincolo de 40\/10, ad\u0103uga\u021bi o a treia clas\u0103 \u2014 de obicei un tiazidic (Olmesar A + HCTZ = triplu ARB+CCB+tiazid\u0103).<\/p>\n<p><strong>Program de monitorizare:<\/strong><\/p>\n<ul>\n<li><strong>Valori ini\u021biale:<\/strong> uree, electroli\u021bi, creatinin\u0103, eGFR. M\u0103surarea TA acas\u0103 la baz\u0103.<\/li>\n<li><strong>1-2 s\u0103pt\u0103m\u00e2ni:<\/strong> repet\u0103 U&amp;E. A\u0219teapt\u0103-te la o cre\u0219tere mic\u0103 a creatininiei (p\u00e2n\u0103 la 30% este acceptabil). Cre\u0219terea potasiului este de obicei minim\u0103.<\/li>\n<li><strong>4-6 s\u0103pt\u0103m\u00e2ni:<\/strong> control TA; verific\u0103 prezen\u021ba edemului la glezne \u0219i hiperplaziei gingivale.<\/li>\n<li><strong>Continuu:<\/strong> U&amp;E anual. M\u0103surarea TA acas\u0103 de dou\u0103 ori pe s\u0103pt\u0103m\u00e2n\u0103.<\/li>\n<li><strong>Opri\u021bi \u0219i investiga\u021bi:<\/strong> cre\u0219tere a creatininiei &gt;30%, potasiu &gt;5,5, hipotensiune simptomatic\u0103, edem sever la glezne care nu r\u0103spunde la reducerea dozei, diaree cronic\u0103 neexplicat\u0103 sau pierdere \u00een greutate (avertizare specific\u0103 olmesartan pentru enteropatie asem\u0103n\u0103toare sprue).<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Efecte Secundare<\/h2>\n<p><strong>Frecvente (&gt;1%):<\/strong><\/p>\n<ul>\n<li><strong>Edem la glezne<\/strong> \u2014 legat de amlodipin\u0103; de obicei mai u\u0219or la Olmesar A dec\u00e2t la monoterapia cu amlodipin\u0103 (aproape \u00eenjum\u0103t\u0103\u021bit de componenta ARB)<\/li>\n<li>Ame\u021beli u\u0219oare, ro\u0219ea\u021b\u0103, cefalee (de obicei \u00een primele 1-2 s\u0103pt\u0103m\u00e2ni; se amelioriaz\u0103 pe m\u0103sur\u0103 ce se dezvolt\u0103 toleran\u021ba la vasodilatator)<\/li>\n<li>Palpita\u021bii (legate de amlodipin\u0103; tahicardia reflex\u0103 este u\u0219oar\u0103 cu amlodipina cu ac\u021biune prelungit\u0103)<\/li>\n<li>Cre\u0219tere mic\u0103 a creatinei (p\u00e2n\u0103 la 30%)<\/li>\n<li>Hiperkaliemie u\u0219oar\u0103<\/li>\n<li>Oboseal\u0103, grea\u021b\u0103, simptome respiratorii superioare<\/li>\n<\/ul>\n<p><strong>Pu\u021bin frecvente, dar clinic importante:<\/strong><\/p>\n<ul>\n<li><strong>Hiperplazie gingival\u0103<\/strong> \u2014 legat de amlodipin\u0103; 1-3% din utilizatorii pe termen lung. Aten\u021bie la igiena oral\u0103 reduce riscul. Schimb\u0103 pe un regim non-DHP sau doar ARB dac\u0103 este sever.<\/li>\n<li><strong>Angioedem<\/strong> \u2014 rat\u0103 mai mic\u0103 dec\u00e2t la inhibitorii ACE dar posibil. \u00centrerupe imediat.<\/li>\n<li><strong>Hiperkaliemie sever\u0103<\/strong> \u2014 \u00een special cu suplimente de potasiu, diuretice economisitoare de K+, AINS sau BCR<\/li>\n<li><strong>Leziune renal\u0103 acut\u0103 \u00een stenoz\u0103 bilateral\u0103 a arterei renale<\/strong> \u2014 acela\u0219i mecanism ca la monoterapia cu ARB<\/li>\n<li><strong>Enteropatie asem\u0103n\u0103toare sprue specific\u0103 olmesartan<\/strong> (Avertizare FDA 2013) \u2014 diaree cronic\u0103, pierdere \u00een greutate, atrofie viloz\u0103 care imit\u0103 boala celiac\u0103. Rare dar recunoscute; se rezolv\u0103 dup\u0103 \u00eentreruperea olmesartanului.<\/li>\n<li><strong>\u00cenr\u0103ut\u0103\u021birea sau declan\u0219area insuficien\u021bei cardiace \u00een FE sever redus\u0103<\/strong> \u2014 amlodipina este neutr\u0103 \u00een IC-FE redus\u0103 (studiu PRAISE) dar nu protejeaz\u0103; exist\u0103 op\u021biuni mai bune pentru IC-FE redus\u0103.<\/li>\n<li><strong>Hipotensiune la prima doz\u0103<\/strong> la pacien\u021bii cu volum sanguin redus sau cei care iau diuretice \u00een doze mari<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Contraindica\u021bii<\/h2>\n<ul>\n<li><strong>Sarcina \u2014 CONTRAINDICA\u021aIE ABSOLUT\u0102 \u00een toate trimestrele.<\/strong> Olmesartanul este teratogen (agenereza renal\u0103 fetal\u0103, oligohidramnios, hipoplazie pulmonar\u0103). Schimba\u021bi la <a href=\"https:\/\/medsbase.com\/ro\/labebet\/\">labetalol<\/a>, methyldopa, sau nifedipine \u00eenainte de concep\u021bie.<\/li>\n<li><strong>Hipotenziune simptomatic\u0103 sever\u0103<\/strong> (TA sistolic &lt;90)<\/li>\n<li><strong>Stenoz\u0103 aortic\u0103 sever\u0103<\/strong> \u2014 vasodilata\u021bia indus\u0103 de amlodipin\u0103 poate declan\u0219a sincop\u0103 \u00een obstruc\u021bie fix\u0103 de ie\u0219ire<\/li>\n<li><strong>Cardiomiopatie hipertrofic\u0103 obstructiv\u0103<\/strong> \u2014 preocupare similar\u0103 legat\u0103 de obstruc\u021bia dinamic\u0103<\/li>\n<li><strong>\u0218oc cardiogen sau infarct miocardic acut \u00een ultima s\u0103pt\u0103m\u00e2n\u0103<\/strong><\/li>\n<li><strong>Stenoz\u0103 bilateral\u0103 a arterei renale<\/strong><\/li>\n<li><strong>Istoric de angioedem la ARB sau inhibitor ACE<\/strong> (\u00een ultimele 4 s\u0103pt\u0103m\u00e2ni)<\/li>\n<li><strong>Hiperkaliemie &gt;5,5 mmol\/L la evaluarea ini\u021bial\u0103<\/strong><\/li>\n<li><strong>Afectare hepatic\u0103 sever\u0103 (Child-Pugh C)<\/strong><\/li>\n<li><strong>Concomitent sacubitril\/valsartan (Entresto)<\/strong>, <strong>aliskiren \u00een diabet sau BCR<\/strong>, <strong>Inhibitori ACE<\/strong> (risc crescut \u00een studiul ONTARGET)<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Interac\u021biuni medicamentoase<\/h2>\n<ul>\n<li><strong>Simvastatin\u0103<\/strong> \u2014 amlodipina cre\u0219te expunerea la simvastatin\u0103 \u0219i riscul de rabdomioliz\u0103. <strong>Doza de simvastatin\u0103 nu trebuie s\u0103 dep\u0103\u0219easc\u0103 20 mg pe zi<\/strong> c\u00e2nd este administrat\u0103 concomitent cu amlodipin\u0103. Utiliza\u021bi alt statin (rosuvastatin\u0103, atorvastatin\u0103 p\u00e2n\u0103 la 40 mg) dac\u0103 sunt necesare doze mai mari de statin\u0103.<\/li>\n<li><strong>Inhibitori puternici ai CYP3A4<\/strong> (claritromicina, itraconazol, ketoconazol, ritonavir, cobicistat, diltiazem, verapamil) \u2014 cresc nivelurile de amlodipin\u0103. Evita\u021bi administrarea cronic\u0103 acolo unde este posibil; monitoriza\u021bi tensiunea arterial\u0103 \u00eendeaproape \u0219i reduce\u021bi doza de amlodipin\u0103 dac\u0103 hipotensiunea sau edemele se agraveaz\u0103.<\/li>\n<li><strong>Inductori puternici ai CYP3A4<\/strong> (rifampicin\u0103, carbamazepin\u0103, fenitoin\u0103, Hypericum perforatum) \u2014 scad nivelurile de amlodipin\u0103 \u0219i efectul antihipertensiv.<\/li>\n<li><strong>Suc de grapefruit<\/strong> \u2014 cre\u0219tere u\u0219oar\u0103 a nivelului de amlodipin\u0103; consumul obi\u0219nuit \u00een cantit\u0103\u021bi mari (&gt;1 L\/zi) poate amplifica efectul antihipertensiv; consumul ocazional este acceptabil.<\/li>\n<li><strong>AINS<\/strong> \u2014 reduc efectul antihipertensiv al ambelor componente; cresc riscul de insuficien\u021b\u0103 renal\u0103 acut\u0103 cu ARB.<\/li>\n<li><strong>Suplimente de potasiu, diuretice economisitoare de potasiu (spironolacton\u0103, eplerenon\u0103, amilorid\u0103)<\/strong> \u2014 hiperkaliemie aditiv\u0103; monitorizare atent\u0103.<\/li>\n<li><strong>Litiu<\/strong> \u2014 ARB-urile reduc clearance-ul litiului; monitoriza\u021bi nivelurile dac\u0103 asocierea este inevitabil\u0103.<\/li>\n<li><strong>Tacrolimus, ciclosporin\u0103<\/strong> \u2014 amlodipina cre\u0219te nivelurile acestora; monitoriza\u021bi nivelurile minime.<\/li>\n<li><strong>Al\u021bi inhibitori ACE, al\u021bi BRA, aliskiren<\/strong> \u2014 nu combina\u021bi.<\/li>\n<li><strong>Sildenafil, tadalafil, blocante alfa<\/strong> \u2014 hipotensiune aditiv\u0103. Separarea dozelor; \u00eencepe\u021bi cu o doz\u0103 mai mic\u0103 de inhibitor PDE5 (sildenafil 25 mg; tadalafil 5 mg).<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Olmesar A vs combina\u021bii ARB+Tiazidic\u0103<\/h2>\n<p>At\u00e2t combina\u021bia ARB+CCB c\u00e2t \u0219i ARB+tiazidic\u0103 sunt recomandate de ghiduri ca combina\u021bii de linia a doua. Diferen\u021be cheie:<\/p>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Factor<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">ARB + CCB (Olmesar A)<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">ARB + HCTZ (de ex. Telma H)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Dovezi de rezultate cardiovasculare<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Mai puternice (ACCOMPLISH)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Moderate<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Profil metabolic<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Neutru<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">\u00cenr\u0103ut\u0103\u021be\u0219te nivelul glucozei, acidului uric \u0219i al lipidelor<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Potrivit \u00een diabet, gut\u0103, sindrom metabolic<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Da (preferat)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Da, dar \u00eenr\u0103ut\u0103\u021be\u0219te nivelul glucozei\/acidului uric<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Edem la glezne<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Posibil (mai pu\u021bin dec\u00e2t amlodipina singur\u0103)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Nu<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Tulburare electrolitic\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Minim\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Hipokaliemie, hiponatremie posibile<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">BPC (TFG 30-60)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Eficient<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">HCTZ pierde eficien\u021ba la valori sc\u0103zute ale GFR<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Preferat \u00een cazul<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Diabet, gut\u0103, boal\u0103 renal\u0103 cronic\u0103, sindrom metabolic, pacien\u021bi de culoare<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">St\u0103ri cu volum expandat, HTN rezistent<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Concluzie: pentru majoritatea pacien\u021bilor mai tineri cu hipertensiune necomplicat\u0103 care necesit\u0103 o combina\u021bie de dou\u0103 medicamente, ARB+CCB (Olmesar A) are un u\u0219or avantaj \u00een ceea ce prive\u0219te dovezile de rezultate cardiovasculare \u0219i profilul metabolic. ARB+HCTZ r\u0103m\u00e2ne prima alegere \u00een st\u0103rile cu volum expandat (hipertensiune sensibil\u0103 la sare, obezitate, pacien\u021bi de culoare \u2014 de\u0219i amlodipina este de asemenea foarte eficient\u0103 la pacien\u021bii de culoare) \u0219i \u00een hipertensiunea rezistent\u0103 care necesit\u0103 terapie tripl\u0103.<\/p>\n<h2 class=\"wp-block-heading\">Depozitare<\/h2>\n<p>P\u0103stra\u021bi Olmesar A la temperaturi sub 25\u00b0C \u00een ambalajul original blister. \u021aine\u021bi departe de copii.<\/p>\n<h2 id=\"faqs\">\u00centreb\u0103ri frecvente<\/h2>\n<h3 class=\"wp-block-heading\">De ce s\u0103 combina\u021bi olmesartan cu amlodipin\u0103 \u00eentr-o singur\u0103 pastil\u0103?<\/h3>\n<p>Dou\u0103 motive. \u00cen primul r\u00e2nd, <strong>reducerea aditiv\u0103 a tensiunii arteriale<\/strong>: cele dou\u0103 medicamente ac\u021bioneaz\u0103 pe c\u0103i complementare (receptorul de angiotensin\u0103 \u0219i canalul de calciu de tip L), produc\u00e2nd o sc\u0103dere a tensiunii arteriale sistolice cu 10-15 mmHg mai mult dec\u00e2t fiecare agent separat. \u00cen al doilea r\u00e2nd, \u0219i mai pu\u021bin evident, <strong>ad\u0103ugarea ARB la amlodipin\u0103 reduce aproximativ la jum\u0103tate rata de edem la nivelul gleznelor<\/strong> \u2014 dilatarea venoas\u0103 indus\u0103 de ARB reechilibreaz\u0103 dilatarea arteriolar\u0103 a amlodipinei, \u00eembun\u0103t\u0103\u021bind presiunea hidrostatic\u0103 capilar\u0103. Dovada din studiul ACCOMPLISH arat\u0103 evenimente cardiovasculare mai reduse la pacien\u021bii cu ARB+amlodipin\u0103 dec\u00e2t la cei cu ARB+HCTZ \u00een cazul pacien\u021bilor cu risc ridicat.<\/p>\n<h3 class=\"wp-block-heading\">Va provoca Olmesar A umflarea gleznelor?<\/h3>\n<p>Posibil \u2014 dar <strong>mai rar dec\u00e2t terapia cu amlodipin\u0103 \u00een monoterapie<\/strong>. Amlodipine singur\u0103 provoac\u0103 edem de glezn\u0103 la 10-20% dintre pacien\u021bi. Ad\u0103ugarea olmesartanului reduce aceast\u0103 rat\u0103 la aproximativ 5-10%. Edemul este de obicei u\u0219or, neprogresiv \u0219i <strong>nu r\u0103spunde la diuretice<\/strong> (este de tip capilar-hidrostatic, nu de suprasarcin\u0103 volumetric\u0103). Dac\u0103 edemul este deranjant, op\u021biunile sunt: reducerea dozei de amlodipin\u0103 la 5 mg (comprimat 20\/5), trecerea la un BCC non-DHP (diltiazem) sau trecerea la o combina\u021bie ARB+tiazidic\u0103.<\/p>\n<h3 class=\"wp-block-heading\">C\u00e2nd ar trebui s\u0103 iau Olmesar A?<\/h3>\n<p>O dat\u0103 pe zi, la aceea\u0219i or\u0103 \u00een fiecare zi. <strong>Ora zilei nu are relevan\u021b\u0103 clinic\u0103<\/strong> pentru Olmesar A \u2014 at\u00e2t olmesartanul (timp de \u00eenjum\u0103t\u0103\u021bire de 13 ore) c\u00e2t \u0219i amlodipina (timp de \u00eenjum\u0103t\u0103\u021bire de 30-50 de ore) asigur\u0103 acoperire antihipertensiv\u0103 de 24 de ore. Administrarea diminea\u021ba este cea mai convenabil\u0103 pentru majoritatea pacien\u021bilor; administrarea seara este folosit\u0103 ocazional la pacien\u021bii care nu prezint\u0103 sc\u0103dere nocturn\u0103 normal\u0103 a tensiunii arteriale.<\/p>\n<h3 class=\"wp-block-heading\">Sunt diabetic \u2014 este Olmesar A sigur?<\/h3>\n<p>Da \u2014 combina\u021bia ARB+amlodipin\u0103 este o <strong>combina\u021bie preferat\u0103 \u00een diabet<\/strong> deoarece este metabolic neutr\u0103 (nu agraveaz\u0103 toleran\u021ba la glucoz\u0103, lipidele sau uratul, spre deosebire de tiazide). Olmesartanul are dovezi dedicate pentru nefropatia diabetic\u0103 (ROADMAP). Monitoriza\u021bi func\u021bia renal\u0103 \u0219i potasiul ca de obicei.<\/p>\n<h3 class=\"wp-block-heading\">Pot lua Olmesar A cu un statin?<\/h3>\n<p>\u00cen general da, cu o excep\u021bie: <strong>doza de simvastatin\u0103 nu trebuie s\u0103 dep\u0103\u0219easc\u0103 20 mg pe zi<\/strong> c\u00e2nd este luat\u0103 cu amlodipin\u0103 (amlodipina cre\u0219te expunerea la simvastatin\u0103 \u0219i riscul de rabdomioliz\u0103). Rosuvastatin (<a href=\"https:\/\/medsbase.com\/ro\/rosu-hdl\/\">Rosu-HDL<\/a>), atorvastatin\u0103 p\u00e2n\u0103 la 40 mg \u0219i pravastatin\u0103 nu sunt afectate de amlodipin\u0103 \u0219i pot fi utilizate \u00een orice doz\u0103.<\/p>\n<h3 class=\"wp-block-heading\">Pot s\u0103 m\u0103n\u00e2nc grapefruit \u00een timp ce iau Olmesar A?<\/h3>\n<p>Consumul ocazional de grapefruit este acceptabil. Un aport mare obi\u0219nuit (mai mult de aproximativ 1 litru de suc pe zi) poate cre\u0219te u\u0219or nivelul amlodipinei prin inhibarea CYP3A4, agrav\u00e2nd poten\u021bial sc\u0103derea tensiunii arteriale sau edemul de glezn\u0103. Alte dihidropiridine (\u00een special felodipina) sunt mult mai sensibile la grapefruit; interac\u021biunea amlodipinei este relativ u\u0219oar\u0103.<\/p>\n<h3 class=\"wp-block-heading\">Pot s\u0103 iau Olmesar A \u00een timpul sarcinii?<\/h3>\n<p><strong>Nu \u2014 absolut contraindicated.<\/strong> Olmesartanul este teratogen (agenereza renal\u0103 fetal\u0103, oligohidramnios, hipoplazie pulmonar\u0103, defecte craniene). Amlodipina singur\u0103 a fost utilizat\u0103 \u00een sarcin\u0103 (exist\u0103 date limitate de siguran\u021b\u0103), dar componenta de olmesartan face ca Olmesar A s\u0103 fie nepotrivit. Trece\u021bi la <a href=\"https:\/\/medsbase.com\/ro\/labebet\/\">labetalol<\/a>, metildop\u0103 sau nifedipin\u0103 (monoterapie) \u00eenainte de concep\u021bie.<\/p>\n<h3 class=\"wp-block-heading\">Ce fac dac\u0103 uit o doz\u0103?<\/h3>\n<p>Lua\u021bi-o c\u00e2t mai cur\u00e2nd v\u0103 aminti\u021bi, cu excep\u021bia cazului \u00een care urm\u0103toarea doz\u0103 este \u00een c\u00e2teva ore \u2014 \u00een acest caz, omite\u021bi doza ratat\u0103. Nu dubla\u021bi doza. Timpul de \u00eenjum\u0103t\u0103\u021bire lung al amlodipinei face ca controlul tensiunii arteriale s\u0103 fie destul de tolerant la o singur\u0103 doz\u0103 ratat\u0103; mai multe zile consecutive ratate vor permite tensiunii arteriale s\u0103 creasc\u0103 din nou.<\/p>\n<h3 class=\"wp-block-heading\">Am dezvoltat diaree cronic\u0103 la Olmesar A \u2014 ce ar trebui s\u0103 fac?<\/h3>\n<p>Investiga\u021bi pentru <strong>enteropatie asem\u0103n\u0103toare sprue asociat\u0103 cu olmesartan<\/strong> \u2014 o complica\u021bie rar\u0103 dar recunoscut\u0103 (avertizare FDA 2013), care se manifest\u0103 prin diaree cronic\u0103, pierdere \u00een greutate \u0219i atrofie viloz\u0103 asem\u0103n\u0103toare bolii celiace. Se rezolv\u0103 dup\u0103 \u00eentreruperea olmesartanului. Schimba\u021bi cu un alt ARB (telmisartan, valsartan, losartan) sau cu o clas\u0103 complet diferit\u0103.<\/p>\n<h3 class=\"wp-block-heading\">Unde pot cump\u0103ra Olmesar A online?<\/h3>\n<p>Pute\u021bi cump\u0103ra Olmesar A (20\/5 mg olmesartan + amlodipin\u0103, 30-180 comprimate) de la MedsBase cu ambalaj discret \u0219i livrare la nivel mondial.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2 class=\"wp-block-heading\">Antihipertensive \u00eenrudite pe MedsBase<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/aquazide\/\">Aquazide \u2014 Hidroclorotiazid\u0103<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/cozartan-h\/\">Cozartan-H \u2014 Losartan + HCTZ<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/diovan-160\/\">Diovan 160 \u2014 Valsartan 160 mg (monoterapie)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/losatec-h\/\">Losatec H \u2014 Losartan + HCTZ<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/olmezest-am\/\">Olmezest AM \u2014 Olmesartan + Amlodipin\u0103<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/telmaheal\/\">Telmaheal \u2014 Telmisartan 20\/40\/80 mg (monoterapie)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/high-blood-pressure-medication\/\"><strong>R\u0103sfoi\u021bi toate medicamentele pentru hipertensiune arterial\u0103<\/strong><\/a><\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:24px 0;border-radius:4px;\"><strong>\u2695 Dezaprobare medical\u0103.<\/strong> Aceast\u0103 pagin\u0103 are scop informativ \u0219i nu \u00eenlocuie\u0219te sfatul medical al unui medic calificat. Hipertensiunea, insuficien\u021ba cardiac\u0103 \u0219i aritmiile necesit\u0103 diagnostic, monitorizare \u0219i individualizarea dozei de c\u0103tre un medic \u2014 utiliza\u021bi \u00eentotdeauna beta-blocante sub \u00eendrumare medical\u0103.<\/div>","protected":false},"excerpt":{"rendered":"<p>Olmesar A este comprimatul cu doz\u0103 fix\u0103 de olmesartan 20 mg + amlodipin\u0103 5 mg de la Cipla \u2014 combina\u021bia ARB+CCB de clas\u0103 ACCOMPLISH, cu 20% mai pu\u021bine evenimente cardiovasculare dec\u00e2t ARB+tiazidic\u0103 \u00een hipertensiunea de risc ridicat. Unic, ad\u0103ugarea olmesartanului la amlodipin\u0103 reduce aproximativ la jum\u0103tate rata de edem tibial cauzat de amlodipin\u0103 \u2014 dilatarea venoas\u0103 a ARB-ului reechilibreaz\u0103 dilatarea arteriolar\u0103 a amlodipinei. Combina\u021bie preferat\u0103 \u00een diabet, gut\u0103 \u0219i sindrom metabolic.<\/p>","protected":false},"featured_media":51976,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3260,3356],"product_tag":[],"class_list":{"0":"post-51975","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-chronic-conditions","8":"product_cat-heart-blood-pressure","9":"product_cat-high-blood-pressure-medication","11":"first","12":"outofstock","13":"shipping-taxable","14":"purchasable","15":"product-type-variable","16":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product\/51975","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/comments?post=51975"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media\/51976"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media?parent=51975"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_brand?post=51975"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_cat?post=51975"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_tag?post=51975"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}