Giran H Tablet

Giran H Tablet is used for: Hypertension, Congestive heart failure

Hypertension Oral 16-32 mg candesartan/12.5-25 mg HCTZ 1 tablet once daily.

The safety and efficacy have not been established in children.

Impaired Renal Function: In patients with mild to moderate renal impairment (ie, creatinine clearance between 30-80 mL/min/1.73m2 BSA), a dose titration is recommended. This should not be used in patients with severe renal impairment (creatinine clearance <30 mL/min/1.73 m2 BSA).

May be taken with or without food.

Candesartan Cilexetil + Hydrochlorothiazide is contraindicated in patients who are hypersensitive to candesartan, to hydrochlorothiazide or to other sulfonamide-derived drugs. Do not co-administer aliskiren with Candesartan Cilexetil + Hydrochlorothiazide in patients with diabetes. Candesartan Cilexetil + Hydrochlorothiazide is contraindicated in patients with anuria.

When pregnancy is detected, discontinue Candesartan Cilexetil + Hydrochlorothiazide as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus. Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide) Photosensitivity may occur; instruct patients taking hydrochlorothiazide to protect skin from sun and undergo regular skin cancer screening Thiazides decrease urinary calcium excretion and may cause mild elevation of serum calcium; avoid therapy in patients with hypercalcemia Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for renal function changes (including acute renal failure) compared to monotherapy Caution in aortic mitral stenosis, hepatic impairment, hypercholesterolemia, hypercalcemia, parathyroid disease, pre-existing renal insufficiency, systemic lupus erythematosus, bilateral renal artery stenosis or anuria Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides Thiazides may decrease urinary calcium excretion Symptomatic hypotension most likely to occur in patients who have been volume and/or salt depleted as a result of prolonged diuretic therapy, dietary salt restriction, dialysis, diarrhea, or vomiting’ may require temporarily reducing dose or volume repletion; volume and/or salt depletion should be corrected before initiating therapy In patients with heart failure, therapy may cause excessive hypotension, which may lead to oliguria, azotemia, and (rarely) with acute renal failure and death; in such patients therapy should be started under close medical supervision; monitor closely for first 2 weeks of treatment and whenever dose of candesartan or diuretic is increased Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function Hydrochlorothiazide may raise serum uric acid level due to reduced clearance of uric acid and may cause or exacerbate hyperuricemia and precipitate gout in susceptible patients Thiazide diuretics reported to cause exacerbation or activation of systemic lupus erythematosus MONITORING PARAMETERS Monitor serum electrolytes periodically; drugs that inhibit the renin-angiotensin system can cause hyperkalemia; hydrochlorothiazide can cause hypokalemia and hyponatremia; hypomagnesema can result in hypokalemia Monitor serum potassium levels, especially in elderly and renally impaired patients.

Pregnancy Category: C (1st trimester); D (2nd and 3rd trimesters) Lactation: enters breast milk/contraindicated

NSAIDs may reduce antihypertensive effect and result in deterioration of renal function including possible acute renal failure. May increase serum lithium concentration. K-sparing diuretics, K supplements or salt substitutes containing K may increase risk of hyperkalaemia. Potentially Fatal: Coadministration w/ aliskiren in diabetic patients may increase risk of renal impairment, hypotension and hyperkalemia. Contraindicated (2) aliskiren sparsentan Serious (23) aminolevulinic acid oral aminolevulinic acid topical benazepril captopril carbamazepine cyclophosphamide cyclosporine dofetilide enalapril fosinopril isocarboxazid lisinopril lithium lofexidine methyl aminolevulinate moexipril perindopril potassium phosphates, IV quinapril ramipril squill trandolapril tretinoin

Side effects of Candesartan Cilexetil + Hydrochlorothiazide : 1-10% Headache (3%),Dizziness (3%),Upper respiratory tract infection (4%),Back pain (3%),Flu-like syndrome (2%) Frequency Not Defined Candesartan Dizziness, headache, vertigo, back pain, upper resp tract infections, pharyngitis, rhinitis, hypotension, hyperkalaemia, increased serum creatinine. Hydrochlorothiazide Anorexia,Epigastric distress,Hypotension,Orthostatic hypotension,Photosensitivity,Anaphylaxis,Anemia,Confusion,Erythema multiforme,Stevens-Johnson syndrome,Exfoliative dermatitis including toxic epidermal necrolysis,Dizziness,Headache,Hyperuricemia,Hypokalemia and/or hypomagnesemia

Candesartan inhibits the binding of angiotensin II to AT1 receptors in many tissues (e.g. vascular smooth muscles, adrenal gland) which leads to vasoconstriction blockade and aldosterone release. Hydrochlorothiazide inhibits the reabsorption of Na and chloride in the distal tubules causing increased excretion of Na and water K and hydrogen ions.

Giran H 8 mg + 12.5 mg Tablet manufactured by Aristopharma Limited. Its generic name is Candesartan Cilexetil + Hydrochlorothiazide. Giran H is availble in Bangladesh. Farmaco BD drug index information on Giran H Tablet is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.