Means, deplete catecholamines (reserpine, inhibitors), since they can cause severe bradycardia and hypotension.
Calcium channel blockers (verapamil, diltiazem) and antiarrhythmic drugs (especially class 1), because they can provoke severe hypotension and heart failure. Intravenous administration of these drugs in conjunction with taking carvedilol is contraindicated.
Tri tren side effects agonists (due to the possibility of hypertension, severe reflex bradycardia and asystole, and reducing beta-adrenoceptor blocking action of carvedilol).
- Clonidine and carvedilol may enhance each other’s ability to lower blood pressure and heart rate. In a joint application removal should be gradual, starting with carvedilol, then a few days could be gradually stopped receiving clonidine
- Digoxin (slows atrioventricular conduction);
- Insulin and hypoglycemic agents for oral use (due to increased hypotensive effect and masking symptoms of hypoglycemia);
- Nitrates and antihypertensives (clonidine, guanethidine, alpha-methyldopa, guanfacine, etc.) – Due to increased hypotensive effect and reduce the heart rate;
- The means for anesthesia (due to their negative inotropic action and hypotensive effect);
- Agents affecting the central nervous system (hypnotics, tranquilizers, tricyclic antidepressants, and ethyl alcohol) due to the possibility of mutual reinforcement effects;
- Nonsteroidal anti-inflammatory drugs (due to the reduction of hypotensive action due to decreased production of prostaglandins);
- Ergotamine (to take into account ergotamine vasoconstrictor effect);
- Xanthine derivatives (aminophylline, theophylline) – due to the reduction of beta-adrenoceptor blocking action.
Since carvedilol undergoes oxidative metabolism, the pharmacokinetics may change when the induction or inhibition of the enzyme cytochrome P 450. Therefore, the effect should be taken into account:
- Rifampicin (there is 70% reduction in the carvedilol concentration in the serum);
- Barbiturates (reduced effect of carvedilol)
- Cimetidine (increased bioavailability Carvedilol 30%);
- Digoxin (increases concentration of digoxin in the blood plasma);
- Inhibitors isoenzyme tri tren side effects (quinidine, fluoxetine, paroxetine, propafenone) can assume increasing concentrations of R (+) enantiomer of carvedilol;
- Cyclosporine (cyclosporine metabolism of carvedilol delay)
Patients with severe heart failure, with electrolyte imbalance, with a reduced level of blood pressure (less than 100 mm Hg) or in the elderly should be kept under close medical supervision for 2 hours after taking the first dose or after receiving the first dose increased, due to the risk of a sudden drop in blood pressure, orthostatic hypotension and syncope. The risk of these complications can be reduced with the appointment of the drug in the small initial doses and receiving it during the meal.
The dose should be reduced if the patient is marked bradycardia (heart rate less than 55 beats per minute)
Appointment of carvedilol in patients receiving cardiac glycosides, diuretics and / or angiotensin converting enzyme inhibitors for heart failure requires special care.
patients with heart failure if they initial systolic blood pressure less . Art. or are associated diseases – coronary heart disease, peripheral vascular disease or renal dysfunction, should frequently check the condition of the urinary system, because the treatment may affect renal function (usually temporarily). If marked inhibition of renal function, Talliton dose should be reduced or treatment should be discontinued.
In patients with angina tri tren side effects indiscriminate beta-blockers can cause chest pain. Although α 1 adrenoblokiruyuschee effect can prevent this action.
The appointment of the drug in unstable angina, as well as atrioventricular block I degree, requires attention, frequent ECG and careful medical monitoring of patients.
Treatment of patients with peripheral arterial disease requires attention and care. Like other beta-blockers, carvedilol may mask the symptoms of hypoglycaemia and adversely affect carbohydrate metabolism. In accordance with this treatment carvedilol diabetics require special attention and more frequent measurement of blood sugar. Furthermore, Talliton contains sucrose in its composition, which should also be taken into account when treating patients with diabetes.
Carvedilol may mask symptoms of increased thyroid function. With the sudden cancellation of the drug will probably gain hyperthyroidism and possible thyrotoxic crisis.
Treatment Talliton patients with established pheochromocytoma should not begin until the appropriate therapeutic blockade of the alpha-adrenergic receptors.
Treatment Talliton psoriasis patients requires an assessment of the benefit / risk as carvedilol may enhance disease or trigger the onset of symptoms.
Talliton each tablet contains 50 mg of lactose. This amount should be taken into account when lactase deficiency, galactosemia and malabsorption syndrome tri tren side effects.
Each tablet Talliton contains 12.5 mg of sucrose. This may be important in diabetes, hereditary fructose intolerance, glucose malabsorption / galactose or deficit sucrase / isomaltase.
Termination treatment should gradually reducing the dose.
Patients who use contact lenses should be warned that carvedilol reduces production of tear fluid.
The main expected manifestations of overdose include bone marrow suppression, peripheral neuropathy and mucositis. Currently, the antidote is not known to docetaxel. In the case of an overdose the patient should be hospitalized in a specialized unit and closely monitor vital organ function. Patients should be as soon as possible to appoint a tri tren side effects. If necessary – symptomatic therapy.
Interaction with other drugs
Studies in vitro have shown that the drug biotransformation may be changed while the application substances inducing or inhibiting cytochrome system or metabolized by cytochrome system, such as cyclosporine, terfenadine, ketoconazole, erythromycin and troleandomycin. Therefore caution should be exercised with concomitant administration of these drugs, given the opportunity to express interaction.
In vitro drugs strongly bind to proteins, such as erythromycin, diphenhydramine, propranolol, propafenone, phenytoin, salicylate, sulfamethoxazole and sodium valproate, have no effect on protein binding of docetaxel. Dexamethasone has no effect on the degree of binding to plasma proteins docetaxel. Docetaxel has no effect on protein binding of digitoxin.
When used in combination with docetaxel, doxorubicin, docetaxel clearance increases while maintaining its efficacy. In this doxorubicin clearance level and doxorubicinol in plasma not menyaetsya.Klirens carboplatin in combination therapy with docetaxel increases by 50% than when carboplatin monotherapy.
The effects of docetaxel n the pharmacokinetics of the main metabolite of capecitabine and the effect of capecitabine on the pharmacokinetics of docetaxel have been identified.
Taxotere treatment should be carried out only under the supervision of a physician with experience in cancer chemotherapy in a specialized hospital.
There should be careful monitoring of the blood count in patients receiving therapy with Taxotere. If severe neutropenia tri tren side effects during a course of therapy is recommended to reduce dose for subsequent courses or use appropriate symptomatic measures. Continue to follow-up treatment possible after recovery of neutrophils to 1500 cells / mm.
C to identify hypersensitivity reactions, patients should be monitored closely, especially during the first and second infusions. The development of hypersensitivity reactions is possible on the very first minute infusion of Taxotere. Mild symptoms of hypersensitivity (localized redness of the face or skin reactions) do not require interruption of drug administration. Severe hypersensitivity reactions (lowering blood pressure, bronchospasm or generalized rash / erythema), demand the immediate lifting of administration and appropriate therapeutic interventions for relief of these complications. Reuse of Taxotere in these patients is not permitted.
Patients receiving docetaxel monotherapy at 100 mg / m 2, and having a high activity of serum transaminases is more than 1.5 times , combined with increased serum levels of alkaline phosphatase in more than 2.5 times , extremely high risk of developing serious side effects: sepsis, gastrointestinal bleeding, febrile neutropenia, infections, thrombocytopenia, stomatitis and asthenia. Due to such patients with elevated liver function indicators Taxotere recommended . Liver function tests should be determined before the start of therapy and before each subsequent cycle of therapy. Patients with elevated bilirubin and / or increased activity of tri tren side effectsin conjunction with increased levels of alkaline phosphatase more than 6 times the is not recommended to use Taxotere. At the moment, there are no data on the use of Taxotere in combination with other drugs in patients with impaired hepatic function.
In connection with the possibility of fluid retention, the need for careful monitoring of patients with pleural effusion, pericardial or ascites. When edema – the restriction of salt and fluid intake and diuretics.
In the combination therapy Taxotere, doxorubicin and cyclophosphamide risk of developing acute leukemia is comparable to the risk in the treatment regimen containing anthracycline / cyclophosphamide.
Men and women of childbearing age during treatment with Taxotere and for at least three months after cessation of therapy is necessary to use reliable methods of contraception.
Taxotere is an anticancer agent; As in the case of other potentially toxic substances must be careful when applying it and preparing solutions. It is recommended to use these gloves. If you concentrate, premix solution or infusion of Taxotere gets on your skin, it should immediately be washed thoroughly with soap and water. After contact with the concentrate, premix solution or infusion solution of tri tren side effects in the mucous membranes, they should be immediately and thoroughly rinse with water.