Logimax

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Logimax: instructions for use and reviews

1. Release form and composition
2. Pharmacological properties
3. Indications for use
4. Contraindications
5. Method of application and dosage
6. Side effects
7. Overdose
8. Special instructions
9. Application during pregnancy and lactation
10. Use in childhood
11. In case of impaired renal function
12. For violations of liver function
13. Use in the elderly
14. Drug interactions
15. Analogs
16. Terms and conditions of storage
17. Terms of dispensing from pharmacies
18. Reviews
19. Price in pharmacies

Latin name: Logimax

ATX code: C07FB02

Active ingredient: metoprolol (Metoprolol) + felodipine (Felodipine)

Manufacturer: AstraZeneca, AB (AstraZeneca, AB) (Sweden)

Description and photo updated: 30.11.2018

Prices in pharmacies: from 716 rubles.

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Sustained-release tablets, coated, Logimax

Logimax is a combined antihypertensive agent.

Release form and composition

Dosage form - tablets of prolonged action, coated: biconvex, round, pink with an apricot shade, engraving "A / FG" on one side (30 pcs. In bottles, in a cardboard box 1 bottle and instructions for use of Logimax).

Composition of 1 coated tablet:

active substances: metoprolol tartrate - 50 mg (corresponds to the content of metoprolol succinate - 47.5 mg), felodipine - 5 mg;
auxiliary components: sodium stearyl fumarate, hydroxypropyl cellulose (hyprolose), hypromellose, polyoxyl 40 hydrogenated castor oil (macrogol glyceryl hydroxystearate 40), propyl gallate, anhydrous lactose, silicon dioxide, microcrystalline cellulose, ethyl silicate, sodium aluminum cellulose;
shell: hypromellose, macrogol 6000, paraffin, titanium dioxide (E171), dyes iron oxide red (E172) and iron oxide yellow (E172).

Pharmacological properties

Pharmacodynamics

Logimax is a combined drug with hypotensive, antiarrhythmic and antianginal effects.

The complementary mechanism of action of metoprolol, which reduces cardiac output, and felodipine, which reduces total peripheral vascular resistance (OPSR), leads to a more pronounced hypotensive effect and better treatment tolerance compared with metoprolol and felodipine alone. Lowering blood pressure (BP) is stable and effective during the entire period between doses (24 hours).

Metoprolol

Metoprolol is a cardioselective antagonist of β ₁ -adrenergic receptors. When used in therapeutic doses, it has no effect on β ₂ -adrenergic receptors located mainly in the bronchi and peripheral vessels. The drug has no intrinsic sympathomimetic activity. It has a slight membrane stabilizing effect.

Beta-blockers have a negative chronotropic and inotropic effect. Metoprolol reduces the stimulating effect of catecholamines on the myocardium, reduces blood pressure, heart rate (heart rate) and cardiac output. With increased secretion of adrenaline under stress, the drug does not interfere with normal physiological vasodilation.

Compared with non-selective beta-blockers, metoprolol has a lesser contractile effect on the muscles of the bronchi, and also to a lesser extent affects the metabolism of carbohydrates and insulin secretion, therefore it can be used in diabetes mellitus. In addition, it has less effect on cardiovascular reactions in hypoglycemia, such as tachycardia. With the use of metoprolol, the blood glucose level is restored to normal faster than with treatment with non-selective beta-blockers.

Metoprolol lowers blood pressure while lying and standing, as well as during physical activity.

At the beginning of use, the drug enhances the OPSS, however, with long-term treatment, the OPSS decreases, as a result of which the blood pressure decreases, while the cardiac output does not change. In arterial hypertension, metoprolol reduces the incidence of mortality from cardiovascular complications.

The drug does not change the electrolyte balance of the blood.

Felodipine

Felodipine is a dihydropyridine derivative, a vasoselective slow calcium channel blocker, is a racemic mixture. It is used to treat arterial hypertension and stable angina pectoris.

Suppresses the conduction and contractility of smooth muscles by acting on the calcium channels of cell membranes. Possesses high selectivity in relation to smooth muscles of arterioles, due to which it does not have a negative inotropic effect on cardiac conduction and contractility.

The antihypertensive effect of felodipine develops due to a decrease in the systemic vascular resistance. With arterial hypertension, blood pressure is effectively reduced in the supine position, sitting and standing, as well as during exercise. The drug does not affect the smooth muscles of the veins and adrenergic vasomotor control, therefore, orthostatic hypotension does not develop.

At the initial stage of therapy, due to a decrease in blood pressure, a temporary reflex increase in heart rate and cardiac output is possible, which is eliminated by a combination with a beta-blocker (metoprolol).

The effect of the drug on blood pressure and OPSS correlates with its plasma concentration. After reaching a stable equilibrium plasma concentration, the hypotensive effect persists for 24 hours.

The use of felodipine causes a reverse development of left ventricular hypertrophy.

Felodipine helps to relax the smooth muscles of the airways. There was a slight effect of the drug on the motility of the gastrointestinal tract.

With prolonged use, the drug does not significantly affect the level of lipids in the blood. In patients with type 2 diabetes mellitus who received felodipine for 6 months, no significant changes in metabolic processes were noted. Thus, the drug can be used in patients with diabetes mellitus, as well as in patients with reduced left ventricular function (in combination with standard therapy), gout, hyperlipidemia, bronchial asthma.

Felodipine reduces vascular resistance in the kidneys, has diuretic and natriuretic activity. Does not affect the excretion of albumin, glomerular filtration, does not have a potassium uretic effect.

Pharmacokinetics

Metoprolol

From the gastrointestinal tract is absorbed quickly and almost completely.

The maximum concentration (C _max) reaches within 1–2 hours. To a large extent, it is exposed to the effect of the first passage through the liver. It is actively metabolized in the liver with the participation of cytochrome P ₄₅₀ isoenzymes, as a result of which three main metabolites are formed that do not have pharmacological activity.

It is excreted by the kidneys mainly in the form of metabolites - more than 95%, no more than 5% of the dose received is excreted unchanged.

The half-life (T _½) is 3-4 hours, this indicator does not change during therapy.

Felodipine

Systemic bioavailability is about 15%. C _max in blood plasma is observed 3-5 hours after oral administration of the drug. Simultaneous food intake affects the rate of absorption of felodipine, due to which C _max increases by about 65%, while bioavailability does not change.

It is characterized by a high bond with plasma proteins - about 99%.

The volume of distribution (V _d) in equilibrium is ~ 10 l / kg. Equilibrium concentration (C _ss) is reached within 5 days.

Felodipine undergoes biotransformation in the liver with the formation of pharmacologically inactive metabolites. It does not accumulate in the body.

The total plasma clearance averages 1.2 L / min.

T _{½ of the} drug in the final phase - about 25 hours. It is excreted: with urine - about 70% in the form of metabolites, no more than 0.5% unchanged, with feces - the rest.

In the elderly and patients with functional disorders of the liver, the plasma concentration of felodipine increases.

In patients with impaired renal function, the concentration of the drug in the plasma does not change, but there is accumulation of inactive metabolites. Hemodialysis does not remove felodipine from the body.

Metoprolol + Felodipine

With the simultaneous administration of felodipine and metoprolol in the composition of Logimax, there are no changes in the bioavailability of the two active substances in comparison with their separate simultaneous administration.

Absorption rates are independent of food intake.

Indications for use

Logimax is intended for the treatment of arterial hypertension.

The drug can be prescribed to patients in whom beta-blockers or blockers of slow calcium channels of the dihydropyridine series, used as monotherapy, do not cause the necessary decrease in blood pressure.

Contraindications

Absolute:

arterial hypotension;
symptomatic bradycardia;
sick sinus syndrome;
atrioventricular block (AV block) of II and III degrees;
unstable angina;
decompensated chronic heart failure (pulmonary edema, hypoperfusion or arterial hypotension) and inotropic therapy with β-adrenergic receptor agonists;
acute myocardial infarction;
suspicion of an acute stage of myocardial infarction (heart rate - 0.24 sec or systolic blood pressure - <100 mm Hg);
cardiogenic shock;
pronounced obliterating disorders of peripheral circulation in the presence of a threat of gangrene development;
age up to 18 years;
pregnancy;
period of breastfeeding;
hypersensitivity to any component of Logimax.

It is not recommended to start treatment with the drug in patients who have not previously received antihypertensive therapy.

Logimax tablets with caution, after assessing the benefits and possible risks, should be used in the following cases:

aortic stenosis;
chronic heart failure;
myocardial infarction;
liver dysfunction;
severe renal failure (creatinine clearance <30 ml / min);
acute metabolic acidosis;
chronic obstructive pulmonary disease, bronchial asthma (requires concomitant therapy with beta ₂ -adrenomimetics).

Logimax, instructions for use: method and dosage

Logimax tablets should be taken orally: swallow whole and drink plenty of water. The drug can be taken on an empty stomach or with a small amount of food that is low in fat and carbohydrates.

The optimal dosage regimen is determined individually. When choosing a dose of Logimax, the doctor takes into account the effect of previously used slow calcium channel blockers or beta-blockers.

The recommended starting dose is 1 tablet 1 time per day, in the morning. If the severity of the clinical effect is not enough, the dose is increased to 1 tablet 2 times a day.

In case of functional impairment of the kidneys, the dose of Logimax does not need to be adjusted.

With cirrhosis of the liver, as a rule, dose adjustment is not required. Patients with severe hepatic impairment can take no more than 1 tablet 1 time per day.

Side effects

The most common side effects of Logimax are: headache (11%), facial flushing, fatigue, dizziness, ankle swelling, nausea. Usually these reactions occur at the beginning of the drug intake or when the dose is increased and, as a rule, go away on their own without special treatment. Most of these phenomena are due to the vasodilating properties of felodipine.

The side effects inherent in each of the active substances of the drug are described below. They are classified as follows: often - ≥ 1/100, sometimes - from ≥ 1/1000 to <1/100, rarely - from ≥ 1/10 00 to <1/1000, very rarely - <1/10 000, including single cases.

Metoprolol

on the part of the cardiovascular system: often - coldness of the extremities, palpitations, bradycardia; sometimes - a reversible increase in symptoms of heart failure; rarely - fainting, conduction disturbances (increased time), edema, arrhythmias;
from the respiratory system: sometimes - shortness of breath, bronchospasm in patients with asthmatic diseases and bronchial asthma;
from the central and peripheral nervous system: often - a feeling of fatigue, headache, dizziness; sometimes - sleep disorders, paresthesia; rarely - anxiety, memory impairment, decreased ability to concentrate, hallucinations, increased nervous excitability, nightmares, depression;
from the digestive system: often - diarrhea / constipation, abdominal pain, nausea, vomiting; rarely - a violation of taste, an increase in the level of hepatic transaminases;
from the hematopoietic system: rarely - thrombocytopenia;
from the senses: rarely - irritation and / or dryness of the eyes, blurred vision, ringing in the ears;
dermatological reactions: rarely - photosensitization, hair loss, hyperhidrosis, exacerbation of psoriasis;
others: sometimes - chest pain, weight gain; rarely - hypersensitivity reactions, reversible libido disorder.

There are isolated cases of development in patients with severe peripheral circulatory disorders of the following phenomena: dry mouth, rhinitis, conjunctivitis, arthralgia, muscle spasms, gangrene.

Felodipine

on the part of the cardiovascular system: often - swelling of the ankles, redness of the face, accompanied by a feeling of heat; sometimes - a feeling of palpitations, tachycardia; rarely - fainting; very rarely - extrasystole, a decrease in blood pressure, accompanied by tachycardia (in predisposed patients, tachycardia can cause an exacerbation of angina pectoris or the development of leukocytoclastic vasculitis);
from the digestive system: sometimes - abdominal pain, nausea; rarely - vomiting; very rarely - gingivitis, hyperplasia of the gums and mucous membrane of the tongue, increased activity of liver enzymes in the blood serum;
from the endocrine system: very rarely - hyperglycemia;
from the musculoskeletal system: rarely - myalgia, arthralgia;
from the central nervous system: often - headache; sometimes - dizziness, paresthesia;
on the part of the urinary system: very rarely - frequent urination;
from the reproductive system: sometimes - sexual dysfunction, impotence;
dermatological and allergic reactions: rarely - urticaria; sometimes - exanthema, itching; very rarely - hypersensitivity reactions, photosensitivity, angioedema (lips or tongue);
others: sometimes - feeling tired; very rarely - fever, sleep disturbances, hyperglycemia.

There are isolated cases of development of hyperplasia of the gums and mucous membrane of the tongue in patients with severe gingivitis / periodontitis. Careful oral hygiene can help prevent or reduce this side effect.

Overdose

A 5-year-old child who took 100 mg of metoprolol showed no signs of intoxication after gastric lavage. In a 12-year-old adolescent, taking 450 mg of metoprolol caused the development of moderate intoxication. In adults, after taking a dose of 1400 mg and 2500 mg, moderate and severe intoxication was noted, respectively. Metoprolol at a dose of 7500 mg caused an extremely severe intoxication with a fatal outcome in an adult.

A 2-year-old child who took 10 mg of felodipine showed minor intoxication. A 17-year-old adolescent after taking a dose of 150-200 mg and an adult patient after taking a dose of 250 mg showed intoxication from a slight to moderate degree.

Logimax is available in a long-acting dosage form, so symptoms of intoxication may appear 12-16 hours after taking an excessive dose of the drug, severe symptoms are possible even after a few days.

The most serious signs of metoprolol overdose are manifestations of the cardiovascular system, sometimes (especially in children and adolescents), disorders of the central nervous system predominate. Possible symptoms: pronounced decrease in blood pressure, asystole, bradycardia, AV-blockade of I-III degree, heart failure, weak peripheral perfusion, cardiogenic shock, apnea, suppression of pulmonary function, suppression of lung function, bronchospasm, impaired consciousness, convulsions, loss of consciousness, increased fatigue, paresthesia, increased sweating, tremors, nausea, vomiting, impaired renal function, transient myasthenic syndrome, esophageal spasm, hyperkalemia, hypoglycemia (especially in children) or hyperglycemia. In case of concomitant use of quinidine, barbiturates,antihypertensive drugs or alcohol, the patient's condition may worsen.

The most serious symptoms of an overdose of felodipine are manifestations from the cardiovascular system: a marked decrease in blood pressure, ventricular fibrillation, ventricular premature beats, AV block, asystole, bradycardia (sometimes tachycardia), atrioventricular dissociation. Also possible: dizziness, headache, impaired consciousness (up to coma), apnea, shortness of breath, pulmonary edema (not cardiac), convulsions, nausea, vomiting, hypothermia, hot flashes, hyperglycemia, hypokalemia, hypocalcemia, acidosis, as well as respiratory distress syndrome in adults.

After taking an excessive dose of Logimax, it is recommended to take activated carbon. If necessary, gastric lavage is performed (in some cases it can be effective even at a late stage of intoxication), however, atropine is preliminarily injected intravenously (for adults - 0.25-0.5 mg, for children - 0.01-0.02 mg / kg), which is due to the risk of stimulating the vagus nerve. Some patients require airway maintenance (intubation) and adequate ventilation. Correction of serum electrolytes and acid-base state is shown. Control of the electrocardiogram is required. In acute intoxication, glucagon may be prescribed; at an early stage, an artificial pacemaker may need to be installed. For seizures, diazepam is prescribed. To relieve bronchospasm, terbutaline can be used (by injection or by inhalation). Arterial hypotension is corrected by intravenous fluid administration. With bradycardia and AV blockade, atropine is prescribed (adults - 0.5-1 mg, children - 0.02-0.05 mg / kg), if necessary, the administration is repeated, or the initial administration of isoprenaline at a dose of 0.000 05-0.000 1 mg is possible / kg / min. In case of myocardial depression, infusion of dopamine or dobutamine is indicated, and intravenous administration of glucagon is also possible. In some cases, adrenaline is added to therapy. With an enlarged ventricular complex (QRS) and arrhythmias, infusions of sodium bicarbonate or sodium chloride are administered. In case of cardiac arrest, resuscitation is performed. All other disorders are treated symptomatically. With bradycardia and AV blockade, atropine is prescribed (adults - 0.5-1 mg, children - 0.02-0.05 mg / kg), if necessary, the administration is repeated, or the initial administration of isoprenaline is possible at a dose of 0.000 05-0.000 1 mg / kg / min. In case of myocardial depression, dopamine or dobutamine infusions are indicated, and intravenous glucagon is also possible. In some cases, adrenaline is added to therapy. With an enlarged ventricular complex (QRS) and arrhythmias, infusions of sodium bicarbonate or sodium chloride are administered. In case of cardiac arrest, resuscitation is performed. All other disorders are treated symptomatically. With bradycardia and AV blockade, atropine is prescribed (adults - 0.5-1 mg, children - 0.02-0.05 mg / kg), if necessary, the administration is repeated, or the initial administration of isoprenaline is possible at a dose of 0.000 05-0.000 1 mg / kg / min. In case of myocardial depression, infusion of dopamine or dobutamine is indicated, and intravenous administration of glucagon is also possible. In some cases, adrenaline is added to therapy. With an enlarged ventricular complex (QRS) and arrhythmias, sodium bicarbonate or sodium chloride infusions are administered. In case of cardiac arrest, resuscitation is performed. All other disorders are treated symptomatically.intravenous administration of glucagon is also possible. In some cases, adrenaline is added to therapy. With an enlarged ventricular complex (QRS) and arrhythmias, sodium bicarbonate or sodium chloride infusions are administered. In case of cardiac arrest, resuscitation is performed. All other disorders are treated symptomatically.intravenous glucagon is also possible. In some cases, adrenaline is added to therapy. With an enlarged ventricular complex (QRS) and arrhythmias, sodium bicarbonate or sodium chloride infusions are administered. In case of cardiac arrest, resuscitation is performed. All other disorders are treated symptomatically.

special instructions

Logimax is not recommended for use in heart failure without appropriate therapy.

If a surgical intervention is necessary, the patient should warn the anesthesiologist about taking an antihypertensive drug.

Patients receiving Logimax should not be given intravenous slow calcium channel blockers such as verapamil.

With concomitant pheochromocytoma, the simultaneous use of alpha-blockers is recommended.

In some cases, against the background of therapy, it is possible to increase AV conduction disorders and the development of AV blockade.

Logimax has less effect on carbohydrate metabolism than non-selective beta-blockers. However, this effect cannot be completely ruled out, so the likelihood of masking the symptoms of hypoglycemia should be considered.

With extreme caution, digitalis preparations should be used simultaneously.

With Prinzmetal's angina, stimulation of alpha-adrenergic receptors can cause spasm of the coronary vessels, which is fraught with an increase in the frequency and severity of angina attacks. For this reason, patients with this disease are not recommended to prescribe non-selective beta-blockers. Beta ₁ -blockers should be used with caution.

Anaphylactic shock while taking beta-blockers can be more severe. At the same time, epinephrine (adrenaline) in a standard dosage does not always cause the expected therapeutic effect.

During the period of therapy, it is worth refusing to consume grapefruit juice, since it contributes to a significant increase in the plasma concentration of felodipine.

Logimax should not be canceled abruptly, as this is fraught with increased symptoms of chronic heart failure, an increased risk of developing myocardial infarction and sudden death. If discontinuation of treatment is required, you need to gradually (over 1–2 weeks) reduce the dose of the drug.

Influence on the ability to drive vehicles and complex mechanisms

Logimax can cause disturbances from the central nervous system, therefore, during the period of therapy, patients should be careful when engaging in potentially hazardous activities that require speed of reactions and concentration of attention.

Application during pregnancy and lactation

Research has shown metoprolol can cause bradycardia in the fetus, newborns and infants. There is no sufficient experience of using felodipine in pregnant women. Data obtained in animal studies show that the drug can inhibit the contractions of the uterus during preterm labor and cause fetal hypoxia. In this regard, Logimax is contraindicated during pregnancy.

Both active substances are able to penetrate into the mother's milk. Although the child receives a small amount of the drug, the risk of negative effects is possible. For this reason, Logimax is not recommended for use during lactation. If antihypertensive therapy is warranted, feeding should be discontinued.

Pediatric use

Clinical experience with the use of the drug in pediatrics is not enough to assess the degree of its safety, therefore Logimax is not used to treat children and adolescents under 18 years of age.

With impaired renal function

With functional disorders of the kidneys, correction of the treatment regimen is not required. However, caution should be exercised in severe renal failure.

For violations of liver function

With cirrhosis of the liver, there is no need to adjust the dosage regimen of Logimax.

In case of serious functional disorders of the liver (for example, after bypass surgery), no more than 1 Logimax tablet can be prescribed once a day.

Use in the elderly

Elderly patients do not need to adjust the therapy regimen.

Drug interactions

Medicines interacting with the cytochrome P ₄₅₀ enzyme system can affect the plasma concentrations of both Logimax active substances.

Felodipine and metoprolol do not interact with each other, since they are metabolized with the participation of different isoenzymes of the cytochrome P _{450 system}.

Metoprolol

Combinations not recommended:

propafenone: the plasma concentration of metoprolol increases 2–5 times, its side effects may increase;
barbiturates: increased metabolism of metoprolol;
verapamil: a decrease in blood pressure and the development of bradycardia are possible, there is a complementary inhibitory effect on the function of the sinus node and AV conduction.

With the simultaneous use of the following drugs, caution should be exercised (dose adjustment of drugs may be required):

beta-blockers, class I antiarrhythmics: the negative inotropic effect may accumulate and, as a consequence, the development of serious hemodynamic adverse reactions in patients with impaired left ventricular function. The use of this combination is also not recommended for patients with impaired AV conduction and sick sinus syndrome;
diphenhydramine: the clearance of metoprolol decreases, its effect increases;
indomethacin and possibly other non-steroidal anti-inflammatory drugs (with the exception of sulindac and diclofenac): the hypotensive effect is weakened;
quinidine and, possibly, other beta-blockers, metabolized with the participation of the isoenzyme CYP2D6: the metabolism of metoprolol is suppressed in patients with rapid hydroxylation, which increases its plasma concentration, increases the blockade of β-adrenergic receptors;
selective serotonin inhibitors (fluoxetine, sertraline, paroxetine), hydralazine, cimetidine: an increase in the concentration of metoprolol in blood plasma is possible;
amiodarone: the risk of developing severe sinus bradycardia increases;
clonidine: hypertensive reactions may increase with abrupt withdrawal;
rifampicin: the metabolism of metoprolol increases, and its plasma concentration decreases;
inhalation anesthetics: increased cardiodepressant effect;
monoamine oxidase inhibitors, beta-blockers in the form of eye drops: side effects may develop (careful monitoring is required);
non-selective beta-blockers (including pindolol and propranolol), epinephrine (adrenaline): in rare cases, severe arterial hypertension and bradycardia develops;
phenylpropanolamine (norephedrine) in a single dose of 50 mg: it is possible to increase diastolic blood pressure to pathological values and develop a hypertensive crisis;
oral hypoglycemic agents: their effect may decrease (dose adjustment is required).

Felodipine

drugs that induce or inhibit CYP3A4: there is a significant effect on the plasma concentration of felodipine (their simultaneous use is not recommended);
tacrolimus: an increase in its concentration in blood plasma is possible (dose adjustment may be required);
cimetidine: C _max and AUC of felodipine increase by 55%;
inhibitors of HIV protease, macrolide antibiotics (for example, erythromycin), azole antifungals (such as itraconazole and ketoconazole): the C _max and AUC of felodipine are significantly increased (not recommended concentrations);
drugs that induce isozymes of the cytochrome P _{450 system} (tincture of St. John's wort, phenobarbital, carbamazepine, phenytoin, rifampicin): the metabolism of felodipine increases;
cyclosporine: the C _{max of} felodipine increases by 150%, its AUC increases by 60%;
grapefruit juice: C _max and AUC of felodipine increase approximately 2 times.

Analogs

Logimax analogs are: Akkuzid, Aritel Plus, Atakand Plus, Biprol Plus, Bisam, Vasotenz N, Vamloset, Gizaar, Duopress, Iruzid, Kapozid, Co-Parnavel, Concor AM, Lodoz, Losartan N, Lortenza, Papazol, Rasilam, Twins Tenoric, Tenoretic, Egipres, Enap-N and others.

Terms and conditions of storage

Store at a temperature not exceeding 30 ° C, out of the reach of children.

The shelf life is 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Logimax

Reviews about Logimax are positive, patients indicate that the drug effectively reduces high blood pressure. The complaints in the reviews usually describe the development of side effects while taking the drug, however, in such cases, interruption of therapy was rarely required.

Price for Logimax in pharmacies

Depending on the place of sale, the price for Logimax can be 799-1108 rubles. per pack containing 30 tablets.

Logimax: prices in online pharmacies

Drug name

Price

Pharmacy

Logimax 50 mg + 5 mg coated tablets of prolonged action 30 pcs.

716 RUB

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Maria Kulkes Medical journalist About the author

Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!