Co-Diovan

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

Co-Diovan: 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. Drug interactions
14. Analogs
15. Terms and conditions of storage
16. Terms of dispensing from pharmacies
17. Reviews
18. Price in pharmacies

Latin name: Co-Diovan

ATX code: C09DA03

Active ingredient: valsartan (Valsartan) + hydrochlorothiazide (Hydrochlorothiazide)

Producer: Novartis Pharma SpA (Novartis Pharma S.p. A.) (Italy); Novartis Pharma Stein AG (Novartis Pharma Stein, AG) (Switzerland)

Description and photo update: 2019-09-07

Prices in pharmacies: from 1300 rubles.

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Co-Diovan is an antihypertensive combination drug, an angiotensin II receptor antagonist and a thiazide diuretic.

Release form and composition

Co-Diovan is available in the form of film-coated tablets: dosage 80 / 12.5 mg - light orange, oval, biconvex, marked "HGH" on one side and "CG" on the other; dosage 160 / 12.5 mg - from brownish red to dark red, oval, biconvex, marked "HHN" on one side and "CG" on the other; dosage 160/25 mg - brown-orange, oval, biconvex, marked "NHH" on one side and "NVR" on the other; dosage 320 / 12.5 mg - pink, oval, beveled, marked "NVR" on one side and "HIL" on the other; 320/25 mg dosage - yellow, oval, with a beveled edge, marked "NVR" on one side and "CTI" on the other (dosage 80 / 12.5 mg, 160 / 12.5 mg or 160/25 mg - 14 pcs. in blisters, in a cardboard box 1, 2 or 7 blisters;dosage 320 / 12.5 mg or 320/25 mg - 7 pcs. in blisters, in a cardboard box 1 blister; 14 pcs. in blisters, in a cardboard box of 1, 2, 4, 7 or 20 blisters. Each pack also contains instructions for the use of Co-Diovan).

1 tablet contains:

active ingredients: valsartan + hydrochlorothiazide in an amount of 80 mg + 12.5 mg, 160 mg + 12.5 mg, 160 mg + 25 mg, 320 mg + 12.5 mg or 320 mg + 25 mg, respectively;
auxiliary components: microcrystalline cellulose, crospovidone, anhydrous colloidal silicon dioxide, magnesium stearate;
film shell: hypromellose, talc, titanium dioxide; additionally: dosage 80 / 12.5 mg - macrogol-8000, iron dye yellow oxide (E172), iron dye red oxide (E172); dosage 160 / 12.5 mg - macrogol-8000, iron dye red oxide (E172); dosage 160/25 mg - iron oxide black (E172), macrogol-4000, iron oxide red (E172), iron oxide yellow (E172); dosage 320 / 12.5 mg - macrogol-4000, iron oxide black (E172), iron oxide red (E172); dosage 320/25 mg - macrogol-4000, iron oxide yellow (E172).

Pharmacological properties

Pharmacodynamics

Co-Diovan is a combined antihypertensive drug, the active substances of which are valsartan (angiotensin II receptor antagonist) and hydrochlorothiazide (thiazide diuretic).

Valsartan is a specific and active antagonist of angiotensin II receptors. Angiotensin II is an active hormone of the RAAS (renin-angiotensin-aldosterone system). It is formed from angiotensin I with the participation of an angiotensin-converting enzyme (ACE) and binds to specific receptors that are located in various tissues on cell membranes. The wide range of its physiological effects includes, first of all, direct and indirect participation in the regulation of blood pressure (BP). Angiotensin II is a potent vasoconstrictor and induces a direct pressor response. At the same time, angiotensin II has a stimulating effect on the secretion of aldosterone, contributing to the retention of sodium ions.

The selective action of valsartan is aimed at blocking the AT ₁ subtype receptors responsible for the vasopressor activity of angiotensin II. This leads to an increase in the concentration of angiotensin II in the blood serum and causes stimulation of unblocked AT ₂ receptors, balancing the vasopressor effects due to the excitation of AT ₁ receptors.

In relation to AT ₁ -receptors, valsartan does not have any pronounced agonistic activity, its affinity for them is approximately 20,000 times higher than for AT ₂ -receptors.

The development of undesirable effects associated with the accumulation of bradykinin is unlikely. This is due to the fact that valsartan does not inhibit ACE, which converts angiotensin I to angiotensin II and causes the destruction of bradykinin.

The incidence of dry cough with valsartan is much lower than with ACE inhibitors. It does not block or interact with receptors of other hormones or ion channels, which are important for the regulation of the functions of the cardiovascular system.

The action of hydrochlorothiazide is aimed at highly sensitive receptors in the distal tubules of the renal cortex and leads to the suppression of the process of reabsorption of sodium and chlorine ions. This causes an increase in approximately the same degree of excretion of sodium and chlorine ions. The diuretic effect of the drug leads to a decrease in the volume of circulating blood plasma, contributing to an increase in renin activity and aldosterone secretion, excretion of potassium through the kidneys and a decrease in serum potassium concentration.

Pharmacokinetics

After oral administration, the maximum concentration (C _max) of valsartan in blood plasma is reached after 2–4 hours. Its bioavailability averages 23%. With simultaneous food intake, the AUC (area under the concentration-time curve) decreases by 48%, but this does not cause a clinically significant decrease in the therapeutic effect. After about 8 hours, the concentration of valsartan in the blood plasma reaches a level similar to that when taken on an empty stomach.

Hydrochlorothiazide is rapidly absorbed in the gastrointestinal tract (GIT), reaching C _max 2 hours after oral administration. In the range of therapeutic doses, the average AUC increases in direct proportion to the dose increase. The absolute bioavailability is 70%. Simultaneous intake of hydrochlorothiazide with food may slightly affect the degree of its systemic availability, but this is not of great clinical significance.

Binding to serum proteins, mainly albumin: valsartan - 94–97%, hydrochlorothiazide 40–70%.

The apparent volume of distribution of hydrochlorothiazide is 4–8 l / kg, as a result of accumulation in erythrocytes, its concentration may exceed the plasma level by 3 times.

Valsartan does not undergo significant biotransformation. Low concentrations of the pharmacologically inactive metabolite of valeryl-4-hydroxy valsartan are found in blood plasma. In the form of metabolites, up to 20% of the valsartan dose is excreted.

Hydrochlorothiazide is excreted from the body almost unchanged in the urine (more than 95% of the dose).

The half-life (T _1/2) of valsartan is 6 hours. It is excreted mainly unchanged: through the intestines - about 83% of the dose, through the kidneys - up to 13%.

The renal clearance of valsartan is about 30% of the total clearance. In the range of therapeutic doses, its kinetic parameters are linear. Its concentration in blood plasma is the same in women and men.

T _{1/2 of the} final phase of hydrochlorothiazide is from 6 to 15 hours.

The kinetics of valsartan and hydrochlorothiazide does not change with repeated use. Against the background of taking the drug once a day, the active substances cumulate slightly.

When the active ingredients are combined, the systemic bioavailability of hydrochlorothiazide decreases by about 30%, the kinetics of valsartan does not change significantly. The interaction of the components has no effect on the effectiveness of the combined use. The results of studies on the use of this combination confirm a distinct antihypertensive effect, exceeding the effect of each of the substances separately.

In some cases, in elderly patients (65 years and older), the AUC of valsartan may slightly increase compared with young patients, but this has no clinical significance. The systemic clearance of hydrochlorothiazide in the elderly (including healthy patients and patients with arterial hypertension) is lower.

With mild and moderate severity of renal dysfunction, T _1/2 increases by 2 times. In case of impaired renal function with creatinine clearance (CC) of 30–70 ml / min, dose adjustment is not required.

With severe impairment of renal function (CC less than 30 ml / min) and the use of hemodialysis, there is no experience with Co-Diovan therapy. During hemodialysis, valsartan is not excreted, and hydrochlorothiazide is effectively excreted from the body.

In mild and moderate liver dysfunctions (5-9 points on the Child-Pugh scale), the AUC of valsartan is 2 times higher than in patients with a healthy liver. The pharmacokinetics of hydrochlorothiazide does not change with impaired liver function. The use of Co-Diovan is contraindicated in severe liver dysfunction (more than 9 points on the Child-Pugh scale) and biliary obstruction.

Indications for use

The use of Co-Diovan is indicated for the treatment of arterial hypertension in patients who need combination therapy.

Contraindications

Absolute:

severe liver dysfunction (more than 9 points on the Child-Pugh scale), cholestasis, biliary cirrhosis;
severe renal dysfunction (CC less than 30 ml / min), anuria;
edema caused by previous therapy with ACE inhibitors or ARBs, hereditary angioedema;
hypercalcemia, hypokalemia, hyponatremia, refractory to adequate therapy;
clinical manifestations of hyperuricemia;
period of pregnancy;
breast-feeding;
age up to 18 years;
hypersensitivity to sulfonamides;
individual intolerance to the components of the drug.

Caution should be exercised when prescribing Co-Diovan tablets for unilateral or bilateral renal artery stenosis, stenosis of the artery of a single kidney, condition after kidney transplantation; if necessary, the simultaneous use of the drug with heparin and other drugs that can increase the level of potassium in the blood plasma, potassium-sparing diuretics, potassium salts, substitutes for food salt containing potassium; with a reduced volume of circulating blood (including those caused by high doses of diuretics), pronounced sodium deficiency in the body; in patients with hypertrophic obstructive cardiomyopathy, chronic heart failure of the III-IV functional class according to the NYHA classification (New York Heart Association), aortic or mitral stenosis, moderate liver dysfunction,systemic lupus erythematosus, diabetes mellitus, primary hyperaldosteronism.

Co-Diovan, instructions for use: method and dosage

Co-Diovan tablets are taken orally, swallowed whole and washed down with liquid, regardless of food intake, 1 pc. 1 time per day every day.

Before starting therapy, it is necessary to make sure that there is no violation of the water-electrolyte balance, if necessary, adjust the volume of circulating blood.

The recommended daily dosage of valsartan / hydrochlorothiazide depends on the clinical situation and can be 80 / 12.5 mg, 160 / 12.5 mg, 320 / 12.5 mg.

If, when taking Co-Diovan at a dose of 160 / 12.5 mg or 320 / 12.5 mg, the desired decrease in blood pressure was not achieved, the patient is prescribed tablets at a dose of 160/25 mg or 320/25 mg.

The maximum decrease in blood pressure occurs after 14-28 days of treatment. In some cases, a longer period (28 to 56 days) of dose titration is required to achieve the desired response to therapy.

With a mild to moderate degree of impaired renal function (CC above 30 ml / min), dose adjustment of Co-Diovan is not required.

With mild and moderate liver dysfunction, not accompanied by cholestasis, the dose of valsartan should not exceed 80 mg.

Side effects

Side effects from the use of Co-Diovan on the part of systems and organs (classified as follows: very often -> 10%; often -> 1% and 0.1% and 0.01% and <0.1%; very rarely - < 0.01%, including isolated cases; frequency not established - it is not possible to establish the frequency of occurrence of adverse reactions based on available data):

from the nervous system: often - headache; infrequently - paresthesia, insomnia; very rarely - dizziness; frequency not set - syncope;
on the part of metabolism and nutrition: infrequently - dehydration;
from the side of the vessels: infrequently - peripheral edema, a significant decrease in blood pressure;
from the organ of hearing and labyrinth disorders: infrequently - tinnitus;
on the part of the organ of vision: infrequently - decreased visual acuity;
from the respiratory system, chest and mediastinal organs: infrequently - cough; frequency not established - pulmonary edema of noncardiogenic etiology;
from the digestive system: very rarely - diarrhea;
from the urinary system: the frequency has not been established - impaired renal function;
from the musculoskeletal system: infrequently - myalgia; very rarely - arthralgia;
general disorders: infrequently - increased fatigue;
laboratory parameters: the frequency is not established - an increase in the level of uric acid and / or urea nitrogen in the blood serum, hypokalemia, hyponatremia, an increase in the concentration of bilirubin in the blood serum, an increase in serum creatinine, neutropenia.

In addition, the development of side effects noted in the course of clinical studies with monotherapy with each of the components separately is possible.

When using valsartan in patients with arterial hypertension, the following adverse events were additionally reported:

on the part of the blood and lymphatic system: the frequency has not been established - a decrease in hematocrit, a decrease in hemoglobin levels, thrombocytopenia;
on the part of the immune system: the frequency has not been established - allergic reactions, hypersensitivity reactions, serum sickness;
from the side of metabolism and nutrition: the frequency has not been established - an increase in the level of potassium in the blood serum;
from the organ of hearing and labyrinth disorders: infrequently - vertigo;
from the side of the vessels: the frequency is not established - vasculitis;
from the digestive system: infrequently - abdominal pain;
on the part of the hepatobiliary system: frequency not established - increased activity of liver enzymes;
from the urinary system: the frequency has not been established - renal failure;
dermatological reactions: frequency not established - itching, rash, Quincke's edema.

With the use of hydrochlorothiazide, the following undesirable effects were additionally recorded:

on the part of the blood and lymphatic system: rarely - thrombocytopenia (including in combination with purple); very rarely - suppression of bone marrow hematopoiesis, leukopenia, hemolytic anemia, agranulocytosis;
from the side of the vessels: often - orthostatic hypotension;
from the heart: rarely - arrhythmias;
from the immune system: very rarely - hypersensitivity reactions;
from the nervous system: rarely - headache;
from the respiratory system, chest and mediastinal organs: very rarely - respiratory distress syndrome (including pneumonitis, pulmonary edema);
from the digestive system: often - decreased appetite, nausea, vomiting; rarely - constipation, diarrhea, abdominal discomfort; very rarely - pancreatitis;
from the hepatobiliary system: rarely - intrahepatic cholestasis, jaundice;
from the genitals and breast: often - impotence;
mental disorders: rarely - sleep disturbance, depression;
dermatological reactions: often - various types of skin rashes, including urticaria; rarely - increased photosensitivity; very rarely - lupus-like reactions, necrotizing vasculitis, toxic epidermal necrolysis, exacerbation of cutaneous manifestations of systemic lupus erythematosus; frequency not established - erythema multiforme.

Overdose

Symptoms

Against the background of an overdose of valsartan, a pronounced decrease in blood pressure, depression of consciousness, the development of vascular collapse and / or shock, including with a fatal outcome, is possible. An overdose of hydrochlorothiazide may be accompanied by the appearance of symptoms such as nausea, drowsiness, heart rhythm disturbances, muscle spasms, hypovolemia, and imbalance in water and electrolyte balance.

Treatment

If an overdose of Co-Diovan is detected early, it is recommended to immediately induce vomiting in the patient. Then symptomatic therapy is prescribed taking into account the time elapsed since the high dose of the drug was taken and the severity of the symptoms. With a pronounced decrease in blood pressure, the patient should, first of all, lay down and raise his legs. Requires intravenous (IV) drip of 0.9% sodium chloride solution, regular monitoring of the state of the heart and respiratory system, circulating blood volume and urine output.

The use of hemodialysis is effective only for removing hydrochlorothiazide from the body.

special instructions

Consideration should be given to the ability of thiazide diuretics to affect serum potassium and magnesium. It is recommended to correct hypokalemia and hypomagnesemia before using Co-Diovan. During treatment, all patients should regularly monitor the content of electrolytes in the blood plasma.

Particular care should be taken in patients with salt loss nephropathy and cardiogenic renal impairment. These conditions are often accompanied by water-electrolyte disturbances. If, against the background of the use of Co-Diovan, symptoms of hypokalemia appear, such as muscle weakness, paresis, changes in electrocardiogram indicators, then the treatment should be discontinued.

There is a risk of developing hyponatremia and hypochloremic alkalosis, aggravating the condition in patients with hyponatremia. Therefore, regular monitoring of the sodium content in the blood plasma is required, since the neurological symptoms of hyponatremia in these cases are rare.

Deficiency of sodium and / or volume of circulating blood can cause a pronounced decrease in blood pressure, accompanied by clinical manifestations. Therefore, before starting treatment, the volume of circulating blood and sodium content in the body should be adjusted.

With a significant decrease in blood pressure, the patient must necessarily take a horizontal position. If necessary, he is prescribed an intravenous infusion of 0.9% sodium chloride solution. Reception of Co-Diovan after stabilization of blood pressure can be continued.

It should be borne in mind that with unilateral or bilateral stenosis of the renal artery, including stenosis of the artery of a single kidney, an increase in the level of urea and creatinine in the blood serum is possible.

In chronic heart failure of the III-IV functional class (according to the NYHA classification) and after myocardial infarction, the use of ACE inhibitors and angiotensin II receptor antagonists is associated with an increased risk of acute renal failure, and therefore the appointment of Co-Diovan in this category of patients is not recommended …

Hydrochlorothiazide can cause an increase in the concentration of cholesterol and triglycerides in the blood serum, a change in glucose tolerance. In predisposed patients, a decrease in uric acid clearance can cause the development of hyperuricemia and gout.

A decrease in urinary calcium excretion due to a thiazide diuretic may cause a slight increase in plasma calcium.

For patients with primary hyperaldosteronism, drug treatment is ineffective due to the fact that they do not show activation of the RAAS.

Hypersensitivity reactions most often occur in patients with a history of allergic reactions and asthma.

In the case of the development of angioedema, the reception of Co-Diovan should be immediately canceled and its use should not be resumed.

With the use of hydrochlorothiazide, such cases of adverse events as transient myopia and acute attacks of angle-closure glaucoma have been reported. Risk factors for acute development of angle-closure glaucoma include an allergic reaction to penicillin and sulfonamide derivatives. Untreated angle-closure glaucoma can lead to vision loss. Therefore, if, after starting therapy with the drug, there is a feeling of sharp pain in the eye or decreased vision, it is necessary to stop taking hydrochlorothiazide and consult a specialist.

In order to prevent photosensitivity, exposure to direct sunlight on exposed areas of the body should be avoided.

Influence on the ability to drive vehicles and complex mechanisms

During the period of application of Co-Diovan, patients are advised to be careful when working with complex mechanisms and driving vehicles.

Application during pregnancy and lactation

The use of Co-Diovan is contraindicated during the period of gestation and breastfeeding.

Women of childbearing age who are planning a pregnancy should not take drugs acting on the RAAS. They should be apprised of the potential dangers of these drugs to the fetus during pregnancy.

Taking the drug during pregnancy increases the risk of spontaneous abortions, damage and death of the fetus, the birth of children with birth defects (including oligohydramnios, impaired renal function). In case of conception during the treatment period, taking Co-Diovan should be stopped immediately.

Pediatric use

The efficacy and safety of Co-Diovan for the treatment of children under the age of 18 have not been established, therefore its use in this category of patients is contraindicated.

With impaired renal function

It is contraindicated to use Co-Diovan for the treatment of patients with severe impaired renal function (CC less than 30 ml / min) and anuria.

Pills should be taken with caution in case of bilateral or unilateral renal artery stenosis, stenosis of the artery of a single kidney, condition after kidney transplantation.

For violations of liver function

It is contraindicated to use Co-Diovan for the treatment of patients with severe (more than 9 points on the Child-Pugh scale) liver dysfunction, cholestasis, biliary cirrhosis.

Caution should be taken with Co-Diovan with a moderate degree of liver dysfunction.

Drug interactions

lithium preparations: under the influence of thiazide diuretics, the renal clearance of lithium preparations decreases, as a result of which the risk of toxic effects of lithium increases. If this combination cannot be avoided, it is recommended to carefully monitor the serum lithium content;
ACE inhibitors, methyldopa, direct renin inhibitors, beta-blockers, vasodilators, angiotensin II receptor antagonists, slow calcium channel blockers and other drugs that lower blood pressure: an increase in the hypotensive effect is possible;
norepinephrine, epinephrine and other α- and β-adrenergic agonists: their effect may be weakened, but joint administration is not required;
derivatives of salicylic acid, indomethacin and other non-steroidal anti-inflammatory drugs (NSAIDs), including COX-2 (selective inhibitors of cyclooxygenase-2): can reduce the diuretic and hypotensive effect of the drug. In the presence of hypovolemia, the risk of developing acute renal failure increases;
potassium-sparing diuretics, potassium-containing substitutes for table salt and dietary supplements that contain potassium, as well as other drugs that increase the level of potassium in the blood: with simultaneous use, it is necessary to observe precautions and carry out frequent determination of potassium in the blood;
glucocorticosteroids (GCS), "loop" diuretics, adrenocorticotropic hormone, amphotericin, carbenoxolone, penicillin, salicylic acid derivatives: the risk of hypokalemia increases;
bepridil, cisapride, diphemanil, mizolastine, halofantrine, ketanserin, pentamidine, terfenadine, sparfloxacin, erythromycin and vincamine for intravenous administration, class IA antiarrhythmics (hydroquinidine, quinidine, disopyramide), antiarrhythmics, class III amyodar (dopamine), antipsychotics (levomepromazine, trifluoperazine, thioridazine, chlorpromazine, cyamemazine, sulpiride, pimozide, haloperidol, amisulpride, tiapride, droperidol): hypokalemia caused by hydrochlorothiazide may appear against the background of their use. Caution is required due to the increased risk of feasting arrhythmias;
cardiac glycosides: while taking them, the risk of arrhythmia increases due to the appearance of such undesirable effects of thiazide diuretic therapy as hypokalemia or hypomagnesemia;
muscle relaxants, including tubocurarine: their action is potentiated;
insulin, hypoglycemic agents for oral administration: due to the effect of thiazide diuretics on glucose tolerance, it may be necessary to adjust the doses of hypoglycemic agents;
metformin: possible development of lactic acidosis and renal failure;
allopurinol: increased frequency of hypersensitivity reactions to allopurinol;
cyclophosphamide, methotrexate and other cytotoxic agents: their excretion by the kidneys decreases, which potentiates their myelosuppression;
amantadine: the likelihood of developing its undesirable effects increases;
diazoxide, beta-blockers: their hyperglycemic effect is enhanced;
probenecid, sulfinpyrazone: the concentration of uric acid in the blood plasma increases;
atropine, biperiden and other anticholinergics: contribute to an increase in the bioavailability of the drug due to a decrease in gastrointestinal motility and a slowdown in gastric emptying;
methyldopa: the risk of developing hemolytic anemia increases;
cholestyramine: helps to reduce the absorption of a thiazide diuretic, therefore, it is recommended to observe an interval of at least 4 hours between taking drugs;
calcium preparations, vitamin D: due to increased calcium reabsorption, the likelihood of hypercalcemia increases;
cyclosporine: the risk of hyperuricemia and symptoms similar to exacerbation of gout increases;
carbamazepine: hyponatremia may develop. Blood sodium levels should be monitored regularly;
ethanol, sedatives, anesthetic drugs: can potentiate the development of orthostatic hypotension;
iodine-containing contrast agents: may contribute to the development of acute renal failure if dehydration occurs against the background of hydrochlorothiazide.

Also, against the background of monotherapy with valsartan, taking warfarin, digoxin, indomethacin, amlodipine, cimetidine, furosemide, atenolol, glibenclamide, hydrochlorothiazide did not lead to clinically significant interactions.

Analogs

The analogues of Co-Diovan are: Valz N, Valsartan-Hydrochlorothiazide-Akrikhin, Duopress, Valsakor N80, Valsakor N160, Valsakor N320, Valsakor ND160.

Terms and conditions of storage

Keep out of the reach of children.

Store at temperatures up to 30 ° C, protected from moisture.

Shelf life: tablets 160/25 mg, 320 / 12.5 mg, 320/25 mg - 2 years; tablets 80 / 12.5 mg, 160 / 12.5 mg - 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Ko-Diovan

Reviews about Ko-Diovan are positive. Patients with arterial hypertension report that regular intake of the drug at a dose of 80 / 12.5 mg ensures the stability of normal blood pressure. The disadvantages of Ko-Diovan include a high price.

Price for Co-Diovan in pharmacies

The price of Co-Diovan for a package containing 28 tablets at a dose of 80 / 12.5 mg can range from 1893 rubles, at a dose of 160 / 12.5 mg - from 2318 rubles.

Co-Diovan: prices in online pharmacies

Drug name

Price

Pharmacy

Co-Diovan 80 mg + 12.5 mg film-coated tablets 28 pcs.

1300 RUB

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Co-Diovan 160 mg + 12.5 mg film-coated tablets 28 pcs.

1561 RUB

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KO-Diovan tablets p.p. 80mg + 12.5mg 28 pcs.

1819 RUB

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KO-Diovan tablets p.p. 160mg + 12.5mg 28 pcs.

2059 RUB

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, 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!