Exforge HCT

1 What is Exforge HCT?

Brand: Exforge HCT

Generic: Amlodipine, Valsartan and Hydrochlorothiazide

Exforge HCT is used together to make a combined antihypertensive preparation. This combined medicinal preparation is prescribed to lower high blood pressure. 

Amlodipine is a calcium channel blocker. It relaxes peripheral and coronary vascular smooth muscle. It produces coronary vasodilation by inhibiting the entry of calcium ions into the slow channels or select voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarization. 

It also increases myocardial oxygen delivery in patients with vasospastic angina. This drug is widely used by the healthcare professional to treat a variety of health disorders like mild to moderate hypertension, chronic stable and vasospastic angina, coronary artery disease, hypertension, and Raynaud’s disease etc. 

This medicine is used alone or in combination with other medicines to relieve chest pain and to treat hypertension. On the contrary, valsartan is an angiotensin II type 1 receptor blocker which produces its blood pressure lowering effects by inhibiting angiotensin II-induced vasoconstriction, aldosterone release and renal reabsorption of sodium. 

Moreover, a thiazide diuretic named as hydrochlorothiazide is used in this drug combination which inhibits the reabsorption of sodium and chloride in the distal tubules causing increased excretion of sodium, potassium and water.

This medicine is available in tablet form in the market and you can get this combined medicine only with your doctor's prescription.

2 What to Know Before Using

Before using Exforge HCT, the risk and benefit ratio of taking the drug should be considered. This is a decision that your doctor will make with your active participation.

There are some important factors such as drug interaction, metabolic impairment, hypersensitivity reaction, pregnancy, lactation etc. which may alter the drug action.

Sometimes presence of other health disorders affects the beneficial effects of this medicine and even may cause serious complications. Make sure you mention your doctor if you have any other medical problems. 

The use of amlodipine is contraindicated if there is history of hypersensitivity reactions to amlodipine or other calcium channel blocker. This combined antihypertensive formulation should not be used in patients with known hypersensitivity to valsartan, hydrochlorothiazide or sulfonamides. 

In addition, this drug should not be used in patients with severe hepatic impairment, anuria, biliary obstruction, untreated Addison’s disease, refractory hypokalaemia, hyponatraemia, hypercalcaemia, and hyperuricaemia.   

Certain drugs should not be used concurrently with such medications. Plasma concentrations may be elevated with azole antifungals and ritonavir. Valsartan may antagonize hypotensive effects and increase the risk of renal impairment with NSAIDs. 

There is increased risk of hyperkalemia with potassium-sparing diuretics, potassium supplements, or potassium containing salt substitutes. In addition, hydrochlorothiazide increases toxicity of lithium. It may potentiate orthostatic hypotension with barbiturates and narcotics. 

Thus, it is always recommended to consult with your doctor if you are in need of some drugs for another health problem in order to avoid unwanted serious complications.

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans. 

But potential benefits may warrant use of the drug in pregnant women despite potential risks.

3 Proper Usage

Exforge HCT should be used following the directions given by a doctor. The dose of this medicine will vary according to patient’s condition or requirements. You should follow the doctor's directions and advices. 

The amount of medicine that you take should not exceed the maximum therapeutic dose. Also, the frequency of your daily drug administration and the duration of drug therapy depend on the particular medical problem for which you are taking the medicine. 

In order to treat hypertension, the treatment is usually started in an adult with one tablet that should be taken once daily.

The dose should not exceed amlodipine 10 mg/day, valsartan 320 mg/day and hydrochlorothiazide 25 mg/day.

Always try to take your medicine in time. If you miss any dose of this medicine, you should take it as soon as possible. But if it is time for your next dose, then you should skip the missed dose and go back to your regular treatment schedule. 

You should store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children. Outdated medicine must be disposed by an appropriate way.

4 Precautions to Take

If you take Exforge HCT, your doctor should perform routine checkups and advise you in taking precautions.

Regular visits are recommended to make sure this medicine is working properly or not while you are receiving a drug therapy. Some important measures should be taken if you feel any discomfort following this drug therapy. 

Although amlodipine is excreted primarily via kidney, mild renal impairment does not appear to have an effect on the plasma concentrations. Severe renal impairment may however require a dosage reduction. 

Amlodipine is not dialyzable and its half-life is prolonged in patients with impaired hepatic function. It should therefore be administered at lower (5mg) initial dose in these patients. An increased number of pulmonary edema has been reported in those who received amlodipine in heart failure

Moreover, this combined antihypertensive preparation should be used with great care in patients with certain diseases like diabetes, impaired liver or renal function, congestive heart failure, sick-sinus syndrome, severe ventricular dysfunction, hypertrophic cardiomyopathy, and severe aortic stenosis. 

This medication may exacerbate systemic lupus erythematosus (SLE). Regular monitoring of serum potassium level is recommended while receiving this combined medicine. 

You should observe for signs of fluid or electrolyte imbalance throughout the treatment period. Before testing for parathyroid function, you are advised to stop receiving this combined therapy. 

Moreover, this medicine may affect the ability to drive or operate machinery.

5 Potential Side Effects

There are some unwanted side effects associated with Exforge HCT that usually do not need medical attention. These side-effects usually go away during the treatment episode as your body adjusts to the medicine. 

Your healthcare professional may advise you about the ways how to prevent or reduce those unwanted side-effects. The common side effects of this combined antihypertensive medication are given below: 

  • Adverse effect profile of amlodipine: headache, peripheral edema, fatigue, somnolence, nausea, abdominal pain, flushing, dyspepsia, palpitations, dizziness etc. Rarely pruritus, rash, dyspnea, asthenia, and muscle cramps. Potentially fatal conditions like hypotension, bradycardia, conductive system delay and CCF may also arise.
  • Adverse effect profile of valsartan: dizziness, headache, dose-related orthostatic hypotension, rash, angioedema, hyperkalemia, myalgia, respiratory tract disorders, back pain, GI disturbances, fatigue, increased serum creatinine, abdominal pain, dry cough, LFT elevation etc. Blood dyscrasias (e.g. neutropenia) are reported in some individuals which are regarded as potentially fatal conditions.
  • Adverse effect profile of hydrochlorothiazide: volume depletion and electrolyte imbalance, dry mouth, lethargy, drowsiness, muscle pain and cramps, hypotension, rashes, photosensitivity, thrombocytopenia, jaundice, pancreatitis, fatigue, weakness, impotence, hyperglycemia, anorexia, gastric irritation, nausea, vomiting, constipation, diarrhea, raised calcium concentration etc. In addition, this drug may precipitate an attack of gout
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