Dilatrend

Дилатренд Drug photo

The description is actual on 29.03.2016

  • Latin name: Dilatrend
  • ATH code: C07AG02
  • Active ingredient: Karvedilol
  • Producer: F. Hoffmann-la Rosh Ltd. (Switzerland)

Structure

1 tablet of drug Dilatrend can include 6,25 mg; 12,5 mg or 25 mg of a karvedilol.

In addition: monohydrate of lactose, K25 povidone, sucrose, krospovidon, magnesium stearate, anhydrous colloid silicon dioxide, iron oxide (yellow, red) as dye.

Release form

Drug Dilatrend is made in the form of tablets No. 30 in a pack.

Pharmacological action

Anti-anginal, vazodilatiruyushchy, anti-proliferative, antioxidant, hypotensive.

Pharmacodynamics and pharmacokinetics

Karvedilol treats group of the medical drugs which are blockers alfa1-, beta1 - and beta2-adrenoceptors which possess organoprotektivny efficiency represent the powerful antioxidants liquidating oxygen free radicals and are characterized by anti-proliferative influence in relation to vascular smooth muscle fabric. Karvedilol is also racemic mix S (-) and R (+) the stereoisomers possessing separately similar antioxidant and alpha and adrenoceptor blocking action. Beta and adrenoceptor blocking effects of drug non-selective are also defined by left-handed stereoisomer S (-).

Karvedilol does not show sympathomimetic internal activity and also as propranolol, shows membranostabiliziruyushchy qualities. Blocking beta adrenoceptors, drug is lowered by activity RAAS (renin-angiotensin-aldosteronovaya system) and reduces release of a renin in this connection the liquid delay inherent in the selection alpha adrenoblokatoloram, is observed rather seldom. The selection blocking karvediloly alfa1-adrenoceptors reduces the general resistance of peripheral vascular system.

Use of a karvedilol does not make negative impact on a lipidic profile and supports a normal ratio between levels of lipoproteins of the low and high density (LPNP/LPVP).

Purpose of a karvedilol to the patients having arterial hypertension due to complex blockade beta and alfa1-adrenoceptors leads to decrease in the ABP which is not followed by parallel increase of the general resistance of peripheral vessels which is noted at therapy by non-selective beta adrenoblockers at this ChSS of the patient a little decreases. Function of kidneys and a renal blood stream remain at the former level. Karvedilol does not make changes to a stroke output, promotes decrease in the general resistance of peripheral vessels, does not break a peripheral blood stream and blood supply of systems and bodies of a human body, including muscles of a skeleton, the lower extremities, forearms, integuments, a carotid artery and a brain. Against administration of drug and performance of exercise stresses increased fatigue of the patient and a cold snap of his extremities was seldom noted. Hypotensive efficiency of a karvedilol, at its reception concerning treatment of arterial hypertension, remains at the high level throughout quite long time.

At reception of a karvedilol for treatment of patients with an ischemic heart disease (coronary heart disease) its anti-anginal and antiischemic positive impact which is shown increase in cumulative duration of exercise stresses, the period up to developing of a depression of a ST segment of 1 mm in depth and an interval of time up to forming of an attack of stenocardia, remaining throughout a long time of carrying out therapy is noted. Reliable decrease karvediloly is proved to need of a myocardium for additional oxygen and reduction of activity of sympathoadrenal system by it. Also drug weakens preloading (pulmonary pressure in capillaries and jamming pressure in an artery of lungs) and an afterload (the general resistance of peripheral vessels).

Carrying out therapy using a karvedilol reduces mortality of patients with CHF (chronic heart failure) of any functional class and in each stage of the development and is quite well transferred by patients (by results of testing of COMET, COPERNICUS). Reception of these tablets significantly reduces episodes of hospitalization of patients because of cardiovascular disturbances, raises fraction of emission and reduces negative manifestations of not ischemic and ischemic genesis. Efficiency of a karvedilol depends on the accepted dose.

At reception of a karvedilol peroral (inside) process of its absorption happens quickly enough. Plasma Cmax of drug is observed approximately after 60 minutes. The indicator of absolute bioavailability is approximately equal to 25%.

High lipophilicity is characteristic of a karvedilol, its linkng with plasma proteins is carried out for 98-99%, Vd equals about 2 l/kg.

Biotransformation of a karvedilol happens in a liver to allocation of a number of products of a metabolism. 60-75% of the soaked-up drug are exposed to metabolic transformations at first "passing" through a liver. Also note existence of enterohepatic circulation of initial substance.

Owing to processes of a hydroxylation and demethylation of a phenolic ring 3 metabolites of a karvedilol (with 10 multiply smaller concentration in comparison with initial substance) possessing beta and adrenoceptor blocking efficiency which at 4 ’-a hydroxyphenolic metabolite is nearly 13 times stronger concerning the karvedilol form. In total 3 active products of a metabolism of drug show weaker vazodilatiruyushchy influence, than the main drug. Two of hydroxycarbacindery metabolites of active ingredient of Dilatrend are very powerful antioxidants, exceeding similar activity of a karvedilol at 30-80 times.

T1/2 of a karvedilol is equal to about 6 hours, the plasma clearance makes 500-700 ml/min. Excretion happens mostly to a stake, the prevailing way of removal of drug – to bile. The insignificant part of the substance accepted inside is removed by kidneys in the form of various products of a metabolism.

At purpose of a karvedilol to patients with renal functional disturbances, even in case of prolonged use of tablets, changes of glomerular filtering and intensity of a renal blood-groove are not observed. At the patients having an arterial hypertension together with a renal failure indicators of Cmax, AUC and T1/2 remain at the former level. Renal excretion of not changed karvedilol at pathologies of kidneys decreases, but with moderately expressed changes in pharmacokinetic parameters of drug.

High performance of a karvedilol was proved at its use for the purpose of therapy of renal hypertensia (an arterial hypertension of renal genesis), including purpose of drug to patients with HPN, and also to patients with the replaced kidney or passing a hemodialysis. In such cases action of a karvedilol leads to gradual lowering of the ABP of the patient, both in day of passing of procedure of a hemodialysis, and in the next days without its use, and hypotensive efficiency of drug is comparable to that at patients with normal renal function. During a hemodialysis itself karvedilol it is not removed as its particles do not pass through a dialysis membrane, most likely because of high linkng of substance with plasma proteins.

At patients with the diagnosed cirrhosis increase in the system bioavailability of drug by 80% occurring owing to decrease in expressiveness of metabolic processes at the first passing through a liver is noted. For this reason purpose of a karvedilol is contraindicated to patients with manifest clinical disturbance of hepatic function.

At elderly patients with an arterial hypertension portability and pharmacokinetics of a karvedilol corresponds that for younger patients.

Data on pharmacokinetic features of drug at children's age (till 18 years) at this stage of its use are limited.

At patients with in parallel observed arterial hypertension and the 2nd type of a diabetes mellitus (non-insulin-dependent) use of a karvedilol did not lead to changes of serumal concentration of the glucose measured after food and on an empty stomach. Also reception preparatf does not influence the level of content in blood of glikozilirovanny hemoglobin and does not demand change of the dosing mode of hypoglycemic remedies. When carrying out some clinical trials it is revealed that at the patients suffering from the 2nd type of a diabetes mellitus, reception of a karvedilol was not followed by changes of results of testing of tolerance to glucose. At patients with an arterial hypertension without manifestations of a diabetes mellitus possessing an insulinorezistentnost (a syndrome of X) therapy karvediloly improves a susceptibility to insulin. Identical indicators were received rather sick with the 2nd type of a diabetes mellitus and arterial hypertension.

Indications to use

Medicine use Dilatrend is shown at:

  • coronary heart disease, including patients with asymptomatic ischemia of a myocardium and unstable stenocardia;
  • essential hypertensia, both as monotherapy, and in a combination with other hypotensive medical drugs, for example, diuretics or antagonists of calcium;
  • the chronic heart failure (CHF) of not ischemic or ischemic nature, from easy to heavy severity in a combination with diuretics, APF inhibitors, drugs of a digitalis or without those (for the purpose of lowering of the possible complications leading to hospitalization and a lethal outcome and also for delay of development of a disease and improvement of the general condition of the patient).

Contraindications

Dilatrend's appointment is absolutely contraindicated at:

  • syndrome of weakness (weak) sinus node;
  • pregnancies;
  • cardiogenic shock;
  • feeding by a breast;
  • the expressed bradycardia (about less than 50 beats/min);
  • high personal sensitivity to a karvedilol or other ingredients of tablets;
  • heavy arterial hypotension;
  • the dekompensirovanny and acute HSN demanding carrying out in/in injections of inotropic drugs;
  • heavy disturbances of hepatic function;
  • bronchial asthma or the phenomena of a bronchospasm (in the anamnesis);
  • II and III extents of AV blockade (except the patients using an electrocardiostimulator);
  • till 18 years (because of unspecified efficiency and safety).

With extra care Dilatrend's use is possible at:

Side effects

HSN observed at Dilatrend's reception concerning treatment

TSNS:

  • headaches (most often at the beginning of therapy and benign);
  • dizziness;
  • adynamy (including increased fatigue);
  • depressions.

Cardiovascular system:

  • postural hypotension;
  • bradycardia;
  • developing of hypostases (including the peripheral, generalized, caused by situation bodies, hypostases of legs and a crotch, a liquid delay, a hypervolemia);
  • the expressed lowering of the ABP;
  • preunconscious and unconscious states;
  • heart failure and atrioventricular block (at increase of dosages).

Bodies of a gastrointestinal tract:

  • nausea with the subsequent vomiting;
  • diarrhea.

System of a hemopoiesis:

  • manifestations of a leukopenia and/or thrombocytopenia.

Metabolism:

  • decompensation of a metabolism of carbohydrates;
  • increase in weight;
  • hyper - or a hypoglycemia (in the presence of a diabetes mellitus);
  • hypercholesterolemia.

Others:

  • renal failure;
  • vision disorders;
  • decrease in renal function (at pathologies of kidneys and a diffusion vasculitis).

The ischemic heart diseases observed at Dilatrend's reception concerning treatment and arterial hypertension

TSNS:

  • decrease in mood;
  • feeling of dizziness;
  • paresthesias;
  • the general weakness and headaches (most often at the beginning of therapy and benign);
  • sleep disorder.

Cardiovascular system:

  • displays of heart failure;
  • peripheral hypostases;
  • bradycardia;
  • AV blockade;
  • postural hypotension;
  • stenocardia;
  • unconscious states (generally in an initiation of treatment);
  • frustration of peripheric circulation (a cryesthesia in legs, Reynaud's syndrome, progressing of the "alternating" lameness).

Respiratory organs:

  • development of an asthma and bronchospasm (at observed predisposition to similar complications);
  • nose congestion;
  • sneezing.

Bodies of a gastrointestinal tract:

Integuments:

Laboratory indicators:

  • leukopenia;
  • increase in activity of enzymes of a liver;
  • thrombocytopenia.

Others:

  • extremity pains;
  • dryness in a mouth;
  • irritation of eyes;
  • grippopodobny syndrome;
  • decrease in a potentiality;
  • vision disorder;
  • decrease in a slezootdeleniye;
  • exacerbation of psoriasis (at its existence);
  • disturbance of an urination.

Due to the beta and adrenoceptor blocking effects of drug suppression of kontrinsulyarny system, progressing of a latent diabetes mellitus, and also a decompensation of the existing diabetes mellitus is theoretically possible.

Dilatrend, application instruction

Tablets Dilatrend are intended for oral (internal) administration with a water volume, sufficient for a full proglatyvaniye of a tablet.

For the purpose of therapy of an ischemic heart disease in the first 2 days recommend reception of tablets in a daily dosage of 25 mg in two steps (on 12,5 mg). At adequate portability of this dose further pass to daily reception 50 mg in two steps (on 25 mg). In the conditions of inefficiency of the used scheme of treatment perhaps gradual (bucketed in 14 days) increase of doses of Dilatrend, up to the most acceptance limits making 100 mg at 24 o'clock in 2 receptions (on 50 mg).

For treatment of an essential hypertension in the first 2 days recommend reception of tablets in a daily dosage of 12,5 mg in one step. At adequate portability of this dose further pass 25 mg of drug to single daily dose. In the conditions of inefficiency of the used scheme of treatment perhaps gradual (bucketed in 14 days) increase of doses of Dilatrend, up to the most acceptance limits making 50 mg at 24 o'clock in 1 or 2 receptions (on 25 mg).

At therapy of HSN selection of dosages of Dilatrend is carried out in an individual order under careful supervision of medical personnel. At already carried out treatment of the patient with use of APF inhibitors, diuretics or drugs of a foxglove, it is necessary to stabilize their dosing mode prior to reception of tablets Dilatrend.

For the first 14 days of treatment to the patient recommend to accept 3,125 mg of Dilatrend twice at 24 o'clock. At adequate portability of this dose its increase (bucketed in 14 days) to 6,25 mg twice a day, up to 12,5 mg later twice a day and perhaps to 25 mg 2 times at 24 o'clock further follows. It is necessary to increase Dilatrend's dosages up to maximum well transferable patient of a dose. For patients with any weight of HSN weighing up to 85 kilograms such daily dose equals 50 mg in 2 receptions (on 25 mg). For patients with HSN of easy and moderate weight weighing more than 85 kilograms – 100 mg in 2 receptions (on 50 mg).

Before each increase of dosages of Dilatrend the attending physician is obliged to perform inspection of the patient for the purpose of possible detection of increase of symptomatology of a vazodilatation or heart failure. In case of tranzitorny increase of negative displays of heart failure or an observed delay of liquid it is necessary to raise a dosage of diuretics (sometimes it is necessary to lower Dilatrend's dose or to suspend his reception).

At more than the 7th a daily break in treatment by Dilatrend, resuming of reception of tablets should be carried out from a smaller previous dosage, with the subsequent its increase according to the scheme which is stated above. In case of the break in treatment exceeding 14 days, its resuming is possible in an initial dose of 3,125 mg twice at 24 o'clock, with the subsequent increase of dosages according to the above-stated recommendations.

Elimination of symptomatology of a vazodilatation is carried out by decrease in doses in parallel of the accepted diuretics. At preservation of symptoms reduce an APF inhibitor dosage (in case of its combined use), and later, at insufficient efficiency, lower Dilatrend's dose. In this situation do not recommend to increase Dilatrend's dose, up to full solution of problems, connected with displays of arterial hypotension or heart failure again.

At Dilatrend's appointment to elderly patients or patients with renal pathologies, correction of the dosing mode is not required.

Overdose

At overdose karvediloly observed: confusion of consciousness, the expressed lowering of the ABP, vomiting, forming of heart failure, bradycardia, a bronchospasm, development of cardiogenic shock, breath disturbance, generalized spasms, a cardiac standstill.

Therapy of such negative complications, in addition to the standard actions (a vomiting call, cleaning of a gastrointestinal tract, reception of sorbents), demands carrying out monitoring and, if necessary, correction of the vital functions of an organism (sometimes in an intensive care unit).

Most often, for leveling of symptomatology of overdose, recommend to resort to the following actions and drugs:

  • to give to the patient horizontal position (lying on spin) and to raise legs a little up;
  • in case of detection of the expressed bradycardia to enter into 0,5-2 mg of Atropine;
  • for the purpose of maintenance and adjustment of cardiovascular function in/in struyno to enter 1-10 mg of the Glucagon then to appoint it in the form of continuous infusion in a dose of 2-5 mg an hour;
  • to appoint sympathomimetics (Epinephrinum, Izoprenalin, Dobutaminum, Ortsiprenalin) which doses are defined depending on the weight of the patient and a therapeutic effectiveness of drug (in case of need introductions of remedies with positive inotropic efficiency reception of inhibitors of phosphodiesterase is in parallel shown);
  • at domination of negative symptomatology of arterial hypotension introduction of Norepinephrinum which is carried out in the conditions of continuous monitoring of function of blood circulation is shown;
  • in case of bradycardia, insensitive to the carried-out therapy, recommend to use an electrocardiostimulator;
  • at a bronchospasm use of aerosol beta-adrenergic agonists is reasonable, at inefficiency practice them in/in maintaining or as alternative, in/in introduction of Aminophyllinum;
  • noted spasms stop slow in/in administration of Clonazepam or Diazepam.

Cases of heavy overdose karvediloly, proceeding with shock symptomatology, often are followed by lengthening of T1/2 of drug and its removal from depot in this connection carrying out the supporting / disintoxication treatment before full stabilization of a condition of the patient can take a long time.

Interaction

Parallel use of Dilatrend with oral hypoglycemic drugs or insulin can lead to strengthening of their sakharosnizhayushchy efficiency. The hypoglycemia symptomatology, in particular tachycardia, can weaken or mask. The patients accepting this combination of medicines should control regularly glucose level in blood.

At the combined treatment using a karvedilol and Digoxin, plasma concentration of the last increases approximately by 15%. Both of these drugs promote delay of atrioventricular conductivity. At appointment stages, the choice of a dosage and cancellation of a karvedilol it is necessary to watch the plasma level of Digoxin regularly.

Joint reception of Dilatrend with Rifampicin lowers the plasma maintenance of a karvedilol approximately for 70%, with Cimetidinum does not change Cmax of a karvedilol, but increases its AUC approximately by 30%. Careful appointment of Dilatrend patients demand already receiving drugs being inductors of multifunctional oxidases (in particular rifampicin) which reduce plasma Cmax of a karvedilol, and also medicines from group of inhibitors of multifunctional oxidases (in particular, Cimetidinum) which raise Cmax of a karvedilol. However, observed influence of Cimetidinum on Cmax of a karvedilol is so insignificant that will hardly lead to any significant changes of its pharmacokinetics.

At reception of a karvedilol by patients with the transplanted kidney and observed vascular rejection of this body moderate increase in average values of content of the Cyclosporine accepted by them was noted. For maintenance of concentration of cyclosporine at the therapeutic level, approximately at 30% of patients it was necessary to lower its dose on average by 20%, therapy of other patients was not exposed to change of the dosing mode. Due to the individual expressed fluctuations of a necessary daily dosage of cyclosporine recommend to carry out careful monitoring of its plasma contents after purpose of a karvedilol and to adjust cyclosporine doses in case of such need.

The concomitant use of Dilatrend and the remedies lowering the level of catecholamines (in particular inhibitors of a monoaminooxidase and Reserpinum) demands careful supervision over a condition of the patient, in connection with a possibility of forming of the expressed bradycardia and/or arterial hypotension.

Parallel use of a karvedilol with a clonidine can lead to potentiation of the reducing a cordial rhythm and hypotensive action. In case of need simultaneous cancellation of these drugs at first stop reception of a karvedilol and only in several days, gradually reducing a dose, cancel a clonidine.

The combined Dilatrend's reception with Diltiazem, Verapamil or other antiarrhytmic drugs (Amiodaronum, Propranolol) can become the reason of disorders of atrioventricular conductivity that demands carrying out such combination therapy under control of indicators of the ABP and an ECG.

Karvedilol, as well as other means with beta and adrenoceptor blocking efficiency, can increase effect in parallel of the accepted anti-hypertensive drugs (in particular alfa1-adrenoblockers), and also the drugs possessing hypotensive side effects.

Karvedilol prevents increase of the ABP at introduction of agonists of alfa1-adrenoceptors (for example, Fenilefrina), but does not influence the increase in the ABP caused by angiotensin II.

In need of carrying out the patient of the general anesthesia should consider possibility of the negative supplementing inotropic effect of active ingredient of Dilatrend — Karvedilolaand some anesthetics.

Terms of sale

The remedy Dilatrend is released from drugstores in the presence of the recipe.

Storage conditions

Drug Dilatrend demands temperature condition of the storage which is not exceeding 25 °C.

Period of validity

Dilatrend's tablets with the different mass maintenance of a karvedilol have different periods of validity: 6.25 mg — 3 years; 12.5 mg — 4 years; 25 mg — 5 years.

Special instructions

At patients with HSN during selection of dosages of Dilatrend the delay of liquid or increase of negative symptomatology of heart failure can be observed. In a case emergence of such complications it is necessary to raise a dose in parallel of the accepted diuretics and not to increase Dilatrend's dosage up to full stabilization of these disturbances. Occasionally resort to decrease in doses of Dilatrend or to his full cancellation it is (very rare). Similar negative episodes do not prevent the subsequent adequate selection of the dosing regime of Dilatrend.

Careful purpose of a karvedilol is demanded by the patients accepting cardiac glycosides because of possible excessive braking of AV conductivity.

In case of Dilatrend's appointment to patients with HSN and the low ABP (at the systolic ABP it is less than 100 mm of mercury.), the ischemic heart disease and a renal failure and/or diffusion vascular changes observed deterioration in renal function (reversible). In this case the dosing mode is regulated according to a functional condition of kidneys.

Patients with HOBL which do not receive inhalation or peroral antiasthmatic remedies can accept Dilatrend only in a case, significant exceeding of possible positive effects from such therapy in comparison with its potential risk. At the present tendency of the patient to a bronkhospastichesky syndrome Dilatrend's reception, because of increase of resistance of ways of breath, can lead to forming respiratory a distress syndrome. Such patients at the beginning of Dilatrend's reception and in the course of increase in its dosages demand careful supervision and reduction of doses of drug in case of identification of the first signs of development of a bronchospasm.

Careful appointment of Dilatrend is demanded by patients with a diabetes mellitus as effects of this drug can weaken or mask hypoglycemia symptomatology (in particular tachycardia). Patients with insufficiency of cordial function and a diabetes mellitus have a carrying out therapy karvediloly can provoke a decompensation of carbohydrate metabolism.

Also care of use Dilatrenda is necessary at therapy of patients with pathologies of peripheral vessels (including Reynaud's syndrome) as such treatment can lead to strengthening of manifestations of arterial insufficiency.

At reception of tablets of Dilatrend it can be observed decrease in expressiveness of symptomatology of a thyrotoxicosis.

Because of possible summation of negative effects of anesthetics and a karvedilol it is necessary to be careful when carrying out surgeries with use of the general anesthesia.

Dilatrend's reception can become the reason of forming of bradycardia therefore at decrease in ChSS of the patient to 55 beats per minute it is necessary to modify a drug dosage towards its decrease.

At purpose of treatment using Dilatrend persons at whose anamnesis there are instructions on development of the heavy phenomena of hypersensitivity and also the patient taking a desensibilizirovanny course of therapy should show extra care as karvedilol can increase sensitivity of the patient to allergens and the level of weight of the anaphylactic phenomena.

Patients in whose anamnesis there are certificates on developing of psoriasis should appoint Dilatrend only after a careful assessment of advantage/risk from carrying out such therapy.

At the patients in parallel accepting antagonists of calcium (for example, Diltiazem, Verapamil), and also other antiarrhytmic drugs, it is necessary to trace constantly indicators of the ABP and to carry out an ECG.

The patients suffering from a pheochromocytoma before purpose of any drug from a beta adrenoblokatornym should appoint action medicines from group of alpha adrenoblockers. There is no experience of use of Dilatrend possessing, both alpha, and beta and adrenoceptor blocking effects, in relation to patients with a pheochromocytoma in this connection such patients need to carry out his appointment with extra care.

Reception of tablets of Dilatrend can provoke developing of pains at patients with Printsmetal's stenocardia. Lack of experience of use of Dilatrend for treatment of such patients, even at its theoretical possibility of prevention of similar manifestations, demands careful purpose of drug.

The patients accepting Dilatrend and using contact lenses have to remember probability of decrease in amount of the emitted lacrimal liquid.

Because therapy with Dilatrend's use is most often fixed on an interval of quite long time, it is necessary to cancel drug gradually, lowering its dosages with the interval making not less than 7 days (in particular for patients with an ischemic heart disease).

In case of storage of tablets of Dilatrend on light it can be observed change of their color.

Dilatrend's analogs

Coincidence on the ATH code of the 4th level:
  • Albetor;
  • Lakardiya;
  • Albetor Long.

Zdravzona

  • Dilatrend 12,5mg tablet No. 30
  • Dilatrend of 25 mg No. 30 of a tablet
  • Dilatrend 6,25mg tablet No. 30

Drugstore of IFC

  • Dilatrend tbl 6,25 mg No. 30, Roche-Diagnostika/Hoffmann-La Rocheitaliya
  • Dilatrend tbl 25 mg No. 30, Roche-Diagnostika/Hoffmann-La Rocheitaliya
  • Dilatrend tbl 12.5mg No. 30, Roche-Diagnostika/Hoffmann-La Rocheitaliya
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Section: Cardiological Cardiovascular
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Education: Graduated from the Vinnytsia national medical university of N. I. Pirogov, pharmaceutical faculty, the higher pharmaceutical education – the specialty "Pharmacist".

Experience: Work in Koneks and Bios-Media pharmacy chains as "Druggist". Work as "Pharmacist" in Avicenna pharmacy chain of the city of Vinnytsia.

PAY ATTENTION! Information on drugs on the website is help generalizing, collected from public sources and can form the basis for making decision on use of medicines it is not aware of treatment. Before medicine use Dilatrend surely consult with the attending physician.