Tarka

The medicine for stabilizing blood pressure Tarka belongs to calcium channel blockers – drugs based on verapamil.

Indications Tarki

The use of Tarka is appropriate to improve the condition of people with essential hypertension if their blood pressure readings stabilize after taking trandolapril and/or verapamil.

Release form

Tarka is produced in capsule form and is classified as a prolonged-release drug.

One capsule of Tarka contains two active ingredients:

• trandolapril in the amount of 2 mg;
• verapamil hydrochloride in the amount of 180 mg.

Tarka capsules are dense, light pinkish gelatin forms, inside which there is a granulated mass of trandolapril and a tablet of verapamil hydrochloride.

The blister plate contains ten capsules of the drug. The cardboard packaging box contains two blister plates and instructions for using Tarka.

Pharmacodynamics

Tarka capsules are a pharmaceutical combination of the calcium antagonist verapamil with the ACE inhibitor trandolapril.

The pharmacological effect of verapamil is explained by the inhibition of the flow of calcium ions through the slow calcium channels of the cell membranes of the smooth muscle structure of blood vessels and the heart muscle.

Verapamil has the following properties:

• lowers blood pressure at rest or during physical activity (through vasodilation);
• reduces the degree of resistance of peripheral vessels and decreases the heart muscle's need for oxygen;
• reduces the contractile function of the heart muscle without affecting the symptomatic regulation of cardiac activity.

The functional orientation of trandolapril is to block the serum renin-angiotensin-aldosterone complex, to reduce the level of angiotensin II in the blood serum, to reduce vasopressor activity and normalize aldosterone production. Trandolapril in Tarka improves peripheral vasodilation by stimulating the prostaglandin system. Probably, a similar mechanism occurs in the hypotensive effect of ACE inhibitors, and is also responsible for the occurrence of individual side effects.

In patients with high blood pressure, treatment with ACE inhibitors leads to a decrease in blood pressure, regardless of body position. No compensatory acceleration of cardiac activity is observed against this background. Peripheral arterial resistance decreases: cardiac output remains unchanged or increases.

Increased renal blood flow may be observed. However, the filtration rate does not change. In order to achieve a stable decrease in blood pressure, some people have to undergo treatment for several weeks. At the same time, the effect of taking Tarka is maintained even with long-term treatment. In the future, blood pressure does not rise even if treatment with Tarka capsules is abruptly interrupted.

No negative interactions between the active ingredients of Tarka were found in the experiments. Therefore, it is assumed that the synergistic effect of verapamil and trandolapril is due to their combined pharmacological properties. Such a combination is considered more effective than taking each drug separately.

Pharmacokinetics

Tarka capsules contain verapamil hydrochloride, which has a slow release, and trandolapril with an accelerated release.

Verapamil is absorbed by approximately 90%. The average bioavailability is 22%, and with prolonged use it can increase to 30%.

The presence of food in the stomach does not interfere with the degree of bioavailability of verapamil.

The average time to reach the maximum serum concentration is 4 hours. Equilibrium with long-term administration of the drug at a frequency of once a day is observed after 3-4 days.

Verapamil binding to plasma albumins can be 90%.

The half-life after prolonged treatment with Tarka is approximately eight hours. Approximately 3.5% of the administered amount of the drug is excreted unchanged by renal filtration. Metabolites are excreted in 70% in urine and 16% in feces.

Bioavailability may increase in patients with liver cirrhosis. However, the kinetic properties of verapamil remain unchanged.

Trandolapril is absorbed relatively quickly, absorption can range from 30 to 60%, regardless of the presence of food in the stomach.

The maximum level of the drug is detected half an hour after administration.

Trandolapril from Tarka capsules is rapidly eliminated from the blood serum, with an average half-life of less than 60 minutes. The drug undergoes hydrolysis processes in plasma to form trandolaprilat.

The time to reach mean serum peak concentrations may range from 3 to 8 hours. Total bioavailability is 13%.

The binding of trandolaprilat to plasma albumins is close to 80%. The binding to ACE is considered saturated. The main amount of circulating trandolaprilat is also bound by creating an unsaturated protein bond. Equilibrium can be achieved after 4 days of continuous administration of Tarka.

The half-life of trandolaprilat is estimated to be 15 and 23 hours.

Between 9 and 14% of the administered amount of trandolapril is excreted in the urine as unchanged trandolaprilate.

The clearance values of trandolaprilat show a linear correlation with creatinine clearance and are in the range of 0.15-4 L/hour, depending on the dosage. Serum trandolaprilat levels are greatly increased in patients with creatinine clearance less than 30 ml/min. After repeated administration to patients with chronic renal failure, steady state is observed within four days.

Serum trandolapril levels in patients with liver cirrhosis are typically approximately ten times higher than in healthy individuals.

Since the pharmacokinetic type of interaction of individual components verapamil and trandolapril has not been studied, the kinetic values of both the first and second drugs are used in relation to the drug Tarka.

Dosing and administration

Adult patients should take one capsule of Tarka daily, preferably in the morning, regardless of whether there is food in the stomach. The Tarka capsule is swallowed whole: do not chew or empty the capsule contents.

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Use Tarki during pregnancy

The use of Tarka by pregnant patients is prohibited.

Experts have failed to prove the safety of using Tarka during pregnancy. On the contrary, cases of intrauterine pulmonary hypoplasia, inhibition of intrauterine fetal growth, and hypoplastic cranial developmental disorders have been recorded.

Women of reproductive age should ensure that they are not pregnant and use reliable methods of contraception before starting treatment with Tarka.

The main ingredients of Tarka are excreted in breast milk, so treatment with the drug during lactation is also contraindicated.

Contraindications

Tarka capsules are not prescribed for the following painful conditions:

• tendency to allergy to this medication or to other ACE inhibitor drugs;
• an episode of atrioventricular block of the second or third degree, in the absence of a functioning IVR;
• hereditary or idiopathic form of angioedema;
• cardiogenic shock;
• acute form of myocardial infarction, accompanied by complications;
• weakness of the sinus node in patients without a functioning sinus venous system;
• cardiac insufficiency in the decompensation stage;
• atrial flutter and/or fibrillation;
• the period of bearing and breastfeeding a child.

Side effects Tarki

Most often, taking Tarka is accompanied by such undesirable symptoms as cough, headache, difficulty with bowel movements, dizziness, hot flashes.

Less common side effects may include:

• thrombocytopenia, leukopenia;
• allergy;
• change in body weight towards decrease;
• sleep disturbances, anxiety, apathy;
• tremors in the limbs, impaired sensitivity of the limbs, vestibular disorders;
• deterioration of vision;
• first degree atrioventricular block;
• bronchitis, pulmonary congestion;
• abdominal pain, diarrhea or constipation, thirst, inflammation of the pancreas;
• jaundice, hepatitis;
• swelling of the face, skin rashes, hyperhidrosis, redness of the skin;
• pain in muscles, joints;
• increase in daily urine volume;
• enlargement of the mammary glands, erectile dysfunction;
• feeling of fatigue.

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Overdose

Taking excessive doses of Tarka may be accompanied by the following symptoms:

• excessive decrease in blood pressure;
• electrolyte imbalances;
• slowing or increasing heart rate;
• loss of consciousness;
• state of shock;
• atrioventricular block;
• heart failure

There have been known cases of patient deaths as a result of Tarka overdose.

In case of overdose, assistance should be directed at maintaining vital functions of the body. Infusion of medications with calcium, β-adrenergic stimulation, cleansing of the stomach and intestines are used.

Due to the prolonged properties of the drug Tarka, it is necessary to establish medical supervision over the patient's condition for at least 2 days.

Hemodialysis is not used in such cases.

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Interactions with other drugs

Tarka + antiarrhythmic agents and β-blockers	Adverse effects on cardiac function
Tarka + quinidine	Enhancement of hypotensive effect
Tarka + antihypertensive drugs, diuretics and vasodilators	Enhancement of hypotensive effect
Tarka + prazosin, terazosin	Enhancement of hypotensive effect
Tarka + drugs used in HIV therapy (eg, ritonavir)	Increased serum verapamil concentrations
Tarka + carbamazepine	Increased blood carbamazepine levels and increased side effects from carbamazepine
Tarka + lithium preparations	Increased neurotoxic effects of lithium
Tarka + rifampicin	Decreased hypotensive effect of verapamil
Tarka + sulfinpyrazone	Reduction of the hypotensive effect of verapamil
Tarka + muscle relaxants	Enhancement of the effect of muscle relaxants
Tarka + aspirin	Increased risk of bleeding
Tarka + ethyl alcohol	Increased concentration of ethyl alcohol in the blood
Tarka + simvastatin and lovastatin	Increased plasma concentrations of the listed drugs
Tarka + potassium preparations	Increased risk of hyperkalemia
Tarka + hypoglycemic drugs	Increased hypoglycemic effect and risk of hypoglycemia
Tarka + nonsteroidal anti-inflammatory drugs	Decreased hypotensive effect

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Storage conditions

Tarka capsules are stored without removing them from the packaging, in dry and warm rooms. It is optimal to store the medicine at a temperature of +18 to +25°C, out of reach of children.

Shelf life

Tarka capsules can be stored for up to 3 years.