Blokatens Uses

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What is Blokatens?

Blokatens contains a combination of Amlodipine (Blokatens) and Valsartan (Blokatens). Amlodipine (Blokatens)) is a calcium channel blocker. It works by relaxing the muscles of your heart and blood vessels.

Valsartan (Blokatens) is an angiotensin II receptor antagonist. Valsartan (Blokatens) keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

Blokatens is used to treat high blood pressure (hypertension).

Blokatens is usually given after others have been tried without successful treatment of hypertension.

Blokatens indications

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Hypertension

Blokatens (Amlodipine (Blokatens) and Valsartan (Blokatens)) is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes, including Amlodipine (Blokatens) and the ARB class to which Valsartan (Blokatens) principally belongs. There are no controlled trials demonstrating risk reduction with Blokatens.

Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than 1 drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).

Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly.

Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.

Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy. Blokatens (Amlodipine (Blokatens) and Valsartan (Blokatens)) is indicated for the treatment of hypertension.

Blokatens may be used in patients whose blood pressure is not adequately controlled on either monotherapy.

Blokatens may also be used as initial therapy in patients who are likely to need multiple drugs to achieve their blood pressure goals.

The choice of Blokatens as initial therapy for hypertension should be based on an assessment of potential benefits and risks including whether the patient is likely to tolerate the lowest dose of Blokatens.

Patients with stage 2 hypertension (moderate or severe) are at a relatively higher risk for cardiovascular events (such as strokes, heart attacks, and heart failure), kidney failure and vision problems, so prompt treatment is clinically relevant. The decision to use a combination as initial therapy should be individualized and should be shaped by considerations such as baseline blood pressure, the target goal and the incremental likelihood of achieving goal with a combination compared to monotherapy. Individual blood pressure goals may vary based upon the patient’s risk.

Data from the high-dose multifactorial study provide estimates of the probability of reaching a blood pressure goal with Blokatens compared to Amlodipine (Blokatens) or Valsartan (Blokatens) monotherapy. The figures below provide estimates of the likelihood of achieving systolic or diastolic blood pressure control with Blokatens 10/320 mg, based upon baseline systolic or diastolic blood pressure. The curve of each treatment group was estimated by logistic regression modeling. The estimated likelihood at the right tail of each curve is less reliable due to small numbers of subjects with high baseline blood pressures.

Figure 1: Probability of Achieving Systolic Blood Pressure <140 mmHg at Week 8

Figure 2: Probability of Achieving Diastolic Blood Pressure <90 mmHg at Week 8

Figure 3: Probability of Achieving Systolic Blood Pressure <130 mmHg at Week 8

Figure 4: Probability of Achieving Diastolic Blood Pressure <80 mmHg at Week 8

For example, a patient with a baseline blood pressure of 160/100 mmHg has about a 67% likelihood of achieving a goal of <140 mmHg (systolic) and 80% likelihood of achieving <90 mmHg (diastolic) on Amlodipine (Blokatens) alone, and the likelihood of achieving these goals on Valsartan (Blokatens) alone is about 47% (systolic) or 62% (diastolic). The likelihood of achieving these goals on Blokatens rises to about 80% (systolic) or 85% (diastolic). The likelihood of achieving these goals on placebo is about 28% (systolic) or 37% (diastolic).

How should I use Blokatens?

Use Blokatens as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Blokatens.

Blokatens description

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Blokatens is a combination of angiotensin II (Ang II) antagonist (Valsartan (Blokatens)) with dihydropyridine derivative (Amlodipine (Blokatens)).

Amlodipine (Blokatens) besylate is 3-ethyl-5-methyl (±)-2-[(2-minoethoxy)methyl]-4-(2-chlorophenyl)-1,4-dihydro-6-methyl 3,5-pyridinedicarboxylate, monobenzenesulphonate.

Valsartan (Blokatens) is (S)-N-valeryl-N-{[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl}-valine.

Blokatens also contains the following excipients: Microcrystalline cellulose; crospovidone; anhydrous colloidal silica; magnesium stearate; hypromellose, macrogol 4000, talc, titanium dioxide (E171), yellow iron oxide (E172).

Blokatens 10/160 mg also contains red iron oxide (E172) as an excipient.

Blokatens dosage

Blokatens Dosage

Generic name: Amlodipine (Blokatens) BESYLATE 5mg, Valsartan (Blokatens) 160mg

Dosage form: tablet, film coated

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

2.1 General Considerations

Dose once daily. The dosage can be increased after 1 to 2 weeks of therapy to a maximum of one 10/320 mg tablet once daily as needed to control blood pressure. The majority of the antihypertensive effect is attained within 2 weeks after initiation of therapy or a change in dose.

Blokatens may be administered with or without food.

Blokatens may be administered with other antihypertensive agents.

2.2 Add-on Therapy

A patient whose blood pressure is not adequately controlled with Amlodipine (Blokatens) (or another dihydropyridine calcium-channel blocker) alone or with Valsartan (Blokatens) (or another angiotensin II receptor blocker) alone may be switched to combination therapy with Blokatens.

A patient who experiences dose-limiting adverse reactions on either component alone may be switched to Blokatens containing a lower dose of that component in combination with the other to achieve similar blood pressure reductions. The clinical response to Blokatens should be subsequently evaluated and if blood pressure remains uncontrolled after 3 to 4 weeks of therapy, the dose may be titrated up to a maximum of 10/320 mg.

2.3 Replacement Therapy

For convenience, patients receiving Amlodipine (Blokatens) and Valsartan (Blokatens) from separate tablets may instead wish to receive tablets of Blokatens containing the same component doses.

2.4 Initial Therapy

A patient may be initiated on Blokatens if it is unlikely that control of blood pressure would be achieved with a single agent. The usual starting dose is Blokatens 5/160 mg once daily in patients who are not volume-depleted.

More about Blokatens (Amlodipine (Blokatens) / Valsartan (Blokatens))

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Blokatens interactions

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What other drugs will affect Blokatens?

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No drug interaction studies have been conducted with Blokatens and other drugs, although studies have been conducted with the individual Amlodipine (Blokatens) and Valsartan (Blokatens) components.

Amlodipine (Blokatens)

Impact of Other Drugs on Amlodipine (Blokatens)

CYP3A Inhibitors

Co-administration with CYP3A inhibitors (moderate and strong) results in increased systemic exposure to Amlodipine (Blokatens) and may require dose reduction. Monitor for symptoms of hypotension and edema when Amlodipine (Blokatens) is co-administered with CYP3A inhibitors to determine the need for dose adjustment.

CYP3A Inducers

No information is available on the quantitative effects of CYP3A inducers on Amlodipine (Blokatens). Blood pressure should be closely monitored when Amlodipine (Blokatens) is co-administered with CYP3A inducers.

Sildenafil

Monitor for hypotension when sildenafil is co-administered with Amlodipine (Blokatens).

Impact of Amlodipine (Blokatens) on Other Drugs

Simvastatin

Co-administration of simvastatin with Amlodipine (Blokatens) increases the systemic exposure of simvastatin. Limit the dose of simvastatin in patients on Amlodipine (Blokatens) to 20 mg daily.

Immunosuppressants

Amlodipine (Blokatens) may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. Frequent monitoring of trough blood levels of cyclosporine and tacrolimus is recommended and adjust the dose when appropriate.

Valsartan (Blokatens)

No clinically significant pharmacokinetic interactions were observed when Valsartan (Blokatens) was coadministered with Amlodipine (Blokatens), atenolol, cimetidine, digoxin, furosemide, glyburide, hydrochlorothiazide, or indomethacin. The Valsartan (Blokatens)-atenolol combination was more antihypertensive than either component, but it did not lower the heart rate more than atenolol alone.

Warfarin: Coadministration of Valsartan (Blokatens) and warfarin did not change the pharmacokinetics of Valsartan (Blokatens) or the time-course of the anticoagulant properties of warfarin.

Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors): In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including Valsartan (Blokatens), may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving Valsartan (Blokatens) and NSAID therapy.

The antihypertensive effect of angiotensin II receptor antagonists, including Valsartan (Blokatens), may be attenuated by NSAIDs including selective COX-2 inhibitors.

Potassium: Concomitant use of Valsartan (Blokatens) with other agents that block the renin-angiotensin system, potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride), potassium supplements, salt substitutes containing potassium or other drugs that may increase potassium levels (e.g., heparin) may lead to increases in serum potassium and in heart failure patients to increases in serum creatinine. If co-medication is considered necessary, monitoring of serum potassium is advisable.

CYP 450 Interactions: In vitro metabolism studies indicate that CYP 450 mediated drug interactions between Valsartan (Blokatens) and coadministered drugs are unlikely because of low extent of metabolism.

Transporters: The results from an in vitro study with human liver tissue indicate that Valsartan (Blokatens) is a substrate of the hepatic uptake transporter OATP1B1 and the hepatic efflux transporter MRP2. Coadministration of inhibitors of the uptake transporter (rifampin, cyclosporine) or efflux transporter (ritonavir) may increase the systemic exposure to Valsartan (Blokatens).

Dual Blockade of the Renin-Angiotensin System (RAS): Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Most patients receiving the combination of two RAS inhibitors do not obtain any additional benefit compared to monotherapy. In general, avoid combined use of RAS inhibitors. Closely monitor blood pressure, renal function, and electrolytes in patients on Blokatens and other agents that affect the RAS.

Do not coadminister aliskiren with Blokatens in patients with diabetes. Avoid use of aliskiren with Blokatens in patients with renal impairment (GFR < 60 mL/min).

Lithium: Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists, including Valsartan (Blokatens). Monitor serum lithium levels during concomitant use.

Blokatens side effects

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What are the possible side effects of Blokatens?

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Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates.

Studies with Blokatens:

Blokatens has been evaluated for safety in over 2600 patients with hypertension; over 1440 of these patients were treated for at least 6 months and over 540 of these patients were treated for at least 1 year. Adverse reactions have generally been mild and transient in nature and have only infrequently required discontinuation of therapy.

The hazards of Valsartan (Blokatens) are generally independent of dose; those of Amlodipine (Blokatens) are a mixture of dose-dependent phenomena (primarily peripheral edema) and dose-independent phenomena, the former much more common than the latter.

The overall frequency of adverse reactions was neither dose-related nor related to gender, age, or race. In placebo-controlled clinical trials, discontinuation due to side effects occurred in 1.8% of patients in the Blokatens-treated patients and 2.1% in the placebo-treated group. The most common reasons for discontinuation of therapy with Blokatens were peripheral edema (0.4%), and vertigo (0.2%).

The adverse reactions that occurred in placebo-controlled clinical trials in at least 2% of patients treated with Blokatens but at a higher incidence in Blokatens patients (n=1437) than placebo (n=337) included peripheral edema (5.4% vs 3.0%), nasopharyngitis (4.3% vs 1.8%), upper respiratory tract infection (2.9% vs 2.1%) and dizziness (2.1% vs 0.9%).

Orthostatic events (orthostatic hypotension and postural dizziness) were seen in less than 1% of patients.

Other adverse reactions that occurred in placebo-controlled clinical trials with Blokatens (≥0.2%) are listed below. It cannot be determined whether these events were causally related to Blokatens.

Blood and Lymphatic System Disorders: Lymphadenopathy

Cardiac Disorders: Palpitations, tachycardia

Ear and Labyrinth Disorders: Ear pain

Gastrointestinal Disorders: Diarrhea, nausea, constipation, dyspepsia, abdominal pain, abdominal pain upper, gastritis, vomiting, abdominal discomfort, abdominal distention, dry mouth, colitis

General Disorders and Administration Site Conditions: Fatigue, chest pain, asthenia, pitting edema, pyrexia, edema

Immune System Disorders: Seasonal allergies

Infections and Infestations: Nasopharyngitis, sinusitis, bronchitis, pharyngitis, gastroenteritis, pharyngotonsillitis, bronchitis acute, tonsillitis

Injury and Poisoning: Epicondylitis, joint sprain, limb injury

Metabolism and Nutrition Disorders: Gout, non-insulin-dependent diabetes mellitus, hypercholesterolemia

Musculoskeletal and Connective Tissue Disorders: Arthralgia, back pain, muscle spasms, pain in extremity, myalgia, osteoarthritis, joint swelling, musculoskeletal chest pain

Nervous System Disorders: Headache, sciatica, paresthesia, cervicobrachial syndrome, carpal tunnel syndrome, hypoesthesia, sinus headache, somnolence

Psychiatric Disorders: Insomnia, anxiety, depression

Renal and Urinary Disorders: Hematuria, nephrolithiasis, pollakiuria

Reproductive System and Breast Disorders: Erectile dysfunction

Respiratory, Thoracic and Mediastinal Disorders: Cough, pharyngolaryngeal pain, sinus congestion, dyspnea, epistaxis, productive cough, dysphonia, nasal congestion

Skin and Subcutaneous Tissue Disorders: Pruritus, rash, hyperhidrosis, eczema, erythema

Vascular Disorders: Flushing, hot flush

Isolated cases of the following clinically notable adverse reactions were also observed in clinical trials: exanthema, syncope, visual disturbance, hypersensitivity, tinnitus, and hypotension.

Studies with Amlodipine (Blokatens):

Norvasc®* has been evaluated for safety in more than 11000 patients in U.S. and foreign clinical trials. Other adverse events that have been reported <1% but >0.1% of patients in controlled clinical trials or under conditions of open trials or marketing experience where a causal relationship is uncertain were:

Cardiovascular: arrhythmia (including ventricular tachycardia and atrial fibrillation), bradycardia, chest pain, peripheral ischemia, syncope, postural hypotension, vasculitis

Central and Peripheral Nervous System: neuropathy peripheral, tremor

Gastrointestinal: anorexia, dysphagia, pancreatitis, gingival hyperplasia

General: allergic reaction, hot flushes, malaise, rigors, weight gain, weight loss

Musculoskeletal System: arthrosis, muscle cramps

Psychiatric: sexual dysfunction (male and female), nervousness, abnormal dreams, depersonalization

Respiratory System: dyspnea

Skin and Appendages: angioedema, erythema multiforme, rash erythematous, rash maculopapular

Special Senses: abnormal vision, conjunctivitis, diplopia, eye pain, tinnitus

Urinary System: micturition frequency, micturition disorder, nocturia

Autonomic Nervous System: sweating increased

Metabolic and Nutritional: hyperglycemia, thirst

Hemopoietic: leukopenia, purpura, thrombocytopenia

Other events reported with Amlodipine (Blokatens) at a frequency of ≤0.1% of patients include: cardiac failure, pulse irregularity, extrasystoles, skin discoloration, urticaria, skin dryness, alopecia, dermatitis, muscle weakness, twitching, ataxia, hypertonia, migraine, cold and clammy skin, apathy, agitation, amnesia, gastritis, increased appetite, loose stools, rhinitis, dysuria, polyuria, parosmia, taste perversion, abnormal visual accommodation, and xerophthalmia. Other reactions occurred sporadically and cannot be distinguished from medications or concurrent disease states such as myocardial infarction and angina.

Adverse reactions reported for Amlodipine (Blokatens) for indications other than hypertension may be found in the prescribing information for Norvasc.

Studies with Valsartan (Blokatens):

Diovan® has been evaluated for safety in more than 4000 hypertensive patients in clinical trials. In trials in which Valsartan (Blokatens) was compared to an ACE inhibitor with or without placebo, the incidence of dry cough was significantly greater in the ACE inhibitor group (7.9%) than in the groups who received Valsartan (Blokatens) (2.6%) or placebo (1.5%). In a 129-patient trial limited to patients who had had dry cough when they had previously received ACE inhibitors, the incidences of cough in patients who received Valsartan (Blokatens), HCTZ, or lisinopril were 20%, 19%, and 69% respectively (p<0.001).

Other adverse reactions, not listed above, occurring in >0.2% of patients in controlled clinical trials with Valsartan (Blokatens) are:

Body as a Whole: allergic reaction, asthenia

Musculoskeletal: muscle cramps

Neurologic and Psychiatric: paresthesia

Respiratory: sinusitis, pharyngitis

Urogenital: impotence

Other reported events seen less frequently in clinical trials were: angioedema.

Adverse reactions reported for Valsartan (Blokatens) for indications other than hypertension may be found in the prescribing information for Diovan.

Clinical Lab Test Findings:

Creatinine: In hypertensive patients, greater than 50% increases in creatinine occurred in 0.4% of patients receiving Blokatens and 0.6% receiving placebo. In heart failure patients, greater than 50% increases in creatinine were observed in 3.9% of Valsartan (Blokatens)-treated patients compared to 0.9% of placebo-treated patients. In post-myocardial infarction patients, doubling of serum creatinine was observed in 4.2% of Valsartan (Blokatens)-treated patients and 3.4% of captopril-treated patients.

Liver Function Tests: Occasional elevations (greater than 150%) of liver chemistries occurred in Blokatens-treated patients.

Serum Potassium: In hypertensive patients, greater than 20% increases in serum potassium were observed in 2.8% of Blokatens-treated patients compared to 3.4% of placebo-treated patients. In heart failure patients, greater than 20% increases in serum potassium were observed in 10% of Valsartan (Blokatens)-treated patients compared to 5.1% of placebo-treated patients.

Blood Urea Nitrogen (BUN): In hypertensive patients, greater than 50% increases in BUN were observed in 5.5% of Blokatens-treated patients compared to 4.7% of placebo-treated patients. In heart failure patients, greater than 50% increases in BUN were observed in 16.6% of Valsartan (Blokatens)-treated patients compared to 6.3% of placebo-treated patients.

Neutropenia: Neutropenia was observed in 1.9% of patients treated with Diovan and 0.8% of patients treated with placebo.

Postmarketing Experience

Amlodipine (Blokatens): Gynecomastia has been reported infrequently and a causal relationship is uncertain. Jaundice and hepatic enzyme elevations (mostly consistent with cholestasis or hepatitis), in some cases severe enough to require hospitalization, have been reported in association with use of Amlodipine (Blokatens).

Valsartan (Blokatens): The following additional adverse reactions have been reported in postmarketing experience with Valsartan (Blokatens):

Blood and Lymphatic: Decrease in hemoglobin, decrease in hematocrit, neutropenia

Hypersensitivity: There are rare reports of angioedema. Some of these patients previously experienced angioedema with other drugs including ACE inhibitors. Blokatens should not be re-administered to patients who have had angioedema.

Digestive: Elevated liver enzymes and very rare reports of hepatitis

Renal: Impaired renal function, renal failure

Clinical Laboratory Tests: Hyperkalemia

Dermatologic: Alopecia, bullous dermatitis

Vascular: Vasculitis

Rare cases of rhabdomyolysis have been reported in patients receiving angiotensin II receptor blockers.

Blokatens contraindications

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What is the most important information I should know about Blokatens?

Hypersensitivity to Amlodipine (Blokatens) besylate and Valsartan (Blokatens) or to any of the excipients of Blokatens.

Concomitant use of angiotensin-receptor antagonists (ARBs) including Valsartan (Blokatens) or of angiotensin converting enzyme inhibitors (ACEIs) with aliskiren in patients with type 2 diabetes.

Use in Pregnancy: As for any drug that also acts directly on renin angiotensin aldosterone system (RAAS), Blokatens must not be used during pregnancy. Due to the mechanism of action of Ang II antagonists, a risk to the fetus cannot be excluded. Administration of ACEIs (a specific class of drugs acting on the RAAS) to pregnant women during the 2nd- and 3rd-trimesters has been reported to cause injury and death to the developing fetus. In addition, in retrospective data, 1st trimester use of ACEIs has been associated with a potential risk of birth defects. There have been reports of spontaneous abortion, oligohydramnios and newborn renal dysfunction when pregnant women have inadvertently taken Valsartan (Blokatens).

There are no adequate clinical data with Amlodipine (Blokatens) in pregnant women. Animal studies with Amlodipine (Blokatens) have shown reproductive toxicity at dose 8 times the maximum recommended dose of 10 mg. The potential risk to humans is unknown.

If pregnancy is detected during therapy, Blokatens must be discontinued as soon as possible.



Active ingredient matches for Blokatens:

Amlodipine/Valsartan in Egypt.


List of Blokatens substitutes (brand and generic names)

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Unit description / dosage (Manufacturer)Price, USD
Tablet; Oral; Amlodipine 10 mg; Valsartan 160 mg (Novartis)
Tablet; Oral; Amlodipine 5 mg; Valsartan 160 mg (Novartis)
Tablet; Oral; Amlodipine 5 mg; Valsartan 80 mg (Novartis)
Tablet, Film-Coated; Oral; Amlodipine 5 mg; Valsartan 80 mg (Novartis)
Tablet, Film-Coated; Oral; Amlodipine 5 mg; Valsartan 160 mg (Novartis)
Tablet, Film-Coated; Oral; Amlodipine 10 mg; Valsartan 160 mg (Novartis)
Tablet; Oral; Amlodipine 5 mg; Valsartan 80 mg (Novartis)

References

  1. DailyMed. "AMLODIPINE BESYLATE; VALSARTAN: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "valsartan". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. PubChem. "amlodipine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Blokatens are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Blokatens. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

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