Smart terminals "Evotor" are multifunctional and easy-to-use devices that are a tablet with a touch screen and are equipped with a fiscal drive and a printer for printing receipts.
The complex combines the necessary set of functions for automating the cashier's workplace in small and medium-sized trade (service) enterprises.
Used for:
- retail points of sale with light and medium traffic;
- for portable and away trade;
- cosmetics and beauty salons;
- small catering establishments: snack bars, cafes, coffee shops and bars.
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The terminals are equipped with ports for connecting additional trading equipment: scanners, acquiring terminals, scales, cash drawers.
The manufacturer's models are ready to work with EGAIS and have a simple interface, thanks to the Evotor OS running on Android. In addition to ease of use, the owner of a smart terminal receives the advantage of access to the user’s personal account, through which the operation of points of sale is configured and monitored, employee performance and store turnover are analyzed.
In addition, you can connect developer applications for keeping records of goods, integration with, bonus programs, etc.
The Evotor operating instructions include several large sections, which we review in today’s article.
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Active ingredients and pharmacokinetics
Equator tablets are an antihypertensive drug, the main active ingredients of which are lisinopril and amlodipine.
Long-term use of lisinopril has a positive effect on blood supply, myocardial and artery hypertrophy. Lisinopril helps to effectively reduce blood pressure, peripheral vascular resistance, and pressure in the capillaries of the lungs. Begins to act one hour after administration. The maximum effect is achieved after six hours and lasts throughout the day.
After administration, lisinopril enters the bloodstream. It is not metabolized and is excreted in the urine. For a long time it provides a therapeutic effect, maintaining normal blood pressure.
Amlodipine has an antihypertensive effect, lowering blood pressure. Significant improvement is observed 6 hours after oral administration and persists for a day. Amlodipine has a beneficial effect on cardiac activity.
Equator tablets should be taken only as prescribed by a doctor.
Amlodipine is absorbed almost completely from the gastrointestinal tract. Metabolized in the liver. About 10% of the substance is excreted in the urine, 20-25% through the intestines.
The combination of these two active components, amlodipine and lisinopril, in Equator makes it possible to block the development of possible negative consequences caused by one of them.
In addition to lisinopril and amlodipine, the drug tablet contains:
- Sodium carboxymethyl starch;
- Microcrystalline cellulose;
- Magnesium stearate.
Ekvator®
Amlodipine
Contraindicated combinations of drugs
Dantrolene (intravenous administration)
In laboratory animals, cases of ventricular fibrillation with death and collapse have been reported during the use of verapamil and intravenous dantrolene, accompanied by hyperkalemia. Due to the risk of developing hyperkalemia, concomitant use of slow calcium channel blockers, including amlodipine, should be avoided in patients susceptible to malignant hyperthermia, as well as during the treatment of malignant hyperthermia.
Not recommended drug combinations
Grapefruit juice
Taking amlodipine with grapefruit or grapefruit juice is not recommended as the bioavailability of amlodipine may be increased in some patients, resulting in increased blood pressure lowering effects.
Combinations of drugs that require special caution when used
Inducers of the CYP3A4 isoenzyme
With simultaneous use of known CYP3A4 inducers, the concentration of amlodipine in the blood plasma may fluctuate. For this reason, it is necessary to both monitor blood pressure and adjust the dose of the drug during and after concomitant use, especially with strong CYP3A4 inducers (for example, rifampicin, St. John's wort (Hypericum perforatum) preparations).
CYP3A4 isoenzyme inhibitors
Concomitant use of amlodipine and strong or moderate inhibitors of CYP3A4 (protease inhibitors, for example, ritonavir, azole antifungals, macrolides, for example, erythromycin or clarithromycin, verapamil or diltiazem) can lead to a significant increase in amlodipine concentrations. Clinical manifestations of these pharmacokinetic abnormalities may be more pronounced in elderly patients. In this regard, monitoring of the clinical condition and dose adjustment of the Equator® drug may be required.
Combinations of drugs that require caution when used
Simvastatin
Repeated administration of amdodipine at a dose of 10 mg in combination with simvastatin at a dose of 80 mg resulted in an increase in simvastatin exposure by 77% compared with simvastatin monotherapy. Therefore, patients receiving amlodipine should take simvastatin at a daily dose of no more than 20 mg.
Calcium preparations
May reduce the effect of BMCC.
Lithium preparations
When BMCC is used together with lithium preparations (no data are available for amlodipine), their neurotoxicity (nausea, vomiting, diarrhea, ataxia, tremor or tinnitus) may increase.
Baclofen
Strengthening the antihypertensive effect. Blood pressure and renal function should be monitored, and the dose of amlodipine should be adjusted if necessary.
Amifostin
The antihypertensive effect of amlodipine may be enhanced.
Glucocorticosteroids
Decreased antihypertensive effect (retention of fluid and sodium ions as a result of the action of corticosteroids).
Tricyclic antidepressants, antipsychotics
There is an increased risk of orthostatic hypotension and increased antihypertensive effect (additive effect).
Tacrolimus
When used simultaneously with amlodipine, there is a risk of increasing the concentration of tacrolimus in the blood plasma. To avoid toxicity of tacrolimus when used concomitantly with amlodipine, the concentration of tacrolimus in the blood plasma of patients should be monitored and the dose of tacrolimus should be adjusted if necessary.
Tasonermin
With simultaneous use, amlodipine may increase the systemic exposure of tasonermin in blood plasma. In such cases, regular monitoring of tasonermin in the blood and dose adjustment if necessary is necessary.
Other interactions with amlodipine
For the treatment of arterial hypertension, amlodipine can be safely used with thiazide diuretics, alpha-blockers, beta-blockers and ACE inhibitors.
In patients with stable angina, simultaneous use of amlodipine with other antianginal drugs, such as long- and short-acting nitrates, beta-blockers, is possible.
It is possible that the antianginal and antihypertensive effects of BMCC may be enhanced when used simultaneously with thiazide and loop diuretics, ACE inhibitors, beta-blockers and nitrates, as well as their antihypertensive effect is enhanced when prescribed with alpha-1-blockers and antipsychotics.
Amlodipine does not cause a negative inotropic effect. However, some CBMCs may increase the negative inotropic effect of antiarrhythmic drugs that cause QT prolongation (eg, amiodarone and quinidine).
Unlike other BMCCs, no significant interaction was detected between amlodipine (3rd generation BMCC) and NSAIDs, including indomethacin.
It is safe to administer amlodipine with oral hypoglycemic agents.
A single dose of sildenafil in a dose of 100 mg in patients with essential arterial hypertension had no effect on the pharmacokinetics of amlodipine.
Combined repeated administration of amlodipine at a dose of 10 mg and atorvastatin at a dose of 80 mg led to an insignificant change in the pharmacokinetic parameters of atorvastatin at steady state.
Ethanol (drinks containing alcohol): amlodipine does not have a significant effect on the pharmacokinetics of ethanol with single or repeated use at a dose of 10 mg.
Interaction studies between cyclosporine and amlodipine have not been conducted in healthy volunteers or in special groups of patients, with the exception of patients after kidney transplantation. Various studies of the interaction of amlodipine with cyclosporine in patients after kidney transplantation show that the use of this combination may not lead to any effect, or increase the minimum concentration of cyclosporine to varying degrees, up to 40%. Cyclosporine concentrations should be monitored in patients after kidney transplantation.
With simultaneous use of amlodipine and digoxin, the renal clearance and concentration of digoxin in the blood serum do not change.
With simultaneous use of warfarin with amlodipine, the prothrombin time does not change.
When used simultaneously with cimetidine, the pharmacokinetics of amlodipine does not change.
Amlodipine does not affect the degree of binding of digoxin, phenytoin, warfarin and indomethacin to plasma proteins in vitro.
Aluminum and magnesium-containing antacids: a single dose of such antacids together with amlodipine does not have a significant effect on the pharmacokinetics of amlodipine.
mTOR inhibitors (mammalian Target of Rapamycin - target of rapamycin in mammalian cells)
mTOR inhibitors (eg, temsirolimus, sirolimus, everolimus) are CYP3A4 substrates. Because amlodipine is a weak CYP3A4 inhibitor, concomitant use may increase exposure to mTOR inhibitors.
Lisinopril
Contraindicated drug combinations
Aliskiren
Concomitant use of ACE inhibitors with aliskiren and aliskiren-containing drugs in patients with diabetes mellitus and/or moderate or severe renal impairment (GFR less than 60 ml/min/1.73 m2 body surface area) is contraindicated.
The administration of ACE inhibitors with angiotensin II receptor antagonists is contraindicated in patients with diabetic nephropathy.
Not recommended drug combinations
Angiotensin II receptor antagonists (ARA II)
The literature has reported that in patients with established atherosclerotic disease, chronic heart failure, or diabetes mellitus with end-organ damage, concomitant therapy with an ACE inhibitor and an ARB II is associated with a higher incidence of hypotension, syncope, hyperkalemia, and deterioration of renal function (including acute renal failure) compared with the use of only one drug that affects the RAAS. Dual blockade (for example, when combining an ACE inhibitor with an ARB II) should be limited to selected cases with careful monitoring of renal function, potassium levels and blood pressure.
Potassium supplements, potassium-sparing diuretics (spironolactone, triamterene, amiloride, eplerenone) or potassium-containing salt substitutes
Hyperkalemia may develop (with possible death), especially if renal function is impaired (additional effects associated with hyperkalemia). ACE inhibitors should not be used concomitantly with substances that increase plasma potassium levels, except in cases of hypokalemia. The combination of lisinopril and the above agents is not recommended. If, however, concomitant use is indicated, they should be used with caution and regular monitoring of serum potassium levels.
Lithium preparations
With the simultaneous use of lithium preparations and ACE inhibitors, a reversible increase in the concentration of lithium in the blood serum and associated toxic effects may be observed. The simultaneous use of lisinopril and lithium preparations is not recommended. If such therapy is necessary, the concentration of lithium in the blood serum should be regularly monitored.
Combinations of drugs that require special caution when used
Insulin and oral hypoglycemic agents
Epidemiological studies have shown that the combined use of ACE inhibitors and hypoglycemic agents (insulins, oral hypoglycemic agents) can enhance their hypoglycemic effect up to the development of hypoglycemia. This effect is most likely to be observed during the first weeks of concomitant therapy, as well as in patients with impaired renal function.
Baclofen
Enhances the antihypertensive effect of ACE inhibitors. Blood pressure levels should be carefully monitored and, if necessary, the dose of antihypertensive drugs should be adjusted.
Diuretics
In patients taking diuretics, especially those that remove fluid and/or salts, a significant decrease in blood pressure may be observed when initiating therapy with an ACE inhibitor. The risk of developing antihypertensive effects can be reduced by discontinuing the diuretic and replacing fluid or salt losses before starting ACE inhibitor therapy. For arterial hypertension in patients with previous diuretic therapy, which could lead to excessive excretion of fluid and/or salts, diuretics should be discontinued before using Equator®.
Renal function (creatinine concentration) should be monitored in the first weeks of using Equator®.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid at a dose of ≥3 g/day
The simultaneous use of ACE inhibitors with NSAIDs (acetylsalicylic acid in a dose that has an anti-inflammatory effect, cyclooxygenase-2 (COX-2) inhibitors and non-selective NSAIDs) may lead to a decrease in the antihypertensive effect of ACE inhibitors. The simultaneous use of ACE inhibitor drugs and NSAIDs may lead to deterioration of renal function, including the development of acute renal failure and an increase in serum potassium, especially in patients with reduced renal function. Caution should be exercised when prescribing this combination, especially in elderly patients. Patients need to compensate for fluid loss and carefully monitor renal function, both at the beginning of treatment and during treatment.
Estramustine, mTOR inhibitors (sirolimus, everolimus, temsirolimus), neutral endopeptidase inhibitors (omapatrilat, ilepatril, daglutril, sacubitril)
Concomitant use with ACE inhibitors is accompanied by an increased risk of developing angioedema.
DPP-4 inhibitors (gliptins)
Linagliptin, saxagliptin, sitagliptin, vildagliptin: when used together with ACE inhibitors, the risk of angioedema increases due to the suppression of dipeptidyl peptidase-4 (DPP-IV) activity by gliptin.
Neutral endopeptidase inhibitors (NEP)
An increased risk of angioedema has been reported with concomitant use of ACE inhibitors and racecadotril (an enkephalinase inhibitor).
When ACE inhibitors are used simultaneously with drugs containing sacubitril/valsartan, the risk of developing angioedema increases, and therefore the simultaneous use of these drugs is contraindicated. ACE inhibitors should be prescribed no earlier than 36 hours after discontinuation of drugs containing sacubitril/valsartan. The use of drugs containing sacubitril/valsartan is contraindicated in patients receiving ACE inhibitors, as well as within 36 hours after discontinuation of ACE inhibitors.
Combinations of drugs that require caution when used
Other antihypertensive agents (eg, beta blockers, calcium channel blockers, diuretics) and vasodilators
The antihypertensive effect of the drug may be enhanced. Caution should be exercised when administered concomitantly with nitroglycerin, other nitrates or other vasodilators, as this may further reduce blood pressure.
Antacids and cholestyramine
Concomitant use with antacids and cholestyramine leads to suppression of gastrointestinal absorption.
Tricyclic antidepressants, neuroleptics, general anesthesia, barbiturates, phenothiazine, ethanol
When taken together, the effect of lisinopril may be enhanced.
Sympathomimetics
Sympathomimetics may reduce the antihypertensive effect of ACE inhibitors.
Muscle relaxants
The simultaneous use of muscle relaxants with ACE inhibitors can lead to a pronounced decrease in blood pressure.
Gold preparations
When using ACE inhibitors, including lisinopril, in patients receiving intravenous gold (sodium aurothiomalate), rare cases of nitrite reactions (a symptom complex that includes facial flushing, nausea, dizziness and hypotension, which can be very severe) have been described after administration of an injectable drug containing gold (eg, sodium aurothiomalate) has been reported more frequently in patients receiving treatment with ACE inhibitors.
Co-trimoxazole (sulfamethoxazole and trimethoprim)
Increased risk of developing hyperkalemia.
Selective serotonin reuptake inhibitors (escitalopram, paroxetine, fluoxetine, sertraline)
When used simultaneously with SSRIs, severe hyponatremia may develop.
Allopurinol, procainamide, cytostatics (5-fluorouracil, vincristine, docetaxel)
Leukopenia may develop.
Tissue plasminogen activators (alteplase, reteplase, tenecteplase)
Increased risk of angioedema when used simultaneously with ACE inhibitors. Observational studies have shown an increased incidence of angioedema in patients taking ACE inhibitors following the use of alteplase for thrombolytic therapy of ischemic stroke.
Instructions for dosage regimen, release form
There are 2 types of Equator tablets:
- tablets 5/10 mg;
- tablets 10/20 mg.
The tablets are white, with the letters A+L engraved on the sides. Packages may contain different numbers of tablets, it all depends on the expected duration of the course of treatment.
The optimal dosage is 1 tablet per day to normalize blood pressure. It is also the maximum dose. Depending on the patient’s condition and his body’s perception of the active ingredients of Equator, tablets with the required quantitative content of the main substances are prescribed.
You can take the drug at any time, no matter - before or after meals. The tablet is washed down with a sufficient amount of clean drinking water.
While taking Equator, it is important to monitor kidney function and the levels of potassium and sodium in the blood. If renal function is impaired, the drug should be immediately discontinued and replaced with another.
Drug interactions Equator
The drug is used with extreme caution in combination:
- with potassium-sparing diuretics (for example, spironolactone, amiloride, triamterene), with potassium and table salt containing potassium. In this case, hyperkalemia may develop, especially with impaired renal function, so the drug can be prescribed only after a careful assessment of the benefit-risk ratio of therapy, subject to regular monitoring of serum potassium levels and renal function indicators;
- with allopurinol, cytostatics, immunosuppressants, corticosteroids, procainamide, since their combination with lisinopril can lead to the development of leukopenia.
Use with caution at the same time:
- with diuretics: a sharp decrease in blood pressure may be noted;
- with other antihypertensive drugs (additive effect);
- with NSAIDs (reduced antihypertensive effectiveness);
- with lithium salts (lithium accumulation may occur, so its level in the blood plasma should be regularly monitored);
- narcotic drugs, anesthetics (strengthen the hypotensive effect of lisinopril).
Lisinopril reduces potassium excretion when combined with diuretics. Lisinopril increases the manifestations of alcohol intoxication. No interactions between lisinopril and amlodipine have been identified.
Contraindications and side effects
"Equator" is prescribed only if therapeutic treatment for high blood pressure has not brought a positive result. The drug may cause:
- arrhythmias, rapid heartbeat;
- heart failure;
- headaches and dizziness;
- excessive sleepiness;
- worsening mood;
- feeling of a rush of blood to the head;
- fainting, insomnia, constant feelings of anxiety;
- neuropathy;
- seizures;
- cough, shortness of breath;
- diarrhea, vomiting, constipation, nausea, flatulence;
- pain in the stomach and head;
- skin itching and rash;
- excessive sweating;
- back pain;
- swelling of the face, tongue, larynx;
- frequent urination;
- renal failure;
- visual impairment;
- impotence;
- fever;
- leukopenia, erythrocytopenia.
If adverse symptoms occur, you should immediately stop taking the drug
The negative effects that can be caused by the use of Equator appear no more often than when taking each of the active ingredients separately.
Contraindications to treatment with Equator are as follows:
- Quincke's edema;
- angioedema;
- arterial hypotension;
- angina pectoris;
- myocardial infarction suffered less than a month ago;
- stenosis of the renal arteries (for the drug in tablets 20/10 mg);
- pregnancy;
- lactation;
- age less than 18 years;
- individual intolerance to components.
Before you start taking the drug, you must carefully read the contraindications
When treated with Equator, it is not recommended to drive or operate other complex mechanisms, as this is unsafe. At the beginning of the course, you may feel dizzy, so you should not do any work that requires concentration.
If the patient used diuretics before starting treatment with Equator, arterial hypotension may occur, since the water-electrolyte balance was disturbed. To avoid this, you should stop taking diuretics 2-3 days before starting the course of Equator therapy.
Overdose of the drug Equator, symptoms and treatment
It may manifest itself as a pronounced dilatation of peripheral vessels, accompanied by an excessive decrease in blood pressure and reflex tachycardia. The patient is placed in a horizontal position with the lower limbs raised, heart function, blood pressure, and water-electrolyte balance are monitored; if necessary, these indicators are corrected and symptomatic treatment is carried out. In case of severe hypotension, intravenous infusion solutions are prescribed; in case of insufficient effectiveness, peripherally acting vasopressors are prescribed. To eliminate the effects of blockade of calcium channels, intravenous administration of calcium gluconate is indicated. Due to the slow absorption of amlodipine in the gastrointestinal tract, gastric lavage can be effective. Lisinopril is excreted from the body during hemodialysis, but amlodipine is not excreted during hemodialysis due to its high degree of binding to plasma proteins.
Analogs
The closest analogue of "Equator" is the drug "Equacard", containing the same active ingredients - amlodipine (5 mg) and lisinopril (10 mg) in one tablet. Also a related drug is Eclamise.
All drugs are based on the interaction of two main components. They can be found separately, Amlodipine and Lisinopril tablets in different release forms and from different manufacturers.
The following drugs are also similar in action:
- "Perestance"
- "Enanorm"
- "Egipres"
- "Triapin"
- "Dalneva"
- "Coriprene"
- "Enal L CombI".
If side effects occur when taking Equator, it is usually changed to one of the above drugs.
"Equator" during pregnancy
An impressive list of contraindications to taking the drug includes pregnancy. The fact is that the main active ingredient, lisinopril, penetrates the placenta, which can cause developmental disorders of the fetus in the womb:
- decreased blood pressure;
- hypoplasia of the skull;
- renal failure;
- hyperkalemia.
Equator should not be taken during pregnancy.
The baby may die before being born. Therefore, taking Equator during pregnancy is prohibited. The same can be said about breastfeeding - the substances of the drug penetrate into the milk, as a result, during lactation, treatment with Equator or any other drugs that contain lisinopril as a component is prescribed only as a last resort.
