Verapamil alkaloid coated pills 80mg N30
Condition: New product
1000 Items
Rating:
Be the first to write a review!
More info
Active ingredients
Verapamil
Release form
Pills
Composition
1 tablet contains: Active ingredient: verapamil hydrochloride 80 mg.
Pharmacological effect
Verapamil belongs to the group of “slow” calcium channel blockers. It has antiarrhythmic, antianginal and antihypertensive activity. It reduces myocardial oxygen demand by reducing myocardial contractility and reducing heart rate. Causes dilatation of the coronary vessels of the heart and increases coronary blood flow; reduces the tone of the smooth muscles of the peripheral arteries and the total peripheral vascular resistance. Verapamil significantly slows down atrioventricular conductivity, inhibits the automatism of the sinus node, which allows the use of the drug for the treatment of supraventricular arrhythmias. Inhibits cytochrome P450 metabolism.
Pharmacokinetics
Associated with plasma proteins by 90%. Penetrates through the blood-brain and placental barrier and into breast milk (in small quantities). Metabolized rapidly in the liver by N-dealkylation and O-demethylation with the formation of several metabolites. The accumulation of the drug and its metabolites in the body explains the increased effect during the course of treatment. The most significant metabolite is pharmacologically active norverapamil (20% of the anti-hypertensive activity of verapamil). The enzyme system CYP3 A4, CYP3 A5 and CYP3 A7 is involved in the metabolism of the drug. T1 / 2 biphasic: about 4 min - early and 2-5 h - final. Excreted by the kidneys 70% (unchanged, 3-5%), with bile 25%. It is not displayed during hemodialysis.
Indications
- relief of supraventricular paroxysmal tachycardia; paroxysms of atrial fibrillation and flutter, atrial premature beats.
Contraindications
- Chronic heart failure IIB-III degree; - Arterial hypotension; - Acute myocardial infarction; - Sinoatrial blockade; - Sinus node weakness syndrome; - Aortic stenosis; - Morgagni-Adams-Stokes syndrome; - Digitalis intoxication; - Atrioventricular block and X-ray syndrome. Grade III; - ventricular tachycardia; - cardiogenic shock; - Wolff-Parkinson-White syndrome orLauna-Gangong-Levine syndrome in combination with atrial flutter or atrial fibrillation (except for patients with a pacemaker); - porphyria; - pregnancy; - lactation period; - parenteral administration during the previous 2 hours of a beta-blocker, - up to 18 years old (efficacy and safety have not been established); - hypersensitivity to the components of the drug, With caution: atrioventricular block I degree, bradycardia, concomitant use of beta-blockers, myocardial infarction with left ventricular failure, nd age, chronic heart failure I and IIA degree expressed by human liver and kidneys.
Precautionary measures
During treatment, psoriasis may worsen. During pheochromocytoma, propranolol can only be used after taking an alpha blocker. After a long course of treatment, propranolol should be discontinued gradually, under the supervision of a physician. during anesthesia, you must stop taking propranolol or find a remedy for anesthesia with minimal negative inotropic effects. The impact on the ability to drive vehicles and control mechanisms of patients whose activities require increased attention, the question of the use of propranolol on an outpatient basis should be addressed only after evaluating the individual response of the patient.
Use during pregnancy and lactation
Contraindicated during pregnancy and lactation.
Dosage and administration
Administer intravenously, slowly, for at least 2 minutes, with continuous monitoring of the electrocardiogram, heart rate and blood pressure. In elderly patients, administration is carried out for at least 3 minutes to reduce the risk of undesirable effects. To stop paroxysmal arrhythmias, they are injected intravenously, in a stream (under ECG and BP control) in 2-4 ml of 0.25% solution (5 -10 mg). In the absence of effect, repeated administration is possible after 30 minutes at the same dose. A solution of verapamil is prepared by diluting 2 ml of a 0.25% solution of the drug in 100-150 ml of a 0.9% solution of sodium chloride.
Side effects
On the part of the cardiovascular system: severe bradycardia (at least 50 beats / min), pronounced decrease in blood pressure, development or worsening of heart failure, tachycardia; possible development of angina, up to myocardial infarction (especially in patients with severe obstructive damage to the coronary arteries), arrhythmias (including flicker and ventricular flutter); with rapid injection - atrioventricular block III, asystole, collapse. On the CNS side: dizziness, headache, fainting, anxiety, lethargy, fatigue, asthenia, somnolence, depression, extrapyramidal disorders. On the digestive system: nausea, increased activity hepatic "transaminases and alkaline phosphatase. Allergic reactions: pruritus, rash, skin hyperimemia, multimorphic exudative erythema (including Stevens-Johnson syndrome). Others: transient vision loss is not the maximum concentration, pulmonary edema, thrombocytopenia asymptomatic, peripheral edema (swelling of the ankles, feet and legs).
Overdose
Symptoms: sinus bradycardia, turning into atrioventricular block, sometimes asystole, marked reduction in blood pressure, heart failure, shock, sinoatrial blockade. Help: with bradycardia and conduction disturbance - in / in the introduction of isoprenaline, atropine, 10-20 ml of 10% solution calcium gluconate, artificial pacemaker; intravenous infusion of plasma-substituting solutions. To increase blood pressure in patients with hypertrophic obstructive cardiomyopathy prescribed alpha-adrenostimulyatory (phenylephrine); isoprenaline and norepinephria should not be used. Hemodialysis is not effective.
Interaction with other drugs
Increases the blood concentration of digoxin, theophylline, prazosin, cyclosporine, carbamazepine, muscle relaxants, quinidine, valproic acid due to suppression of cytochrome P450 metabolism. it may be necessary to reduce the dose of the latter. Calcium preparations reduce the effectiveness of verapamil. Rifampicin, barbiturates, nicotine, speeding up metabolism in the liver, lead to a decrease in the concentration of verapamil in the blood,reduce the severity of antianginal, hypotensive and antiarrhythmic actions. When used simultaneously with inhalation anesthetics, the risk of developing bradycardia, atrioventricular block, and heart failure increases. Procainamide, quinidine and other drugs that cause prolongation of the QT interval increase the risk of significant prolongation of the latter. Combination with beta-blockers may lead to increased negative inotropic effect, increasing the risk of atrioventricular conduction disorders, bradycardia (to be administered by verapamil and beta-blockers to be performed at intervals of several hours). Prazosin and other alpha-blockers enhance the hypotensive effect. Non-steroidal anti-inflammatory drugs reduce the antihypertensive effect due to the suppression of prostaglandin synthesis, retention of sodium ions and body fluids. Increases the concentration of cardiac glycosides (requires careful monitoring and reduces the dose of cardiac glycosides). Sympathomimetics reduce the hypotensive effect of verapamil. before and 24 hours after the use of verapamil (summation of the negative inotropic effect, up to death). Estrogens reduce hypotensive effect due to fluid retention in the body. Plasma concentrations of drugs that are characterized by a high degree of protein binding (including coumarin and indandione derivatives, nonsteroidal anti-inflammatory drugs, quinine, salicylates, sulfinpyrazone) may increase. Drugs that reduce blood pressure increase the hypotensive effect of verapamil. Increases the risk of neurotoxic effect of lithium preparations. Enhances the activity of peripheral muscle relaxants (may require changing the dosing regimen).
special instructions
The treatment requires control of the function of the cardiovascular and respiratory systems, glucose and electrolytes in the blood, circulating blood volume and the amount of urine released. May prolong the PQ interval at plasma concentrations above 30 ng / ml. It is not recommended to stop treatment suddenly. Impact on the ability to drive motor vehicles and control mechanisms. Use caution when working with drivers of vehicles and people whose profession is associated with increased concentration of attention (the reaction rate decreases).