Cordinik pills 10 mg 60 pcs
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Active ingredients
Nicorarandil
Release form
Pills
Composition
Nicorandil 10 mg; Excipients: potato starch - 5 mg, microcrystalline cellulose 102 - 84 mg, calcium stearate - 1 mg.
Pharmacological effect
Antianginal agent, has nitrate-like properties and the ability to open potassium channels. Due to the opening of potassium channels, nicorandil causes hyperpolarization of the cell membrane, and the nitrate-like effect is to increase the intracellular content of cyclic guanyl monophosphate. These pharmacological effects lead to the relaxation of smooth muscle cells and provide a protective effect on cardiomyocytes during ischemia. Hemodynamic effects are expressed in a balanced decrease in pre- and afterload (unlike nitrates and blockers of slow calcium channels, which act mainly on pre- or afterload, respectively. Given the selective vasodilation of the coronary arteries, ultimately, the load on the ischemic myocardium is minimal. Nicorandil does not affect myocardial contractility, does not alter heart rate radically.; Reduces systemic blood pressure by less than 10%, has a beneficial effect on cerebral circulation in patients with ischemic stroke. Nicorandil does not affect lipid metabolism and glucose metabolism. Nicorandil suppresses angina pectoris with a decrease in pain during 4 -7 minutes after taking under the tongue and complete relief of the attack within 12-17 minutes.
Pharmacokinetics
After ingestion nicorandil is quickly and completely absorbed from the gastrointestinal tract. Cmax in plasma is achieved in 0.5–1 h. Nicorarandil is slightly bound to plasma proteins. The free fraction in the blood plasma is about 75%. It is not subjected to intensive metabolism in the liver. T1 / 2 is 50 min. Excreted mainly by the kidneys.
Indications
Relief of strokes; prevention of attacks of stable angina pectoris (in combination with other antianginal drugs) and as monotherapy for intolerance to beta-blockers and slow calcium channel blockers.
Contraindications
Acute myocardial infarction (and for 3 months after it); cardiogenic shock, collapse; unstable angina, includingPrinzmetal angina pectoris; chronic heart failure III or IV functional class according to the NYHA classification; severe bradycardia (heart rate less than 50 beats / min); AV block II and III degree; left ventricular failure with low filling pressure; severe hypotension (diastolic blood pressure at rest less than 100 mm Hg); severe anemia; refractory hyperkalemia; simultaneous administration of PDE5 inhibitors (sildenafil, vardenafil, tadalafil); pregnancy, lactation (breastfeeding); children and adolescents up to 18 years.
Use during pregnancy and lactation
Contraindicated in pregnancy, during lactation.
Dosage and administration
Is ingested. Dose set individually depending on the severity and duration of the disease. Single dose - 10-20 mg, the frequency of use - 1-3 times / day. The maximum daily dose is 80 mg. ; If a headache occurs, the initial dose may be reduced.
Side effects
From the side of the cardiovascular system: heartbeat, tachycardia, lowering blood pressure, postural hypotension, flushing of the skin of the face, peripheral edema. When using nicorandil in a high dose, arterial hypotension and / or tachycardia is possible. On the CNS side: headache, dizziness, tinnitus, insomnia. stomatitis (extremely rare); in some cases - an increase in the activity of ALT, AST, ALP.; On the part of the respiratory system: bronchitis, shortness of breath, increased cough.; Allergic reactions: skin rash, itching; rarely - angioedema.; Other: weakness.
Overdose
Symptoms: pronounced decrease in blood pressure, tachycardia. ; Treatment: gastric lavage, the appointment of activated carbon (especially in the first 2 hours after an overdose), maintaining the function of the cardiovascular system, the elevated position of the limbs, symptomatic and supportive therapy, intravenous calcium gluconate and dopamine. Perhaps the use of hemodialysis.
Interaction with other drugs
With simultaneous use with prolonged-acting nitrates, an additive anti-hypertensive effect may develop.that with simultaneous use of nicorandil potentiates the effects of tricyclic antidepressants, antihypertensives and other vasodilators, as well as ethanol; Nicorarandil potentiates the hypotensive effect of PDE5 inhibitors (the combination is contraindicated) .; .
special instructions
Caution should be used in patients with cardiac arrhythmias, with impaired renal function and / or liver, hypovolemia, hypotension, pulmonary edema, angle-closure glaucoma, hyperkalemia, AV degree I blockade, and hyperthyroidism; Treatment should be stopped gradually .; During the period of treatment, blood pressure should be monitored, ECG indicators, the content of potassium and sodium ions in the blood; possible enhancement of existing cardiac arrhythmias.; Impact on the ability to drive vehicles and control mechanisms; When driving vehicles and other potentially dangerous activities, it should be borne in mind that nicorandil can cause a decrease in the ability to concentrate and a decrease in the speed of psychomotor reactions.