Cordaflex coated pills prolonged 20mg N30
Condition: New product
1000 Items
Rating:
Be the first to write a review!
More info
Active ingredients
Nifedipine
Release form
Pills
Composition
Nifedipine 20 mg adjuvants: microcrystalline cellulose - 99 mg, lactose monohydrate - 30 mg, croscarmellose sodium - 26 mg, methyl methacrylate and ethyl acrylate copolymer [1: 2] - 1.9 mg, talc - 2 mg, magnesium stearate - 0.6 mg, hyprolose - 0.5 mg. composition: hypromellose - 5.26 mg, titanium dioxide - 1.64 mg, iron dye red oxide (e172) - 0.48 mg, iron dye black oxide (e172) - 0.12 mg, magnesium stearate - 0.5 mg.
Pharmacological effect
Selective blocker of slow calcium channels, a derivative of 1.4-dihydropyridine. It has antihypertensive and antianginal action. Nifedipine reduces the current of extracellular calcium ions into the interior of cardiomyocytes and smooth muscle cells of the coronary and peripheral arteries. In therapeutic doses, normalizes the transmembrane current of calcium ions, disturbed in a number of pathological conditions, especially in hypertension. Reduces spasm and dilates coronary and peripheral arterial vessels, reduces total peripheral resistance, reduces afterload and myocardial oxygen demand. At the same time, it improves the blood supply to the ischemic zones of the myocardium without the development of the robbery syndrome, and also increases the number of functioning collaterals. Nifedipine has practically no effect on the sinoatrial and atrioventricular nodes and does not have an antiarrhythmic effect. Does not affect the tone of the veins. Nifedipine increases renal blood flow, causing moderate natriuresis. In high doses inhibits the release of calcium ions from intracellular depots. Reduces the number of functioning calcium channels, without affecting the time of their activation, inactivation and recovery.
Pharmacokinetics
AbsorptionWhen ingestion is rapidly and almost completely (more than 90%) absorbed from the gastrointestinal tract. Absolute bioavailability - 40-70%. After ingestion of Cordaflex Cmax in the blood is achieved within 0.5-1 h after administration. Distribution Binding to plasma proteins (albumin) is 94-97%. Unbound nifedipine is distributed in all organs and tissues. It penetrates through BBB (less than 5%), through the placental barrier, is excreted in breast milk. There is no cumulative effect. Metabolism Nifedipine is extensively metabolized during the first passage through the liver (40-60%). Fully metabolized to inactive metabolites. Withdrawal of T1 / 2 nifedipine is approximately 2 h.60-80% of the ingested dose of the drug is excreted in the urine in the form of inactive metabolites, the rest - with bile and feces.
Indications
- arterial hypertension, including hypertensive crises; - ischemic heart disease: stable angina (exertional angina), angiospastic stenocardia (Prinzmetal stenocardia).
Contraindications
- acute myocardial infarction (first 4 weeks); severe hypotension (systolic blood pressure below 99 mm Hg); severe aortic stenosis, idiopathic hypertrophic subaortic stenosis; - chronic heart failure in the stage of decompensation; - unstable angina, - increased sensitivity to nifedipine and other components of the drug, other derivatives of 1,4-dihydropyridine. With care: pronounced mitral stenosis, hypertrophic obstructive cardiomyopathy, chronic heart failure chnost, severe violations of cerebral circulation, sick sinus syndrome, severe tachycardia, advanced age, the age of 18 years, renal or hepatic insufficiency (especially patients who are on hemodialysis - a high risk of excessive and unpredictable reduction in blood pressure), lactose intolerance.
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
The use of Cordaflex in pregnant women is indicated when it is impossible to use other drugs that have no restrictions. Since nifedipine is excreted in breast milk, the use of Cordaflex during lactation should be avoided or breastfeeding should be stopped during treatment with the drug.
Dosage and administration
Dosing regimen set individually, depending on the severity of the disease and the patient's response to the therapy.The drug is taken orally before eating, with a small amount of water, without chewing. Cordaflex is prescribed 10 mg (1 tab.) 3 times / day. If necessary, the dose of the drug can be increased to 20 mg (2 tab.) 1-2 times / day. The maximum daily dose is 40 mg. The interval between taking the drug is at least 2 hours. To speed up the action of the drug at the onset of an angina or hypertensive crisis, the tablet should be chewed, held in the mouth for a while and then swallowed with a small amount of water. If you need to increase the dose to 80-120 mg / For the treatment of stenocardia or hypertension, it is recommended to transfer the patient to the drug in the form of coated pills, 20 mg. In elderly patients, the pharmacokinetics of nifedipine and It varies, and therefore, to maintain the therapeutic effect may require a lower dozy.Pri human liver or renal drug is recommended to be used with caution in the same doses as in the normal liver and kidney function (development of tolerance). In severe impaired liver function, the maximum daily dose should not exceed 40 mg.
Side effects
Since the cardiovascular system: facial flushing, severe hypotension, peripheral edema, tachycardia; rarely, the occurrence of angina attacks (drug withdrawal is required), heart failure, syncope. From the side of the central nervous system and peripheral nervous system: headache, dizziness, fatigue, sleep disturbances (drowsiness or insomnia); in isolated cases - mood lability, visual disturbances; with prolonged use in high doses - paresthesia in the limbs, tremor. On the part of the digestive system: diarrhea, constipation, nausea, heartburn; rarely (with long-term use of the drug) - dry mouth, flatulence, intrahepatic cholestasis, increased activity of hepatic transaminases; in some cases - gingival hyperplasia, gingivitis, anorexia. On the side of the hematopoietic system: rarely - thrombocytopenia, thrombocytopenic purpura, leukopenia; in some cases - anemia. From the urinary system: an increase in daily urine output; rarely - deterioration of renal function in patients with chronic renal failure, nocturnal urination. For the musculoskeletal system: myalgia; very rarely - arthritis, arthralgia. From the endocrine system: in isolated cases - gynecomastia,hyperglycemia (completely disappear after discontinuation of the drug), change in body weight, galactorrhea. Allergic reactions: rarely - urticaria, rash, pruritus; very rarely - photodermatitis. Others: feeling hot; very rarely - weakness, sweating, fever, chills.
Overdose
Symptoms: severe hypotension, tachycardia, chest pain (angina), headache, collapse, loss of consciousness, nodular or ventricular premature beats due to inhibition of sinus node activity, bradycardia, syncope. In severe cases, possible impairments of consciousness with the transition to coma, hyperkalemia, metabolic alkalosis, hypoxia, cardiogenic shock with pulmonary edema. Treatment: given the absence of a specific antidote, in cases of early detoxification, gastric lavage is performed with the appointment of activated carbon. If necessary, you can do the washing of the small intestine, which is more appropriate in case of an overdose of drugs with controlled release. When prescribing laxatives, it should be borne in mind that the intake of slow calcium channel blockers inhibits intestinal motility until complete atony. Since nifedipine is largely associated with plasma proteins, hemodialysis is not effective and plasmapheresis may be effective. Symptomatic therapy is shown. Symptoms of cardiac arrhythmia with bradycardia can be eliminated by the introduction of beta-adrenergic mimetics and / or atropine. For life-threatening bradycardia, an artificial pacemaker should be used. With a pronounced decrease in blood pressure, infusion of usual doses of norepinephrine (noradrenaline) or epinephrine (epinephrine) is indicated, dopamine (maximum dose 25 μg / kg body weight / min), dobutamine (maximum dose 15 μg / kg body weight / min), isoprenaline and 10% calcium gluconate solution (10–20 ml IV With the development of symptoms of heart failure, it is recommended in / in the introduction of fast-acting cardiac glycosides digitalis.
Interaction with other drugs
The combination of Cordaflex with beta-blockers, diuretics, ACE inhibitors, and nitrates is rational from the point of view of enhancing the antihypertensive and antianginal effects.All of the above combinations are safe and effective in most clinical situations, because they lead to summation or potentiation of effects, but in some cases there is a risk of pronounced reduction in blood pressure and an increase in heart failure symptoms. Cordaflex combined with clonidine, methyldopa, octadine, prazosin, according to indications however, it can cause severe orthostatic hypotension. Strengthening of the hypotensive effect is also observed in combination therapy with cimetidine, ranitidine and tricyclic a Nepedipine increases the concentration of digoxin and theophylline in the blood plasma, and therefore the clinical effect and / or the content of digoxin and theophylline in the blood plasma should be monitored. Procaine, quinidine and other drugs that cause prolongation of the QT interval, increase the negative inotropic effect and increase risk of lengthening the QT interval. Under the influence of nifedipine, the concentration of quinidine in the serum is significantly reduced, which is apparently due to a decrease in its bioavailability, as well as the induction of enzymes that inactivate quinidine. With the abolition of nifedipine, a transient increase in the concentration of quinidine is observed (approximately 2 times), which reaches a maximum level of 3-4 days. When using such combinations, caution should be exercised, especially in patients with impaired left ventricular function. Nifedipine can displace drugs associated with proteins with a high degree of binding (including indirect anticoagulants - derivatives of coumarin and indandion, NSAIDs), as a result an increase in their concentrations in the blood plasma. When administered concurrently with rifampicin, phenytoin and calcium preparations, the effect of nifedipine is weakened. Nifedipine inhibits the removal of vincristine from the body and can t cause increased side effects of vincristine, if necessary reduce the dose of vincristine. Diltiazem inhibits nifedipine metabolism in the body, if necessary, reduce the dose of nifedipine. effects. In a similar waysimultaneous use of Cordaflex and cimetidine increases the concentration of nifedipine in the blood plasma, enhances its effects; however, simultaneous use with ranitidine does not lead to a significant increase in the concentration of nifedipine in the blood plasma. Since nifedipine is metabolized by the CYP3A4 isoenzyme, any inhibitor or inducer of this enzyme can affect the metabolism of nifedipine. Cyclosporin is also a substrate of CYP3A4 isoenzyme; therefore, with the combined use of cyclosporine and nifedipine, each can increase the duration of the effect of the other.
special instructions
The antihypertensive effect of Cordaflex is enhanced by hypovolemia. Reducing pressure in the pulmonary artery and hypovolemia after dialysis can also enhance the effects of the drug, and therefore reduce its dose. In rare cases, at the beginning of the course of treatment with Cordaflex or with an increase in its dose soon after taking the drug, chest pain may occur (angina pectoris due to paradoxical ischemia). If you find a causal relationship between taking the drug and angina pectoris, treatment should be discontinued. Patients with diabetes need careful medical supervision during Cordaflex therapy. In hypertension or coronary vascular disease, abrupt withdrawal of nifedipine can cause hypertensive crisis or myocardial ischemia (ricochet phenomenon). while the patient is undergoing surgery under general anesthesia, it is necessary to inform the anesthesiologist about the therapy being carried out. During the course of treatment with Cordaflex, the use of alcoholic beverages is not recommended due to the risk of an excessive decrease in blood pressure. Impact on the ability to drive vehicles and control mechanisms In the initial, individually determined period of use of Cordaflex, driving and other potentially hazardous activities that require the speed of psychomotor reactions. In the process of further treatment, the degree of restriction is determined depending on the individual patient's response to the drug.