General characteristics. Compound:
Active ingredient: 40.0 mg nifedipine
Excipients: microcrystalline cellulose, cellulose, lactose, hypromellose (methylhydroxypropylcellulose), magnesium stearate, colloidal silicon dioxide, anhydrous.
Shell: hypromellose (methylhydroxypropylcellulose), macrogol 6000, macrogol 400, red iron oxide dye, E172, titanium dioxide, E171, talc.
Cordipine is a calcium antagonist that blocks calcium channels in muscle cells hearts and blood vessels. It has hypotensive (lowers blood pressure), vasodelating, antianginal and anti-ischemic effects.
Pharmacological properties:
Pharmacodynamics. Cordipin® XL is a drug from the group of “slow” calcium channel blockers.
It blocks the flow of calcium ions through the membrane of cardiac muscle cells and vascular smooth muscles. Blockade of the entry and accumulation of calcium ions inside cells leads to expansion of peripheral and coronary vessels, reduces overall peripheral resistance blood vessels (OPSS), reduces afterload on the heart, reduces coronary blood flow and reduces myocardial oxygen demand.Mostly at the beginning of therapy, the heart rate and cardiac output may decrease as a result of activation of the baroreceptor reflex. With long-term therapy with nifedipine, heart rate and cardiac output return to the values they had before the start of therapy. In patients with arterial hypertension There is a more pronounced decrease in blood pressure.
Pharmacokinetics.
The release of nifedipine from Cordipine® XL tablets is very slow, almost linear, i.e. release occurs at a constant level. Nifedipine released from the tablets is quickly and almost completely absorbed. The lower value of the equilibrium concentration level is achieved after taking the first dose of Cordipine® CL (after 24 hours). When the equilibrium state has already been achieved, the maximum concentration of the drug is reached 5 2.7 hours after oral administration. The effect of the drug lasts 24 hours, so a single dose per day is sufficient. Protein binding of nifedipine is 94-99%. Nifedipine is almost completely metabolized. The half-life (T 1/2) of the drug is 14.9 6.0 hours, less than 1% of the drug dose is excreted unchanged in the urine. 70-80% of the dose taken is excreted in the urine in the form of metabolites. The elimination of nifedipine may be slower if renal function is impaired.Indications for use:
Cordipin® XL is used to treat:
Arterial hypertension
.Stable (angina pectoris)
.Vasospastic angina
Important! Get to know the treatment
Directions for use and dosage:
The dosage regimen for Cordipin® HL is individual. The usual dose of Cordipin® XL, modified release, both at the beginning of therapy and during ongoing treatment, is one 40 mg tablet taken once a day; The maximum recommended dose is two tablets (80 mg) per day in one or two divided doses.
Cordipin® CL tablets should be taken after meals, they should be swallowed whole with a glass of water, the tablets should not be broken or chewed.
If the patient forgot to take the next dose of Cordipine® CL, next appointment he should not double the dose of the drug.
Features of application:
It is recommended to discontinue treatment with Cordipin® CL gradually.
It should be borne in mind that angina pectoris may occur at the beginning of treatment, especially after recent abrupt withdrawal of beta-blockers (the latter should be withdrawn gradually).The simultaneous administration of beta-blockers must be carried out under conditions of careful medical supervision, as this may cause an excessive decrease in blood pressure, and in some cases, aggravation of symptoms.
In case of severe heart failure, the drug is dosed with great caution.
The diagnostic criteria for prescribing the drug for vasospastic angina are: classic clinical picture accompanied by an increase in the ST segment, the occurrence of ergonovine-induced angina or spasm coronary arteries, detection of coronary spasm with or detection of an angiospastic component without confirmation (for example, with a different voltage threshold or when electrocardiogram data indicate a transient angiospasm).
For patients with severe obstructive cardiomyopathy, there is a risk of increased frequency, severity and duration of angina attacks after taking nifedipine; V in this case discontinuation of the drug is necessary.
In patients on hemodialysis with high blood pressure and irreversible kidney failure with reduced total number blood, the drug should be used with caution; a sharp drop in blood pressure may occur.
Patients with impaired liver function are closely monitored and, if necessary, reduce the dose of the drug and/or use other dosage forms of nifedipine. If during therapy the patient requires surgery under general anesthesia, it is necessary to inform the anesthesiologist about the nature of the therapy being performed.
During treatment it is possible positive results when performing direct Coombs reaction and laboratory tests for antinuclear antibodies.
Caution should be used when coadministering disopyramide and flecainamide due to a possible increase in inotropic effect.
Prescription of nifedipine for pregnant women is indicated only if the expected benefit to the mother outweighs the potential risk to the fetus. Nifedipine is not recommended for use in the 1st trimester of pregnancy.
The drug is released from breast milk Therefore, it is recommended to stop breastfeeding while taking the drug.
In some patients, especially at the beginning of treatment, the drug may cause pain, which reduces the ability to drive a car or use other machinery. In the future, the degree of restrictions is determined depending on the individual tolerability of the drug.
Side effects:
From the outside cardiovascular system: manifestations of excessive vasodilation (asymptomatic decrease in blood pressure, “flushes” of blood to the facial skin, flushing of the facial skin, feeling of heat), palpitations, peripheral, development or worsening of heart failure (HF) (more often worsening of an existing one), chest pain; rarely - excessive decrease in blood pressure (BP), fainting,
In some patients, especially at the beginning of treatment, angina attacks may occur, which requires discontinuation of the drug. Isolated cases of myocardial infarction have been described.From the central side nervous system:, dizziness, increased fatigue, weakness, drowsiness. With long-term ingestion in high doses - limbs, feeling, with long-term ingestion in high doses - extrapyramidal (parkinsonian) disorders (ataxia, “mask-like” face, shuffling gait, stiffness of movements of the arms and legs, hands and fingers, difficulty swallowing).
From the outside digestive system: dry mouth, decreased appetite (nausea, or); rarely - gum hyperplasia (bleeding, pain, swelling), with long-term use - liver dysfunction (intrahepatic, increased activity of "liver" transaminases).
From the hematopoietic organs: , asymptomatic, thrombocytopenic purpura, .
Allergic reactions: rarely - exfoliative, photodermatitis; very rarely - .
From the musculoskeletal system: rarely - swelling of the joints, upper and lower extremities.
From the urinary system: increased daily diuresis, deterioration of renal function (in patients with renal failure).
Other: rarely - difficulty breathing; very rarely - visual impairment (including transient blindness at the maximum concentration of nifedipine in the blood plasma), (in elderly patients, completely disappearing after discontinuation of the drug), weight gain.
Interaction with other drugs:
The severity of the decrease in blood pressure increases with the simultaneous use of other antihypertensive drugs, beta-blockers, nitrates, cimetidine (to a lesser extent ranitidine), inhalational anesthetics, diuretics and tricyclic antidepressants.
Medicines from the BMCC group can further enhance the negative inotropic effect (lowering the strength of heart rate) antiarrhythmic drugs such as amiodarone and quinidine.
Nifedipine causes a decrease in the concentration of quinidine in the blood plasma, which may occur after discontinuation of nifedipine. sharp increase quinidine concentrations.
Increases the plasma concentration of digoxin and theophylline, and therefore the clinical effect and the content of digoxin and theophylline in the blood plasma should be monitored.
Inducers of microsomal liver enzymes (rifampicin, etc.) reduce the concentration of nifedipine. In combination with nitrates, tachycardia increases. The hypotensive effect is reduced by sympathomimetics, non-steroidal anti-inflammatory drugs, estrogens, and calcium supplements.
Nifedipine can displace drugs characterized by a high degree of binding from protein binding (including indirect anticoagulants - coumarin and indanedione derivatives, anticonvulsants, non-steroidal anti-inflammatory drugs, quinine, salicylates, sulfinpyrazone), as a result of which their concentration in the blood plasma may increase.
Nifedipine inhibits the elimination of vincristine from the body and may cause increased side effects of vincristine; if necessary, the dose of vincristine is reduced.
Lithium preparations can increase toxic effects (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus). With the simultaneous administration of cephalosporins (for example, cefixime) and nifedipine in probands, the bioavailability of the cephalosporin increased by 70%. Grapefruit juice suppresses the metabolism of nifedipine in the body, and therefore their simultaneous use is contraindicated.
Suppresses the metabolism of prazosin and other alpha-blockers, as a result of which the hypotensive effect may be enhanced. Procainamide, quinidine and others medicines, causing elongation QT interval, increase the negative inotropic effect and may increase the risk of significant prolongation of the QT interval.
Contraindications:
Increased sensitivity to nifedipine or other dihydropyridine derivatives, other components of the drug (each Cordipine CL tablet contains 30 mg of lactose, so the drug is not recommended for lactase deficiency, malabsorption syndrome), (risk of myocardial infarction), severe stenosis aortic valve, (in the stage of decompensation), pronounced (systolic blood pressure below 90 mmHg), acute period myocardial infarction (during the first 4 weeks), pregnancy (first trimester), lactation period, age up to 18 years (efficacy and safety have not been established).
With caution: severe stenosis of the aortic mouth or mitral valve, hypertrophic obstructive, severe and tachycardia, malignant, myocardial infarction with left ventricular failure, chronic heart failure, unstable angina, simultaneous administration of beta-blockers or cardiac glycosides, obstruction gastrointestinal tract(gastrointestinal tract), pregnancy II - III trimester, mild or moderate arterial hypotension, concomitant use of rifampicin, severe disorders cerebral circulation, impaired liver and/or kidney function, (risk of arterial hypotension), old age.
Overdose:
Symptoms: causes peripheral vasodilation with severe and possibly prolonged systemic arterial hypotension: headache, hyperemia of the facial skin, prolonged pronounced decrease in blood pressure, depression of the sinus node, bradycardia and/or tachycardia, bradyarrhythmia. In severe poisoning, loss of consciousness, coma.
Treatment for overdose is standard procedures removal of the drug from the body (purpose activated carbon, ), restoration of stable hemodynamic parameters, careful monitoring of the activity of the heart, lungs and excretory system.
The antidote is calcium preparations; intravenous administration of a 10% solution of calcium chloride or calcium gluconate is indicated, followed by switching to a long-term infusion.
Due to the high degree of binding to plasma proteins, hemodialysis is not effective.
The clearance of nifedipine is increased in patients with impaired liver function.
Storage conditions:
Store at a temperature not exceeding 25 °C.Keep out of the reach of children.
Vacation conditions:
By prescription
Package:
Modified-release film-coated tablets, 40 mg. 10 tablets in a blister. 2 blisters in a cardboard box along with instructions for use.
Active ingredient
Release form
extended-release film-coated tablets
Owner/Registrar
International Classification of Diseases (ICD-10)
I10 Essential [primary] hypertension I20 Angina pectoris [angina pectoris] I20.1 Angina pectoris with documented spasmPharmacological group
Calcium channel blocker. Antianginal and antihypertensive drug.
Pharmacological action
Slow calcium channel blocker. Inhibits the flow of calcium ions through the membrane of cardiac muscle cells and vascular smooth muscles. Blockade of the entry and accumulation of calcium ions inside cells leads to dilation of peripheral and coronary vessels, reduces peripheral vascular resistance, reduces afterload on the heart, reduces coronary blood flow and reduces myocardial oxygen demand.
Mainly at the beginning of therapy, a decrease in heart rate and cardiac output is possible as a result of activation of the baroreceptor reflex.
With long-term therapy with nifedipine, heart rate and cardiac output return to the values that existed before the start of therapy.
In patients with arterial hypertension, a more pronounced decrease in blood pressure is observed.
The effect of the drug lasts 24 hours, so a single dose per day is sufficient.
Pharmacokinetics
Suction and distribution
The release of nifedipine from Cordipin ® CL tablets is slow and almost linear, i.e. release occurs at a constant level. After release, nifedipine is quickly and almost completely absorbed.
C ss min is achieved after taking the first dose of Cordipine CL (after 24 hours), C ss max of nifedipine in the blood is observed after 5.0 ± 2.7 hours.
The binding of nifedipine to plasma proteins is 94-99%.
Metabolism and excretion
Nifedipine is almost completely metabolized.
T1/2 is 14.9±6 hours. Less than 1% of the dose is excreted in the urine unchanged, 70-80% of the dose is excreted in the urine in the form of metabolites.
Pharmacokinetics in special clinical situations
If renal function is impaired, the excretion of nifedipine may be slower.
Arterial hypertension;
Stable angina (angina pectoris);
Angiospastic (vasospastic) angina.
Cardiogenic shock (risk of myocardial infarction);
Acute period of myocardial infarction (during the first 4 weeks);
Severe aortic valve stenosis;
Chronic heart failure (in the stage of decompensation);
Severe arterial hypotension (systolic blood pressure below 90 mmHg);
Porphyria;
I trimester of pregnancy;
Lactation period;
Age up to 18 years (efficacy and safety have not been established);
Lactase deficiency, galactosemia, malabsorption syndrome;
Hypersensitivity to nifedipine and other components of the drug;
Hypersensitivity to other dihydropyridine derivatives;
WITH caution the drug should be used for severe stenosis of the aortic orifice or mitral valve, hypertrophic obstructive cardiomyopathy, severe bradycardia and tachycardia, SSSS, malignant arterial hypertension, myocardial infarction with left ventricular failure, chronic heart failure, unstable angina, gastrointestinal obstruction, in the II and III trimesters of pregnancy , with mild or moderate arterial hypotension, severe violations cerebral circulation, impaired liver and/or kidney function, hemodialysis (risk of arterial hypotension); simultaneously with beta-blockers, cardiac glycosides, rifampicin; in elderly patients.
From the cardiovascular system: manifestations of excessive vasodilation (asymptomatic decrease in blood pressure, flushing of the facial skin, flushing of the facial skin, feeling of heat), tachycardia, palpitations, arrhythmia, peripheral edema, development or worsening of heart failure (usually worsening of existing ones), chest pain; rarely - excessive decrease in blood pressure, fainting; in some cases (especially at the beginning of treatment) - attacks of angina pectoris (drug discontinuation is required); in isolated cases - myocardial infarction.
From the central nervous system and peripheral nervous system: headache, dizziness, increased fatigue, weakness, drowsiness; with long-term use in high doses - paresthesia in the limbs, depression, anxiety, extrapyramidal (parkinsonian) disorders (ataxia, mask-like face, shuffling gait, stiffness in the movements of the arms and legs, tremor of the hands and fingers, difficulty swallowing).
From the digestive system: dry mouth, loss of appetite, dyspepsia (nausea, diarrhea or constipation); rarely - gum hyperplasia (bleeding, pain, swelling); with long-term use - liver dysfunction (intrahepatic cholestasis, increased activity of liver transaminases).
From the hematopoietic organs: anemia, asymptomatic agranulocytosis, thrombocytopenia, thrombocytopenic purpura, leukopenia.
From the musculoskeletal system: arthritis; rarely - arthralgia, swelling of the joints, myalgia, convulsions of the upper and lower extremities.
From the urinary system: increased daily diuresis, deterioration of renal function (in patients with renal failure).
From the outside respiratory system: rarely - difficulty breathing, cough; very rarely - pulmonary edema, bronchospasm.
From the senses: very rarely - visual impairment (including transient blindness at the maximum concentration of nifedipine in the blood plasma).
From the outside endocrine system: very rarely - gynecomastia (in elderly patients, completely disappears after discontinuation of the drug), galactorrhea.
From the side of metabolism: very rarely - hyperglycemia, weight gain.
Allergic reactions: rarely - itchy skin, exfoliative dermatitis; very rarely - autoimmune hepatitis.
Dermatological reactions: rarely - exanthema, photodermatosis.
Overdose
Symptoms: the drug causes peripheral vasodilation with severe and possibly prolonged arterial hypotension: headache, facial flushing, prolonged pronounced decrease in blood pressure, depression of the sinus node, bradycardia and/or tachycardia, bradyarrhythmia. In case of severe poisoning - loss of consciousness, coma.
Treatment: standard measures aimed at removing the drug from the body (prescribing activated carbon, gastric lavage), stabilizing hemodynamic parameters; careful monitoring of the activity of the heart, lungs and excretory system.
The antidote is calcium preparations. IV administration of a 10% solution of calcium chloride or calcium gluconate is indicated, followed by switching to a long-term infusion.
Due to the high degree of binding to plasma proteins, hemodialysis is not effective.
The clearance of nifedipine is increased in patients with impaired liver function.
Special instructions
It is recommended to discontinue treatment with Cordipin ® CL gradually.
It should be borne in mind that at the beginning of treatment, the development of angina pectoris is possible, especially after the recent abrupt withdrawal of beta-blockers (the latter should be withdrawn gradually). The simultaneous administration of beta-blockers must be carried out under close medical supervision, since this may result in an excessive decrease in blood pressure, and in some cases, aggravation of symptoms of heart failure.
Diagnostic criteria for prescribing the drug for angiospastic angina are: a classic clinical picture, accompanied by an increase in the ST segment, the occurrence of ergonovine-induced angina or coronary artery spasm, detection of coronary spasm during angiography or identification of an angiospastic component without confirmation (for example, with a different voltage threshold or with unstable angina , When ECG data indicate transient vasospasm).
For patients with severe obstructive cardiomyopathy, there is a risk of increased frequency, severity and duration of angina attacks after taking nifedipine; in this case, discontinuation of the drug is necessary.
In patients on hemodialysis with high blood pressure and irreversible renal failure with reduced blood volume, the drug should be used with caution, because A sharp drop in blood pressure may occur.
The condition of patients with impaired liver function should be carefully monitored and, if necessary, reduce the dose of the drug and/or use other dosage forms of nifedipine.
If during therapy the patient requires surgical intervention under general anesthesia, it is necessary to inform the anesthesiologist about the nature of the therapy being performed.
During treatment, positive results are possible with direct Coombs test and laboratory tests for antinuclear antibodies.
Caution should be used when prescribing the drug simultaneously with disopyramide and flecainamide.
Impact on the ability to drive vehicles and operate machinery
In some patients, especially at the beginning of treatment, the drug may cause dizziness, which reduces the ability to drive a car or use other machinery. In the future, the degree of restrictions is determined depending on the individual tolerability of the drug.
For renal failure
In patients with impaired renal function, dose adjustment is usually not required.
In case of liver dysfunction
The use of the drug is contraindicated for porphyria.
Physician supervision, especially at the beginning of treatment, is required for patients with severe liver disease who have suffered a myocardial infarction.
Elderly
WITH caution the drug should be used in elderly patients.
Use during pregnancy and breastfeeding
The use of Cordipin ® CL in the first trimester of pregnancy is contraindicated. In the second and third trimesters, use is possible only if the expected benefit of therapy for the mother outweighs the potential risk for the fetus.
Nifedipine is excreted in breast milk, so if it is necessary to use the drug during lactation, breastfeeding should be stopped.
Drug interactions
The severity of the decrease in blood pressure increases with the simultaneous use of Cordipine HL with other antihypertensive drugs, beta-blockers, nitrates, cimetidine (to a lesser extent with ranitidine), inhalational anesthetics, diuretics, tricyclic antidepressants.
Medicines from the group of slow calcium channel blockers can further enhance the negative inotropic effect of antiarrhythmic drugs such as amiodarone and quinidine.
Nifedipine causes a decrease in the concentration of quinidine in the blood plasma; after discontinuation of nifedipine, a sharp increase in the concentration of quinidine may occur.
Nifedipine increases plasma concentrations of digoxin and theophylline (when combined, monitoring of the clinical effect and concentrations of digoxin and theophylline in the blood plasma is required).
Inducers of microsomal liver enzymes (including rifampicin) reduce the concentration of nifedipine in the blood plasma
When used simultaneously with nitrates, tachycardia increases.
The hypotensive effect is reduced by sympathomimetics, NSAIDs, estrogens, and calcium supplements.
Nifedipine is able to displace drugs characterized by a high degree of binding from their binding to plasma proteins (including indirect anticoagulants derivatives of coumarin and indanedione, anticonvulsants, NSAIDs, quinine, salicylates, sulfinpyrazone), as a result of which their concentrations in the blood plasma may increase.
Nifedipine slows down the elimination of vincristine from the body and may cause increased side effect vincristine (with this combination, if necessary, the dose of vincristine should be reduced).
Lithium preparations may increase side effects nifedipine (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus).
With the simultaneous administration of cephalosporins (for example, cefixime) and nifedipine, the bioavailability of the cephalosporin increased by 70%.
Nifedipine inhibits the metabolism of prazosin and other alpha-blockers, as a result of which the hypotensive effect may be enhanced.
Procainamide, quinidine, and other drugs known to prolong the QT interval enhance the negative inotropic effect and may increase the risk of significant QT prolongation.
Grapefruit juice suppresses the metabolism of nifedipine, so its use is contraindicated during treatment with Cordipine HL.
Installed individually.
The drug is prescribed in an average dose of 40 mg (1 tablet) 1 time/day both at the beginning of therapy and during long-term treatment. If necessary, the dose is increased to a maximum of 80 mg (2 tablets)/day in 1 or 2 doses.
If you miss a regular dose of the drug, you should not double the dose the next time you take it.
The drug should be taken after meals. The tablets are taken whole, without breaking or chewing, with a glass of water.
Storage conditions and shelf life
The drug should be stored out of the reach of children at a temperature not exceeding 25°C. Shelf life - 3 years.
Instructions for use
Cordipin XL tab. 40 mg No. 20
Dosage forms
tablets 40mg
Synonyms
Adalat
Vero-Nifedipine
Calcigard retard
Cordafen
Cordaflex
Cordaflex RD
Cordipin
Cordipin retard
Corinfar
Osmo-Adalat
Phenigidine
Group
Calcium channel blockers of the dihydropyridine group
International nonproprietary name
Nifedipine
Compound
The active substance is nifedipine.
Manufacturers
Krka d.d. (Slovenia), Krka d.d., Novo Mesto (Slovenia)
Pharmacological action
Antianginal, hypotensive. Blocks calcium channels, inhibits the transmembrane flow of calcium ions into smooth muscle cells of arterial vessels and cardiomyocytes. Expands peripheral, mainly arterial vessels, incl. coronary, lowers blood pressure, reduces total peripheral vascular resistance and afterload on the heart. Increases coronary blood flow, reduces the strength of heart contractions, heart function and myocardial oxygen demand. Improves myocardial function and helps reduce heart size in chronic heart failure. Reduces blood pressure pulmonary artery, has a positive effect on cerebral hemodynamics. Inhibits platelet aggregation, has antiatherogenic properties, improves post-stenotic circulation in atherosclerosis. Increases the excretion of sodium and water, reduces myometrial tone. When taken orally, it is quickly and completely absorbed. Bioavailability of all dosage forms is 40-60%. About 90% of the dose taken is bound to plasma proteins. After oral administration, the maximum concentration in plasma is created after 30 minutes, the half-life is 2-4 hours. It is excreted by the kidneys in the form inactive metabolites and with feces. In small quantities it passes through the blood-brain barrier and the placental barrier and penetrates into breast milk. Does not have mutagenic or carcinogenic activity.
Side effect
From the cardiovascular system and blood (hematopoiesis, hemostasis: facial hyperemia with a feeling of heat, palpitations, tachycardia, hypotension (up to fainting), angina-like pain, very rarely - anemia, leukopenia, thrombocytopenia, thrombocytopenic purpura. From the nervous system systems and sensory organs: dizziness, headache, stupefaction, change visual perception, loss of sensation in the arms and legs. From the gastrointestinal tract: constipation, nausea, diarrhea, gingival hyperplasia (with long-term treatment), increased activity of liver transaminases. From the respiratory system: bronchospasm. From the musculoskeletal system: myalgia, tremor. Allergic reactions: itching, urticaria, exanthema, exfoliative dermatitis. Other: swelling and redness of the arms and legs, photodermatitis, hyperglycemia, gynecomastia (in elderly patients), burning sensation at the injection site (with intravenous administration).
Indications for use
Arterial hypertension, including hypertensive crisis, prevention of angina attacks (including Prinzmetal's angina), hypertrophic cardiomyopathy (obstructive, etc.), Raynaud's disease, pulmonary hypertension, broncho-obstructive syndrome.
Contraindications
Hypersensitivity, acute period of myocardial infarction (first 8 days), cardiogenic shock, severe aortic stenosis, heart failure in the stage of decompensation, severe arterial hypotension, tachycardia, pregnancy, breastfeeding. Restrictions on use: You should refrain from using the drug in pediatric practice, since the safety and effectiveness of its use in children have not been determined.
Overdose
Symptoms: severe bradycardia, bradyarrhythmia, arterial hypotension, in severe cases - collapse, conduction slowdown. When taking a large number of retard tablets, signs of intoxication appear no earlier than after 3-4 hours and can additionally be expressed in loss of consciousness up to coma, cardiogenic shock, convulsions, hyperglycemia, metabolic acidosis, hypoxia. Treatment: gastric lavage, taking activated charcoal, administering norepinephrine, calcium chloride or calcium gluconate in atropine solution intravenously. Hemodialysis is ineffective.
Interaction
The hypotensive effect is enhanced by nitrates, diuretics, beta-blockers, tricyclic antidepressants, fentanyl, and alcohol. Increases the activity of theophylline, reduces the renal clearance of digoxin. Increases the side effects of vincristine (reduces excretion). Increases the bioavailability of cephalosporins (cefixime). Cimetidine and ranitidine increase plasma levels. Diltiazem slows metabolism (requires a reduction in the dose of nifedipine). Incompatible with rifampicin (accelerates biotransformation and does not allow the creation effective concentrations). Grapefruit juice (large quantities) increases bioavailability. Increases the concentration of cardiac glycosides in the blood.
Special instructions
Elderly patients are advised to reduce daily dose(decreased metabolism). Use with caution when working for drivers vehicles and people whose profession is associated with increased concentration. The drug should be discontinued gradually. In patients with stable angina, at the beginning of treatment, a paradoxical increase in anginal pain may occur; with severe coronary sclerosis and unstable angina, aggravation of myocardial ischemia may occur. It is not recommended to use drugs short acting For long-term treatment angina pectoris or arterial hypertension, because the development of unpredictable changes in blood pressure and reflex angina is possible.
Storage conditions
Store at room temperature, in a cool, dry place, away from children.
Cordipin contains the active ingredient nifedipine .
Additional Ingredients: cornstarch, lactose monohydrate, sodium lauryl sulfate, pregelatinized starch, povidone, talc, colloidal silicon dioxide.
Release form
Cordipine is produced in film-coated tablets that contain 10 mg of the active ingredient. There are 10 or 50 pieces in a package.
Tablets are also produced Kordipin HL modified release containing 40 mg active substance. There can be 10 or 20 pieces in a package.
Another form of the drug is tablets. Cordipin Retard, have a prolonged effect. Each tablet contains 20 mg of nifedipine. The package can contain 15 or 30 pieces.
Pharmacological action
Cordipine is a calcium antagonist drug that blocks calcium channels in the muscle cells of the heart and blood vessels. The drug has a hypotensive and anti-ischemic effect.
Under the influence of the drug, the Ca2+ current into smooth muscle cells and cardiomyocytes of the arteries decreases; when taking high doses of the drug, the release of calcium from intracellular depots is suppressed. Nifedipine reduces the number of functioning channels, without affecting the period of their activation, inactivation and restoration.
Under the influence of this drug, the processes of excitation and contraction are disconnected in the myocardium, as well as in the smooth muscles of blood vessels.
When taking the drug in therapeutic doses, normalization of the transmembrane Ca2+ current is observed, which is disrupted in patients with arterial hypertension. The product does not affect the tone of the veins. Kordipin activates blood supply to ischemic areas of the myocardium and improves coronary blood flow.
Its effect ensures dilation of peripheral arteries, reduces afterload, myocardial tone, and reduces myocardial oxygen demand. Does not have antiarrhythmic activity. Stimulates blood flow in the kidneys, under its influence moderate natriuresis is noted.
Pharmacokinetics and pharmacodynamics
The effect of oral administration of the drug is observed after 20 minutes. After taking the tablets, the effect lasts from 4 to 6 hours.
If prolonged forms of the drug were used, the effect develops more slowly, but can last from 12 to 24 hours.
Indications for use of Cordipin
The following indications for the use of Cordipin are determined:
- illness and;
- (used if necessary to stop a hypertensive crisis);
- spasm of the coronary arteries;
- carrying out differential diagnosis between organic and functional stenosis of the coronary arteries.
Contraindications
The following contraindications to taking the drug are defined:
- high sensitivity to any of the components of the product;
- severe forms of arterial hypotension (if systolic blood pressure is less than 90 mm Hg);
- pregnancy And lactation .
Use with caution in the following cases:
- with severe stenosis of the aortic orifice or mitral valve;
- with pronounced or bradycardia ;
- with symptoms of gastrointestinal obstruction;
- with moderate or mild arterial hypotension ;
- with LV failure;
- in case of severe cerebrovascular accidents;
- with hepatic or;
- patients in childhood or old age.
Side effects
The following negative effects may occur when taking this medication:
- Cardiovascular system: , tachycardia , excessive vasodilation (flushing, asymptomatic decrease in blood pressure, feeling of heat), very strong decrease in blood pressure (rare), symptoms of heart failure, fainting.
- Nervous system: , high level fatigue, asthenia . With prolonged use, tremor, paresthesia of the extremities, extrapyramidal disorders, may occur.
- Digestive system: increased appetite, dry mouth, dyspepsia. In rare cases it may appear gingival hyperplasia . Long-term treatment may lead to liver dysfunction.
- Blood-forming organs: leukopenia , anemia , thrombocytopenic purpura , thrombocytopenia , agranulocytosis .
- Musculoskeletal system: appears in rare cases arthralgia , myalgia , swelling of the joints .
- Urinary system: deterioration of kidney function, increase in daily diuresis.
- Allergic manifestations: in rare cases develops, exanthema , autoimmune hepatitis .
- Visual impairment may also develop, gynecomastia , galactorrhea , hyperglycemia , body weight gain.
Instructions for use of Cordipin (Method and dosage)
The drug must be taken orally, the tablets are washed down with a small amount of liquid. The specialist selects doses on an individual basis. As a rule, the initial dose is 10 mg - one tablet should be taken two to three times a day. If there is such a need, you can increase the dose to two tablets 1-2 times a day.
The maximum daily dose of short-acting nifedipine is 40 mg.
If it is necessary to take the drug constantly, it is recommended to use prolonged forms of the drug.
Instructions for use Cordipina Retard involves taking 1 tablet twice a day per day. If necessary, then the dose can be increased to 2 tablets twice a day. The maximum dose of the drug per day is 120 mg.
If a patient is diagnosed with angina, it is advisable to begin treatment by taking 10 mg of the drug three times a day. After four to five days, the dose should be increased by 10 mg.
Dosage should be adjusted (reduce dose) in people with impaired cerebral blood flow and those with liver dysfunction.
Overdose
In case of overdose, blood pressure can sharply decrease, manifested headache , develops tachycardia or bradycardia , the functioning of the sinus node is inhibited. In cases of severe overdose, a person may lose consciousness. In this case, it is necessary to take measures to remove the medicine from the body - take it, rinse the stomach. It is necessary to carefully monitor the functioning of the heart.
The antidote to Cordipin is calcium supplements . If there is a pronounced decrease in blood pressure, administration of or Dopamine intravenously. If conduction is impaired, it is indicated isoprenaline , atropine , artificial driver rhythm . If heart failure develops, strophanthin is administered intravenously.
If during treatment you carry out laboratory tests antinuclear antibodies and direct Coombs test, positive results may be observed.
It is important to take the drug regularly, regardless of how the patient is feeling, since a person may not feel the symptoms of arterial hypertension.
In the first days of treatment, there may be angina pectoris , especially if beta-blockers were abruptly discontinued.
If during treatment a person needs to undergo surgery and at the same time use general anesthesia, you should definitely tell your anesthesiologist about the treatment.
It is necessary to treat elderly people with caution due to the high likelihood of them having impaired renal function.
During therapy, you should drive carefully and perform those actions that require quick reactions.
Cordipin's analogs
Level 4 ATX code matches:In addition to drugs Kordipin HL, Cordipin Retard There are analogs of the drug that are available in tablets.
These are the medications: , Phenigidine , Corinfar UNO , Nikerdia , , Cordaflex RD .
These are drugs with both regular and prolonged release of the active substance.
For children
There is no data on the safety and effectiveness of this product for children and adolescents under 18 years of age. Therefore, this medicine is not used to treat patients in this age category.
With alcohol
You should completely abstain from drinking alcohol while taking this drug.
Excipients: microcrystalline cellulose, cellulose, lactose, methylhydroxypropylcellulose, magnesium stearate, colloidal anhydrous silicon, macrogol, iron oxide (E172), titanium dioxide (E171), talc.
10 pcs. - blisters (2) - cardboard boxes.
Description medicinal product CORDIPIN ® HL based on officially approved instructions for use of the drug and made in 2008. Update date: ..0
Calcium channel blocker. Inhibits the flow of calcium ions through the membrane of cardiomyocytes and vascular smooth muscles. Blockade of the entry and accumulation of calcium ions inside cells leads to dilation of peripheral and coronary vessels, a decrease in peripheral vascular resistance, a decrease in afterload on the heart and myocardial oxygen demand.
Mainly at the beginning of therapy, heart rate and cardiac output may decrease as a result of baroreceptor activation. With long-term therapy with nifedipine, heart rate and cardiac output return to the values they had before the start of therapy.
In patients with arterial hypertension, a more pronounced decrease in blood pressure is observed.
Suction and distribution
The release of nifedipine from Cordipin CL tablets is slow and almost linear, i.e. release occurs at a constant level. After release, nifedipine is quickly and almost completely absorbed from the gastrointestinal tract.
The minimum C ss value is achieved after the first dose of Cordipine HL (after 24 hours). When the equilibrium state has already been achieved, C ss max of nifedipine in the blood is observed after 5.0 ± 2.7 hours.
The binding of nifedipine to plasma proteins is 94-99%.
Metabolism and excretion
Nifedipine is almost completely biotransformed in the body.
T1/2 is 14.9±6 hours. Less than 1% of the dose is excreted in the urine unchanged, 70-80% of the dose is excreted in the form of metabolites.
Pharmacokinetics in special clinical situations
If renal function is impaired, T1/2 may increase.
Installed individually.
The drug is prescribed in an average dose of 40 mg (1 tablet) 1 time/day both at the beginning of therapy and during long-term treatment. If necessary, the dose is increased to a maximum of 80 mg (2 tablets)/day in 1 or 2 doses.
If the patient forgets to take the next dose of the drug, the next dose should not be doubled.
U patients with impaired renal function Dose adjustment is usually not required.
The tablets should be taken after meals, they must be swallowed whole, without breaking or chewing, with a glass of water.
From the cardiovascular system: possible headache, redness of the face, swelling of the ankles;
From the side of the central nervous system: rarely - dizziness, increased fatigue.
From the digestive system: rarely - nausea, heartburn, constipation, diarrhea, increased activity of liver transaminases;
From the musculoskeletal system: rarely - muscle weakness, muscle cramps.
Allergic reactions: rarely - skin rash, urticaria, itching.
Use during pregnancy and breastfeeding
To date, the safety of using Cordipine CL during pregnancy has not been established, and therefore the drug should not be prescribed to pregnant women.
Nifedipine is excreted in breast milk, so if it is necessary to use the drug during lactation, breastfeeding should be stopped.
At the beginning of treatment with Cordipine HL, especially when used simultaneously with beta-blockers, arterial hypotension is possible. In such cases, patients must be closely monitored.
Physician supervision, especially at the beginning of treatment, is required for patients with hypertrophic cardiomyopathy, unstable angina, diabetes mellitus, severe liver dysfunction, pulmonary hypertension, as well as elderly patients.
During treatment with Cordipin CL in patients with acute coronary insufficiency due to reflex tachycardia, the course of coronary artery disease may worsen (more frequent attacks of angina).
When using nifedipine, changes in alkaline phosphatase, ALT, AST, and LDH levels are possible. These changes are most often not associated with clinical manifestations, although symptoms of cholestasis and jaundice have been observed in some cases.
Cordipin HL should be discontinued 36 hours before planned anesthesia with fentanyl.
Before performing an inhalation test with methacholine to determine bronchial hyperreactivity, Cordipin CL should also be discontinued.
If it is necessary to discontinue therapy, the dose of the drug should be reduced gradually, since abrupt cessation of administration (especially after long-term treatment) may lead to the development of withdrawal syndrome.
During the treatment period, you should avoid drinking grapefruit juice and alcohol.
Impact on the ability to drive vehicles and operate machinery
In some patients, especially at the beginning of treatment, the drug may cause dizziness, which is reversible. Therefore, until the patient’s individual response to treatment is established, you should refrain from driving or engaging in other potentially dangerous activities. dangerous species activities.
Symptoms: excessive arterial hypotension;
Treatment: If the patient is conscious, vomiting should be induced. Careful monitoring of hemodynamic status and symptomatic therapy are necessary.
With simultaneous use of Cordipin HL with other antihypertensive drugs, beta-blockers, diuretics, nitroglycerin and isosorbide mononitrate or dinitrate long acting a synergistic effect on blood pressure is observed.
With the simultaneous use of Cordipine CL and fentanyl, an additional decrease in blood pressure is possible.
With simultaneous use of Cordipine CL with cimetidine, tricyclic antidepressants, ranitidine, the antihypertensive effect of nifedipine may be enhanced.
Rifampin induces the activity of liver enzymes, accelerating the metabolism of nifedipine, which leads to a decrease in the effectiveness of the latter.
When used simultaneously with calcium supplements, the therapeutic effectiveness of Cordipine HL is reduced.
With the simultaneous use of Cordipine HL and digoxin, carbamazepine, phenytoin and theophylline, the concentrations of the latter in the blood plasma increase.
With the simultaneous use of Cordipine CL and quinidine, the concentration of the latter in the blood plasma decreases.
It is possible to enhance the effect of Cordipin HL when used simultaneously with grapefruit juice and ethanol.
