Infringements of an intimate rhythm, hypertonic illness, ischemic illness of heart, chronic coronary insufficiency
Cordarone pharmachologic effect:
Class III antiarrhythmic drugs. It has antiarrhythmic and antianginal effects.
Antiarrhythmic effect is due to an increase in phase 3 of the action potential, mainly due to the reduction of potassium current through the cell membrane channels of cardiomyocytes, and a decrease in sinus automatism (which leads to bradycardia unresponsive to atropine effects). The drug blocks the uncompetitive a- and b-adrenergic receptors. Slows sinoatrialnuyu, atrial and nodal conduction, without affecting the intraventricular conduction. Cordarone increases the refractory period and reduces the excitability of the myocardium. It slows conduction of excitation and prolongs the refractory period of additional atrioventricular pathways.
Antianginal effect cordarone due to a decrease in myocardial oxygen consumption (due to the deceleration in heart rate and decrease in systemic vascular resistance), a non-competitive blockade of a- and b-adrenergic receptors, increase coronary blood flow by direct effect on the smooth muscles of arteries, maintaining cardiac output by reducing the pressure in the aorta and decreased peripheral resistance .
Cordarone no significant negative inotropic effect, reduces myocardial contractility mainly after / in the introduction.
Affects the exchange of thyroid hormone, inhibits the conversion of T4 TK (blockade of 5-thyroxine deiodinase) and blocks the capture of these hormones cardiocytes and hepatocytes, which leads to a weakening of the stimulating effect of thyroid hormones on the myocardium. Determined in plasma during the 9 months after stopping its administration.
Therapeutic effects are observed at 1 week (from several days to 2 weeks) after the start of ingestion of the drug.
With on / in a cordarone its activity reaches a maximum after 15 minutes and disappears after about 4 hours after administration. Despite the fact that the amount of blood introduced cordarone rapidly reduced drug tissue saturation is achieved. drug gradually displayed the absence of repeated injections. With the resumption of his administration or the appointment of a preparation for oral administration shaped its tissue supply.
Cordarone indications for use:
- Cupping of paroxysmal tachycardia;
- Cupping ventricular paroxysmal tachycardia;
- Cupping supraventricular paroxysmal tachycardia with high ventricular rate, particularly against the background of sinroma Wolff-Parkinson-White syndrome;
- Relief of paroxysmal and sustained atrial fibrillation (AF) and atrial flutter.
- Life-threatening ventricular arrhythmias and ventricular fibrillation (treatment should be started in hospital under careful cardiac monitoring);
- Supraventricular paroxysmal tachycardia, including documented recurrent bouts of sustained supraventricular paroxysmal tachycardia in patients with organic heart disease; documented episodes of recurrent sustained supraventricular paroxysmal tachycardia in patients without organic heart disease, when other classes of antiarrhythmic drugs are not effective or are contraindicated to the use thereof; documented episodes of recurrent sustained supraventricular paroxysmal tachycardia in patients with WPW syndrome;
- Atrial fibrillation (AF) and atrial flutter.
Prevention of sudden arrhythmic death in patients at high risk after recent myocardial infarction, with more than 10 PVCs 1 hour, klinichekie manifestations of chronic heart failure and reduced left ventricular ejection fraction (<40%):
- Kordaron especially recommended for patients with organic heart disease (including coronary heart disease), accompanied by left ventricular dysfunction.
The injectable form Cordarone is intended to apply in cases when it is necessary to achieve rapid antiarrhythmic effect or if it can not be administered orally. Only for use in the hospital.
Cordarone mode of application:
Loading dose: Various schemes may be used.
In a hospital initial dose divided into several stages is from 600 to 800 mg (up to a maximum of 1200 mg) per day to a total dose of 10 g (usually within 5-8 days).
Ambulatory initial dose divided into several stages is from 600 mg to 800 mg per day to a total dose of 10 grams (usually 10-14 days).
Maintenance dose: 3 mg / kg of body weight per day, and may be in the range of from 100 mg / day to 400 mg / day for a single administration. It should use the minimum effective dose according to the individual therapeutic result.
Since Kordaron has a very long half-life, it can be taken every second day (200 mg can be given every other day and 100 mg taken daily is recommended); You can also take breaks (2 days per week).
The recommended loading dose for adults is 5 mg / kg body weight of the patient, to be administered in 250 mL of 5% glucose solution for 20 minutes to 2 hours. Administration may be repeated 2-3 times in 24 hours. The rate of infusion should be adjusted according to the results.
The therapeutic effect of the drug is in the first minutes of administration, and then gradually decreases, so the need to maintain the infusion.
The recommended maintenance dose for adults: 10-20 mg / kg / day (on the average from 600 to 800 mg / day, the maximum dose - 1200 mg / day) in 250 ml of 5% glucose solution for several days. From the first day of infusion should begin the transition to oral medication.
The recommended adult dose is 5 mg / kg should be administered for at least 3 minutes. Repeated injections should be performed no earlier than 15 minutes after the first injection. If necessary, continuation of treatment should be used intravenous infusion.
For children older than 3 years, the recommended dose is 5 mg / kg. For the use of the drug in children is responsible pediatrician.
Do not mix Kordaron in the same syringe with other drugs.
Cordarone side effects:
Bodies of: deposition of lipofuscin in the corneal epithelium (in this case, usually subjective complaints of patients are not available); In rare cases, if the deposits are large and partially fill the pupil, there are complaints of luminous spots or "fog" before your eyes in bright light.
Dermatological reactions: otosensibilizatsiya, which usually manifests as erythema exposed skin; in some cases, may appear weak pigmentation on exposed skin.
Endocrine status: long-term assignment in rare cases may develop hypothyroidism, much less - hyperthyroidism.
Cardiovascular system: the use of high doses cordarone and in predisposed patients, may cause bradycardia, slowing AV conduction, hypotension.
Nnervnoy System: isolated cases of peripheral neuropathy, tremor.
Gastrointestinal tract and liver: rarely nausea, heaviness in the epigastric pain, liver function abnormalities.
Respiratory system: describes cases of pneumonitis, alveolitis;
For parenteral administration can sense heat, increased sweating; bronchospasm, apnea (in patients with severe respiratory failure); increased intracranial pressure; locally - phlebitis.
- Hypersensitivity to iodine and / or amiodarone.
- Sick sinus syndrome (sinus bradycardia, sinoatrial block), except where correction artificial pacemaker (risk of "stop" sinus node).
- Violations of the atrioventricular and intraventricular conduction
(Atrioventricular block (II-III cent.), Bundle branch block) in the absence of an artificial pacemaker (pacemaker).
- The combination with drugs that can cause polymorphic ventricular tachycardia type "pirouette";
- Dysfunction of the thyroid gland (hypothyroidism, gipertirez).
- Hypokalemia, heart failure (decompensation stage).
- Children's age (18 years) (effectiveness and safety have been established).
- Simultaneous reception of MAO inhibitors.
- Interstitial lung disease
Cordarone for intravenous use is not recommended in these cases:
• are allergic to iodine or amiodarone;
• sinus bradycardia, sinoatrial heart block;
• sick sinus syndrome, except pacemaker correction;
• severe conduction abnormalities in the absence of an artificial pacemaker,
• in combination with drugs that may induce paroxysmal ventricular tachycardia;
• thyroid dysfunction;
• pregnancy, except in exceptional circumstances;
• Children up to 3 years.
Interaction with other drugs:
To enhance the effect of anti-anginal advisable cordarone combined use of drugs with long-acting nitrates.
Perhaps appoint Cordarone simultaneously with cardiotonic drugs, particularly drugs with digitalis, but in this case increases the risk of bradycardia.
Cordarone can be administered in combination with anticoagulants, diuretics.
Admission cordarone inside for a long period of time preceding the operation, no adverse effect on anesthesia and resuscitation. There was no interaction cordarone with droperidol, fenoperidinom, hlorprotiksenom, dextromoramide, pancuronium bromide, pentobarbital.
Do not appoint Cordarone simultaneously with verapamil, MAO inhibitors. Not recommended for use in combination with Cordarone beta-blockers (except in certain severe cases of the specific features of hemodynamics).
Information in respect of intravenous amiodarone overdose there. There is some information regarding acute overdose amiodarone ingested pills. Described several cases of sinus bradycardia, cardiac arrest, attacks of ventricular tachycardia, paroxysmal tachycardia "torsade de pointes", circulatory disorders and hepatic dysfunction, blood pressure-lowering treatment should be symptomatic (gastric lavage, the appointment of cholestyramine, with bradycardia - beta-agonists or installation pacemaker tachycardia type "feast" - in / magnesium salts slows pacing). Neither amiodarone or its metabolites are not removed during the hemodialysis.
Cordarone product form:
Tablets solution for intravenous injection.
30 tablets of 200 mg are packed in blisters cordarone hot sealing PVC / aluminum. The blisters are packed in a cardboard box. Cartons containing 6 colorless glass vials type I.
Cordarone storage conditions:
The solution - at room temperature (no more than 25 ° C) in the original cardboard box, in a dry place inaccessible to children. Tablets - at a temperature below 30 ° C.
Active substance: Amiodarone hydrochloride 150 mg;
- Benzyl alcohol - 60 mg;
- Polysorbate 80 - 300 mg;
Water for injection 3.0 ml.
Cordarone Pharmacological group:
Antiarrhythmic drugs. Medicines used for violations of excitability and automaticity of the heart.
Cordarone Active substance: Amiodarone
Before and during treatment is recommended ECG study. Because prolongation of ventricular repolarization pharmacological effect cordarone vyzyvet certain ECG changes: lengthening the interval QT, Q-Tc (korregirovat) waves may cause increase in U. Acceptable Q-Tc intervals less than 450 ms or no more than 25% of the original value. These changes are not a manifestation of the toxic effect of the drug, however, require monitoring for dose adjustments and evaluation of possible actions proaritmogennoe cordarone.
Older people can temporarily slow down the heart rate with the development of bradycardia.
The appearance of shortness of breath or nonproductive cough may be due to toxic effects on the lungs cordarone.
With the development of atrioventricular block II and III degree, sino-atrial block or two-beam intraventricular blockade, treatment should be discontinued.
Since Kordaron contains iodine, it is recommended to carry out a study of thyroid function before and during treatment. Admission cordarone can distort the results of radioisotope studies of thyroid, but does not affect the accuracy of the determination of the content of T3, T4 and TSH in blood plasma.
Before and during the treatment of treatment is recommended defining the level of potassium in the blood serum.
- Intravenous cordarone usually be administered as an intravenous infusion, rather than as an injection syringe due to the danger
occurrence of hemodynamic disturbances (hypotension, acute heart failure).
- Intravenous cordarone syringe in the form of injections should only be done in emergency situations when no other therapeutic options and only in coronary care departments under continuous electrocardiographic monitoring.
- Cordarone When administered as an injection syringe, the dose is about 5 mg / kg should be administered for at least 3 minutes again.
The injection should not be repeated sooner than 15 minutes after the first injection, even if the latter consists of only one ampoule
(Possible irreversible collapse).
Do not mix in the same syringe with other drugs. If necessary, long-term treatment should go to intravenous infusion.
- Kordaron for intravenous injection should be used only in specialized hospital wards under constant supervision
(ECG, blood pressure).
- Use with caution in the case of arterial hypotension, severe respiratory failure, decompensated cardiomyopathy and severe heart failure.
General anesthesia: the anesthetist before surgery should be made aware that the patient receives amiodarone.
Before starting treatment with Cordarone it is recommended to perform an ECG recording, determine the level of thyroid hormones (T3, T4 and TSH) and potassium in the blood serum.
Side effects of the drug generally depend on the dose; therefore, caution should be exercised in determining the minimum effective maintenance dose to avoid or minimize the occurrence of undesirable effects.
Patients should be warned that they are in the course of treatment avoided sunlight or take protective measures (eg, solntsezatsitnye cream).
Amiodarone can cause thyroid dysfunction, especially in patients with impaired function of the thyroid gland in their own or family history. Therefore, before starting treatment, during treatment and several months after the end of treatment should be careful clinical and laboratory monitoring. If you suspect a thyroid dysfunction should be the measurement of TSH levels in blood serum.