Cordaflex retard pills 20mg №60

Mechanism of action

A selective class II Calcium channel blocker derived from dihydropyridine. Causes antianginal and hypotensive effects. Expands the coronary and peripheral arteries, reduces the myocardial oxygen demand by reducing the afterload on the heart. It has a slight negative inotropic effect. Practically does not possess antiarrhythmic activity. It has no inhibitory effect on the conductive system of the heart. As a result, a decrease in peripheral vascular resistance and a decrease in blood pressure can cause minor reflex tachycardia.

Suction
When ingestion is rapidly and almost completely (more than 90%) absorbed from the gastrointestinal tract. Bioavailability is about 50%. C_max in the blood is achieved 1-3 h after administration.
Distribution
Plasma protein binding - more than 90%.
Metabolism
Nifedipine is extensively metabolized in the liver to form several metabolites that do not possess pharmacological activity.
Removal
70-80% of Nifedipine is excreted by the kidneys as inactive metabolites, the rest through the intestines. T_1/2 is 2-4 hours
Pharmacokinetics in special clinical situations
In the elderly, the metabolism of nifedipine in the liver is reduced.

Indications and usage

- Ischemic heart disease: for the prevention (in some cases - relief) of attacks in various forms of angina, including angiospastic (Prinzmetal angina);
- arterial hypertension of various origins;
- Raynaud's syndrome.

Cordaflex 10 mg is prescribed on 1 tab. 3-4 times / day If necessary, gradually increase the dose to 20 mg 2 times / day. The maximum daily dose is 40 mg.
When conducting a course of therapy, it is recommended to use a prolonged form of the drug - Cordaflex Retard 20 mg. The drug is prescribed in 20-40 mg 2 times / day.
Elderly people the initial dose of the drug is reduced by half.
The drug is taken regardless of the meal.

Adverse reactions

Cardiovascular: severe hypotension, redness of the skin, peripheral edema, tachycardia; rarely - increased angina attacks.
On the part of the central nervous system and peripheral nervous system: sleep disturbances, drowsiness, minor transient visual disturbances, paresthesia, tremor.
On the part of the digestive system: diarrhea, constipation, nausea, heartburn, intrahepatic cholestasis, increased activity of hepatic transaminases; very rarely - hypertrophic gingivitis.
From the hemopoietic system: thrombocytopenia, leukopenia; rarely - anemia.
Allergic reactions: rash, pruritus.
Other: hyperemia of the face and skin of the upper body, fever, hyperhidrosis, myalgia, gynecomastia, decreased libido.

Contraindications

- cardiogenic shock;
- severe arterial hypotension (systolic blood pressure below 90 mm Hg);
- severe aortic stenosis, idiopathic hypertrophic subaortic stenosis;
- I trimester of pregnancy;
- severe heart failure;
- Hypersensitivity to nifedipine.

Pregnancy and breastfeeding

Cordaflex is contraindicated for use in the first trimester of pregnancy.
The use of Cordaflex in pregnant women is indicated only in cases where the normalization of blood pressure is impossible when using other antihypertensive drugs.
Since nifedipine is excreted in breast milk, the use of Cordaflex during lactation should be avoided or breastfeeding should be discontinued during drug treatment.

Special notes

With caution, Cordaflex is prescribed to patients with malignant hypertension, hypovolemia or being on hemodialysis because of the risk of severe arterial hypotension on the background of peripheral vasodilation.
Elderly patients are more likely to decrease cerebral blood flow due to severe peripheral vasodilation.
In cases of insufficient efficacy of antianginal or antihypertensive monotherapy with Cordaflex, a combination treatment with nitrates and beta-blockers has been shown.
In chronic heart failure, the combined use of Cordaflex and cardiac glycosides is possible in individually determined doses.
During the course of treatment with Cordaflex, alcohol is prohibited due to the risk of an excessive decrease in blood pressure.
Use in pediatrics
Due to the lack of sufficient clinical data, the drug is not recommended for use in children under the age of 18.
Influence on ability to drive motor transport and control mechanisms
In the initial, individually determined period of use of Cordaflex, driving of vehicles and engaging in other potentially hazardous activities that require the speed of psychomotor reactions is not allowed. In the process of further treatment, the degree of restriction is determined depending on the individual patient's response to the drug.

Overdosage

Symptoms: severe arterial hypotension, headache, collapse, tachycardia, inhibition of sinus node activity, bradycardia, arrhythmia.
Treatment: given the lack of a specific antidote, in cases of early detoxification, gastric lavage is performed with the appointment of Activated carbon. Once, and then according to indications in the form of a long-term infusion, in / in impose 10% solutions of Calcium gluconate or calcium chloride. With a sharp decrease in blood pressure is shown in / in the infusion of norepinephrine, with the development of heart failure - glycosides.

Drug Interactions

The combined use of nitrates with Cordaflex greatly enhances the antianginal effect.
The simultaneous use of Cordaflex and beta-blockers in most clinical situations is effective and safe, as it leads to the summation of the antianginal and antihypertensive effects of drugs, but in some cases, the development of severe arterial hypotension and heart failure is possible.
The combination of Cordaflex with clonidine (clofelin), alpha methyldopa (dopegite), diuretics, Captopril, octadine, prazosin, reserpine is considered rational from the point of view of enhancing the hypotensive effect. Do not use Cordaflex with apressin.
With simultaneous use of Cordaflex and calcium preparations, the effect of nifedipine is reduced due to the antagonistic interaction caused by an increase in the concentration of calcium ions in the extracellular space.
The hypotensive effect of Cordaflex with simultaneous use with cimetidine is significantly enhanced due to an increase in the concentration of nifedipine in the blood plasma, which requires correction of the doses of drugs.
Under the influence of Cordaflex, the concentration of quinidine in the serum is significantly reduced, which is apparently due to a decrease in the bioavailability of quinidine, the induction of enzymes that inactivate it, an increase in blood flow in the liver and kidneys, an increase in the distribution of the drug, as well as a change in hemodynamics.With the cancellation of Cordaflex after its simultaneous use with quinidine, a transient increase in the concentration (approximately 2 times) of the last serum is observed, which reaches a maximum level at the 3-4th day after discontinuation, as well as prolongation of the QT interval on the ECG. Thus, when using a combination of quinidine with Cordaflex caution should be exercised, especially in patients with depression of left ventricular function.
If administered concurrently with rifampicin, a weakening of the action of Cordaflex will be observed.

Storage conditions

The drug should be stored in a dark place at room temperature. Shelf life - 4 years.