Cordipin Retard 20mg 2p x 30 tablets — Made in Slovenia — Free Delivery
(Cordipin Retard )
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Description Cordipin Retard 20mg 2p x 30 tablets — Made in Slovenia — Free Delivery
Indications
Arterial hypertension, angina, mainly vasospastic and chronic stable angina.
Application
The dose is set individually for each patient. Tablets can be taken during or after a meal. You should warn about the need to regularly take the pill at the same time and not increase the prescribed dose. if the patient forgot to take the pill on time, do not double the subsequent dose.
Cordipin XL. The dose is set individually for each patient. Usually the initial and maintenance dose is 1 tablet per day; The maximum recommended dose is 2 tablets per day as a single dose. The dose is selected gradually, with an interval of 7-14 days. Take the whole tablet with a glass of water before, during or after a meal.
Cordipin retard. The usual dose is 1 prolonged-release tablet 2 times a day. If necessary, the dose can be increased to 2 tablets 2 times a day. For patients with Prinzmetal's angina (vasospastic angina), the daily dose can be increased to 80 mg or a maximum of 120 mg per day.
Contraindications
Hypersensitivity to nifedipine or any component of the preparation, hypersensitivity to other dihydropyridines; cardiogenic shock, severe aortic stenosis, porphyria, lactation period - for cordipin xl, in addition, an acute period of myocardial infarction - for cordipin retard.
Side effects
The most common side effects are dizziness, headache, fatigue, weakness, orthostatic hypotension, facial flushing (facial flushing), peripheral edema, gastrointestinal disturbances (dry mouth, gingival hypertrophy, nausea, heartburn, constipation, diarrhea), fast or irregular heart rate, palpitations, chest pain. rarely occur such adverse reactions: myalgia, muscle cramps, itching, urticaria, skin rash.
From the side of the cardiovascular system: tachycardia, arterial hypotension, orthostatic hypotension, myocardial ischemia, conduction disturbance.
From the side of the central nervous system: dizziness, headache, fatigue, paresthesia, tremor, depression, nervousness, sleep disorders, blurred vision, anxiety, ataxia.
From the gastrointestinal tract and hepatobiliary system: dry mouth, gum hypertrophy, nausea, heartburn, belching, vomiting, intestinal colic, flatulence, constipation, diarrhea, allergic hepatitis, cholestasis, jaundice.
On the part of the respiratory system: angioedema, difficulty in nasal breathing (nasal congestion), shortness of breath, cough, epistaxis, infections of the upper respiratory tract.
From the skin: rash, itching, erythema, rarely - exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, alopecia, photosensitivity.
From the urinary system: nocturia, increased diuresis, dysuria, hematuria.
From the hemopoietic system: rarely - anemia, leukopenia, thrombocytopenia, aplastic anemia.
Other reactions: weight gain, gynecomastia, fever, in rare cases - a transient increase in serum glucose concentration.
special instructions
Nifedipine should be used with caution in patients with a tendency to arterial hypotension, severe mitral / aortic stenosis, malignant hypertension, hypovolemia, myocardial infarction, heart failure.
At the beginning of treatment with nifedipine, as well as with increasing doses, and especially with the simultaneous use of β-adrenergic blockers, arterial hypotension may occur.
The combined use of nifedipine and β-adrenergic blockers can sometimes lead to the development of heart failure.
At the beginning of treatment with nifedipine or when the dose is increased in patients with severe coronary disease, the course of coronary artery disease (with an increase in the frequency of angina attacks) may worsen due to activation of the sympathetic-adrenal system.
During treatment with nifedipine, it is necessary to limit the introduction of large volumes of fluid, as this increases the preload of the heart and increases the risk of pulmonary edema.
During therapy with nifedipine, peripheral edema (often of the lower extremities) may appear, while the use of diuretics is effective.
Nifedipine can affect the value of some laboratory tests (increased activity of alkaline phosphatase, AlAT, AST, LDH, increased serum urea and creatinine, positive Coombs test) without clinical manifestations, although cases of cholestasis and jaundice have been observed.
Use during pregnancy and lactation. Nifedipine can be used to treat pregnant women only when the potential benefit to the mother outweighs the possible risk to the fetus. Breastfeeding women should not use this preparation because nifedipine passes into breast milk.
Children. The safety and efficacy of nifedipine in children has not been sufficiently studied, so this preparation is not prescribed for this age group.
Influence on the ability to drive vehicles and work with other mechanisms. Nifedipine does not significantly affect the ability to drive vehicles and work with other mechanisms. However, in sensitive patients, especially at the beginning of treatment or while taking alcohol, nifedipine can cause hypotension and dizziness and impair the ability to drive vehicles and work with potentially dangerous mechanisms. Until an appropriate individual response to treatment is identified, patients are not recommended to drive vehicles and work with other mechanisms.
Interactions
With the combined use of antihypertensive agents, β-adrenergic blockers, diuretics, nitroglycerin and long-acting isosorbide, it is necessary to take into account the possibility of a synergistic effect of nifedipine. the hypotensive effect of nifedipine is enhanced with the simultaneous use of tricyclic antidepressants.
In patients treated with nifedipine, fentanyl may cause hypotension. Nifedipine should be discontinued at least 36 hours before elective fentanyl anesthesia.
Concurrent use of nifedipine and cimetidine, ranitidine can lead to an increase in the concentration of nifedipine in the blood serum and an increase in the hypotensive effect of nifedipine.
In patients already taking cimetidine, nifedipine should be used with caution, increasing the dose very gradually.
The introduction of nifedipine can lead to an increase in the concentration of carbamazepine and phenytoin in the blood serum.
Nifedipine can lead to a decrease in the concentration of quinidine in the blood serum, while quinidine can increase the patient's sensitivity to the action of nifedipine.
Nifedipine can enhance the toxic effect of magnesium sulfate, which leads to neuromuscular blockade. The combined administration of nifedipine and magnesium sulfate is dangerous and can threaten the patient's life, so the use of these preparations at the same time is not recommended.
During the combined administration of nifedipine and theophylline or digoxin, the concentration of theophylline or digoxin in the blood serum may increase.
Parallel administration of rifampicin and nifedipine is impractical, since due to the stimulation of liver enzymes by rifampicin and the acceleration of the metabolism of nifedipine, it is practically impossible to achieve an effective level of nifedipine concentration in the blood, which can lead to a weakening of the effects of the latter.
Simultaneous treatment with nifedipine and itraconazole (possibly also with other azole antimycotics, erythromycin and clarithromycin, which inhibit the action of the CYP 3A4 isoenzyme) can lead to an increase in the concentration of nifedipine in the blood serum and an increase in its action, as well as an increase in the frequency of side effects. If side effects of nifedipine occur, it is necessary to reduce its dose (if possible) or stop using the antimycotic agent.
The concentration of nifedipine in the blood serum and its effect may also increase with the combined administration of such preparations: cyclosporine, indinavir, ritonavir or saquinavir (inhibitors of the activity of the cytochrome isoenzyme CYP 3A4). If side effects of nifedipine occur, the dose should be reduced.
During the combined administration of tacrolimus and nifedipine, the concentration of tacrolimus in the blood serum may increase (it is metabolized with the participation of the CYP 3A4 isoenzyme).
In patients taking coumarin anticoagulants, an increase in prothrombin time was observed after administration of nifedipine.
Nifedipine may alter the corresponding bronchial response to methacholine (if possible, treatment with nifedipine should be discontinued before a methacholine test is performed).
Grapefruit juice may increase the serum concentration of nifedipine and enhance its hypotensive effect and the incidence of vasodilatory side effects.
Overdose
The first manifestation of an overdose is mainly hypotension. after taking a large number of tablets, shock, bradycardia or tachycardia, heart failure, nausea, vomiting, drowsiness, dizziness, confusion, lethargy, metabolic acidosis, coma and convulsions may also occur. these symptoms generally appear a few hours after the preparation has been used.
After taking a large number of tablets, it is necessary to take measures to remove the preparation from the gastrointestinal tract (gastric lavage, taking activated charcoal and a laxative).
If hypotension occurs, the patient should be transferred to a horizontal position with raised lower limbs. Parenteral administration of solutions and plasma substitutes is recommended. If these measures are ineffective, it is recommended to introduce sympathomimetics (dopamine, dobutamine or norepinephrine) to increase blood pressure. During treatment, it is required to control the function of the heart, respiration, the volume of circulating fluid and diuresis.
The cardiodepressive effect of nifedipine is inhibited by the administration of calcium in the form of a 10% solution of gluconate or calcium chloride (calcium chloride is not recommended for patients with acidosis). If therapy fails, glucagon can also be administered.
With bradycardia, atropine and orciprenaline are used; in severe cases, a temporary pacemaker is installed.
Hemodialysis, hemoperfusion and plasmapheresis are ineffective measures to remove nifedipine from the body.
Storage conditions
In a place protected from light at a temperature not exceeding 25 ° C.
Tags: Cordipin
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