Instructions for use CORDARON, p-d/injections

Pharmacodynamics and pharmacokinetics

The main substance is amiodarone . It has coronary dilation, antianginal, hypotensive, alpha-adrenergic blocking, beta-adrenergic blocking effects. Under the influence of the drug, the oxygen demand of the heart muscle decreases, which explains the antianginal effect . Cordarone inhibits the functioning of alpha and beta adrenergic receptors of the cardiovascular system without blocking them.

Amiodarone reduces the sensitivity of the sympathetic nervous system to hyperstimulation, reduces the tone of the coronary arteries, improves blood flow, slows down the pulse, increases the energy reserves of the myocardium, and lowers blood pressure.

The antiarrhythmic effect is achieved by influencing the course of electrophysiological processes in the myocardium, lengthening the action potential of myocardiocytes, increasing the refractory, effective period of the atria, His bundle, AV node, and ventricles.

Cordarone is able to inhibit diastolic, slow depolarization of the cell membrane of the sinus node, inhibit atrioventricular conduction, and cause bradycardia . The structure of the main component of the drug is similar to thyroid hormone.

Indications for use of Cordarone

The drug is prescribed for paroxysmal rhythm disturbances (treatment, prevention). Indications for the use of Cordarone are: ventricular fibrillation , fatal ventricular arrhythmias, supraventricular arrhythmias, atrial flutter, atrial paroxysm , angina pectoris , ventricular arrhythmia in patients with Chagas myocarditis , arrhythmias in coronary insufficiency, parasystole .

Overdose of the drug Cordarone, symptoms and treatment

Information regarding overdose of Cordarone is limited. In some cases, sinus bradycardia, ventricular arrhythmia, torsade de pointes tachycardia, liver damage, and vascular insufficiency were observed. Considering the pharmacokinetic profile of the drug, it is recommended to monitor the patient’s condition over a long period of time (especially monitoring of cardiac activity). Treatment is symptomatic. Neither Cordarone nor its metabolites are removed by dialysis.

Contraindications

Cordarone is not prescribed for sinus bradycardia , iodine intolerance, amiodarone, cardiogenic shock , collapse, hypokalemia, hypothyroidism , arterial hypotension, breastfeeding, interstitial lung diseases, pregnancy, taking MAO inhibitors, hypokalemia, 2-3 degree atrioventricular block.

Elderly people, with liver pathology, heart failure, patients under 18 years of age, with pathology of the hepatic system are prescribed with caution.

Side effects

Nervous system: sleep disturbances, memory disturbances, peripheral neuropathy , paresthesia, auditory hallucinations, fatigue, depression, dizziness, weakness, headaches, optic neuritis , intracranial hypertension , ataxia, extrapyramidal manifestations .

Sense organs: retinal microdetachment, lipofuscin deposition in the corneal epithelium, uveitis.

Cardiovascular system: drop in blood pressure, tachycardia, progression of CHF, atrioventricular block, sinus bradycardia. Metabolism: thyrotoxicosis, hypothyroidism, increased T4 levels.

Respiratory system: apnea , bronchospasm , pleurisy, pulmonary fibrosis , alveolitis , interstitial pneumonia, shortness of breath, cough.

Digestive system: liver cirrhosis , jaundice, cholestasis, toxic hepatitis, increased levels of liver enzymes, loss, dulling of taste perception, decreased appetite, vomiting, nausea.

Long-term use causes aplastic anemia , hemolytic anemia, thrombocytopenia, allergic reactions, dermatitis. When administered parenterally, phlebitis develops.

Cordarone can cause the following side effects: alopecia, decreased potency, myopathy, vasculitis, epididymitis , photosensitivity, skin pigmentation, increased sweating.

Instructions for use of Cordarone (Method and dosage)

Cordarone solution, instructions for use

The solution is administered intravenously at a dose of 5 mg/kg to relieve acute arrhythmias; for patients with CHF it is administered at a dose of 2.5 mg/kg. Infusions are carried out over 10-20 minutes.

Cordarone tablets, instructions for use

Tablets are taken before meals: 0.6-0.8 grams for 2-3 doses; the dosage is reduced after 5-15 days to 0.3-0.4 grams per day, after which they switch to maintenance therapy of 0.2 grams per day for 1-2 doses.

To prevent accumulation, the drug is taken for 5 days, after which a break is taken for 2 days.

Dosage regimen

When using oral Cordarone in a hospital, the initial dose, divided into several doses, ranges from 600-800 mg / day to a maximum of 1200 mg / day until a total dose of 10 g is reached (usually over 5-8 days).

For outpatient use of Cordarone, the initial dose, divided into several doses, is from 600 to 800 mg / day until a total dose of 10 g is reached (usually within 10-14 days).

The maintenance dose can vary in different patients from 100 to 400 mg/day. The minimum effective dose should be used according to the individual therapeutic effect.

The average therapeutic single dose of Cordarone is 200 mg. The average therapeutic daily dose is 400 mg. The maximum single dose is 400 mg. The maximum daily dose is 1200 mg. The drug can be taken every other day or take breaks from taking it.

With the exception of emergency clinical situations, Cordarone for intravenous administration should be used only in a hospital under constant monitoring of ECG and blood pressure. To avoid injection site reactions, Cordarone should be administered through a central venous catheter, except in cases of cardiac resuscitation for atrial fibrillation resistant to cardioversion (introduction into the largest peripheral vein is possible).

When administered intravenously, Cordarone should not be mixed with other drugs or simultaneously administered other drugs through the same venous access. It is administered only in diluted form, for which you should use exclusively a 5% glucose solution.

Interaction

Cordarone causes an increase in the level of procainamide, phenytoin, quinidine, digoxin, cyclosporine, flecainide in the blood plasma.

The drug causes increased effects of indirect anticoagulants (acenocoumarol and warfarin).

When prescribing warfarin, its dosage is reduced to 66%, when prescribing acenocoumarol - by 50%, monitoring of prothrombin time is mandatory.

Loop diuretics , astemizole, tricyclic antidepressants, phenothiazines, terfenadine , thiazides, sotalol, glucocorticosteroids, laxatives, pentamidine, tetracosactide, first class antiarrhythmics, amphotericin B can provoke an arrhythmogenic effect.

Cardiac glycosides , Verapamil , beta-blockers increase the likelihood of inhibition of atrioventricular conduction and the development of bradycardia.

Drugs that cause photosensitivity may cause additive photosensitizing effects.

Arterial hypotension, bradycardia, and conduction disturbances can develop during oxygen therapy and during general anesthesia using drugs for inhalation anesthesia.

Cordarone is capable of inhibiting the absorption of sodium pertechnette , sodium iodide, by the thyroid gland.

With the simultaneous use of lithium drugs, the risk of hypothyroidism increases. Cimetidine increases the half-life of the main component, and cholestyramine reduces its absorption in the blood plasma.

Pharmacological properties of the drug Cordarone

Class III antiarrhythmic agent. The mechanism of action of amiodarone is due to the blockade of ion channels of the cell membranes of cardiomyocytes (mainly potassium, to a very small extent - calcium and sodium), as well as non-competitive suppression of α- and β-adrenergic activity. As a class III antiarrhythmic agent (according to the Vaughan Williams classification), it increases the 3rd phase of the action potential. Slows down conduction in the sinoatrial, AV node and atria, especially at high heart rates. Does not change intraventricular conduction. Increases the refractory period and reduces the excitability of the myocardium of the atria, ventricles and AV node. The antianginal effect of the drug is due to a decrease in myocardial oxygen demand (due to a decrease in heart rate and a decrease in afterload) and an increase in coronary blood flow due to a direct effect on the smooth muscles of the coronary arteries. Supports cardiac output by reducing aortic pressure and peripheral vascular resistance. With intravenous administration, maximum activity is achieved after 15 minutes and lasts up to 4 hours. After oral administration, amiodarone is absorbed slowly, the pharmacokinetics are characterized by significant individual fluctuations. Amiodarone has a very large and variable volume of distribution due to extensive accumulation in various tissues (adipose tissue, heavily perfused organs such as the liver, lungs and spleen). Bioavailability when taken orally ranges from 30–80% (on average about 50%). After a single dose, the maximum concentration in the blood plasma is reached after 3–7 hours. The therapeutic effect is usually observed 1 week after the start of therapy (from several days to 2 weeks). Amiodarone has a long half-life (20–100 days). In the first days of treatment, the drug accumulates in almost all tissues, especially in adipose tissue. Elimination begins within a few days and steady-state plasma concentrations are achieved within one or several months. Taking into account the pharmacokinetics, obtaining a therapeutic effect requires the use of an initial saturating dose in order to achieve drug accumulation in tissues. 200 mg of amiodarone contains 75 mg of iodine, 6 mg of which is released as free iodine. Amiodarone is primarily excreted in bile and feces. Excretion in urine is insignificant, which allows the drug to be prescribed in normal doses to patients with renal failure. After discontinuation of the drug, its removal from the body continues for several months; It should be taken into account that after discontinuation of the drug, its effect lasts from 10 days to 1 month.

special instructions

On the eve of the appointment of antiarrhythmic therapy, the liver system is examined, the functioning of the thyroid gland is assessed, an X-ray examination of the pulmonary system is carried out, and the level of electrolytes in the plasma is determined.

During treatment, it is necessary to monitor the level of liver enzymes and ECG. External respiration function is examined once every six months, an X-ray examination of the lungs is carried out once a year, and the level of thyroid hormones is determined once every 6 months. In the absence of a clinical picture of thyroid dysfunction, antiarrhythmic treatment is continued.

It is recommended to use special sunscreens and avoid direct sunlight to prevent the development of photosensitivity . Periodic observation by an ophthalmologist is required to diagnose deposits in the cornea.

Discontinuation of the drug may cause a recurrence of the rhythm disorder.

Parenteral administration of the drug Cordarone is possible only in a hospital setting under the control of blood pressure, pulse, and ECG.

Prescription during breastfeeding and pregnancy is possible only in cases that threaten the woman’s life.

After cessation of treatment, the pharmacodynamic effect persists for 10-30 days.

Cordarone contains iodine, which can provoke false-positive tests for the determination of radioactive iodine in the thyroid gland.

During surgical interventions, the team should be informed about the use of the drug due to the possibility of developing acute distress syndrome

Amiodarone affects driving and attention.

MNN: Amiodarone.

How long can I take the medicine?

After saturation with the drug (usually within a week), they switch to maintenance therapy, which can last quite a long time. Therapy should be carried out under the supervision of the attending physician.

Use during pregnancy and breastfeeding

Pregnancy

Currently available clinical information is insufficient to determine the possibility or impossibility of developmental defects in the embryo when amiodarone is used in the first trimester of pregnancy.

Since the fetal thyroid gland begins to bind iodine only from the 14th week of pregnancy, it is not expected to be affected by amiodarone if it is used earlier. Excess iodine when using the drug after this period can lead to the appearance of laboratory symptoms of hypothyroidism in the newborn or even to the formation of a clinically significant goiter.

Due to the effect of the drug on the fetal thyroid gland, amiodarone is contraindicated during pregnancy, except in special cases when the expected benefit outweighs the risk (in case of life-threatening ventricular arrhythmias).

Lactation period

Amiodarone is excreted into breast milk in significant quantities, so it is contraindicated during breastfeeding (therefore, during this period the drug should be discontinued or breastfeeding should be discontinued).

Cordarone price, where to buy

The price of Cordarone in 200 mg tablets is 320 rubles per pack of 30 pieces.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

LuxPharma* special offer

• Cordarone tab.
  200 mg No. 30 1700 rub. order

Pharmacy Dialogue

• Cordarone (200 mg tablet No. 30)Chinoin

  RUB 194 order

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Pharmacy24

• Cordarone 200 mg No. 30 tablets Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
  204 UAH.order
• Cordarone 150 mg 50 mg/ml 3 ml No. 6 injection solution Sanofi Vinthrop Industries, France

  219 UAH. order

PaniPharmacy

• Cordarone ampoule Cordarone solution d/in. 150mg amp. 3ml No. 6 France, Sanofi Winthrop Industrie

  225 UAH order

• Cordarone tablets Cordarone tablets. 200 mg No. 30 France, Sanofi Winthrop Industrie

  206 UAH order

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Compound