Korglikard - instructions for use, dose, side effects, contraindications

Active substanceLeidyza leaves glycosideLeidyza leaves glycoside

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Korglikard

solution in / in

EXPERIMENTAL FACTORY ГНЦЛС, ООО Ukraine

Dosage form: & nbspsolution for intravenous administration

Composition:

1 ml of solution contains

active substance Korglikona - 0.60 mg;

Excipients: chlorobutanol hydrate, water for injection.

Description:Transparent liquid slightly yellowish in color.

Pharmacotherapeutic group:Cardiotonic - cardiac glycoside

ATX: & nbsp

C.01.A.X Other cardiac glycosides

Pharmacodynamics:

Purified preparation from leaves of the lily of the valley of May and its varieties. Cardiac glycoside, has a positive inotropic effect. This is due to the direct inhibitory effect of sodium-potassium ATPase on the membranes of cardiomyocytes, which leads to an increase in the intracellular content of sodium ions and, accordingly, a decrease in potassium ions. The increased content of sodium ions causes activation of sodium / calcium metabolism, an increase in the content of calcium ions, as a result of which the force of myocardial contraction increases.

As a result of increased contractility of the myocardium, the shock volume of blood increases, the final systolic and terminal diastolic volumes of the heart decrease, which, along with an increase in myocardial tone; leads to a reduction in its size and, thus reducing myocardial oxygen demand.

Has a negative chronotropic effect, reduces excessive sympathetic activity by increasing the sensitivity of cardiopulmonary baroreceptors. Owing to the increase in the activity of the vagus nerve, antiarrhythmic action is caused by a decrease in the rate of impulses through the atrioventricular node and an elongation of the effective refractory period. This effect is enhanced by direct action on the atrioventricular node and sympatholytic action.

The negative dromotropic effect is manifested in the increased refractoriness of the atrioventricular node.

With ciliary tachyarrhythmias, cardiac glycosides help slow down ventricular contractions, extend diastole, improve intracardiac and systemic hemodynamics. Positive batmotropic effect is manifested in sub-toxic and toxic doses.

Has a direct vasoconstrictive effect, which is most clearly manifested in the absence of stagnant peripheral edema. At the same time, the indirect vasodilating effect (in response to an increase in the minute volume of blood and the reduction of excessive sympathetic stimulation of the vascular tone), as a rule,prevails over direct vasoconstrictive action, resulting in a decrease in the overall peripheral vascular resistance.

With intravenous administration, the effect begins 3-5 minutes and reaches a maximum after 25-30 minutes.

Pharmacokinetics:

Distribution: binding to blood plasma proteins is negligible.

Excretion: practically does not undergo biotransformation in the liver and is unchanged in urine.

Indications:

As part of the complex therapy of chronic heart failure II functional class (in the presence of clinical manifestations) and III-IV functional class by classification NYHA, tahisystolic form of flicker and atrial flutter of paroxysmal and chronic course (especially in combination with chronic heart failure).

Contraindications:

Glycoside intoxication, hypersensitivity to the drug, atrioventricular blockade of the 2nd degree, Wolff-Parkinson-White syndrome, intermittent complete blockade, pregnancy and lactation.

Carefully:

Atrioventricular blockade of the 1st degree, syndrome of weakness of the sinus node without a pacemaker,probability of unstable conduction at the atrioventricular node, history of Morgagni-Adams-Stokes attacks, hypertrophic subaortic stenosis, isolated mitral stenosis with a rare heart rate, cardiac asthma in patients with mitral stenosis (in the absence of tachysystolic forms of atrial fibrillation), acute myocardial infarction infarction, unstable angina, arteriovenous shunt, hypoxia, heart failure with diastolic dysfunction (restrictive cardiomyopathy, amyloidosis heart, constrictive pericarditis, cardiac tamponade), arrythmia, marked dilatation of the cavities of the heart, "pulmonary" heart, electrolyte disorders: hypokalemia, hypomagnesemia, hypercalcemia , hyponatremia; hypothyroidism, alkalosis, myocarditis, elderly age, renal and hepatic insufficiency, obesity.

Dosing and Administration:

Enter intravenously slowly for 5-6 minutes (in 10-20 ml of 20% or 40% solution of dextrose) 1-2 times a day. Adults injected in a single dose of 0.5-1 ml, children aged 2 to 5 years - 0.2-0.5 ml, from 6 to 12 years - 0.5-0.75 ml. When administered 2 times a day, the interval between injections is 8-10 hours.

Higher doses for adults in the vein: single - 1.0 ml, daily - 2.0 ml.

Side effects:

The side effects of Korglikarda are associated with an increased sensitivity of the patient to cardiac glycosides or an overdose.

From the side of the cardiovascular system: arrhythmia, atrioventricular block.

From the central nervous system and sensory organs: Drowsiness, confusion, sleep disorders, headache pain, dizziness, delirious psychosis, decreased visual acuity.

From the hematopoiesis: thrombocytopenia, thrombocytopenic purpura, nasal bleeding.

From the digestive system: anorexia.

Other: allergic reactions.

Overdose:

From the side of the cardiovascular system: ventricular paroxysmal tachycardia, ventricular extrasystole (often bigemia, polytope ventricular extrasystole), nodal tachycardia, flicker and atrial flutter, atrioventricular blockade.

From the side of the digestive tract: anorexia, vomiting, diarrhea, abdominal pain, necrosis of the intestine.

From the nervous system and sense organs: neuritis, manic-depressive syndrome, staining of visible objects in yellow-green color, flashing of flies before the eyes, reduced visual acuity, perception of objects in a reduced or enlarged form.

Treatment: abolition of cardiac glycosides, administration of antidotes (unitiol, ethylenediaminetetraacetic acid), symptomatic therapy. As antiarrhythmic drugs - preparations of I class (lidocaine, phenytoin). With hypokalemia - intravenous administration of potassium chloride (6-8 g / day at the rate of 1 - 1.5 g per 0.5 l isotonic solution of dextrose and 6-8 units of insulin, injected drip, for 3 hours). With severe bradycardia, atrioventricular blockade - M-holinoblokatory. Beta-adrenostimulyatorov enter dangerous, because of the possible potentiation of arrhythmogenic action of cardiac glycosides. With a full transverse blockade with attacks of Morgagni-Adams-Stokes - a temporary pacing.

Interaction:

Adrenomimetic means. The combined use of ephedrine hydrochloride, epinephrine hydrochloride or norepinephrine hydrotartrate, as well as selective beta-adrenomimetic agents with cardiac glycosides may contribute to the occurrence of cardiac arrhythmia.

Aminazine and other phenothiazine derivatives. The action of cardiac glycosides decreases.

Anticholinesterase drugs. With the simultaneous use of anticholinesterase drugs with cardiac glycosides, bradycardia increases.If necessary, it can be eliminated or weakened by the administration of atropine sulfate.

Glucocorticosteroids. When hypokalemia occurs as a result of prolonged treatment with glucocorticosteroids, an increase in undesirable effects of cardiac glycosides is possible.

Diuretics. When combining diuretic drugs (cause hypokalemia and hypomagnesemia, but increase the concentration of calcium ions in the blood) with cardiac glycosides, the effect of the latter is enhanced. At the same time, the optimal dosing should be followed. You can periodically prescribe potassium-sparing diuretics (spironolactone, triamterene), which eliminate hypokalemia. However, hyponatraemia may develop.

Preparations of potassium. Under the influence of potassium preparations undesirable effects of cardiac glycosides decrease.

Preparations of calcium. In the treatment of cardiac glycosides, parenteral administration of calcium preparations is dangerous, since cardiotoxic effects (cardiac arrhythmias and etc.) are amplified.

Acids of ethylenediaminetetraacetic disodium salt. There is a decrease in the effectiveness and toxicity of cardiac glycosides.

Preparations corticotropin. Action of cardiac glycosides under the influence of corticotropin may increase.

Xanthine derivatives. Preparations of caffeine or theophylline sometimes contribute to the occurrence of cardiac arrhythmias.

Sodium adenosine triphosphate. Do not prescribe sodium adenosine triphosphate concomitantly with cardiac glycosides.

Ergocalciferol. In hypervitaminosis caused by ergocalciferol, it is possible an increase in the action of cardiac glycosides, due to the development of hypercalcemia.

Narcotic analgesics. The combination of fentanyl and cardiac glycosides can cause hypotension.

Naproxen. In healthy people, the joint use of cardiac glycosides with naproxen does not affect the results of psychological testing.

Paracetamol. The clinical significance of this interaction has not been adequately studied, but there are data on the decrease in kidney secretion of cardiac glycosides under the influence of paracetamol.

Special instructions:

The likelihood of intoxication is increased with hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia, hypothyroidism, severe dilatation cavities of the heart, pulmonary heart, myocarditis, obesity, old age.With severe mitral stenosis and normo- or bradycardia, heart failure develops as a result of a decrease in diastolic filling of the left ventricle. Strophantine, increasing the contractility of the right ventricular myocardium, causes a further increase in pressure in the pulmonary artery system, which can provoke pulmonary edema or aggravate left ventricular failure. Patients with mitral stenosis are assigned cardiac glycosides upon adherence to right ventricular failure, or in the presence of atrial tachyarrhythmia. Korglikon with Wolff-Parkinson-White syndrome, reducing atrioventricular conduction, promotes impulses through additional pathways - bypassing the atrioventricular node, provoking the development of paroxysmal tachycardia. As one of the methods for monitoring the level of digitalization in the appointment of cardiac glycosides, monitoring of their plasma concentration is used.

Form release / dosage:Solution for intravenous administration 0.6 mg / ml.

Packaging:

When produced at OOO "Experimental Plant" GNTSLS ", Ukraine.

1 ml in ampoules.

For 10 ampoules together with the instruction for use and scarifier ampoule or disk cutting ceramic in a pack of cardboard with a cardboard separator.

If there are break rings on the ampoule or break point, the ampoule scarifier or ceramic cutting disc is not put into the pack.

When manufactured at OOO "Pharmaceutical Company" Health ", Ukraine.

1 ml in ampoules.

For 10 ampoules together with the instruction for use and scarifier ampoule or disk cutting ceramic in a pack of cardboard with a cardboard separator.

If there are fracture rings or points and incisions on the ampoule, the ampoule scarifier or ceramic cutting disc is not inserted into the pack.

Storage conditions:

Store in a dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years. Do not use after the expiry date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:П N016062 / 01

Date of registration:24.09.2009 / 10.01.2018

Expiration Date:Unlimited

The owner of the registration certificate:EXPERIMENTAL FACTORY ГНЦЛС, ООО EXPERIMENTAL FACTORY ГНЦЛС, ООО Ukraine

Manufacturer: & nbsp

EXPERIMENTAL FACTORY ГНЦЛС, ООО Ukraine

Information update date: & nbsp03.02.2018

Illustrated instructions

Instructions

Korglikard (Corglycard)