Celanid - instructions for use, doses, side effects, contraindications

Active substanceLanatoside CLanatoside C

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Celanid®

pills inwards

FARMTSENTR VILAR, ZAO Russia

Dosage form: & nbsppills

Composition:

Composition (per one tablet)

Active substance:

Lanatoside C-0.000250 g

(Celanide®) (in terms of 100% and absolutely dry substance)

Excipients:

Milk sugar (lactose) - 0.068000 g

Sugar (refined sugar, granulated sugar) - 0.016200 g

Potato starch - 0.014550 g

Calcium stearate (calcium stearic acid) - 0.001000 g

Description:

The tablets are round biconvex in white.

Pharmacotherapeutic group:Cardiotonic - cardiac glycoside

ATX: & nbsp

C.01.A.A Glycosides of Digitalis

C.01.A.A.06 Lanatoside C

Pharmacodynamics:

Lanatoside C - cardiac glycoside, obtained from the leaves of foxglove - Digitalis lanata Ehrh., family of creepers - Scrophulariaceae.

Pharmacodynamics

Lanatoside C blocks transport sodium / potassium-ATPase, as a result of which the content of sodium ions in cardiomyocytes increases, which leads to the discovery of calcium channels and the entry of calcium ions into the cardiomyocyte. Excess sodium ions helps to accelerate the release of calcium ions from the sarcoplasmic reticulum and increase its concentration in the cell, which leads to inhibition of the troponin complex, which has a depressing effect on the interaction of actin and myosin.Increases the strength and speed of myocardial contraction by a mechanism different from the Frank-Starling mechanism (it does not depend on the degree of pre-stretching of the myocardium); The systole becomes shorter and energy-efficient. As a result of increased myocardial contractility, the shock volume of blood and the minute volume of blood increase.

Reduces the end systolic and terminal diastolic volumes of the heart, which along with an increase in myocardial tone leads to a reduction in its size and, thus, to a decrease in myocardial oxygen demand.

The negative dromotropic effect is manifested in the increased refractoriness of the atrioventricular (AV) node. With ciliary tachyarrhythmias, cardiac glycosides slow the heart rate contractions (heart rate), prolong diastole, improving intracardiac and systemic hemodynamics. Decrease in heart rate occurs as a result of direct and indirect effects on the regulation of the heart rhythm.

Provides direct vasoconstrictive action (in the event that the positive inotropic effect of cardiac glycosides is not realized in patients with normal contractility or with excessive stretching of the heart); in patients with chronicheart failure (CHF) causes mediated vasodilating effect, reduces venous pressure, increases diuresis, reduces edema, dyspnea.

Positive batmotropic effect is manifested in sub-toxic and toxic doses.

The initial effect of the drug is manifested through 1,5-2 hours, the maximum effect - in 4-6 hours.

Pharmacokinetics:

Suction: when ingested well absorbed in the gastrointestinal tract (GIT). Bioavailability of the drug is 15 - 45% and varies widely, depending on the acidity of gastric juice, intestinal motility and blood supply, drug interaction (Activated carbon, antacid preparations, astringents reduce the absorption of the drug in the digestive tract; metoclopramide and neostigmine methylsulfate increase peristalsis of the intestine, drastically reducing the bioavailability of the drug).

Distribution: when entering the systemic bloodstream at 20 - 25% of the drug binds to blood plasma proteins. The half-life is 28 - 36 hours.

Excretion: biotransformiruetsya in the liver and is excreted from the body in the form of inactive metabolites by the kidneys and through the intestine.Slightly cumulates.

Indications:In the complex therapy of chronic heart failure II (in the presence of clinical manifestations), III and 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 components of the drug, AV blockade of the II degree, Wolff-Parkinson-White syndrome (syndrome WPW), intermittent complete blockade, pregnancy and the period of breastfeeding, fructose intolerance and / or insufficiency of sugarase / isomaltase, lactase deficiency, lactose intolerance, glucose-galactose malabsorption, since the preparation contains lactose and sucrose. Age to 18 years.

Carefully:

Carefully (comparing benefit / risk): bradycardia, AV blockade of I degree, syndrome of weakness of sinus node without artificial pacemaker, paroxysmal ventricular tachycardia, hypertrophic obstructive cardiomyopathy, acute myocardial infarction, unstable angina, probability of unstable conduction AV Mitra-Adams-Stokes, isolated mitral stenosis with a rare heart rate (hypertrophic subaortic stenosis), cardiac asthma in patients with mitral stenosis (in the absence of tachycystolic form of atrial fibrillation), CHF with diastolic dysfunction (restrictive cardiomyopathy, amyloidosis, constrictive pericarditis, cardiac tamponade), extrasystole, marked dilatation of the heart cavities, "pulmonary" heart.

Water-electrolyte disorders: hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia.

Hypothyroidism, alkalosis, myocarditis, arteriovenous shunt, hypoxia, advanced age, renal / hepatic insufficiency, obesity.

Dosing and Administration:

Inside. The dose is set individually depending on the clinical picture and individual sensitivity,

Celanide® is prescribed by mouth, starting with 0.25 mg (1 tablet) - 0.5 mg (2 tablets) 3-4 times a day.

When the therapeutic effect is reached (3-5 days), the daily dose is reduced to a maintenance dose of 0.25 mg (1 tablet) - 0.5 mg (2 tablets).

Higher doses for adults: single dose - 0.5 mg (2 tablets), daily - 1 mg (4 tablets).

If the excretory function of the kidneys is impaired, the dose is reduced: in case of creatinine clearance (CK) of 50-80 ml / min, the average maintenance dose is 50 % from the average maintenance dose for individuals with normal renal function; with SC less than 10 ml / min - 25% of the usual dose.

Side effects:

From the digestive system possible: decreased appetite, nausea, vomiting, diarrhea.

From the side of the cardiovascular system: arrhythmias, AV blockade.

From the central nervous system: drowsiness, delirious psychosis, sleep disorders, headache, dizziness, confusion.

From the hematopoiesis: thrombocytopenia, thrombocytopenic purpura.

Allergic reactions: skin rash.

Other: decreased visual acuity, nosebleeds, petechiae, gynecomastia.

Overdose:

The likelihood of intoxication is increased with hypokalemia, hyponatremia, hypercalcemia, hypernatremia, hypothyroidism, "pulmonary" heart, myocarditis.

Symptoms:

From the cardiovascular system: ventricular paroxysmal tachycardia, ventricular extrasystole (often polytopic or bigemia), nodular tachycardia, sinoatrial (SA) blockade, flicker and flutter of the atria, AV blockade.

From the digestive tract: loss of appetite, abdominal pain, nausea, vomiting, diarrhea, bowel necrosis.

From the central nervous system and sensory organs: drowsiness, confusion, delirious psychosis, neuritis, radiculitis, manic-depressive syndrome, paresthesia, decreased visual acuity, change in visual perception (staining of visible objects in yellow-green color, perception of objects in reduced or enlarged form), flashing of flies before eyes.

Treatment:

In case of signs of overdose, it is necessary to reduce the dose or temporarily stop taking the drug. To reduce the occurrence of side effects it is recommended to wash the stomach with a suspension of activated charcoal, use of salt laxatives, colestyramine, unithiol, potassium preparations; oxygen therapy; at disturbances of a rhythm, which do not correct potassium preparations, antiarrhythmics are recommended (diphenin, lidocaine).

Interaction:

Antacids, sulfasalazine, colestramine - reduce the absorption of the drug from the gastrointestinal tract, so the dose should be increased, after the withdrawal of antacids should initially be prescribed a lower dose of the drug.

In combination with potassium permanganate, ammonia-anise drops, hydrogen peroxide, silver nitrate, raspberry syrup, alkaloid salts, sulfonamides, tannin lantozide C It forms a precipitate, with acids and bases - inactive products.

When combined with barbiturates (especially phenobarbital) due to the induction of liver enzymes and the acceleration of metabolism, the effectiveness of the drug decreases.

Glucocorticosteroids, diuretics increase the risk of hypokalemia and hypomagnesemia; thiazides, calcium preparations (especially with intravenous administration) - hypercalcemia; amiodarone, Mercazolil - hypothyroidism. Catecholamines, calcium preparations, diuretics increase the risk of developing glycosidic intoxication.

Synergism with lantozidum C has calcium preparations.

The combination of lantozide C with aminazine promotes an increase in blood coagulability. With the joint administration of lantozide C with heparin, the effect of heparin may be weakened due to the increase in blood coagulability under the influence of the drug.

When taking the drug along with lincomycin develops pseudomembranous colitis.

Excretion of lantozide C is reduced and its toxicity is increased when it is combined with diuretics (except potassium-sparing), insulin, amphotericin, with prolonged use, dextrose, glucocorticosteroids, antibiotics, as a result of hypokalemia and hypomagnesemia.

With concomitant use with quinidine, verapamil, nifedipine, spironolactone (to a lesser extent), the concentration of lantozide C in the blood plasma increases (a competitive decrease in secretion by the proximal tubules of the kidneys).

At the same time, it is recommended to use Celanide® (lantozide C) with some medicines. With the introduction of lantozide C with anabolic steroids, thiamine chloride, riboflavin, pyridoxine, folic acid, orotic acid, methyluracil, methionine, phosphadene, inosine, its inotropic effect is enhanced.

Special instructions:

Control of their plasma concentration is used as one of the methods for monitoring the level of digitalization in the appointment of cardiac glycosides.

With hypertrophic obstructive cardiomyopathy, the use of lantozide C leads to an increase in obstruction.

With severe mitral stenosis, normo- or bradycardia, heart failure develops as a result of a decrease in diastolic filling of the left ventricle (LV). Lanatoside C, 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 LV failure. In patients with mitral stenosis, cardiac glycosides are prescribed for right ventricular failure or with ciliary tachyarrhythmia.

In patients with AV blockade of the second degree, the appointment of cardiac glycosides can aggravate it and lead to the development of the attack of Morgagni-Adams-Stokes. The appointment of cardiac glycosides for AV blockade of the 1st degree requires caution, frequent ECG monitoring, and in some cases - preventive use of drugs that improve AV conductivity. Lanatoside C in case of a syndrome WPW, reducing AV conductivity, facilitates, impulses through additional ways of bypassing AV node and thereby provokes the development of paroxysmal tachycardia.

Use the drug only as prescribed, without changing the dose alone.

If your heart rate is less than 60 beats per minute, you should immediately consult your doctor.

If the patient did not take the drug for more than 2 days, it is necessary to inform the doctor about it.

Before stopping the use of the drug, you should inform the doctor about it.

If side effects occur, seek medical attention immediately.

Before surgery or during emergency care, the doctor should be warned about the use of the drug.

One tablet contains 0.09875 g carbohydrates, which corresponds to 0.008 XE (bread units).

Effect on the ability to drive transp. cf. and fur:

When using the drug should be careful when dealing with activities that require increased concentration and speed of psychomotor reactions (including vehicle management, work with moving mechanisms).

Form release / dosage:

Tablets 250 mcg.

Packaging:

For 10 or 30 tablets in a planar cell packaging made of polyvinylchloride film and aluminum foil with thermal lacquer coating.

3 contourcell packagings No. 10 or 1 contour pack No. 30 together with instructions for the medicalapplication put in a pack of cardboard for consumer packaging.

Storage conditions:

In the dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

4 years.

Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LS-002139

Date of registration:07.02.2012

The owner of the registration certificate:FARMTSENTR VILAR, ZAO FARMTSENTR VILAR, ZAO Russia

Manufacturer: & nbsp

FARMTSENTR VILAR, ZAO Russia

Information update date: & nbsp27.09.2015

Illustrated instructions

Instructions

Celanid® (Celanid®)