Pektrol

Pektrol – a peripheral vazodilatator, anti-anginal means.

Form of release and structure

Dosage form – tablets of the prolonged action, film coated (on 10 pieces in blisters, 3 or 10 blisters in a cardboard pack):

• 40 mg: a round form, slightly biconvex, color, white with a yellowish shade (existence of impregnations is possible), with an engraving of "IM40" on one of the parties;
• 60 mg: an oval form, slightly biconvex, color, white with a yellowish shade (existence of impregnations is possible), with an engraving "60" on one party and risky on both parties.

Structure of 1 tablet:

• Active agent: isosorbide mononitrate – 40 or 60 mg;
• Auxiliary components: wax of karnaubskiya, magnesium stearate, the stearic acid purified, a gipromelloza, silicon dioxide colloid, lactoses monohydrate;
• Film cover: talc, titanium dioxide, magnesium stearate, dye ferrous oxide yellow (E172), and also a gipromelloz (in tablets of 60 mg).

Indications to use

• Treatment of chronic heart failure (as a part of a combination therapy);
• Prevention of attacks of stenocardia at patients with the coronary heart disease (CHD).

Contraindications

Absolute:

• Acute heart failure;
• Cardiac tamponade;
• Acute myocardial infarction with the expressed arterial hypotension;
• Arterial hypotension and hypovolemia (diastolic arterial pressure is lower than 60 mm hg, systolic arterial pressure less than 100 mm hg, the central venous pressure is lower than 4-5 mm hg);
• Left ventricular failure with low end diastolic pressure;
• Vascular collapse;
• Shock;
• The diseases and states which are followed by the increased intracranial pressure (including number a hemorrhagic stroke, effects of a craniocereberal injury);
• Toxic fluid lungs;
• Age up to 18 years;
• Hypersensitivity to any component of drug or nitrates.

Relative (it is necessary to take Pektrol with caution because of the increased risk of side effects):

• Prolapse of the mitral valve;
• Mitral and/or aortal stenosis;
• Tendency to orthostatic disturbances of vascular regulation;
• Chronic cardial compression;
• Hypertrophic cardiomyopathy;
• Thyrotoxicosis;
• Heavy anemia;
• The expressed liver/renal failure;
• Advanced age.

Route of administration and dosage

Pektrol it is necessary to accept inside after food: it is necessary to swallow of tablets entirely and to wash down with a large amount of water (1 glass).

Specific doses and frequency rate of receptions depend on disease severity and are defined individually by the doctor.

The recommended initial dose makes 40 mg of 1 times a day (in the morning). It is more preferable to patients who have night attacks of stenocardia to accept drug in the evening. If expressiveness of effect of drug is not enough, from the 3-5th day of treatment the dose is increased to 60 mg of 1 times a day or on 40 mg by 2 times a day.

At chronic heart failure therapy is begun usually in a hospital and carry out it until the optimum maintenance dose taking into account clinical effect and side effects is picked up.

For the supporting treatment usually appoint 40 or 60 mg of 1 times a day or 40 mg 2 times a day. In the latter case it is necessary to take the first pill in the morning, and the second – approximately in 7 hours. At the same time the interval between evening and morning receptions should not be less than 12 hours.

Side effects

• Dermatological reactions: rash on skin; in individual cases – exfoliative dermatitis;
• From cardiovascular system: the expressed lowering of arterial pressure, a passing dermahemia of the person, tachycardia, feeling of heat, a nitrate headache, вертиго; seldom – paradoxical reaction (strengthening of attacks of stenocardia), an orthostatic collapse;
• From the central nervous system: a sight illegibility, constraint, reduction in the rate of reactions (especially in an initiation of treatment), drowsiness; seldom – brain ischemia;
• From the alimentary system: feeling of easy burning of language, nausea, dryness in a mouth, vomiting;
• Others: tolerance (including cross to other nitrates).

Special instructions

Pektrol – drug for prevention of attacks of stenocardia, is not applied to their stopping.

The correct use of drug allows to prevent development of tolerance to nitrates. It is very important to observe strictly the mode of dosing and a 12-hour interval between evening and morning receptions. In this case it is possible to reach the period with low concentration of nitrates (less than 100 ¡ú/l) with preservation of therapeutic effect.

Pektrol it is not necessary to cancel sharply, it is necessary to reduce a dose gradually.

During treatment it is necessary to keep the arterial pressure and heart rate under control.

At transfer of the patient from dinitrate isosorbide on Pektrol it is necessary to calculate the general daily dose in advance taking into account that 20 mg of isosorbide of dinitrate correspond to 10 mg of isosorbide-5-mononitrate.

As drug can influence the speed of psychophysical reactions, during treatment it is necessary to drive with care the car and to carry out potentially dangerous types of activity.

Medicinal interaction

Barbiturates accelerate biotransformation of isosorbide of mononitrate and reduce its concentration in blood.

In case of simultaneous use Pektrol increases concentration of dihydroergotamine in blood.

Strengthening of anti-hypertensive effect is possible at simultaneous use of vazodilatator, beta adrenoblockers, blockers of slow calcium channels, tricyclic antidepressants, neuroleptics, ethanol, a novokainamid, quinidine, dihydroergotamine, sildenafit.

Strengthening of anti-anginal effect is possible at simultaneous use of acetylsalicylic acid, blockers of slow calcium channels (for example, nifedipine or verapamil), propranolol, Amiodaronum.

At the combined use with alpha adrenoblockers (including dihydroergotamine) or beta адреностимуляторами decrease expressiveness of anti-anginal effect is possible that is shown by an excessive lowering of arterial pressure and tachycardia.

The adsorbing, enveloping and knitting drugs reduce mononitrate isosorbide absorption in digestive tract.

M-holinoblokatory (including atropine) increase risk of increase in intraocular pressure.

Terms and storage conditions

To store at a temperature up to 25 °C in the place, unavailable to children.

Period of validity – 3 years.