Кординик®

General characteristics. Structure:

Active agent: nikorandit 10 mg;
excipients: potato starch – 5 mg, microcrystallic cellulose of 102 - 84 mg, calcium stearate – 1 mg; for a dosage of 20 mg:
active agent: nikorandit 20 mg;
excipients: potato starch – 10 mg, microcrystallic cellulose of 102 - 168 mg, calcium stearate – 2 mg.
Description: tablets of color, white with a weak grayish-yellowish shade, ploskotsilindrichesky with a facet.

Pharmacological properties:

Pharmacodynamics. Nikorandil possesses anti-anginal action which is based on a combination of nitratopodobny properties and ability to open potassium channels. Due to opening of potassium channels nikorandit causes hyperpolarization of a cellular membrane, and the nitratopodobny effect consists in increase in intracellular maintenance of a cyclic guanilmonofosfat. These pharmacological effects lead to relaxation of smooth muscle cells and cellular protection of a myocardium at ischemia. Hemodynamic effects are expressed in the balanced decrease before - and afterloads (unlike nitrates and blockers of "slow" calcium channels (BMKK) which work mainly on before - or an afterload, respectively). Taking into account the selection vazodilatation of coronary arteries as a result load of an ischemic myocardium is minimum. Nikorandil does not influence contractility of a myocardium, practically does not change the heart rate (HR). Reduces the system arterial pressure (AP) less than by 10%, exerts beneficial positive influence on cerebral circulation at patients with an ischemic stroke. Nikorandil does not influence indicators of lipidic exchange and metabolism of glucose. Nikorandil stops a stenocardia attack with reduction of a pain syndrome within 4-7 minutes after reception under language and its full stopping within 12-17 minutes.

Pharmacokinetics. Nikorandil is quickly and completely soaked up from digestive tract, reaching the maximum concentration in a blood plasma in 0,5-1 hour. It is not subject to intensive metabolism in a liver and has an elimination half-life of 50 min. It is removed generally by kidneys. Nikorandil slightly contacts proteins of a blood plasma. The free fraction in a blood plasma makes about 75%. Pharmacokinetic indicators depend on age of the patient, existence of the accompanying pathology of a liver or kidneys, purpose of the accompanying therapy a little.

Indications to use:

• stopping of attacks of stenocardia;
• prevention of attacks of stable stenocardia (in a combination with other anti-anginal means) and in monotherapy at intolerance of beta adrenoblockers and BMKK.

Route of administration and doses:

Inside. Washing down with water, to accept irrespective of meal. The dose of drug is selected individually depending on severity and duration of a disease. Stopping of an attack of stenocardia. Drug should be accepted at once at the first signs of an attack of stenocardia: drug in a dose of 20 mg is put under language and held before full dissolution, without swallowing. Prevention of attacks of stable stenocardia (long therapy of stable stenocardia). Drug is usually appointed in a dose from 10 to 20 mg 3 times a day. Maximum daily dose of 80 mg. At emergence of a headache the initial dose can be reduced.

Features of use:

Drug needs to be cancelled gradually. During therapy by drug it is necessary to control the arterial pressure, ECG indicators, the maintenance of potassium ions and ions of sodium in blood; strengthening of the available disturbances of a heart rhythm is possible. It is necessary to be careful at control of vehicles and occupations other potentially dangerous types
activity, demanding the increased concentration of attention and speed of psychomotor reactions.

Side effects:

 

Interaction with other medicines:

At a concomitant use with antidepressants, phosphodiesterase-5 inhibitors (sildenafit, vardenafit, tadalafit), vazodilatator, antihypertensives, tricyclic antidepressants, diuretics, beta adrenoblockers, monoamine oxidase inhibitors (MAO) and ethanol – strengthening of anti-anginal action.

Contraindications:

• hypersensitivity to drug;
• an acute myocardial infarction (and within 3 months after);
• cardiogenic shock, collapse;
• unstable stenocardia;
• chronic heart failure of III or IV functional classes on NYHA classification;
• the expressed bradycardia (ChSS less than 50 уд. / mines);
• atrioventricular block of II and III degrees;
• a left ventricular failure with low filling pressure;
• arterial hypotension (systolic ABP less than 100 mm of mercury.);
• a concomitant use of inhibitors of phosphodiesterase-5 (sildenafit, vardenafit, tadalafit);
• pregnancy and period of a lactation;
• age up to 18 years (efficiency and safety are not established).
With care: disturbances of a heart rhythm, atrioventricular block of degree, Printsmetal's stenocardia, arterial hypotension, renal failures and/or liver, hypovolemia, fluid lungs, closed-angle glaucoma, hyperpotassemia, anemia.

Overdose:

Symptoms: the expressed decrease in the ABP, tachycardia.
Treatment: a gastric lavage, purpose of absorbent carbon (especially in the first 2 h after overdose), maintenance of function of cardiovascular system, sublime position of extremities, a symptomatic and maintenance therapy, in/in administration of calcium of a gluconate and dopamine. Use of a hemodialysis is possible.

Storage conditions:

In the dry, protected from light place at a temperature not above 25 °C. To store
in the place, unavailable to children. Period of validity 2 years. Not to use after the termination of a period of validity.

Issue conditions:

According to the recipe

Packaging:

Tablets of 10 mg and 20 mg. On 10 tablets in a blister strip packaging. On 2, 3 or 6 blister strip packagings together with the application instruction place in a pack from a cardboard.