Kardiket

Kardiket – the drug used for stopping and the prevention of attacks of stenocardia, and also treatment of other manifestations of coronary insufficiency at coronary heart disease.

Form of release and structure

Kardiket is let out in the form of tablets of the prolonged action: white, round, on the one hand – convex, with a text of "SCHWARZ PHARMA", with another – flat, with risky, a facet and an engraving: under risky (depending on a dose) – "20", "40" or "60", over risky – "IR" (on 10 pieces in blisters, on 2 or 5 blisters in a cardboard pack).

Is a part of 1 tablet:

• Active agent: isosorbide dinitrate – 20, 40 or 60 mg;
• Auxiliary components: monohydrate of lactose, talc, magnesium stearate, potato starch, polyvinyl acetate.

Indications to use

• Chronic heart failure (along with cardiac glycosides, diuretics and/or inhibitors of an angiotensin-converting enzyme);
• Long therapy of coronary heart disease: prevention of attacks of stenocardia;
• Secondary prevention of a myocardial infarction and therapy at the remaining stenocardia (along with other medicines).

Contraindications

• Hemorrhagic (apoplectic) stroke;
• Acute vascular insufficiency (vascular collapse, shock);
• Heavy stenosis (mitral and/or aortal);
• The acute myocardial infarction which is followed by the expressed arterial hypotension;
• The expressed arterial hypotension (with a systolic pressure less than 90 mm hg);
• The closed-angle glaucoma which is followed by high intraocular pressure;
• Craniocereberal injuries;
• Hypovolemia;
• Simultaneous use with inhibitors of phosphodiesterase of type 5 (such as sildenafit, tadalafit or vardenafit) as these drugs exponentiate hypotensive effect of nitrates;
• Age up to 18 years (efficiency and safety of reception of Kardiket for this age group of patients are not established);
• Hypersensitivity to drug components.

Relative contraindications to performing therapy are:

• The expressed anemia;
• Toxic fluid lungs;
• Hypertrophic subaortic stenosis (because of possible risk of increase of attacks of stenocardia);
• Cardiac tamponade;
• Hematencephalon;
• Chronic cardial compression.

Kardiket should be taken with caution and under careful medical control: to elderly patients, and also patients with tendency to disturbances of regulation of blood circulation because of the lowered arterial pressure (at orthostatic disturbances of regulation of blood circulation), with the expressed liver failure (because of risk of development of a methemoglobinemia), the heavy renal failure, a hyperthyroidism raised by a digestive tract peristaltics, a sprue, diseases which are followed by increase in intracranial pressure.

The feeding and pregnant women can accept Kardiket only in cases when the estimated advantage for health of mother is higher than possible risk for the child and/or a fruit.

Route of administration and dosage

Kardiket is accepted inside, washing down with a small amount of liquid. It is not necessary to chew tablets. Drug can be accepted irrespective of meal time.

The mode of dosing is defined by indications and a dosage form:

• 20 mg: 2 times a day on 1 tablet. If necessary increase in frequency rate of administration of drug up to 3 times a day is possible;
• 40 mg: once a day on 1 tablet or 2 times a day on 1/2 tablets. If necessary it is possible to accept drug 2 times a day on 1 tablet (the second pill is recommended to be taken within 8 hours after reception of the first);
• 60 mg: once a day on 1 tablet. If necessary increase in frequency rate of administration of drug up to 2 times a day is possible (the second pill is recommended to be taken within 8 hours after reception of the first).

Treatment needs to be begun with the minimum doses. It is necessary to increase a dose to the most effective gradually. Duration of therapy is defined by the doctor individually. To Kardiket it is intended for long therapy, and sharply it is not necessary to interrupt administration of drug without instructions of the doctor.

Side effects

During Kardiket's reception the following disturbances can be observed:

• Cardiovascular system: at the beginning of a medical course there can be a "nitrate" headache which usually passes independently within several days. Sometimes at the first reception of Kardiket or at increase in a dose the expressed lowering of arterial pressure is observed, especially, when the patient gets up that can be followed by block, tachycardia, and also feeling of weakness and dizziness. In rare instances at the expressed lowering of arterial pressure symptoms of stenocardia (paradoxical strengthening of attacks of stenocardia) can amplify. In extremely exceptional cases the kollaptoidny states which are followed to a syncope (a sudden loss of consciousness) and bradycardia are observed;
• Central nervous system: constraint, a sight illegibility, drowsiness, decline in the ability to bystry motor and mental reactions (especially at the beginning of a therapy course); seldom – brain ischemia;
• Alimentary system: seldom – an eructation, nausea, dryness in a mouth, vomiting, an abdominal pain;
• Allergic reactions: skin rash;
• Others: exfoliative dermatitis, tolerance development (including cross to other nitrates), a dermahemia of the person.

Special instructions

It is not necessary to apply to stopping of attacks of stenocardia of Kardiket.

During therapy it is necessary to control the arterial pressure and heart rate.

At long continuous reception of Kardiket tolerance development, and also development of cross tolerance to other medicines of group of nitrates is possible. For prevention of reduction of its efficiency it is necessary to avoid continuous therapy using high doses.

At an acute heart failure or an acute myocardial infarction of Kardiket it is necessary to accept only at careful clinical observation of the patient.

At patients with primary pulmonary diseases during therapy the temporary anoxemia can develop. At coronary heart disease it can lead to development of tranzitorny ischemia of a myocardium.

To avoid increase of attacks of stenocardia it is recommended to avoid sharp cancellation of therapy.

In case of development of an attack of stenocardia it is necessary to apply nitrates of bystry action to its stopping in addition.

For prevention of undesirable lowering of arterial pressure the dose of drug should be selected individually.

During therapy lowering of arterial pressure and development of dizziness upon sharp transition from situation is possible "lying" or "sitting" in vertical position, against the background of the ethanol use, when performing physical exercises and in hot weather, and also strengthening of stenocardia at sharp lowering of arterial pressure, ischemia up to a myocardial infarction and sudden death (paradoxical "nitrate reactions").

Intensity of a headache can be reduced decrease in a dose of Kardiket and/or a concomitant use of the means containing menthol (for example, validol).

At frequent use of Kardiket without breaks can develop accustoming which demands increase in a dose. For prevention of development of tolerance it is recommended to observe daily within 8-12 hours "a beznitratny interval", more preferably at night. At most of patients such way of administration of drug is more effective, than continuous therapy.

If against the background of Kardiket's reception dryness in a mouth or an illegibility of sight remain or are strongly expressed, therapy has to be stopped.

During treatment alcohol intake needs to be excluded.

At Kardiket's use it is necessary to abstain from driving of motor transport and performance of potentially dangerous types of the works demanding high concentration of attention and bystry psychomotor reactions.

Medicinal interaction

At simultaneous use of Kardiket with some medicines there can be undesirable effects:

• Beta adrenoblockers, other vasodilating drugs (vazodilatator), hypotensive medicines, blockers of slow calcium channels, the phosphodiesterase 5 inhibitors which are applied at treatment of erectile dysfunction, tricyclic antidepressants and neuroleptics, quinidine, новокаинамид and also ethanol: strengthening of hypotensive effect of isosorbide of dinitrate;
• Digidroergotamin: increase in its concentration in blood and, thus, strengthening of hypotensive action;
• Sympathomimetic means, alpha adrenoblockers: decrease in anti-anginal effect of isosorbide of dinitrate;
• M-holinoblokatory (atropine): increase in probability of increase in intraocular pressure;
• The knitting, adsorbing and enveloping means: dinitrate isosorbide absorption reduction in digestive tract.

At treatment of coronary heart disease it is rational to apply Kardiket along with Amiodaronum and other medicines, such as blockers of slow calcium channels (nifedipine, verapamil), propranolol.

Improvement of coronary circulation is promoted by the combined Kardiket's use and acetylsalicylic acid.

Terms and storage conditions

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

Period of validity – 5 years.