Ritmonorm

Ritmonorm – the medicine having antiarrhytmic effect. Is beta adrenoblocker.

Form of release and structure

Ritmonorm is issued in the form of tablets, film coated: biconvex, round, white or almost white color, on one party there is an engraving "150" (in blisters on 10 pieces, in a cardboard pack five blisters).

Structure on 1 tablet:

• active ingredient: a propafenona a hydrochloride – 150 mg;
• auxiliary components: starch corn, gipromelloza 2910, croscarmellose sodium, magnesium stearate, cellulose microcrystallic, water;
• film cover: macrogoal 6000, titanium dioxide, macrogoal 400, gipromelloza of 2910.

Indications to use

• the heavy ventricular paroxysmal tachyarrhythmia posing a threat for life;
• paroxysmal supraventricular tachyarrhythmias, including supraventricular tachycardia at patients with paroxysmal fibrillation of auricles and/or a WPW-syndrome, and also AV nodal tachycardia.

Contraindications

Absolute:

• severe forms of HOBL (chronic obstructive pulmonary disease);
• serious organic changes of a myocardium (for example, cardiogenic shock, the expressed arterial hypotension, SSSU (sick sinus syndrome), refractory CHF (chronic heart failure) with emission of a left ventricle less than 35%, the expressed bradycardia, distal blockade, blockade of legs of a ventriculonector or AV blockade (at patients without artificial pacemakers), disturbance of intra-atrial conduction);
• myasthenia гравис;
• the myocardial infarction transferred the patient within the last three months;
• the expressed changes of water and electrolytic balance;
• Brugad's syndrome;
• children's and teenage age less than 18 years;
• concomitant use with ritonaviry;
• hypersensitivity to any of drug components.

Relative (Ritmonorm appoint with care):

• organic changes of a myocardium;
• paroxysmal ciliary arrhythmia;
• disturbance of renal and/or hepatic function;
• obstructive diseases of a respiratory organs, including bronchial asthma;
• advanced age;
• existence at patients of an electrocardiostimulator;
• period of pregnancy and feeding by a breast.

Route of administration and dosage

Pill Ritmonorm is taken inside, swallowing entirely and washing down with enough liquid.

The dose is selected individually taking into account portability and efficiency of drug.

Treatment should be begun in the conditions of a hospital. Previously cancel all antiarrhytmic means. During therapy it is necessary to control the electrocardiogram, arterial pressure and to determine QRS complex width.

At considerable expansion of the QRS complex and AV blockade it is recommended to reduce a dose.

To adult patients with the body weight of 70 kg and more Ritmonorm appoint in an initial dose 150 mg three times a day. Further, bucketed not less than 3-4 days, increase in a dose up to 300 mg two times a day, and in case of need – to 300 mg three times a day is possible (it is the maximum daily dose). To patients with body weight less than 70 kg appoint drug in lower doses. Increase in a dose is begun not earlier than in 3-4 days of therapy.

At patients of advanced age treatment is carried out strictly under control of the doctor. Increase in a dose is begun not earlier than in 5-8 days of therapy.

At an abnormal liver function and/or kidneys Ritmonorm's dose is titrated under control of the electrocardiogram and careful clinical observation.

Side effects

• immune system: frequency is unknown – hypersensitivity (it is shown by skin rash, a blood dyscrasia, a cholestasia);
• lymphatic system and blood: infrequently – reduction of quantity of thrombocytes; frequency is unknown – decrease in quantity of leukocytes and granulocytes, an agranulocytosis;
• nervous system: very often – dizziness; often – taste change, headaches; infrequently – paresthesias, an incoordination of movements, unconscious states; frequency is unknown – concern, extrapyramidal frustration, spasms;
• mentality: often – a sleep disorder, the increased uneasiness; infrequently – nightmares in a dream; frequency is unknown – confusion and disturbance of consciousness;
• sense bodys: often – the reduced clearness of sight; infrequently – вертиго;
• metabolism and food: infrequently – appetite reduction;
• digestive tract: often – a lock, diarrhea, nausea, vomiting, dryness of a mucous oral cavity, abdominal pain; infrequently – the increased gas generation, abdominal distention; frequency is unknown – diseases of digestive tract and desires on vomiting;
• liver and biliary tract: often – an abnormal liver function; frequency is unknown – hepatitis, a cholestasia, jaundice, hepatocellular disturbances;
• respiratory system: often – the speeded-up and complicated breath;
• cardiovascular system: very often – heartbeat, disturbance of conductivity in heart; often – tachycardia, bradycardia, a sinus bradycardia, an atrial flutter; infrequently – arrhythmia, ventricular tachycardia, the expressed lowering of arterial pressure; frequency is unknown – orthostatic hypotension, reduction of heart rate, heart failure, fibrillation of ventricles;
• connecting and musculoskeletal fabric: frequency is unknown – a volchanochnopodobny syndrome;
• skin and hypodermic fabrics: infrequently – skin rash and an itch, an erythema, a small tortoiseshell;
• generative organs: infrequently – ED (erectile dysfunction); frequency is unknown – decrease in number of spermatozoa (reversible);
• general frustration: often – weakness, fever, increased fatigue, thorax pain.

Special instructions

Propafenon is capable to reveal an asymptomatic current of a syndrome of Brugad, causing brugadopodobny changes on the electrocardiogram. At once after an initiation of treatment it is recommended to conduct examination for an exception of a syndrome of Brugad and corresponding changes on an ECG.

At patients with electrocardiostimulators their reprogramming as Ritmonorm can influence a frequency threshold and a threshold of sensitivity of artificial pacemakers can be required.

During treatment it is necessary to abstain from driving, and also occupations other activity demanding high concentration of attention and bystry reaction.

Medicinal interaction

At complex use with the local anesthetics and other means reducing contractility of a myocardium and/or urezhayushchy heart rate strengthening of side effects is possible.

At joint reception with venlafaksiny, metoprololy, propranolol, cyclosporine, digoxin, desipramine and theophylline plasma concentration of these drugs can increase that demands reduction of a dose of the listed medicines.

At simultaneous use of Ritmonorm with Cimetidinum, erythromycin, ketokonazoly, quinidine and grapefruit juice increase in plasma concentration of a propafenon is possible.

The concomitant use of Amiodaronum can lead to repolarization and disturbance of conductivity and to be followed by proaritmogenny action.

At joint appointment with lidocaine the risk of development of by-effects of lidocaine from the central nervous system increases; with rifampicin – decrease in concentration of a propafenon and reduction of its antiarrhytmic activity is possible; with indirect anticoagulants – lengthening of a prothrombin time is possible; with paroksetiny or fluoxetine – concentration of a propafenon can increase and the desirable therapeutic effect will be reached at use of smaller doses of drug.

Terms and storage conditions

To store in the place unavailable to children, at a temperature of 15-25 °C.

Period of validity – 5 years.