When Cordarone is prescribed: instructions for use

Cordarone has antianginal and antiarrhythmic effects. Pharmacologists refer it to the group of agents with antiarrhythmic effect.

Its active ingredient is amiodarone. It is used to prevent angina pectoris, its attacks, as well as for the treatment and prophylactic methods for cardiac arrhythmias, for diagnosing various types of tachycardia, as well as atrial shudders. It is an indispensable drug for ventricular extrasystoles.

On this page you will find all the information about Cordaron: complete instructions for use for this drug, average prices in pharmacies, complete and incomplete analogues of the drug, as well as reviews of people who have already used Cordaron. Want to leave your opinion? Please write in the comments.

Clinico-pharmacological group

Antiarrhythmic drug.

Pharmacy sales terms

It is released on prescription.

Prices

How much is Kordaron? The average price in pharmacies is 330 rubles.

Release form and composition

The following dosage forms of Cordarone are produced:

  • Solution for intravenous administration: light yellow transparent (3 ml in ampoules of colorless glass with two marking rings and a break point in the upper part; in plastic planimetric packs of 6 ampoules each; in a cardboard bundle 1 package).
  • Tablets: round from white with a creamy shade to white. On one side there is a fault line, on both sides there is a bevel from the edges to the fault line and engraving “200” under it, a chamfer and a heart-shaped symbol above the fault line (10 pieces in blisters; 3 blisters in a cardboard box).

1 ampoule contains:

  • Active ingredient: amiodarone hydrochloride - 0.15 g.
  • Auxiliary components: polysorbate 80 - 0.3 g, water for injection - up to 3 ml, benzyl alcohol - 0.06 g.

The composition of 1 tablet includes:

  • Active ingredient: amiodarone hydrochloride - 0.2 g.
  • Auxiliary components: magnesium stearate, anhydrous colloidal silicon dioxide, lactose monohydrate, povidone K90F, corn starch.

Pharmacological effect

Cordarone is a third-class antiarrhythmic drug. Eliminates angina and arrhythmia, helps block adrenergic receptors, slow sinoatrial, atrial and nodal conduction, without affecting the intraventricular conduction.

Also, the drug reduces myocardial excitability, lengthens the refractory period. Cordarone also has an antianginal effect due to a decrease in oxygen consumption by the myocardium. This is due to a decrease in heart rate and a decrease in total vascular peripheral resistance. Due to the direct effect on the muscles of the arteries, Cordaron increases coronary blood flow, in addition, the drug supports cardiac output, reduces myocardial contractility.

According to reviews, Kordaron reaches its maximum activity 15 minutes after intravenous administration, the medicinal effect on the body lasts for four hours. Gradually, the amount of the drug in the blood decreases, but this does not interfere with tissue saturation. If the patient does not receive repeated injections, the drug is eliminated from the body within a few months.

Indications for use

What helps? Cordarone tablets is used to treat the following diseases and conditions:

  • heart rhythm disorders in patients with pathology of left ventricular function or coronary heart disease;
  • supraventricular paroxysmal tachycardias;
  • atrial fibrillation and flutter;
  • life-threatening ventricular arrhythmias, in particular, ventricular fibrillation and ventricular tachycardia.

Cordarone is indicated for the prevention of sudden death in patients at high risk: having more than 10 ventricular extrasystoles per hour, reduced left ventricular emission fraction, in patients after a recent myocardial infarction, as well as in patients with clinical manifestations of chronic heart failure.

The use of Cordarone in the form of an injection is shown in the following cases:

  • for relief of attacks of ventricular paroxysmal tachycardia, including one characterized by a high frequency of ventricular contractions;
  • for cardiac resuscitation in cardiac arrest caused by ventricular fibrillation in the event of defibrillation failure;
  • for the relief of atrial fibrillation and atrial flutter.

In the treatment of ventricular arrhythmias, the use of the drug should be made in a hospital and careful cardiac monitoring.

Contraindications

This drug can be used by patients only on prescription after a thorough examination. Before starting therapy, it is recommended to carefully read the enclosed instructions for limitations. Contraindications to the use of the drug Cordarone are:

  1. Age up to 18 years;
  2. Pregnancy and breastfeeding period;
  3. Hypokalemia or hypomagnesemia;
  4. Sinus bradycardia;
  5. Severe dysfunction of the thyroid gland (hyper or hypothyroidism);
  6. Interstitial lung disease;
  7. The simultaneous use of drugs that change the performance of the electrocardiogram and can cause the development of paroxysmal tachycardias;
  8. Congenital lactose intolerance or lactase deficiency;
  9. Individual intolerance to the components of the drug;
  10. Simultaneous use with agents that prolong the QT interval and cause the development of paroxysmal tachycardias, including ventricular “pirouette” tachycardia: Class IA antiarrhythmic drugs (hydroquinidine, quinidine, procainamide, disopyramide) and class III (bridil tosilate, ibutilid, iutilidyridine, disaciramide) and class III (bretiel tosilat, ibutilid, iutilidi, zooperidamide) non-anti-aging products cisapride, tricyclic antidepressants, azoles, macrolide antibiotics (including spiramycin, erythromycin when i / v administration), antimalarial drugs (chloroquine, halofantrine, quinine, mefloquine), difemanyl methylsulfate, pentamidine co, when administered parenterally, mizolastine, fluoroquinolones, astemizole and terfenadine.

With special care, the drug can be used in patients with chronic heart failure in the stage of decompensation, liver or kidney failure, bronchial asthma, respiratory failure, as well as the elderly (over 65 years).

Additional contraindications to the use of the solution:

  1. Severe arterial hypotension, cardiogenic shock, collapse;
  2. Violations of intraventricular conduction (two-and three-beam blockade) in the absence of a permanent pacemaker;
  3. Heart failure, hypotension, cardiomyopathy, or severe respiratory failure - for intravenous injection.

All of these contraindications should not be considered when conducting cardio-resuscitation in cardiac arrest against the background of ventricular fibrillation resistant to cardioversion.

Use during pregnancy and lactation

The use of amiodarone in pregnant women is possible with ventricular arrhythmias that pose a threat to the mother’s life if the expected clinical effect outweighs the potential risk and danger to the fetus.

Do not use during lactation.

Instructions for use

The instructions for use indicate that the tablets Cordarone taken by mouth before meals and washed down with a sufficient amount of water. The drug should be taken only on prescription.

  1. Load (“saturating”) dose: various saturation patterns can be applied.
  2. In the hospital: the initial dose, divided into several doses, ranges from 600-800 mg (up to a maximum of 1200 mg) / day until a total dose of 10 g is reached (usually within 5-8 days).
  3. Outpatient: the initial dose, divided into several doses, ranges from 600 to 800 mg per day until a total dose of 10 g is reached (usually within 10-14 days).
  4. Maintenance dose: may vary in different patients from 100 to 400 mg / day. You should apply the minimum effective dose in accordance with the individual therapeutic effect.

Because Cordaron has a very large T1 / 2, it can be taken every other day or take breaks in its reception 2 days a week.

  • The average therapeutic single dose is 200 mg.
  • The average therapeutic daily dose is 400 mg.
  • The maximum single dose - 400 mg.
  • The maximum daily dose is 1200 mg.

Side effects

During therapy may develop disorders of some body systems:

  1. Digestive system: very rarely - nausea;
  2. Endocrine system: with unknown frequency - hyperthyroidism;
  3. Musculoskeletal system: with unknown frequency - pain in some parts of the spine (lumbar and lumbosacral);
  4. Immune system: very rarely - anaphylactic shock; with unknown frequency - angioedema (angioedema);
  5. Nervous system: very rarely - headache, benign intracranial hypertension (pseudotumor of the brain);
  6. Skin and subcutaneous tissue: very rarely - excessive sweating, feeling of heat; with unknown frequency - urticaria;
  7. Local reactions: often - reactions at the injection site (infection, infiltration, erythema, pain, necrosis, edema, thrombophlebitis, pigmentation, extravasation, induration, inflammation, cellulitis, phlebitis).
  8. Respiratory system: very rarely - cough, interstitial pneumonitis, shortness of breath, apnea and / or bronchospasm (in patients with severe respiratory failure, especially in bronchial asthma), acute respiratory distress syndrome (sometimes fatal);
  9. Biliary tract and liver: very rarely - an isolated increase in the activity of hepatic transaminases in serum (usually mild, normal values ​​are reduced by a factor of 1.5-3 times with a decrease in dose or even spontaneously), acute liver damage (within 24 hours after administration of Cordarone) with jaundice and / or increased transaminase, including the development of liver failure, sometimes fatal;
  10. Cardiovascular system: often - bradycardia (usually a moderate decrease in heart rate), a decrease in blood pressure, usually transient and moderate (cases of collapse or severe arterial hypotension were observed with too rapid administration of the drug or overdose); very rarely - arrhythmogenic effect (the emergence of new arrhythmias, including ventricular tachycardia "pirouette", or exacerbation of existing ones, sometimes with subsequent cardiac arrest. These effects are mainly observed when using Cordaron along with drugs that prolong the period of ventricular repolarization of the heart or in case of abnormal contents in blood electrolytes); severe bradycardia or, in rare cases, sinus node arrest, which requires cessation of therapy, especially in patients with sinus node dysfunction and / or elderly patients, flushing of the skin of the face; with unknown frequency - ventricular tachycardia of the pirouette type.

Overdose

When ingesting large doses of the drug, patients show signs of overdose, which are expressed in strengthening the above-described side effects, the development of sinus bradycardia, up to cardiac arrest.

With the development of similar symptoms or accidental ingestion of a large dose of the drug, the patient should wash the stomach as soon as possible, give activated carbon or other sorbents to drink. If necessary, symptomatic treatment. Hemodialysis is not effective, there is no specific antidote for the drug.

Special instructions

Because The side effects of amiodarone are dose-dependent, patients should be treated with minimal effective doses to minimize the possibility of their occurrence.

Patients should be warned that during treatment they avoid exposure to direct sunlight or take protective measures (for example, the use of sunscreen, wearing appropriate clothing).

Treatment monitoring

Before starting amiodarone, it is recommended to conduct an ECG study and determine the content of potassium in the blood. Hypokalemia should be adjusted prior to the use of amiodarone. During treatment, it is necessary to regularly monitor the ECG (every 3 months) and transaminase activity and other indicators of liver function.

In addition, due to the fact that amiodarone can cause hypothyroidism or hyperthyroidism, especially in patients with a history of thyroid disease, a clinical and laboratory test (TSH concentration in serum determined using an ultrasensitive TSH test) should be performed before taking amiodarone the object of identifying violations of the function and diseases of the thyroid gland. During treatment with amiodarone and for several months after it is discontinued, the patient should be regularly examined for clinical or laboratory signs of changes in thyroid function. If you suspect a dysfunction of the thyroid gland, it is necessary to determine the serum TSH concentration (using an ultrasensitive TSH test).

In patients receiving long-term treatment for rhythm disturbances, an increase in the frequency of ventricular defibrillation and / or an increase in the threshold of the pacemaker or implanted defibrillator has been reported, which may reduce the effectiveness of these devices. Therefore, before starting or during treatment with amiodarone should regularly check the correctness of their functioning.

Regardless of the presence or absence during pulmonary symptomatic treatment with amiodarone, it is recommended to conduct x-ray pulmonary and pulmonary functional tests every 6 months.

The appearance of shortness of breath or dry cough, both isolated and accompanied by worsening of the general condition (fatigue, weight loss, fever), may indicate pulmonary toxicity, such as interstitial pneumonitis, the development of which requires an X-ray examination of the lungs and pulmonary function. samples.

Due to the lengthening of the period of repolarization of the ventricles of the heart, the pharmacological effect of the drug Cordaron causes certain ECG changes: lengthening the QT, QTc (corrected) interval, U waves may occur. An increase in the QTc interval of no more than 450 ms or no more than 25% of the original value is possible. These changes are not a manifestation of the toxic effect of the drug, but require monitoring for dose adjustment and evaluation of the possible proarrhythmic effect of the drug Cordarone.

With the development of AV block II and III degree, sinoatrial block or double-diplex intraventricular block, treatment should be stopped. At occurrence of an AV blockade of the I degree it is necessary to strengthen supervision.

Although the occurrence of arrhythmias or weighting of existing rhythm disturbances, sometimes fatal, was noted, the proarrhythmic effect of amiodarone is mild (less pronounced than in most antiarrhythmic drugs) and usually manifests itself in the context of factors that increase the duration of the QT interval, such as interaction with other drugs and / or with violations of the content of electrolytes in the blood. Despite the ability of amiodarone to increase the duration of the QT interval, it showed low activity against provoking ventricular tachycardia of the “pirouette” type.

In case of blurred vision or a decrease in visual acuity, an ophthalmologic examination, including examination of the fundus of the eye, is urgently needed. With the development of neuropathy or neuritis of the optic nerve caused by amiodarone, the drug must be canceled because of the risk of developing blindness.

Since Cordaron contains iodine, its intake may interfere with the absorption of radioactive iodine and distort the results of a radioisotope study of the thyroid gland, but the administration of the drug does not affect the accuracy of the determination of T3, T4 and TSH in plasma. Amiodarone inhibits the peripheral conversion of thyroxine (T4) to triiodothyronine (T3) and can cause isolated biochemical changes (an increase in the concentration of free T4 in the blood serum, with a slightly lower or even normal concentration of free T3 in the blood serum) in clinically euthyroid patients, which is not the cause to cancel amiodarone.

The development of hypothyroidism can be suspected with the appearance of the following clinical signs, usually mild: an increase in body mass, cold intolerance, decreased activity, excessive bradycardia.

Before surgery, the anesthesiologist should be informed that the patient is taking Cordarone.

Prolonged treatment with Cordarone may increase the hemodynamic risk inherent in local or general anesthesia. This applies in particular to its bradycardic and hypotensive effects, reduction of cardiac output and conduction disorders.

In addition, in patients taking Cordaron, in rare cases, immediately after surgery, acute respiratory distress syndrome was noted. With artificial lung ventilation, such patients require careful monitoring.

It is recommended that careful monitoring of functional liver tests (determination of transaminase activity) before starting the administration of Cordarone and regularly during treatment with the drug is recommended. When taking the drug Cordarone possible acute liver dysfunction (including hepatocellular insufficiency or liver failure, sometimes fatal) and chronic liver damage. Therefore, treatment with amiodarone should be discontinued with an increase in the activity of transaminases, 3 times higher than VGN.

Clinical and laboratory signs of chronic liver failure while taking amiodarone orally may be minimal (hepatomegaly, increased transaminase activity, 5 times higher than VGN) and reversible after discontinuation of the drug, however, cases of death in liver damage have been reported.

Drug interactions

Only the attending physician can determine the possibility of concomitant therapy, given the condition and clinical indications of the patient.

Reviews

We picked up some reviews of people taking Cordarone:

  1. Hope. Took kordaron 3 years to 1 tabl.v day. Doctors did not even set a break for 1-2 days a week and did not say to protect themselves from the sun! It was necessary to reach everything by the “spear” method itself. The drug is very toxic. Canceled herself. After cancellation after 3 months, hyperthyroidism was revealed, not to mention a rash on the legs, the development of blurred vision, nausea, headaches ... If you can do without it on other drugs, then, of course, it is better to treat them and not start!
  2. Igor Kordaron was appointed two weeks ago and then it all started the same, like Alla Koltsova. He spent 10 days in the hospital while he was picked up (supposedly) with the right medicines. After reading your feedback three days ago, I stopped taking cordarone and returned to the old drugs. Digoxin (once in two days) and Corvedelol (in the morning and in the evening). And the dream appeared and the shortness of breath passed. Correctly write, how many doctors so many recipes. I want to say that these drugs were prescribed to me seven months ago, so check with your doctor.
  3. Victor. After a heart operation, I developed atrial fibrillation, completely lost my ability to work, blood stagnation, liver enlargement and other rather serious complications. Treatment in the cardiology department, including the administration of cardamom by drop, did not produce results. I had to go to NIIASKH, where he underwent a procedure of fibrillation, after which the pulse improved. But I was recommended to continue taking Cordarone pills according to the 5-day regimen, 2 days of rest. Due to the fact that cordaron is a rather expensive medicine, on the recommendation of doctors, he began taking amidoron. By its qualities, it completely replaces cordaron and perfectly blocks heart impulses. In addition, I was convinced that the generics of our production are no worse than imported ones. And yet, as can be seen, not always therapeutic treatment can lead to a positive result.

Analogs

What can replace the tool? Analogs can be called drugs:

  • Amiodarone;
  • Amiokordin;
  • Vero Amiodarone;
  • Cardiodarone;
  • Opacordain;
  • Rhythtiodarone;
  • Sedacoron.

Before using analogues consult your doctor.

Storage conditions and shelf life

Cordarone solution should be stored at room temperature not exceeding 25 ° C. Store in an original cardboard box, in a dry place, away from children.

Tablets should be stored at temperatures below 28-30 ° C.

Watch the video: Amiodarone Nursing Considerations, Side Effects and Mechanism of Action Pharmacology for Nurses (December 2019).

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