Cordarone instructions for intravenous use. When is Cordarone prescribed: instructions for use

In this article you can read the instructions for use of the drug Cordaron. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Cordarone in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Cordarone in the presence of existing structural analogues. Use for the treatment of arrhythmia and atrial and ventricular fibrillation in adults, children, as well as during pregnancy and lactation. Composition of the drug.

Cordaron- antiarrhythmic drug. Amiodarone (the active ingredient of the drug Cordarone) belongs to class 3 (class of repolarization inhibitors) and has a unique mechanism of antiarrhythmic action, because in addition to the properties of class 3 antiarrhythmics (potassium channel blockade), it has the effects of class 1 antiarrhythmics (sodium channel blockade), class 4 antiarrhythmics (calcium channel blockade) and a non-competitive beta-blocker effect.

In addition to the antiarrhythmic effect, the drug has antianginal, coronary dilation, alpha and beta adrenergic blocking effects.

The antiarrhythmic effect of the drug is due to an increase in the duration of phase 3 of the action potential of cardiomyocytes, mainly due to blocking the ion current in potassium channels (the effect of class 3 antiarrhythmics according to the Vaughan-Williams classification); a decrease in the automaticity of the sinus node, leading to a decrease in heart rate; non-competitive blockade of alpha and beta adrenergic receptors; slowing of sinoatrial, atrial and AV conduction, more pronounced with tachycardia; no changes in ventricular conductivity; an increase in refractory periods and a decrease in the excitability of the myocardium of the atria and ventricles, as well as an increase in the refractory period of the AV node; slowing down conduction and increasing the duration of the refractory period in additional AV conduction bundles.

In addition, Cordarone has the following properties: no negative inotropic effect when taken orally; reduction of oxygen consumption by the myocardium due to a moderate decrease in peripheral vascular resistance and heart rate; an increase in coronary blood flow due to a direct effect on the smooth muscle of the coronary arteries; maintaining cardiac output by reducing pressure in the aorta and reducing peripheral vascular resistance; influence on the exchange of thyroid hormones: inhibition of the conversion of T3 to T4 (blockade of thyroxine-5-deiodinase) and blocking the uptake of these hormones by cardiocytes and hepatocytes, leading to a weakening of the stimulating effect of thyroid hormones on the myocardium.

After starting to take the drug orally, the therapeutic effects develop on average within a week (from several days to 2 weeks). After stopping its use, amiodarone is detected in the blood plasma for 9 months. The possibility of maintaining the pharmacodynamic effect of amiodarone for 10-30 days after its discontinuation should be taken into account.

Compound

Amiodarone hydrochloride + excipients.

Pharmacokinetics

Bioavailability after oral administration in different patients ranges from 30% to 80% (average value about 50%). Amiodarone is characterized by slow release into tissues and high affinity for them. During the first days of treatment, the drug accumulates in almost all tissues, especially in adipose tissue and, in addition, in the liver, lungs, spleen and cornea. An equilibrium state is achieved after 1 to several months, depending on the individual characteristics of the patient. The pharmacokinetics of the drug explain the use of loading doses, which are aimed at quickly achieving the required level of tissue penetration at which the therapeutic effect of amiodarone is manifested. Metabolized in the liver. The main metabolite, desethylamiodarone, is pharmacologically active and can enhance the antiarrhythmic effect of the main compound. Amiodarone elimination begins within a few days. It is excreted mainly through the intestines.

Indications

Pills

Relapse prevention:

• life-threatening ventricular arrhythmias and ventricular fibrillation (treatment should begin in the hospital with careful cardiac monitoring);
• supraventricular paroxysmal tachycardias, incl. documented attacks of recurrent sustained supraventricular paroxysmal tachycardia in patients with organic heart diseases; documented attacks of recurrent sustained supraventricular paroxysmal tachycardia in patients without organic heart disease, when antiarrhythmic drugs of other classes are not effective or there are contraindications to their use; documented attacks of recurrent sustained supraventricular paroxysmal tachycardia in patients with WPW syndrome;
• atrial fibrillation (atrial fibrillation) and atrial flutter.

Prevention of sudden arrhythmic death in high-risk patients:

• patients after a recent myocardial infarction with more than 10 ventricular extrasystoles per hour, clinical manifestations of chronic heart failure and reduced left ventricular ejection fraction (<40%).

Solution

• relief of attacks of ventricular paroxysmal tachycardia;
• relief of attacks of supraventricular paroxysmal tachycardia with a high frequency of ventricular contractions (especially against the background of WPW syndrome);
• relief of paroxysmal and stable forms of atrial fibrillation (atrial fibrillation) and atrial flutter;
• Cardiac resuscitation for cardiac arrest caused by ventricular fibrillation resistant to cardioversion.

Release forms

Tablets 200 mg.

Solution for intravenous administration (injections in injection ampoules).

Instructions for use and dosage

Pills

When prescribing the drug in a loading dose, various schemes can be used.

When used in a hospital, the initial dose, divided into several doses, ranges from 600-800 mg per day to a maximum of 1200 mg per day until a total dose of 10 g is reached (usually over 5-8 days).

For outpatient use, the initial dose, divided into several doses, ranges from 600 mg to 800 mg per day until a total dose of 10 g is reached (usually within 10-14 days).

The maintenance dose may vary between patients from 100 mg per day to 400 mg per day. The minimum effective dose should be used according to the individual therapeutic effect.

Because Amiodarone has a very long half-life, the drug can be taken every other day or take breaks from taking it 2 days a week.

The average therapeutic single dose is 200 mg. The average therapeutic daily dose is 400 mg.

The maximum single dose is 400 mg. The maximum daily dose is 1200 mg.

Ampoules

Cordarone for intravenous administration is intended for use in cases where rapid achievement of an antiarrhythmic effect is required, or if it is impossible to administer the drug orally.

With the exception of emergency clinical situations, the drug should be used only in a hospital in an intensive care unit under constant monitoring of ECG and blood pressure.

When administered intravenously, Cordarone should not be mixed with other drugs or simultaneously administered other drugs through the same venous access. The drug should be administered only in diluted form. To dilute Cordarone, only a 5% dextrose (glucose) solution should be used. Due to the characteristics of the dosage form of the drug, it is not recommended to use concentrations of the infusion solution that are less than those obtained by diluting 2 ampoules in 500 ml of 5% dextrose (glucose).

To avoid injection site reactions, Cordarone should be administered through a central venous catheter, except in cases of cardiac resuscitation for ventricular fibrillation resistant to cardioversion, when, in the absence of central venous access, the drug can be administered into the peripheral veins (the largest peripheral vein with maximum blood flow).

Severe cardiac arrhythmias, in cases where it is impossible to take the drug orally (except in cases of cardiac resuscitation for cardiac arrest caused by ventricular fibrillation resistant to cardioversion)

The drug is administered intravenously (dropper) through a central venous catheter.

The loading dose is usually 5 mg/kg body weight in 250 ml of a 5% dextrose (glucose) solution, administered over 20-120 minutes, if possible using an electronic pump. This dose can be repeated 2-3 times within 24 hours. The rate of administration of the drug is adjusted depending on the clinical effect. The therapeutic effect appears within the first minutes of administration and gradually decreases after stopping the infusion, therefore, if it is necessary to continue treatment with the injection form of Cordarone, it is recommended to switch to constant IV drip administration of the drug.

Maintenance doses: 10-20 mg/kg/24 hours (usually 600-800 mg, but can be increased to 1200 mg over 24 hours) in 250 ml of 5% dextrose (glucose) solution for several days. From the first day of infusion, a gradual transition to taking Cordarone orally at a dose of 600 mg (3 tablets) per day should begin. The dose can be increased to 800-1000 mg (4-5 tablets) per day.

Cardiac resuscitation for cardiac arrest caused by ventricular fibrillation resistant to cardioversion

The drug is administered intravenously. The first dose is 300 mg (or 5 mg/kg) in 20 ml of a 5% dextrose (glucose) solution. If fibrillation does not stop, then additional administration of Cordarone intravenously in a bolus at a dose of 150 mg (or 2.5 mg/kg) is possible.

Side effect

• moderate dose-dependent bradycardia
• conduction disturbances (sinoatrial block, AV block of various degrees)
• arrhythmogenic effect (there are reports of the emergence of new arrhythmias or aggravation of existing ones, in some cases with subsequent cardiac arrest; these effects are observed mainly in cases of Cordarone use in conjunction with drugs that prolong the QTc interval or with electrolyte imbalances; in the light of available data, it is impossible determine whether the occurrence of these rhythm disturbances is caused by Cordarone, or is associated with the severity of cardiac pathology, or is a consequence of treatment failure)
• severe bradycardia or, in exceptional cases, sinus node arrest (mainly in patients with sinus node dysfunction and elderly patients)
• progression of heart failure (with long-term use)
• nausea, vomiting
• loss of appetite
• dullness or loss of taste
• a feeling of heaviness in the epigastrium (occurs mainly at the beginning of treatment, disappears after reducing the dose)
• interstitial or alveolar pneumonitis
• bronchiolitis obliterans with pneumonia (sometimes fatal)
• pleurisy
• bronchospasm (in patients with severe respiratory failure, especially in patients with bronchial asthma)
• acute respiratory distress syndrome (sometimes fatal and sometimes immediately after surgery; possible interaction with high doses of oxygen)
• pulmonary hemorrhage
• microdeposits in the corneal epithelium consisting of complex lipids, including lipofuscin
• Optic neuritis
• hypothyroidism (weight gain, chilliness, apathy, decreased activity, drowsiness, bradycardia that is excessive compared to the expected effect of amiodarone)
• hyperthyroidism, which may appear during and after treatment (cases of hyperthyroidism that developed several months after discontinuation of amiodarone have been described)
• photosensitivity
• grayish or bluish pigmentation of the skin (this pigmentation slowly disappears after stopping treatment)
• erythema (during radiation therapy)
• skin rash (usually unspecific)
• alopecia
• exfoliative dermatitis (no connection with the drug has been established)
• tremor or other extrapyramidal symptoms
• sleep disorders
• nightmares
• myopathy
• headache
• thrombocytopenia, hemolytic anemia, aplastic anemia
• vasculitis
• several cases of impotence (no connection with the drug has been established).

Contraindications

• SSS (sinus bradycardia, sinoatrial block) except in cases of correction with an artificial pacemaker (danger of “stopping” the sinus node);
• 2nd and 3rd degree AV block in the absence of a permanent artificial pacemaker (pacemaker);
• two- and three-bundle blockades in the absence of a pacemaker;
• hypokalemia, hypomagnesemia;
• interstitial lung diseases;
• thyroid dysfunction (hypothyroidism, hyperthyroidism);
• congenital or acquired prolongation of the QT interval;
• combination with drugs that can prolong the QT interval and cause the development of paroxysmal tachycardias, including polymorphic ventricular tachycardia of the "pirouette" type: class 1 A antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide, procainamide); class 3 antiarrhythmic drugs (dofetilide, ibutilide, bretylium tosylate); sotalol; other (non-antiarrhythmic) drugs such as bepridil; vincamine; some neuroleptics phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine, fluphenazine), benzamides (amisulpride, sultopride, sulpiride, tiapride, veralipride), butyrophenones (droperidol, haloperidol), sertindole, pimozide; cisapride; tricyclic antidepressants; antibiotics of the macrolide group (in particular erythromycin with intravenous administration, spiramycin); azoles; antimalarials (quinine, chloroquine, mefloquine, halofantrine); pentamidine for parenteral administration; difemanil methyl sulfate; mizolastine; astemizole, terfenadine; fluoroquinolones;
• children and adolescents under 18 years of age (efficacy and safety have not been established);
• pregnancy;
• lactation period;
• hypersensitivity to iodine and/or amiodarone.

Use during pregnancy and breastfeeding

Cordarone is contraindicated during pregnancy and lactation (breastfeeding).

Currently available clinical information is insufficient to determine the risk of developmental defects in the embryo when using Cordarone in the 1st trimester of pregnancy.

Since the fetal thyroid gland begins to bind iodine only from the 14th week of pregnancy (amenorrhea), amiodarone is not expected to affect it if it is used earlier. Excess iodine when using the drug after this period can lead to the appearance of laboratory symptoms of hypothyroidism in the newborn or even to the formation of a clinically significant goiter. Due to the effect of the drug on the thyroid gland of the fetus, Cordarone is contraindicated for use during pregnancy, with the exception of special cases of vital indications (with life-threatening ventricular cardiac arrhythmias).

Amiodarone is excreted in breast milk in significant quantities, so if it is necessary to use the drug during lactation, breastfeeding should be discontinued.

Use in elderly patients

Use with caution in elderly patients (high risk of developing severe bradycardia).

Use in children

Contraindicated in children and adolescents under 18 years of age (efficacy and safety have not been established).

special instructions

Side effects of Cordarone are dose-dependent, therefore, to minimize the possibility of their occurrence, the drug should be used in the minimum effective dose.

During treatment, patients should avoid exposure to direct sunlight or take protective measures (eg, using sunscreen, wearing appropriate clothing).

Before starting amiodarone, it is recommended to conduct an ECG study and determine the level of potassium in the blood. Hypokalemia should be corrected before starting amiodarone. During treatment, it is necessary to regularly monitor the ECG (every 3 months), the level of liver transaminases and other indicators of liver function.

In addition, due to the fact that Cordarone can cause hypothyroidism or hyperthyroidism, especially in patients with a history of thyroid disease, before taking amiodarone, a clinical and laboratory (TSH level) examination should be performed to identify dysfunctions and diseases of the thyroid gland. During treatment with amiodarone and for several months after its cessation, regular examinations are required to identify clinical or laboratory signs of changes in thyroid function. If thyroid dysfunction is suspected, it is necessary to determine the level of TSH in the blood serum.

Regardless of the presence or absence of pulmonary symptoms during treatment with amiodarone, it is recommended to conduct an X-ray examination of the lungs and pulmonary function tests every 6 months.

In patients receiving long-term treatment for arrhythmias, an increase in the frequency of ventricular fibrillation and/or an increase in the threshold for the response of a pacemaker or implanted defibrillator has been reported, which may reduce their effectiveness. Therefore, before starting or during treatment with Cordarone, the correct functioning of these devices should be checked regularly.

The appearance of shortness of breath or a dry cough, either isolated or accompanied by a deterioration in general condition, indicates the possibility of pulmonary toxicity, such as interstitial pneumopathy, the suspicion of which requires X-ray examination of the lungs and pulmonary function tests.

Due to the prolongation of the period of repolarization of the ventricles of the heart, the pharmacological action of Cordarone causes certain changes in the ECG: prolongation of the QT interval, QTc (corrected), possible appearance of U waves. An increase in the QTc interval is permissible by no more than 450 ms or by no more than 25% of the original value. These changes are not a manifestation of the toxic effect of the drug, but require monitoring to adjust the dose and assess the possible proarrhythmogenic effect of Cordarone.

If 2nd and 3rd degree AV block, sinoatrial block or double-bundle intraventricular block develops, treatment should be discontinued. If 1st degree AV block occurs, increased clinical monitoring is required.

Although the occurrence of arrhythmias or worsening of existing rhythm disturbances has been noted, the proarrhythmogenic effect of amiodarone is weak, less than that of most antiarrhythmic drugs, and usually occurs in combination with certain drugs or with electrolyte imbalances.

If vision is blurred or visual acuity is reduced, an ophthalmological examination, including fundus examination, should be performed. With the development of neuropathy or optic neuritis caused by amiodarone, the drug must be discontinued due to the risk of blindness.

Since Cordarone contains iodine, its intake may distort the results of a radioisotope study of the thyroid gland, but does not affect the reliability of the determination of the content of T3, T4 and TSH in the blood plasma.

Before surgery, the anesthesiologist should be informed that the patient is receiving Cordarone. Prolonged treatment with Cordarone may increase the hemodynamic risk inherent in local or general anesthesia. This especially applies to its bradycardic and hypotensive effects, decreased cardiac output and conduction disorders.

In addition, in rare cases, acute respiratory distress syndrome was observed in patients receiving Cordarone immediately after surgery. During mechanical ventilation, such patients require careful monitoring.

Impact on the ability to drive vehicles and operate machinery

During treatment with Cordarone, you should refrain from driving a car and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Drug interactions

Contraindicated combinations

The use of Cordarone as part of combination therapy with drugs that can cause polymorphic ventricular tachycardia of the "pirouette" type is contraindicated, because when combined with amiodarone, the risk of developing this complication and death increases:

• antiarrhythmics: class 1A (quinidine, hydroquinidine, disopyramide, procainamide), class 3 (dofetilide, ibutilide, bretylium tosylate), sotalol;
• other (non-antiarrhythmic) drugs such as bepridil; vincamine; some neuroleptics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine, fluphenazine), benzamides (amisulpride, sultopride, sulpiride, tiapride, veralipride), butyrophenones (droperidol, haloperidol), sertindole, pimozide; tricyclic antidepressants; cisapride; macrolide antibiotics (erythromycin with intravenous administration, spiramycin); azoles; antimalarials (quinine, chloroquine, mefloquine, halofantrine, lumefantrine); pentamidine for parenteral administration; difemanil methyl sulfate; mizolastine; astemizole; terfenadine; fluoroquinolones (in particular moxifloxacin).

• with beta-blockers, with blockers of slow calcium channels that slow down heart rate (verapamil, diltiazem), because there is a risk of developing disorders of automatism (severe bradycardia) and conduction;
• with laxatives that stimulate intestinal motility, which can cause hypokalemia, which increases the risk of developing torsades de pointes. During treatment with Cordarone, laxatives from other groups should be used.

Combinations that require caution when using

With drugs that can cause hypokalemia:

• diuretics that cause hypokalemia (in monotherapy or combination);
• amphotericin B (iv);
• glucocorticosteroids (GCS) for systemic use;
• tetracosactide.

The risk of developing ventricular arrhythmias increases, especially ventricular tachycardia of the “pirouette” type (hypokalemia is a predisposing factor). It is necessary to monitor the content of electrolytes in the blood, and, if necessary, correct hypokalemia, constant clinical observation and ECG monitoring. In the event of the development of ventricular tachycardia of the "pirouette" type, antiarrhythmic drugs should not be used (ventricular pacing should be started, possibly intravenous administration of magnesium salts).

With procainamide

Amiodarone may increase plasma concentrations of procainamide and its metabolite N-acetyl procainamide, which may increase the risk of procainamide side effects.

With indirect anticoagulants

Amiodarone increases warfarin concentrations by inhibiting the CYP2C9 isoenzyme. When warfarin is combined with amiodarone, the effects of the indirect anticoagulant may be enhanced, which increases the risk of bleeding. The prothrombin time (INR) should be monitored more frequently and the anticoagulant dose adjusted both during treatment with amiodarone and after its discontinuation.

With cardiac glycosides (digitalis preparations)

Impairments of automatism (severe bradycardia) and atrioventricular conduction may occur. In addition, when combining digoxin with amiodarone, an increase in the concentration of digoxin in the blood plasma is possible (due to a decrease in its clearance). Therefore, when combining digoxin with amiodarone, it is necessary to determine the concentration of digoxin in the blood and monitor possible clinical and ECG manifestations of digitalis intoxication. Digoxin dosages may need to be reduced.

With esmolol

Possible disturbances in contractility, automaticity and conductivity (suppression of compensatory reactions of the sympathetic nervous system). Clinical and ECG monitoring is required.

With phenytoin (and, by extrapolation, with fosphenytoin)

Amiodarone can increase plasma concentrations of phenytoin due to inhibition of the CYP2C9 isoenzyme, therefore, when combining phenytoin with amiodarone, an overdose of phenytoin may develop, which can lead to the appearance of neurological symptoms; clinical monitoring is necessary and, at the first signs of overdose, a reduction in the dose of phenytoin; it is advisable to determine the concentration of phenytoin in the blood plasma.

With drugs metabolized by the CYP3A4 isoenzyme

When amiodarone, which is an inhibitor of the CYP3A4 isoenzyme, is combined with these drugs, their plasma concentrations may increase, which may lead to increased toxicity and/or increased pharmacodynamic effects and may require a dose reduction of these drugs:

• cyclosporine: there may be an increase in the concentration of cyclosporine in the blood plasma, associated with a decrease in the metabolism of the drug in the liver, which may increase the nephrotoxic effect of cyclosporine. It is necessary to determine the concentration of cyclosporine in the blood, monitor kidney function and correct the dosage regimen of cyclosporine during treatment with amiodarone and after discontinuation of the drug.
• fentanyl: when combined with amiodarone, the pharmacodynamic effects of fentanyl may be enhanced and the risk of developing its toxic effects may increase.
• other drugs metabolized by CYP3A4: lidocaine (risk of sinus bradycardia and neurological symptoms), tacrolimus (risk of nephrotoxicity), sildenafil (risk of increased side effects), midazolam (risk of psychomotor effects), triazolam, dihydroergotamine, ergotamine, statins, including simvastatin (increased risk of muscle toxicity, rhabdomyolysis, and therefore the dose of simvastatin should not exceed 20 mg per day; if it is ineffective, you should switch to another statin that is not metabolized by CYP3A4).

With orlistat

There is a risk of a decrease in the concentration of amiodarone and its active metabolite in the blood plasma. Clinical and, if necessary, ECG monitoring is necessary.

With clonidine, guanfacine, cholinesterase inhibitors (donepezil, galantamine, rivastigmine, tacrine, ambenonium chloride, pyridostigmine bromide, neostigmine bromide), pilocarpine

There is a risk of developing excessive bradycardia (cumulative effects).

With cimetidine, grapefruit juice

There is a slowdown in the metabolism of amiodarone and an increase in its plasma concentrations, and an increase in the pharmacodynamic and side effects of amiodarone is possible.

With drugs for inhalation anesthesia

The possibility of developing the following severe complications in patients receiving amiodarone during anesthesia has been reported: bradycardia (resistant to atropine administration), arterial hypotension, conduction disturbances, decreased cardiac output. Very rare cases of severe respiratory complications (adult acute respiratory distress syndrome), sometimes fatal, have been observed that developed immediately after surgery, the occurrence of which is associated with high oxygen concentrations.

With radioactive iodine

Amiodarone contains iodine and therefore can interfere with the absorption of radioactive iodine, which can distort the results of radioisotope studies of the thyroid gland.

With rifampicin

Rifampicin is a strong inducer of CYP3A4, therefore, when used together with amiodarone, a decrease in plasma concentrations of amiodarone and desethylamiodarone is possible.

With St. John's wort preparations

St. John's wort is a powerful CYP3A4 inducer. In this regard, it is theoretically possible to reduce the plasma concentration of amiodarone and reduce its effect (clinical data are not available).

With HIV protease inhibitors (including indinavir)

HIV protease inhibitors are CYP3A4 inhibitors, therefore, when used simultaneously with amiodarone, they can increase the concentration of amiodarone in the blood.

With clopidogrel

Clopidogrel, which is an inactive thienopyrimidine drug, is metabolized in the liver to form active metabolites. There is a possible interaction between clopidogrel and amiodarone, which may lead to a decrease in the effectiveness of clopidogrel.

With dextromethorphan

Dextromethorphan is a substrate of CYP2D6 and CYP3A4. Amiodarone inhibits CYP2D6 and may theoretically increase plasma concentrations of dextromethorphan.

Analogues of the drug Cordarone

Structural analogues of the active substance:

• Amiodarone;
• Amiocordin;
• Vero Amiodarone;
• Cardiodarone;
• Opacordan;
• Rhythmiodarone;
• Sedakoron.

Analogs by pharmacological group (antiarrhythmic drugs):

• Adenocor;
• Allapinin;
• Asparkam;
• Bretylate;
• Hypertonplant (Gnafalin);
• Dinexan;
• Difenin;
• Cardiodarone;
• Quinidin Durules;
• Lidocaine;
• Moracizine;
• Multaq;
• Neo Gilurithmal;
• Nibentan;
• Novocainamide;
• Pamaton;
• Panangin;
• Procainamide Eskom;
• Propanorm;
• Propafenone;
• Profenan;
• Ritalmex;
• Rhythmiodarone;
• Rhythmodan;
• Rhythmonorm;
• Sedakoron;
• Trimecaine;
• Ethacizin;
• Ethmozin.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

Catad_pgroup Antiarrhythmic drugs

Cordarone tablets - instructions for use

INSTRUCTIONS
According to the medical use of the drug

Registration number:

Trade name of the drug: Cordarone ® .

International nonproprietary name:

Dosage form:

Compound
One tablet contains:
active substance- amiodarone hydrochloride 200.0 mg;
Excipients: lactose monohydrate, corn starch, magnesium stearate, povidone K90F, colloidal anhydrous silicon dioxide.

Description
White to off-white round tablets with a break line on one side and a bevel on both sides. There is an engraving: a heart symbol above the fault line and 200 below the fault line and a bevel from the edges to the fault line.

Pharmacotherapeutic group:

ATX code: C01BD01.

Pharmacological properties
Pharmacodynamics
Amiodarone belongs to class III antiarrhythmic drugs (class of repolarization inhibitors) and has a unique mechanism of antiarrhythmic action, since in addition to the properties of class III antiarrhythmics (potassium channel blockade), it has the effects of class I antiarrhythmics (sodium channel blockade), class IV antiarrhythmics (calcium channel blockade) ) and non-competitive beta-blocking action.
In addition to the antiarrhythmic effect, it has antianginal, coronary dilation, alpha and beta adrenergic blocking effects.
Antiarrhythmic properties:

Cordarone is a drug that experts classify as an antiarrhythmic drug. The active compound in its composition is amiodarone hydrochloride. The medication is available in the form of tablets and a solution for intravenous injection. This drug is prescribed for the treatment of heart rhythm disorders, as well as for the elimination of angina pectoris, tachycardia and attacks of these diseases. During therapy with Cordarone provides a strong coronary and adrenaline blocking effect.

Cordarone: composition and release form

The remedy is offered in the form of tablets and solution. One tablet contains amiodarone hydrochloride in an amount of 200 mg as the active substance. Additional substances are the following components:

• povidone;
• starch;
• silica;
• lactose monohydrate;
• Magnesium stearate.

Cordarone in the form of a solution contains 50 mg in 1 ml active substance. Additional components are:

• polysorbate;
• benzyl alcohol.

Reviews about the drug contain information about the main indications for the use of this medicine. You can find out about them when reading the instructions to Cordarone 200. The main indications for use are the following cases:

The drug Cordarone 200 is also prescribed as a prevention of relapses:

• atrial fibrillation and atrial flutter;
• ventricular arrhythmia and ventricular fibrillation. These conditions can be life-threatening for the affected person.

Application and dosage

Reading the instructions for this drug helps each patient learn how to take this drug correctly. It states that the drug Cordarone 200 in tablet form is taken orally before meals. The medicine should be taken with a small amount of water. Note that the dosage of the drug is determined by the attending physician, who is guided by clinical indications and also takes into account the patient’s condition.

When choosing loading "saturating" dose Various saturation schemes can be used.

For inpatient treatment, the initial dose of Cordarone 200 is 600-800 mg per day. The maximum dose of the drug should not exceed 1200 mg. Treatment is carried out until the total dose of the drug is reached in the amount of 10 g. Treatment according to this scheme usually lasts for 5-8 days.

During therapy on an outpatient basis starting dose varies from 600 to 800 mg. Therapy is carried out until a total dose of 10 g is reached. The duration of treatment does not exceed 14 days.

Maintenance dose depending depending on the patient's condition may vary from 100 to 400 mg per day. It is necessary to use the minimum effective dose, focusing on the individual therapeutic effect. It is necessary to adhere to this recommendation because the drug Cordarone has a very large T1/2. It should be taken every other day or take breaks from taking it 2 days a week.

Cordarone: contraindications

Reviews from former patients about treatment This drug contains information about contraindications to the use of Cordarone 200. The main ones include the following:

The instructions for the drug Cordarone 200 indicate the presence of side effects. The patient may encounter them when taking this medicine. To the number most common side effects conditions that occur during treatment with Cordarone include the following conditions:

Price

Cordarone tablets are a fairly common drug, so going to any pharmacy you can purchase this product. Cordaron 200 is offered at a price of 300 rubles. It is not necessary to purchase the product at a regular pharmacy. If you want to buy medicine at a low price, you can order it online.

Analogs

Often when treating heart diseases, patients we have to use analogues. The need to purchase and use them is due to the fact that some patients, when they come to the pharmacy to buy this medicine, do not find the necessary medicine on the windows. And sometimes there are contraindications does not allow treatment original medicine. The group of analogues of this drug, which are most often prescribed by doctors, usually include the following drugs:

• Amiocordin;
• Aritmil;
• Rotaritmil;
• Cardiodarone.

Reviews

Previously, I didn’t pay much attention to the pain that arose in my heart area. However, at a certain point I had to think about the health of this organ. When faced with heart disease for the first time, I did not know what medications to take to eliminate the discomfort that arose. Therefore, I had to seek qualified medical help. But the drugs that the specialists prescribed did not help me.

Arriving at an appointment with a new specialist, after an examination, he prescribed me Cordarone 200. By that time, I already had a sad experience of using ineffective drugs, so I started taking the new drug with one blaster, which contained 10 tablets. The doctor prescribed me this medicine in a dosage of two tablets per day. He also instructed to take 3 tablets per day if the heart rate exceeds 90 beats per minute.

This medicine was prescribed after a diagnosis of cardiac arrhythmia, rapid heartbeat and high shallow breathing. All these symptoms were accompanied by severe pain in the chest area. I took the drug Cordarone 200 together with Panangin.

Within a couple of hours after taking it I felt relief. I didn’t even believe that the drug worked so quickly. I tried to sit quietly so that the pain that had left my chest would not return. On the third day of treatment, I forgot about the discomfort and felt only lightness.

Of course, I understand that taking Cordarone 200 is part of the treatment and you cannot prescribe other drugs yourself. You should trust the doctor and take the remedies prescribed by him, as well as follow all the instructions he gives. About the drug Cordarone, I want to say that although it is an effective remedy, you cannot take these tablets for a long time, otherwise it can lead to certain health problems.

Elena Sergeevna

Several years ago, my mother was faced with a problem such as severe arrhythmia. At a doctor's appointment, he prescribed her the drug Cordarone. She has been taking these pills for a long time and they help her well when she has discomfort in the heart area. Although Cordarone tablets look inconspicuous in appearance, they provide a strong effect. As needed, when my mother has heart pain, she takes this drug in small doses.

She began the course of therapy by taking half a tablet. When such a small dose did not help her, she drank the other half. In reviews, many patients write that to eliminate unpleasant symptoms in the heart area, it is enough to take 0.5 tablets of Cordarone. However, sometimes my mother would have such pain that she had to take the whole pill. She likes the strong effect of this drug, which eliminates pain in the heart area.

After taking it, within the first hours, the pulse is restored, and attacks of arrhythmia are stopped. When my mother's blood pressure rises, she takes a drug that lowers blood pressure. Although Cordarone 200 is an effective remedy for arrhythmia, it must be taken with extreme caution. If you exceed the dosage, you may experience unpleasant symptoms. And then you will have to call an ambulance.

Valentina Mikhailovna

I didn’t go to the doctors for a long time, because until a certain point I didn’t have any health problems. However, a few months ago I encountered a problem such as arrhythmia. Severe pain in the heart area forced me to visit a cardiologist. The specialist ordered an examination and, based on its results, reported that I had paroxysmal tachycardia.

To treat this disease, he prescribed me the drug Etatsizin. While taking it, this medicine did not relieve the attacks that occurred. I used a variety of methods to reduce pain: I pressed on my eyeballs, held my breath, and even tried to breathe more slowly to reduce my pulse. Often I had to call an ambulance at home. Specialists administered drugs intravenously, but they did not provide the desired effect.

I also took other antiarrhythmic medications. However, they did not bring serious relief. Moreover, often there was no reason for the occurrence of attacks. Sometimes my arrhythmia attacks lasted 6 hours. It really exhausted me.

Having visited another specialist, after an examination he reported that my blood pressure was very low, 100/70. This is how he explained the fact that the drugs that were prescribed to me earlier did not stop the attacks of arrhythmia.

So that I could cope with my problem, he prescribed me the drug Cordarone, which is produced by a French company. I didn't even hope for relief. However, after taking one tablet, I was surprised to find that the attack stopped. I felt completely different. I found a remedy that helps relieve pain.

About Cordarone, I want to say that this medicine has a strong effect. Of course, there are some contraindications. One of them is that this remedy should not be taken if you have serious thyroid disease. Treatment with Cordarone should not be carried out without permission either. First you need to see a doctor. Having received a prescription for this drug, you must take it in accordance with the dosage. In this case, you will be able to cope with arrhythmia.

Conclusion

Arrhythmia and tachycardia are serious diseases that many people face in adulthood. If you feel unpleasant sensations in the heart area that occur with enviable consistency, then in this case you should immediately consult a doctor. Cardiologists often prescribe a drug such as Cordarone to patients when diagnosing tachycardia and arrhythmia. This product, which is produced by a French company, is quite effective. Taking it in accordance with the dosage prescribed by the doctor allows you to stop attacks of arrhythmia and eliminate the symptoms of tachycardia.

This medicine is used for treatment in both outpatient and inpatient settings. Before starting therapy, contraindications should be clarified. This drug should not be used during pregnancy or lactation. In addition, Cordarone is not prescribed to patients under 18 years of age. Such information can be found in the instructions for use, as well as in reviews. There are quite a lot of them on the Internet. Many people who have recovered from arrhythmia indicate in their reviews how they were able to overcome the disease. From the reviews about this drug you can learn a lot of other information that is valuable for the patient.

The responses contain information about the correct use of the medicine, contraindications, side effects, as well as the cost of the medicine and its analogues. In terms of price, this product is inexpensive. Reviews confirm this. If the drug is not available in the pharmacy, then you can purchase and treat with analogues. A list of drugs that can act as drug substitutes is present in many reviews.

Note that the analogue of Cordarone 200 can only be prescribed by the attending physician. He also determines a treatment regimen that will ensure high effectiveness of therapy. To quickly get rid of the disease, you should, when the first signs of cardiac dysfunction appear, consult a doctor to make an accurate diagnosis and prescribe adequate treatment. By following all the recommendations of the cardiologist, you can quickly get rid of the disease and return to your normal life.

Cordarone harm and benefit

Cordaron

Cordarone is an antiarrhythmic drug that can be used to eliminate any arrhythmias. Cordarone is used both as an emergency treatment for life-threatening arrhythmias and as ongoing maintenance treatment.

My review will be devoted to Cordarone, a drug for the treatment of arrhythmias. This is a drug for long-term treatment, and for “first aid”, and for prevention... In any case, this is really a very, very strong medicine. Therefore, I’ll probably break the “traditions” of pharmacological reviews a little by talking about Cordarone. But I hope that this is forgivable, if only because I will describe here an important drug, and, moreover, an interesting drug!

Cordarone is a unique remedy of its kind. Due to the fact that it combines the properties of antiarrhythmics of all classes (that is, it has a multifaceted and complex effect), it can be used to treat absolutely any type of arrhythmias. As a rule, if other medications do not work, Cordarone will definitely help.

In addition, Cordarone dilates coronary vessels and reduces blood pressure. These are not its main effects (the main one is antiarrhythmic), but they are also quite pronounced.

At its core, Cordarone is an “analogue” of thyroid hormones. It blocks the activation of thyroxine, and this effect is often a problem with long-term treatment. In most cases, Cordarone is not prescribed as a drug for continuous use, so its benefits, even against the background of this feature, outweigh the harm from it.

It turned out a little differently for me: I took a variety of antiarrhythmics, but the effect of the treatment was still not satisfactory. For almost two years I consistently drank half a tablet of Etatsizin a day, and felt quite good. When even Etatsizin stopped working, my doctor had to prescribe me Cordarone (daily!), since it was guaranteed to eliminate the arrhythmia.

After 8 months of taking it, I began to experience all the symptoms of hypothyroidism: my weight began to steadily increase, terrible weakness and constant drowsiness appeared. It became difficult for me to do any business - I immediately felt tired. TSH in tests increased several times (last time it was almost 16.5, instead of 3-4!). All this was also aggravated by the fact that about ten years ago I had a lobe of my thyroid gland removed.

In addition to hypothyroidism, I experienced other side effects:

• blurred vision;
• bradycardia;
• sleep disturbance;
• change in skin color - it has become bluish;
• tremor;
• photosensitivity - being in the sun can sometimes be downright painful.

My doctor warned me about these consequences. In addition, he mentioned other common adverse reactions to taking Cordarone:

• nausea and vomiting;
• change in taste sensations;
• decreased appetite;
• heaviness and pain in the abdomen;
• the occurrence of acute hepatitis;
• pneumonia, pulmonary fibrosis.

Separately, it is worth mentioning how Cordarone is combined with other drugs. Surely, a whole book could be written about this, but, fortunately, I don’t have much experience in this. I had to stop taking Nebivolol, because taking these drugs together, the pulse constantly dropped to 50-55/minute, which is not enough for me. Now I don’t take anything at all to treat arterial hypertension; Cordarone lowers my blood pressure to normal levels.

Another drug is Plavix. I do not have a diagnosis of coronary heart disease (and even atherosclerosis, supposedly), but my blood is “thick”, and Plavix was needed as a preventive measure. I didn’t stop taking it, but I had to reduce the dose: in combination with Cordarone, all the side effects of Plavix and similar drugs appear much more often.

An interesting property of Cordarone: the indications for the use of tablets and injections are different.

Tablet forms are indicated for the treatment of any types of arrhythmias and their prevention:

• atrial fibrillation and flutter;
• sudden “arrhythmic death”;
• paroxysmal tachycardias;
• atrial fibrillation.

Injections (droppers) with Cordarone are used as an “ambulance” if cardiac resuscitation is necessary, for example, to eliminate ventricular fibrillation (this condition can lead to death in 40-50 seconds!).

There are no contraindications for drugs such as Cordarone. If a medicine is used “for life-saving indications”, that is, in the absence of treatment the patient may die, only the relationship between the benefits and harms of the drug is considered.

Nevertheless, here are the conditions in which Cordarone is prescribed especially carefully:

• thyroid disease is the most important condition;
• sick sinus syndrome;
• inadequate response of the body to iodine;
• severe forms of intracardiac blockade;
• deficiency of potassium and magnesium;
• pregnancy.

As I already indicated, these are NOT contraindications. Cordarone can be used in these conditions, but only if it is a matter of preserving the patient’s life.

This is the review of Cordaron that I wanted to present to you. Many people encounter this drug, and most of the information about it is difficult to understand. I analyzed everything that my attending physician told me: this resulted in this review.

Thank you for your attention, and may arrhythmias bypass you. Do not be ill!

otzivilekarstv.ru

CORDARON

DOSAGE FORM, COMPOSITION AND PACKAGING

Tablets are round, divisible, white or off-white in color, engraved with a symbol in the form of a center and the number “200” on one side; tablets can be easily separated along the break line under normal conditions of use.

1 tab. amiodarone hydrochloride 200 mg

Excipients: lactose monohydrate, corn starch, polyvidone K90F, colloidal anhydrous silicon dioxide, magnesium stearate.

10 pieces. - blisters (3) - cardboard packs.

PHARMACHOLOGIC EFFECT

Class III antiarrhythmic drug. Has antiarrhythmic and antianginal effects.

The antiarrhythmic effect is due to an increase in phase 3 of the action potential, mainly due to a decrease in potassium current through the channels of the cell membranes of cardiomyocytes and a decrease in the automaticity of the sinus node. The drug non-competitively blocks α- and β-adrenergic receptors. Slows down sinoatrial, atrial and nodal conduction without affecting intraventricular conduction. Cordarone increases the refractory period and reduces myocardial excitability. Slows down the conduction of excitation and lengthens the refractory period of additional atrioventricular pathways.

The antianginal effect of Cordarone is due to a decrease in oxygen consumption by the myocardium (due to a decrease in heart rate and a decrease in peripheral resistance), non-competitive blockade of α- and β-adrenergic receptors, an increase in coronary blood flow through a direct effect on the smooth muscles of the arteries, maintaining cardiac output by reducing pressure in the aorta and reducing peripheral resistance .

Cordarone does not have a significant negative inotropic effect and reduces myocardial contractility mainly after intravenous administration.

It affects the exchange of thyroid hormones, inhibits the conversion of T3 to T4 (blockade of thyroxine-5-deiodinase) and blocks the uptake of these hormones by cardiocytes and hepatocytes, which leads to a weakening of the stimulating effect of thyroid hormones on the myocardium. Determined in blood plasma for 9 months after stopping its use.

Therapeutic effects are observed 1 week (from several days to 2 weeks) after starting to take the drug orally.

With intravenous administration of Cordarone, its activity reaches a maximum after 15 minutes and disappears approximately 4 hours after administration. Despite the fact that the amount of administered Cordarone in the blood quickly decreases, tissue saturation with the drug is achieved. In the absence of repeated injections, the drug is gradually eliminated. When its administration is resumed or when the drug is prescribed for oral administration, its tissue reserve is formed.

PHARMACOKINETICS

Suction

After oral administration, amiodarone is absorbed slowly (absorption is 30-50%), the rate of absorption is subject to significant fluctuations. Bioavailability after oral administration ranges from 30 to 80% in different patients (on average about 50%). After a single dose of the drug orally, Cmax in blood plasma is achieved within 3-7 hours.

Distribution

Amiodarone has a large Vd. Amiodarone accumulates most in adipose tissue, liver, lungs, spleen and cornea. After a few days, amiodarone is eliminated from the body. Css is achieved within 1 to several months, depending on the individual characteristics of the patient. Binding to blood plasma proteins is 95% (62% to albumin, 33.5% to beta-lipoproteins).

Metabolism

Metabolized in the liver. The main metabolite, desethylamiodarone, is pharmacologically active and can enhance the antiarrhythmic effect of the main compound. Each dose of Cordarone (200 mg) contains 75 mg of iodine; 6 mg of this was determined to be released as free iodine. With prolonged treatment, its concentrations can reach 60-80% of amiodarone concentrations.

Removal

Elimination when taken orally occurs in 2 phases: T1/2 in the α-phase - 4-21 hours, T1/2 in the β-phase - 25-110 days. After prolonged oral administration, the average T1/2 is 40 days (this is important when choosing a dose, since at least 1 month is required to stabilize the plasma concentration, and complete elimination can last more than 4 months).

After discontinuation of the drug, its complete elimination from the body continues for several months. The presence of pharmacodynamic effects of Cordarone should be taken into account for 10 days and up to 1 month after its discontinuation. Amiodarone is excreted in bile and feces. Renal excretion is negligible.

Pharmacokinetics in special clinical situations

Insignificant excretion of the drug in the urine allows the drug to be prescribed in moderate doses for renal failure. Amiodarone and its metabolites are not dialyzable.

INDICATIONS

Relief of attacks of ventricular paroxysmal tachycardia;

Relief of attacks of supraventricular paroxysmal tachycardia with a high frequency of ventricular contractions (especially against the background of WPW syndrome);

Relief of paroxysmal and persistent forms of atrial fibrillation (atrial fibrillation) and atrial flutter.

Relapse Prevention

Life-threatening ventricular arrhythmias and ventricular fibrillation (treatment should be started in a hospital with careful cardiac monitoring);

Supraventricular paroxysmal tachycardias, incl. documented attacks of recurrent sustained supraventricular paroxysmal tachycardia in patients with organic heart diseases; documented attacks of recurrent sustained supraventricular paroxysmal tachycardia in patients without organic heart disease, when antiarrhythmic drugs of other classes are not effective or there are contraindications to their use; documented attacks of recurrent sustained supraventricular paroxysmal tachycardia in patients with WPW syndrome;

Atrial fibrillation (atrial fibrillation) and atrial flutter.

Prevention of sudden arrhythmic death in high-risk patients after a recent myocardial infarction, with more than 10 ventricular extrasystoles per hour, clinical manifestations of chronic heart failure and reduced left ventricular ejection fraction (Cordarone is especially recommended for patients with organic heart disease (including . with ischemic heart disease), accompanied by left ventricular dysfunction.

Cordarone for intravenous administration is intended only for use in a hospital in cases where rapid achievement of an antiarrhythmic effect is required or when it is impossible to take the drug orally.

DOSING REGIME

For oral administration

When prescribing the drug in a loading dose, various schemes can be used. When used in a hospital, the initial dose, divided into several doses, ranges from 600-800 mg/day to a maximum of 1200 mg/day (usually for 5-8 days).

For outpatient use, the initial dose, divided into several doses, ranges from 600 mg to 800 mg / day (usually for 10-14 days).

The maintenance dose is determined at the rate of 3 mg/kg body weight per day and can range from 100 mg/day to 400 mg/day when taken once a day. The minimum effective dose should be used. Because Amiodarone has a very long half-life, the drug can be taken every second day (200 mg can be given every second day, and 100 mg is recommended to be taken daily) or taken in breaks (2 days a week).

For solution for intravenous administration

The loading dose of Cordarone is initially 5-7 mg/kg body weight in 250 ml of a 5% dextrose (glucose) solution for 30-60 minutes. The therapeutic effect of Cordarone appears during the first minutes of administration and disappears gradually, which requires adjustment of the rate of its administration in accordance with the results of treatment.

For maintenance therapy, the drug is prescribed as a continuous or intermittent (2-3 times/day) intravenous infusion in a 5% dextrose (glucose) solution for several days at a dose of up to 1200 mg/day. After IV administration in a loading dose, instead of continuing the IV infusion, it is possible to switch to taking Cordarone orally at a dose of 600-800 mg to 1200 mg/day. From the first day of intravenous administration of Cordarone, it is advisable to begin a gradual transition to taking the drug orally.

When performing intravenous injections, the drug at a dose of 5 mg/kg is administered over at least 3 minutes. Cordarone cannot be taken into the same syringe with other medications!

For intravenous infusion, concentrations below 600 mg/l should not be used. To prepare solutions for intravenous administration, use only a 5% dextrose (glucose) solution.

SIDE EFFECT

Solution for intravenous administration

Systemic reactions: feeling of heat, increased sweating, decreased blood pressure (usually moderate and transient); cases of severe arterial hypotension or collapse (have been reported with overdose or too rapid administration), moderate bradycardia (in some cases, especially in elderly patients, severe bradycardia and, in exceptional cases, sinus node arrest, requiring discontinuation of therapy); rarely - proarrhythmic effect. At the beginning of therapy, there is an increase in the activity of hepatic transaminases in the blood serum, which usually remains moderate (1.5-3 times higher than the upper limit of normal (ULN)) and, as a rule, normalizes when the dose is reduced or even spontaneously. If transaminase levels increase significantly, treatment should be discontinued. There are isolated case reports of acute liver failure with high serum levels of liver transaminases and/or jaundice (some with fatal outcome). In isolated (exceptionally rare) cases, anaphylactic shock, benign intracranial hypertension (pseudotumor of the brain), bronchospasm and/or apnea were observed in patients with severe respiratory failure, especially in patients with bronchial asthma. Several cases of acute respiratory distress, mostly associated with interstitial pneumonitis, have been observed.

Local reactions: phlebitis (can be avoided by using a central venous catheter).

For oral administration

From the cardiovascular system: bradycardia (mostly moderate and dose-dependent); in some cases (with sinus node dysfunction, in the elderly) - severe bradycardia; in exceptional cases - sinus block; rarely - conduction disorders (sinoatrial block, AV block of various degrees, intraventricular block); in some cases - the emergence of new arrhythmias or aggravation of existing ones, in some cases - with subsequent cardiac arrest (according to available data, it is impossible to establish a connection with the use of the drug, with the severity of heart damage or with the ineffectiveness of treatment). These effects are observed mainly in cases of combined use of Cordarone with drugs that prolong the period of repolarization of the ventricles of the heart (QTc interval) or in case of electrolyte imbalance.

On the part of the organ of vision: microdeposits of lipofuscin in the cornea of ​​the eye (almost always present) are usually limited to the pupil area, are reversible after discontinuation of the drug, sometimes lead to visual impairment in the form of the appearance of a colored halo in bright light or a feeling of fog; in some cases - neuropathy/optic neuritis (the connection with amiodarone has not been clearly established to date).

Dermatological reactions: photosensitivity; erythema (during radiotherapy); in some cases - rash (usually nonspecific), exfoliative dermatitis (the connection with taking the drug has not been formally established); with prolonged use in high doses - grayish or bluish pigmentation of the skin (slowly disappears after stopping treatment).

From the endocrine system: an increase in the level of T3 in the blood serum (T4 remains normal or slightly reduced) in such cases, in the absence of clinical signs of thyroid dysfunction, discontinuation of the drug is not required); possible development of hypothyroidism (mild weight gain, decreased activity, more pronounced (compared to expected) bradycardia); hyperthyroidism (both during therapy and for several months after stopping the drug). Suspicion of hyperthyroidism may arise from the following mild clinical symptoms: weight loss, development of arrhythmia, angina pectoris, heart failure. The diagnosis is confirmed by a clear decrease in serum TSH. Amiodarone should be discontinued.

From the digestive system: nausea, vomiting, taste disturbances (usually found at the beginning of therapy when used in loading doses and decrease when the dose is reduced); at the beginning of treatment - an isolated increase (1.5-3 times higher than ULN) in the activity of liver transaminases (they decrease with a decrease in the dose of the drug or even spontaneously); in some cases - acute liver dysfunction and/or jaundice (require discontinuation of the drug), fatty hepatosis, cirrhosis. Clinical symptoms and laboratory changes may be minimal (hepatomegaly is possible, increased activity of liver transaminases is increased to 1.5-5 times compared to ULN); Therefore, regular monitoring of liver function is recommended during treatment.

From the respiratory system: in some cases - pneumonitis, fibrosis, pleurisy, bronchiolitis obliterans with pneumonia (sometimes resulting in death), bronchospasm in patients with severe respiratory diseases (especially bronchial asthma), acute respiratory distress syndrome in adults.

From the central nervous system and peripheral nervous system: rarely - sensorimotor peripheral neuropathies and/or myopathies (usually reversible after discontinuation of the drug), extrapyramidal tremor, cerebellar ataxia; in rare cases - benign intracranial hypertension, nightmares.

Allergic reactions: rarely - vasculitis, kidney damage with increased creatinine levels, thrombocytopenia; in some cases - hemolytic anemia, aplastic anemia.

Other: alopecia; in some cases - epididymitis, impotence (no connection with the use of the drug has been established).

CONTRAINDICATIONS

For oral administration

SSS (sinus bradycardia, sinoatrial block) except in cases of correction with an artificial pacemaker;

AV and intraventricular conduction disorders (2nd and 3rd degree AV block, bundle branch block) in the absence of an artificial pacemaker (pacemaker);

Thyroid dysfunction (hypothyroidism, hyperthyroidism);

Hypokalemia;

Heart failure (in the stage of decompensation);

Concomitant use of MAO inhibitors;

Interstitial lung diseases;

Pregnancy;

Lactation;

For solution for intravenous administration

SSS (sinus bradycardia, sinoatrial block) with the exception of patients with an artificial pacemaker (danger of sinus node arrest);

AV blockade of II and III degrees, intraventricular conduction disorders (blockade of two and three branches of the His bundle); in these cases, IV amiodarone can be used in specialized departments under the cover of an artificial pacemaker (pacemaker);

Acute cardiovascular failure (shock, collapse);

Severe arterial hypotension;

Simultaneous use with drugs that can cause polymorphic ventricular tachycardia of the “pirouette” type;

Thyroid dysfunction (hypothyroidism, hyperthyroidism);

Pregnancy;

Lactation;

Age up to 18 years (efficacy and safety have not been established);

Hypersensitivity to iodine and/or amiodarone.

IV administration is contraindicated in severe pulmonary dysfunction (interstitial lung disease), cardiomyopathy or decompensated heart failure (possible deterioration of the patient's condition).

Use with caution in chronic heart failure, liver failure, bronchial asthma, and in old age (due to the high risk of developing severe bradycardia).

PREGNANCY AND LACTATION

During pregnancy, Cordarone is prescribed only for health reasons, because the drug has an effect on the fetal thyroid gland.

Amiodarone is excreted in breast milk in significant quantities, so the drug is contraindicated for use during lactation.

SPECIAL INSTRUCTIONS

Before starting and during treatment, it is recommended to conduct an ECG study. Due to the prolongation of the period of repolarization of the ventricles of the heart, the pharmacological action of Cordarone causes certain changes in the ECG: prolongation of the QT interval, QTc, the appearance of U waves is possible. An increase in the QTc interval is permissible by no more than 450 ms or by no more than 25% of the original value. These changes are not a manifestation of the toxic effect of the drug, but require monitoring to adjust the dose and assess the possible proarrhythmogenic effect of Cordarone.

It should be taken into account that in elderly patients there is a more pronounced decrease in heart rate.

If second or third degree AV block, sinoatrial or bifascicular block develops, treatment with Cordarone should be discontinued.

The appearance of shortness of breath or nonproductive cough may be associated with the toxic effect of Cordarone on the lungs. In patients with increasing shortness of breath during exercise, regardless of the deterioration of their general condition (increased fatigue, weight loss, increased body temperature), a chest x-ray should be performed before starting therapy. Respiratory problems are mostly reversible with early discontinuation of amiodarone. Clinical symptoms usually resolve within 3-4 weeks, followed by a slower recovery of radiographic appearance and pulmonary function (several months). Therefore, the possibility of re-evaluating amiodarone therapy and prescribing corticosteroids should be considered.

If blurred vision or decreased visual acuity occurs while taking Cordarone, it is recommended to conduct a full ophthalmological examination, including fundoscopy. Cases of optic neuropathy and/or optic neuritis require a decision on the advisability of using Cordarone.

Cordarone contains iodine (200 mg contains 75 mg of iodine), so it may affect the results of tests for the accumulation of radioactive iodine in the thyroid gland, but does not affect the reliability of the determination of T3, T4 and TSH. Amiodarone may cause thyroid dysfunction, especially in patients with a history of thyroid dysfunction (including a family history). Therefore, before starting treatment, during treatment and several months after the end of treatment, careful clinical and laboratory monitoring should be carried out. If thyroid dysfunction is suspected, serum TSH levels should be measured. When signs of hypothyroidism appear, normalization of thyroid function is usually observed within 1-3 months after cessation of treatment. In life-threatening situations, treatment with amiodarone can be continued, with simultaneous additional administration of levothyroxine. Serum TSH levels serve as a guide for levothyroxine dosage. If signs of hyperthyroidism appear, amiodarone should be discontinued. Normalization of thyroid function usually occurs within several months after discontinuation of the drug. In this case, clinical symptoms normalize before normalization of the level of hormones that reflect the function of the thyroid gland occurs. In severe cases, immediate medical intervention is required. Treatment in each individual case is selected individually and includes antithyroid drugs (which may not always be effective), corticosteroids, and beta-blockers.

Cordarone for intravenous administration is used only in a specialized hospital department under constant monitoring of ECG and blood pressure. In this case, Cordarone should be administered by infusion rather than by injection due to the risk of hemodynamic disturbances (hypotension, acute cardiovascular failure).

IV injections of Cordarone should be performed only in emergency situations, when there are no other therapeutic options, and only in cardiac intensive care units with continuous ECG monitoring.

When administering Cordarone by injection, a dose of approximately 5 mg/kg should be administered over at least 3 minutes. The injection should not be repeated earlier than 15 minutes after the first injection, even if the last one consisted of only one ampoule (irreversible collapse is possible).

Particular caution is required when infusing the drug in cases of arterial hypotension, severe respiratory failure, decompensated cardiomyopathy or severe heart failure.

Patients should avoid prolonged exposure to the sun and UV radiation (or use sunscreen).

Impact on the ability to drive vehicles and operate machinery

Currently, there is no evidence that Cordarone affects the ability to drive vehicles and operate machinery.

OVERDOSE

Symptoms: sinus bradycardia, cardiac arrest, ventricular tachycardia, paroxysmal ventricular tachyarrhythmias of the “pirouette” type, circulatory disorders, liver dysfunction, decreased blood pressure.

Treatment: symptomatic therapy is carried out (gastric lavage, administration of cholestyramine, for bradycardia - beta-adrenergic stimulants or installation of a pacemaker, for tachycardia of the “pirouette” type - intravenous administration of magnesium salts, reducing pacemaker). Amiodarone and its metabolites are not removed by dialysis.

There is no information about overdose with intravenous administration of Cordarone.

DRUG INTERACTIONS

When taking Cordarone simultaneously with antiarrhythmic drugs (including bepridil, class I A drugs, sotalol), as well as with vincamine, sultopride, erythromycin for intravenous administration, pentamidine for parenteral administration, the risk of developing polymorphic paroxysmal ventricular tachycardia of the “pirouette” type increases. Therefore, these combinations are contraindicated.

Combination therapy with beta-blockers and some calcium channel blockers (verapamil, diltiazem) is not recommended, because Automaticity disorders (manifested by bradycardia) and conduction may develop.

It is not recommended to use Cordarone simultaneously with laxatives (stimulating intestinal motility), which can cause hypokalemia, because the risk of developing ventricular tachycardia of the “pirouette” type increases.

Cordarone should be used with caution simultaneously with drugs that cause hypokalemia (diuretics, systemic corticosteroids and mineralocorticoids, tetracosactide, amphotericin B /for intravenous administration/), because the development of ventricular tachycardia of the “pirouette” type is possible.

When Cordarone is used simultaneously with anticoagulants for oral administration, the risk of bleeding increases (therefore, it is necessary to monitor the level of prothrombin and adjust the dose of anticoagulants).

With the simultaneous use of Cordarone with cardiac glycosides, disturbances in automaticity (manifested by severe bradycardia) and disturbances in atrioventricular conduction may be observed. In addition, it is possible to increase the concentration of digoxin in the blood plasma due to a decrease in its clearance (therefore, it is necessary to monitor the concentration of digoxin in the blood plasma, conduct an ECG and laboratory monitoring, and, if necessary, change the dosage regimen of cardiac glycosides).

With the simultaneous use of Cordarone with phenytoin, cyclosporine, flecainide, it is possible to increase the concentration of the latter in the blood plasma (therefore, the concentration of phenytoin, cyclosporine, flecainide in the blood plasma should be monitored and their dose adjusted if necessary).

Cases of bradycardia (resistant to atropine), arterial hypotension, conduction disturbances, and decreased cardiac output have been described in patients taking Cordarone and undergoing general anesthesia.

When using oxygen therapy in the postoperative period in patients receiving Cordarone, rare cases of severe respiratory complications, sometimes resulting in death (acute adult respiratory distress syndrome), have been described.

When used together with simvastatin, the risk of side effects (primarily rhabdomyolysis) may increase due to disruption of the metabolism of simvastatin (if it is necessary to use such a combination, the dose of simvastatin should not exceed 20 mg/day; if the therapeutic effect is not achieved at this dose, you should switch to another lipid-lowering drug).

CONDITIONS OF DISCHARGE FROM PHARMACIES The drug is dispensed with a prescription. The drug in the form of a solution for intravenous administration is intended for use only in a hospital setting.

CONDITIONS AND DURATION OF STORAGE

The drug in tablet form should be stored at room temperature (not higher than 30°C). The shelf life of the tablets is 3 years. The drug in the form of a solution for intravenous administration should be stored in a dry place at a temperature not exceeding 25°C. The shelf life of the solution for intravenous administration is 2 years.

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Cordarone - use and contraindications

The drug Cordarone, with all its indications and contraindications for use, belongs to the group of third class antiarrhythmic drugs. That is, its action is based on the blockade of potassium channels. The medicine also has the properties of antiarrhythmics of the first and fourth classes. And accordingly, it can simultaneously block sodium and calcium channels. Among other things, the drug has beta-adrenergic blocking, antianginal and coronary dilatatory effects.

Indications for use of Cordarone tablets

The drug is based on amiodarone hydrochloride. The standard dosage of the active substance is 200 mg. In addition to this, the drug contains the following auxiliary components:

• anhydrous colloidal silica;
• lactose monohydrate;
• magnesium stearate;
• corn starch;
• povidone.

The drug Cordarone is indicated for use both for treatment and for preventive purposes. It is usually prescribed for:

• supraventricular paroxysmal tachycardias;
• ventricular arrhythmias;
• Wolff-Parkinson-White syndrome;
• supraventricular and ventricular extrasystole;
• atrial flutter;
• sinus tachycardia;
• recovery after myocardial infarction;
• acute phase of myocardial infarction;
• atrial fibrillation;
• ventricular dysfunction;
• coronary heart disease;
• attacks of angina.

How exactly to use Cordarone tablets is determined by your attending physician. Different regimens can be used in therapy. For example, in a hospital setting, the optimal initial dose is 600-800 mg of amiodarone hydrochloride, divided into several doses. The maximum permissible total daily dose is 10 g. And such treatment lasts from five to eight days.

The outpatient treatment regimen is similar, but it should last a little longer - from ten days to two weeks. It is important to remember that the half-life of Cordarone is rather long, so it is recommended to use it every other day. You can also take tablets with short breaks - up to a couple of days.

Contraindications to the use of Cordarone

Almost any medication has contraindications. And Cordaron was no exception. It is not recommended to be treated with this antiarrhythmic if:

• hypersensitivity to the components of the composition;
• prolongation of the QT interval (both congenital and acquired);
• sinus bradycardia;
• sinoatrial block;
• pregnancy;
• breastfeeding;
• interstitial lung disease;
• hypokalemia;
• hypomagnesemia;
• thyroid dysfunction (such as hyper- or hypothyroidism);
• atrioventricular block from the first to the third degree.

Children under eighteen should not take the pills. Patients with:

• arterial hypotension;
• decompensated or severe chronic heart failure;
• cardiogenic shock;
• bronchial asthma;
• cardiomyopathy;
• liver failure.

Elderly patients whose bodies are weakened by age-related changes and are at risk should also take the medicine under the supervision of a specialist.

It is very undesirable to combine Cordarone with the following medications:

• Quinidine;
• Mefeloquine;
• Quinine;
• Pimozide;
• Fluphenazine;
• Spiramycin;
• Mizolastine;
• Sultopride;
• Terfenadine;
• Haloperidol;
• Bretylia;
• Sotalol;
• Spiramycin;
• Chlorpromazine;
• Cyamemazine.

Content

The life expectancy of patients with cardiac disorders can be significantly increased if they take the drug Cordarone. Two forms of the drug expand the list of indications, making it possible to resist fatal pathological conditions. Before proceeding to use the product, it is important to carefully read the instructions.

Composition and release form

The drug is available in two forms: tablets and solution for intravenous administration. The tablets are round in shape, double-sided, white in color, sometimes with a creamy tint. On one of the sides there is an engraving: under the dividing line there is the number 200, above the line there is a symbol in the form of a heart. They are packaged in 10 pieces in blisters, which are placed in cardboard packages. The solution is a light yellow transparent liquid in 3 ml ampoules. One box contains six ampoules. Composition of both forms of Cordarone:

Pharmacodynamics and pharmacokinetics

Instructions for use Cordarone indicates that it is a third class antiarrhythmic drug (repolarization inhibitors), which has a unique mechanism of action. In addition to the properties of a potassium channel blocker, it exhibits the effect of a class 1 antirhythmic agent (blocks sodium channels), class 4 (calcium channel blocker) and a non-competitive beta-blocker effect. The product is active:

1. antianginal;
2. coronary dilator;
3. alpha adrenergic blocking.

The antiarrhythmic effect of the drug is to increase the duration of the action potential phase of myocardiocytes by blocking the ion current in potassium channels. This leads to a decrease in the automaticity of the sinus node, heart rate, and non-competitive blockade of alpha and beta adrenergic receptors. Due to Cordarone, sinotrial, atrial, and atrioventricular blockade during tachycardia is slowed down. When the drug works, the refractory period of the atrioventricular node increases, conduction in additional bundles slows down.

When the drug acts, there are no changes in ventricular conductivity, refractory periods increase and the excitability of the myocardium of the atria and ventricles decreases. The drug does not exhibit a negative inotropic effect, increases coronary blood flow with a direct effect on the smooth muscles of the coronary arteries, and reduces oxygen consumption by the myocardium. Due to the action of the drug, cardiac output is maintained, pressure in the aorta is reduced, the exchange of thyroid hormones is influenced and their uptake by hepato- and cardiomyocytes is blocked.

After use, the effect of the drug develops within seven days; after discontinuation of treatment, amiodarone is detected in the blood for another 9 months. The pharmacodynamic properties of the active component appear for another 10–30 days from the date of discontinuation of the drug. Amiodarone has 30–80% bioavailability, reaches maximum concentration after 3–7 hours, binds to plasma proteins by 95%, and slowly enters tissues.

The drug accumulates in adipose tissue, liver, spleen, lungs, and cornea of ​​the eye. The active component is metabolized in the liver using isoenzymes to form the active metabolite desethylamiodarone. The remaining dose is excreted through the intestines; hemodialysis is ineffective for their removal. Hatching occurs in two phases: the first phase lasts 4–21 hours, the second – 25–110 days. The tablets contain iodine, which is released in the body and excreted by the intestines; iodide reaches 70% concentration in the blood.

Indications for use of Cordarone

Cordarone in tablet form is prescribed for both treatment and prevention of various pathological conditions. The main list includes:

1. Paroxysmal supraventricular tachycardia in patients, both with and without organic heart disease; in patients with Wolff-Parkinson-White syndrome.
2. Ventricular arrhythmias that are life-threatening for the patient, including ventricular fibrillation, as well as ventricular tachycardia;
3. Atrial flutter and atrial fibrillation;
4. Rhythm disturbances in patients due to ischemic disease or dysfunction of the left ventricle.
5. To prevent unexpected arrhythmic death in patients who have recently experienced myocardial infarction and have chronic signs of heart failure or low ejection fraction (less than 40%) on the left ventricle.

The use of Cordarone in the form of a solution is prescribed in a number of cases. The list of instructions is represented by the following states:

• to stop attacks of ventricular paroxysmal tachycardia;
• paroxysmal and stable varieties of atrial fibrillation;
• atrial flutter, high blood pressure;
• supraventricular paroxysmal tachycardia with a significant level of ventricular beat frequency;
• cardiac resuscitation in case of cardiac arrest with simultaneous ventricular fibrillation resistant to defibrillation.

How to take Cordarone

Achieving a therapeutic effect depends largely on correct adherence to the drug regimen. The final regimen is approved by the doctor, who takes into account all aspects of the patient’s current condition and the degree of likelihood of the risk of side effects. The manufacturer's instructions provide rules for the use of Cordarone both in tablet form and in the form of injections.

In hospital treatment conditions, the total dosage should reach a volume of 10 g after 6–9 days of administration. To do this, take Cordarone 0.6–0.8 g (maximum 1.2) every day in several approaches. Outpatient treatment involves saturation to the level of 10 g for 10–14 days at a daily dose of 0.6-0.8 g. The maintenance dose must be effective and is determined on an individual basis. Average values ​​are 0.1–0.4 g per day. More often, 0.2 g is prescribed twice a day. Maximum daily values: 0.4 g at a time and 1.2 - total daily dose. Let's take it every other day.

Solution

Intravenous administration is used as an emergency measure to achieve an antiarrhythmic effect or if the patient is unable to take pills. With the exception of emergency cases, the solution is used only in intensive treatment (inpatient) mode with regular monitoring of cardiogram and blood pressure levels. The solution is injected intravenously at a rate of 5 mg per kg to stop acute arrhythmias. Patients diagnosed with chronic heart failure receive a dose of 2.5 mg per kg. The infusion procedure lasts 10–20 minutes.

special instructions

The medicine Cordarone has a number of special instructions for its use. The instructions describe the following:

1. Adverse reactions of the drug are dose-dependent, so treatment is carried out in minimally effective doses to minimize their occurrence.
2. During therapy, direct exposure to sunlight should be avoided. If this cannot be avoided, you should use sunscreen or wear covering clothing.
3. Before starting therapy with the drug, the patient’s heart condition is examined (an electrocardiogram is performed), and the level of potassium in the blood is determined. Hypokalemia is corrected before treatment. During therapy, an ECG is done every 3 months to determine the activity of liver transaminases.
4. Amiodarone can cause hypothyroidism or hyperthyroidism, therefore, in patients with thyroid diseases, before starting treatment, the level of hormones in the blood should be determined and oxygen therapy prescribed. During therapy, regular examination is required to identify signs of changes in the functioning of the thyroid gland.
5. Long-term use of the medicine may increase the frequency of ventricular defibrillation or the threshold for the activation of a pacemaker or implanted defibrillator.
6. Every six months of treatment with Cordarone, an X-ray examination of the lungs is performed.
7. If shortness of breath, dry cough, general fatigue, weight loss, or fever appear, pulmonary toxicity or interstitial pneumonitis can be suspected.
8. Taking the drug causes ECG changes, prolongs the period of ventricular repolarization, and prolongs the QT interval.
9. Treatment is stopped with the development of 2nd and 3rd degree atrioventricular block, sinotrial block, and double-bundle intraventricular block.
10. Amiodarone has a weak proarrhythmogenic effect, although the occurrence of arrhythmia and worsening of existing rhythm disturbances have been reported during its use. It is unlikely that the drug provokes ventricular tachycardia of the torsade de pointes type.
11. If blurred vision occurs or its acuity decreases, an ophthalmological examination is urgently performed, including examination of the fundus. If optic neuritis or neuropathy develops, treatment is canceled - there is a risk of blindness.
12. The tablets contain iodine, so taking them may slow down the absorption of radioactive iodine and distort the results of radioisotope studies of the thyroid gland.
13. The development of hypothyroidism is accompanied by an increase in body weight, bradycardia, cold intolerance, and decreased activity.
14. Long-term treatment with the drug may increase the hemodynamic risk of local or general anesthesia and cause acute respiratory distress syndrome.
15. While taking the medication, acute liver dysfunction, hepatocellular or liver failure may occur. If transaminase activity triples, therapy is stopped. The symptoms are reversible, but sometimes life-threatening.
16. Doctors do not recommend that patients receiving treatment with Cordarone operate dangerous machinery or drive vehicles.

Drug interactions

The instructions for use of Cordarone talk about its drug interactions with other drugs. Basic combinations:

1. The combination of the drug with antiarrhythmic drugs (Quinidine, Bepridil, Procainamide), Vincamine, neuroleptics (phenothiazines, benzamides), tricyclic antidepressants, azoles, macrolides (Erythromycin), antimalarial drugs (Quinine), Terfenadine, Astemizole is contraindicated due to the possible manifestation of ventricular tachycardia.
2. Combinations that require caution in use due to the increased risk of side effects: fluoroquinolones, Moxifloxacin, drugs to slow heart rate, beta-blockers, slow calcium channel blockers (Verapamil), systemic corticosteroids, amphotericin B.
3. Simultaneous use of the drug with laxatives, stimulating intestinal motility, and diuretics can lead to hypokalemia.
4. The combination of amiodarone with clonidine, galantamine, pilocarpine, ambenonium chloride can cause bradycardia.
5. Cordarone in combination with digitalis preparations, cardiac glycosides, Digoxin can lead to bradycardia and an increase in the concentration of drugs in the blood.
6. Combining the drug with Dabigatran increases the risk of bleeding and hyperstimulation.
7. Amiodarone increases the concentration of Warfarin, Phenytoin, Flecainide, Cyclosporine, Dextromethorphan, anticoagulants, glucocorticosteroids, tetracosactides, thiazides in the blood, which leads to bleeding or overdose.
8. Cordarone increases the pharmacodynamics of Fentanyl, increases the risk of developing muscle toxicity of statins, sinus bradycardia when combined with Lidocaine, nephrotoxicity with Tacrolimumos, side effects of Sildenafil, psychomotor effects of Midazolam.
9. The drug reduces the effectiveness of Clopidogrel.
10. It is recommended to avoid combining the drug with grapefruit juice, Cimetidine, HIV protease inhibitors, Indinavir.
11. Rifampicin and St. John's wort preparations can reduce the concentration of amiodarone.

Cordarone and alcohol

According to the instructions, Cordarone in ampoules and tablets is incompatible with alcohol. During drug therapy, it is strictly forbidden to drink alcohol, because this increases the load on the liver and increases the manifestation of side effects. As a result of combination with ethanol, organ function may be affected and the effectiveness of medication treatment may decrease.

Side effects of Cordarone

The drug Cordarone may exhibit side effects during use. Instructions for use indicate the following:

• bradycardia, conduction disturbance, arrhythmia, sinus node arrest, vasculitis, progression of heart failure, ventricular tachycardia, angina pectoris;
• nausea, dysgeusia, vomiting;
• increased activity of liver enzymes, acute liver damage, jaundice, liver failure, hepatitis, cirrhosis;
• pulmonary toxicity, pneumonia, fibrosis, pleurisy, bronchiolitis, shortness of breath, dry cough, bronchospasm, distress syndrome, alveolitis; apnea;
• depression;
• pulmonary hemorrhage;
• hypotension, increased heart rate;
• lipofuscin microdeposits in the retinal corneal epithelium, blurred vision, blurred vision, optic neuritis, neuropathy;
• phlebitis, cholestasis;
• hypothyroidism, hyperthyroidism, thyrotoxicosis;
• photosensitivity, grayish-blue skin pigmentation, erythema, skin rash, alopecia, dermatitis, urticaria;
• tremor, sleep disturbances, nightmares, myopathy, cerebellar ataxia, hypertension, headache;
• impotence, epididymitis;
• paresthesia;
• thrombocytopenia, anemia;
• angioedema;
• bone marrow granuloma.

Overdose

Symptoms of an overdose include sinus bradycardia, cardiac arrest, ventricular tachycardia, and liver damage. Treatment consists of gastric lavage, taking activated carbon, beta-agonists, intravenous administration of magnesium salts, cholestyramine. The installation of a pacemaker is shown. There is no specific antidote, hemodialysis is ineffective.

Contraindications

The drug is prescribed with caution for decompensated or severe chronic heart failure, liver failure, bronchial asthma, respiratory failure, in old age, with first-degree atrioventricular block. According to the instructions, contraindications to taking Cordarone are:

• sick sinus syndrome, bradycardia, sinotrial block;
• atrioventricular block 2 and 3 degrees;
• hypomagnesemia, hypokalemia;
• interstitial lung disease;
• hypo- or hyperthyroidism;
• age under 18 years;
• lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
• pregnancy, lactation;
• increased sensitivity of the patient to the components of the composition.

Terms of sale and storage

Cordarone is a prescription drug that should be stored at temperatures up to 30 degrees for three years.

Analogs

To replace the drug, there are some medications that are similar to it in the active substance or pharmacological effect. These include:

• Amiodarone is the closest analogue of Cordarone with antiarrhythmic action and contains the same component;
• Amiocordin – tablets based on amiodarone;
• Aritmil - antiarrhythmic tablets with the same active substance composition;
• Cardiodarone – coronary dilation tablets based on amiodarone;
• Rotaritmil is an antiarrhythmic tablet based on amiodarone.

Cordarone price

Cordarone tablets and injection solution are sold through pharmacy chains at prices depending on the pricing policy of the sellers. The approximate cost of the medicine in Moscow is indicated in the table.