Medicinal reference book geotar. Nifedipine - a drug for cardiological and vascular therapy Nifedipine duration of action

And The history of the use of nifedipine in cardiology exceeds 30 years. In the 70-80s, it was one of the most popular cardiological drugs. However, in the mid-90s, a significant number of publications appeared in the English-language literature, indicating the unsafe use of nifedipine in patients with coronary heart disease (CHD). A higher incidence of myocardial infarction was established compared with patients receiving other antihypertensive drugs. In addition, it was indicated that nifedipine therapy increases the risk of bleeding and even cancer. These works caused a wide discussion not only among doctors, but also in the media. Attention was drawn to the serious shortcomings of these studies. First, the baseline status of the patients was not known in the meta-analysis of published studies. It is possible that nifedipine was prescribed more frequently than other drugs to patients with hypertension (AH) who had angina pectoris. Secondly, very high doses (up to 120 mg of nifedipine per day, with an average of 80 mg per day) were used in the analyzed studies. Third, all patients received a rapidly absorbed form of short-acting nifedipine. Since nifedipine is a vasodilator, when taking high doses of nifedipine, vasodilation was maximal, which was accompanied by pronounced compensatory stimulation of the sympathetic nervous system and, of course, could lead to an exacerbation of coronary artery disease. The result of this discussion was a revision of the indications for the appointment of short-acting nifedipine, in particular, it was not recommended to prescribe it to patients with myocardial infarction and unstable angina pectoris.

The results of subsequent studies indicate good tolerability and high efficacy of prolonged forms of nifedipine. A number of studies have revealed their beneficial effect on the structural and functional state of the heart, blood vessels and kidneys, both in hypertension and in parenchymal arterial hypertension.

Our application experience nifedipine retard (Corinfar-retard AVD GmbH, Germany) is based on an analysis of the results obtained in 1311 patients with arterial hypertension (AH) and stable angina pectoris. Among them were 174 patients with stage I-II hypertension (WHO classification, 1962), 16 patients with hypertension in chronic pyelonephritis, 261 patients with stable angina pectoris II-IV functional classes (FC) and 722 patients with stable angina pectoris, combined with GB. The vast majority of patients received the drug on an outpatient basis and were observed by cardiologists of St. Petersburg polyclinics. Patients received the drug free of charge. All patients kept diaries, which reflected the dynamics of well-being, the number of angina attacks per day, the number of nitroglycerin tablets taken, and the presence of side effects. During the first month, visits to the doctor were weekly, thereafter - once every 2 weeks. The duration of observation was 3 months. For 6 months, 21 patients with HD received nifedipine retard. In all patients with GB, the drug was prescribed as monotherapy. In the absence of the proper antihypertensive effect, after a month, patients were transferred to combination therapy. Almost all patients with angina pectoris received nitrosorbide for a long time, and persons with angina pectoris III-IV FC also received b-blockers (including those with concomitant hypertension). The indication for the appointment of nifedipine-retard was the persistence of angina attacks.

The study did not include patients with diabetes mellitus, heart defects, atrial fibrillation, heart failure, as well as persons who had a stroke.

With GB, the initial dose of the drug was 20 mg 2 times a day. In the future, taking into account the effect achieved, the dose was reduced (up to 20 mg 1 time per day). However, in 5 (2.6%) patients, normalization of blood pressure (BP) values ​​was achieved only with the appointment of 60 mg per day (in 3 divided doses). In patients with coronary artery disease, the effectiveness of therapy was compared when prescribing the drug at a dose of 20 mg 1 and 2 times a day.

In patients with hypertension who received the drug for 6 months before therapy and 6 months after its initiation, systemic and renal hemodynamics were assessed.

The results of the studies indicate a clear antihypertensive efficacy of nifedipine retard both in patients with isolated hypertension and in its combination with coronary artery disease (Table 1). In patients who required a large dose of the drug to normalize blood pressure, its initial level was higher, as well as in those who received nifedipine 2 times a day. The decrease in blood pressure in all regimens of therapy was not accompanied by a statistically significant increase in heart rate.

Long-term therapy with nifedipine retard resulted in significant changes in central and regional renal hemodynamics. In particular, total peripheral vascular resistance (TPVR) decreased by 16.7% (p<0,05), одновременно на 16,4% увеличился сердечный индекс (р <0,05). Почечное сосудистое сопротивление (ПСС) снизилось в большей мере, чем ОПСС; снижение ПСС закономерно привело к увеличению эффективного почечного кровотока (рис. 1).

*EPK stands for Efficient Renal Blood Flow.
Rice. 1. Changes in systemic and renal hemodynamics during 6-month therapy with nifedipine retard

Six-month therapy was accompanied by a decrease in the mass index of the left ventricular myocardium (LVMI) by 9.3%, the thickness of the posterior wall (VCW) of the left ventricle by 9.8% and the interventricular septum (VVS) by 6.5% in the absence of significant changes in the size of the cavity of the left ventricle and ejection fraction of the left ventricle (Table 2).

The decrease in LVMI was maximal in individuals with the highest initial values ​​and did not correlate with the degree of BP decrease. Indicators of diastolic function (isovolumic relaxation time, E/A ratio) did not change significantly, only a tendency to their improvement was noted. At the same time, the time of isovolumic relaxation decreased to a greater extent in patients with the most significant decrease in LVMI (r = 0.65, p< 0,005).

Nifedipine retard also had a favorable effect on the course of angina pectoris, which manifested itself in a decrease in the number of angina attacks. Initially, in patients without hypertension, the number of angina attacks was 29.38 ± 2.18 per month, in patients with concomitant hypertension - 30.1 ± 1.7 per month. After 12 weeks of therapy, it decreased to 11.6 ± 1.37 and 11.9 ± 1.2 per month, respectively. The greatest antianginal effect was obtained with initially non-severe exertional angina (FC II), while at the same time, with severe exertional angina (FC III-IV), the effectiveness of therapy was less.

In 257 patients with coronary artery disease without hypertension, the effectiveness of nifedipine-retard therapy was compared with single and double doses (20 mg 1 time and 2 times a day). A double dose of the drug had a more pronounced antianginal effect, not accompanied by a significant increase in the number of side effects.

In 58 out of 722 patients with coronary artery disease, combined with hypertension, rhythm disturbances (extrasystoles of low gradations) were registered on the initial electrocardiograms. Therapy with nifedipine retard did not lead to an increase in the number of extrasystoles. On the contrary, in 32 patients who initially had extrasystole, it ceased to be detected.

It should be noted the good tolerability of the drug. Among the observed side effects, palpitations (3.8%), headache (3.5%), flushing of the face (3.9%), dizziness (1.28%), feeling of heat (1.28%), increased diuresis (1.5%) and edema (1.14%). The severity of side effects was maximum in the early stages after the start of therapy. The majority of patients (n = 64) subsequently improved tolerability of the drug while maintaining the same dose; in 14 patients, due to side effects, the dose of nifedipine was reduced; 2.1% of patients were forced to stop taking the drug due to poor tolerance.

Thus, the results of the performed study indicate a high antihypertensive and antianginal efficacy of nifedipine retard. The basis of the blood pressure-lowering action of nifedipine is a decrease in peripheral vascular resistance . It is known that when using calcium antagonists, the degree of vasodilation in different vascular regions is different. Maximum vasodilation is noted in the vessels of the skeletal muscles and coronary arteries, to a lesser extent - in the kidneys. Skin vessels are practically insensitive to the action of dihydropyridines. H. Struyker-Bodier et al. indicate that differences in vascular sensitivity are determined by the initial vascular tone and the number of voltage-gated calcium channels. In the kidneys, the maximum sensitivity to the action of calcium antagonists is inherent in afferent arterioles. In addition, these drugs inhibit the ability of preglomerular arterioles to constrict in response to both increased transmural pressure and impulses from the macula densa.

The antianginal effect of dihydropyridines is due to coronary dilatation and a decrease in the work of the heart due to a decrease in pre- and afterload. Long-acting drugs and long-acting forms of short-acting compounds, including nifedipine, have a minimal ability to stimulate the sympathetic nervous system, which can explain their lack of arrhythmogenic effects and a beneficial effect on the course of angina pectoris.

The beneficial effect of these drugs on the internal organs is due not only to the improvement of regional blood flow. The results of experimental studies indicate the ability of these compounds to cause relaxation of mesangial cells, reduce collagen synthesis by fibroblasts, increase tissue tolerance to ischemia, and improve intracellular calcium metabolism (reduction of mitochondrial overload). The result of these changes is a slow progression of experimental nephrosclerosis.

So, long-acting nifedipine preparations can be recommended for patients with various forms of hypertension . They can be used both for monotherapy and in combination with other drugs with a vasodilatory effect (myotropic drugs, a-blockers). In chronic renal failure, as well as in patients with bilateral renal artery stenosis and Conn's syndrome, they have advantages over angiotensin-converting enzyme inhibitors.

In IHD, their use is justified in stable angina . P. Heidenreich et al. performed a meta-analysis of 90 studies on the use of long-acting nitrates, b-blockers and calcium antagonists. The duration of observation in all studies exceeded a week, but only in two of them - 6 months. The authors did not reveal differences in the antianginal efficacy of calcium antagonists with b-blockers. When taking short-acting nifedipine, less antiangial activity was noted, although the number of nitroglycerin tablets taken and exercise tolerance changed equally with all drugs. The differences concerned only the rarer withdrawal of b-blockers compared to calcium antagonists due to side effects, which allowed the authors to recommend b-blockers as first-line drugs in the treatment of stable angina pectoris.

The results of the meta-analysis revealed another interesting feature - in the United States, long-acting nitrates are more often used in the monotherapy of stable angina pectoris, in Europe - calcium antagonists. Among patients with stable angina pectoris, there are patients in whom the appointment of calcium antagonists has certain advantages over therapy with b-blockers. In particular, calcium antagonists are most effective in vasospastic angina , as well as with a combination of dynamic and fixed coronary obstruction. The combination of prolonged nifedipine with b-blockers and nitrates is quite acceptable. In addition, these compounds should be prescribed to patients with contraindications to b-blockers (bronchial asthma, slowing of atrioventricular and sinoatrial conduction, intermittent claudication, Raynaud's syndrome, type I diabetes mellitus, etc.). They are preferable to b-blockers in individuals with severe dyslipidemia and metabolic syndrome. Another initial indication for the appointment of drugs in this group are bradycardia and sick sinus syndrome.

References can be found at http://www.site

Nifedipine-retard -

Corinfar-retard (trade name)

(AWD)

Nifedipine is an antihypertensive and antianginal drug. Instructions for use explain at what pressure to take tablets and dragees 10 mg, retard or prolonged 20 mg, capsules 5 mg and 10 mg. Reviews of cardiologists confirm that this drug effectively reduces pressure, improves coronary blood supply, and has a pronounced anti-ischemic effect.

Release form and composition

Nifedipine is available in the following dosage forms:

1. Capsules 5 mg and 10 mg.
2. Tablets 10 mg.
3. Long-acting tablets (retard), film-coated 20 mg.
4. Dragee 10 mg.

Nifedipine tablets are packaged in a blister of 10 pieces. A cardboard pack contains 5 blisters (50 tablets) and instructions for using the drug. The main active ingredient of the drug is nifedipine.

pharmachologic effect

The therapeutic effect of Nifedipine is aimed at reducing pressure, dilating the coronary and peripheral arteries, reducing total peripheral vascular resistance, improving coronary blood supply and preventing calcium entry into cardiomyocytes and vascular smooth muscle cells.

In addition, the drug has an anti-ischemic effect. Nifedipine does not affect myocardial conduction and does not exhibit antiarrhythmic activity.

Indications for use

What helps Nifedipine? Tablets are prescribed if the patient has:

• Arterial hypertension (as a single drug or in combination with other antihypertensive drugs).
• Angina at rest and exertion (including variant) in coronary heart disease.

At what pressure is prescribed?

Nifedipine is a fairly strong drug that is taken at high pressure (during jumps) from 150 to 110 mm Hg.

Instructions for use (at what pressure to take)

Nifedipine dragee or tablets

The dosage regimen is set individually, depending on the severity of the disease and the patient's response to therapy. It is recommended to take the drug during or after a meal with a small amount of water.

Initial dose: 1 tablet (tablet) (10 mg) 2-3 times a day. If necessary, the dose of the drug can be increased to 2 tablets or dragees (20 mg) - 1-2 times a day. The maximum daily dose is 40 mg.

In elderly patients or patients receiving combined (antanginal or antihypertensive) therapy, as well as in violation of liver function, in patients with severe cerebrovascular accident, the dose should be reduced.

Retard tablets

Taken inside. Tablets should be swallowed whole, without chewing, during or after a meal, with a small amount of water. The recommended dose of the drug is 20 mg 2 times a day. With insufficient severity of the effect, it is possible to increase the dose of the drug to 40 mg 2 times a day. The maximum daily dose is 80 mg.

In case of impaired liver function, the daily dose should not exceed 40 mg. In elderly patients or patients receiving combined (antanginal or antihypertensive) therapy, smaller doses are usually prescribed. The duration of treatment is determined in each case individually.

Contraindications

Taking Nifedipine tablets is contraindicated in a number of pathological and physiological conditions of the body, which include:

• Arterial hypotension is a decrease in the level of systemic arterial pressure, in which systolic blood pressure is less than 90 mm Hg. Art.
• Children's age up to 18 years.
• Idiopathic hypertrophic subaortic stenosis, in which the cause of the narrowing remains unclear.
• Hypersensitivity to nifedipine or auxiliary components of the drug.
• Stenosis (narrowing) of the mitral or aortic valve of the heart.
• Cardiogenic shock is an acute and severe insufficiency of the pumping function of the heart, accompanied by vascular collapse.
• Pregnancy at any time during its course, breastfeeding.
• Expressed increased heart rate (tachycardia).
• Acute myocardial infarction (death of a section of the heart muscle due to acute circulatory disorders in it) within 4 weeks.
• Sick sinus syndrome is a functional insufficiency of the atrial pacemaker.
• Severe heart failure in the stage of decompensation.

Nifedipine tablets are used with caution in chronic heart failure, a pronounced decrease in the functional activity of the liver and kidneys, severe circulatory disorders in the brain, diabetes mellitus, especially at the stage of decompensation, malignant arterial hypertension.

Also, with extreme caution, the drug is used in people on hemodialysis (hardware blood purification) due to the high risk of developing severe arterial hypotension. Before starting the use of Nifedipine tablets, you should make sure that there are no contraindications.

Side effects

Treatment with the drug can cause the following side effects:

• From the digestive system: diarrhea, heartburn, nausea, worsening of the liver; in some cases - gingival hyperplasia. With prolonged use of the drug in high doses, the appearance of dyspeptic symptoms, the development of intrahepatic cholestasis or an increase in the activity of hepatic transaminases may occur.
• From the peripheral nervous system and central nervous system: headaches. With long-term therapy at high dosages, muscle pain, paresthesia, sleep disturbances, tremors, and minor visual disturbances are possible.
• From the endocrine system: the development of gynecomastia.
• From the side of the cardiovascular system: a feeling of warmth, hyperemia of the skin, peripheral edema, arterial hypotension, tachycardia, asystole, ventricular tachycardia, increased angina attacks, bradycardia.
• From the urinary system: increased daily diuresis, impaired renal function (with prolonged use in high dosages). On the part of the hematopoietic system: extremely rarely - thrombocytopenia, leukopenia.
• Allergic reactions: rash on the skin.

When administered intravenously, the drug causes a burning sensation at the injection site. With intracoronary administration of the drug within a minute after the start of the infusion, hypotension and an increase in heart rate may develop.

Children, during pregnancy and lactation

According to the instructions, Nifedipine is contraindicated during pregnancy and lactation. In gynecological practice, in some cases, it is practiced to prescribe the drug during pregnancy as an antihypertensive agent, when other drugs are ineffective.

It is also noted that Nifedipine during pregnancy helps to reduce the tone of the uterus, but the drug has not yet received wide distribution for this indication.

Application in childhood

Nifedipine should not be used in children and adolescents under 18 years of age, since the safety and efficacy of the drug in this age group has not been established.

special instructions

Nifedipine should only be used under the supervision of a physician, especially in diabetes mellitus, malignant hypertension, severe cerebrovascular accident, hypovolemia, and impaired renal and hepatic function.

Cancellation of the reception should be done gradually, since with a sharp cessation of the course, a withdrawal syndrome may be observed. During the period of long-term use of Nifedipine, it is necessary to stop drinking alcohol, and at the beginning of treatment, doctors recommend avoiding driving vehicles and engaging in other hazardous activities.

drug interaction

Rifampicin: acceleration of metabolism and, as a result, weakening of the action of nifedipine. Nitrates: increased tachycardia and hypotensive effect of nifedipine. Quinidine: decrease in its concentration in blood plasma.

Beta-blockers: the risk of a pronounced decrease in blood pressure, in some cases - aggravation of heart failure (such combined treatment should be carried out under close medical supervision).

Other antihypertensive drugs, diuretics, tricyclic antidepressants, ranitidine, cimetidine: increased severity of lowering blood pressure. Theophylline, digoxin: an increase in their concentration in blood plasma.

Nifedipine's analogs

According to the structure, analogues are determined:

1. Sponif 10.
2. Nifecard HL.
3. Nifelat Q.
4. Nifedex.
5. Nikardia.
6. Nifadil.
7. Nifelat R.
8. Fenigidin.
9. Nifesan.
10. Vero Nifedipine.
11. Nifedicap.
12. Calciguard retard.
13. Kordafen.
14. Nifebene.
15. Nifedicor.
16. Osmo Adalat.
17. Corinfar retard.
18. Cordipin.
19. Nifelat.
20. Nifehexal.
21. Sanfidipin.
22. Nifecard.
23. Adalat.

Holiday conditions and price

The average cost of Nifedipine (tablets 10 mg No. 50) in Moscow is 29 rubles. Released by prescription.

The shelf life of the tablets is 3 years from the date of their manufacture. The drug should be stored in its original packaging, in a dark, dry place out of the reach of children at an air temperature not higher than +25 C.

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In this article, we will consider the instructions for the use of Nifedipine: at what pressure this drug is prescribed, how effective it is and what contraindications it has. This remedy is one of the most prominent representatives of antihypertensive drugs. It blocks the calcium tubules, due to which the musculature of the vessels relaxes, which helps to lower the pressure to normal levels in a short time. This drug has a number of different advantages and can be used to treat chronic processes and relieve emergency conditions.

Nifedipine is in great demand among hypertensive patients, and therefore there is often a shortage of it in pharmacies. In such cases, the drug can be replaced with similar medicines. Today, Nifedipine analogues have identical pharmacological effects and are used in the treatment of similar diseases. Next, we will consider what substitutes this drug has, and find out what advantages and disadvantages they have. But first, let's study the instructions for using the medication.

The composition of the drug and its form of release

"Nifedipine" is a drug from the category of drugs for vascular and cardiotherapy. Release it in tablets. There are 2 types of them: short and prolonged effects on the body. The former are used to normalize pressure or in the presence of pain in the chest. Extended-release tablets are prescribed to patients who have hypertension that is in the compensation stage.

The main active ingredient of the drug is a derivative of dihydropyridine. This component is able to relax the muscles of the vascular system in the shortest possible time, expand the arteries and increase blood flow, which helps to reduce heart rate and reduce pressure. So, judging by the instructions for the use of Nifedipine, at what pressure this remedy is prescribed, there is no need to think. This is a drug for hypertensive patients.

The therapeutic effect occurs, as a rule, already 20 minutes after ingestion. More than 90% of the active ingredient is absorbed through the intestines, which makes it possible to reduce the load on the stomach and gallbladder, facilitating the work of the kidneys and liver.

How the drug works

The mechanism of action of "Nifedipine" is that the drug blocks the activity of slow calcium channels of cell membranes. Calcium ions enter in smaller quantities into the arteries of the heart, muscles, and also peripheral vessels. As a result:

• blood circulation in the heart is activated;
• the lumen of the coronary and arterial vessels increases;
• increased blood flow in the kidneys;
• pressure decreases;
• decreased vascular resistance to blood flow in the periphery.

Like other drugs in the form of tablets, Nifedipine also contains excipients, which are magnesium, sodium, potato and wheat starch, as well as microcrystalline cellulose, along with titanium dioxide, hypromelose and macrogol. The shell of the tablets is made of gelatin and talc.

Most of the above substances increase the impact of the main component on the body, which provides a high therapeutic effect. If necessary, a long course of administration is prescribed a prolonged form, and to combat acute attacks of angina pectoris and hypertension, short-acting tablets that do not have a shell are prescribed.

When to use the remedy

What are the indications for Nifedipine? It is prescribed in the following cases:

• If the patient has angina pectoris.
• With arterial hypertension as part of monotherapy or in combination with other antihypertensive drugs.

Please note that for the use of Nifedipine, the indications must be strictly observed.

How should the medication be taken

It is unacceptable to prescribe a remedy on your own. Its reception should be carried out under the supervision of a medical specialist, who is obliged to familiarize himself in detail with the condition of his patient and analyzes of his biological material, and in addition, with the results of an electrocardiogram. The age of the patient is of great importance when choosing the dosage and duration of the treatment course.

The maximum daily dose of the main active ingredient should not exceed 40 mg. It is better to take it with meals, and you should choose liquid, but at the same time light meals. You can not drink this medicine with natural juices or sparkling water, as they contain aggressive ingredients that can dissolve the tablet shell before it enters the intestines.

The course of therapy with Nifedipine is usually at least 60 days. The initial dose for any indication for the use of this drug is 10 milligrams twice a day. According to the results of the therapeutic effect, the doctor adjusts the single and daily intake, increasing or decreasing the dosage until the desired effect is achieved. In severe cases, it can reach 80 mg.

There are contraindications for taking Nifedipine. The tool is prohibited:

• with acute myocardial infarction;
• severe forms of heart failure;
• arterial hypotension;
• the presence of unstable angina;
• cardiogenic shock;
• tachycardia;
• narrowing of the mitral valve;
• bradycardia.

Manifestation of side effects of the drug

With an increase in the dosage of Nifedipine, side effects are not excluded. They may appear as follows:

1. From the side of the cardiovascular system - tachycardia, decreased pressure, chest pain, fainting, angina pectoris.
2. From the nervous system - dizziness, difficulty swallowing, fatigue, drowsiness, headaches, depression.

Duration of reception, as a rule, is determined individually. Abrupt withdrawal of the drug is not practiced, as this can cause unwanted side reactions in the form of increased heart rate, pressure surges and malfunctions of the intestines. There are also likely to be malfunctions in the work of the hematopoietic organs.

Nifedipine analogues and their trade names

As already noted, there are only 2 types of Nifedipine tablets: short and prolonged exposure. Analogues of the drug, which are short-acting, include Fenigidin, Nicardia, Procardia, Kordaflex and Farmadipin.

Substitutes for prolonged action are such drugs as "Corinfar Uno" along with "Kordipin-retard", "Calcigard retard" and "Nifekard".

Immediately before choosing one or another Nifedipine analogue, it is necessary to justify the purposes for which the drug will be used and determine what effect should be obtained after using the drug. For example, in the treatment of hypertension, it is best to use analogs with prolonged exposure. And to eliminate the hypertensive crisis, the choice of a short-acting analogue is recommended.

Among other things, before buying a drug, you should carefully study the attached instructions. But a doctor should prescribe it, since in case of non-compliance with the recommendations, the state of health and the progression of pathological processes may worsen.

Advantages and disadvantages

Consider the main advantages of Nifedipine analogues, as well as their disadvantages. If there is a need to replace "Nefedipin", it is necessary to take into account the pros and cons of the proposed funds:

• Some analogues of Nefedipine can have a local effect on the body, that is, they affect only the heart.
• Reduce the risk of negative effects on fetal development (if used during pregnancy).
• When breastfeeding, there is no need to interrupt the lactation period.

The disadvantages of substitutes include the following disadvantages:

• A parallel intake of several drugs at once is required instead of one to replace the effect of Nefedipine.
• Carrying out substitution therapy can cost the patient more than the cost of one Nifedipine.

Which analogue should be preferred

Absolutely all substitutes for "Nefedipin" are high-quality products and have the same properties as it. In this regard, the patient may opt for a less expensive drug, however, this will have to take into account the mechanism of action and the dosage of the drug.

In medical practice, there are many examples when the same active ingredient in medicines from different pharmacological manufacturers had different effects. But with Nifedipine, the situation is different. Almost twenty years have passed since the release of this drug, and all its analogues do not differ from the original. In this regard, when purchasing a medication, you can save money by choosing a less expensive substitute. According to the medicinal properties, the analogue of "Nifedipine" of prolonged action will be similar to the original.

I must say that it is extremely unlikely to purchase a fake drug in a pharmacy, which will contain chalk instead of the active ingredient, because Nifedipine is an inexpensive remedy, and the named replacement will definitely not bring significant benefits. In addition, an experienced hypertensive patient can easily identify a fake, since he knows what therapeutic effect the drug should have and will not buy it next time.

Review of the most popular substitutes for "Nefedipin": "Corinfar"

Before replacing this drug with a drug similar in effect, it is imperative to consult a doctor to select the optimal dosage and identify contraindications to the use of the drug. Next, consider the analogues of "Nifedipine" in action: "Corinfar", "Cordaflex" and "Corinfar Uno".

The first substitute for "Nifedipine" is produced in the form of tablets. It has a prolonged action, and it is prescribed for the treatment of diseases of the heart and blood vessels:

• if the patient has arterial hypertension;
• against the background of ischemia of the myocardium;
• in the presence of angina pectoris.

Treatment with Corinfar is easily tolerated by patients, without side effects. In this case, the analogue of "Nifedipine" should be taken only on the recommendation of a specialist and under his supervision.

It is important to know that after a sharp cessation of taking Corinfar, hypertensive patients may develop a withdrawal syndrome, which will be expressed in an increase in blood pressure, and in addition, in insufficient blood supply to the myocardium.

The drug "Cordaflex"

This is another analogue of Nifedipine, which belongs to the category of antihypertensive drugs. This substitute is quite common among people who have been suffering from hypertension for many years. The drug eliminates spasms of the coronary arteries, relaxing the vascular walls and reducing myocardial oxygen demand. I must say that Kordaflex does not cause arrhythmias. This drug is prescribed in the following cases:

• If the patient has arterial hypertension at different stages.
• Against the background of ischemic heart disease.
• With a hypertensive crisis.
• In the presence of stable angina pectoris.

"Corinfar Uno"

This is the most popular analogue of Nifedipine tablets, since a single dose of this drug can provide a constant concentration of the active ingredient in the bloodstream for a whole day. Thanks to this tool, the productivity of treatment increases, the frequency of various complications decreases, and the internal organs are not subjected to additional stress. Due to this, these tablets are in great demand among a certain category of patients.

The use of long-acting substitutes requires strict rules to be followed. The listed analogues of "Nifedipine" are forbidden to grind or dissolve under the tongue. Tablets must be taken in an unchanged state with a sufficient amount of liquid. You can not share a single dosage of the drug if the instructions for this possibility are not indicated.

Analogues in the treatment of hemorrhoids

The drug "Nifedipine" is endowed with many medicinal properties. So, it is also used to eliminate the symptoms of hemorrhoids. The named medication in this case can be replaced by the drug "Relief". This analogue promotes the healing of cracks, eliminating tissue swelling and restoring damaged vessels. As part of the treatment of hemorrhoids, you can use any suitable analogue of the gel "Nifedipine".

It is possible to make a healing drug on your own at home. To do this, you need to prepare the necessary components, namely, Levomekol ointment, Nifedipine, Lidocaine and Cardiket tablets are taken. The method of preparation of the analog of "Nifedipine" is as follows:

• One tablet of Kardiket and eight pills of Nifedipine are crushed to a powdery state.
• 30 g of Levomekol and 5 g of Lidocaine are added to the powder.
• Then everything is thoroughly mixed and the resulting mixture is used as an ointment. It is applied in a thin layer to problem areas.

This ointment is applied once a day, but in some situations it can be applied twice a day. In fact, "Nifedipine" is produced in the form of a large number of structural analogues, and each of these substitutes has its own name. But absolutely all of them contain the same active ingredient and have a similar therapeutic effect.

Comparative characteristics of Kapoten and Nifedipine

Some patients are trying to determine, for example, which is better - Kapoten or Nifedipine. There is no unambiguous opinion about which of these drugs is better for combating hypertension. Only the attending physician can decide what exactly should be taken by a particular patient to reduce pressure. Therefore, everything is purely individual. Sometimes it is enough to regularly take only Kapoten tablets in order to improve the condition and forget about the increase in pressure. But for some, "Capoten" for contraindications or for some other reason known to the doctor may not be suitable, and "Nifedipin", in turn, will effectively replace it.

By the way, Kapoten should never be used by people suffering from an increased heart rate, which exceeds 85 beats per minute. But at the same time, it must be emphasized that Kapoten is classified as the most harmless medicine. This analogue has a milder effect on the patient's body than Nifedipine, and practically does not have any side effects.

But Nifedipine has one definite advantage, which is that this drug is much cheaper than Kapoten. While about 300 rubles will have to be paid for Kapoten, Nifedipine costs patients three times cheaper.

Andipan or Nifedipine

"Andipan" is a combined drug that gives vasodilating, analgesic, antispasmodic and sedative effects. It is prescribed for pain associated with spasm of peripheral arteries, cerebral vessels, smooth muscles of the stomach and intestines. And also in the presence of arterial hypertension. They have similar contraindications and side effects.

14.05.2017

Nifedipine tablets are necessary for hypertensive patients and are a common remedy for pressure , eliminating pain, reducing ischemia.

The drug is produced in several versions:

• adalat - solution for intravenous administration;
• short acting tabletsremove the crisis (cordaflex, nifedipine, cordafen, cordipin, fenigidin);
• long-acting drug that is drunklong-term (cordaflex rd, corinfar, nifecar chl, calciguard retard, osmo-adalat).

Listed medicines for pressure combines the active substance, the mechanism of action on the body and the pharmacological effect. Differ from downgrading AD drugs by the duration of the result obtained, the speed of the onset of the effect from the moment of taking / administering the medication. Given the differences, each form has its own indications, which the doctor must know about.

How does nifedipine affect the body?

Learn more about Nifedipine instructions for use, at what pressureand how to take, what side effects and contraindications. However, it is not necessary to understand medical terminology. The active substance is classified as a Ca-channel blocker. This means that the channels in the cell wall through which calcium enters are blocked.

Many calcium channels in the muscles, including the heart. Penetrating into the cell, calcium provokes excitation, causing a contraction of muscle tissue.

Under conditions of blocking calcium channels, much of it will not enter the cell, which means that the lumen in the vessels will expand, because their walls of their circular muscle fibers will not actively contract under the influence of calcium.

Due to the expansion of the cardiac arteries, blood flow to the myocardium improves, and the increased lumen of distant arteries provides a decrease pressure . The vascular walls relax, the lumen of the veins and arteries increases, the frequency of myocardial contractions succeeds reduce.

Dilated blood vessels, through which blood circulates to the heart and brain, provide blood flow to the main organs, the supply of glucose and oxygen. Against the background of such favorable conditions, cells affected by ischemia and pathologies are poorly restored.

When is Nifedipine prescribed?

pressure medication prescribed for various pathologies, each time selecting the appropriate form of medication:

• as a prophylaxis of angina pectoris in patients with ischemic disease;
• in order to reduce vasospasm in patients with Prinzmetal's angina;
• for downhill pain in the chest if nitroglycerin is not possible accept ;
• to control blood pressure in hypertensive patients in the long term;
• to quickly to stop a hypertensive crisis;
• with Raynaud's syndrome to relieve spasms of distant blood vessels.

An intravenous liquid form of the drug is administered in a hospital if the patient is in serious condition. Short acting tablets fast reduce blood pressure, used in case of an acute attack of angina pectoris and hypertension.

For long-term treatment of hypertension, indicators pressure normalized with prolonged-release tablets.

Dosage of the drug

If the patient has read the instructions and knows what dosagereduces pressure, with hypertension, act according to the principle: “what I want, then I drink ' is dangerous. The doctor can prescribe pills, they act individually for each patient.

The standard daily dosage is 30-80 g. If short-acting tablets are taken, then the daily dose is divided into 3-4 doses, and if long-acting tablets are prescribed, they are taken 1-2 times a day. In case of severe hypertension and variant angina pectoris, the daily dosage can be increased to 120 mg for some time, but as prescribed by the doctor and when the drug is well tolerated. The maximum daily dose is 120 mg.

When you need to remove the pressure surge, put a 10-20 mg tablet under the tongue, which will work for 15 minutes. Do the same for chest pain. In the hospital, an attack of angina pectoris or a crisis is stopped by intravenous administration of Nifedipine in a volume of 5 mg / h, the daily rate is 30 mg.

An overdose of the drug is manifested by facial swelling, headache, prolonged pressure drop, bradycardia, bradyarrhythmia and the absence of a pulse in distant arteries. In case of severe intoxication, loss of consciousness and collapse are possible.

To provide first aid, you need to do a gastric lavage, then prescribe activated charcoal at the rate of 1 tablet per 10 kg of body weight. Nifedipine's drug antidote is calcium; calcium chloride or calcium gluconate in a 10% solution is administered to help the patient.

Adverse reactions

Like other pressure pills, Nifedipine causes side reactions in the body:

• from the gastrointestinal tract: diarrhea, nausea, heartburn and liver failure. If you take the drug for a long time in high doses, this will affect the liver in the form of cholestasis or an increase in transaminases;
• from the side of the cardiovascular system: swelling of the skin and extremities, a strong drop in pressure, a feeling of warmth, asystole, tachycardia, bradycardia, angina pectoris;
• from the side of the central and peripheral nervous system: headaches, with prolonged use, muscle pain, sleep problems, tremors and visual disturbances;
• from the genitourinary system: increased diuresis, against the background of long-term use - failure of the kidneys;
• on the part of hematopoiesis: leukopenia and thrombocytopenia;
• from the endocrine system - a manifestation of gynecomastia.

As an allergy to the components of Nifedipine, a rash on the skin, burning at the injection site is possible. With intravenous administration, an increase in the frequency of myocardial contractions and the development of hypotension are possible.

Contraindications

Nifedipine is not prescribed for hypotension, collapse, severe aortic stenosis, cardiogenic shock, severe heart failure, acute myocardial infarction, tachycardia, minors.

Pregnant and lactating Nifedipine is not recommended, although in gynecological practice there are cases when the drug was necessary in case of ineffectiveness of the drugs. In such cases, the doctor weighs the risks, and may prescribe the drug in late pregnancy in order to stop the hypertensive crisis and normalize the condition of the expectant mother.

In pregnant women, Nifedipine reduces the tone of the uterus, but clinical studies on this issue have not been conducted. It is strictly forbidden for pregnant women to drink the medicine on their own, the decision should be made by the doctor.

A similar appointment with caution applies to patients with diabetes mellitus, malignant arterial hypertension, serious circulatory disorders in the brain, malfunctions of the kidneys and liver.

The effectiveness of Nifedipine

Since the development of the drug, there have been enough international studies on the effectiveness, according to the results, reports have been presented on the benefits, safety and feasibility of prescribing Nifedipine. In 2000, the results of the INSIGHT study were presented, according to which the drug is safe, effectively helps with hypertension, is well tolerated compared to diuretic drugs, and helps reduce the risk of heart attack and stroke in hypertensive patients.

The results of the Action study confirmed the safety of long-acting nifedipine, its ability to reduce the need for coronary artery bypass grafting and coronary angiography. In combination with other drugs, Nifedipine improves the prognosis in hypertensive patients and patients with angina pectoris, including the state after myocardial infarction.

In the recommendations of the European Society of Cardiology there are notes on the positive effect of long-acting nifedipine on the health of patients with stable angina, both in monotherapy and in combination with nitrates and beta-blockers.

Short-term tablets are recommended as a means of emergency care for a hypertensive crisis, if taken for a long time, this is fraught with complications.

Drug Interactions

Before prescribing pills for pressure, the doctor will assess the patient's condition, refer him for diagnosis, select the dosage and regimen of therapy. You need to tell your doctor if you are taking medications, as Nifedipine does not work well with all of them.

The combined use of Nifedipine with diuretics, nitrates, tricyclic antidepressants leads to an accumulation of the effect and an increase in the pressure-reducing effect.

In combination with beta-blockers, the hypotensive effect increases, heart failure develops. Cimetidine together with Nifedipine increases the concentration of the latter in the blood plasma. If you take Rifampicin against the background of Nifedipine, then the metabolism of the latter will accelerate, the effectiveness of its action on the body will decrease.

It is important to consider that long-term treatment of patients with high blood pressure or coronary artery disease is carried out with long-acting drugs. It is valid for 12-24 hours. As for short-term tablets, they should be used as an ambulance for a hypertensive crisis, when you need to effectively and quickly reduce blood pressure.

According to research and practice, if you use short-acting Nifedipine for a long time, this is fraught with a stroke or heart attack.

The doctor selects the dosage of tablets individually in each individual case. Self-treatment, relying on the instructions for the drug - is not worth it, this can lead to dangerous consequences.

Nifedipine is an antihypertensive and antianginal agent, a selective calcium channel blocker of the II class. Effectively reduces pressure, improves coronary blood supply, has a pronounced anti-ischemic effect.

Antagonist of calcium ions, inhibits their entry into cardiomyocytes and smooth muscle cells of the coronary and peripheral arteries through slow membrane channels. Expands the coronary and peripheral arterial vessels, reduces myocardial oxygen demand, lowers peripheral vascular resistance and blood pressure.

It is quickly absorbed in the digestive tract (when used as a solution or tablets with a regular release of the active substance). The maximum plasma concentration when taking conventional dosage forms is reached after 30-60 minutes.

Nifedipine does not affect the tone of the veins. It reduces spasm, dilates peripheral and coronary vessels (mainly arterial), lowers blood pressure and total peripheral vascular resistance, reduces myocardial tone, afterload and oxygen demand of the heart muscle, and prolongs diastolic relaxation of the left ventricle.

Under its influence, coronary blood flow increases, blood supply to ischemic areas of the myocardium improves, and the functioning of collaterals is activated. Almost no effect on the atrioventricular and sinoatrial nodes and has no antiarrhythmic effect. Increases blood flow in the kidneys, causes a moderate excretion of sodium in the urine.

The clinical effect occurs after 20 minutes and lasts from 4 to 6 hours. When using various retard forms, the maximum concentration of nifedipine in the blood plasma is observed several hours after oral administration, the duration of action is on average 10-12 hours, some dosage forms - up to 24 hours.

Indications for use

What helps Nifedipine? According to the instructions, the drug is prescribed in the following cases:

• Angina at rest and exertion (including variant) in coronary heart disease;
• Arterial hypertension (as a single drug or in combination with other antihypertensive drugs).

At what pressure is Nifedipine used? As we can see from the indications for use, with increased (hypertension). This drug reduces blood pressure, and with low blood pressure it is dangerous to take it.

Instructions for use Nifedipine, dosage

Tablets are taken orally after meals, they are not chewed and washed down with a sufficient amount of water. The dosage and mode of taking the drug are set by the doctor individually, depending on the therapeutic efficacy.

According to the instructions for use, the initial dose of Nifedipine is 10 mg once a day. If necessary and in the absence of a therapeutic effect, it is increased to 20 mg 1-2 times a day.

• The maximum daily dose should not exceed 40 mg.

To stop a hypertensive crisis, it is used sublingually at a dose of 10 mg as a solution for oral administration (or after chewing the tablet), if necessary, after 20–30 minutes, the administration is repeated, sometimes increasing the dose to 20–30 mg. Or the drug is administered intravenously at a dose of 5 mg for 4-8 hours, the maximum dose is 15-30 mg / day (for no more than 3 days).

For the elderly, as well as for patients with a concomitant decrease in the functional activity of the liver or kidneys, a dosage reduction is required.

Side effects

The instruction warns of the possibility of developing the following side effects when prescribing Nifedipine:

• From the digestive system: diarrhea, heartburn, nausea, worsening of the liver; in some cases - gingival hyperplasia. With prolonged use of the drug in high doses, the appearance of dyspeptic symptoms, the development of intrahepatic cholestasis or an increase in the activity of hepatic transaminases may occur.
• From the side of the cardiovascular system: a feeling of warmth, hyperemia of the skin, peripheral edema, arterial hypotension, tachycardia, asystole, ventricular tachycardia, increased angina attacks, bradycardia.
• From the peripheral nervous system and central nervous system: headaches. With long-term therapy at high dosages, muscle pain, paresthesia, sleep disturbances, tremors, and minor visual disturbances are possible.
• From the urinary system: increased daily diuresis, impaired renal function (with prolonged use in high dosages).
• On the part of the hematopoietic system: extremely rarely - thrombocytopenia, leukopenia.
• From the endocrine system: the development of gynecomastia.
• Allergic reactions: rash on the skin.

When administered intravenously, the drug causes a burning sensation at the injection site.

With intracoronary administration, within a minute after the start of the infusion, hypotension and an increase in heart rate may develop.

Contraindications

Nifedipine is contraindicated in the following cases:

• Hypersensitivity to nifedipine or auxiliary components of the drug.
• Acute myocardial infarction (death of a section of the heart muscle due to acute circulatory disorders in it) within 4 weeks.
• Cardiogenic shock is an acute and severe insufficiency of the pumping function of the heart, accompanied by vascular collapse.
• Arterial hypotension is a decrease in the level of systemic arterial pressure, in which systolic blood pressure is less than 90 mm Hg. Art.
• Sick sinus syndrome is a functional insufficiency of the atrial pacemaker.
• Severe heart failure in the stage of decompensation.
• Stenosis (narrowing) of the mitral or aortic valve of the heart.
• Idiopathic hypertrophic subaortic stenosis, in which the cause of the narrowing remains unclear.
• Expressed increased heart rate (tachycardia).
• Children's age up to 18 years.
• Pregnancy at any time, breastfeeding.

Nifedipine is used with caution in chronic heart failure, a pronounced decrease in the functional activity of the liver and kidneys, severe circulatory disorders in the brain, diabetes mellitus, especially at the stage of decompensation, malignant arterial hypertension.

Also, with extreme caution, the drug is used in people on hemodialysis (hardware blood purification) due to the high risk of developing severe arterial hypotension.

Before using, you should make sure that there are no contraindications.

Overdose

Manifested by arterial hypotension, bradycardia, heart failure, shock, metabolic acidosis and convulsions.

Nifedipine analogues, price in pharmacies

If necessary, you can replace Nifedipine with an analogue for the active substance - these are drugs:

1. Cordipin,
2. Corinfar Retard,
3. Nifecard,
4. Calcigard Retard HL.

ATX code:

• Adalat,
• calciguard retard,
• Kordafen,
• Cordylin,
• Corinfar.

When choosing analogues, it is important to understand that the instructions for use of Nifedipine, the price and reviews of drugs of similar action do not apply. It is important to consult a doctor and not to make an independent replacement of the drug.

Price in Russian pharmacies: Nifedipine tablets 10 mg 50 pcs. - from 27 to 39 rubles, according to 739 pharmacies.

Store at temperatures up to 25 ºC in a place protected from light and moisture, out of the reach of children.

Shelf life - 3 years. Conditions for dispensing from pharmacies - by prescription.

What do the reviews say?

According to doctors, Nifedipine is a cheap, affordable and effective treatment for high blood pressure (including hypertensive crisis) and ischemia. However, some doctors note that the drug reduces the upper (systolic) pressure and has little effect on the lower (diastolic).

The disadvantages include a large number of contraindications and a whole list of side effects that may occur during treatment. Especially often patients complain of heartburn, headache, flushing to the face and drowsiness.