кардиогенный шок (риск развития инфаркта миокарда); - острый период инфаркта миокарда (в течение первых 4 недель); - выраженный стеноз аортального клапана; - хроническая сердечная недостаточность (в стадии декомпенсации); - выраженная артериальная гипотензия (систолическое АД ниже 90 мм рт.ст.); - порфирия; - I триместр беременности; - период лактации; - возраст до 18 лет (эффективность и безопасность не установлены); - дефицит лактазы, галактоземия, синдром мальабсорбции; - повышенная чувствительность к нифедипину и другим компонентам препарата; - повышенная чувствительность к другим производным дигидропиридина; С осторожностью следует применять препарат при выраженном стенозе устья аорты или митрального клапана, гипертрофической обструктивной кардиомиопатии, выраженной брадикардии и тахикардии, СССУ, злокачественной артериальной гипертензии, при инфаркте миокарда с левожелудочковой недостаточностью, хронической сердечной недостаточности, нестабильной стенокардии, непроходимости ЖКТ, во II и III триместрах беременности, при легкой или умеренной артериальной гипотензии, тяжелых нарушениях мозгового кровообращения, нарушениях функции печени и/или почек, гемодиализе (риск возникновения артериальной гипотензии); одновременно с бета-адреноблокаторами, сердечными гликозидами, рифампицином; у пациентов пожилого возраста.
Блокатор медленных кальциевых каналов. Ингибирует ток ионов кальция через мембрану клеток сердечной мышцы и гладких мышц сосудов. Блокада поступления и накопления ионов кальция внутри клеток ведет к расширению периферических и коронарных сосудов, снижает ОПСС, уменьшает постнагрузку на сердце, уменьшает коронарный кровоток и снижает потребность миокарда в кислороде. Преимущественно в начале терапии возможно уменьшение ЧСС и сердечного выброса в результате активации рефлекса барорецепторов. При длительной терапии нифедипином ЧСС и сердечный выброс возвращаются к значениям, которые имелись до начала терапии. У пациентов с артериальной гипертензией наблюдается более выраженное снижение АД. Эффект препарата продолжается 24 ч, поэтому достаточно однократного его назначения в сутки.
кардиогенный шок (риск развития инфаркта миокарда); - острый период инфаркта миокарда (в течение первых 4 недель); - выраженный стеноз аортального клапана; - хроническая сердечная недостаточность (в стадии декомпенсации); - выраженная артериальная гипотензия (систолическое АД ниже 90 мм рт.ст.); - порфирия; - I триместр беременности; - период лактации; - возраст до 18 лет (эффективность и безопасность не установлены); - дефицит лактазы, галактоземия, синдром мальабсорбции; - повышенная чувствительность к нифедипину и другим компонентам препарата; - повышенная чувствительность к другим производным дигидропиридина; С осторожностью следует применять препарат при выраженном стенозе устья аорты или митрального клапана, гипертрофической обструктивной кардиомиопатии, выраженной брадикардии и тахикардии, СССУ, злокачественной артериальной гипертензии, при инфаркте миокарда с левожелудочковой недостаточностью, хронической сердечной недостаточности, нестабильной стенокардии, непроходимости ЖКТ, во II и III триместрах беременности, при легкой или умеренной артериальной гипотензии, тяжелых нарушениях мозгового кровообращения, нарушениях функции печени и/или почек, гемодиализе (риск возникновения артериальной гипотензии); одновременно с бета-адреноблокаторами, сердечными гликозидами, рифампицином; у пациентов пожилого возраста.
Применение при беременности и в период грудного вскармливания
Назначение препарата Кордипин ХЛ в I триместре беременности противопоказано. Во II и III триместрах применение возможно только в том случае, если предполагаемая польза терапии для матери, превышает потенциальный риск для плода. Нифедипин выделяется с грудным молоком, поэтому при необходимости применения препарата в период лактации следует прекратить грудное вскармливание.
Способ применения и дозы
Устанавливают индивидуально. Препарат назначают в средней дозе 40 мг (1 таб.) 1 раз/сут как в начале терапии, так и при продолжительном лечении. При необходимости дозу увеличивают до максимальной - 80 мг (2 таб.)/сут в 1 или 2 приема. В случае пропуска приема очередной дозы препарата, при следующем приеме не следует удваивать дозу. Препарат следует принимать после еды. Таблетки принимают целиком, не разламывая и не разжевывая, запивая стаканом воды.
Побочное действие
Со стороны сердечно-сосудистой системы: проявления чрезмерной вазодилатации (бессимптомное снижение АД, приливы крови к коже лица, гиперемия кожи лица, чувство жара), тахикардия, сердцебиение, аритмия, периферические отеки, развитие или усугубление сердечной недостаточности (чаще усугубление уже имевшейся), загрудинные боли; редко - чрезмерное снижение АД, обморок; в отдельных случаях (особенно в начале лечения) - приступы стенокардии (требуется отмена препарата); в единичных случаях – инфаркт миокарда. Со стороны ЦНС и периферической нервной системы: головная боль, головокружение, повышенная утомляемость, слабость, сонливость; при длительном применении в высоких дозах - парестезии в конечностях, депрессия, чувство тревоги, экстрапирамидные (паркинсонические) нарушения (атаксия, маскообразное лицо, шаркающая походка, скованность движений рук и ног, тремор кистей и пальцев рук, затрудненное глотание). Со стороны пищеварительной системы: сухость во рту, снижение аппетита, диспепсия (тошнота, диарея или запор); редко - гиперплазия десен (кровоточивость, болезненность, отечность); при длительном приеме - нарушения функции печени (внутрипеченочный холестаз, повышение активности печеночных трансаминаз). Со стороны органов кроветворения: анемия, бессимптомный агранулоцитоз, тромбоцитопения, тромбоцитопеническая пурпура, лейкопения. Со стороны костно-мышечной системы: артрит; редко - артралгия, отечность суставов, миалгия, судороги верхних и нижних конечностей. Со стороны мочевыделительной системы: увеличение суточного диуреза, ухудшение функции почек (у пациентов с почечной недостаточностью). Со стороны дыхательной системы: редко - затруднение дыхания, кашель; очень редко - отек легких, бронхоспазм. Со стороны органов чувств: очень редко - нарушение зрения (в т. ч. транзиторная слепота при максимальной концентрации нифедипина в плазме крови). Со стороны эндокринной системы: очень редко - гинекомастия (у пациентов пожилого возраста, полностью исчезает после отмены препарата), галакторея. Со стороны обмена веществ: очень редко - гипергликемия, увеличение массы тела. Аллергические реакции: редко - кожный зуд, эксфолиативный дерматит; очень редко - аутоиммунный гепатит. Дерматологические реакции: редко - экзантема, фотодерматоз.
Передозировка
Симптомы: препарат вызывает периферическую вазодилатацию с выраженной и, возможно, пролонгированной артериальной гипотензией: головная боль, гиперемия кожи лица, длительное выраженное снижение АД, угнетение деятельности синусового узла, брадикардия и/или тахикардия, брадиаритмия. При тяжелом отравлении - потеря сознания, кома. Лечение: стандартные меры, направленные на выведение препарата из организма (назначение активированного угля, промывание желудка), стабилизацию показателей гемодинамики; тщательный контроль деятельности сердца, легких и выделительной системы. Антидотом являются препараты кальция. Показано в/в введение 10% раствора кальция хлорида или кальция глюконата, с последующим переключением на длительную инфузию. Вследствие высокой степени связывания с белками плазмы крови, гемодиализ не эффективен. Рекомендуется контролировать содержание глюкозы в крови (может снижаться высвобождение инсулина) и электролитов (калия, кальция). Клиренс нифедипина увеличивается у пациентов с недостаточностью функции печени.
Особые указания
Прекращать лечение препаратом Кордипин ХЛ рекомендуется постепенно. Следует иметь в виду, что в начале лечения возможно развитие стенокардии, особенно после недавней резкой отмены бета-адреноблокаторов (последние следует отменять постепенно). Одновременное назначение бета-адреноблокаторов необходимо проводить под тщательным врачебным контролем, поскольку при этом возможно чрезмерное снижение АД, а в некоторых случаях - усугубление симптомов сердечной недостаточности. Диагностическими критериями для назначения препарата при ангиоспастической стенокардии являются: классическая клиническая картина, сопровождающаяся повышением сегмента ST, возникновение эргоновин-индуцированной стенокардии или спазма коронарных артерий, выявление коронароспазма при ангиографии или выявление ангиоспастического компонента без подтверждения (например, при разном пороге напряжения или при нестабильной стенокардии, когда данные ЭКГ свидетельствуют о преходящем ангиоспазме). Для пациентов с тяжелой обструктивной кардиомиопатией существует риск увеличения частоты, тяжести проявления и продолжительности приступов стенокардии после приема нифедипина; в данном случае необходима отмена препарата. У пациентов, находящихся на гемодиализе, с высоким АД и необратимой почечной недостаточностью с уменьшенным ОЦК препарат следует применять с осторожностью, т.к. может произойти резкое падение АД. Следует тщательно контролировать состояние пациентов с нарушением функции печени и при необходимости уменьшить дозу препарата и/или применять другие лекарственные формы нифедипина. Если во время терапии пациенту требуется провести хирургическое вмешательство под общей анестезией, необходимо информировать врача-анестезиолога о характере проводимой терапии. Во время лечения возможны положительные результаты при проведении прямой реакции Кумбса и лабораторных тестов на антинуклеарные антитела. С осторожностью следует назначать препарат одновременно с дизопирамидом и флекаинамидом. Влияние на способность к вождению автотранспорта и управлению механизмамиУ некоторых пациентов, особенно в начале лечения, препарат может вызвать головокружение, что снижает способность к управлению автомобилем или другими механизмами. В дальнейшем степень ограничений определяют в зависимости от индивидуальной переносимости препарата.
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40 мгвспомогательные вещества: целлюлоза микрокристаллическая, целлюлоза, лактоза, гипромеллоза (метилгидроксипропилцеллюлоза), магния стеарат, кремния диоксид коллоидный безводный.состав оболочки: гипромеллоза (метилгидроксипропилцеллюлоза), макрогол 6000, макрогол 400, краситель железа оксид красный (е172), титана диоксид (е171), тальк."}}]},{"id":2,"name":"Фармакологические свойства","slug":"pharmacologic_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Блокатор медленных кальциевых каналов. Ингибирует ток ионов кальция через мембрану клеток сердечной мышцы и гладких мышц сосудов. Блокада поступления и накопления ионов кальция внутри клеток ведет к расширению периферических и коронарных сосудов, снижает ОПСС, уменьшает постнагрузку на сердце, уменьшает коронарный кровоток и снижает потребность миокарда в кислороде. Преимущественно в начале терапии возможно уменьшение ЧСС и сердечного выброса в результате активации рефлекса барорецепторов. При длительной терапии нифедипином ЧСС и сердечный выброс возвращаются к значениям, которые имелись до начала терапии. У пациентов с артериальной гипертензией наблюдается более выраженное снижение АД. Эффект препарата продолжается 24 ч, поэтому достаточно однократного его назначения в сутки."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["артериальная гипертензия; - стабильная стенокардия (стенокардия напряжения); - ангиоспастическая (вазоспастическая) стенокардия."]}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["кардиогенный шок (риск развития инфаркта миокарда); - острый период инфаркта миокарда (в течение первых 4 недель); - выраженный стеноз аортального клапана; - хроническая сердечная недостаточность (в стадии декомпенсации); - выраженная артериальная гипотензия (систолическое АД ниже 90 мм рт.ст.); - порфирия; - I триместр беременности; - период лактации; - возраст до 18 лет (эффективность и безопасность не установлены); - дефицит лактазы, галактоземия, синдром мальабсорбции; - повышенная чувствительность к нифедипину и другим компонентам препарата; - повышенная чувствительность к другим производным дигидропиридина; С осторожностью следует применять препарат при выраженном стенозе устья аорты или митрального клапана, гипертрофической обструктивной кардиомиопатии, выраженной брадикардии и тахикардии, СССУ, злокачественной артериальной гипертензии, при инфаркте миокарда с левожелудочковой недостаточностью, хронической сердечной недостаточности, нестабильной стенокардии, непроходимости ЖКТ, во II и III триместрах беременности, при легкой или умеренной артериальной гипотензии, тяжелых нарушениях мозгового кровообращения, нарушениях функции печени и/или почек, гемодиализе (риск возникновения артериальной гипотензии); одновременно с бета-адреноблокаторами, сердечными гликозидами, рифампицином; у пациентов пожилого возраста."]}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Назначение препарата Кордипин ХЛ в I триместре беременности противопоказано. Во II и III триместрах применение возможно только в том случае, если предполагаемая польза терапии для матери, превышает потенциальный риск для плода. Нифедипин выделяется с грудным молоком, поэтому при необходимости применения препарата в период лактации следует прекратить грудное вскармливание."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Устанавливают индивидуально. Препарат назначают в средней дозе 40 мг (1 таб.) 1 раз/сут как в начале терапии, так и при продолжительном лечении. При необходимости дозу увеличивают до максимальной - 80 мг (2 таб.)/сут в 1 или 2 приема. В случае пропуска приема очередной дозы препарата, при следующем приеме не следует удваивать дозу. Препарат следует принимать после еды. Таблетки принимают целиком, не разламывая и не разжевывая, запивая стаканом воды."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны сердечно-сосудистой системы: проявления чрезмерной вазодилатации (бессимптомное снижение АД, приливы крови к коже лица, гиперемия кожи лица, чувство жара), тахикардия, сердцебиение, аритмия, периферические отеки, развитие или усугубление сердечной недостаточности (чаще усугубление уже имевшейся), загрудинные боли; редко - чрезмерное снижение АД, обморок; в отдельных случаях (особенно в начале лечения) - приступы стенокардии (требуется отмена препарата); в единичных случаях – инфаркт миокарда. Со стороны ЦНС и периферической нервной системы: головная боль, головокружение, повышенная утомляемость, слабость, сонливость; при длительном применении в высоких дозах - парестезии в конечностях, депрессия, чувство тревоги, экстрапирамидные (паркинсонические) нарушения (атаксия, маскообразное лицо, шаркающая походка, скованность движений рук и ног, тремор кистей и пальцев рук, затрудненное глотание). Со стороны пищеварительной системы: сухость во рту, снижение аппетита, диспепсия (тошнота, диарея или запор); редко - гиперплазия десен (кровоточивость, болезненность, отечность); при длительном приеме - нарушения функции печени (внутрипеченочный холестаз, повышение активности печеночных трансаминаз). Со стороны органов кроветворения: анемия, бессимптомный агранулоцитоз, тромбоцитопения, тромбоцитопеническая пурпура, лейкопения. Со стороны костно-мышечной системы: артрит; редко - артралгия, отечность суставов, миалгия, судороги верхних и нижних конечностей. Со стороны мочевыделительной системы: увеличение суточного диуреза, ухудшение функции почек (у пациентов с почечной недостаточностью). Со стороны дыхательной системы: редко - затруднение дыхания, кашель; очень редко - отек легких, бронхоспазм. Со стороны органов чувств: очень редко - нарушение зрения (в т. ч. транзиторная слепота при максимальной концентрации нифедипина в плазме крови). Со стороны эндокринной системы: очень редко - гинекомастия (у пациентов пожилого возраста, полностью исчезает после отмены препарата), галакторея. Со стороны обмена веществ: очень редко - гипергликемия, увеличение массы тела. Аллергические реакции: редко - кожный зуд, эксфолиативный дерматит; очень редко - аутоиммунный гепатит. Дерматологические реакции: редко - экзантема, фотодерматоз."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: препарат вызывает периферическую вазодилатацию с выраженной и, возможно, пролонгированной артериальной гипотензией: головная боль, гиперемия кожи лица, длительное выраженное снижение АД, угнетение деятельности синусового узла, брадикардия и/или тахикардия, брадиаритмия. При тяжелом отравлении - потеря сознания, кома. Лечение: стандартные меры, направленные на выведение препарата из организма (назначение активированного угля, промывание желудка), стабилизацию показателей гемодинамики; тщательный контроль деятельности сердца, легких и выделительной системы. Антидотом являются препараты кальция. Показано в/в введение 10% раствора кальция хлорида или кальция глюконата, с последующим переключением на длительную инфузию. Вследствие высокой степени связывания с белками плазмы крови, гемодиализ не эффективен. Рекомендуется контролировать содержание глюкозы в крови (может снижаться высвобождение инсулина) и электролитов (калия, кальция). Клиренс нифедипина увеличивается у пациентов с недостаточностью функции печени."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Прекращать лечение препаратом Кордипин ХЛ рекомендуется постепенно. Следует иметь в виду, что в начале лечения возможно развитие стенокардии, особенно после недавней резкой отмены бета-адреноблокаторов (последние следует отменять постепенно). Одновременное назначение бета-адреноблокаторов необходимо проводить под тщательным врачебным контролем, поскольку при этом возможно чрезмерное снижение АД, а в некоторых случаях - усугубление симптомов сердечной недостаточности. Диагностическими критериями для назначения препарата при ангиоспастической стенокардии являются: классическая клиническая картина, сопровождающаяся повышением сегмента ST, возникновение эргоновин-индуцированной стенокардии или спазма коронарных артерий, выявление коронароспазма при ангиографии или выявление ангиоспастического компонента без подтверждения (например, при разном пороге напряжения или при нестабильной стенокардии, когда данные ЭКГ свидетельствуют о преходящем ангиоспазме). Для пациентов с тяжелой обструктивной кардиомиопатией существует риск увеличения частоты, тяжести проявления и продолжительности приступов стенокардии после приема нифедипина; в данном случае необходима отмена препарата. У пациентов, находящихся на гемодиализе, с высоким АД и необратимой почечной недостаточностью с уменьшенным ОЦК препарат следует применять с осторожностью, т.к. может произойти резкое падение АД. Следует тщательно контролировать состояние пациентов с нарушением функции печени и при необходимости уменьшить дозу препарата и/или применять другие лекарственные формы нифедипина. Если во время терапии пациенту требуется провести хирургическое вмешательство под общей анестезией, необходимо информировать врача-анестезиолога о характере проводимой терапии. Во время лечения возможны положительные результаты при проведении прямой реакции Кумбса и лабораторных тестов на антинуклеарные антитела. С осторожностью следует назначать препарат одновременно с дизопирамидом и флекаинамидом. Влияние на способность к вождению автотранспорта и управлению механизмамиУ некоторых пациентов, особенно в начале лечения, препарат может вызвать головокружение, что снижает способность к управлению автомобилем или другими механизмами. 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