Антиаритмический препарат класса IС, блокирует быстрые натриевые каналы.; Обладает слабой β-адреноблокирующей активностью (соответствует примерно 1/40 части активности пропранолола) и м-холиноблокирующим эффектом. Антиаритмический эффект основывается на местноанестезирующем и прямом мембраностабилизрующем действии на миокардиоциты, а также на блокаде адренергических β-адренорецепторов и кальциевых каналов.; Местноанестезирующее действие приблизительно соответствует активности прокаина .; Пропафенон, блокируя быстрые натриевые каналы, вызывает дозозависимое снижение скорости деполяризации и угнетает фазу 0 потенциала действия и его амплитуду в волокнах Пуркинье и сократительных волокнах желудочков, угнетает автоматизм. Замедляет проведение по волокнам Пуркинье. Удлиняет время проведения по синоатриальному узлу и предсердиям. При применении пропафенона происходит удлинение интервала PQ и расширение комплекса QRS (от 15 до 25) на ЭКГ, а также интервалов АН и HV на гисограмме. Замедляя проведение, препарат удлиняет эффективный рефрактерный период в предсердиях, AV-узле, дополнительных пучках, и, в меньшей степени, желудочках. Не наблюдается каких-либо значительных изменений интервала QT. Электрофизиологические эффекты более выражены в ишемизированном, чем в нормальном миокарде. Оказывает отрицательное инотропное действие, которое обычно проявляется при снижении фракции выброса левого желудочка ниже 40%.; Действие препарата начинается через 1 ч после приема внутрь, достигает максимума через 2-3 ч и длится 8-12 ч.
Показания к применению
Профилактика и лечение наджелудочковых и желудочковых экстрасистолий.
Профилактика и лечение пароксизмальных нарушений ритма (наджелудочковые - фибрилляция и трепетание предсердий , синдром Вольфа-Паркинсона-Уайта).
Профилактика и лечение предсердно-желудочковой re-entry тахикардии.
Тяжелые формы хронической сердечной недостаточности (в стадии декомпенсации), неконтролируемая хроническая сердечная недостаточность.
Кардиогенный шок (за исключением артериальной гипотензии, обусловленной тахикардией, и антиаритмического шока).
Выраженная брадикардия.
Выраженная артериальная гипотензия.
Синоатриальная блокада, нарушение внутрипредсердного проведения.
Блокада ножек пучка Гиса.
Внутрижелудочковая бифасцикулярная блокада и AV-блокада II и III степени (без установки электрокардиостимулятора).
СССУ .
Синдром "тахикардии-брадикардии".
Инфаркт миокарда.
Период лактации (грудного вскармливания).
Детский и подростковый возраст до 18 лет (эффективность и безопасность не установлены).
Интоксикация дигоксином .
Повышенная чувствительность к компонентам препарата.
С осторожностью следует назначать препарат в следующих случаях: ХОБЛ.
Миастения (в т.ч миастения gravis).
Сердечная недостаточность (фракция выброса менее 30%).
Кардиомиопатия.
Артериальная гипотензия.
Печеночный холестаз.
Печеночная и/или почечная недостаточность.
Электролитные нарушения (должны быть обязательно скорректированы до назначения пропафенона).
Пациенты в возрасте старше 70 лет.
Пациенты с постоянным или временным электрокардиостимулятором.
Одновременное назначение с другими антиаритмическими средствами аналогичного действия.
Применение при беременности и в период грудного вскармливания
Применение пропафенона при беременности, особенно в I триместре, возможно только в том случае, когда ожидаемая польза для матери превышает потенциальный риск для плода.
Побочное действие
Со стороны сердечно-сосудистой системы; Брадикардия , AV-диссоциация, желудочковые тахиаритмии, стенокардия, ухудшение течения сердечной недостаточности (у больных со сниженной функцией левого желудочка), синоатриальная блокада, AV-блокада, нарушения внутрижелудочковой проводимости, наджелудочковые тахиаритмии, при приеме в высоких дозах - Ортостатическая гипотензия .; ; Со стороны пищеварительной системы; Изменение вкуса, сухость во рту, горечь во рту, тошнота, снижение аппетита, чувство тяжести в эпигастрии, запор или диарея; редко - нарушения функции печени, холестатическая желтуха , холестаз.; ; Со стороны ЦНС; Головная боль, Головокружение ; редко - нечеткость зрения, диплопия, судороги.; ; Со стороны системы кроветворения; Лейкопения, агранулоцитоз, увеличение времени кровотечения , тромбоцитопения, появление антинуклеарных антител.; ; Со стороны половой системы; Олигоспермия, снижение потенции.; ; Аллергические реакции; Кожная сыпь, зуд, экзантема, покраснение кожи, крапивница, волчаночноподобный синдром.; ; Прочие; Слабость, бронхоспазм, геморрагические высыпания на коже.
Передозировка
При одномоментном приеме дозы, в 2 раза превышающей суточную, симптомы интоксикации могут появляться через 1 ч, максимум - через несколько часов.; Симптомы: стойкое снижение АД, тошнота, рвота, сухость во рту, Мидриаз , сонливость, Экстрапирамидные синдромы , спутанность сознания, брадикардия, удлинение интервала QT, нарушения внутрипредсердной и внутрижелудочковой проводимости, желудочковые тахиаритмии, пароксизмы полиморфной желудочковой тахикардии, синоатриальная блокада, AV-блокада, асистолия, Кома , судороги, делирий, отек легких.; Лечение: промывание желудка, дефибрилляция, введение добутамина , диазепама ; при необходимости - ИВЛ и непрямой массаж сердца. Гемодиализ неэффективен.
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