Kordafen
Kordafen: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Cordafen
ATX code: C08CA05
Active ingredient: nifedipine (nifedipine)
Manufacturer: Pharmaceutical Works POLPHARMA, SA (Poland)
Description and photo update: 2018-25-10
Cordafen is a slow calcium channel blocker.
Release form and composition
Kordafen is available in the form of film-coated tablets: round, biconvex, yellow (25 pieces in blisters, 2 blisters in a cardboard box).
1 tablet contains:
- active substance: nifedipine - 10 mg;
- auxiliary components: lactose, potato starch, magnesium stearate, microcrystalline cellulose, talc, gelatin;
- shell composition: macrogol 6000, hypromellose, titanium dioxide, propylene glycol, quinoline yellow varnish (E104), talc.
Pharmacological properties
Pharmacodynamics
The active substance of Cordafen, nifedipine, is a derivative of 1,4-dihydropyridine, a selective blocker of slow calcium channels. It has vasodilating, antianginal and antihypertensive activity. The mechanism of action of nifedipine is aimed at reducing the flow of calcium ions into the smooth muscle cells of arteries (including peripheral and coronary) and cardiomyocytes. High doses of the drug inhibit the release of calcium ions from intracellular stores. By reducing the number of functioning channels, it does not affect the period of their activation, inactivation or restoration. Acting on the processes of excitation and contraction, mediated by tropomyosin and troponin in the myocardium, and calmodulin - in the smooth muscles of the vessels, it disconnects them. Therapeutic doses of the drug normalize,caused by arterial hypertension and other pathological conditions, a violation of the transmembrane movement of calcium ions. Does not affect the tone of the veins. Strengthening the coronary blood flow, it helps to improve the blood supply to the ischemic zones of the myocardium, without causing the development of the phenomenon of "stealing". Activates the functioning of collaterals. Expands peripheral vessels (mostly arterial), lowering their total resistance, afterload, myocardial tone and oxygen demand, increases the period of diastolic relaxation of the left ventricle. Has almost no effect on the sinoauricular and atrioventricular nodes, has no antiarrhythmic activity. The action of the drug affects the renal blood flow, increasing it. Causes moderate natriuresis. Negative foreign,dromo- and chronotropic action is compensated by reflex activation of the sympathoadrenal system and a response increase in heart rate to peripheral vasodilation.
After oral administration, the therapeutic effect occurs in 1/3 hour and lasts for 4-6 hours.
Pharmacokinetics
Almost complete (more than 90%) absorption of nifedipine occurs in the gastrointestinal tract. The bioavailability of the drug is 40–70%.
During the first passage through the liver, 40-60% of the dose taken is intensively metabolized. The maximum concentration of nifedipine in blood plasma after oral administration of 10 mg is achieved in 0.5-1 hour.
The half-life is 2-4 hours.
Binding to albumin (blood plasma proteins) - 94–97%.
Nifedipine crosses the placental barrier and is excreted in breast milk. Less than 5% of the dose is passed through the blood-brain barrier. Nifedipine is metabolized to a greater extent to three metabolites that have no pharmacological activity.
Approximately 60-80% of the drug is excreted through the kidneys with urine, the rest through the bile ducts, with feces.
Indications for use
- prevention of attacks with vasospastic angina (Prinzmetal's angina) and other forms of angina in patients with ischemic heart disease;
- arterial hypertension - monotherapy or in combination with other antihypertensive drugs.
Contraindications
- arterial hypotension (systolic blood pressure less than 90 mm Hg);
- chronic heart failure in the stage of decompensation;
- cardiogenic shock, collapse;
- sick sinus syndrome;
- severe aortic stenosis;
- unstable angina;
- the period of the first 4 weeks after myocardial infarction;
- lactose intolerance;
- age up to 18 years;
- The first 20 weeks of pregnancy;
- lactation period;
- hypersensitivity to dihydropyridine derivatives;
- individual intolerance to the components of the drug.
Caution should be exercised when prescribing Cordafen to patients with severe stenosis of the aortic orifice or mitral valve, severe bradycardia and tachycardia, hypertrophic obstructive cardiomyopathy, with myocardial infarction with left ventricular failure, malignant arterial hypertension, concomitant use of beta-adrenergic blockers, or cardiac arrest (including patients on hemodialysis), impaired liver function, severe cerebrovascular accidents, in old age.
Instructions for the use of Kordafen: method and dosage
Cordafen tablets are taken orally, swallowed whole and washed down with a sufficient amount of liquid, regardless of the meal.
Recommended dosage: initial dose - 1 pc. 3 times a day. If it is necessary to achieve the desired therapeutic effect, a single dose can be increased to 2 pcs. and take it 2 times a day, carefully monitoring blood pressure (BP). The maximum daily dose should not exceed 4 pcs. (With 40 mg).
Patients on combination (antianginal or antihypertensive) therapy, with impaired liver function, severe cerebrovascular accidents or in old age, should be prescribed Cordafen in lower doses.
If the clinical condition of the patient requires the use of higher doses of nifedipine, prolonged-acting drugs should be used for the appointment.
Side effects
- on the part of the cardiovascular system: the development of excessive vasodilation (asymptomatic lowering of blood pressure, flushing of the skin of the face, aggravation or development of heart failure, a feeling of heat, flushing of the skin of the face), palpitations, tachycardia, arrhythmia, peripheral edema, chest pain; rarely - an excessive decrease in blood pressure, fainting; possibly - angina attacks requiring discontinuation of the drug (more often at the beginning of treatment); isolated cases - myocardial infarction;
- from the hematopoietic organs: asymptomatic agranulocytosis, anemia, thrombocytopenia, leukopenia, thrombocytopenic purpura;
- from the central nervous system: weakness, headache, increased fatigue, drowsiness, dizziness; against the background of long-term oral therapy in high doses - depression, paresthesia of the extremities, anxiety, extrapyramidal disorders (mask-like face, ataxia, constrained movements of the arms and legs, shuffling gait, tremors of the fingers and hands, difficulty swallowing);
- on the part of the immune system: rarely - itchy skin, exanthema, urticaria, photodermatitis, exfoliative dermatitis; very rarely - autoimmune hepatitis;
- from the digestive system: dry mouth, dyspepsia (nausea, diarrhea or constipation), increased appetite; rarely - gingival hyperplasia (soreness, swelling, bleeding), against the background of long-term use - intrahepatic cholestasis, an increase in the activity of liver enzymes;
- on the part of the urinary system: an increase in daily urine output, with renal failure - a deterioration in renal function;
- on the part of the musculoskeletal system: arthritis; rarely - joint swelling, cramps of the upper and lower extremities, arthralgia, myalgia;
- others: rarely - cough, difficulty breathing; very rarely - visual impairment, including transient blindness at the maximum concentration of nifedipine in the blood plasma, bronchospasm, galactorrhea, pulmonary edema, hyperglycemia, weight gain, in elderly patients - transient gynecomastia.
Overdose
Symptoms: facial flushing, headache, bradycardia, bradyarrhythmia, marked lowering of blood pressure for a long time, suppression of sinus node function, collapse.
Treatment: in case of depression of the sinus node, collapse - gastric lavage, intake of activated carbon. The antidote is calcium ion preparations - a 10% solution of calcium chloride or calcium gluconate, which are slowly injected intravenously (IV) followed by a long infusion. With a pronounced decrease in blood pressure, intravenous administration of dobutamine or dopamine is indicated. In case of conduction disturbance - isoprenaline, atropine, if necessary, use an artificial pacemaker. With the development of heart failure, strophanthin should be administered intravenously. The use of catecholamines is indicated only in a condition that threatens the patient's life. This is due to their low efficiency, requiring the use of high doses of the drug, which increase the risk of arrhythmia. It is necessary to monitor laboratory indicators of the concentration level in blood plasma glucose,potassium and calcium. Hemodialysis is ineffective.
special instructions
It is possible that the symptoms of coronary heart disease may increase up to the development of acute myocardial infarction, therefore, at the beginning of use and with an increase in the dose of the drug, the patient's condition should be monitored.
When prescribing nifedipine, previously used beta-blockers should not be abruptly canceled, since this can cause an increase in the symptoms of myocardial ischemia.
It is necessary to take Cordafen with caution in case of heart failure, aortic stenosis, especially against the background of concomitant therapy with beta-blockers. Nifedipine can accelerate the onset of heart failure or aggravate existing symptoms, including the appearance of peripheral edema.
Regular careful monitoring of blood pressure is required, especially at the beginning of treatment and after increasing the dose of Cordafen, since nifedipine can cause severe hypotension.
Long-term use of nifedipine can lead to an increase in the symptoms of coronary heart disease, the development of myocardial infarction, and an increase in mortality in patients with chronic ischemic heart disease or arterial hypertension.
The use of Cordafen is indicated for patients with resistance or intolerance to organic nitrates.
When carrying out a surgical intervention requiring the use of general anesthesia drugs, the anesthesiologist must be informed about the nature of the therapy.
Due to the risk of arterial hypotension, it is recommended to take Kordafen with caution to patients on hemodialysis.
Influence on the ability to drive vehicles and complex mechanisms
Against the background of the use of Kordafen, a decrease in the speed of psychomotor reactions is possible, especially at the beginning of treatment, this must be taken into account when performing potentially hazardous activities, including the management of various types of transport.
Application during pregnancy and lactation
According to the instructions, Kordafen is not recommended to be prescribed during the first 20 weeks of pregnancy.
The appointment of nifedipine at a later stage of the gestation period is possible only in special cases, when the expected therapeutic effect of therapy for the mother exceeds the potential threat to the fetus.
The use of Kordafen during breastfeeding is contraindicated.
If it is necessary to prescribe nifedipine during lactation, it is recommended to stop breastfeeding.
Pediatric use
The appointment of Cordafen for the treatment of children under the age of 18 is contraindicated due to the lack of data on the safety and effectiveness of its use.
With impaired renal function
Care should be taken when prescribing Cordafen to patients with impaired renal function.
The dose of the drug should be adjusted according to the degree of renal impairment.
For violations of liver function
Cordafen should be used with caution in patients with impaired liver function, the dose should be prescribed less than the recommended dose.
Use in the elderly
It is recommended to use Cordafen with caution for the treatment of elderly patients.
A dose lower than the recommended dose is required.
Drug interactions
With the simultaneous use of Kordafen:
- antihypertensive drugs, nitrates, cimetidine, ranitidine, inhalation anesthetics, tricyclic antidepressants increase the severity of lowering blood pressure;
- quinidine lowers its level of concentration in blood plasma; it should be borne in mind that its sharp increase can occur when nifedipine is canceled;
- amiodarone and quinidine enhance their negative inotropic effect, which lowers the force of heart contraction;
- digoxin, theophylline can increase their plasma content, therefore, monitoring of the clinical effect and the level of their concentration in the blood plasma is required;
- sympathomimetics, non-steroidal anti-inflammatory drugs, estrogens help to reduce the antihypertensive effect of the drug;
- rifampicin and other inducers of microsomal liver enzymes lower the concentration of nifedipine;
- calcium preparations cause a decrease in the therapeutic effect of nifedipine;
- nitrates increase tachycardia;
- quinine, salicylates, indirect anticoagulants (derivatives of indandione and coumarin), sulfinpyrazone, anticonvulsants, non-steroidal anti-inflammatory drugs and other drugs, which are characterized by a high degree of protein binding, can significantly increase their blood plasma levels;
- prazosin and other alpha-blockers lower their metabolism, increasing the risk of increased hypotensive effect;
- lithium preparations increase the toxic effect;
- vincristine slows down its excretion from the body, possibly increasing its side effects;
- drugs that cause prolongation of the QT interval (including quinidine, procainamide) increase the risk of significant prolongation of the QT interval;
- grapefruit juice inhibits the metabolic processes of nifedipine in the body, so the combination with it is contraindicated.
Analogs
Analogs of Cordafen are: Adalat, Depin-E, Corinfar, Anifed, Nifedipine, Vero-Nifedipine, Hypernal, Zenusin, Cordaflex, Nifedikor, Nicardia, Cordipin, Nifebene, Calcigard, Nifedex, Nifegexon, Nifianecidon Ekodipine, Sanfidipine.
Terms and conditions of storage
Keep out of the reach of children.
Store at temperatures up to 25 ° C in a dark place.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Kordafen
Reviews about Kordafen are mostly positive. Compared with many other previously taken antihypertensive drugs, patients report a rapid and effective action of the drug. Regular intake of pills helps stabilize blood pressure in hypertension.
Price for Cordafen in pharmacies
The price of Kordafen for one package can be from 64 rubles.
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
