Diltiazem Lannacher
Diltiazem Lannacher: 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: Diltiazem Lannacher
ATX code: C08DB01
Active ingredient: diltiazem (Diltiazem)
Manufacturer: GLPHARMA (Austria)
Description and photo updated: 2018-29-11
Prices in pharmacies: from 113 rubles.
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Diltiazem Lannacher is a drug that has hypotensive, antianginal and antiarrhythmic effects.
Release form and composition
Dosage form - tablets of prolonged action, film-coated: round, biconvex, white; the cross section shows a white core (10 pcs. in blisters, in a cardboard box 2 blisters with 90 mg tablets or 3 blisters with 180 mg tablets and instructions for use of Diltiazem Lannacher).
Composition of 1 tablet:
- active substance: diltiazem hydrochloride - 90 or 180 mg;
- auxiliary components: magnesium stearate, hypromellose 5 mPa * s, lactose monohydrate, copolymer of methacrylic acid and ethyl acrylate (1: 1), copolymer of methyl methacrylate and ethyl acrylate (2: 1), copolymer of methyl methacrylate, trimethylammonioethyl: 2: ethyl methacrylate (0) chloride and 1 1);
- film shell: copolymer of methyl methacrylate and ethyl acrylate (2: 1), titanium dioxide, hypromellose 5 mPa * s, macrogol 6000, talc.
Pharmacological properties
Pharmacodynamics
The active ingredient of Diltiazem Lannacher - diltiazem hydrochloride, is a slow calcium channel blocker (BMCC), a benzothiazepine derivative with antiarrhythmic, antihypertensive and antianginal properties.
The main effects of Diltiazem Lannacher:
- a decrease in the intracellular content of calcium ions in cardiomyocytes and smooth muscle cells;
- expansion of coronary and peripheral arteries and arterioles;
- increased coronary, cerebral and renal blood flow;
- a decrease in the tone of smooth muscles;
- decrease in total peripheral vascular resistance (OPSS);
- decrease in heart rate (HR).
The antiarrhythmic effect of diltiazem is explained by its ability to suppress the transport of ionized calcium in the heart tissues, as a result of which the effective refractory period increases and the conduction time in the atrioventricular (AV) node is lengthened. This effect is of particular clinical importance for patients with sick sinus syndrome and the elderly, since blockage of calcium channels in them can interfere with the generation of impulses in the sinus node and cause sinoatrial blockade. Normal atrial action potential and intraventricular conduction do not change (changes in normal sinus rhythm are usually not observed), however, with a decrease in the amplitude of atrial contraction, the conduction velocity and depolarization rate decrease. It is possible to shorten the anterograde effective refractory period in additional bypass beams.
The antihypertensive effect of Diltiazem Lannacher develops as a result of dilatation of resistive vessels and a decrease in OPSS. The degree of decrease in blood pressure (BP) is associated with its baseline value (in normotonics, the effect on blood pressure is minimal). The drug lowers blood pressure while lying down and standing.
Diltiazem Lannacher rarely causes postural arterial hypotension and reflex tachycardia. The maximum heart rate does not change or decreases slightly.
Diltiazem improves diastolic relaxation of the myocardium in arterial hypertension, ischemic heart disease (CHD) and hypertrophic obstructive cardiomyopathy. Reduces the renal and peripheral effects of angiotensin II. Reduces platelet aggregation. With prolonged use, Diltiazem Lannacher does not cause the development of hypercatecholaminemia, does not increase the activity of the renin-angiotensin-aldosterone system (RAAS).
The antianginal effect develops due to the expansion of peripheral vessels and a decrease in systemic blood pressure (afterload), due to which the tension of the myocardial wall decreases, and its oxygen demand decreases.
When diltiazem is used in doses that do not cause the development of a negative inotropic effect, Diltiazem Lannacher promotes relaxation of the smooth muscles of the coronary vessels, dilatation of large and small arteries.
Diltiazem has a minimal effect on the smooth muscles of the gastrointestinal tract. Does not affect blood lipid profile. With prolonged use (within 8 months) does not cause the development of tolerance.
In arterial hypertension, the drug can cause regression of left ventricular hypertrophy.
The action of Diltiazem Lannacher begins 2–3 hours after administration and lasts for 12–14 hours. The maximum antihypertensive effect develops within 2 weeks.
Pharmacokinetics
Once in the gastrointestinal tract, diltiazem is absorbed quickly and almost completely. The maximum plasma concentration (C max) reaches after 6-14 hours. Plasma proteins bind 70-80% of the substance (of which 35-40% - with albumin). Penetrates into breast milk.
Undergoes intensive metabolism in the liver (with the participation of isoenzymes CYP3A5, CYP3A4, CYP3A7) by demethylation and deacetylation, as a result of which the active metabolite deacetyldyltiazem is formed, the plasma concentration of which is 5-10 less than the concentration of diltiazem, and the activity is 2-4 times lower.
The half-life (T 1/2) of diltiazem occurs in two phases: the first is 20-30 minutes, the second is 3.5 hours (with high and repeated doses - 5-8 hours). T 1/2 of diltiazem in the composition of prolonged-release tablets Diltiazem Lannacher is up to 10 hours.
Excretion of the drug: with bile - 65%, through the kidneys - 35%, of which 2-4% unchanged.
With prolonged use, the pharmacokinetics of diltiazem does not change. The drug does not induce its own metabolism and does not cumulate.
In elderly patients, a decrease in the clearance of diltiazem is possible.
With hepatic failure, the bioavailability of the drug and its T 1/2 increase.
In patients with impaired renal function and angina pectoris, the pharmacokinetics of diltiazem does not change. The drug is not excreted during hemodialysis and peritoneal dialysis.
Indications for use
- treatment of arterial hypertension;
- prevention of angina attacks, including Prinzmetal's angina;
- prevention of attacks of supraventricular arrhythmias (atrial fibrillation or flutter, paroxysmal tachycardia, extrasystole).
Contraindications
Absolute:
- severe arterial hypotension (systolic blood pressure less than 90 mm Hg);
- wide-complex ventricular tachycardia;
- decompensated chronic heart failure;
- acute heart failure;
- sick sinus syndrome without the use of an artificial pacemaker;
- severe bradycardia;
- sinoatrial and AV blockade of II and III degrees (except for patients with a pacemaker);
- myocardial infarction with signs of left ventricular failure;
- cardiogenic shock;
- Laun-Ganong-Levin syndrome in combination with atrial flutter or fibrillation (with the exception of patients with a pacemaker);
- Wolff-Parkinson-White syndrome;
- lactose intolerance, lactase deficiency and glucose-galactose malabsorption;
- age up to 18 years;
- period of pregnancy and lactation;
- hypersensitivity to any component of the drug or other benzodiazepine derivatives.
Relative (Diltiazem Lannacher tablets should be used with caution):
- acute phase of myocardial infarction (without signs of left ventricular failure);
- AV blockade I degree or lengthening of the PQ interval;
- mild to moderate degree of arterial hypotension;
- hypertrophic obstructive cardiomyopathy;
- severe aortic stenosis;
- compensated chronic heart failure;
- tendency to bradycardia;
- simultaneous use of beta-blockers or digoxin;
- acute porphyria;
- severe violations of liver and kidney function;
- elderly age.
Diltiazem Lannacher, instructions for use: method and dosage
Diltiazem Lannacher tablets should be taken orally, before meals, swallowed whole with a sufficient amount of liquid.
The optimal dose is selected by the doctor depending on individual characteristics.
At the beginning of therapy, 1 tablet of 90 mg is usually prescribed 2 times a day. Correction of the regimen is carried out no earlier than 2 weeks later.
The average maintenance dose can vary from 180 to 270 mg. The maximum daily dose should not exceed 360 mg.
With long-term treatment with a good therapeutic effect, the doctor may reduce the dose of Diltiazem Lannacher.
Side effects
- allergic reactions: facial flushing, skin rash, itching, increased photosensitivity, exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome;
- on the part of the cardiovascular system: arrhythmia (including flickering and fluttering of the ventricles), a marked decrease in blood pressure, redness of the skin, ventricular premature beats, shortness of breath, angina pectoris, sinoauricular block, tachycardia, bradycardia, peripheral edema, heart fainting, chronic AV block up to asystole; when using Diltiazem Lannacher in high doses - bradycardia, angina pectoris, AV block;
- from the nervous system: increased fatigue, asthenia, general weakness, headache, insomnia, drowsiness, dizziness, extrapyramidal disorders, anxiety, a state of pathological fear, depression, parkinsonism (mask-like face, difficulty swallowing, trembling of hands and fingers, ataxia, stiffness hands or feet, shuffling gait); when using Diltiazem Lannacher in high doses - paresthesia;
- from the digestive system: dry mouth, hypertrophic gingivitis, abdominal pain, heartburn, nausea, increased appetite, diarrhea, constipation, vomiting, intestinal obstruction, liver dysfunction, hypercreatininemia;
- on the part of the organ of vision: transient blindness;
- others: peripheral edema, an increase in the concentration of liver enzymes in the blood serum; when using the drug in high doses - an increase in body weight, agranulocytosis, thrombocytopenia, pulmonary edema (cough, difficulty breathing, stridorous breathing), galactorrhea.
In case of abrupt withdrawal of Diltiazem Lannacher, withdrawal syndrome, arterial hypertension, tachycardia, as well as worsening of the course of angina pectoris, may develop.
Overdose
Symptoms: nausea, vomiting, hyperkalemia, metabolic acidosis, asystole, bradycardia, impaired atrioventricular and sinoatrial conduction, a pronounced decrease in blood pressure, turning into collapse, heart failure, cardiogenic shock.
After taking an excessive dose of Diltiazem Lannacher, you should wash your stomach and take activated charcoal. Further treatment of an overdose is symptomatic, depending on the severity of its manifestations. Give atropine, dopamine, dobutamine, or isoprenaline as needed. In case of severe conduction disturbances, it may be necessary to conduct pacing. Hemodialysis and peritoneal dialysis are not effective.
special instructions
Diltiazem reduces OPSS and can cause the development of secondary arterial hypotension, therefore, at the beginning of treatment, before specifying the optimal therapeutic dose, blood pressure should be carefully monitored.
With the simultaneous use of beta-blockers, drug treatment should be carried out under the supervision of a cardiologist.
In patients with bradycardia and grade I AV block, diltiazem is used with extreme caution, since it reduces myocardial conductivity. Caution is also required when treating patients with impaired left ventricular function.
If it is necessary to carry out a planned surgical intervention using general anesthesia, the patient should warn the anesthesiologist about taking Diltiazem Lannacher.
If persistent rashes appear on the skin that develop into exfoliative dermatitis or erythema multiforme, Diltiazem Lannacher should be canceled.
During the period of therapy, it is recommended to refrain from drinking alcoholic beverages.
Influence on the ability to drive vehicles and complex mechanisms
Diltiazem Lannacher can cause side effects that can affect concentration and reaction speed, which must be taken into account by vehicle drivers and persons employed in potentially hazardous industries.
Application during pregnancy and lactation
It is contraindicated to take BMCC during pregnancy and lactation.
Women of reproductive age should exclude pregnancy before taking the pills.
Pediatric use
Diltiazem Lannacher is not used in children and adolescents (up to 18 years), since the efficacy and safety of its use in patients of this age category have not been established.
With impaired renal function
Diltiazem Lannacher is used with caution in renal failure. A dose reduction is required. Treatment should be monitored for urinary urea.
For violations of liver function
Diltiazem Lannacher is used with caution in severe hepatic impairment. The maximum daily dose is 90 mg. Treatment should be carried out under close monitoring of liver function.
Use in the elderly
In old age, Diltiazem Lannacher is used with caution. Due to the likelihood of an increase in the half-life of diltiazem, the doctor selects an adequate dose individually.
Drug interactions
- antihypertensive drugs, antipsychotics (neuroleptics), ethanol: the hypotensive effect is enhanced;
- phenytoin, estrogens, glucocorticosteroids, nonsteroidal anti-inflammatory drugs (including indomethacin), sympathetic drugs: the hypotensive effect of diltiazem decreases;
- digoxin: its concentration in the blood may increase;
- salicylates: increased inhibition of the ability to aggregate platelets;
- adenosine: the risk of developing prolonged bradycardia increases;
- quinidine, procainamide and other drugs that can prolong the QT interval: the likelihood of a significant lengthening of the QT interval increases;
- general anesthetics: their cardiodepressant effect is enhanced;
- inhalation anesthetics (hydrocarbon derivatives), thiazide diuretics and other drugs that can lower blood pressure: the hypotensive effect of diltiazem is enhanced;
- lithium preparations: it is possible to increase the neurotoxic effect of diltiazem (ataxia, tinnitus, trembling, diarrhea, nausea, vomiting);
- antiarrhythmics, cardiac glycosides, beta-blockers: possible violation of AV conduction, the development of bradycardia, the appearance of symptoms of heart failure;
- nifedipine: its excretion decreases and plasma concentration increases;
- oral hypoglycemic agents (for example, chlorpropamide, glipizide): their effect is enhanced;
- propranolol: an increase in its bioavailability is possible;
- rifampicin, diazepam, phenobarbital: the plasma concentration of diltiazem decreases;
- moracizine, quinidine, valproic acid: their concentration in the blood increases;
- cimetidine: the metabolism of diltiazem in the liver is weakened and its excretion slows down, as a result of which the duration of its action increases;
- ritonavir: may increase the plasma concentration of diltiazem;
- midazolam: its metabolism is inhibited, plasma concentration increases, as a result of which the sedative effect is enhanced;
- lovastatin, simvastatin: their plasma concentrations significantly increase, and the effect is enhanced (dose adjustment is required, as well as careful monitoring of the patient's condition for the possible development of myositis or rhabdomyolysis);
- cyclosporine: in patients with a transplanted kidney, intoxication and paresthesia may develop (intensive monitoring of the concentration of the drug in the blood plasma is necessary);
- theophylline, carbamazepine: their plasma concentrations increase (by 40–70%), the risk of side effects increases, including headache, ataxia, confusion, diplopia, nystagmus, vomiting;
- digoxin, imipramine, cyclosporine, lithium preparations: their concentration in the blood increases.
Simultaneous food intake by 20-30% increases the absorption and bioavailability of diltiazem.
If necessary, Diltiazem Lannacher can be used in combination with nitrates (including prolonged forms).
Analogs
Analogues of Diltiazem Lannacher are: Adalat, Amlovas, Amlodak, Amlodipine, Amlodipharm, Verapamil, Diltiazem, Isoptin, Kalchek, Corvadil, Corinfar, Latsipil, Nifedipin, Norvask, Normodipin, Osmo-Adalat, Stamlo Korinfar, Fgelordi …
Terms and conditions of storage
Keep out of reach of children at temperatures up to 30 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews of Diltiazem Lannacher
Reviews of Diltiazem Lannacher are positive: the drug is effective when used according to indications, is well tolerated and does not cause adverse reactions. Patients consider the correct selection of a maintenance dose to be the main condition for the effectiveness of therapy. Only the presence of a large list of contraindications is referred to a negative point.
Price for Diltiazem Lannacher in pharmacies
Approximate prices for Diltiazem Lannacher: 20 tablets of 90 mg - 145 rubles, 30 tablets of 180 mg - 312 rubles.
Diltiazem Lannacher: prices in online pharmacies
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Drug name Price Pharmacy |
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Diltiazem Lannacher 90 mg film-coated tablets of prolonged action 20 pcs. 113 RUB Buy |
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Diltiazem Lannacher tablets p.p. prolonged action 90mg 20 pcs. 143 r Buy |
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Diltiazem Lannacher 180 mg film-coated tablets of prolonged action 30 pcs. 234 r Buy |
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Diltiazem Lannacher tablets p.p. prolonged action 180mg 30 pcs. 279 r Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, 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!
