Dinisorb
Dinisorb: 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. For violations of liver function
- 12. Drug interactions
- 13. Analogs
- 14. Terms and conditions of storage
- 15. Terms of dispensing from pharmacies
- 16. Reviews
- 17. Price in pharmacies
Latin name: Dinisorb
ATX code: C01DA08
Active ingredient: isosorbide dinitrate (Isosorbide dinitrate)
Manufacturer: National Medical Research Center of Cardiology, Federal State Budgetary Institution of the Ministry of Health of the Russian Federation (National Medical Research Center of Cardiology, Federal State Budgetary Institution of the Ministry of Health of the Russian Federation) (Russia)
Description and photo update: 2019-11-07
Dinisorb is an antianginal drug of peripheral action from the group of nitrovasodilators.
Release form and composition
Dosage form - a concentrate for the preparation of a solution for infusion: slightly yellowish or colorless transparent liquid, odorless (10 ml of concentrate in ampoules; in a carton pack, 2 cell contour packs containing 5 ampoules, and instructions for use of Dinisorb).
Composition of 1 ml of solution prepared from the concentrate:
- active substance: isosorbide dinitrate - 1 mg;
- auxiliary component: 0.9% sodium chloride solution in water for injection.
Pharmacological properties
Pharmacodynamics
The active substance of Dinisorb is isosorbide dinitrate, an antianginal agent, a peripheral vasodilator that mainly affects the venous vessels. Its mechanism of action is associated with the release of nitric oxide in vascular smooth muscle.
Nitric oxide increases the level of cyclic guanosine monophosphate and triggers the activation of guanylate cyclase, thereby relaxing smooth muscles. Large veins and arteries relax to a greater extent than precapillary sphincters and arterioles. In part, this reaction is due to the less intense formation of nitric oxide from the molecules of the active substance in the walls of the arterioles, as well as reflex reactions.
By reducing preload (reduced blood flow to the right atrium and expansion of peripheral veins) and afterload (lowering the total peripheral vascular resistance), as well as the direct coronary dilating action, Dinisorb reduces myocardial oxygen demand.
The drug promotes regression of manifestations in pulmonary edema, a decrease in pressure in the pulmonary circulation, and also reduces blood flow to the right atrium. In an area with reduced blood supply, it promotes the redistribution of coronary blood flow.
In patients with ischemic heart disease, taking the drug serves to increase exercise tolerance.
Pharmacokinetics
Dinisorb has no effect of the first passage through the liver, which is associated with the method of administration of the drug (intravenous injections).
The drug is metabolized in the liver, with the formation of two active metabolites. By means of the kidneys it is excreted by 75-85% in the form of isosorbide-5-mononitrate with a half-life of 5 hours, by 15-25% in the form of isosorbide-2-mononitrate with a half-life of 2.5 hours. When administered intravenously, the half-life is 20 minutes. …
Indications for use
- unstable angina;
- angina pectoris with confirmed spasm;
- acute myocardial infarction, not accompanied by severe arterial hypotension;
- acute left ventricular failure;
- period before and during surgical interventions, especially in cardiovascular surgery [to control blood pressure (BP) when it rises].
Contraindications
Absolute:
- liver failure;
- severe chronic heart failure;
- cardiogenic shock;
- severe arterial hypotension (systolic blood pressure less than 100 mm Hg, diastolic - less than 60 mm Hg);
- hemorrhagic stroke;
- toxic pulmonary edema;
- acute circulatory disorders (collapse, shock);
- glaucoma (risk of increased intraocular pressure);
- thyrotoxicosis;
- severe anemia;
- traumatic brain injury;
- combined therapy with tadalafil, vardenafil and sildenafil (phosphodiesterase type 5 inhibitors; in view of the fact that they potentiate the hypotensive effect of nitrates);
- age under 18;
- individual intolerance to the components of the drug.
Relative (Dinisorb is prescribed under medical supervision):
- cardiac tamponade, constrictive pericarditis, hypertrophic obstructive cardiomyopathy;
- acute myocardial infarction, accompanied by a reduced filling pressure of the left ventricle (it is important not to allow a decrease in systolic blood pressure to 90 mm Hg);
- mitral and / or aortic stenosis;
- anemia;
- tendency to orthostatic reactions (with a change in body position, there is a sharp decrease in blood pressure);
- pathologies accompanied by an increase in intracranial pressure (with intravenous administration of large doses of nitroglycerin, an increase in pressure was noted in the anamnesis);
- pregnancy and the period of breastfeeding.
Dinisorb, instructions for use: method and dosage
The solution prepared from the Dinisorb concentrate is injected intravenously slowly. To obtain a solution, 0.5–1 ml of the drug is preliminarily diluted in 10–20 ml of physiological sodium chloride solution.
The dosage of the drug is set individually in accordance with the patient's clinical condition and hemodynamic parameters.
Depending on the patient's response, the initial dose is from 1 to 2 mg in 1 hour, subject to monitoring heart rate, blood pressure, urine output and electrocardiogram. The maximum daily dose ranges from 8 to 10 mg per hour.
With heart failure, an increase in the dose is usually required - in some cases up to 50 mg per hour. The average dose is approximately 7.5 mg per hour. If the patient has previously received organic nitrates (for example, isosorbide-5-mononitrate or isosorbide dinitrate), he may be given a higher dose of Dinisorb to achieve the desired hemodynamic effect. The maximum dose is 120 mg.
Side effects
- cardiovascular system: lowering blood pressure, feeling of heat, transient hyperemia of the facial skin, tachycardia, headache, dizziness; in some cases - collapse, paradoxical reaction (intensification of angina attacks);
- digestive system: dry mouth, a slight burning sensation of the tongue, nausea, vomiting;
- central nervous system: blurred vision, drowsiness; rarely - cerebral ischemia;
- immune system: possible skin rash;
- other reactions: exfoliative dermatitis; development of tolerance, including cross, to other nitrates is possible.
Overdose
The main symptoms: headache, fainting, lowering blood pressure (systolic blood pressure less than 90 mm Hg), hyperemia, nausea, diarrhea, vomiting, skin hyperemia, visual disturbances, convulsions, collapse, dizziness, increased sweating, palpitations. In cases of the use of isosorbide dinitrate in high doses - bradycardia, dyspnea, hyperpnea, increased intracranial pressure, methemoglobinemia (anoxia, cyanosis), paralysis, coma.
Therapy: cancellation of further use of the solution. To normalize blood pressure, the patient is advised to take a prone position, while the head of the bed should be lowered and the patient's legs should be raised. Thus, usually within 15–20 minutes, blood pressure returns to normal after stopping the administration of the drug.
In case of shock or severe arterial hypotension, the volume of circulating blood is replaced. In exceptional cases, dopamine and / or norepinephrine (norepinephrine) may be administered to maintain blood circulation.
It should be borne in mind that adrenaline (epinephrine) and related compounds are contraindicated to be administered.
As antidotes for methemoglobinemia, depending on its severity, use:
- exchange blood transfusion, hemodialysis, oxygen therapy;
- ascorbic acid: taking 1 g by mouth or intravenous administration in the form of sodium salt.
special instructions
The use of Dinisorb is not effective in heart failure caused by toxic pulmonary edema and cardiac tamponade.
It is important not to allow abrupt withdrawal of the drug and gradually reduce the dose. In this case, you should monitor the heart rate and blood pressure.
It is not recommended to use the concentrate when it becomes cloudy (crystal precipitation in the liquid).
Influence on the ability to drive vehicles and complex mechanisms
During the period of therapy, driving vehicles and engaging in potentially hazardous types of work is not recommended due to the fact that the regular use of isosorbide dinitrate reduces the patient's ability to concentrate and reduces the speed of psychomotor reactions.
Application during pregnancy and lactation
Dinisorb during pregnancy / lactation is prescribed only in cases where the expected benefit to the mother outweighs the potential risk to the fetus or child.
Pediatric use
The drug is not prescribed to patients under 18 years of age, since the efficacy and safety of its use in patients of this age group has not been established.
For violations of liver function
In liver failure, Dinisorb is not used, since there is a likelihood of developing methemoglobinemia.
Drug interactions
Possible interactions of isosorbide dinitrate with other drugs / substances:
- α-blockers (dihydroergotamine, prazosin and others), β-adrenostimulants: can reduce the severity of the antianginal action of isosorbide dinitrate (excessive lowering of blood pressure, tachycardia);
- acetylsalicylic acid, blockers of slow calcium channels (nifedipine, verapamil, etc.), propranolol, amiodarone: can enhance the antianginal effect of isosorbide dinitrate;
- antihypertensive drugs, phosphodiesterase type 5 inhibitors, dihydroergotamine, slow calcium channel blockers, β-blockers, quinidine, ethanol, procainamide, tricyclic antidepressants, neuroleptics (antipsychotics), vasodilators: isosorbide their hypotensive effect can enhance.
Care should be taken to combine the use of any vasodilating drugs, the action of which is associated with nitric oxide (including the classic donors of nitric oxide - molsidomine, sodium nitroprusside, isosorbide mononitrate, isosorbide dinitrate, nitroglycerin and others) with sapropterin, which is a coenzyme of nitric oxide synthetase.
Analogs
Dinisorb's analogs are Nitrosorbide, Nitroglycerin, Izoket, Kardiket, Izakardin, etc.
Terms and conditions of storage
Store in a place protected from light and moisture at temperatures up to 25 ° C. Keep out of the reach of children.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Dinisorba
On specialized sites and forums, there are not enough reviews about Dinisorba that would make it possible to reliably assess the effectiveness and safety of the drug in the treatment of heart diseases.
The price of Dinisorb in pharmacies
The approximate price for Dinisorb, a concentrate for the preparation of a solution for infusion, in a package of 10 ampoules of 10 ml, is 635 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!
