Calcigard retard
Calcigard retard: 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: Calcigard retard
ATX code: C08CA05
Active ingredient: nifedipine (Nifedipine)
Manufacturer: Torrent Pharmaceuticals Ltd. (Torrent Pharmaceuticals Ltd.) (India)
Description and photo updated: 30.11.2018
Prices in pharmacies: from 54 rubles.
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Calcigard retard is a drug with vasodilating, antianginal and hypotensive action.
Release form and composition
The drug is produced in the form of tablets of prolonged action, film-coated: biconvex, round, brown, with a notch on one side (10 pieces in a blister, in a cardboard box of 3, 6 or 10 blisters and instructions for using Calcigard retard).
1 film-coated tablet contains:
- active substance: nifedipine - 20 mg;
- additional components: polysorbate-80, lactose monohydrate, microcrystalline cellulose, macrogol 6000, starch, povidone (K-30), sodium lauryl sulfate, stearic acid, magnesium stearate;
- film shell: ethyl cellulose, hypromellose, titanium dioxide, chocolate brown varnish, diethyl phthalate, talc.
Pharmacological properties
Pharmacodynamics
Nifedipine is a 1,4-dihydropyridine derivative, a selective slow calcium channel blocker (BMCC) with vasodilating, antianginal and hypotensive effects. The active substance reduces the flow of calcium ions (Ca 2+) through membranes into myocardial cells and smooth muscle cells of peripheral and coronary arteries; when used in high doses, it inhibits the release of Ca 2+ from intracellular stores. Nifedipine reduces the number of active channels without affecting the period of their activation, inactivation and recovery. The substance separates the processes of excitation and contraction in the heart muscle, mediated by troponin and tropomyosin, and in the smooth muscles of the vascular walls - mediated by calmodulin.
Reception of Calcigard retard in therapeutic doses helps to normalize the transmembrane current of Ca 2+, disturbed in certain pathological conditions, primarily in arterial hypertension. Does not affect the tone of the veins, promotes increased coronary blood flow, improved blood supply to ischemic areas of the myocardium, without causing the phenomenon of "steal", stimulates the functioning of collaterals.
As a result of the expansion of peripheral arteries produced by nifedipine, the total peripheral vascular resistance (OPSR) is weakened, the tone of the heart muscle, afterload, myocardial oxygen demand, and the duration of diastolic relaxation of the left ventricle increase
The active substance has practically no effect on the atrioventricular and sinoatrial nodes and does not show antiarrhythmic activity. Increases renal blood flow, leads to a moderate increase in natriuresis. The negative chrono-, dromo- and inotropic effect is compensated by reflex activation of the sympathoadrenal system and an increase in the number of heart contractions (HR) as a result of peripheral vasodilation. With oral administration of nifedipine, the effect is noted after 20 minutes, the duration of the effect when using the retard form (prolonged form) is 12-24 hours.
Pharmacokinetics
Nifedipine is characterized by high absorption (over 92–98%), bioavailability is 40–60%, while the latter increases with the simultaneous intake of Calcigard retard with food. Has the effect of the first passage through the liver. The active substance passes through the blood-brain barrier and is excreted in breast milk. Metabolic transformation completely takes place in the liver with the participation of isoenzymes CYP3A7, CYP3A5 and CYP3A4.
The half-life of the substance (T ½) is 3.8-16.9 hours. Eliminated mostly by the kidneys in the form of metabolites and unchanged in trace amounts, 20% - through the intestines in the form of metabolites. There is no cumulative effect of the drug. The pharmacokinetic parameters of the substance are not affected by hemodialysis and peritoneal dialysis, as well as the presence of chronic renal failure (CRF). Plasmapheresis can enhance drug elimination.
Indications for use
- arterial hypertension (as a monotherapy drug or in combination with other antihypertensive drugs);
- ischemic heart disease (CHD) (angina pectoris of exertion and rest, including variant).
Contraindications
Absolute:
- cardiogenic shock (due to the risk of developing myocardial infarction);
- chronic heart failure (CHF) in the stage of decompensation;
- severe aortic valve stenosis;
- collapse;
- condition after myocardial infarction during the first four weeks;
- severe arterial hypotension [systolic blood pressure (BP) below 90 mm Hg. Art.];
- pregnancy (during the first 20 weeks) and lactation;
- age up to 18 years;
- hypersensitivity to any of the constituents of the drug.
Relative (you should take Calcigard retard 20 mg tablets with extreme caution):
- sick sinus syndrome (SSS);
- hypertrophic obstructive cardiomyopathy;
- severe stenosis of the aortic orifice or mitral valve;
- severe bradycardia / tachycardia;
- myocardial infarction with left ventricular failure;
- mild / moderate arterial hypotension;
- malignant arterial hypertension;
- unstable angina;
- severe forms of cerebrovascular accident;
- obstruction of the gastrointestinal tract (GIT);
- violations of the liver and / or kidneys;
- combined administration with rifampicin, β-blockers or cardiac glycosides;
- hemodialysis;
- pregnancy after 20 weeks;
- elderly age.
Calcigard retard, instructions for use: method and dosage
Calcigard retard tablets are taken orally, the dosage regimen is determined individually, taking into account the severity of the disease and the response to the treatment. The tablets are recommended to be taken during or after meals, with a little water.
The starting dose is 20 mg (1 tablet) twice a day. If necessary, a gradual increase in the dose is allowed, but the maximum daily dose of Calcigard retard should not exceed 120 mg.
Patients receiving combined (antihypertensive / antianginal) therapy, as well as in severe cerebrovascular accidents or liver functional disorders, need to reduce the standard daily dose.
Side effects
- central nervous system: drowsiness, weakness, increased fatigue, dizziness, headache; with prolonged use of high doses - anxiety, depression, paresthesia of the extremities, extrapyramidal disorders (shuffling gait, mask-like face, ataxia, stiffness of the arms and legs, difficulty swallowing, tremor of the hands and fingers);
- hematopoietic organs: thrombocytopenia, anemia, thrombocytopenic purpura, asymptomatic agranulocytosis, leukopenia;
- cardiovascular system: chest pain, palpitations, manifestations of excessive vasodilation (flushing of the skin of the face, feeling of heat, flushing of the skin of the face, the occurrence / worsening of heart failure, asymptomatic decrease in blood pressure), peripheral edema, arrhythmia, tachycardia; rarely - a significant decrease in blood pressure, fainting; the appearance of angina attacks (mainly at the beginning of the course of treatment) - with this complication, the cancellation of Calcigard retard is required; isolated cases - myocardial infarction;
- digestive system: increased appetite, dry mouth, dyspepsia (diarrhea / constipation, nausea); rarely - gingival hyperplasia (soreness, swelling, bleeding); against the background of long-term use - violations of the liver (increased activity of liver enzymes, intrahepatic cholestasis);
- urinary system: increased daily urine output, deterioration of kidney function (in the presence of renal failure);
- musculoskeletal system: joint swelling, arthralgia (rarely), myalgia, arthritis, cramps of the upper and lower extremities;
- allergic reactions: rarely - urticaria, pruritus, photodermatitis, exfoliative dermatitis, exanthema; extremely rare - autoimmune hepatitis;
- others: rarely - cough, difficulty breathing; extremely rarely - weight gain, visual impairment (including transient blindness with the maximum plasma level of nifedipine in the blood), galactorrhea, hyperglycemia, bronchospasm, pulmonary edema, gynecomastia (in elderly patients, completely disappears after discontinuation of admission).
Overdose
Symptoms of an overdose of Calcigard retard can be: flushing of the skin of the face, headache, lowering blood pressure, inhibition of the sinus node, arrhythmia, bradycardia. In this condition, gastric lavage, the intake of activated carbon, symptomatic therapy aimed at stabilizing the work of the cardiovascular system are prescribed. The antidote of the drug is calcium, a slow intravenous (IV) infusion of 10% solution of calcium gluconate or calcium chloride is shown with further switching to a long infusion.
If there is an excessive decrease in blood pressure, dobutamine / dopamine is injected intravenously. In case of conduction disturbances, administration of isoprenaline, atropine is prescribed, or an artificial pacemaker is installed. When heart failure occurs, intravenous strophanthin is injected. Catecholamines are allowed to be used only with life-threatening circulatory failure (due to the low degree of their effectiveness, a high dosage is required, which aggravates the threat of an increase in the tendency to arrhythmias caused by intoxication). Blood glucose, potassium and calcium ions should be monitored due to impaired insulin release. Hemodialysis is ineffective.
special instructions
Calcigard retard therapy is recommended to be stopped gradually.
During treatment, it is required to refrain from drinking ethanol-containing drinks.
With the combined use of Calcigard retard with β-blockers, an excessive decrease in blood pressure can be recorded, and in some cases - an increase in the manifestations of heart failure. Therefore, when implementing this combination, patients need careful medical supervision.
At the beginning of the course of therapy, it is necessary to take into account the likelihood of angina pectoris, especially in the period after the recent abrupt cessation of the use of β-blockers, in connection with which the latter must be canceled gradually.
Against the background of severe heart failure, titration of doses of nifedipine should be performed with great caution.
In the presence of severe obstructive cardiomyopathy after taking the drug, the threat of an increase in the severity of the manifestation, the duration and frequency of angina attacks increases. In this case, the use of Calcigard retard should be canceled.
The diagnostic criteria for the use of a drug for the treatment of vasospastic angina pectoris include:
- the appearance of spasm of the coronary arteries or ergonovine-induced angina pectoris;
- the presence of a classic clinical picture against the background of an increase in the ST segment;
- diagnosis of coronary spasm during angiography or the establishment of an angiospastic component in the absence of confirmation (including with a different voltage threshold or unstable angina pectoris, if the electrocardiogram data indicate the development of transient angiospasm).
Patients on hemodialysis treatment who have high blood pressure, irreversible kidney failure or reduced total blood volume should use the drug with extreme caution due to a possible sharp drop in blood pressure.
If, during the period of therapy, the patient requires an operation under general anesthesia, the anesthesiologist should be informed about the nature of the treatment received.
While taking the drug, positive results may be observed during laboratory tests for antinuclear antibodies and direct Coombs' test.
Influence on the ability to drive vehicles and complex mechanisms
During treatment, especially at the beginning of the course in some patients, the drug can provoke the appearance of dizziness, which can negatively affect the ability to control complex mechanisms, including vehicles. In the implementation of further therapy, the degree of restrictions is established taking into account the individual tolerance of nifedipine.
Application during pregnancy and lactation
Calcigard retard should not be used during the first 20 weeks of pregnancy.
Prescription of the drug, starting from the 20th week of pregnancy, is indicated only if the expected benefit of therapy for the woman significantly exceeds the potential threat to the fetus.
Nifedipine passes into breast milk, therefore, during the period of taking the drug, it is recommended to stop breastfeeding. There is no data on the use of Calcigard retard in lactating women.
Pediatric use
Calcigard retard tablets 20 mg are contraindicated for pediatric patients, since the safety and efficacy of nifedipine therapy in children and adolescents has not been studied.
With impaired renal function
Patients with impaired renal function should use the drug with caution, avoiding high doses.
For violations of liver function
Against the background of hepatic failure, T ½ of nifedipine increases, since the total clearance decreases. During therapy with Kaltsigard retard, the condition of patients with impaired liver function should be carefully monitored, if necessary, it is required to reduce the dose of the drug and / or use other dosage forms of nifedipine.
Use in the elderly
Elderly patients are prescribed the drug with caution, in reduced doses.
Drug interactions
- quinidine: its plasma level in the blood decreases, after discontinuation of nifedipine therapy, a sharp increase in the concentration of quinidine may occur;
- other antihypertensive drugs, nitrates, cimetidine, ranitidine (to a lesser extent), tricyclic antidepressants, inhalation anesthetics: the severity of the decrease in blood pressure increases;
- prazosin and other α-blockers: the metabolism of these drugs is inhibited, which can lead to an increase in the hypotensive effect;
- quinidine, amiodarone, flecainide, disopyramide (antiarrhythmic drugs): the negative inotropic effect of these substances may be aggravated (including weakening of the force of heart contraction); combination therapy should be performed with caution;
- theophylline, digoxin: their plasma concentration increases; the level of these agents in plasma and the clinical effect should be monitored;
- lithium preparations: it is possible to increase toxic effects such as nausea, vomiting, diarrhea, tinnitus, ataxia, tremors;
- rifampicin and other inducers of microsomal liver enzymes: the concentration of nifedipine decreases;
- nitrates: the risk of increased tachycardia is aggravated;
- non-steroidal anti-inflammatory drugs (NSAIDs), sympathomimetics, estrogens: the hypotensive effect is weakened (due to the suppression of the production of prostaglandins in the kidneys and fluid retention and Na + in the body - for NSAIDs, fluid retention - for estrogens);
- calcium preparations: the effectiveness of BMCC decreases;
- vincristine: the rate of excretion of this substance decreases, which can lead to an increase in its side effects and, as a result, to the need to reduce the dose;
- anticonvulsants, indirect anticoagulants (derivatives of indandione and coumarin), NSAIDs, salicylates, quinine, sulfinpyrazone and other drugs with a high degree of protein binding: it is possible that these drugs are displaced from the connection with proteins, leading to an increase in their plasma level;
- quinidine, procainamide and other drugs that cause prolongation of the QT interval: the threat of a significant prolongation of the QT interval is aggravated;
- grapefruit juice: the metabolism of nifedipine in the body is inhibited, which is why this combination is contraindicated.
Analogs
Analogues of Calcigard retard are: Nifecard CL, Fenigidin, Kordaflex, Corinfar, Nifedipin, Adalat, Kordipin CL, Osmo-Adalat, Nifedipin-Akrikhin, Kordipin retard, etc.
Terms and conditions of storage
Store in a place protected from moisture and light, out of the reach of children, at a temperature not exceeding 30 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Calcigard retard
The few reviews about Calcigard retard are in most cases positive. Patients note the effectiveness of treatment with the drug for cardiovascular diseases and its relatively good tolerance. According to reviews, the drug demonstrates good results when used as an antihypertensive agent (in monotherapy mode and in combination with other antihypertensive drugs), as well as in the treatment of angina pectoris of exertion and rest.
Some patients, however, indicate the development of side effects in the form of headache, dizziness, weakness, nausea, palpitations, mainly at the beginning of the course of drug treatment.
Price for Calcigard retard in pharmacies
The price of Calcigard retard, prolonged-release film-coated tablets, can be: for a package containing 30 pieces, - 65 rubles, 100 pieces. - 150 rubles.
Calcigard retard: prices in online pharmacies
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Drug name Price Pharmacy |
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Calcigard retard 20 mg film-coated tablets of prolonged action 30 pcs. RUB 54 Buy |
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Calcigard retard 20 mg film-coated tablets of prolonged action 100 pcs. 135 RUB 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!
