Trimectal MV
Trimectal MV: 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: Trimektal MR
ATX code: C01EB15
Active ingredient: Trimetazidine (Trimetazidine)
Manufacturer: CJSC "Vertex" (Russia)
Description and photo update: 2018-25-10
Prices in pharmacies: from 371 rubles.
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Trimectal MV is an antihypoxic agent.
Release form and composition
Dosage form of Trimectal MV - film-coated tablets with modified release: round, biconvex, almost white or white with a yellowish tinge color (10, 20 and 30 pcs. In blisters, in a cardboard box 3 or 6 packs of 10 tablets or 2, 3, 5 or 6 packs of 20 tablets, or 1, 2 or 4 packs of 30 tablets; 60 pcs. in polyethylene cans, in a cardboard box 1 can).
Composition of 1 tablet:
- active substance: trimetazidine dihydrochloride - 35 mg;
- additional components: magnesium stearate - 2.5 mg, calcium hydrogen phosphate dihydrate - 73.8 mg, colloidal silicon dioxide - 1.2 mg, Kollidon SR (polyvinyl acetate - 80%, povidone - 19%, sodium lauryl sulfate - 0.8%, silicon dioxide - 0.2%) - 137.5 mg;
- the composition of the film shell: macrogol 4000 (polyethylene glycol 4000), titanium dioxide, hypromellose and talc, or macrogol 4000 (polyethylene glycol 4000), talc, titanium dioxide and dry mixture for film coating containing hypromellose.
Pharmacological properties
Pharmacodynamics
Trimetazidine - an active component of Trimectal MV - a substance that has an antihypoxic effect, optimizes the metabolism and function of cardiomyocytes and brain neurons, exerting a direct influence on them. The cytoprotective property of the drug is due to the ability to increase the energy potential, activate oxidative decarboxylation and rationalize oxygen consumption (enhance aerobic glycolysis and block fatty acid oxidation). Trimetazidine is able to inhibit fatty acid oxidation due to the enzyme 3-ketoacyl-CoA-thiolase of mitochondrial long-chain fatty acid isoform, as a result of which glucose oxidation is enhanced, glycolysis with glucose oxidation is accelerated, which determines the protection of the myocardium from ischemia.
The pharmacological properties of the drug are based on the switching of energy metabolism from fatty acid oxidation to glucose oxidation. Trimetazidine prevents a decrease in the content of phosphocreatine and the intracellular level of adenosine triphosphoric acid (ATP), maintains myocardial contractility. Under conditions of acidosis, it prevents the accumulation of sodium and calcium ions in cardiomyocytes, normalizes the functioning of membrane ion channels and the intracellular content of potassium ions.
Trimectal MB reduces the increased content of phosphates and reduces intracellular acidosis caused by reperfusion and myocardial ischemia. It increases the duration of the electrical potential, preserves the integrity of cell membranes, prevents the damaging action of free radicals and the activation of neutrophils in the ischemic zone, reduces the severity of ischemic damage to the myocardium and the release of creatine phosphokinase (CPK) from cells.
Trimetazidine reduces the severity of tinnitus and dizziness. In case of vascular pathologies, it improves the functional activity of the retina.
In the course of experimental studies, it was found that trimetazidine:
- reduces the size of myocardial damage;
- reduces intracellular acidosis and the severity of changes in transmembrane ion flux that occur during ischemia;
- reduces the level of migration and infiltration of polynuclear neutrophils in reperfused and ischemic heart tissues;
- supports energy metabolism of the heart and neurosensory tissues during ischemia;
- has no direct effect on hemodynamic parameters.
Clinical trials have confirmed the efficacy and safety of trimetazidine in patients with stable angina pectoris, including as part of combination therapy with insufficient efficacy of other antianginal drugs.
In patients with angina pectoris, trimetazidine:
- reduces the frequency of angina attacks;
- significantly reduces the need to take short-acting nitroglycerin;
- reduces fluctuations in blood pressure during exercise (without significant changes in heart rate);
- increases the coronary reserve, which slows down the onset of exercise-induced ischemia (starting from the 15th day of therapy);
- improves the contractile function of the left ventricle in patients with ischemic dysfunction.
Pharmacokinetics
After oral administration, trimetazidine is absorbed quickly and almost completely in the gastrointestinal tract. The maximum concentration in the blood reaches 5 hours after ingestion. It is characterized by high bioavailability - 90%. After 24 hours, the plasma concentration of trimetazidine remains at the level determined after 11 hours and is 75%. The equilibrium state is reached after 60 hours. Food does not affect the absorption and bioavailability of the drug.
V d (volume of distribution) of trimetazidine is 4.8 l / kg, which suggests a good diffusion of its distribution in tissues. In vitro connection with blood plasma proteins is about 16%.
It is excreted mainly by the kidneys, and in unchanged form - about 60%. T ½ (half-life) is 7 hours in adult patients, about 12 hours in patients over the age of 65 years.
Hepatic clearance of trimetazidine decreases with age; renal clearance is directly correlated with creatinine clearance.
The drug crosses the histohematogenous barriers.
In patients over 75 years of age, due to age-related decline in renal function, an increase in the plasma concentration of trimetazidine is possible.
In patients with moderate renal insufficiency (creatinine clearance from 30 to 60 ml / min), the concentration of the drug in the blood plasma can be increased by 2.4 times, in patients with severe renal insufficiency (creatinine clearance <30 ml / min) - approximately 4 times compared with patients with normal renal function. No special features regarding the safety of the drug were found in this group of patients.
Indications for use
Trimectal MV is prescribed to patients with coronary heart disease to prevent attacks of stable angina pectoris (as a monopreparation or as part of combination therapy).
Contraindications
- renal failure of severe severity (creatinine clearance <30 ml / min);
- Parkinson's symptoms or Parkinson's disease (restless legs syndrome, tremors, and other associated movement disorders);
- age up to 18 years;
- pregnancy and lactation;
- hypersensitivity to any component of the drug.
Trimectal MV should be used with caution in the treatment of patients over 75 years old, patients with moderate renal and severe hepatic impairment.
Instructions for the use of Trimectal MV: method and dosage
Coated tablets Trimectal MV are taken orally, without chewing, with water, optimally during meals.
Adult patients are prescribed 1 tablet 2 times a day - morning and evening.
The maximum daily dose is 70 mg.
For patients with moderate renal insufficiency, Trimectal MB 35 mg tablets are prescribed 1 pc. Once a day. The drug should be taken in the morning with breakfast.
For patients over the age of 75 years, the dose is selected with caution.
The doctor determines the duration of therapy individually.
Side effects
- on the part of the cardiovascular system: rarely (from> 1/10 000 to <1/1000) - hot flushes to the skin of the face, palpitations, a marked decrease in blood pressure, tachycardia, extrasystole, orthostatic hypotension (possible loss of balance, dizziness, general weakness), especially with the combined use of antihypertensive drugs;
- from the digestive system: often (from> 1/100 to <1/10) - dyspepsia, abdominal pain, nausea, diarrhea, vomiting; the frequency is unknown (according to the available data, it is not possible to establish the frequency) - constipation;
- from the central nervous system: often - headache, dizziness; frequency unknown - sleep disturbances (drowsiness / insomnia), unsteadiness of gait, instability in the Romberg position, symptoms of parkinsonism (akinesia, tremor, increased tone), restless legs syndrome and other movement disorders;
- from the liver and biliary tract: the frequency is unknown - hepatitis;
- on the part of the hematopoietic organs: the frequency is unknown - thrombocytopenia, agranulocytosis, thrombocytopenic purpura;
- on the part of the skin: often - skin rashes, itching, urticaria; frequency unknown - Quincke's edema, acute generalized exanthematous pustulosis;
- general disorders: often - asthenia.
Overdose
Overdose cases have not been reported to date.
Recommended therapy for overdose is symptomatic.
special instructions
Trimectal MV is not intended to relieve angina attacks. Should not be used for the initial course of unstable angina pectoris and myocardial infarction at the prehospital stage and in the first days of hospitalization.
If an attack of angina pectoris occurs against the background of the use of the drug, it is necessary to consult a doctor to review and adapt the therapy regimen.
Trimetazidine can cause or worsen the existing symptoms of parkinsonism, therefore, patients, especially the elderly, should be monitored during treatment. In doubtful cases, a consultation with a neurologist is required. Patients should be warned about the need for a complete cancellation of Trimectal MV in case of such disorders as restless legs syndrome, instability in the Romberg position, tremors, unsteadiness of gait, symptoms of parkinsonism. Such cases are rare and these disorders usually resolve after stopping trimetazidine, usually within 4 months. If symptoms persist for more than 4 months, consultation with a neurologist is required. Due to unsteadiness of gait and instability in the Romberg position, as well as with a pronounced decrease in blood pressure, there may be cases of falls, especially in patientsreceiving antihypertensive drugs.
Due to the peculiarity of the dosage form of Trimectal MB, the tablet framework may not dissolve in the intestine and be excreted in the feces, this phenomenon does not affect the effectiveness of trimetazidine.
Influence on the ability to drive vehicles and complex mechanisms
According to the instructions, Trimectal MV can cause side effects from the central nervous system, therefore, vehicle drivers and patients employed in potentially hazardous industries (requiring increased attention and speed of reactions) should be careful during therapy.
Application during pregnancy and lactation
There are no data on the safety of using Trimectal MB during pregnancy. Animal studies did not reveal the presence of direct or indirect reproductive toxicity, as well as the effect of trimetazidine on the reproductive function of rats of both sexes. However, it is not recommended to prescribe the drug during pregnancy as a precaution.
There is no information on the excretion of trimetazidine and its metabolites into breast milk. However, the risk to a breastfed baby cannot be completely excluded, therefore, Trimectal MV should not be used in breastfeeding women.
Pediatric use
Trimectal MV is contraindicated in patients under 18 years of age.
With impaired renal function
Trimectal MB should be used with caution in the treatment of patients with moderate renal failure (creatinine clearance 30-60 ml / min). The drug is contraindicated in severe renal failure (creatinine clearance <30 ml / min).
For violations of liver function
Trimectal MV should be used with caution in the treatment of patients with severe hepatic impairment.
Use in the elderly
Trimectal MV should be used with caution when treating patients over 75 years old.
Drug interactions
Trimetazidine increases the anti-ischemic effect of other antianginal drugs used simultaneously. No other drug interactions have been reported.
Analogs
Analogs of Trimectal MV are: Antisten MV, Trimitard MV, Predizin, Vero-Trimetazidine, Antisten, Rimecor, Deprenorm MV, Trimetazidin-Teva, Preductal MV, Preductal OD, Rimecor MV, Angiosil retard, Triducard, Trimet, Precard, Trimetazidin, Trimetazidine, Trimetazidin MV-Teva, Trimetazidin-Biocom MV.
Terms and conditions of storage
Store no more than 3 years in a dark place at temperatures up to 25 ° C. Keep out of the reach of children.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Trimektal MV
This drug, as a rule, is prescribed as part of a combination therapy, therefore, it is rather difficult to assess the degree of its effectiveness and positive effect on the human body. Nevertheless, positive reviews about Trimectal MV are common. Patients note a decrease in blood pressure fluctuations, the severity of tinnitus, nausea and dizziness.
Of the shortcomings, many note mild side effects at the beginning of the course of treatment (such as flushing of the skin of the face).
Price for Trimectal MV in pharmacies
The price of Trimectal MV 35 mg is 300-380 rubles. per pack of 60 tablets, 480–655 rubles. per pack of 120 tablets.
Trimectal MV: prices in online pharmacies
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Drug name Price Pharmacy |
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Trimectal MV 35 mg film-coated tablets with modified release 60 pcs. 371 r Buy |
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Trimectal MV 35 mg film-coated tablets with modified release 120 pcs. 393 r Buy |
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Trimectal MV tablets p.o. 35mg 60 Pcs. 482 r Buy |
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!
