Pectrol
Pectrol: 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: Pektrol
ATX code: C01DA14
Active ingredient: Isosorbide mononitrate (Isosorbide mononitrate)
Producer: Valpharma SA (San Marino), Valpharma International SpA (Italy), KRKA (Slovenia)
Description and photo update: 2019-09-08
Prices in pharmacies: from 100 rubles.
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Pectrol is a peripheral vasodilator, antianginal agent.
Release form and composition
Dosage form - tablets of prolonged action, film-coated (10 pcs. In blisters, 3 or 10 blisters in a cardboard box):
- 40 mg: round, slightly biconvex, white with a yellowish tinge of color (possibly inclusions), engraved with "IM40" on one side;
- 60 mg: oval, slightly biconvex, white with a yellowish tinge of color (possibly interspersed), engraved “60” on one side and a line on both sides.
Composition of 1 tablet:
- Active ingredient: isosorbide mononitrate - 40 or 60 mg;
- Auxiliary components: carnauba wax, magnesium stearate, purified stearic acid, hypromellose, colloidal silicon dioxide, lactose monohydrate;
- Film shell: talc, titanium dioxide, magnesium stearate, iron dye yellow oxide (E172), as well as hypromellose (60 mg tablets).
Pharmacological properties
Pharmacodynamics
Pectrol is a peripheral vasodilator that predominantly affects the venous vessels.
The mechanism of its action is as follows: the active substance of the drug (isosorbide mononitrate) stimulates the formation of nitric oxide in vascular endothelial cells; nitric oxide activates intracellular guanylate cyclase, resulting in an increase in the amount of cGMP (cyclic guanosine monophosphate), which mediates vasodilation. When the smooth muscles of the blood vessel walls relax, venous return to the heart decreases, the load on the heart decreases, which ultimately leads to a decrease in the oxygen demand of the heart muscle. The dilating effect of nitrates on arterioles and arteries reduces afterload (ejection resistance). A coronary dilating effect is observed, blood flow to the right atrium decreases, the pressure in the pulmonary circulation decreases, the symptoms of pulmonary edema disappear.
Isosorbide mononitrate promotes the redistribution of blood circulation through the blood vessels of the myocardium in the area with reduced blood circulation. Patients with angina pectoris and coronary artery disease have increased exercise tolerance. The drug dilates the blood vessels of the dura mater and the brain, which can lead to headaches. Pectrol inhibits platelet aggregation and reduces thromboxane synthesis in platelets.
In the course of treatment, cross-tolerance can develop, as with other nitrates. After a break in therapy, the sensitivity to the drug quickly recovers.
The antianginal effect develops within 30-40 minutes after taking the tablets and lasts for 8-10 hours.
Pharmacokinetics
Pectrol is rapidly and completely absorbed from the digestive tract. Bioavailability of isosorbide mononitrate is almost 100%, since there is no "first pass" effect through the liver. Food intake, pH in the intestinal lumen or intestinal peristalsis do not affect the release of the active substance from the tablets.
The drug is distributed in the general body fluid. About 5% of isosorbide mononitrate binds to plasma proteins. The effective concentration of the drug is 100 ng / ml and is reached 30 minutes after ingestion.
It is metabolized by conjugation with glucuronic acid and denitrization. The excretion of the inactive metabolite occurs through the kidneys. Renal clearance is 115 ml / min, and the elimination half-life is 4-10 hours.
In patients with renal and hepatic insufficiency, the pharmacokinetics of the drug does not change significantly.
Indications for use
- Treatment of chronic heart failure (as part of combination therapy);
- Prevention of angina attacks in patients with ischemic heart disease (IHD).
Contraindications
Absolute:
- Acute heart failure
- Cardiac tamponade;
- Acute myocardial infarction with severe arterial hypotension;
- Arterial hypotension and hypovolemia (diastolic blood pressure below 60 mm Hg, systolic blood pressure less than 100 mm Hg, central venous pressure below 4-5 mm Hg);
- Left ventricular failure with low end-diastolic pressure;
- Vascular collapse;
- Shock;
- Diseases and conditions accompanied by increased intracranial pressure (including hemorrhagic stroke, the consequences of traumatic brain injury);
- Toxic pulmonary edema;
- Age under 18;
- Hypersensitivity to any component of the drug or nitrates.
Relative (Pectrol should be taken with caution because of the increased risk of side effects):
- Mitral valve prolapse;
- Mitral and / or aortic stenosis;
- Tendency to orthostatic disorders of vascular regulation;
- Constrictive pericarditis;
- Hypertrophic cardiomyopathy;
- Thyrotoxicosis;
- Severe anemia;
- Severe hepatic / renal impairment;
- Elderly age.
Instructions for the use of Pectrol: method and dosage
The tablets should be taken orally after meals: swallow whole and drink plenty of water (1 glass).
Specific doses and frequency of administrations depend on the severity of the disease and are determined individually by the doctor.
The recommended starting dose is 40 mg once a day (in the morning). For patients who have nocturnal attacks of angina pectoris, it is preferable to take the drug in the evening. If the severity of the effect of the drug is not enough, from the 3-5th day of treatment, the dose is increased to 60 mg 1 time per day or 40 mg 2 times a day.
In chronic heart failure, therapy is usually started in a hospital and carried out until the optimal maintenance dose is selected, taking into account the clinical effect and side effects.
For maintenance treatment, usually 40 or 60 mg 1 time per day or 40 mg 2 times a day is prescribed. In the latter case, the first tablet should be taken in the morning, and the second after about 7 hours. In this case, the interval between evening and morning receptions should not be less than 12 hours.
Side effects
- Dermatological reactions: skin rash; in individual cases - exfoliative dermatitis;
- From the side of the cardiovascular system: a marked decrease in blood pressure, transient hyperemia of the facial skin, tachycardia, a feeling of heat, nitrate headache, vertigo; rarely - a paradoxical reaction (increased angina attacks), orthostatic collapse;
- From the side of the central nervous system: blurred vision, stiffness, decreased reaction rate (especially at the beginning of treatment), drowsiness; rarely - cerebral ischemia;
- From the digestive system: a slight burning sensation of the tongue, nausea, dry mouth, vomiting;
- Others: tolerance (including cross-tolerance to other nitrates).
Overdose
In case of an overdose, the following symptoms occur: dizziness, headache, vomiting, nausea, diarrhea, bradycardia, palpitations, dyspnea, hyperpnea, skin hyperemia, methemoglobinemia, visual disturbances, hyperthermia, increased intracranial pressure, fainting, sweating, collapses, and paralysis …
In case of accidental or deliberate overdose of the drug, gastric lavage is performed. With a strong decrease in blood pressure, phenylephrine is prescribed intravenously, with methemoglobinemia - 1 g of ascorbic acid (intravenously or orally) and 1% methylene blue solution at a dose of 1-2 mg / kg of body weight intravenously. The use of epinephrine and related compounds is ineffective.
special instructions
Pectrol is a drug for the prevention of angina attacks, it is not used to stop them.
Correct use of the drug can prevent the development of nitrate tolerance. It is very important to strictly adhere to the dosage regimen and the 12-hour interval between evening and morning doses. In this case, it is possible to achieve a period with a low concentration of nitrates (less than 100 ng / l) while maintaining the therapeutic effect.
Pectrol should not be canceled abruptly, it is necessary to gradually reduce the dose.
Blood pressure and heart rate should be kept under control during treatment.
When transferring a patient from isosorbide dinitrate to Pectrol, the total daily dose must be calculated in advance, taking into account that 20 mg of isosorbide dinitrate corresponds to 10 mg of isosorbide-5-mononitrate.
Since the drug can affect the rate of psychophysical reactions, during treatment, you should drive a car with caution and perform potentially hazardous activities.
Application during pregnancy and lactation
For pregnant women, Pectrol is prescribed only in cases where the expected benefit to the mother is higher than the potential risk to the fetus.
If it is necessary to use the drug during breastfeeding, breastfeeding should be discontinued.
Pediatric use
According to the instructions, Pectrol is not used in children and adolescents under the age of 18, since there are no data on the safety and efficacy of using the drug in this group of patients.
With impaired renal function
In patients with severe renal failure, the drug is used with caution.
For violations of liver function
In patients with hepatic insufficiency, the drug is used with caution (due to the risk of developing methemoglobinemia).
Use in the elderly
In elderly patients, the drug is used with caution.
Drug interactions
Barbiturates accelerate the biotransformation of isosorbide mononitrate and reduce its concentration in the blood.
In the case of simultaneous use, Pectrol increases the concentration of dihydroergotamine in the blood.
An increase in the antihypertensive effect is possible with the simultaneous use of vasodilators, beta-blockers, slow calcium channel blockers, tricyclic antidepressants, neuroleptics, ethanol, novocainamide, quinidine, dihydroergotamine, sildenafil.
An increase in the antianginal effect is possible with the simultaneous use of acetylsalicylic acid, blockers of slow calcium channels (for example, nifedipine or verapamil), propranolol, amiodarone.
When combined with alpha-blockers (including dihydroergotamine) or beta-adrenostimulants, the antianginal effect may decrease, which is manifested by an excessive decrease in blood pressure and tachycardia.
Absorbent, enveloping, and astringent preparations reduce the absorption of isosorbide mononitrate in the gastrointestinal tract.
M-anticholinergics (including atropine) increase the risk of increased intraocular pressure.
Analogs
Pectrol analogues are: Efoks, Efoks Long, Monocinque, Monocinque retard, Monosan.
Terms and conditions of storage
Store at temperatures up to 25 ° C out of reach of children.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Pectrol
Reviews about Pectrol are few. Patients report the appearance of headache and sedation at the beginning of treatment, as well as an increase in heart rate up to 120 beats per minute and a jump in blood pressure. Despite this, the drug is effective when used according to indications.
Price for Pectrol in pharmacies
The price of Pectrol in a dosage of 40 mg (for a package containing 30 tablets) is 160–190 rubles, in a dosage of 60 mg (for a package containing 30 tablets) - 210–250 rubles.
Pectrol: prices in online pharmacies
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Drug name Price Pharmacy |
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Pectrol 40 mg film-coated tablets of prolonged action 30 pcs. RUB 100 Buy |
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Pectrol 60 mg film-coated tablets of prolonged action 30 pcs. 112 RUB Buy |
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Pectrol tablets p.p. prolonged action 40mg 30 pcs. 162 RUB Buy |
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Pectrol tab.prolong.p.o. 60mg n30 233 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!
