Propanorm

Propanorm is an antiarrhythmic drug used in cardiac practice to treat disorders of the conduction system of the heart.

Its antiarrhythmic effect is based on blockade of calcium channels and beta-adrenoreceptors, as well as on the membrane-stabilizing action exerted on myocardiocytes.

It starts to act about an hour after ingestion, the maximum effect is achieved in a couple of hours and lasts up to about twelve hours, in direct dependence on the specific characteristics of the organism. After consumption, more than 95% of the drug is absorbed. It is excreted by the kidneys, and also partially with bile. In liver failure, excretion of the drug worsens.

Clinical and pharmacological group

Antiarrhythmic drug. Class I C.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much is Propanorm in pharmacies? The average price is at the level of330 rubles.

Form of issue and composition

Dosage form - coated tablets: round, convex on both sides, almost white or white (in blisters 10 tab., 5 blisters in a pack of cardboard).

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Active substance: propafenone hydrochloride, in 1 tablet - 150 or 300 mg, which corresponds to the content of propafenone 135.7 and 271.05 mg respectively.

Auxiliary components: microcrystalline granulated cellulose, macrogol 6000, magnesium stearate, croscarmellose sodium, emulsion of dimethicone with silicon dioxide, sodium lauryl sulfate, titanium dioxide, corn starch, hypromellose 5, copovidone.

Pharmacological effect

The main active substance of tablets Propanorm refers to antiarrhythmic drugs class 1C. Propaphenone blocks the sodium channels of the pacemaker's cells and the conduction system of the heart. It also blocks to a small extent m-holinoretseptory and ß-adrenoreceptors.

Due to this, the drug slows down the conduction of nerve impulses along the fibers of the conducting atrial system, as well as through the atrioventricular node, which contributes to the normalization of the rhythm of cardiac contractions. In this case, the electrophysiological effects of the active substance Propanorm tablets are more pronounced in areas of the heart with insufficient circulation (ischemia) and metabolic disorders in them.

Indications for use

According to the instructions to Propanorm, the use of an antiarrhythmic drug is recommended for prevention and treatment:

Atrial-ventricular re-entry of tachycardia;
Nadzheludochkovyh and ventricular extrasystoles;
Paroxysmal rhythm disturbances - flutter and atrial fibrillation, WPW syndrome.

Also, the drug is prescribed for the prevention of stable monomorphic ventricular tachycardia.

Contraindications

The use of Propanorm is contraindicated against the background of:

Myocardial infarction;
Intoxication Digoxin;
Dysfunction of the sinus node;
Lactation periods;
Pronounced bradycardia and arterial hypotension;
Block block of the bundle;
Cardiogenic shock (except for antiarrhythmic shock and arterial hypotension);
Severe forms of CHF (in the stage of decompensation);
Sinoatrial blockade, atrial fibrillation;
Intraventricular bifascicular blockade and AV blockade of II and III degree;
Hypersensitivity to the ingredients of the drug.

The use of propanorm is allowed only to persons who have reached the age of 18, because of the lack of objective information about its safe and effective use in children.

With extreme caution, the drug is recommended for patients of advanced age, and also in the presence of patients:

Cardiomyopathy;
COPD;
Permanent or temporary pacemaker;
Electrolyte disturbances (a mandatory correction is required before the appointment of Propanorm);
Heart failure (ejection fraction less than 30%);
Arterial hypotension (including myasthenia gravis);
Hepatic and renal insufficiency;
Hepatic cholestasis.

Caution is used in combination with other antiarrhythmic drugs that have a similar effect. In pregnancy, the appointment of Propanorm is possible only in extreme cases, when the estimated clinical effect exceeds the potential risk to the fetus.

Use in pregnancy and lactation

Appointment Propanorm for pregnant women, especially in the I trimester, is allowed only in case of significant excess of the benefit of such therapy in comparison with possible negative consequences for the fetus.

Nursing women Propanorm prescribed contraindicated.

Dosage and route of administration

In the instructions for use indicated that the tablets Propanorm taken inside, after a meal. They should be swallowed whole, washed down with a small amount of water.

The dose of the drug should be selected individually, depending on the therapeutic effect and the tolerability of the patient's therapy.

It is recommended to begin therapy in a hospital, previously canceling all antiarrhythmic drugs (under the control of blood pressure, ECG, QRS latitude estimation). If, on the background of the treatment, the QRS complex is enlarged or the QT interval is extended by more than 20% compared to the initial values, or the PQ interval is longer than by 50%, prolongation of the QT interval by more than 500 ms, an increase in the frequency and severity of arrhythmia, the dose should be reduced or the drug should be temporarily discontinued. In patients with a significantly expanded complex of QRS and AV blockade II and III degree, it is recommended to reduce the dose.

At a patient's body weight of 70 kg or more, the initial dose is 150 mg 3 times / day (in a hospital under the control of blood pressure, ECG). The dose can be increased gradually, at intervals of 3-4 days to 300 mg 2 times / day, and if necessary - to a maximum dose of 300 mg 3 times / day.
In elderly patients and patients with a body weight of less than 70 kg, the drug is started from lower doses, gradually increasing the dose. The same tactics should be followed when carrying out maintenance therapy.

Do not start increasing the dose if the duration of the drug is less than 5-8 days.

When the liver function is disrupted, the drug is recommended to be used in doses of 20-30% of the usual dose. If the kidney function is impaired (CC less than 10 ml / min), the initial dose should be reduced.

Side effects

During the application of the Propanorm tablets, allergic skin reactions, paresthesia, tremor, dizziness, sleep disorders, headache pain, dryness and bitterness in the mouth, constipation, nausea, vomiting, hypotension, AV blockade, sinoauric blockade (SA-blockade), bradycardia.

Side effects arising from the use of Propanorm:

Cardiac: hypotension, blockade of the legs of the bundles of the Gys, AV-blockade, bradycardia;
Non-cardiac: fainting, dizziness, fatigue, abdominal pain, constipation, bitterness or dry mouth, nausea, vomiting; rarely - Allergic skin reactions, cholestatic jaundice, headache; in exceptional cases - thrombocytopenia, leukopenia.

Overdose

In the case of a single dose of propafenone twice the recommended daily dosage, a negative symptoms of intoxication may appear after 60 minutes, maximum for several hours.

For the state of intoxication with an overdose of propafenone, the following conditions are characteristic: stable decrease in blood pressure, extrapyramidal disorders, nausea / vomiting, mydriasis, dry mouth, drowsiness, bradycardia, confusion, AV blockade, QT interval prolongation, ventricular tachyarrhythmia, intraventricular and atrial conduction, paroxysm of ventricular polymorphic tachycardia, asystole, sinoatrial block, coma, delirium, convulsions, pulmonary edema.

Treatment of overdose events, depending on their severity, may require GIT cleaning, administration Diazepam and Dobutamine, carrying out an indirect heart massage and defibrillation, transferring the patient to mechanical ventilation.

special instructions

Treatment should begin in a hospital, because the risk of arrhythmogenic action associated with the use of the drug Propanorm.

When prescribing the drug inside, it is recommended that the previous antiarrhythmic therapy should be discontinued before the start of treatment at a time equal to 2-5 half-lives of these drugs.

Every patient who receives Propanorm should receive an ECG and a clinical examination before and during therapy (including ECG monitoring) for the early detection of side effects, evaluation of the effectiveness of the drug and the need to continue therapy (control of water-electrolyte balance, periodic determination of the activity of microsomal liver enzymes, especially transaminases).

Given the likely proaritmogenic effect of the drug, iv injection of the drug Propanorm is recommended only for the intended purpose and under the supervision of a doctor.

In the event that during the therapy will manifest a sinoatrial blockade or AV-blockade II-III degree or frequently recurring extrasystole, treatment with Propanorm should be stopped.

Pacemakers should be checked and, if necessary, reprogrammed, as the drug may affect the sensitivity threshold and the frequency threshold of the artificial pacemaker.

There is a risk of conversion of paroxysmal atrial fibrillation to atrial flutter with an AV blockade of 2: 1 or 1: 1, with a very high incidence of ventricular contraction (ie> 180 bpm).

As with the use of other antiarrhythmic drugs I C class, patients with organic myocardial changes When using the drug Propanorm may be predisposed to the development of serious side effects.

Propanorm may worsen the course of myasthenia gravis.

In elderly patients, treatment should be started gradually, the dose of the drug should be titrated with extreme caution and increased gradually. The same applies to maintenance therapy. Any increase in the dose that may be required should be given only after 5-8 days of therapy.

In patients with impaired hepatic and / or renal function, caspulation of propafenone in the body can occur even with conventional therapeutic doses. Such patients are recommended to reduce the dose and regularly conduct ECG monitoring, regular monitoring of laboratory parameters and control of the concentration of propafenone in the blood plasma.

The use of the drug Propanorm can reveal the asymptomatic course of the Brugada syndrome and cause brugadopodobnye changes in the ECG. Therefore, after the beginning of therapy with the drug, an ECG examination should be performed to exclude the Brugada syndrome and brugad-like changes on the ECG.

Patients undergoing long-term treatment with anticoagulants and hypoglycemic drugs should undergo thorough clinical and laboratory monitoring.

It should be borne in mind that in the treatment of ventricular arrhythmias, Propanorm is more effective than antiarrhythmic drugs IA and IB classes.

The chemical and physical stability of the preparation Propanorm after dilution in a 5% solution of glucose is maintained at 25 ° C for 72 hours. However, from the microbiological point of view, the prepared solution should be used immediately. In this case, it is recommended to use the preparation no later than 24 hours under the temperature conditions of its storage from 2 ° to 8 ° C, and only if the dilution of the solution was Observed Visual impairment, dizziness, fatigue and postural hypotension may affect the ability of controlled aseptic conditions.

Drug Interactions

When using the drug, it is necessary to take into account the interaction with other drugs:

Lidocaine: cardiodepressant effect is intensified (this combination is contraindicated);
Warfarin: its effect is enhanced;
Rifampicin: the concentration of propafenone in the blood decreases;
Amiodarone: increased risk of developing tachycardia as pirouette;
Drugs that inhibit bone marrow hematopoiesis: the risk of myelosuppression increases;
Beta-adrenoblockers, tricyclic antidepressants: antiarrhythmic effect is increased;
Local anesthetics: increased risk of damage to the central nervous system;
Cimetidine, quinidine: the concentration of propafenone in plasma is increased by 20%;
Ciclosporin, anticoagulants of indirect action, propranolol, metoprolol, digoxin: their concentration increases, the risk of developing glycosidic intoxication;
Drugs that oppress the sinoatrial node and AV node, which have a negative inotropic effect: the risk of side effects increases.

Reviews

We picked up some reviews of people who used the drug Propanorm:

Natalia. With ventricular ekstrasistolii took 6 months "Propanorm" - helped, spam me from RFA. While the rhythm is normal.
Sasha. I was treated for obesity, there was a side effect of arrhythmia. I was prescribed Bisoprolol, but I did not drink it. And then after treatment I noticed an arrhythmia and discomfort in the chest. "Propanorm" saved me. I drink two a day. The state of health is excellent, no interruptions. The rhythm is clear, calm. Super drug. I will drink the course then write the result.

In general, reviews about the Propanorme position it as a fairly effective and relatively safe remedy, most often completely coping with its purpose in case of application strictly according to indications. Naturally, you can not prescribe this drug yourself. Therapy with its use should be carried out exclusively under the supervision of a physician with an individual selection of the dosage regimen and taking into account all the features of the patient's state of health.