When appointing Cordarone: instructions for use

Cordarone has antianginal and antiarrhythmic action. Pharmacologists refer it to a group of drugs with antiarrhythmic effect.

Its active ingredient is amiodarone. Used to prevent stenocardia, her attacks, as well as for treatment and preventive methods at disturbance of a warm rhythm, at diagnostics of various types of a tachycardia, and also shudders of the atria. It is an indispensable preparation for ventricular extrasystole.

On this page you will find all information about Cordarone: the full instructions for use on this medicated medium, average prices in pharmacies, complete and incomplete analogs of the drug, as well as reviews of people who have already applied Cordaron. Want to leave your opinion? Please write in the comments.

Clinical and pharmacological group

Antiarrhythmic drug.

Conditions of leave from pharmacies

It is released on prescription.

Price list

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

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Form of issue and composition

The following dosage forms of Cordarone are available:

• Solution for intravenous administration: light yellow transparent (in ampoules of colorless glass of 3 ml with two marking rings and a break point in the upper part; in contour packs of plastic for 6 ampoules; in cardboard pack of 1 pack).
• Tablets: round from white with a creamy shade to white. On one side there is a fault line, on both - a bevel from the edges to the fault line and an engraving "200" under it, chamfer and a heart symbol above the fault line (in blisters for 10 pcs, 3 blisters per cardboard pack).

In 1 ampoule contains:

• Active ingredient: amiodarone hydrochloride 5 g.
• Auxiliary components: polysorbate 80 g, water for injection - up to 3 ml, benzyl alcohol 6 g.

The composition of 1 tablet includes:

• Active substance: amiodarone hydrochloride
• Auxiliary components: magnesium stearate, anhydrous colloidal silicon dioxide, lactose monohydrate, povidone K90F, corn starch.

Pharmacological effect

Cordarone is an antiarrhythmic drug of the third class. Eliminates angina and arrhythmia, promotes blockade of adrenoreceptors, slows down sinoatrial, atrial and nodal conduction, while not affecting intraventricular conduction.

Also, the drug reduces myocardial excitability, lengthens the refractory period. Cordarone also has an antianginal effect, caused by a decrease in oxygen consumption by the myocardium. This is due to a decrease in the heart rate and a decrease in the overall vascular peripheral resistance. Thanks to the direct effect on the musculature of the arteries, Cordarone increases coronary blood flow, in addition, the drug maintains cardiac output, reduces myocardial contractility.

According to reviews, Cordarone reaches its maximum activity 15 minutes after intravenous administration, the drug effect on the body continues for four hours. Gradually the amount of the drug in the blood decreases, but this does not interfere with the saturation of the tissues. If the patient does not receive repeated injections, the drug is excreted from the body in a few months.

Indications for use

What helps? Cordarone in tablets is used to treat the following diseases and pathological conditions:

• disorders of the heart rhythm in patients with pathology of left ventricular function or ischemic heart disease;
• supraventricular paroxysmal tachycardia;
• atrial fibrillation and atrial flutter;
• life-threatening ventricular arrhythmias, in particular, ventricular fibrillation and ventricular tachycardia.

The use of Cordarone is indicated for the prevention of sudden death in patients at high risk: having more than 10 ventricular extrasystoles per hour, reduced fraction of left ventricular outflow in patients after recent myocardial infarction, as well as in patients with clinical manifestations of chronic cardiac insufficiency.

The use of Cordarone in the form of an injection solution is indicated in the following cases:

• for relief of attacks of ventricular paroxysmal tachycardia, including those characterized by a high frequency of contractions of the ventricles;
• for cardiac recovery in case of cardiac arrest caused by ventricular fibrillation, in case of defibrillation inefficiency;
• For arresting attacks of atrial fibrillation and atrial flutter.

When treating ventricular arrhythmias, the drug should be administered in a hospital setting and careful cardiomonitor monitoring.

Contraindications

This drug can be used by patients only as directed by a doctor after a thorough examination. Before starting therapy, it is recommended that you carefully read the enclosed instruction for restrictions. Contraindications to the use of Cordarone are:

1. Age to 18 years;
2. Pregnancy and the period of breastfeeding;
3. Hypokalemia or hypomagnesemia;
4. Sinus bradycardia;
5. Severe thyroid dysfunction (hyper or hypothyroidism);
6. Interstitial lung disease;
7. Simultaneous use of drugs that change the parameters of the electrocardiogram and can cause the development of paroxysmal tachycardias;
8. Congenital lactose intolerance or lactase insufficiency;
9. Individual intolerance to the components of the drug;
10. Simultaneous use with agents that extend the QT interval and cause the development of paroxysmal tachycardias, including ventricular "pirouette" tachycardia: antiarrhythmic drugs IA class (hydroquinidine, quinidine, procainamide, disopyramide) and grade III (brethilium tosylate, ibutilide, dofetilide), sotalol; other drugs not antiarrhythmic action: vincamine, bepridil, phenothiazines (fluphenazine, cyamemazine, chlorpromazine, levomepromazine, trifluoperazine, thioridazine), benzamides (sultopride, amisulpride, sulpride, verialapride, tiaprid), pimozide, butyrophenones (haloperidol, droperidol), sertindole, cisapride, tricyclic antidepressants, azoles, macrolide antibiotics (including spiramycin, erythromycin for IV injection), antimalarial drugs (chloroquine, halofantrine, quinine, mefloquine), dipemannil methyl sulfate, pentamidine only with parenteral administration, misolastine, fluoroquinolones, astemizole and terfenadine.

With special care, the drug can be used in patients with chronic heart failure in the stage of decompensation, hepatic or renal insufficiency, bronchial asthma, respiratory failure, and also to the elderly (more than 65 years).

Additional contraindications for the use of the solution:

1. Severe arterial hypotension, cardiogenic shock, collapse;
2. Violations of intraventricular conduction (two- and three-beam blockades) in the absence of a permanent pacemaker;
3. Heart failure, arterial hypotension, cardiomyopathy or severe respiratory failure - for intravenous administration.

All these contraindications should not be taken into account when cardiac recovery is performed when cardiac arrest occurs against the background of ventricular fibrillation that is resistant to cardioversion.

Application in pregnancy and lactation

The use of amiodarone in pregnant women is possible with ventricular arrhythmias that represent threat to the mother's life if the expected clinical effect exceeds the potential risk and the fetus.

Can not be used for lactation.

Instructions for use

The instructions for use indicate that Cordarone tablets are taken orally before meals and are washed down with sufficient water. The drug should be taken only as directed by a doctor.

1. Load ("saturating") dose: various saturation schemes can be applied.
2. Inpatient: the initial dose divided into several receptions ranges from 600-800 mg (to a maximum of 1200 mg) / day until a total dose of 10 g (usually within 5-8 days).
3. Outpatient: the initial dose divided into several doses ranges from 600 to 800 mg per day until a total dose of 10 g is reached (usually within 10-14 days).
4. Supportive dose: can vary in different patients from 100 to 400 mg / day. A minimum effective dose should be applied in accordance with the individual therapeutic effect.

Because Cordarone has a very large T1 / 2, it can be taken every other day or take breaks in its reception 2 days a week.

• The average therapeutic single dose is 200 mg.
• The average therapeutic daily dose is 400 mg.
• The maximum single dose is 400 mg.
• The maximum daily dose is 1200 mg.

Side effects

During therapy, the development of disorders from certain body systems may occur:

1. Digestive system: very rarely - nausea;
2. Endocrine system: with unknown frequency - hyperthyroidism;
3. Musculoskeletal system: with unknown frequency - pain in some parts of the spine (lumbar and lumbosacral);
4. Immune system: very rarely - anaphylactic shock; with unknown frequency - angioedema (Quincke's edema);
5. Nervous system: very rarely - headache, benign intracranial hypertension (pseudotumour of the brain);
6. Skin and subcutaneous tissues: very rarely - increased sweating, a feeling of heat; with unknown frequency - hives;
7. Local reactions: often - reactions at the injection site (infection, infiltration, erythema, pain, necrosis, edema, thrombophlebitis, pigmentation, extravasation, compaction, inflammation, cellulitis, phlebitis).
8. Respiratory system: very rarely - cough, interstitial pneumonitis, dyspnea, apnea and / or bronchospasm (in patients with severe respiratory insufficiency, especially with bronchial asthma), acute respiratory distress syndrome (sometimes with lethal outcome);
9. Bile ducts and liver: very rarely - an isolated increase in the activity of hepatic transaminases in the blood serum (as a rule, moderate, excess of normal values ​​in, -3 times decreases with decreasing doses or even spontaneously), acute liver damage (within 24 hours after the administration of Cordarone) with jaundice and / or increased transaminases, including the development of hepatic insufficiency, sometimes with lethal outcome;
10. Cardiovascular system: often - bradycardia (usually a moderate decrease in the heart rate), lowering blood pressure, usually transient and moderate (cases of collapse or severe arterial hypotension were observed with too rapid administration of the drug or an overdose); rarely - arrhythmogenic action (occurrence of new arrhythmias, including ventricular tachycardia "pirouette or aggravation of existing, sometimes - with the subsequent stopping heart. These effects are mainly observed with the use of Cordarone together with drugs that prolong the period of repolarization of the ventricles of the heart or violations of the blood in the electrolytes); severe bradycardia or, in rare cases, stopping the sinus node, which requires discontinuation of therapy, especially in patients with sinus node dysfunction and / or elderly patients, flushing of blood to the skin of the face; with unknown frequency - ventricular tachycardia type of pirouette.

Overdose

When ingesting large doses of the drug in patients there are signs of overdose, which are expressed in the enhancement of the above-described side effects, the development of sinus bradycardia, up to cardiac arrest.

With the development of such symptoms or accidental ingestion of a large dose of the drug, the patient should rinse the stomach as soon as possible, give him or her to drink activated charcoal or other sorbents. If necessary, symptomatic treatment is performed. Hemodialysis is not effective, there is no specific antidote for the drug.

special instructions

Because the side effects of amiodarone are dose-dependent, patients should be treated with minimal effective doses in order to minimize their occurrence.

Patients should be warned that during treatment they avoid exposure to direct sunlight rays or take protective measures (for example, the use of sunscreen, wearing appropriate clothes).

Monitoring of treatment

Before starting to take amiodarone, it is recommended to conduct an ECG and to determine the potassium content in the blood. Hypokalemia should be corrected before starting amiodarone. During treatment, it is necessary to regularly monitor the ECG (every 3 months) and the activity of transaminases and other indicators of liver function.

In addition, due to the fact that amiodarone can cause hypothyroidism or hyperthyroidism, especially in patients with thyroid disease a gland in the anamnesis, before reception of an amiodarone it is necessary to spend clinical and laboratory (concentration TTG in blood serum, determined with the help of ultrasensitive analysis on TSH) examination for the detection of functional disorders and diseases thyroid gland. During treatment with amiodarone and for several months after discontinuation it should be regularly examine the patient for clinical or laboratory signs of a change in function thyroid gland. If there is a suspicion of a thyroid dysfunction, the serum TSH should be determined (using an ultrasensitive TSH assay).

Patients receiving long-term treatment for rhythm disturbances reported cases of increased ventricular defibrillation and / or an increase in the threshold of activation of a pacemaker or an implanted defibrillator, which may reduce the effectiveness of these devices. Therefore, before starting or during treatment with amiodarone, regular monitoring of their proper functioning should be carried out.

Regardless of the presence or absence during the treatment of amiodarone pulmonary symptoms It is recommended that every 6 months to conduct a chest X-ray and pulmonary functional tests.

The appearance of dyspnoea or dry cough, both isolated and accompanied by deterioration of the general condition (fatigue, weight loss, fever) may indicate pulmonary toxicity, such as interstitial pneumonitis, whose suspected development requires an X-ray examination of the lungs and pulmonary functional samples.

Because of the prolongation of the repose period of the ventricles of the heart, the pharmacological action of the drug Cordarone causes certain changes in ECG: lengthening of the interval QT, QTc (corrected), waves may appear U. It is permissible to increase the interval QTs not more than 450 ms or no more than 25% of the original value. These changes are not a manifestation of the toxic effect of the drug, but require monitoring to correct the dose and evaluate the possible pro-arrhythmogenic effect of the drug Cordarone.

With the development of AV blockade II and III degree, sinoatrial blockade or a two-beam intraventricular blockade, treatment should be discontinued. When an AV blockade of the 1st degree occurs, surveillance should be strengthened.

Although there was an occurrence of arrhythmia or weighting of existing rhythm disturbances, sometimes fatal, pro-arrhythmogenic effect of amiodarone is weakly expressed (less pronounced than most antiarrhythmic drugs) and usually manifests itself in the context of increasing factors duration of the QT interval, such as interaction with other drugs and / or in disturbances of the electrolyte content in blood. Despite the ability of amiodarone to prolong the duration of the QT interval, it showed low activity with respect to provoking ventricular tachycardia of the "pirouette" type.

With blurred vision or with reduced visual acuity, an ophthalmological examination, including examination of the fundus, should be performed urgently. With the development of neuropathy or neuritis of the optic nerve caused by amiodarone, the drug must be canceled because of the danger of developing blindness.

Since Cordarone contains iodine, its administration can disrupt the absorption of radioactive iodine and distort the results of radioisotope studies of the thyroid gland, however, taking the drug does not affect the reliability of determining the content of T3, T4 and TSH in plasma blood. Amiodarone inhibits peripheral transformation of thyroxine (T4) into triiodothyronine (T3) and can cause isolated biochemical changes (increase in free T4 concentration in serum, with a slightly reduced or even normal concentration of free T3 in the blood serum) in clinically euthyroid patients, which is not the reason for cancellation amiodarone.

The development of hypothyroidism can be suspected when the following clinical signs appear, usually weakly expressed: weight gain, cold intolerance, decreased activity, excessive bradycardia.

Before surgery, you should inform the anesthesia doctor that the patient is taking Cordarone.

Long-term treatment with Cordarone may increase the hemodynamic risk inherent in local or general anesthesia. In particular, this refers to its bradycardic and hypotensive effects, reduction of cardiac output and conduction disorders.

In addition, in patients taking Cordarone, in rare cases, immediately after surgery, acute respiratory distress syndrome was noted. With artificial ventilation of the lungs, such patients require careful monitoring.

It is recommended to carefully monitor functional liver tests (determination of transaminase activity) before starting Cordarone and regularly during treatment with the drug. When taking Cordarone, acute liver function abnormalities (including hepatocellular insufficiency or liver failure, sometimes fatal) and chronic liver damage are possible. Therefore, treatment with amiodarone should be discontinued with an increase in the activity of transaminases, which is 3 times higher than UGN.

Clinical and laboratory signs of chronic liver failure with amiodarone oral intake may be minimal (hepatomegaly, an increase in the activity of transaminases, 5 times higher than UGN) and reversible after discontinuation of the drug, however, cases of fatal outcome were reported liver.

Drug Interactions

Only the attending physician can determine the possibility of concomitant therapy, taking into account the condition and clinical indications of the patient.

Reviews

We picked up some reviews of people taking the drug Cordarone:

1. Hope. Accepted kordaron 3 years on 1 tabl.v day. Doctors did not even set a break for 1-2 days a week and did not say to defend themselves from the sun! Until all the method "poke" had to go myself. The drug is very toxic. Canceled itself. After the abolition, after 3 months, hyperthyroidism was discovered, not to mention rashes on the legs, development of blurred vision, nausea, headaches... If you can do without it on other preparations, then, of course, it is better to treat them and not start off!
2. Igor. Kordaron have appointed or nominated weeks two back and here all the same has begun, as at Alla Koltsovoj. I stayed in the hospital for 10 days, until I got the necessary medicines (supposedly). After reading your testimonies three days ago I quit taking the cordarone and returned to the old medicines. Digoxin (once every two days) and corvadelol (morning and evening). And the dream appeared and the dyspnea passed. Correctly write how many doctors so many prescriptions. I want to say that these medicines were prescribed to me seven months ago, so consult a doctor.
3. Victor. After heart surgery, I developed atrial fibrillation, completely lost my ability to work, stagnation of blood, enlargement of the liver and other rather serious complications. Treatment in the cardiology department, including the introduction of cardamom by drip, did not yield any results. I had to go to NIISSH, where I went through the procedure of fibrillation, after which the pulse was adjusted. But I was recommended to continue taking the cordarone tablets according to the 5-day schedule, 2 days rest. Due to the fact that Kordaron is a rather expensive medicine, on the recommendation of doctors began to take amidorone. By its qualities, it completely replaces cordarone and perfectly blocks heart impulses. In addition, I was convinced that the generics of our production are no worse than imported ones. And yet, apparently, not always therapeutic treatment can lead to a positive result.

Analogues

How can I replace a remedy? Analogues can be called medicines:

• Amiodarone;
• Amiocordin;
• Vero Amiodarone;
• Cardiodarone;
• Opakorden;
• Rhythmiodaron;
• Sedacoron.

Before using analogues, consult your doctor.

Storage conditions and shelf life

Kordaron's solution should be stored at room temperature, not exceeding 25 ° C. Store in the original box of cardboard, in a dry place, away from children.

Tablets should be stored at a temperature below 28-30 ° C.

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