Sotageksal

Sotagexal is a non-selective blocker.

Like other beta-blockers, sotalol inhibits the secretion of renin, and this effect has a pronounced character both at rest and during exercise. The action of the drug causes a decrease in the heart rate (negative chronotropic action) and a limited decrease in the force of the heartbeats (negative inotropic action).

The main effect of Sotagexal is to increase the duration of effective refractory periods in the atrial, ventricular and additional ways of carrying out the pulse.

Clinical and pharmacological group

Beta1 beta2-adrenoblocker.

Terms of sale from pharmacies

Can buyby prescription.

Price

How much does Sotagexal cost in pharmacies? The average price is at the level of100 rubles.

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Composition and form of release

Dosage form: tablets: round, almost white or white:

• 80 mg: on one side convex, with the engraving "SOT on the other side of the risk, the surface of the tablet is chamfered to the risk;
• 160 mg: convex on both sides, engraved "SOT" on one side and risky on the other.

Packing tablets: 10 pcs. in blisters, 1, 2, 3, 5 or 10 blisters in a cardboard bundle.

Active substance: sotalol hydrochloride, in one tablet - 80 or 160 mg.

Additional components: giprolase, corn starch, sodium carboxymethyl starch, magnesium stearate, silicon dioxide colloid, lactose monohydrate.

pharmachologic effect

Sotagexal has an antiarrhythmic and hypotensive effect, reduces the level of Ca2 + (calcium in the body cells) and eliminates signs of coronary insufficiency.

The main component of Sotalol reduces the excitability of the myocardium and normalizes the frequency of cardiac contractions. The systematic use of the drug leads to the achievement of an antihypertensive effect, i.e. lowering blood pressure to normal, the blood flow of the atrium walls is established. With hypertension, the positive effect is achieved after 2-4 days of regular use.

Sotagexal also promotes an increase in oxygen metabolism in tissues and eliminates the underlying causes arrhythmias - increased pressure on the walls of blood vessels, violation of blood supply and, including, nervous excitability. The drug has positive characteristics as an effective complex agent for the treatment of cardiovascular pathologies at different stages of development.

Indications for use

Sotagexal is prescribed for various heart rhythm disorders:

1. Ventricular arrhythmias with severe symptoms.
2. Arrhythmias associated with excessive circulation or hypersensitivity to catecholamines.
3. Supraventricular tachyarrhythmias with severe symptomatology (nodal / ventricular / paroxysmal tachycardia in the background of WPW syndrome and / or paroxysms in atrial fibrillation).

Sotagexal is recommended to prevent paroxysms in atrial fibrillation and atrial flutter after recovery of sinus rhythm, as well as ventricular arrhythmias (with proven effectiveness).

Contraindications

Absolute:

• COPD (chronic obstructive pulmonary disease) or bronchial asthma;
• Severe allergic rhinitis;
• Renal failure (CC (creatinine clearance) is less than 10 ml / min);
• Metabolic acidosis;
• General anesthesia, leading to suppression of myocardial function (trichlorethylene or cyclopropane);
• Pheochromocytoma, without simultaneous administration of alpha-blockers;
• Simultaneous use of MAO inhibitors (monoamine oxidase);
• The period of breastfeeding;
• Cardiogenic shock;
• Syndrome of weakness of the sinus node;
• CHF (chronic heart failure) IIb-III stage;
• Sinoatrial block;
• Arterial hypotension (with systolic blood pressure less than 90 mm Hg. item);
• AV blockade of 2 or 3 degrees;
• Acquired or congenital syndrome of prolonged QT interval;
• Pronounced bradycardia (heart rate (heart rate) less than 50 beats per minute);
• Acute myocardial infarction;
• Obliterating vascular diseases;
• Tachycardia of the "pirouette" type;
• Children and adolescents under 18 years of age (safety and efficacy of Sotagexal not established);
• Hypersensitivity to the main or auxiliary components of the drug and / or sulfonamides.

Relative (Sotagexal is used with caution):

• Thyrotoxicosis;
• Violation of the water-electrolyte balance (hypokalemia, hypomagnesemia);
• Depression (including in the anamnesis);
• Elderly age;
• Psoriasis;
• Diabetes;
• Recently suffered myocardial infarction;
• AV-blockade of 1 degree;
• Elongation of the interval QT;
• Impaired renal function;
• Allergic reactions (history) and desensitizing treatment (with extreme caution, since the drug reduces sensitivity to allergens).

Intended use for pregnancy and lactation

The administration of Sotagexal during pregnancy, especially in the first trimester, is possible only for life reasons.

In the case of treatment during pregnancy, the drug should be discontinued 48 to 72 hours before the expected the onset of labor, because of the possible development of hypokalemia, arterial hypotension, bradycardia and respiratory depression newborn.

If you need to use the drug Sotageksal during lactation should stop breastfeeding.

Dosage and route of administration

As indicated in the instructions for use Sotageksal taken inside for 1-2 hours before meals, without chewing, squeezed a sufficient amount of liquid. Simultaneous intake of food (especially milk and dairy products) reduces the absorption of the drug.

The dose of the drug is selected individually, depending on the severity of the disease and the patient's response to treatment.

• The initial dose is 80 mg / day. If the therapeutic effect is insufficient, the dose can be gradually increased to 240-320 mg / day, divided into 2-3 doses. In most patients, the therapeutic effect is achieved at a total daily dose of 160-320 mg divided into 2 doses.
• In life-threatening severe arrhythmias, a dose increase of up to 480 mg, divided into 2 or 3 separate doses, is possible. However, such doses can be prescribed only in cases where the potential benefit outweighs the risk of side effects, especially pro-arrhythmogenic action.

Because of the risk of developing cumulation in case of impaired renal function, the drug should be administered with QC and heart rate control (at least 50 beats per minute). With renal failure, the half-life (T1 / 2) of sotalol increases, so a dose reduction is required with serum creatinine levels above 120 μmol / L.

Recommended dosing taking into account the value of serum creatinine level:

• up to 120 μmol / l: usual dose;
• 120-200 μmol / l: 3/4 of the usual dose;
• 200-300 μmol / l: 1/2 of the usual dose;
• 300-500 μmol / l: 1/4 of the usual dose.

With a severe degree of renal failure, the patient must ensure regular monitoring of electrocardiography (ECG) and the level of sotalol in the blood serum.

Duration of treatment is prescribed by the doctor individually.

If you miss an incidental dose, you should not reimburse it at the next admission, you should take only the prescribed single dose.

Side effect

The use of Sotagexal may cause the following side effects:

1. Endocrine system: hypoglycemia (most often in patients with diabetes mellitus, or with strict adherence to diets);
2. Genitourinary system: decreased potency;
3. Respiratory system: bronchospasm (especially when pulmonary ventilation is impaired);
4. Digestive system: flatulence, vomiting, abdominal pain, nausea, diarrhea, dry mouth, constipation;
5. Dermatological reactions: urticaria, skin rash, psoriasis dermatosis, redness, alopecia, itching;
6. Cardiovascular system: fainting, shortness of breath, palpitation, bradycardia, retrosternal pain, increased symptoms of cardiac insufficiency, AV-blockade, edema, arrhythmogenic action, lowering of arterial pressure; rarely - increased seizures angina pectoris;
7. Organs of the senses: a decrease in tearing, visual impairment, inflammation of the cornea and conjunctiva (should be taken into account when wearing contact lenses), a violation of taste sensations, hearing;
8. Central nervous system: sleep disorders (insomnia or drowsiness), anxiety, dizziness, headache, increased fatigue, depression, tremor, mood changes, depression, asthenia, paresthesia in limbs;
9. Laboratory indicators: increased results in photometric analysis of urine for metanephrine;
10. Other: convulsions, muscle weakness, cold extremities, fever.

Overdose

Symptoms of an overdose of Sotagexal: decreased blood pressure, bronchospasm, hypoglycemia, bradycardia, generalized convulsive seizures, lengthening of the QT interval, ventricular tachycardia (including pirouette), loss consciousness. In severe cases, the development of symptoms of cardiogenic shock and asystole (possibly fatal) is possible.

Recommended treatment: gastric lavage, hemodialysis, activated charcoal. Symptomatic therapy is also recommended:

• atrioventricular blockade of 2-3 degrees: a temporary artificial pacemaker can be installed;
• bradycardia: atropine - intravenous jet injection 1-2 times; glucagon - the first short intravenous infusion in a dose, mg per 1 kg of body weight, the following mg per 1 kg of body weight intravenously for 12 hours;
• marked decrease in blood pressure: the use of epinephrine;
• bronchospasm: use of aminophylline or sympathomimetics of beta-2-adrenoreceptors (inhalation);
• pirouette tachycardia: magnesium sulfate and / or epinephrine, cardioversion, if necessary - the installation of a temporary artificial pacemaker.

special instructions

In the presence of hypomagnesemia or hypokalemia, treatment can be started only after correction of existing disorders.

Patients receiving drugs that cause a decrease in potassium and / or magnesium in the body, during the period of application of Sotagexal requires control of acid-base and electrolyte balance.

The drug can cause inflammation of the cornea and conjunctiva, which should be taken into account by people wearing contact lenses.

During treatment, the following parameters should be monitored: heart rate, blood pressure and electrocardiogram. In the case of a decrease in the heart rate or a marked decrease in pressure, the dose of Sotagexal should be reduced.

The drug should be withdrawn gradually (especially after a long course of therapy) and under the supervision of the attending physician.

Sotalol may mask certain symptoms of thyrotoxicosis (eg, tachycardia). In the case of abrupt withdrawal of the drug in these patients may increase the symptoms of the disease.

Care should be taken in patients receiving hypoglycemic drugs, because during prolonged breaks in eating can develop hypoglycemia, and Sotagexal will mask such obvious signs of it as tremor and tachycardia.

During pregnancy (especially in the first trimester), Sotagexal is used only in absolute indications, after a thorough assessment of the risk-benefit ratio. The drug should be discontinued no later than 48-72 hours before the expected date of delivery, because there is a risk of development in newborns hypokalemia, arterial hypotension, bradycardia and oppression respiration.

Interaction with other drugs

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

1. With simultaneous application of Sotagexal with reserpine, clonidine, alpha-methyldopa, guanfacin and cardiac glycosides, it is possible to develop a pronounced bradycardia and slow the excitation in a heart.
2. Beta-adrenoblockers can potentiate the hypertension of withdrawal, after stopping the use of clonidine, therefore beta-adrenoblockers should be canceled gradually, a few days before the phasing out of admission clonidine.
3. The appointment of insulin or other oral hypoglycemic agents, especially when exercising, can lead to increased hypoglycemia and the manifestation of its symptoms (increased sweating, rapid heart rate, tremor). Diabetes requires correction of insulin doses and / or hypoglycemic drugs.
4. With the simultaneous administration of slow calcium channel blockers such as verapamil and diltiazem, it is possible to decrease the blood pressure as a result of worsening contractility. Avoid intravenous administration of these drugs against the background of the use of sotalol (except in cases of emergency medicine).
5. With the simultaneous administration of nifedipine and other derivatives of α-dihydropyridine, a decrease in blood pressure is possible.
6. The simultaneous administration of norepinephrine or MAO inhibitors, as well as the abrupt withdrawal of clonidine, can cause hypertension. In this case, the abolition of clonidine should be carried out gradually and only a few days after the end of Sotagexal.
7. Tricyclic antidepressants, barbiturates, phenothiazines, opioid and antihypertensives, diuretics and vasodilators can cause a sharp decrease in blood pressure.
8. The use of funds for inhalation anesthesia, incl. tubokurarina on the background of taking Sotagexal increases the risk of oppression of myocardial function and the development of arterial hypotension.
9. Potassium-withdrawing diuretics (eg, furosemide, hydrochlorothiazide) can trigger the occurrence of arrhythmia caused by hypokalemia.
10. When used simultaneously with Sotagexal may require the use of higher doses of beta-adrenomimetics, such as salbutamol, terbutaline and isoprenaline.
11. The combined use of antiarrhythmic agents of class I A (especially quinidine type: disopyramide, quinidine, procainamide) or class III (eg, amiodarone) can cause a pronounced lengthening of the interval QT. Drugs that increase the duration of the QT interval should be used with caution with drugs that extend the QT interval, such as antiarrhythmics of the first class, phenothiazines, tricyclic antidepressants, terfenadine and astemizole, as well as some antibiotics of quinolone series.

Reviews

We offer you to familiarize yourself with the opinions of people who used the drug Sotageksal:

1. Kostya. Assigned for mild sinus arrhythmia after atrial fibrillation (first detected). Appointed on a quarter of, 6 twice a day. The dose is minimal from the minimum. But the arrhythmia persisted (or a new one began) and a fairly palpable bradycardia, the pulse after the second day of intake slowed and rarely exceeded 50 beats per minute. Even lower was. I had to cancel. The pulse was restored, the arrhythmia stopped. Moreover, the arrhythmia was recorded as on an automatic tonometer (although antiarrhythmic!) And manually. But the main thing is a bradycardia. Well, the maximum was during the day 50. So be careful with the drug!
2. Raisa. After suffering a heart attack and stent placement, arrhythmia appeared, Concor 10 no longer helped, they discharged Sotagexal. At first everything was fine, the arrhythmia did not have an inoculation, but then a month later, depression began. At first I could not understand what was happening, as if there was no reason for a depressive state, but the state is such that I do not want to live and it lasted almost half a year. I read the annotation to the drug, and there it is indicated in the first place in the first place "very often (it is more than 1/10 cases)" causes depressive conditions. She stopped taking Sotahexal, again switched to Concor, everything was normal. Read carefully the side effects.

Analogues

Structural analogs for the active substance:

• Darub;
• Sotaleks;
• Sotalol Canon;
• Sotalol hydrochloride.

Before buying an analogue, consult your doctor.

Shelf life and storage conditions

Shelf life of the drug is 5 years. It is stored at a temperature of 15 to 25 °, away from children.

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