Preparation "Corglikon": instructions for use, price, analogues and indications. Description of the drug Corglikon, instructions for its use and possible side effects Application in old age

Corglikon - Cardiotonic drug, heart glycoside.

Release form and composition

Dosage form - a solution for intravenous (in / c) administration (1 ml in ampoules, in cardboard packs of 10 pcs. Or 10 pcs. In the contour cellular packaging, in a cardboard pack 1 package and instructions for the use of Corgal Golon).

The active ingredient is Corgalicon (glycoside of the leaves of the Lily of the Lily of Maysky), in 1 ml - 0.6 mg.

Pharmacological properties

Pharmacodynamics

Corglikon is a purified drug based on the leaves of the May valley and its varieties. It has a positive inactropic effect, which is due to the direct inhibitory effect of the Na + / K + -TF enzyme on the cardiomyocyte membranes. As a result, the intracellular content of sodium ions increases and, as a result, the content of potassium ions is reduced. Increased sodium ion levels lead to an activation of sodium-calcium exchange and an increase in calcium ions content, thereby increasing the strength of myocardial reduction.

The increase in the contractibility (contractile ability) of myocardium helps to increase the impact volume of blood, a decrease in the final systolic and final diastolic volume of the heart. In aggregate with an increase in myocardial tone, these effects lead to a reduction in its size and reduce the need of the heart muscle in oxygen.

Corglikon has a negative chronotropic effect. Contributing an increase in the sensitivity of cardiopulmonary baroreceptors, it oppresses excessive sympathetic activity. Intensifying the activity of the wandering nerve, the heart glycoside has an antiarrhythmic effect, due to the elongation of an effective refractory period and reducing the rate of pulses through an atrioventricular (AV) node. This effect increases due to sympatholic effects and direct influence on the AV node.

The negative drromotropic effect is manifested by an increase in the AV-node refractor.

In patients with flickering tachiaritium, Corglikon slows the ventricular abbreviations, lengthens diastole, improves systemic and intracardiac hemodynamics. A positive battle effect manifests itself when applying a drug in toxic and suboxy doses.

Corgalicon has a direct vasoconstrictor effect, manifested most clearly in the absence of stagnant peripheral edema. In this case, an indirect vasodilative effect (in response to an increase in the minute volume of blood and the decrease in excessive sympathetic stimulation of the vascular tone) usually prevails over a direct vasoconstrictor action, as a result of which the OPS is reduced (general peripheral vascular resistance).

After intravenous administration of the drug, the start of action is marked after 3-5 minutes, the maximum effect is developing in 25-30 minutes.

Pharmacokinetics

Corglikon slightly connects with plasma proteins.

Practically, not biotransformed in the liver. Displays with urine unchanged.

Indications for use

• Clinical manifestations of chronic heart failure of the II-IV functional class, as part of complex therapy;
• Paroxysmal and chronic flow of atrial trembles with a tachiisistolic form of flicker (especially against the background of chronic heart failure).

Contraindications

• Pregnancy and breastfeeding period;
• Glycoside intoxication;
• Wolf Parkinson-White syndrome;
• Atrioventricular (AV) blockade of the II degree;
• Intermittent full blockade;
• Hypersensitivity to Corglikon.

With extreme caution, comparing the estimated benefit and possible risk, it is necessary to prescribe Corglikon to patients: with a sinus weakness syndrome in the absence of a rhythm driver, an unstable angina, an atrioventricular blockade of I degree, acute myocardial infarction, an anamnesis on the attacks of Morgali-Adams-Stokes attacks, isolated Mitral stenosis with a rare heart rate, hypertrophic subaartal stenosis, arteriovenous shunt, hypoxia, heart failure with a diastolic function impaired (consumer pericarditis, heart amyloidosis, heart tamponade, restrictive cardiomyopathy); At the risk of unstable on an atrioventricular node, extrasystole, cardiac asthma, against the background of mitral stenosis (in patients without tachiisistolic shape of fliccific arrhythmia), "pulmonary" heart, severe dilatation of heart cavities, hypothyroidism, myocarditis, alkalosis, obesity, renal and / or liver failure ; Elderly patients.

Corglikon, Application Instructions: Method and Dosage

The solution is designed for intravenous slow (for 5-6 minutes) administration.

• Adults: 0.5-1 ml;
• Children: from 2 to 5 years - 0.2-0.5 ml, from 6 to 12 years - 0.5-0.75 ml.

The use of the drug is shown 1-2 times a day, at 2 other purposes, the interval should be observed between the use of the drug at 8-10 hours.

The maximum one-time dose for adults should not exceed 1 ml.

Side effects

The use of Corgal Golon can cause side effects in patients in case of overdose or hypersensitivity to cardiac glycosides:

• From the hematopolosis organs: nasal bleeding, thrombocytopenic purpura, thrombocytopenia;
• From the side of the cardiovascular system: AV blockade, arrhythmia;
• From the digestive system: anorexia;
• From the nervous system and sense organs: headache, confusion, drowsiness, sleep disorders, delicious psychosis, dizziness, reduction of visual acuity;
• Others: Allergic reactions.

Overdose

Possible symptoms of overdose of the drug Corglikon:

• From the cardiovascular system: the flickering and fluttering of atrial, node tachycardia, ventricular paroxysmal tachycardia, AV blockade, ventricular extrasystolia (often political ventricular extrasystole, bigemia);
• From the side of the senses and nervous system: a decrease in visual acuity, the flashes of flies in front of the eyes, the perception of objects in an increased or reduced form, painting visible items in yellow-green color, neuritis, manico-depressive syndrome;
• From the digestive tract: abdominal pain, diarrhea, vomiting, anorexia, intestinal necrosis.

With the appearance of signs of overdose, Corglikon is canceled. The introduction of antidote (ethylenediaminetetraacetic acid, unitiol) and the conduct of symptomatic therapy is shown. As antiarrhythmic drugs, drug I preparations are used (for example, phenytoin, lidocaine).

In hypokalemia, potassium chloride is introduced intravenously for 3 hours (6-8 g per day at the rate of 1-1.5 g per 0.5 liters of isotonic declaration solution and 6-8 urin insulin).

With pronounced AV blockade and bradycardia, m-cholinoblocators are prescribed. It is forbidden to use beta-adrenostimulants due to the danger of the potentiation of arrhythmogenic effect of the heart glycoside.

With a full transverse blockade with Morganya - Adams - Stokes, temporary electrocardiosulation is required.

special instructions

Hypothyroidism, hypocalemia, hypercalcemia, hypocalemia, hypercalcemia, hypercalcemia, hypercalcemia, hypercalcemia, hypercalcemia, expressed dilatation of the heart cavities, myocarditis, "pulmonary" heart, obesity, and an elderly age of the patient, can be promoted.

With severe brady or normocardia and mitral stenosis, the development of cardiac insufficiency is due to a decrease in the diastolic filling of the left ventricle. Stroofantin, increasing the reduction of myocardial myocardium, contributes to a further increase in pressure in the pulmonary artery system, which can cause the exacerbation of the left-handhold insufficiency or pulmonary edema.

The use of the drug is shown to patients with mitral stenosis with worldwire insufficiency or flickering tachyarhythmia.

To monitor the level of digitalization of cardiac glycosides, it is necessary to monitor the level of their concentration in the blood plasma.

Impact on the ability to control vehicles and complex mechanisms

During the treatment of Corglikon patients, it is recommended to refrain from practicing potentially hazardous activities that require reinforced concentration and speed of psychomotor reactions, including from managing motor vehicles.

Application during pregnancy and lactation

The drug Corglikon is contraindicated to pregnant and nursing women.

Childcare

With violations of the kidney function

Corglikon with renal failure should be used with caution.

When violations of the liver function

Corglikon with liver failure should be used with caution.

Application in old age

It should be borne in mind that elderly patients have increased the risk of inxication of cardiac glycosides.

Medicinal interaction

With the simultaneous use of Corgal Golon:

• Ephedrine hydrochloride, norepinenaline hydrotatch, adrenaline hydrochloride, selective beta adrethrenimetics, as well as xanthine derivatives (including theophylline and caffeine preparations) can contribute to the development of heart arrhythmias;
• Corticotropin preparations contribute to the increase in the actions of Corgal Golglon;
• Aminazine and other phenothiazine derivatives reduce the clinical effect of cardiac glycosides;
• Calcium preparations for parenteral use - enhance the heart arrhythmia and other cardiotoxic effects;
• Glucocorticosteroids against the background of hypokalemia, resulting from long-term use, can cause an increase in the side effects of Corgal Golong;
• The denatrium salt of ethylenediaminetetraacetic acid reduces the toxicity and therapeutic effect of cardiac glycosides;
• Anticholinesterase remedies enhance bradycardia, if necessary, the use of Corgal Golon, additionally prescribed the administration of atropine sulfate;
• Narcotic analgesics, in particular fentanyl, can cause hypotension;
• Potassium preparations reduce the side effects of cardiac glycosides;
• Naproxen does not affect the results of psychological testing in healthy people;
• Paracetamol reduces the excretion by kidney kilklick;
• Diuretic agents increase the effect of the drug, if necessary, it is necessary to observe the optimal dosing of each of the drugs;
• Ergocalciferol, in the case of hypervitaminosis on the background of long-term use, can contribute to strengthening the effect of the drug due to the development of hypercalcemia.

Analogs

Korglikon analogues are: Corgalikard, Digoxin, Drops of Zelenina, Stroofantin K, Adonis Bromine.

Terms and conditions of storage

Store in the light-protected place at a temperature of 8-15 ° C. Take care of children.

Shelf life - 2 years.

1 ml of solution contains:

Active substance: Corglikon (lily of the glycoside leaves) 0.6 mg;

excipients: chlorobutanol hemihydrate 4.0 mg, water for injection to 1 ml.

The purified drug from the Lily of the Lrangess Maysky and its varieties. The heart glycoside, blocks the transport Na + / K + -tf-Azu, as a result, the content of sodium ions in cardiomyocyte increases, which leads to the opening of the calcium channels and the entry of calcium ions in cardiomyocytes. The excess of sodium ions leads to an acceleration of calcium ions from sarcoplasmic reticulum, thus the concentration of calcium ions increases, which leads to inhibiting the troponin complex that has an inhibitory effect on the interaction of actin and myozin. Increases the strength and speed of contraction of myocardium (positive inotropic effect), which occurs according to the mechanism other than the mechanism of the Frank Starling, and does not depend on the degree of preliminary stretch of myocardium; Systole becomes shorter and energetically economical.

As a result of an increase in the contractibility of myocardium, the impact volume of blood and the minute blood volume increase increases, the final systolic and final diastolic volume of the heart decreases, which, along with an increase in the myocardial tone, leads to a reduction in its size and thus to reduce the needs of myocardium in oxygen.

It has a negative chronotropic effect, reduces excessive sympathetic activity by increasing the sensitivity of cardiopulmonal baroreceptors.

Due to the increase in the activity of the vagus nerve, an antiarrhythmic effect is caused by a decrease in the rate of pulses through an atrioventricular node and the elongation of an effective refractory period. This effect is amplified by direct action on an atrioventricular node and a sympatholytic effect.

A negative drromotropic effect is manifested in increasing the refractority of an atrioventricular (AV) node.

With flickering tachyarhyrahythmia, cardiac glycosides contribute to the slowdation of heart rate, lengthen the diastole, improve intracardiac and systemic hemodynamics. A positive battle effect manifests itself in the suboxy and toxic doses.

It has a direct vasoconstrictor action (in the event that the positive inotropic effect of cardiac glycosides is not realized - in patients with normal reduction or with excessive stretching of the heart); In patients with chronic heart failure, an indirect vasodilative effect is caused, reduces venous pressure, increases diuresis: reduces swelling, shortness of breath. When intravenous administration, the action begins after 10 minutes and reaches a maximum after 2 hours.

Distribution: Binding of plasma proteins is insignificant.

Establishment: It is practically no biotransformation in the liver and unchanged by the kidneys.

Comprehensive benefit / risk:

an atrioventricular blockade of an I degree, a sinus node weak syndrome without a rhythm driver, the likelihood of an unstable on an atrioventricular node, an anamnesis instructions for Morgali-Adams-Stokes attacks, hypertrophic obstructive cardiomyopathy, isolated mitral stenosis with a rare heart rate, cardiac asthma in patients with mitral Stenosis (with the absence of tachiisistolic shape of flickering arrhythmia), acute myocardial infarction, unstable angina, arteriovenous shunt, hypoxia, heart failure with a diastolic function (restrictive cardiomyopathy, heart amyloidosis, pericitative pericarditis, heart tamponade), atrial extrasystolia, pronounced heart cavity dilatation , "pulmonary" heart, electrolyte disorders: hypokalemia, hypocaliamia, hypercalcemia, hyponatremia; hypothyroidism, thyrotoxicosis, alkalosis, myocarditis, elderly age, renal and / or liver failure, obesity.

Input intravenously slowly for 5-6 minutes (at 10-20 ml of 40% declaration solution (glucose) or isotonic sodium chloride solution) 1-2 times a day. Adults are injected in a single dose of 0.5-1 ml, children aged 2 to 5 years - 0.2-0.5 ml, from 6 to 12 years of 0.5-0.75 ml. When introducing 2 times a day, the interval between injections is 8-10 hours. Higher doses for adults with intravenous administration: single - 1.0 ml, daily 2.0 ml.

Precautions when applied

With quick intravenous administration, bradyrithmy, ventricular tachycardia, AV blockades and heart stops are possible. At maximum actions, extrasystole may appear, sometimes in the form of bigenini. To prevent this effect, the dose can be divided into 2-3 administration. If other heart glycosides were prescribed to the patient, it is necessary to take a break before intravenous administration (5-24 days, depending on the severity of the cumulative properties of the preceding drug). Treatment is carried out under constant ECG control.

Coglick's side effects are associated with increased patient sensitivity to cardiac glycosides or overdose.

From the side of the cardiovascular system: Arrhythmia, AV blockade.

On the part of the central nervous system and sense organs:sleepiness, confusion of consciousness, sleep disorders, headache, dizziness, delicious psychosis, reducing visual acuity, violation of color perception.

On the part of the blood formation organs: Thrombocytopenia, thrombocytopenic purpura, nasal bleeding, petechia.

From the digestive system:nausea, vomiting, diarrhea, anorexia.

Others: Allergic reactions, gynecomastia.

From the cardiovascular system: ventricular paroxysmal tachycardia, ventricular extrasystole (often bigemia, political ventricular extrasystole), nodular tachycardia, flickering and fluttering atrial, AV blockade.

From the gastrointestinal tract: Reduced appetite, nausea, vomiting, diarrhea, abdominal pain, intestinal necrosis.

From the side of the nervous system and the senses: drowsiness, confusion of consciousness, delicious psychosis, reduction of visual acuity, painting visible objects in yellow-green color, flickering "flies" before eyes, perception of objects in a reduced or enlarged form; Neuritis, radiculitis, manic-depressive syndrome, paresthesia.

Treatment: Cancel the heart glycosides, the introduction of antidotes (, sodium edetat), symptomatic therapy. As antiarrhythmic drugs, the preparations I class (,). In hypokalemia - in / in the introduction of potassium chloride (6-8 g / day at the rate of 1-1.5 g by 0.5 liters of 5% dextrose solution and 6-8 sneakers; injected droplet, for 3 hours). With severe bradycardia, AV blockade - M-cholinoblocators. Beta adreminimetics are dangerous, due to the possible increase in arrhythmogenic action of cardiac glycosides. With a full transverse blockade with the attacks of Morgali-Adams - Stokes - temporal electrocardialism.

Adrenomimetic means.The joint use of ephedrine, epinephrim, norepinephrine, as well as selective beta-adrenomimetic agents with heart glycosides, can contribute to the occurrence of heart arrhythmia.

Chorpromazine and other phenothiazine derivatives. The action of cardiac glycosides is reduced.

Anticholinesterase preparations.With the simultaneous use of anticholinesterase preparations with bradycardia cardiac glycosides, it is amplified. If necessary, it can be eliminated or weakened by the administration of atropine.

Glucocorticosteroids.In the event of hypokalemia, as a result of long-term treatment (glucocorticosteroids, it is possible to increase the undesirable effects of cardiac glycosides.

Diuretic means.With the joint use of diuretic agents (cause hypokalemia and hypomagnation, but increase the concentration of calcium ions in the blood) with heart glycosides, the effect of the latter is enhanced. With simultaneous use, you need to adhere to the optimal dosing. It is possible to periodically assign potassium-saving diuretics (amyloride, triamtenen), which eliminate hypokalemia. However, hyponatremia may develop.

Potassium preparations. Under the influence of potassium preparations, undesirable effects of heart glycosides are reduced. Preparations of potassium salts can not be applied if under the influence of heart glycosides there were conductivity violations on the ECG, but potassium salts are often prescribed together with drugs for the prevention of heart rhythm disorders.

Calcium preparations. In the treatment of cardiac glycosides, the parenteral use of calcium preparations is dangerous, since cardiotoxic effects (heart arrhythmias, etc.) are amplified.

Sodium Edetat.There is a decrease in the effectiveness and toxicity of cardiac glycosides.

Corticotropin preparations.The action of heart glycosides under the influence of corticotropin can be intensified.

Derivatives xanthine.Preparations of caffeine or teofilin sometimes contribute to the occurrence of heart arrhythmia.

TrifoSajenin. Do not be prescribed simultaneously with cardiac glycosides.

Vitamin D. With hypervitaminosis caused by ergocalciferol, it is possible to increase the action of cardiac glycosides due to the development of hypercalcemia.

Narcotic analgesics. The combination of fentanyl and heart glycosides can cause a hypotension.

NaproxenIn healthy volunteers, the sharing of heart, glycosides with naproxen does not affect the results of psychological testing.

Paracetamol. The clinical significance of this interaction is not sufficiently studied, but there is data on reducing the highlighting of cardiac glycosides under the influence of paracetamol.

Preparations caffeine and Teofillin Enhance the risk of developing arrhythmias.

Beta adrenoblockers, antiarrhythmic agents IA class, magnesium sulfate Enhance the severity of reducing atrioventricular conduction.

County, Tetracycline Enhance the concentration in the blood plasma of heart glycosides.

Glucocorticosteroids, diuretics, saluretics increase the risk of hypokalemia, hypomagnemia, angiotensin-plating enzyme inhibitors and angiotensin II receptor antagonists - reduce; thiazids and calcium salts (especially when in / in administration) - hypercalcemia; , hypothyroidism. Laxative means:, amphotericin in, salicylates Increase the risk of glycosida intoscience.

Inductors of liver microsomal enzymes (,); And also cytostatic agents can reduce the concentration of cardiac glycosides in the blood plasma.

The probability of intoxication is increasing with hypokalemia, hypercalcalemia, hypercalcemia, hypernatremia, hypothyroidism, pronounced dilatation of the heart cavities, pulmonary heart, myocarditis, obesity, old age. With severe mitral stenosis and normo or bradycardia, heart failure develops due to a decrease in the diastolic filling of the left ventricle.

Heart glycosides are prescribed with mitral stenosis patients with the joining of destroying failure, or in the presence of flickering tachyarhythmia. Corgalicon with Wolf Parkinson-White syndrome, reducing AV conductivity, contributes to the conduct of pulses through additional paths - bypassing AV assembly, provoking the development of paroxysmal tachycardia.

As one of the methods of control over the level of digitalization when prescribing heart glycosides, their plasma concentrations are monitored.

Store in a dark place at temperatures from 8 ° C to 15 ° C.

Keep out of the reach of children.