The use of anaprilin. Does Anaprilin have worthy analogues?

Anaprilin (INN - propranolol) is a non-selective (non-selective) beta-blocker used for the treatment and prevention of cardiovascular diseases and related complications. The drugs of this group have been successfully used in cardiological practice for over 40 years. Beta blockers are valuable in a combination of critical pharmacological effects: antihypertensive, antianginal (anti-ischemic) and antiarrhythmic. When arterial hypertension drugs in this group are first-line drugs, especially in young patients.

The pharmacological affiliation of anaprilin makes a brief excursion into the neurohumoral "ins and outs" of beta-adrenergic receptors, which are powerful regulators of the physiological functions of the body, mandatory. These receptors interact with adrenaline and norepinephrine, transmitting biological signals received from them to the executing cells. There are beta-1- and beta-2-adrenergic receptors. The first ones are "scattered" mainly in cardiomyocytes and the conducting system of the heart, adipose tissue and kidneys. Their excitement causes an increase and more frequent contractions of the heart muscle, an increase in the ability of the heart to self-excitement, relief of atrioventricular conduction, an increase in the "requests" of the myocardium to provide itself with oxygen. Beta-2-adrenergic receptors are found in the bronchial tree, blood vessels, liver, uterus (excitation of these receptors causes relaxation of all these organs), pancreas, platelets. Depending on their ability to "turn off" these receptors, non-selective (blocking both types of receptors) and selective beta-blockers are released.

Anaprilin belongs to the first group. By blocking beta-adrenergic receptors, it inhibits the synthesis of cAMP, which reduces the flow of calcium ions into the cell. This leads to a decrease in the heart rate, suppression of the excitability and conductivity of the myocardium, and a decrease in its contractility. The antihypertensive effect of anaprilin is manifested by a decrease in the minute cardiac output, stimulation of peripheral vessels along the sympathetic pathway, suppression of the activity of the renin-angiotensin-aldosterone system. The antianginal (anti-ischemic) effect of the drug is associated with a decrease in the oxygen demand of the heart muscle. A decrease in heart rate entails a lengthening of the period of relaxation of the myocardium and an increase in the degree of its saturation with blood. The antiarrhythmic effect develops due to the elimination of a number of provoking factors (tachycardia, activation of sympathetic nervous system, increasing the concentration of cAMP), slowing down the atrioventricular conduction and inhibition of spontaneous excitation of myocardial cells that generate impulses that determine the heart rate. Anaprilin is able to prevent the occurrence of headaches of a vascular nature: this is due to a decrease in the lumen of the arteries of the brain due to the blockade of beta-adrenergic receptors localized there, a decrease in platelet aggregation, stimulation of oxygen transport in the tissue and suppression of renin release.

Anaprilin is available in tablets. The dosage regimen of the drug is individual. According to general recommendations, the initial single dose of anaprilin is 20 mg, then, as necessary, it is increased to 40-80 mg. Frequency rate of admission - 2-3 times a day. The maximum daily dose should not exceed 320 mg.

Pharmacology

Non-selective beta-blocker. It has antihypertensive, antianginal and antiarrhythmic effects. Due to the blockade of beta-adrenergic receptors, it reduces the formation of cAMP from ATP stimulated by catecholamines, as a result of which it reduces the intracellular intake of calcium ions, has negative chrono-, dromo-, batmo- and inotropic action (reduces heart rate, inhibits conductivity and excitability, reduces myocardial contractility). At the beginning of the use of β-adrenergic blockers, the OPSS in the first 24 hours increases (as a result of a reciprocal increase in the activity of α-adrenergic receptors and the elimination of stimulation of β 2 -adrenergic receptors in the vessels of skeletal muscle), but after 1-3 days it returns to the initial, and at long-term use decreases.

The hypotensive effect is associated with a decrease in the minute volume of blood, sympathetic stimulation of peripheral vessels, a decrease in the activity of the renin-angiotensin system (it is important in patients with initial hypersecretion of renin), the sensitivity of the aortic arch baroreceptors (there is no increase in their activity in response to a decrease in blood pressure) and the effect on Central nervous system. The antihypertensive effect stabilizes by the end of 2 weeks of the course appointment.

The antianginal effect is due to a decrease in myocardial oxygen demand (due to a negative chronotropic and inotropic effect). A decrease in heart rate leads to a lengthening of diastole and an improvement in myocardial perfusion. By increasing the end-diastolic pressure in the left ventricle and increasing the stretching of the muscle fibers of the ventricles, oxygen demand can increase, especially in patients with chronic heart failure.

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers, and a slowdown in AV conduction. The suppression of impulse conduction is observed mainly in the antegrade and, to a lesser extent, in the retrograde directions through the AV node and along the additional pathways. It belongs to the II class of antiarrhythmic drugs. Reducing the severity of myocardial ischemia - due to a decrease in myocardial oxygen demand, postinfarction mortality can also be reduced due to antiarrhythmic action.

The ability to prevent the development of vascular headaches is due to a decrease in the severity of the expansion of cerebral arteries due to beta-blockade of vascular receptors, inhibition of platelet aggregation and lipolysis caused by catecholamines, a decrease in platelet adhesion, prevention of activation of blood coagulation factors during the release of adrenaline in tissue, stimulation of the flow of blood renin.

A decrease in tremor against the background of the use of propranolol is mainly due to the blockade of peripheral β 2 -adrenergic receptors.

Increases atherogenic properties of blood. Strengthens the contractions of the uterus (spontaneous and caused by drugs that stimulate the myometrium). Increases the tone of the bronchi. In high doses, it causes sedation.

Pharmacokinetics

After oral administration, about 90% of the dose taken is absorbed, but bioavailability is low due to metabolism during the "first pass" through the liver. C max in blood plasma is reached after 1-1.5 hours. Protein binding is 93%. T 1/2 is 3-5 hours. It is excreted by the kidneys mainly in the form of metabolites, unchanged - less than 1%.

Release form

10 pieces. - contour cell packaging (5) - cardboard packs.
10 pieces. - contour cell packs (10) - cardboard packs.
20 pcs. - contour cell packaging (5) - cardboard packs.
100 pieces. - dark glass jars (1) - cardboard packs.

Dosage

Individual. For oral administration, the initial dose is 20 mg, a single dose is 40-80 mg, the frequency of administration is 2-3 times / day.

Intravenous jet slowly - initial dose of 1 mg; then, after 2 minutes, the same dose is administered again. If there is no effect, repeated administrations are possible.

Maximum doses: for oral administration - 320 mg / day; at repeated introductions i / v stream total dose - 10 mg (under the control of blood pressure and ECG).

Interaction

With simultaneous use with hypoglycemic agents, there is a risk of developing hypoglycemia due to the enhancement of the action of hypoglycemic agents.

With simultaneous use with MAO inhibitors, there is a possibility of developing undesirable manifestations drug interactions.

Cases of the development of severe bradycardia with the use of propranolol for arrhythmia caused by digitalis drugs have been described.

When used simultaneously with agents for inhalation anesthesia the risk of suppression of myocardial function and the development of arterial hypotension increases.

With simultaneous use with amiodarone, arterial hypotension, bradycardia, ventricular fibrillation, asystole are possible.

With simultaneous use with verapamil, arterial hypotension, bradycardia, dyspnea are possible. The C max in the blood plasma increases, the AUC increases, the clearance of propranolol decreases due to the inhibition of its metabolism in the liver under the influence of verapamil.

Propranolol does not affect the pharmacokinetics of verapamil.

A case of severe arterial hypotension and cardiac arrest with simultaneous use with haloperidol is described.

With simultaneous use with hydralazine, C max in blood plasma and AUC of propranolol increase. It is believed that hydralazine can reduce hepatic blood flow or inhibit the activity of hepatic enzymes, which leads to a slowdown in the metabolism of propranolol.

With simultaneous use, propranolol can inhibit the effects of glibenclamide, glyburide, chlorpropamide, tolbutamide, because non-selective beta 2 -adrenergic blockers are able to block the β 2 -adrenergic receptors of the pancreas associated with insulin secretion.

The release of insulin from the pancreas caused by the action of sulfonylurea derivatives is inhibited by beta-blockers, which to some extent prevents the development of the hypoglycemic effect.

With simultaneous use with diltiazem, the concentration of propranolol in the blood plasma increases due to the inhibition of its metabolism under the influence of diltiazem. An additive inhibitory effect on the activity of the heart is observed due to the slowing down of the impulse conduction through the AV node caused by diltiazem. There is a risk of developing severe bradycardia, the stroke and minute volume is significantly reduced.

With simultaneous use, cases of an increase in the concentration of warfarin and phenindione in blood plasma have been described.

With simultaneous use with doxorubicin, experimental studies have shown an increase in cardiotoxicity.

With the simultaneous use of propranolol prevents the development of the bronchodilating effect of isoprenaline, salbutamol, terbutaline.

With simultaneous use, cases of an increase in the concentration of imipramine in the blood plasma have been described.

With simultaneous use with indomethacin, naproxen, piroxicam, acetylsalicylic acid it is possible to reduce the antihypertensive effect of propranolol.

With simultaneous use with ketanserin, an additive hypotensive effect may develop.

When used simultaneously with clonidine, the antihypertensive effect is enhanced.

In patients receiving propranolol, in the case of abrupt withdrawal of clonidine, severe arterial hypertension may develop. It is believed that this is due to an increase in the content of catecholamines in the circulating blood and an increase in their vasoconstrictor action.

With simultaneous use with caffeine, it is possible to reduce the effectiveness of propranolol.

With simultaneous use, it is possible to enhance the effects of lidocaine and bupivacaine (including toxic ones), apparently due to a slowdown in the metabolism of local anesthetics in the liver.

With simultaneous use with lithium carbonate, a case of the development of bradycardia has been described.

With simultaneous use, a case of increased side effects of maprotiline has been described, which is apparently due to a slowdown in its metabolism in the liver and cumulation in the body.

With simultaneous use with mefloquine, the QT interval increases, a case of cardiac arrest has been described; with morphine - the inhibitory effect on the central nervous system caused by morphine is enhanced; with sodium amidotrizoate - cases of severe arterial hypotension have been described.

With simultaneous use with nizoldipine, an increase in C max and AUC of propranolol and nizoldipine in blood plasma is possible, which leads to severe arterial hypotension. There is a message about increased beta-blocking action.

Cases of an increase in C max and AUC of propranolol, arterial hypotension and a decrease in heart rate have been described with simultaneous use with nicardipine.

With simultaneous use with nifedipine in patients with coronary artery disease, severe arterial hypotension may develop, an increase in the risk of developing heart failure and myocardial infarction, which may be due to an increase in the negative inotropic effect of nifedipine.

Patients receiving propranolol are at risk of developing severe arterial hypotension after taking the first dose of prazosin.

With simultaneous use with prenylamine, the QT interval increases.

With simultaneous use with propafenone, the concentration of propranolol in the blood plasma increases and a toxic effect develops. It is believed that propafenone inhibits the metabolism of propranolol in the liver, decreasing its clearance and increasing serum concentrations.

With the simultaneous use of reserpine, other antihypertensive drugs, the risk of developing arterial hypotension and bradycardia increases.

With simultaneous use, the C max and AUC of risatriptan increase; with rifampicin - the concentration of propranolol in the blood plasma decreases; with suxamethonium chloride, tubocurarine chloride - it is possible to change the action of muscle relaxants.

With simultaneous use, theophylline clearance decreases due to a slowdown in its metabolism in the liver. There is a risk of developing bronchospasm in patients with bronchial asthma or COPD. Beta-blockers can block the inotropic effect of theophylline.

With simultaneous use with phenindione, cases of a slight increase in bleeding without changes in blood coagulation indicators have been described.

With simultaneous use with flecainide, an additive cardiodepressant effect is possible.

Fluoxetine inhibits the isoenzyme CYP2D6, which leads to inhibition of the metabolism of propranolol and its cumulation and may enhance the cardiodepressant effect (including bradycardia). Fluoxetine and, mainly, its metabolites are characterized by a long T 1/2, so the likelihood of drug interactions persists even several days after discontinuation of fluoxetine.

Quinidine inhibits the isoenzyme CYP2D6, which leads to inhibition of the metabolism of propranolol, while its clearance decreases. Possible enhancement of beta-adrenergic blocking action, orthostatic hypotension.

With simultaneous use in blood plasma, the concentrations of propranolol, chlorpromazine, thioridazine increase. A sharp decrease in blood pressure is possible.

Cimetidine inhibits the activity of microsomal liver enzymes (including the isoenzyme CYP2D6), this leads to inhibition of the metabolism of propranolol and its cumulation: there is an increase in the negative inotropic effect and the development of cardiodepressive action.

With simultaneous use, the hypertensive effect of epinephrine increases, there is a risk of developing severe life-threatening hypertensive reactions and bradycardia. The bronchodilating effect of sympathomimetics (epinephrine, ephedrine) decreases.

With simultaneous use, cases of a decrease in the effectiveness of ergotamine have been described.

There are reports of a change in the hemodynamic effects of propranolol when used simultaneously with ethanol.

Side effects

From the side of the central nervous system and peripheral nervous system: increased fatigue, weakness, dizziness, headache, drowsiness or insomnia, vivid dreams, depression, anxiety, confusion, hallucinations, tremors, nervousness, restlessness.

From the senses: a decrease in the secretion of lacrimal fluid (dryness and soreness of the eyes).

From the side of the cardiac vascular system: sinus bradycardia, AV block (up to the development of complete transverse blockade and cardiac arrest), arrhythmias, development (worsening) of chronic heart failure, lowering blood pressure, orthostatic hypotension, manifestation of angiospasm (increased peripheral circulation disorders, cold snap lower limbs, Raynaud's syndrome), chest pain.

From the side digestive system: nausea, vomiting, epigastric discomfort, constipation or diarrhea, liver dysfunction (dark urine, yellowness of the sclera or skin, cholestasis), taste changes, increased activity of hepatic transaminases, LDH.

From the respiratory system: nasal congestion, bronchospasm.

From the side endocrine system: change in blood glucose concentration (hypo- or hyperglycemia).

From the hematopoietic system: thrombocytopenia (unusual bleeding and hemorrhage), leukopenia.

Dermatological reactions: increased sweating, psoriasis-like skin reactions, exacerbation of psoriasis symptoms.

Allergic reactions: itching, skin rash, urticaria.

Others: back pain, arthralgia, decreased potency, withdrawal syndrome (increased angina attacks, myocardial infarction, increased blood pressure).

Indications

Arterial hypertension; exertional angina, unstable angina; sinus tachycardia (including with hyperthyroidism), supraventricular tachycardia, tachysystolic atrial fibrillation, supraventricular and ventricular premature beats, essential tremor, prevention of migraine, alcohol withdrawal (agitation and trembling), anxiety, pheochromocytoma ( adjunctive treatment), diffuse-toxic goiter and thyrotoxic crisis (as an adjuvant, including with intolerance to thyrostatic drugs), sympathoadrenal crises against the background of diencephalic syndrome.

Contraindications

AV block II and III degree, sinoatrial blockade, bradycardia (heart rate less than 55 beats / min), SSSU, arterial hypotension (systolic blood pressure less than 90 mm Hg, especially with myocardial infarction), chronic heart failure stage IIB-III, acute heart failure, cardiogenic shock, hypersensitivity to propranolol.

Application features

Application during pregnancy and lactation

The use of propranolol during pregnancy is possible only if the intended benefit to the mother outweighs the potential risk to the fetus. If it is necessary to use it during this period, careful monitoring of the condition of the fetus is necessary, 48-72 hours before delivery, propranolol should be canceled.

It should be borne in mind that a negative effect on the fetus is possible: intrauterine growth retardation, hypoglycemia, bradycardia.

Propranolol is excreted in breast milk. If necessary, use during lactation should establish medical supervision of the child or stop breastfeeding.

Application for violations of liver function

Use with caution in patients with hepatic impairment.

Application for impaired renal function

Use with caution in patients with renal failure.

Application in children

Use with caution in children (efficacy and safety have not been determined).

special instructions

Use with caution in patients with bronchial asthma, COPD, with bronchitis, decompensated heart failure, diabetes mellitus, with renal and / or hepatic failure, hyperthyroidism, depression, myasthenia gravis, psoriasis, occlusive peripheral vascular disease, during pregnancy, during lactation, in elderly patients, in children (efficacy and safety have not been determined).

During the treatment period, an exacerbation of psoriasis is possible.

With pheochromocytoma, propranolol can be used only after taking an alpha-blocker.

After a long course of treatment, propranolol should be discontinued gradually, under the supervision of a physician.

During treatment with propranolol, intravenous administration of verapamil, diltiazem should be avoided. A few days before anesthesia, it is necessary to stop taking propranolol or choose an anesthesia drug with a minimal negative inotropic effect.

Influence on the ability to drive vehicles and use mechanisms

In patients whose activities require increased attention, the issue of using propranolol on an outpatient basis should be resolved only after assessing the patient's individual response.

Anaprilin is a beta-blocker with antianginal, hypotensive, antiarrhythmic action. This is a budget drug that normalizes the pulse, eliminates panic attacks, and normalizes blood pressure indicators. The use of the drug is possible only on the recommendation and by prior agreement with the doctor, since the tablets have a list of contraindications and possible side effects. Patients are often interested in: are there any analogues of the Anaprilin drug?

Such medicines exist, but their use is also possible only on the recommendation of a specialist.

The active substance of the drug is rapidly absorbed and has a short period of pharmacological activity, since it is quickly excreted. Achievement of the maximum concentration is observed 60-120 minutes after the application of the agent.

Anaprilin is contraindicated in combination with medications from the group of antipsychotics and tranquilizers.

Analogues of the drug Anaprilin

Anaprilin - cheap pills, the price in February 2018 is from 20 rubles. for 50 pcs. The active component of the drug is propranolol. As a substitute, the physician may recommend the use of the following exact structural analogs:

• Gemngiola;
• Nolotena;
• Propranobene;
• Inderal;
• Adrenoblok;
• Stobetina;
• Propramine;
• Betacapa;
• Obese - from 60 rubles. for 60 tablets.

Anaprilin and its analogs are identical in composition, and are also similar possible contraindications, side effects, application features.

Pharmacological group analogs

There are also analogues of the drug Anaprilin not in composition, but from a similar pharmacological group of beta-blockers, which demonstrate a similar therapeutic effect, but differ in composition.

Modern analogues of Anaprilin pharmacological group with a selective action are drugs based on the following active substances:

• Nebivolol;

The described drugs differ in their pharmacological and pharmacokinetic properties: bioavailability, duration of action, etc. The selection of a suitable medication is carried out by the doctor, taking into account the indications for use, the presence of concomitant diseases, and the individual characteristics of the patient's body.

Active substance

The active ingredient of Anaprilin and its analogs is propranolol, 10 or 40 mg. As auxiliary substances, manufacturers use talc, milk sugar, starch, calcium stearate.

Dosage form

The drug is presented in pharmacies in the form of tablets for internal use - white, flat-cylindrical, with chamfers, risks or without risks. The medicine is released in blisters, cardboard boxes or glass jars.

pharmachologic effect

Medicines based on propranolol demonstrate hypotensive, antianginal, antiarrhythmic properties. Under the action of the active component, the following is observed:

The half-life is up to 3 hours. The active substance is excreted by the kidneys.

It is necessary to stop using the drug gradually, since against the background of a sharp withdrawal, the likelihood of increased myocardial ischemia increases and exercise tolerance worsens.

Indications

Indications for the use of the drug and its analogues are the diagnosis of the following diseases and abnormalities:

Anaprilin and its analogs are also prescribed to patients with thyrotoxic goiter before preparing for surgical intervention... Medicines based on propranolol can be used in case of intolerance to thyrostatic drugs.

The tablets are used regardless of food intake, exact dosage are selected depending on the indications for use. The duration of the course of admission is determined by the doctor.

Contraindications

Among the absolute contraindications to the use of Anaprilin and other analogs, which include propranolol, there are:

• individual intolerance to the components of the drug;
• the development of diabetes mellitus;
• patients with bronchial asthma, vasomotor rhinitis;
• identification of obliterating diseases affecting the arteries (for example, Raynaud's disease);
• predisposition to the development of bronchospastic reactions;
• development of metabolic acidosis;
• pregnancy;
• development acute heart attack myocardium, acute heart failure, arterial hypotension, sick sinus syndrome, sinoatrial block, AV block 2-3 tbsp.

Medicines based on propranolol are also not used for bradycardia (heart rate less than 55 beats per minute).

Side effects

Patients may experience unwanted adverse reactions against the background of the use of Anaprilin or drugs similar in composition.

In order to prevent the danger of a sharp decrease in blood pressure indicators against the background of the use of Anaprilin and drugs similar to it, one should refrain from drinking alcohol.

In rare cases, there were complaints of insomnia, depression, nausea, headache, decreased mental and motor reactions, stool disorders, exacerbation of psoriasis, development of asthenic syndrome, spasms peripheral arteries, dysfunction of the organs of vision, allergic reactions. Patients with a history of insulin-dependent diabetes mellitus are more likely to develop hypoglycemia, while non-insulin-dependent patients are more likely to develop hyperglycemia.

Important! Propranolol-based drugs can weaken attention and slow down the speed of motor reactions, which should be taken into account by people whose activities require increased attention.

Testimonials

Reviews of the drugs are mostly positive. Doctors recommend not using beta blockers as self-medication. Such drugs are used in complex treatment regimens, selected individually.

“Several weeks ago, I felt a sharp deterioration in health: a sharp jolt in the heart, lack of air, pounding in the temples. My heart literally jumped out of my chest, my head began to ache, and my eyes started to chill. There was no way to breathe or talk, and it was lucky that I was not alone at home. Relatives opened all the windows, called an ambulance.

The doctor diagnosed arrhythmia and injected some medicine, after which it became easier. He recommended taking Anaprilin tablets in order to finally normalize his state of health. Immediately after using the drugs, I began to feel sleepy. The pills are now always in the medicine cabinet, I took them for 7 days, 1 each, the attack did not recur. "

Anna

“Stressful situations, as well as transitional periods from winter to spring and from summer to autumn, cause bouts of tachycardia. The neurologist recommended taking Anaprilin or its analogues, after it turned out at the reception that the pulse exceeded 90 beats per minute.

The drug normalizes not only the pulse, but also the pressure indicators. This medicine is recommended for patients with vegetative dystonia, in whom, in the first place, the cardiovascular system reacts. Anaprilin acts very quickly, taking 0.5 tablets is enough to achieve a result. I do not take it all the time, only if necessary. The course of treatment will consist of other drugs recommended by the doctor. "

Christina

“I was always attentive to nutrition and lifestyle, I drank vitamins and adaptogens in courses and never complained about heart problems. However, one day I encountered a frightening symptom: my heart began to beat abruptly very quickly, and there was not enough air. At first I thought it was due to stress or fluctuations in hormones, I decided to drink a course of potassium and magnesium. Vitamins Panangin and Asparkam solved the problem for some time, but over time the attack recurred.

I went to the doctor, numerous studies were prescribed, all the results are normal. Without making an accurate diagnosis, I recommended taking propranolol (Anaprilin). The tablets act very quickly and normalize the pulse within 40-60 minutes after taking the tablet. After contacting another doctor, problems with thyroid, in which Anaprilin is also recommended. It is worth remembering that this medication masks the symptoms and can make the diagnosis difficult. It's still a remedy symptomatic treatmentthat does not affect the root cause. "

Valeria

At the moment, I am taking more long-acting modern beta-blockers, but Anaprilin, due to the speed of its action, is always at hand. I accept in minimum dosage, 10 mg each. I hold the pill under my tongue until it is completely dissolved, I do not drink it with water.

The pill has an unpleasant taste, after which it feels numbness of the tongue, but copes with tachycardia. Now the doctor recommends taking Bisoprolol and is happy with the action of this medication, but such pills should be taken regularly, over time, dosage adjustment may be required. "

Maria

The drug Anaprilin and its analogues have both advantages and significant disadvantages. If you need to use drugs from the group of beta-blockers, you must first consult with your doctor and refrain from self-medication. It is necessary to remember about the existence of more modern, selective drugs.

To reduce the pulse and blood pressure, the drug Anaprilin is used, analogues allow you to replace the drug if it is not available at the nearest pharmacy.

They can be more effective, have fewer side effects.

What is Anaprilin used for?

The drug is used to treat problems associated with the cardiovascular system. When increased pressure Anaprilin helps from the first dose, and the full effect appears after 3 weeks.

What helps medicine:

• arrhythmia, takardia;
• angina pectoris;
• increased arterial pressure;
• high pulse;
• ischemic disease;
• thyrotoxicosis.

For prophylaxis, tablets are used after myocardial infarction. During pregnancy, treatment is possible if the benefit to the woman outweighs the risk of fetal complications. During admission, an unscheduled ultrasound scan is recommended, since growth retardation and hypoglycemia are possible.

Contraindications:

• asthma;
• circulatory disorders;
• liver disease;
• colitis;
• heart failure;
• intolerance to the components.

Carefully:

• pregnancy and lactation;
• over 50 years of age;
• diabetes;
• diseases of the liver, kidneys.

Cardiovascular medications are taken only as directed by a doctor. Self-medication is prohibited.

What can replace Anaprilin

Modern drugs do not have a strong effect on the body, they have a minimal list of side effects. There are analogues with the same active substance, as well as with a similar therapeutic effect.

A consultation with a doctor is required before starting use, and the instructions for use will help identify contraindications and determine the dosage.

Russian counterparts

Domestic analogs are affordable and are not inferior in quality to Anaprilin. Among the most demanded, a rating has been compiled, a similar list includes the most popular drug substitutes.

Possible side effects:

• allergic reactions;
• nausea, vomiting;
• impaired visual acuity;
• stool change;
• chest pain;
• sleep disturbance.

Analogs do not exclude the development of individual intolerance to the components.

Russian counterparts:

1. Sotalol Canon. Available in pill form. It is prescribed for tachycardia, arrhythmias, to maintain the pulse normal. The main component is sotalol.
2. Vero-Anaprilin. In terms of composition, the active substances are identical to Anaprilin. Has similar side effects and contraindications. Differs in a low price, no more than 20 rubles per package.
3. Atenolol. It is used to restore blood pressure, treat cardiovascular diseases. Has side effects on the work of the pancreas.

The drug for each patient is selected individually, based on contraindications and chronic diseases. An incorrectly selected treatment regimen leads to an overdose. Symptoms include seizures, numbness in the limbs, and increased heart rate.

Foreign analogues

Foreign counterparts of the new generation have a minimum number of contraindications and side effects. The drugs are available in tablets, capsules.

Foreign analogues:

1. Sotagexal. The tablets are manufactured in Germany. The active ingredient is sotalol hydrochloride. They are used for cardiac arrhythmias, ventricular tachycardia.
2. Propranolol. Manufactured in Germany. It is prescribed in case of myocardial infarction, angina pectoris, high pressure... It has high efficiency and a small list of contraindications.
3. Propranobene. The capsules are manufactured in Germany. The drug is used for diseases of cardio-vascular system... Virtually no side effects.

Foreign drugs have positive reviews from doctors and patients, are highly effective in the treatment and prevention of diseases of the heart and blood vessels.

Prices and terms of dispensing from pharmacies

Anaprilin substitutes are medications, aimed at the treatment and prevention of diseases of the cardiovascular system. Capsules and tablets are packed in blisters. Each package contains instructions in Russian.

Any drug that is prescribed for hypertension, ischemia, myocardial infarction is dispensed only with a prescription. It is recommended to store tablets in a dark, cool place out of the reach of children.

Anaprilin's analogs differ in efficiency and price. Only the attending physician can replace the drug with another in order to avoid complications, overdose.

The task of the doctor is to keep the Hippocratic oath and provide medical assistance... When prescribing anaprilin, you should carefully familiarize yourself with this drug and study the instructions for use.

Anaprilin is a cardiovascular agent that is used for diseases of the nervous system, for arterial hypertension and cardiac pathologies: angina pectoris, tachycardia. These pills are also used with increased anxiety, panic attacks and other disorders associated with nerves.

When using this medicine, not only pressure is normalized, but also endurance increases: it is easier to reflect on the body physical exercise... Reduced attacks of angina pectoris and the risk of sudden death.

Anaprilin composition

Anaprilin is a drug product included in the group B - adrenergic blockers... A dynamically acting element in the composition of this agent - (reduces the power and frequency of contractions of the heart muscle). Other elements of anaprilin are optional, do not include the same medicinal propertiesas the main component.

List of additional ingredients:

The active element weakens the effect of the myocardium of sympathetic impulses. Thanks to him, heartbeats are reduced.

Anaprilin release form

Anaprilin tablets are produced in tablets with a dosage of 10 mg and 40 mg. They are placed in multi-circuit plastic cell packages. The packs of this medication are made of plastic. Available in packs of 10, 50 and 100.

Fifty tablets are placed either in plastic containers with cardboard packaging or in dark glass jars. The jar itself is located in a cardboard box. An injection form has been created.

Indications for use

The main indications for the use of anaprilin are diseases of the heart and vascular system, which are inseparable from high blood pressure. The medicine is prescribed for sinus and atrial fibrillation, with myocardial infarction and mitral valve prolapse.

Anaprilin tablets are effective for arrhythmias. Among other things, these pills relieve the signs of an oncoming migraine. Initially, the drug was created only for adults, but now, if necessary, it is prescribed for children. The indications of anaprilin are in the instructions.

So, what will Anaprilin help with?

The medicine is prescribed for the following common diseases:

What does Anaprilin help with? The use of anaprilin is also effective for indications of essential tremor and cardiac arrhythmias. In addition to the above diseases, extrasystole also belongs to them.

pharmachologic effect

The main component of anaprilin produces antianginal, antiarrhythmic and hypotensive effects. With regular consumption of anaprilin, the intensity of contractions of the heart muscle decreases. The need for oxygen in the muscles of the heart decreases.

Anaprilin normalizes blood pressure and improves peripheral vascular resistance. In addition to the significant effect, the main element - propranolol - increases the contractions of the muscles of the uterus, favors the cessation of blood flow after childbirth and after operations, and also stimulates the functions of digestion. Decreased intake of calcium ions inside cells.

The hypotensive effect stabilizes and returns to normal around the second week of the prescribed course by the doctor. The antianginal effect occurs due to a decrease in the need for myocardium in oxygen (due to a negative chronotropic effect). Reduction of severe ischemia. Sudden mortality is lowered due to antiarrhythmic action.

The ability to prevent acute headaches is provided by a decrease in the expansion of the arteries. This medication provides a reduction in tremor.

Anaprilin in large doses has a sedative effect.

This agent is rapidly absorbed into the blood. The half-life of the main substance anaprilin lasts from three to five hours, with prolonged use of this drug, the period increases to twelve hours. The kidneys excrete propranolol by metabolites (ninety percent), but one percent remains in a stable form. Positive dynamics was noted in many patients after a month of using Anaprilin.

Method of administration and dose

The drug should be used strictly after a doctor's prescription. So, the trip to the doctor is complete, how do you take anaprilin? Anaprilin is taken half an hour before eating and washed down with plenty of water. The tablets do not need to be broken in half, ground into a fine powder, or chewed. The effect is manifested two hours after ingestion, and the period of influence lasts up to five hours.

To speed up the effect (about twenty minutes), it is recommended to place the tablet under the tongue. Attention! With this method of use, a sensation of numbness of the tongue is possible.

The dosage and frequency of use of pills is regulated by the diseases set by the doctor and the age of the person who applied. Also, this information is in the instructions for use for anaprilin.

The duration of the course of treatment is also set by the doctor. Most often, treatment for heart and vascular diseases lasts three or four weeks. If necessary, the course can be resumed.

The interval between taking anaprilin tablets should last at least one and a half or two months.

The instructions for use describe in detail how to use anaprilin in a dosage of 10 mg or 40 mg.

In accordance with the instructions for the use of anaprilin for arrhythmias, 10-30 milligrams are used three or four times a day. With arterial hypertension, the initial dosage is set - 80 milligrams twice a day. The total amount is 160 mg. As directed by a doctor, over time, the dose can be increased to 320 milligrams per day.

In conditions of migraine, taking anaprilin is designed for 80-160 mg per day. For angina pectoris, the drug is used for the first 3 days at 20 mg four times a day. In the next three days, the dosage is increased to 40 mg. This dose is taken three times a day, and on the fourth - 20 mg again. If indicated, the dosage is increased to 200-240 mg per day (40 mg five or six times a day).

After a heart attack, the drug is used at 160 milligrams per day, taking 40 mg four times a day.

In the treatment of essential tremor, the initial dosage is distributed at 20 mg two or three times a day. The serving is gradually increased to 160 milligrams.

It is important! Only by prescription, prescribed by a doctor, anaprilin is prescribed to children from the age of three in a small dose of 0.25-0.5 mg per kilogram of body weight. The frequency of use is three / four times a day. The drug should be given to children with extreme caution and under the close supervision of a doctor with the placement of the child in a medical facility.

The use of anaprilin during panic attacks lowers the frequent contraction of the heart muscles, normalizes blood pressure, which is often underestimated during panic attacks, relieves fears without apparent reasons, reduces anxiety attacks in a short time.

During a long treatment with this remedy, it is necessary to jointly use cardiac glucosides. Cancellation of anaprilin should occur gradually, otherwise myocardial ischemia may develop.

Contraindications

Anaprilin has a number of contraindications, which should not be used this medicine... It is recommended to consult your doctor.

Anaprilin is not used with the following contraindications:

Anaprilin should not be used during pregnancy, because there is not enough information about the effect of the elements of anaprilin on the child. It is possible to slow down intrauterine growth of the fetus. In order not to harm the unborn child, the use of anaprilin is strictly prohibited. You can not drink these pills while breastfeeding: breast milk the elements of anaprilin seep.

It is categorically impossible to combine this medicine with drinks containing alcohol. Alcohol and anaprilin are incompatible. The use of anaprilin with alcohol is risky and often leads to rapid death. When combined with alcohol, the following side effects are possible: low blood pressure, chills, nausea and vomiting. Alcoholic drinks can lead to fainting. With alcohol, the effectiveness of the drug is reduced to a minimum.

Anaprilin is not prescribed for people with bronchial asthma. The combined use of tablets with tranquilizers is prohibited. During therapy, an increase and exacerbation of psoriasis is possible.

The use of anaprilin affects the visual organs: the medicine should be used with caution by people whose work is inextricably linked with driving.

The drug should be used with careful care by people in old age, with renal failure and in acute states of depression.

Side effects

With the side effects of anaprilin, the following symptoms appear:

When side effect there are coughing and dyspnea (shortness of breath), pharyngitis.

Anaprilin overdose

In case of an overdose of this drug, the occurrence of the following manifestations symptoms:

If you take anaprilin without a doctor's prescription for panic attacks, the dose may not be calculated correctly: this will lead to an overdose.

In case of severe symptoms, gastric lavage should be performed. Symptomatic remedies are prescribed.

Where to buy Anaprilin and storage conditions

The drug is sold in pharmacies with a doctor's prescription. From the beginning of the release, the medicine should be stored for no more than four years. Anaprilin is stored in a dark place at a temperature of eight to twenty-five degrees.

Anaprilin price

The average cost of this drug is twenty rubles. The price of anaprilin is influenced by the volume of the package and the quantity. Anaprilin in the amount of 50 ampoules of 10 milligrams costs twenty rubles. The cost for 50 pieces in a dosage of forty milligrams is twenty-five or thirty rubles.

Analogs

At the current time, it is easy to find a replacement for anaprilin in pharmacy stores. List of known analogues of anaprilin:

Analogs of the drug Anaprilin are in different price categories.

International name

Propranolol (Propranolol)

Group affiliation

Beta blocker

Dosage form

Sustained-release capsules, solution for intravenous administration, solution for intramuscular injection, tablets, film-coated tablets also:
Anaprilin; eye drops

pharmachologic effect

Non-selective beta-blocker. It has antianginal, hypotensive and antiarrhythmic effects. Nonselectively blocking beta-adrenergic receptors (75% of beta1- and 25% of beta2-adrenergic receptors), reduces the formation of cAMP from ATP stimulated by catecholamines, as a result of which it reduces the intracellular intake of Ca2 +, has a negative chrono-, dromo-, batmo- and inotropic effect (decreases heart rate , inhibits conductivity and excitability, reduces myocardial contractility).

At the beginning of the use of beta-blockers, OPSS increases in the first 24 hours (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors and the elimination of stimulation of beta2-adrenergic receptors of the vessels of skeletal muscles), but after 1-3 days it returns to the initial one, and decreases with prolonged administration.

The hypotensive effect is associated with a decrease in IOC, sympathetic stimulation of peripheral vessels, a decrease in the activity of the renin-angiotensin system (it is important in patients with initial hypersecretion of renin), the sensitivity of the aortic arch baroreceptors (there is no increase in their activity in response to a decrease in blood pressure) and the effect on the central nervous system. The antihypertensive effect stabilizes by the end of 2 weeks of the course appointment.

The antianginal effect is due to a decrease in myocardial oxygen demand (due to a negative chronotropic and inotropic effect). A decrease in heart rate leads to a lengthening of diastole and an improvement in myocardial perfusion. Due to an increase in the end-diastolic pressure in the LV and an increase in the stretching of the muscle fibers of the ventricles, it can increase the demand for oxygen, especially in patients with CHF.

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers, and a slowdown in AV conduction. Suppression of impulse conduction is observed mainly in the antegrade and, to a lesser extent, in the retrograde directions through the AV node and along additional pathways. According to the classification of antiarrhythmic drugs, it belongs to group II drugs.

Reducing the severity of myocardial ischemia - due to a decrease in myocardial oxygen demand, postinfarction mortality can also decrease due to antiarrhythmic action.

The ability to prevent the development of vascular headaches is due to a decrease in the severity of the expansion of cerebral arteries due to beta-blockade of vascular receptors, inhibition of platelet aggregation and lipolysis caused by catecholamines, a decrease in platelet adhesion, prevention of activation of blood coagulation factors during the release of adrenaline in tissue, stimulation of the flow of blood renin.

A decrease in tremor against the background of the use of propranolol is mainly due to the blockade of peripheral beta2-adrenergic receptors. Increases atherogenic properties of blood. Strengthens uterine contractions (spontaneous and caused by drugs that stimulate the myometrium). Increases the tone of the bronchi, in large doses causes a sedative effect.

Indications

Arterial hypertension, exertional angina, unstable angina pectoris, sinus tachycardia (including thyrotoxicosis), supraventricular tachycardia, atrial fibrillation, supraventricular and ventricular extrasystole, myocardial infarction (100 mm systolic blood pressure). abstinence (agitation and trembling), anxiety, pheochromocytoma (auxiliary treatment), migraine (prevention of seizures), diffuse-toxic goiter and thyrotoxic crisis (as an auxiliary drug, including with intolerance to thyrostatic drugs), sympathoadrenal crises against the background of diencephalic syndrome.

Contraindications

Hypersensitivity, acute HF or decompensated CHF, cardiogenic shock, grade II-III AV block, SA block, SSS, sinus bradycardia (heart rate less than 55 / min), Prinzmetal angina, cardiomegaly (no signs of heart failure), arterial hypotension (systolic blood pressure less 90 mm Hg, especially with myocardial infarction); COPD bronchial asthma (severe course); peripheral vascular occlusive disease (complicated by gangrene, "intermittent" claudication or pain at rest), diabetes mellitus with ketoacidosis, metabolic acidosis, concomitant use of MAO inhibitors, lactation period. With caution. History of allergic reactions, CHF, pheochromocytoma, liver failure, Chronic renal failure, Raynaud's syndrome, myasthenia gravis, thyrotoxicosis, depression (including history), psoriasis, pregnancy, elderly age, childhood (efficacy and safety not determined).

Side effects

From the nervous system: increased fatigue, weakness, dizziness, headache, drowsiness or insomnia, "nightmares", depression, anxiety, confusion or short-term memory loss, hallucinations, asthenia, myasthenia gravis, paresthesia in the extremities (in patients with "intermittent "lameness and Raynaud's syndrome), tremor.

From the senses: impaired visual acuity, decreased secretion of lacrimal fluid, dryness and soreness of the eyes, keratoconjunctivitis.

On the part of the CVS: sinus bradycardia, palpitations, myocardial conduction disturbance, AV blockade (up to the development of complete transverse blockade and cardiac arrest), arrhythmias, weakening of myocardial contractility, development (worsening) of CHF, lowering blood pressure, orthostatic hypotension, manifestation of angiospasm (increased disturbance peripheral circulation, coldness of the lower extremities, Raynaud's syndrome), chest pain.

From the digestive system: dryness of the oral mucosa, nausea, vomiting, epigastric pain, flatulence, constipation or diarrhea, liver dysfunction (dark urine, yellowness of the sclera or skin, cholestasis), taste changes.

From the respiratory system: nasal congestion, rhinitis, difficulty breathing, laryngo- and bronchospasm.

From the endocrine system: hyperglycemia (in patients with non-insulin dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), decreased thyroid function.

Allergic reactions: itching, skin rash, urticaria.

From the side skin: increased sweating, skin flushing, exanthema, alopecia, psoriasis-like skin reactions, exacerbation of psoriasis symptoms.

Laboratory indicators: thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia, increased activity of "hepatic" transaminases, hyperbilirubinemia.

Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia.

Others: back pain, arthralgia, weakening of libido, decreased potency, withdrawal syndrome (increased angina attacks, increased blood pressure).

Application and dosage

With arterial hypertension - inside, 40 mg 2 times a day. If the hypotensive effect is insufficient, the dose is increased to 40 mg 3 times or 80 mg 2 times a day. The maximum daily dose is 320 mg (in exceptional cases - 640 mg).

For angina pectoris, cardiac arrhythmias - in the initial dose of 20 mg 3 times a day, then the dose is gradually increased to 80-120 mg in 2-3 doses. The maximum daily dose is 240 mg.

For the prevention of migraine, as well as with essential tremor - at an initial dose of 40 mg 2-3 times a day, if necessary, the dose is gradually increased to 160 mg / day.

When using the prolonged form (depot capsules 80 mg), the frequency of administration is 1 time per day.

When paroxysmal disorders heart rate and thyrotoxic crisis - intravenous stream, slowly, in an initial dose of 1 mg (1 ml of 0.1% solution), then after 2 minutes the same dose of the drug is injected again. In the absence of an effect, intravenous administration is repeated until a maximum dose of 10 mg is reached, under the control of blood pressure and ECG.

For childbirth and stimulation generic activity - 20 mg 4-6 times at intervals of 30 minutes (80-120 mg / day) In case of fetal hypoxia, the dose is reduced. For the prevention of postpartum complications - 20 mg 3 times a day for 3-5 days.

If liver function is impaired, dose reduction is necessary. Renal dysfunction does not require dose adjustment.

special instructions

Monitoring patients taking propranolol should include monitoring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), ECG, blood glucose concentration in patients with diabetes mellitus (once every 4-5 months) ... In elderly patients, it is recommended to monitor kidney function (1 time in 4-5 months).

The patient should be trained in the method of calculating the heart rate and instructed on the need for medical advice if the heart rate is less than 50 / min.

Before prescribing propranolol to patients with CHF ( early stages) it is necessary to use digitalis and / or diuretics.

In "smokers" the effectiveness of beta-blockers is lower.

Patients using contact lenses, should take into account that during treatment, it is possible to reduce the production of tear fluid.

Patients with pheochromocytoma are prescribed only after taking an alpha-blocker.

With thyrotoxicosis, propranolol can mask certain clinical signs thyrotoxicosis (eg tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated, since it can aggravate the symptoms.

When prescribing beta-blockers to patients receiving hypoglycemic drugs, care should be taken, since hypoglycemia may develop during long breaks in food intake. Moreover, her symptoms such as tachycardia or tremor will be masked by the action of the drug. Patients should be instructed that the main symptom of hypoglycemia during treatment with beta-blockers is increased sweating.

With the simultaneous administration of clonidine, its reception can be stopped only a few days after the discontinuation of propranolol.

It is possible that the severity of the hypersensitivity reaction and the lack of effect from the usual doses of epinephrine against the background of a burdened allergic history are possible.

A few days before general anesthesia with chloroform or ether, you must stop taking the drug. If the patient took the drug before the operation, he should choose drugs for general anesthesia with minimal negative inotropic effect.

Reciprocal activation of n.vagus can be eliminated by intravenous administration of atropine (1-2 mg).

Drugs that reduce the supply of catecholamines (for example, reserpine) can enhance the action of beta-blockers, therefore, patients taking such drug combinations should be under constant medical supervision for the detection of arterial hypotension or bradycardia.

Cannot be used simultaneously with antipsychotic drugs (neuroleptics) and anxiolytic drugs (tranquilizers).

Caution should be used in conjunction with psychoactive drugs, such as MAO inhibitors, with their course use for more than 2 weeks.

If elderly patients develop an increasing bradycardia (less than 50 / min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe liver and kidney dysfunction, it is necessary to reduce the dose or stop treatment ... It is recommended to discontinue therapy with the development of depression caused by the intake of beta-blockers.

It is impossible to abruptly interrupt treatment due to the risk of developing severe arrhythmias and myocardial infarction. Cancellation is carried out gradually, reducing the dose for 2 weeks or more (by 25% in 3-4 days).

Use during pregnancy and lactation is possible if the benefits to the mother outweigh the risk of side effects in the fetus and child. If necessary, admission during pregnancy - close monitoring of the condition of the fetus, 48-72 hours before delivery should be canceled.

Should be canceled before testing in the blood and urine of catecholamines, normetanephrine and vanilla-mandelic acid; antinuclear antibody titers.

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially dangerous species activities requiring increased concentration of attention and speed of psychomotor reactions.

Interaction

Allergens used for immunotherapy or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving propranolol. Iodine-containing radiopaque drugs for intravenous administration increase the risk of developing anaphylactic reactions.

When administered intravenously, phenytoin, drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressant effect and the likelihood of lowering blood pressure.

Changes the effectiveness of insulin and oral hypoglycemic drugs, masks the symptoms of developing hypoglycemia (tachycardia, increased blood pressure).

Reduces the clearance of lidocaine and xanthines (except diphylline) and increases their plasma concentration, especially in patients with an initially increased clearance of theophylline under the influence of smoking.

The antihypertensive effect is weakened by NSAIDs (Na + delay and blockade of Pg synthesis by the kidneys), corticosteroids and estrogens (Na + delay).

Cardiac glycosides, methyldopa, reserpine and guanfacine, BMCC (verapamil, diltiazem), amiodarone, and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV blockade, cardiac arrest and heart failure. Nifedipine can lead to a significant decrease in blood pressure.

Diuretics, clonidine, sympatholytics, hydralazine, and other antihypertensive drugs can lead to an excessive decrease in blood pressure.

Prolongs the action of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins.

Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedative and hypnotic drugs increase CNS depression.

Simultaneous use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect, the break in treatment between taking MAO inhibitors and propranolol should be at least 14 days.

Unhydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders.

Strengthens the effect of thyrostatic and uterotonizing drugs; reduces the effect of antihistamine drugs.

Simultaneous administration with phenothiazine derivatives increases plasma concentrations of both drugs.

Sulfasalazine and cimetidine increase the plasma concentration of propranolol (inhibit metabolism), rifampicin shortens T1 / 2.

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