Cordarone - instructions for use, reviews, analogs and form of release (tablets 200 mg, injections in ampoules for intravenous injections) of a drug for arrhythmia and fibrillation in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Kordaron. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Cordarone in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Kordaron in the presence of existing structural analogues. Use to treat arrhythmias and atrial fibrillation and ventricles in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

Kordaron antiarrhythmic drug. Amiodarone (active ingredient of the drug Cordarone) belongs to class 3 (class of inhibitors of repolarization) and has a unique mechanism of antiarrhythmic action, In addition to the properties of antiarrhythmics of class 3 (potassium channel blockade), it has the effects of antiarrhythmics of class 1 (blockade of sodium channels), antiarrhythmics of class 4 (calcium channel blockade), and uncompetitive beta-adrenergic blocking action.

In addition to antiarrhythmic action, the drug has antianginal, coronary dilatation, alpha and beta-adrenergic blocking effects.

Antiarrhythmic effect of the drug is due to an increase in the duration of the 3-phase potential action of cardiomyocytes, mainly by blocking the ion current in the potassium channels (the effect of antiarrhythmics class 3 according to the classification of Vaughan-Williams); a decrease in the automatism of the sinus node, leading to a decrease in heart rate; non-competitive blockade of alpha- and beta-adrenergic receptors; retardation of sinoatrial, atrial and AV-conduction, more pronounced with tachycardia; absence of changes in ventricular conduction; an increase in refractory periods and a decrease in the excitability of the myocardium of the atria and ventricles,as well as an increase in the refractory period of the AV node; slowing down and increasing the duration of the refractory period in additional beams of AV-conduction.

In addition, Cordarone has the following properties: the absence of negative inotropic effect when administered orally; reduction of oxygen consumption by myocardium due to a moderate decrease in OPSS and heart rate; increase in coronary blood flow due to direct effect on the smooth muscles of the coronary arteries; maintaining cardiac output by reducing the pressure in the aorta and reducing OPSS; influence on the exchange of thyroid hormones: inhibition of the transformation of T3 to T4 (blockade of thyroxine-5-deiodinase) and blocking the seizure of these hormones by cardiocytes and hepatocytes, leading to a weakening of the stimulating effect of thyroid hormones on the myocardium.

After the beginning of taking the drug inside, therapeutic effects develop on average a week (from several days to 2 weeks). After stopping its reception, amiodarone is determined in the blood plasma for 9 months. It should be taken into account the possibility of maintaining the pharmacodynamic action of amiodarone within 10-30 days after its withdrawal.

Composition

Amiodarone hydrochloride + excipients.

Pharmacokinetics

Bioavailability after oral administration varies from 30% to 80% in different patients (mean value about 50%). Amiodarone is characterized by a slow intake into tissues and high affinity for them. During the first days of treatment, the drug accumulates in almost all tissues, especially in adipose tissue and in addition to it in the liver, lungs, spleen and cornea. The equilibrium state is achieved after 1 to several months, depending on the individual characteristics of the patient. Features of the pharmacokinetics of the drug explains the use of loading doses, which is aimed at quickly achieving the required level of penetration into the tissue, in which the therapeutic effect of amiodarone is manifested. Metabolised in the liver. The main metabolite, desethylamiodarone, is pharmacologically active and can enhance the antiarrhythmic effect of the basic compound. Removal of amiodarone begins in a few days. It is excreted mainly through the intestine.

Indications

Pills

Relapse prevention:

• life-threatening ventricular arrhythmias and ventricular fibrillation (treatment should be started inhospital with careful cardiomonitoring);
• supraventricular paroxysmal tachycardias, incl. documented attacks of recurrent persistent supraventricular paroxysmal tachycardia in patients with organic heart disease; documented attacks of recurrent persistent supraventricular paroxysmal tachycardia in patients without organic heart disease, when antiarrhythmic drugs of other classes are not effective or there are contraindications to their use; documented attacks of recurrent persistent supraventricular paroxysmal tachycardia in patients with WPW syndrome;
• atrial fibrillation (atrial fibrillation) and atrial flutter.

Preventing sudden arrhythmic death in high-risk patients:

• patients with recent myocardial infarction, having more than 10 ventricular extrasystoles per hour, clinical manifestations of chronic heart failure and a reduced fraction of left ventricular ejection (<40%).

Solution

• relief of paroxysmal tachycardia;
• suppression of attacks of supraventricular paroxysmal tachycardia with a high incidence of ventricular contractions (especially in the background of WPW syndrome);
• arresting a paroxysmal and stable form of atrial fibrillation (atrial fibrillation) and atrial flutter;
• Cardiorehabilitation in case of cardiac arrest caused by ventricular fibrillation resistant to cardioversion.

Forms of release

Tablets 200 mg.

Solution for intravenous administration (injections in ampoules for injection).

Instructions for use and dosage

Pills

When prescribing the drug in a loading dose, various schemes can be used.

When used in a hospital, the initial dose divided into several doses ranges from 600-800 mg per day to a maximum of 1200 mg per day until a total dose of 10 g is reached (usually within 5-8 days).

For outpatient use, the initial dose divided into several doses ranges from 600 mg to 800 mg per day until a total dose of 10 g is reached (usually within 10-14 days).

The maintenance dose may vary in different patients from 100 mg per day to 400 mg per day. A minimum effective dose should be applied in accordance with the individual therapeutic effect.

BecauseAmiodarone has a very long half-life, the drug can be taken every other day or take breaks in its reception 2 days a week.

The average therapeutic single dose is 200 mg. The average therapeutic daily dose is 400 mg.

The maximum single dose is 400 mg. The maximum daily dose is 1200 mg.

Ampoules

Cordarone for intravenous administration is intended for use in those cases when rapid antiarrhythmic effect is required, or if it is not possible to administer the drug inside.

Except for urgent clinical situations, the drug should be used only in a hospital in an intensive care unit under the constant monitoring of ECG and blood pressure.

With IV administration, Cordarone should not be mixed with other drugs or simultaneously administered other drugs through the same venous access. The drug should be administered only in diluted form. To dilute Cordarone, only 5% Dextrose (glucose) solution should be used. Due to the peculiarities of the dosage form of the drug, it is not recommended to use concentrations of the infusion solution, less than 5 ml of dextrose (glucose) obtained during dilution of 2 ampules in 500 ml.

To avoid reactions at the site of administration, Cordarone should be administered through a central venous catheter, except in cases of cardiac retention in ventricular fibrillation resistant to cardioversion, where, in the absence of central venous access, the drug can be injected into the peripheral veins (the largest peripheral vein with maximum blood flow).

Severe disturbances of the heart rhythm, in cases when reception of noreparate inwards is impossible (with the exception of cases of cardiac recovery in case of cardiac arrest caused by ventricular fibrillation resistant to cardioversion)

The drug is administered intravenously by drop (dropper) through a central venous catheter.

The loading dose is usually 5 mg / kg of body weight in 250 ml of a 5% solution of dextrose (glucose), the introduction is carried out for 20-120 minutes, possibly using an electronic pump. This dose can be re-introduced 2-3 times within 24 hours. The rate of drug administration is adjusted depending on the clinical effect. The therapeutic effect appears during the first minutes of administration and gradually decreases after the cessation of infusion,therefore, if it is necessary to continue the treatment with the Kordaron injection form, it is recommended to switch to a constant IV injection of the drug.

Maintenance doses: 10-20 mg / kg / 24 hours (usually 600-800 mg, but can be increased to 1200 mg for 24 hours) in 250 ml of 5% dextrose (glucose) solution for several days. From the first day of the infusion, you should begin a gradual transition to taking Cordarone inside at a dose of 600 mg (3 tablets) per day. The dose can be increased to 800-1000 mg (4-5 tablets) per day.

Cardioreanimation in cardiac arrest caused by ventricular fibrillation resistant to cardioversion

The drug is injected intravenously. The first dose is 300 mg (or 5 mg / kg) in 20 ml of a 5% solution of dextrose (glucose). If fibrillation does not stop, it is possible additional administration of Cordarone IV dose in a dose of 150 mg (or 2.5 mg / kg).

Side effect

• mild dose-dependent bradycardia
• conduction disorder (sinoatrial block, AV block of various degrees)
• arrhythmogenic action (there are reports of the occurrence of new arrhythmias or exacerbation of the existing, in some cases - with subsequent cardiac arrest, these effects are observed mainly in cases of using Cordarone in conjunction with drugs,prolonging the QTc interval or in case of electrolyte balance disturbances; in the light of available data, it is impossible to determine whether the occurrence of these rhythm disturbances is caused by Cordarone, or is associated with the severity of cardiac pathology, or is a consequence of ineffective treatment)
• severe bradycardia or, in exceptional cases, stopping the sinus node (predominantly in patients with sinus node dysfunction and elderly patients)
• progression of heart failure (with prolonged use)
• nausea, vomiting
• loss of appetite
• dullness
• a feeling of heaviness in the epigastrium (occurs mainly at the beginning of treatment, pass after a decrease in dose)
• interstitial or alveolar pneumonitis
• bronchiolitis obliterans with pneumonia (sometimes fatal)
• pleurisy
• bronchospasm (in patients with severe respiratory failure, especially in patients with bronchial asthma)
• acute respiratory distress syndrome (sometimes with a fatal outcome and sometimes immediately after surgery, it is assumed that it is possible to interact with high doses of oxygen)
• pulmonary hemorrhage
• microdeposition in the epithelium of the cornea, consisting of complex lipids, including lipofuscin
• optic neuritis
• hypothyroidism (weight gain, chilliness, apathy, decreased activity, drowsiness, excessive bradycardia compared with the expected effect of amiodarone)
• hyperthyroidism, the appearance of which is possible during and after treatment (cases of hyperthyroidism that developed several months after amiodarone withdrawal were described)
• photosensitization
• grayish or bluish skin pigmentation (after the cessation of treatment, this pigmentation slowly disappears)
• erythema (during radiotherapy)
• skin rash (usually mildly specific)
• alopecia
• exfoliative dermatitis (no connection with drug administration)
• tremor or other extrapyramidal symptoms
• sleep disorders
• nightmares
• myopathy
• headache
• Thrombocytopenia, hemolytic anemia, aplastic anemia
• vasculitis
• several cases of impotence (communication with the drug is not established).

Contraindications

• SSSU (sinus bradycardia, sinoatrial blockade) with the exception of cases of correction by an artificial pacemaker (danger of "stopping" the sinus node);
• AV-blockade of 2 and 3 degrees in the absence of a permanent artificial pacemaker (pacemaker);
• two- and three-beam blockades in the absence of a pacemaker;
• hypokalemia, hypomagnesemia;
• interstitial lung diseases;
• dysfunction of the thyroid gland (hypothyroidism, hyperthyroidism);
• congenital or acquired lengthening of the QT interval;
• combination with drugs that can prolong the QT interval and cause the development of paroxysmal tachycardias, including polymorphic ventricular tachycardia of the pirouette type: antiarrhythmics of class 1 A (quinidine, hydroquinidine, disopyramide, procainamide); antiarrhythmic drugs of class 3 (dofetilide, ibutilid, brethilia tosilate); sotalol; other (non-antiarrhythmic) drugs, such as beprideal; wincamine; some neuroleptics phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine, fluphenazine), benzamides (amisulpride, sultopride, sulpiride, tiaprid, verialpyride), butyrophenones (droperidol, haloperidol), sertindole, pimozide; cisapride; tricyclic antidepressants; antibiotics of the macrolide group (in particular erythromycin with iv introduction, spiramycin); azoles; antimalarial drugs (quinine,chloroquine, mefloquine, halofantrine); pentamidine with parenteral administration; diphenamyl methyl sulfate; misolastine; astemizole, terfenadine; fluoroquinolones;
• children and adolescents under 18 years of age (efficacy and safety not established);
• pregnancy;
• lactation period;
• increased sensitivity to iodine and / or amiodarone.

Application in pregnancy and lactation

Cordaron is contraindicated in pregnancy and lactation (breastfeeding).

Currently available clinical information is not sufficient to determine the degree of risk of developmental malformations in the embryo when using Cordarone in the first trimester of pregnancy.

Since the fetal thyroid begins to bind Iodine only from the 14th week of pregnancy (amenorrhea), it is not expected that amiodarone will affect it if it is used earlier. Excess iodine in the use of the drug after this period can lead to the appearance of laboratory symptoms of hypothyroidism in a newborn or even to the formation of a clinically significant goiter in it. Due to the effect of the drug on the thyroid of the fetus, Cordarone is contraindicated in pregnancy,except for special cases of life indications (with life-threatening ventricular arrhythmias).

Amiodarone is excreted in breast milk in significant amounts, so if you need to use the drug during lactation, breastfeeding should be abolished.

Application in elderly patients

With caution should be used in elderly patients (high risk of pronounced bradycardia).

Use in children

Contraindicated in children and adolescents under the age of 18 years (efficacy and safety not established).

special instructions

Side effects of Cordarone are dose-dependent, therefore, in order to minimize the possibility of their occurrence, the drug should be applied at the lowest effective dose.

Patients during treatment should avoid exposure to direct sunlight or take protective measures (for example, the use of sunscreen, wearing appropriate clothing).

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

In addition, due to the fact that Cordarone can cause hypothyroidism or hyperthyroidism, especially in patients with a history of thyroid disease, a clinical and laboratory (TSH) test should be performed before the reception of amiodarone for signs of thyroid dysfunction and disease. During treatment with amiodarone, and for several months after discontinuation, regular examinations are required to determine whether there are clinical or laboratory signs of a change in thyroid function. If there is a suspicion of thyroid dysfunction, it is necessary to determine the level of TSH in the blood serum.

Regardless of the presence or absence of pulmonary symptoms during treatment with amiodarone, it is recommended to perform an X-ray examination of the lungs and pulmonary functional tests every 6 months.

Patients receiving long-term treatment for rhythm disorders reported cases of increased ventricular fibrillation and / or an increase in the thresholdpacemaker or implanted defibrillator, which can reduce their effectiveness. Therefore, before starting or during treatment, Cordarone should regularly check the correct functioning of these devices.

The appearance of dyspnoea or dry cough, both isolated and accompanied by worsening of the general condition, indicates the possibility of pulmonary toxicity, such as interstitial pneumopathy, suspected development of which requires an X-ray examination of lung and pulmonary functional tests.

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

With the development of AV blockade of 2 and 3 degrees, a sinoatrial blockade or a two-beam intraventricular blockade, treatment should be discontinued.If there is an AV blockade of 1 degree, the clinical control needs to be strengthened.

Although there was an occurrence of arrhythmia or aggravation of the existing rhythm disturbances, the pro-arrhythmogenic effect of amiodarone is weak, less than most antiarrhythmic drugs, and usually manifests in combination with certain drugs or in electrolyte imbalance.

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

Since Cordarone contains iodine, its administration may distort the results of a radioisotope study of the thyroid gland, but does not affect the reliability of the determination of T3, T4 and TSH in blood plasma.

Before surgery, the anesthesiologist should be informed that the patient is receiving Cordarone. Long-term treatment with Cordarone may increase the hemodynamic risk inherent in local or general anesthesia.This is especially true for its bradycardic and hypotensive effects, reduction in cardiac output and conduction disorders.

In addition, in patients receiving Cordarone, in rare cases, immediately after surgery, acute respiratory distress syndrome was noted. In patients with mechanical ventilation, such patients require careful monitoring.

Impact on the ability to drive vehicles and manage mechanisms

In the period of treatment, Cordarone should refrain from driving a car and practicing potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions

Drug Interactions

Contraindicated combinations

Contraindicated the use of Cordarone in combination therapy with drugs that can cause polymorphic ventricular tachycardia such as "pirouette", tk. when combined with amiodarone, the risk of this complication and death is increased:

• antiarrhythmics: class 1A (quinidine, hydroquinidine, disopyramide, procainamide), class 3 (dofetilide, ibutilide, brethilia tosylate), sotalol;
• other (non-antiarrhythmic) drugs, such as beprideal; wincamine; some neuroleptics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine, fluphenazine), benzamides (amisulpride, sultopride, sulpiride, tiaprid, verialpyride), butyrophenones (droperidol, haloperidol), sertindole, pimozide; tricyclic antidepressants; cisapride; macrolide antibiotics (erythromycin with iv introduction, spiramycin); azoles; antimalarials (quinine, chloroquine, mefloquine, halofantrine, lumefantrine); pentamidine with parenteral administration; diphenamyl methyl sulfate; misolastine; astemizole; terfenadine; fluoroquinolones (in particular moxifloxacin).

Unrecommended combinations

• with beta-adrenoblockers, with slow calcium channel blockers, slowing heart rate (verapamil, diltiazem), tk. there is a risk of development of violations of automatism (pronounced bradycardia) and conduction;
• with laxatives, stimulating intestinal motility, which can cause hypokalemia, which increases the risk of developing a ventricular pirouette tachycardia. During the treatment, Cordarone should use laxatives of other groups.

Combinations where caution is required

With drugs that can cause hypokalemia:

• diuretics that cause hypokalemia (in monotherapy or combination);
• amphotericin B (IV);
• glucocorticosteroids (GCS) for systemic use;
• tetracosactide.

The risk of ventricular arrhythmias increases, especially ventricular pirouette tachycardia (hypokalemia is a predisposing factor). It is necessary to control the content of electrolytes in the blood, if necessary - correction of hypokalemia, constant clinical observation and ECG monitoring. In the case of development of ventricular tachycardia of the "pirouette" type, antiarrhythmics should not be used (ventricular pacing should be started, and / or magnesium salts may be injected).

With procainamide

Amiodarone can increase the plasma concentration of procainamide and its metabolite N-acetyl procainamide, which may increase the risk of side effects of procainamide.

With anticoagulants of indirect action

Amiodarone increases the concentration of Warfarin by inhibiting the isoenzyme CYP2C9.When warfarin is combined with amiodarone, the effects of an indirect anticoagulant may increase, which increases the risk of bleeding. It should be more often monitor prothrombin time (INR) and adjust the dose of anticoagulant as during treatment with amiodarone, and after its withdrawal.

With cardiac glycosides (digitalis preparations)

Possible occurrence of violations of automatism (pronounced bradycardia) and atrial-ventricular conduction. In addition, with the combination of Digoxin with amiodarone, an increase in the concentration of digoxin in the blood plasma is possible (due to a decrease in its clearance). Therefore, when digoxin is combined with amiodarone, it is necessary to determine the concentration of digoxin in the blood and to monitor possible clinical and ECG manifestations of digitalis intoxication. You may need to reduce the dosage of digoxin.

With esmolol

Possible violations of contractility, automatism and conduction (suppression of compensatory reactions of the sympathetic nervous system). Clinical and ECG monitoring is required.

With phenytoin (and, by extrapolation, with fosphenytoin)

Amiodarone can increase plasma concentrations of phenytoin by inhibiting the isoenzyme CYP2C9,therefore, when phenytoin is combined with amiodarone, the development of an overdose of phenytoin may occur, which can lead to the appearance of neurologic symptoms; requires clinical monitoring and, at the first signs of an overdose, a decrease in the dose of phenytoin, it is desirable to determine the concentration of phenytoin in the blood plasma.

With drugs metabolized by the isoenzyme CYP3A4

When combined amiodarone, an inhibitor of isozyme CYP3A4, with these drugs, may increase their plasma concentrations, which can lead to increased toxicity and / or enhance the pharmacodynamic effects and may require dose reduction of these drugs:

• Cyclosporine: Cyclosporine is possible to increase the concentration in plasma associated with decreased drug metabolism in the liver, which can increase the nephrotoxic effect of cyclosporine. It is necessary to determine the concentration of cyclosporin in the blood, monitor kidney function and correct the dosage regimen of cyclosporine during the treatment with amiodarone and after drug withdrawal.
• fentanyl: when combined with amiodarone, the pharmacodynamic effects of fentanyl may be increased and the risk of developing its toxic effects may be increased.
• other drugs metabolized with CYP3A4: lidocaine (risk of sinus bradycardia and neurological symptoms), tacrolimus (risk of nephrotoxicity), sildenafil (risk of increased side effects), midazolam (risk of psychomotor effects), triazolam, dihydroergotamine, ergotamine, statins, including simvastatin (increased risk of muscle toxicity, rhabdomyolysis, so the dose of simvastatin should not exceed 20 mg per day, if it is ineffective, go to another statin that does not metabolize using CYP3A4).

With Orlistat

There is a risk of reducing the concentration of amiodarone and its active metabolite in the blood plasma. Clinical and, if necessary, ECG monitoring is required.

With clonidine, guanfacin, cholinesterase inhibitors (donepezil, galantamine, rivastigmine, tacrine, ambenonium chloride, pyridostigmine bromide, neostigmine bromide), pilocarpine

There is a risk of developing excessive bradycardia (cumulative effects).

With cimetidine, grapefruit juice

There is a slowing of the metabolism of amiodarone and an increase in its plasma concentrations, possibly an increase in the pharmacodynamic and side effects of amiodarone.

With preparations for inhalation anesthesia

The possibility of developing the following severe complications in patients receiving amiodarone has been reported in the course of anesthesia: bradycardia (resistant to atropine administration), arterial hypotension, conduction abnormalities, cardiac output reduction. There were very rare cases of severe complications from the respiratory system (acute respiratory distress syndrome of adults), sometimes fatal, which developed immediately after surgery, the occurrence of which is associated with high concentrations of oxygen.

With radioactive iodine

Amiodarone contains iodine and therefore can disrupt the absorption of radioactive iodine, which can distort the results of the radioisotope study of the thyroid gland.

With rifampicin

Rifampicin is a potent inducer of CYP3A4, so when combined with amiodarone, plasma concentrations of amiodarone and desethylamiodarone may decrease.

With preparations of St. John's wort

St. John's wort is a powerful inducer of СYР3А4. In this regard, it is theoretically possible to reduce the plasma concentration of amiodarone and reduce its effect (no clinical data are available).

With HIV protease inhibitors (incl.indinavir)

HIV protease inhibitors are inhibitors of CYP3A4, so when used simultaneously with amiodarone, they can increase the concentration of amiodarone in the blood.

With clopidogrel

Clopidogrel, which is an inactive thienopyrimidine drug, is metabolized in the liver with the formation of active metabolites. Possible interaction between Clopidogrel and amiodarone, which can lead to a decrease in the effectiveness of clopidogrel.

With dextromethorphan

Dextromethorphan is a substrate of CYP2D6 and CYP3A4. Amiodarone inhibits CYP2D6 and can theoretically increase the plasma concentration of dextromethorphan.

Analogues of the medicinal product Cordarone

Structural analogs for the active substance:

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

Analogues on the pharmacological group (antiarrhythmic drugs):

• Adenocorus;
• Allapinin;
• Asparks;
• Bretilate;
• Hypertonplant (Gnafalin);
• Dinexan;
• Diphenine;
• Cardiodarone;
• Kinidin Durules;
• Lidocaine;
• Morazizin;
• Multac;
• Neo Giluritmal;
• Nibentan;
• Novocaineamide;
• Pamaton;
• Panangin;
• Procainamide Eskom;
• Propanorm;
• Propaphenone;
• Profen;
• Ritalmex;
• Rhythmiodaron;
• Rhythmodan;
• Rhythm monm;
• Sedacorone;
• Trimecaine;
• Etatsizin;
• Ethmosin.

Similar medicines:

Other medicines: