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Kordafleks - instructions for use, analogs, reviews and release form (tablets 10 mg, 20 mg retard 40 mg RD) drugs for the treatment of Raynaud's syndrome, angina and reduce the pressure in adults, children and in pregnancy

Kordafleks - instructions for use, analogs, reviews and release form (tablets 10 mg, 20 mg retard 40 mg RD) drugs for the treatment of Raynaud's syndrome, angina and reduce the pressure in adults, children and in pregnancy

In this article, you can read the instructions for using the drug Kordaflex. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Kordaflex 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 Kordaflex in the presence of existing structural analogs. Use for the treatment of Reynaud's syndrome, angina pectoris and pressure reduction in adults, children, as well as during pregnancy and lactation.

 

Kordaflex - selective blocker of slow calcium channels, derivative of 1,4-dihydropyridine. Has antihypertensive and antianginal action.

 

Nifedipine (the active substance of the drug Cordaflex) reduces the current of extracellular calcium ions inside cardiomyocytes and smooth muscle cells of the coronary and peripheral arteries. In therapeutic doses normalizes the transmembrane current of calcium ions, disrupted in a number of pathological conditions, especially in hypertension. Reduces spasm and dilates coronary and peripheral arterial vessels, reduces OPSS, reduces afterload and myocardial oxygen demand. At the same time it improves the blood supply of the ischemic zones of the myocardium without the development of the syndrome of "stealing", and also increases the number of functioning collaterals.

 

Cordaflex has virtually no effect on the sinoatrial and AV node and does not have both pro- and antiarrhythmic effects. Does not affect the tone of the veins. Nifedipine increases renal blood flow, causing a mild sodium naresis. In high doses, it inhibits the release of calcium ions from intracellular stores.Reduces the number of functioning calcium channels, without affecting the time of their activation, inactivation and recovery.

 

After a single dose of Cordaflex, the effect lasts more than 24 hours.

 

Composition

 

Nifedipine + excipients.

 

Pharmacokinetics

 

When ingestion quickly and almost completely (more than 90%) is absorbed from the digestive tract. Bioavailability is 40-70%. After ingestion of 1 tablet prolonged action of 20 mg (retard) therapeutic concentration of nifedipine in blood plasma is achieved after 1 hour and remains at a constant level up to 6 hours (plateau prolonged action), and in the next 30-36 h gradually decreases. Binding to plasma proteins (albumins) is 94-97%. Unbound nifedipine is distributed in all organs and tissues. Penetrates through the blood-brain barrier (GEB) (less than 5%), through the placental barrier, excreted in breast milk. Do not cumulate. Nifedipine is extensively metabolized in the liver with the formation of 3 metabolites that do not have pharmacological activity. 60-80% of the dose taken internally is excreted in the urine in the form of inactive metabolites, the rest - with bile and feces.In elderly patients, the metabolism of nifedipine in the liver is reduced.

 

Indications

  • arterial hypertension of various genesis, including hypertensive crises (for tablets 10 mg);
  • IHD: for the prevention of seizures with various forms of angina pectoris (stable and postinfarction), incl. angiospastic (stenocardia of Prinzmetal);
  • Raynaud's syndrome (for prolonged-action tablets).

 

Forms of release

 

The tablets covered with a cover of 10 mg.

 

Tablets of prolonged action, coated with 20 mg (retard).

 

Controlled-release tablets coated with 40 mg (Cordaflex RD).

 

Instructions for use and dosing regimen

 

The dosage regimen is set individually, depending on the degree of severity of the disease and the patient's response to ongoing therapy.

 

Adults CORDAFLEX in the form of tablets, coated with a coat, appoint 10 mg (1 tablet) 3 times a day. If necessary, the dose of the drug can be increased to 20 mg (2 tablets) 1-2 times a day. The maximum daily dose is 40 mg. The interval between doses of the drug is at least 2 hours.

 

To accelerate the effect of the drug at the beginning of the development of an attack of angina or hypertensive crisis, the tablet should be chewed, held in the mouth for a while, and then swallowed with a small amount of water.

 

If it is necessary to increase the dose to 80-120 mg per day for the treatment of angina or hypertension, it is recommended to transfer the patient to the drug in the form of long-acting tablets.

 

When conducting course therapy, it is recommended to use Cordaflex in the form of long-acting tablets. The initial dose is 20 mg (1 tablet) 2 times a day with an interval of 12 hours. If necessary, the dose of the drug is gradually increased to achieve the optimal clinical effect. For prolonged maintenance therapy, as a rule, it is enough to take 20-40 mg (1-2 tablets) 2 times a day. The maximum daily dose is 120 mg.

 

In elderly patients, the pharmacokinetics of nifedipine varies, and therefore the initial dose of the drug is reduced by a factor of 2 and lower doses may be required to maintain the therapeutic effect.

 

With moderate violations of the liver or kidney correction of the dosing regimen is not required. With a pronounced violation of liver function, the maximum daily dose should not exceed 40 mg.

 

The drug in the form of tablets containing 10 mg of nifedipine, taken inside before meals, in the form of long-acting tablets - regardless of food intake, without chewing, squeezed with a small amount of water.

 

Kordaflex RD

 

The dose should be selected individually, depending on the severity of the patient's condition and the effectiveness of the treatment.

 

With arterial hypertension Kordaflex RD appoint 40 mg (1 tablet) 1 time per day. If necessary, the dose can be increased to 80 mg (2 tablets in 1-2 divided doses). An increase in the dose of more than 80 mg is not recommended.

 

With IHD appoint 40 mg (1 tablet) 1 time per day. If necessary, the dose can be increased to 80 mg (2 tablets in 1 or 2 doses). Doses greater than 80 mg can be given in exceptional cases under medical supervision. The daily dose should not exceed 120 mg.

 

Tablets should be taken with food (for example, breakfast), swallowed whole and washed down with a sufficient amount of water.

 

For violations of kidney or liver function, the drug should be used with caution in the same doses as with normal kidney or liver function. Perhaps the development of tolerance. With a significant decrease in liver function, do not exceed the dose of 40 mg per day.

 

Side effect

  • hyperemia of the facial skin;
  • severe arterial hypotension;
  • peripheral edema;
  • tachycardia;
  • increased angina attacks (drug withdrawal required);
  • increased heart failure;
  • fainting;
  • headache;
  • dizziness;
  • increased fatigue;
  • sleep disorders (drowsiness or insomnia);
  • visual impairment;
  • paresthesia in the limbs;
  • tremor;
  • diarrhea;
  • constipation;
  • nausea;
  • heartburn;
  • dry mouth;
  • flatulence;
  • gingivitis;
  • anorexia;
  • Thrombocytopenia, thrombocytopenic purpura, leukopenia, anemia;
  • increased daily diuresis;
  • impairment of renal function in patients with chronic renal insufficiency;
  • myalgia;
  • gynecomastia;
  • Hyperglycemia (completely disappear after discontinuation of the drug);
  • change in body weight;
  • galactorrhea;
  • hives;
  • exanthema;
  • itching;
  • autoimmune hepatitis;
  • feeling of heat;
  • weakness;
  • sweating;
  • fever;
  • chills;
  • photodermatitis.

 

Contraindications

  • acute stage of myocardial infarction;
  • cardiogenic shock;
  • severe arterial hypotension (systolic blood pressure below 90 mm Hg);
  • severe aortic or mitral stenosis, idiopathic hypertrophic subaortic stenosis;
  • severe heart failure;
  • 1 trimester of pregnancy;
  • lactation period (breastfeeding);
  • children and adolescents under 18;
  • hypersensitivity to nifedipine and other components of the drug.

 

Application in pregnancy and lactation

 

Cordaflex is contraindicated for use in the first trimester of pregnancy.

 

The use of Cordaflex in pregnant women is shown only in those cases when the normalization of blood pressure is impossible with the use of other antihypertensive drugs.

 

Because nifedipine is excreted in breast milk, Kordaflex should be avoided during lactation or breastfeeding should be discontinued during treatment with the drug.

 

Application in elderly patients

 

In elderly patients, the pharmacokinetics of nifedipine varies, and therefore the initial dose of the drug is reduced by a factor of 2 and lower doses may be required to maintain the therapeutic effect.

 

Use in children

 

Due to the lack of sufficient clinical data, the drug is not recommended for use in children and adolescents under the age of 18 years.

 

special instructions

 

The antihypertensive effect of Cordaflex increases with hypovolemia. Decreased pressure in the pulmonary artery and hypovolemia after dialysis can also enhance the effects of the drug, which is why it is recommended to reduce its dose.

 

In rare cases, at the beginning of a course of treatment with Cordaflex or with an increase in its dose, soon after taking the drug maythere is pain in the chest (angina due to paradoxical ischemia). If there is a causal relationship between taking the drug and stenocardia, treatment should be discontinued.

 

With arterial hypertension or coronary artery disease, abrupt withdrawal of nifedipine may cause hypertensive crisis or myocardial ischemia (the phenomenon of "bounce").

 

If during the therapy the patient needs surgical intervention under general anesthesia, it is necessary to inform the anesthetist about the ongoing therapy with Cordaflex.

 

In elderly patients, the reduction of cerebral blood flow is more likely due to severe peripheral vasodilation.

 

During the course of treatment Cordaflex did not recommend the use of alcoholic beverages because of the risk of excessive blood pressure lowering.

 

Impact on the ability to drive vehicles and manage mechanisms

 

In the initial, individually defined period of application Kordafleks not allowed to drive vehicles and engage in other potentially dangerous activities requiring rapidity of psychomotor reactions. In the course of further treatment, the degree of restriction is determined depending on the patient's individual response to the drug.

 

Drug Interactions

 

Rational in terms of increasing antihypertensive and anti-anginal action is the combination of Cordaflex with beta-adrenoblockers, diuretics, ACE inhibitors, nitrates. All of the above combinations in most clinical situations are safe and effective, since they lead to summation or potentiation of effects, but in some cases there is a risk of a marked decrease in blood pressure and increased symptoms of heart failure.

 

The combination of Cordaflex with clonidine, methyldopa, octadine, prazosin according to the indications is possible, however it can cause strong orthostatic hypotension.

 

Strengthening of the hypotensive effect is also observed with combined therapy with cimetidine, Ranitidine and tricyclic antidepressants.

 

Nifedipine increases the concentration of Digoxin and theophylline in the blood plasma, and therefore the clinical effect and / or the content of digoxin and theophylline in the blood plasma should be monitored.

 

Procaine, quinidine and other drugs that cause prolongation of the QT interval increase the negative inotropic effect and increase the risk of prolongation of the QT interval.Under the influence of nifedipine, the concentration of quinidine in serum is significantly reduced, which is apparently due to a decrease in its bioavailability, as well as the induction of enzymes that inactivate quinidine. With the withdrawal of nifedipine, there is a transient increase in the concentration of quinidine (approximately 2-fold), which reaches a maximum level of 3-4 days. Care should be taken when using such combinations, especially in patients with left ventricular dysfunction.

 

Nifedipine may displace drugs that are highly binding (including indirect anticoagulants, coumarin and indanedione derivatives, non-steroidal anti-inflammatory drugs (NSAIDs)) from protein binding, and as a result, their concentrations in the blood plasma may increase.

 

With simultaneous administration with rifampicin, phenytoin and calcium preparations, the action of nifedipine is weakened.

 

Nifedipine inhibits the excretion of vincristine from the body and may cause an increase in the side effect of vincristine, if necessary, reduce the dose of vincristine.

 

Diltiazem inhibits the metabolism of nifedipine in the body, if necessary, reduce the dose of nifedipine.

 

Grapefruit juice, Erythromycin and antifungal drugs of the azole group (fluconazole, intraconazole, ketoconazole) can suppress the metabolism of nifedipine and therefore enhance its effects.

 

Alcohol enhances the hypotensive effect of Nifedipine.

 

Similarly, the simultaneous use of Cordaflex and cimetidine increases the concentration of nifedipine in blood plasma, enhances its effects; However, simultaneous use with ranitidine does not lead to a significant increase in the concentration of nifedipine in blood plasma.

 

Since nifedipine is metabolized by the CYP3A4 isoenzyme, any inhibitor or inducer of this enzyme can affect the metabolism of nifedipine. Ciclosporin is also a substrate of the CYP3A4 isoenzyme; so when combined use of cyclosporine and nifedipine, each can increase the duration of the effect of another.

 

Analogues of the drug Kordaflex

 

Structural analogs for the active substance:

  • Adalate;
  • Calzigard retard;
  • Kordafen;
  • Cordaflex RD;
  • Cordipine;
  • Cordipine retard;
  • Corinfar;
  • Corinfar retard;
  • Corinfar OOE;
  • Nicardy;
  • Nykardija SD retard;
  • Nyfadil;
  • Nifébyen;
  • Nifhexal;
  • Nifedex;
  • Nifedikap;
  • Nifedikor;
  • Nifedipine;
  • Nifecard;
  • Nifelate;
  • Nifesan;
  • Osmo Adalat;
  • Sanfidipine;
  • Sponify 10;
  • Phenigidine.

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Reviews (10):
Guests
Inessa Eduardovna
Good medicine. I keep my stenocardia in check by means of cordaflex, while I did not give a misfire. Assigned long ago, we can say even with the advice, so to the medicine this trust is absolute, not as it is now all for the money appointed, only more expensive.
Guests
Galina
Cordaflex 20 is one of the few drugs against hypertension that helps me maintain blood pressure at 140/90 in 63 years. Admission to 10 mg 4 r. in a day.
Guests
Mikhail Gennadievich
I am 64 years old. I accept cordaflex retard on 20 mg in the morning and in the evening more than 6 years. Tried to replace with another drug (on the advice of the therapist).As a result, again Cordaflex 20 mg retard. The pressure is constantly below 140/90.
Guests
Irina
Saw Cordaflex, the doctor changed to a lopaz. Saw a lopaz, there was no sense. Has passed again on kordafleks 20 mg in the morning and in the evening - pressure 130-140 on 90-100 (working 140-90).
Guests
porphilkin vitaliy gavrilovich
Can take in the morning kordafleks, and for the night ramazid?
Administrators
admin
porphilkin vitaliy gavrilovichIt is more rational to do the opposite. In the morning take Ramazid N, and at night Kordaflex. The rest of the preparations are combined and even enhance the mutual positive effect of sharing.
Guests
Olga
Tell me, please, is it possible to combine Kordaflex and Lorista and how to do it correctly? Loristu took a long time for 50 mg at night, but recently this is of little help, tried to help 5 mg of Cordaflex, it's getting better. At what time do you need to take it or can it be necessary at the same time? Thank you very much for your answer.
Administrators
admin
Olga, Cordaflex is routinely taken by 10 mg 3 times a day, can be used 2 times a day with a corresponding increase in dosage for 1 reception. I prefer to appoint Loristo in the morning, but if you take it for a long time in the evening, it is also acceptable. For correction of therapy it is better to address to the attending physician, it is better if it will be the cardiologist.
Guests
Irina
Whether it is possible to accept kordafleks at a high blood pressure as an ambulance?
Administrators
admin
Irina, Can. The maximum concentration of the drug Cordaflex in the blood is the same as that of the popular for these purposes Captopril (30-60 minutes).

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