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Verapamilum - the description, contraindications, application
The latin name: Verapamil
Verapamil Pharmacological groups: Blockers of calcium canals
Verapamil Working substance: Verapamil
Verapamil Application: the Paroxysmal supraventricular tachycardia (except for a WPW-set of symptoms), a sinus tachycardia, an atrial extrasystole, a fibrillation and an atrial flutter, a stenocardia (including. , strains, postmyocardial infarction), an arterial hypertension, a hypertonic crisis, an idiopathic hypertrophic subaortal stenosis, a hypertrophic cardiomyopathy
Verapamil Contraindications: Hypersensitivity, a serious hypotension, a cardiogenic shock, AV blockade II and III degrees, a myocardial infarction (acute or recently transferred and complicated with the phenomena of a bradycardia, a hypotension, failures), a chronic heart failure of III stage, a WPW-set of symptoms and a set of symptoms of delicacy of sinus unit (if not it is implanted an electrocardiostimulator), sinuatrial blockade, set of symptoms - Adams - the Stoke, a digitalis intoxication, a serious stenosis of an ostium of an aorta, pregnancy, a feeding a breast
Verapamil Restrictions to application: AV blockade I of a degree, chronic heart failure I and II stages, the expressed bradycardia (less than 50 ./mines), the mild or moderate hypotension, the expressed myopathy (set of symptoms ), infringements of function of a liver or kidneys, a ventricular tachycardia with wide complex QRS (for / conducting).
Verapamil Application at pregnancy and a feeding a breast: It counterindicative at pregnancy. For the period of treatment it is necessary to stop thoracal feeding
Verapamil Side effects: From the side of cardiovascular system and a blood (a hemopoiesis, a hemostasis): a hypotension, a bradycardia (sinus), V blockade, a heart failure. From the side of nervous system and sense organs: a headache, a giddiness, a nervousness, block, a sleepiness, delicacy, fatigability, paresthesias. From the side of bodies of the GASTROINTESTINAL TRACT: a nausea, the dyspeptic phenomena, a constipation; rarely - a hyperplasia a gum, rising of activity of hepatic transaminases, an alkaline phosphatase. Allergic reactions: a dermal eruption, a urticaria, a dermal itch; rarely - a Quincke's disease, Stevens set of symptoms - Johnson. Other: a dermahemia of the person, a bronchospasm (at / introduction), peripheric edemas, it is very rare - a gynecomastia, augmentation of a secretion of Prolactinum (separate cases).
Verapamil Interaction: Enlarges a level in plasma of digoxin, the cyclosporine, Theophyllinum, Karbamazepinum, reduces - a lithium. The metoprolol and Propranololum weakens antibacterial activity of Rifampicinum, effect of Fenobarbitalum, a clearance, strengthens action of relaxants. Rifampicinum, Sulfinpyrazonum, Fenobarbitalum, salts of calcium, vitamin D - weaken action. Hypotensive effect antihypertensive drugs (strengthen diuretics, vasodilators), tricyclic both tetracyclic antidepressants and neuroleptics: antianginal - Sodium nitritums. -adrenoblockers, antiarrhythmics IA of a class, cardiac glycosides, inhalation anesthetics, radiopaque substances will potentiate oppressing influence on automatism of sinuatrial unit, AV conduction and a contractility of a myocardium (is relative). At simultaneous application with Acidum acetylsalicylicum - intensifying of an available bleeding. Cimetidinum enlarges the maintenance of Verapamilum in plasma
Verapamil Overdosage: Signs: an arterial hypotension, a bradycardia, AV blockade, a cardiogenic shock, a coma, an asystolia. Treatment: as a specific antidote use calcium a gluconate (10-20 ml of 10 % of a solution /); at a bradycardia and AV to blockade enter Atropinum, an isoprenaline or ; at a hypotension - plasma substituting solutions, Dopaminum, Norepinephrinum; at display of attributes of a heart failure - Dobutaminum.
Verapamil Way of application and dose: Inside, during time or right after meal, washing down with enough of a liquid. A stenocardia - on 80-120 mg 3 times day, on a background of infringement of function of a liver, in advanced age - on 40 mg 3 times day. Arrhythmias - at a chronic fibrillation of auricles on a background of therapy by cardiac glycosides - 240-320 mg / in 2-3 receptions; for prophylaxis of a paroxysmal supraventricular tachycardia - 240-480 mg / in 2-3 receptions. A hypertension - on 80 mg 3 times day, if necessary - up to 360 mg; to patients of advanced age or small body height - on 40 mg 3 times day; to children till 6 years - 40-60 mg / , 6-14 years - 80-360 mg in 3-4 receptions. As medicinal forms of prolonged action at a hypertension - on 180-240 mg single-passly in the morning; at poor efficiency a dose enlarge as follows: 240 mg in the morning, then 180 mg in the morning + 180 mg in the evening (it is possible 240 mg in the morning + 120 mg in the evening) and further on 240 mg 2 times day with an interval 12 h, to older persons or patients of small body height - 120 mg; at absence of adequate effect after a dose of her of 120 mg serially rise up to 180, 240, 360 and 480 mg single-passly in the morning. At a stenocardia and an arrhythmia - as forms on 120-240 mg 2 times day with an interval 12 h. Tablets on 200 mg: on 1 tab. 1-2 of time in day or on 2 tab. 1 of times in day. Medicinal forms of 24-hour controllable release (are accepted inside only entirely) - at a hypertension on 180 mg single-passly for the night; if necessary a dose up to 240 mg 360 mg serially enlarge by night, (2 tab. on 180 mg) for the night and then 480 mg (2 tab. on 240 mg) for the night. / it is sluggish: the adult an initial dose of 5-10 mg (during not less than 2 mines), at poor effect probably repeated introduction through 30 mines in a dose of 10 mg. To children till 1 year under the control the ELECTROCARDIOGRAM in a dose of 0,1-0,2 mkg / kg (routinely single-pass dose makes 0,75-2 mg), during not less than 2 mines, to children of 1-15 years in a dose of 0,1-0,3 mg / kg during not less than 2 mines (routinely single-pass dose makes no more than 2-5 mg). At a hypertonic crisis - 5-10 mg / are sluggish
Verapamil Precautionary measures: With care appoint to patients with a hypertrophic cardiomyopathy the complicated obstruction of a left ventricle, high pressure of jamming in pulmonary capillaries, a paroxysmal night short wind or an orthopnea, infringement of function of sino - atrial unit. At purpose with the expressed infringement of function of a liver and nervous - muscle transfer (myopathy ) the constant medical control and, probably, decrease of a dose is necessary for patients. With care to apply in an operating time to drivers of vehicles and people which trade is connected to the raised concentration of attention (drops reaction rate), it is recommended to exclude reception of alcohol
Verapamil Special indicatings: the Injection form is incompatible with Albuminum, injection forms of Amphotericinum In, , Sulfametoxazolum, Trimethoprimum and can drop out in a deposit in a solution with pH above 6,0
Trading names of drugs with working substance Verapamil:
Verapamil Verapamilum (Verapamil) Verapamilum a hydrochloride of 0,08 g (Verapamil hydrochloride 0,08 g) (Veromil) Verapamilum (Verapamil) Verapamilum of a hydrochloride a solution for injections of 0,25 % (Solutio Verapamili hydrochloridi pro injectionibus 0,25 %) Isoptinum (Isoptin) Verapamilum - (Verapamil-MIK) Verapamilum of a hydrochloride the tablets covered with an environment (Tabulettae Verapamili hydrochloridi obductae) Isoptinum SR 240 (Isoptin SR 240) Verapamilum - (Verapamil-ratiopharm) -Verapamilum (Vero-Verapamil) (Lekoptin) Verapamilum a hydrochloride (Verapamili hydrochloride) 240 mg (Verogalid ER 240 mg) Finoptinum (Finoptin)
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