How much does Cardiket 20 cost. Cardiket - instructions for use. Description of the dosage form

Catad_pgroup Nitrates and other antianginal

Kardiket - instructions for use

Registration number:

P N013273 - 230615

Trade name of the drug:

Cardicket ®

International non-proprietary name:

isosorbide dinitrate

Dosage form:

long-acting tablets

Compound:

1 extended-release tablet contains:
active substance: isosorbide dinitrate 20.00 mg / 40.00 mg / 60.00 mg (using a mixture (trituration) of isosorbide dinitrate and lactose monohydrate 40/60).
Excipients: lactose monohydrate 157.95 mg/ 162.70 mg/ 250.70 mg, talc 55.00 mg/ 45.00 mg/ 72.715 mg, magnesium stearate 2.05 mg/ 2.08 mg/ 2.515 mg, polyvinyl acetate 15, 00 mg / 9.00 mg / 12.00 mg, potato starch - / 1.22 mg / 2.07 mg.

Description:

Round white tablets, odorless. On the one hand, flat, with a chamfer and a risk and engraving above the risk - “IR”, under the risk - “20” (for 20 mg tablets), “40” (for 40 mg tablets), “60” (for 60 mg tablets) ; on the other hand - convex with the engraving "SCHWARZ PHARMA".

Pharmacotherapeutic group:

vasodilator - nitrate.

ATX code:

C01DA08

Pharmacological properties

Pharmacodynamics
Isosorbide dinitrate is a peripheral vasodilator with a predominant effect on venous vessels. It has an antianginal effect, causes a hypotensive effect. The mechanism of action is associated with the release of nitric oxide (endothelial relaxing factor) in the vascular endothelium, causing the activation of intracellular guanylate cyclase, resulting in an increase in the level of cyclic guanosine monophosphate (cGMP) (vasodilation mediator). The latter stimulates cGMP-dependent protein kinase, which disrupts the phosphorylation of several smooth muscle cell proteins, including the myosin light chain, which ultimately reduces contractility and subsequently leads to relaxation of vascular smooth muscle.
Acts on peripheral arteries and veins. Relaxation of the veins leads to a decrease in venous return to the heart (preload), which reduces the filling pressure of the left ventricle. Expansion of arterial vessels also occurs (albeit to a lesser extent), which is accompanied by a decrease in blood pressure (BP), a decrease in the total peripheral vascular resistance (afterload).
A decrease in pre- and afterload leads to a decrease in myocardial oxygen consumption.
Promotes the redistribution of coronary blood flow in favor of subendocardial zones, especially in atherosclerosis of the coronary arteries (mainly large ones). Vasodilation of the collateral arteries may improve myocardial blood supply. By reducing myocardial oxygen consumption and improving oxygen delivery to ischemic areas, the zone of myocardial damage is reduced.
Improves hemodynamics in patients with chronic heart failure, both at rest and during exercise.
Reduces blood flow to the right atrium, helps to reduce pressure in the pulmonary circulation and regression of symptoms in pulmonary edema.
Expands the vessels of the brain, dura mater, which may be accompanied by a headache.
It also relaxes the smooth muscles of the bronchi, gastrointestinal tract, bile and urinary tract.
As with other nitrates, cross-tolerance develops. After cancellation (break in treatment), sensitivity to it is quickly restored. In order to prevent the occurrence of tolerance, it is recommended to observe a daily, preferably nightly "nitrate-free interval" for 8-12 hours. In most patients, this therapy is more effective than continuous treatment.

Pharmacokinetics
When taken orally, isosorbide dinitrate is rapidly absorbed. The relative bioavailability for sustained release forms of isosorbide dinitrate compared to conventional tablets is more than 80% when taken orally. Started action - after 15-30 minutes, the maximum concentration of the substance in the blood plasma is reached after 15 minutes - 1 - 2 hours. It is metabolized in the liver to form active metabolites of isosorbide-5-mononitrate (half-life (T½) is 4-6 hours) and isosorbide-2-mononitrate (half-life (T½) is 1.5-2 hours). It is excreted by the kidneys (mainly in the form of metabolites).

Indications for use

Long-term treatment of coronary heart disease (prevention of angina attacks).
Secondary prevention of myocardial infarction and treatment of persistent angina pectoris (as part of combination therapy).
Long-term treatment of severe chronic heart failure (as part of combination therapy with cardiac glycosides, diuretics, angiotensin-converting enzyme (ACE) inhibitors).

Contraindications

Hypersensitivity to isosorbide dinitrate, other nitrates or excipients.
Acute circulatory disorders (shock, collapse)
Cardiogenic shock (if measures are not taken to maintain end-diastolic pressure).
Hypertrophic obstructive cardiomyopathy.
constructive pericarditis.
Cardiac tamponade.
Severe arterial hypotension (systolic blood pressure below 90 mm Hg).
Severe hypovolemia.
Severe anemia.
Severe aortic and subaortic stenosis, severe mitral stenosis.
Simultaneous administration of phosphodiesterase-5 inhibitors (including sildenafil, vardenafine, tadalafil).
Age up to 18 years (efficacy and safety not established).
Due to the presence of lactose, patients with congenital galactose intolerance or malabsorption of glucose and galactose should not take this drug.

Carefully
low filling pressure of the left ventricle, including in acute myocardial infarction, dysfunction of the left ventricle (for example, with left ventricular failure); aortic and / or mitral stenosis of mild to moderate degree; diseases accompanied by increased intracranial pressure (up to now, an increase in intracranial pressure has been observed only after intravenous administration of nitroglycerin in high doses); cerebral hemorrhage, increased intraocular pressure, incl. angle-closure glaucoma, a tendency to orthostatic disorders of vascular regulation, severe renal and / or liver failure. hypothyroidism, malnutrition and malnutrition; pregnancy, lactation.

Precautions for use

Kardiket ® in the dosage form of a prolonged-release tablet is not used to relieve angina attacks.
In acute myocardial infarction or acute heart failure, the drug should be used only under the condition of careful clinical monitoring of the patient. Interruptions in therapy with Cardiket ® for taking phosphodiesterase-5 inhibitors are not acceptable, as the risk of developing angina attacks and the “withdrawal” syndrome increases. In the event of an attack of angina pectoris, fast-acting nitrates should be additionally used to stop the attack.
Against the background of treatment, a decrease in blood pressure and the appearance of dizziness with a sharp transition from a “lying” or “sitting” position to a “standing” position are possible, while drinking alcohol, when exercising and in hot weather, and it is also possible to increase angina pectoris with a sharp decrease in blood pressure, development ischemia up to myocardial infarction and sudden death (paradoxical "nitrate reactions").
With prolonged use of the drug Kardiket®, tolerance may develop, and therefore, it is recommended to cancel for 24-48 hours or after 3-6 weeks of regular use of the drug, take a break for 3-5 days, replacing the drug Kardiket® with other antianginal drugs for this time .

Dosage and administration

Prolonged-release tablets cannot be divided!
The drug should be taken orally, without chewing and with a small amount of liquid, regardless of the time of the meal. Unless otherwise stated:
Kardiket ® prolonged-release tablets 20 mg: 1 tablet 2 times a day. To maintain the therapeutic effect, take the second tablet no later than 6-8 hours after the first. If the therapeutic effect is insufficient, the dose can be increased to 1 tablet 3 times a day, one tablet every 6 hours.
Kardiket ® tablets of prolonged action 40 mg: at the beginning of treatment - 1 tablet 1 time per day. If the therapeutic effect is insufficient, the dose can be increased to 1 tablet 2 times a day. To maintain the therapeutic effect at a dosage twice a day, take the second tablet no later than 6-8 hours after the first. Kardiket ® tablets of prolonged action 60 mg: at the beginning of treatment - 1 tablet 1 time per day. If necessary, the dose can be increased to 1 tablet 2 times a day. To maintain the therapeutic effect at a dosage twice a day, take the second tablet no later than 6-8 hours after the first.
Kardiket tablets of prolonged action 40 mg: at the beginning of treatment - 1 tablet 1 time per day. If the therapeutic effect is insufficient, the dose can be increased to 1 tablet 2 times a day. To maintain the therapeutic effect at a dosage twice a day, take the second tablet no later than 6-8 hours after the first.
Kardiket ® tablets of prolonged action 60 mg: at the beginning of treatment - 1 tablet 1 time per day. If necessary, the dose can be increased to 1 tablet 2 times a day. To maintain the therapeutic effect at a dosage twice a day, take the second tablet no later than 6-8 hours after the first.
Treatment should begin with the lowest dose and slowly increase the dose to the maximum effective dose. The decision on the duration of treatment is made by the doctor. This medicine is intended for long-term use and should not be stopped abruptly without consulting a doctor.

Overdose

Symptoms: pronounced decrease in blood pressure with orthostatic vasodilation, reflex tachycardia and headache. You may experience pallor, increased sweating, "threaded" pulse, weakness, dizziness, incl. postural, skin hyperemia, nausea, vomiting, diarrhea. At high doses (more than 20 mg / kg of body weight), methemoglobinemia, cyanosis, tachypnea, dyspnea should be expected due to the formation of nitritions due to the metabolism of isosorbide mononitrate, anxiety, loss of consciousness and cardiac arrest are also possible. It is possible that these symptoms may be caused by an overdose of isosorbide dinitrate. At very high doses of the drug, intracranial pressure may increase with cerebral symptoms. In chronic overdose, an increase in methemoglobin is detected.
Treatment: if symptoms of an overdose appear, the drug should be stopped, gastric lavage, activated charcoal should be taken.
With a pronounced decrease in blood pressure and / or a state of shock - give the patient a horizontal position with raised legs and take measures to replenish the volume of circulating blood (BCC); in exceptional cases, infusions of norepinephrine (norepinephrine) and / or dopamine can be performed to improve blood circulation. The introduction of epinephrine (adrenaline) and related compounds is contraindicated.
For methemoglobinemia:
1. Ascorbic acid - 1 g orally or in the form of sodium salt intravenously - 0.1 - 0.15 ml / kg of 1% solution up to 50 ml.
2. Oxygen therapy, hemodialysis, exchange transfusion.

Side effect

Possible side effects are listed below by body systems and frequency of occurrence: very often (more than 1/10), often (more than 1/100 and less than 1/10), infrequently (more than 1/1000 and less than 1/100), rarely ( more than 1/10000 and less than 1/1000), very rarely (less than 1/10000), the frequency is unknown.
From the side of the central nervous system
Very common: headache.
Often: drowsiness, slight dizziness.
From the side of the cardiac system
Often: tachycardia.
Infrequently: a "paradoxical" increase in angina attacks.
From the vascular system:
Often: orthostatic hypotension.
Uncommon: collapse (sometimes accompanied by bradyarrhythmia and syncope).
The frequency is unknown - hypotension.
From the gastrointestinal tract
Uncommon: nausea, vomiting.
Very rare: heartburn.
Skin and subcutaneous tissue disorders
Infrequently, skin allergic reactions (including rash), "flushing" of blood to the skin of the face.
Very rare: angioedema, Stevens-Johnson syndrome.
Frequency unknown: exfoliative dermatitis.
General disorders and disorders at the injection site
Often: asthenia.
Other: development of tolerance (including cross to other nitrates).
To prevent the development of tolerance, continuous high doses of the drug should be avoided.
For organic nitrates, cases of development of severe hypotension, accompanied by nausea, vomiting, anxiety, pallor and increased sweating, have been noted.
Prolonged use of the drug can cause transient hypoxemia due to the relative redistribution of blood flow to hypoventilated alveolar areas (in patients with coronary heart disease, it can lead to myocardial hypoxia).

Interaction with other drugs

When combined with amiodarone, propranolol, "slow" calcium channel blockers (verapamil, nifedipine, etc.), the antianginal effect may be enhanced.
Under the influence of beta-adrenergic stimulants, alpha-blockers, a decrease in the severity of the antianginal effect (tachycardia and an excessive decrease in blood pressure) is possible. Barbiturates accelerate metabolism and reduce the concentration of isosorbide mononitrate in the blood. Reduces the effect of vasopressors.
M-anticholinergics, incl. atropine (and other drugs with an m-anticholinergic effect) increases the likelihood of an increase in intraocular pressure when used with nitrates. Nitro compounds can reduce the therapeutic effect of norepinephrine (norepinephrine).
Barbiturates accelerate metabolism and reduce the concentration of nitro compounds in blood plasma.
The use of isosorbide dinitrate with antihypertensive agents (for example, beta-blockers, diuretics, slow calcium channel blockers, angiotensin-converting enzyme inhibitors), neuroleptics, tricyclic antidepressants, ethanol and ethanol-containing agents may lead to an increase in the hypotensive effect of isosorbide dinitrate.
Simultaneous administration of the drug Kardiket ® and phosphodiesterase-5 inhibitors (including sildenafil, tadalafil, vardenafil) is contraindicated due to the possibility of enhancing the hypotensive effect of the drug.
With simultaneous use with dihydroergotamine, it is possible to increase the concentration and enhance the effect of dihydroergotamine.
Adsorbents, astringents and enveloping agents reduce the absorption of the drug in the gastrointestinal tract.
Caution is advised when using sapropterin-containing drugs (sapropterin, a nitric oxide synthase cofactor) with all vasodilators whose pharmacological action is associated with nitric oxide (NO), including classic NO donators (for example, nitroglycerin, isosorbide dinitrate, isosorbide mononitrate) and others.

Use during pregnancy and during breastfeeding

Clinical studies of the use of the drug Kardiket ® in pregnant women have not been conducted. Use during pregnancy is possible only if the intended benefit to the mother outweighs the possible risk to the fetus and / or child. At the same time, careful monitoring of the condition of the pregnant woman and the development of the fetus is carried out.
There is evidence of the penetration of nitrates into breast milk, but the exact content of isosorbide dinitrate and its metabolites in breast milk has not been determined. A possible risk of developing methemoglobinemia in infants has also been reported, so taking the drug during breastfeeding should be done with caution.
Use in children
So far, there is no experience in treating children with this drug.
Use in elderly patients
There is no information on the need for dosage adjustments in elderly patients.

Influence on the ability to drive vehicles and mechanisms

Isosorbide dinitrate may reduce the ability to drive vehicles and engage in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions. Therefore, it is recommended to be careful when driving vehicles and engaging in other potentially hazardous activities that require an increased concentration of attention and speed of psychomotor reactions.

Release form

Long-acting tablets 20 mg, 40 mg, 60 mg. 10 tablets in a blister of polypropylene foil, or transparent polypropylene foil and aluminum foil, or PVC film and aluminum foil. On 2 or 5 blisters together with the application instruction in a cardboard pack.

Storage conditions

At a temperature not higher than 25°C.
Keep out of the reach of children.

Best before date

Shelf life 5 years.
Do not use the drug after the expiration date.

Holiday conditions

On prescription.

Manufacturer

Acica Pharmaceuticals GmbH
Galileistraße 6 08056 Zwickau, Germany

RU owner
USB Pharma GmbH
Alfred Nobel Strasse 10 40789,
Monheim, Germany

Issuing quality control
Acica Pharmaceuticals GmbH
Alfred Nobel Strasse 10, 40789 Monheim, Germany
or
CJSC PharmFirma Sotex
141345, Moscow region,
Sergiev Posad municipal district, rural settlement Bereznyakovskoye, pos. Belikovo, 11

Questions and complaints from consumers should be directed to:
Moscow, 105082, Perevedenovsky lane, 13, building 21.

In this article, you can read the instructions for using the drug cardiket. Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Kardiket in their practice are presented. We kindly ask you to actively add your reviews about the drug: the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Kardiket's analogs in the presence of the available structural analogs. Use for the treatment and prevention of angina attacks, myocardial infarction in adults, children, as well as during pregnancy and lactation. The composition of the drug.

cardiket- antianginal drug, organic nitrate.

Isosorbide dinitrate (the active substance of the drug Kardiket) causes relaxation of the smooth muscle wall of blood vessels, thus inducing vasodilation. Isosorbide dinitrate acts as a peripheral vasodilator, affecting both arteries and veins. These effects contribute to the deposition of venous blood and reduce venous return to the heart, reducing end-diastolic pressure and left ventricular volume (reduce preload).

The drug is characterized by a combination of rapid onset of effect with duration of action.

The advantages of the drug are determined by the fact that the active substance contained in tablets and capsules of prolonged action quickly enters the bloodstream. As a result, the drug provides a rapid onset of effect in the treatment of angina pectoris and retains its protective effect for a long time.

The onset of action of the drug is noted after 15-30 minutes.

Compound

Isosorbide dinitrate + excipients.

Pharmacokinetics

Capsules after oral administration dissolve in the stomach within a few minutes. The contents of the granules with the active substance are released gradually over several hours. After oral administration of isosorbide, dinitrate is rapidly absorbed. Binding to plasma proteins - 30%. It is metabolized in the liver with the formation of active metabolites - isosorbide-5-mononitrate (T1 / 2 is 4-6 hours) and isosorbide-2-mononitrate (T1 / 2 - 1.5-2 hours). It is excreted in the urine (almost completely in the form of metabolites).

Indications

long-term treatment of coronary artery disease: prevention of angina attacks;
chronic heart failure (as part of combination therapy with cardiac glycosides, ACE inhibitors and / or diuretics);
secondary prevention of myocardial infarction and treatment of persistent angina pectoris (as part of combination therapy) for prolonged-release tablets.

Release forms

Long-acting tablets 20 mg, 40 mg and 60 mg retard.

Long-acting capsules 120 mg.

Instructions for use and dosage

Long-acting tablets 20 mg are prescribed 1 tablet 2 times a day. With an increase in the need for the drug, the dose can be increased to 1 tablet 3 times a day.

Prolonged-release tablets 40 mg at the beginning of treatment are prescribed 1 tablet 1 time per day or 1/2 tablet 2 times a day. If the therapeutic effect is insufficient, the dose can be increased to 1 tablet 2 times a day. The second tablet should be taken no later than 8 hours after the first.

Prolonged-release tablets 60 mg at the beginning of treatment are prescribed 1 tablet 1 time per day. If necessary, the dose can be increased to 1 tablet 2 times a day. The second tablet should be taken no later than 8 hours after the first.

The drug in the form of prolonged-release capsules is prescribed 120 mg 1 time per day.

Treatment should begin with the lowest dose and slowly increase the dose to the maximum effective dose. The decision on the duration of treatment is made by the doctor. The drug is intended for long-term use, and without consulting a doctor, you should not abruptly stop taking it.

The drug is taken orally, regardless of the meal, without chewing and drinking a small amount of liquid. In order to split a tablet in half, it must be placed on a hard surface with a fault line up and press the tablet with your thumb. It easily splits into two halves.

Side effect

headache ("nitrate" headache), which, as a rule, disappears after a few days with further use of the drug;
a pronounced decrease in blood pressure, especially when the patient gets out of bed, which may be accompanied by tachycardia (paradoxical bradycardia is also possible), lethargy, as well as dizziness and a feeling of weakness;
paradoxical increase in angina attacks;
collaptoid states, sometimes with bradycardia and sudden loss of consciousness (syncope);
nausea, vomiting;
dry mouth;
belching;
abdominal pain;
stiffness;
drowsiness;
blurred vision;
decreased ability to quick mental and motor reactions (especially at the beginning of treatment);
cerebral ischemia;
skin rash;
development of tolerance (including cross to other nitrates);
exfoliative dermatitis;
hyperemia of the skin.

Contraindications

acute myocardial infarction with severe arterial hypotension;
acute vascular insufficiency (shock, vascular collapse);
severe arterial hypotension (systolic pressure less than 90 mm Hg);
angle-closure glaucoma with high intraocular pressure;
traumatic brain injury;
severe aortic and / or mitral stenosis;
hypovolemia;
hemorrhagic stroke;
children and adolescents under 18 years of age (efficacy and safety of use have not been established);
concomitant use of phosphodiesterase type 5 inhibitors (such as sildenafil, vardenafil or tadalafil), as they potentiate the hypotensive effect of nitrates;
hypersensitivity to nitrates.

Relative contraindications:

cardiac tamponade;
hypertrophic obstructive cardiomyopathy (may increase angina attacks);
severe anemia;
constrictive pericarditis;
hemorrhage in the brain;
toxic pulmonary edema.

Use during pregnancy and lactation

During pregnancy and lactation, the use of Kardiket is possible only if the intended benefit to the mother outweighs the possible risk to the fetus and / or child.

Use in children

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

special instructions

Kardiket is not used to stop angina attacks.

During treatment, control of blood pressure and heart rate is necessary.

With constant continuous treatment using Kardiket in high doses, tolerance may develop, as well as the appearance of cross-tolerance to other drugs of the nitrate group. To prevent a decrease in the effectiveness of the drug, its constant use in high doses should be avoided.

When taking Cardiket in patients with primary pulmonary diseases, temporary hypoxemia may occur due to the relative redistribution of blood flow to hypoventilated alveolar zones. In patients with CAD, this can lead to transient myocardial ischemia.

In acute myocardial infarction or acute heart failure, the drug should be used only under the condition of careful clinical monitoring of the patient.

To prevent an increase in angina attacks, abrupt withdrawal should be avoided.

Against the background of treatment with Kardiket, in the event of an attack of angina pectoris, fast-acting nitrates should be additionally used to stop it.

To prevent an undesirable decrease in blood pressure, the dose of the drug should be individually selected.

Against the background of treatment, a decrease in blood pressure and the appearance of dizziness are possible with a sharp transition to a vertical position from a “lying” or “sitting” position, with the use of ethanol (alcohol), exercise and hot weather, as well as increased angina pectoris with a sharp decrease in blood pressure, ischemia up to to myocardial infarction and sudden death (paradoxical "nitrate reactions").

The severity of headache during therapy with Kardiket can be reduced by reducing its dose and / or concomitantly taking menthol-containing drugs (validol).

With frequent use without application-free intervals, addiction may develop, requiring an increase in dose.

In order to prevent the occurrence of tolerance, it is recommended to observe a daily, preferably nightly "nitrate-free interval" for 8-12 hours. In most patients, this therapy is more effective than continuous treatment.

If, while taking the drug, blurred vision or dry mouth persist or are severe, treatment should be discontinued.

During the period of treatment with the drug, alcohol should be excluded.

Influence on the ability to drive vehicles and control mechanisms

During the period of therapy with Kardiket, it is necessary to refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

drug interaction

It is possible to increase the hypotensive effect of Kardiket while taking it with other vasodilators (vasodilators), antihypertensive drugs, beta-blockers, slow calcium channel blockers, phosphodiesterase 5 inhibitors used to treat erectile dysfunction, neuroleptics and tricyclic antidepressants, novocainamide, quinidine, and also ethanol.

The simultaneous use of Kardiket with dihydroergotamine can lead to an increase in the concentration of dihydroergotamine in the blood and, thus, enhance its hypotensive effect.

With the simultaneous use of sympathomimetic drugs, alpha-blockers, it is possible to reduce the antianginal effect of the drug Kardiket.

The combination of amiodarone and other drugs such as propranolol, slow calcium channel blockers (verapamil, nifedipine) and Kardiket is rational for the treatment of coronary artery disease.

The combined use of acetylsalicylic acid and Kardiket improves coronary circulation.

With the combined use of Kardiket with m-anticholinergics (atropine), the likelihood of an increase in intraocular pressure increases.

Adsorbents, astringents and enveloping agents reduce the absorption of Kardiket in the gastrointestinal tract.

Analogues of the drug Kardiket

Structural analogues for the active substance:

Aerosonite;
Dinisorb;
Isacardine;
ISO Mac retard;
Iso Mac spray;
Isoket;
Isolong;
Isosorbide dinitrate;
Cardix;
Nitrosorbide;
TD spray Iso Mac.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases that the corresponding drug helps with and see the available analogues for the therapeutic effect.

Kardiket is an antianginal drug that is used to prevent angina attacks during long-term therapy for coronary heart disease. Available in the form of tablets engraved with 20, 40, 60 and prolonged-release capsules (Cardiket Retard).

Pharmacological action of Kardiket

The instructions for Kardiket indicate that the active ingredient of the drug is isosorbide dinitrate (20, 40, 60 or 120 mg). The excipients of the tablets are lactose monohydrate, magnesium stearate, polyvinyl acetate, potato starch. Excipients capsules - sugar balls, lactose, semi-cellulose, shellac, talc.

Cardicket Retard is an organic nitrate.

When applied, Kardiket has a relaxing effect on the smooth muscle walls of blood vessels, due to which vasodilation is induced. The action of the active substance of the drug is similar to a peripheral vasodilator and extends not only to the arteries, but also to the veins. This effect of the drug contributes to the deposition of blood in the veins and a decrease in venous return to the heart. In this case, there is a decrease in the end diastolic pressure of the left ventricle, the preload on it decreases.

In reviews of Kardiket it is noted that the effect of the drug comes on quickly and lasts a long time. The advantage of Kardiket is its ability to quickly penetrate into the bloodstream, as a result of which the therapeutic effect of the drug in the treatment of angina pectoris occurs within a short period of time and lasts for a long time. Reviews of Kardiket also indicate that the onset of action of the drug is observed within 20-30 minutes after taking the tablets.

Capsules and tablets Kardiket after oral administration are rapidly absorbed by the gastrointestinal tract. The contents of the drug, together with the active ingredient, are released from the body after a few hours. The drug reaches its maximum plasma concentration in 1-2 hours. It has a low ability to bind to proteins and an average bioavailability.

The instructions for Kardiket noted that the period of complete elimination of the drug from the body is 24 hours. The agent is metabolized in the liver with the formation of two metabolites. Excreted from the body through the kidneys.

Indications for the use of Kardiket

The instructions for Kardiket indicate that the drug is prescribed for long-term therapy of coronary heart disease and for the prevention of angina attacks.

Effective use of Kardiket as part of complex therapy with cardiac glycosides, diuretics and angiotensin-converting enzyme inhibitors in chronic heart failure.

The drug is prescribed as part of combination therapy for the secondary prevention of myocardial infarction and for the treatment of persistent angina pectoris.

Method of application and dosage

Kardiket Retard 20 mg is prescribed to take 1 tablet 2 times a day. If necessary, the number of doses of the drug can be increased up to 3 times a day.

Tablets Kardiket 40 mg and 60 mg should be taken in the initial dose - 1 tab. 1 time per day or 1/2 tablet 2 times a day. If the therapeutic effect is insufficient, the dose can be increased to 2 tablets per day. The interval between doses of the drug should be at least 8 hours.

Capsules Kardiket Retard 120 mg should be taken one per day.

Treatment with the drug should begin with minimal doses, gradually bringing the dosage to the most effective. The duration of therapy is determined and adjusted by the attending physician. As a rule, long-term therapy is prescribed.

Tablets and capsules should be taken regardless of the meal as a whole, without crushing or chewing, with the necessary amount of water.

Side effects of Kardiket

In reviews of Kardiket, there are reports that during drug therapy, adverse reactions from the organs and systems of the body may occur:

Central nervous system: visual impairment, drowsiness, stiffness, slowing down of psychophysical reactions, ischemic disorders;
Cardiovascular system: at the beginning of therapy, nitrate headaches may occur, which disappear after a few days of regular use of the medication. Possible increased heart rate, hypotension, orthostatic collapse, feeling of weakness, lethargy, paradoxical bradycardia and angina pectoris, loss of consciousness against the background of a decrease in heart rate;
Gastrointestinal tract: nausea, dry mouth, vomiting, belching, epigastric pain.

Reviews of Kardiket indicate that allergic reactions may occur in the form of a skin rash, itching, urticaria, redness, exfoliative dermatitis. It is also possible to develop addiction to the drug, which leads to a decrease in its therapeutic effectiveness.

Contraindications to the use of Kardiket

The drug Kardiket is not prescribed to people who have:

Acute vascular insufficiency;
Myocardial infarction with severe symptoms of arterial hypotension;
Angle-closure glaucoma, accompanied by high intraocular pressure;
Severe mitral/aortic stenosis;
Traumatic brain injury;
hemorrhagic stroke;
Hypovolemia (decrease in the volume of circulating blood);
Hypersensitivity to the components of the drug and nitrates.

Kardiket is not prescribed simultaneously with phosphodiesterase type 5 inhibitors (since they activate the hypotensive effect of nitrates), as well as during pregnancy and lactation.

Relative contraindications to Kardiket are:

Hypertrophic obstructive cardiomyopathy;
cardiac tamponade;
Severe anemia;
Hemorrhages in the brain;
Constrictive pericarditis;
Toxic pulmonary edema.

With caution, Kardiket is prescribed in the presence of:

Malabsorption syndrome;
Diseases accompanied by increased intracranial pressure;
severe renal failure;
Severe liver failure;
Orthostatic disturbances in the regulation of blood circulation;
Hyperthyroidism;
Increased peristalsis of the gastrointestinal tract.

Overdose

Among the numerous reviews about Kardiket there are reports that in case of an overdose of the drug there is a decrease in blood pressure, collapse, headaches, fainting, dizziness, visual disturbances, increased heart rate, skin flushing, vomiting, diarrhea, anoxia, dyspnea, hyperpnea, perspiration, bradycardia , paralysis, craniocerebral hypertension.

Additional Information

During therapy with the drug, you must stop taking alcohol.

If severe headaches appear while taking the medication, it is recommended to take menthol-containing drugs (for example, validol) and reduce the dosage of Kardiket.

In accordance with the instructions, Kardiket should be stored in a dark, dry, cool place and out of the reach of children. The shelf life of the drug is 60 months.

From pharmacies, the drug is dispensed only by prescription.

Compound

active substance: isosorbide dinitrate;

1 tablet of prolonged action contains 20 mg or 40 mg, 60 mg of isosorbide dinitrate;

Excipients: lactose monohydrate, talc magnesium stearate polyvinyl acetate; potato starch.

Dosage form

Prolonged action tablets.

Basic physical and chemical properties: white tablet.

Upper side: flat bevelled with breakline, engraved with "IR" on one side of the breakline and "20" or "40" or "60" on the other.

Reverse: raised, inscription "SCHWARZ PHARMA".

Pharmacological group

Vasodilators used in cardiology.

ATX code C01D A08.

Pharmacological properties

Pharmacological.

mechanism of action

Like all organic nitrates, isosorbide dinitrate (ISDN) acts as a nitric oxide (NO) donor. Nitric oxide leads to relaxation of vascular smooth muscle by stimulating guanylate cyclase and further increasing the concentration of intracellular cyclic guanosine monophosphate (cGMP). Thus, (cGMP)-dependent protein kinase is stimulated, and as a result, the phosphorylation of various proteins in smooth muscle cells changes. In turn, this leads to dephosphorylation of myosin light chains and a decrease in their contractility.

pharmacodynamic

ISDN causes relaxation of vascular smooth muscle, which leads to vasodilation. The action of isosorbide dinitrate extends to peripheral veins and arteries. The latter effect promotes venous deposition of blood and reduces venous return to the heart; thus, ventricular end-diastolic pressure and volume (preload) are reduced.

The action on the arteries, and at higher doses on the arterioles, leads to a decrease in systemic vascular resistance (afterload). This, in turn, reduces the work of the heart.

The effect on both preload and afterload leads to a further decrease in the oxygen consumption of the heart.

In addition, ISDN causes a redistribution of blood flow in the subendocardial regions of the heart if the coronary circulation is partially obstructed by atherosclerotic lesions. The latter effect may be due to selective dilatation of large coronary vessels. Nitrate-induced dilatation of collateral arteries may improve myocardial perfusion. In addition, nitrates widen the lumen at the site of eccentric stenosis because they tend to counteract possible constrictive factors affecting the partially preserved smooth muscle of the coronary vessel at the site of narrowing. In addition, nitrates reduce coronary spasm.

In patients with congestive heart failure, nitrates improve hemodynamics at rest and during exercise. This beneficial effect develops through a number of mechanisms, including a reduction in valvular regurgitation (by reducing ventricular dilatation) and a reduction in myocardial oxygen demand.

Thus, an increase in oxygen supply with a decrease in the need for it to the heart muscle reduces the area of myocardial damage. Thus, isosorbide dinitrate may be beneficial for patients with myocardial infarction.

Effects on other organ systems include relaxation of bronchial muscles, muscles of the gastrointestinal tract, and muscles of the biliary and urinary tracts; there are reports of the effect of relaxing the smooth muscles of the uterus.

Pharmacokinetics.

In the digestive tract, isosorbide dinitrate is released from the extended-release tablet slowly, over several hours. The drug is rapidly absorbed, starting from the oral mucosa (the onset of therapeutic action for tablets of 20 mg, 40 mg, 60 mg occurs after 1 min, 2 min, 5 min, respectively), the maximum therapeutic concentration in blood plasma is reached after 6 min. , 10 min, 15 min respectively. In the gastrointestinal tract, absorption is somewhat slower (the onset of action of the drug after 15-30 minutes), the time to reach the maximum concentration (Cmax) is from 15 minutes to 1-2 hours. The absorption of the active substance is high. Binding to plasma proteins - 30%.

The first pass effect is higher with oral administration.

ISDN is metabolized in the liver to form isosorbide-2-mononitrate (T 1/2 - 1.5-2 hours) and isosorbide-5-mononitrate (T 1/2 - 4-6 hours). Both metabolites have pharmacologic activity.

bioavailability

The relative bioavailability of Cardiquet ® retard when administered orally is about 80% compared to that of isosorbide dinitrate in the form of tablets, they do not have a prolonged action. After the first passage through the liver, bioavailability is 15-30%.

Indications

Prevention and long-term treatment of angina pectoris.

Contraindications

The drug is contraindicated:

hypersensitivity to isosorbide dinitrate, other nitrate compounds or to an excipient;
in acute circulatory failure (shock, vascular collapse);
with cardiogenic shock (if a sufficient level of end-diastolic pressure is maintained by appropriate measures);
with hypertrophic obstructive cardiomyopathy;
with constrictive pericarditis;
with cardiac tamponade;
with severe hypotension (systolic blood pressure below 90 mm Hg);
with severe anemia
with severe hypovolemia.
During therapy with nitrates, phosphodiesterase inhibitors, such as sildenafil, tadalafil, vardenafil, should not be used (see sections "Peculiarities of use" and "Interaction with other drugs and other types of interactions").
During therapy with nitrates, a soluble guanylate cyclase stimulator, riociguat, should not be used (see Section "Interaction with other drugs and other types of interactions").

Interaction with other medicinal products and other forms of interaction

The hypotensive effect of the drug may be enhanced with simultaneous use with antihypertensive drugs (for example, with β-blockers, diuretics, calcium channel blockers, ACE inhibitors), vasodilators, antipsychotics, tricyclic antidepressants, and also when drinking alcohol.

The hypotensive effect of the drug is enhanced when taken simultaneously with phosphodiesterase inhibitors (such as sildenafil, tadalafil, vardenafil), which can lead to life-threatening cardiovascular complications (see sections "Contraindications" and "Peculiarities of use"). Do not use isosorbide dinitrate therapy simultaneously with phosphodiesterase inhibitors (such as sildenafil, tadalafil, vardenafil).

The use of Cardiquet® retard with riociguat, a soluble guanylate cyclase stimulator, is contraindicated (see "Contraindications"), since the simultaneous use of these drugs can lead to arterial hypotension.

Patients who have recently received therapy with phosphodiesterase inhibitors (eg, sildenafil, vardenafil, tadalafil) should not use isosorbide dinitrate for the treatment of acute conditions.

There are reports that the simultaneous use of the drug with dihydroergotamine can lead to an increase in the concentration of dihydroergotamine in the blood and, thus, enhance its effect.

Sapropterin (tetrahydrobiopterin, BH 4) is a cofactor for nitric oxide synthetase. With caution, it is recommended to use drugs containing sapropterin, simultaneously with any vasodilators, the mechanism of action of which is also associated with an effect on the metabolism of nitric oxide or which are also classic donors of nitric oxide (including nitroglycerin (GTN), isosorbide dinitrate (ISDN), isosorbide mononitrate (IMN)).

Application features

The drug should be used with caution and under medical supervision in the following cases:

at low filling pressure, incl. in acute myocardial infarction in violation of the function of the left ventricle (left ventricular failure). It is necessary to maintain pressure not lower than 90 mm. rt. V.;
with aortic and / or mitral stenosis;
with orthostatic dysfunction
in diseases associated with increased intracranial pressure (possibly increased. To date, such symptoms have been observed only after intravenous administration of high doses of nitroglycerin).

The drug is intended for the treatment of acute attacks of angina pectoris.

The development of tolerance (decreased effectiveness) has been described, as well as cross-tolerance to other drugs of the nitrate group (decreased effect if the patient has previously taken another nitrate). To prevent a decrease or loss of effect, long-term use of large doses (120 mg per day) should be avoided.

Patients on maintenance therapy with the drug should be advised that they should not take medicinal products containing phosphodiesterase inhibitors (eg sildenafil, tadalafil, vardenafil) due to the risk of uncontrolled arterial hypotension. ISDN therapy should not be discontinued when taking drugs containing phosphodiesterase inhibitors (for example, sildenafil, tadalafil and vardenafil), due to an increased risk of an angina attack (see Sections "Contraindications" and "Interaction with other medicinal products and other types of interactions").

Due to the fact that the drug contains lactose, it should not be prescribed to patients with rare genetic diseases, such as galactose intolerance, Lapp hereditary lactase deficiency, glucose-galactose malabsorption.

Use during pregnancy or lactation.

pregnancy

Reproductive toxicity studies in animals using isosorbide dinitrate at doses toxic to adults have not revealed evidence of toxic effects on the fetus. However, there are no adequate and well-controlled studies in pregnant women.

Given that animal studies cannot always predict the effect on humans, the drug should be used during pregnancy only if absolutely necessary and under the constant supervision of a physician.

lactation

It is not known whether isosorbide dinitrate passes into breast milk, therefore it is not recommended to prescribe to women during breastfeeding.

fertility

There are no data on the effect of isosorbide mononitrate on human fertility.

The ability to influence the reaction rate when driving vehicles or operating other mechanisms.

Even when used as directed, the drug may affect the reaction rate when driving vehicles or working with other mechanisms. This effect is enhanced by alcohol.

Dosage and administration

Cardiket ® retard 20 mg 1 tablet 2 times a day (equivalent to 40 mg of isosorbide dinitrate). The second/next dose should be taken no earlier than 6-8 hours after the first dose.

With an increased need for nitropreparations, the daily dose can be increased to 1 tablet 3 times a day (equivalent to 60 mg of isosorbide dinitrate), the interval between doses is 6:00.

Cardiket ® retard 40 mg 1 tablet 1 time per day (equivalent to 40 mg of isosorbide dinitrate). With an increased need for nitropreparations, the daily dose can be increased to 1 tablet 2 times a day (equivalent to 80 mg of isosorbide dinitrate). The second/next dose should be taken no earlier than 6-8 hours after the first dose.

Cardiket ® retard, 60 mg 1 tablet 1 time per day (equivalent to 60 mg of isosorbide dinitrate). With an increased need for nitropreparations, the daily dose can be increased to 1 tablet 2 times a day (equivalent to 120 mg of isosorbide dinitrate). The second/next dose should be taken no earlier than 6-8 hours after the first dose.

Elderly patients

There is no evidence of the need to change the dosage for elderly patients.

pediatric population

The safety and efficacy of isosorbide dinitrate in children has not yet been established.

mode of application

Swallow the tablets without chewing with a sufficient amount of liquid (for example, a glass of water).

Treatment should begin with small doses, gradually increasing the dose to the maximum effective. The duration of the course of treatment is determined by the doctor.

Since Cardiquet ® retard are matrix tablets, in some cases, their matrix framework may be excreted with feces without active substance.

Children. Do not apply to children.

Overdose

Experience gained in animal studies

In mice, significant lethality (LD50) was observed after a single dose of the drug at a dose of 33.4 mg/kg.

Experience with the drug in humans:

symptoms:

decrease in blood pressure ≤ 90 mm Hg;
pallor;
sweating;
weak filling of the pulse
tachycardia
dizziness (orthostatic reactions when changing body position);
headache;
asthenia
weakness,
dizziness
nausea
vomit
diarrhea
in patients taking other organic nitrates, cases of methemoglobinemia have been reported. During the biotransformation of isosorbide mononitrate, nitrite ions are released, which can induce methemoglobinemia and cyanosis, followed by tachypnea, anxiety, loss of consciousness and cardiac arrest. It is impossible to exclude the possibility of this adverse reaction with an overdose of isosorbide dinitrate;
excessive doses may increase intracranial pressure, sometimes causing cerebral symptoms.

General activities:

stop taking the drug
general measures to be taken in case of nitrate-induced hypotension:
provide the patient with a horizontal position with the head down with a low headboard and raised legs
ensure the supply of oxygen;
increase plasma volume (intravenous infusion)
conduct special anti-shock therapy (the patient must be in the intensive care unit!).

Special events.

Kardiket: instructions for use and reviews

Kardiket is a drug used to stop and prevent angina attacks, as well as to treat other manifestations of coronary insufficiency in coronary heart disease.

Release form and composition

Kardiket is produced in the form of prolonged-release tablets: white, round, on the one hand - convex, with the inscription "SCHWARZ PHARMA", on the other - flat, with a risk, chamfer and engraving: at risk (depending on the dose) - "20", "40" or "60", above the risk - "IR" (10 pieces in blisters, 2 or 5 blisters in a cardboard box).

The composition of 1 tablet includes:

Active substance: isosorbide dinitrate - 20, 40 or 60 mg;
Auxiliary components: lactose monohydrate, talc, magnesium stearate, potato starch, polyvinyl acetate.

Pharmacological properties

Pharmacodynamics

Isosorbide dinitrate is a peripheral vasodilator that acts primarily on the venous vessels. Differs in antianginal and hypotensive effects. The mechanism of action is due to the main endothelial relaxing factor - the release of nitric oxide in the vascular endothelium, as a result of which intracellular guanylate cyclase is activated and the level of cyclic guanosine monophosphate (vasodilation mediator) increases. Cyclic guanosine monophosphate stimulates cGMP-dependent protein kinase, which disrupts the phosphorylation of individual proteins of smooth muscle cells (including the myosin light chain). This effect leads to a decrease in contractility and relaxation of vascular smooth muscles.

Isosorbide dinitrate acts on peripheral veins and arteries. Due to the relaxation of the veins, the venous return to the heart (preload) is reduced, which leads to a decrease in the filling pressure of the left ventricle. To a lesser extent, dilatation of arterial vessels occurs, which leads to a decrease in blood pressure and a decrease in the total peripheral vascular resistance (afterload).

Due to a decrease in pre- and afterload, myocardial oxygen consumption decreases.

The drug redistributes coronary blood flow in favor of subendocardial zones, especially in atherosclerosis of the coronary arteries (mainly large ones). Due to vasodilation of the collateral arteries, myocardial blood supply may improve. The drug reduces myocardial oxygen consumption, improves oxygen transport to ischemic areas, and reduces the zone of myocardial damage.

In chronic heart failure, isosorbide dinitrate improves hemodynamics both during exercise and at rest.

After taking Cardiket, there is a decrease in blood flow to the right atrium, which helps to reduce pressure in the pulmonary circulation, as well as regression of symptoms observed with pulmonary edema.

Isosorbide dinitrate promotes vasodilation of the brain and dura mater, resulting in headaches.

The use of this substance leads to relaxation of the smooth muscles of the bronchi, urinary and biliary tract, and the gastrointestinal tract.

As with other nitrates, cross-tolerance develops to isosorbide dinitrate. Sensitivity to Kardiket is quickly restored after cancellation and a break in treatment. To prevent tolerance, a daily, preferably overnight, “nitrate-free interval” of 8–12 hours should be followed. For most patients, this treatment is more effective than continuous therapy.

Pharmacokinetics

When taken orally, isosorbide dinitrate is rapidly absorbed. In comparison with conventional tablets, the relative bioavailability of the drug with prolonged action when taken orally is over 80%. The effect appears after 0.25–0.5 h, and the time to reach the maximum plasma concentration is from 15 minutes to 1–2 h. As a result of metabolism in the liver, two main active metabolites are formed: isosorbide-2-mononitrate with a half-life of 1.5 to 2 hours and isosorbide-5-mononitrate with a half-life of 4 to 6 hours. It is excreted by the kidneys (mainly as metabolites).

Indications for use

Chronic heart failure (simultaneously with cardiac glycosides, diuretics and / or angiotensin-converting enzyme inhibitors);
Long-term therapy of coronary heart disease: prevention of angina attacks;
Secondary prevention of myocardial infarction and therapy for persistent angina pectoris (simultaneously with other drugs).

Contraindications

Hemorrhagic (apoplexy) stroke;
Acute vascular insufficiency (vascular collapse, shock);
Severe stenosis (mitral and/or aortic);
Acute myocardial infarction, accompanied by severe arterial hypotension;
Severe arterial hypotension (with systolic pressure less than 90 mm Hg);
Angle-closure glaucoma, accompanied by high intraocular pressure;
Traumatic brain injury;
hypovolemia;
Simultaneous use with phosphodiesterase type 5 inhibitors (such as sildenafil, tadalafil or vardenafil), since these drugs potentiate the hypotensive effect of nitrates;
Age up to 18 years (the efficacy and safety of taking Kardiket for this age group of patients have not been established);
Hypersensitivity to the components of the drug.

Relative contraindications to therapy are:

Severe anemia;
Toxic pulmonary edema;
Hypertrophic obstructive cardiomyopathy (due to the possible risk of increased angina attacks);
cardiac tamponade;
Hemorrhage in the brain;
Constrictive pericarditis.

According to the instructions, Kardiket should be taken with caution and under close medical supervision: elderly patients, as well as patients with a tendency to circulatory disorders due to low blood pressure (with orthostatic circulatory disorders), with severe liver failure (due to the risk of developing methemoglobinemia), severe renal failure, hyperthyroidism, increased motility of the gastrointestinal tract, malabsorption syndrome, diseases that are accompanied by increased intracranial pressure.

Breastfeeding and pregnant women should only take Kardiket if the intended health benefit to the mother outweighs the potential risk to the baby and/or fetus.

Instructions for use Kardiket: method and dosage

Kardiket is taken orally with a small amount of liquid. Tablets should not be chewed. The drug can be taken regardless of the meal time.

The dosage regimen is determined by the indications and dosage form:

20 mg: 2 times a day, 1 tablet. If necessary, it is possible to increase the frequency of taking the drug up to 3 times a day;
40 mg: 1 tablet once a day or 1/2 tablet 2 times a day. If necessary, Kardiket can be taken 2 times a day, 1 tablet (the second tablet is recommended to be taken within 8 hours after taking the first);
60 mg: 1 tablet once a day. If necessary, it is possible to increase the frequency of taking the drug up to 2 times a day (the second tablet is recommended to be taken within 8 hours after taking the first).

Treatment should begin with minimal doses. Increase the dose to the most effective should be gradually. The duration of therapy is determined by the doctor individually. Kardiket is intended for long-term therapy, and Kardiket should not be abruptly interrupted without the doctor's instructions.

Side effects

While taking Kardiket, the following disorders may occur:

Cardiovascular system: at the beginning of the treatment course, a "nitrate" headache may occur, which usually resolves on its own within a few days. Sometimes at the first reception of Kardiket or when the dose is increased, there is a pronounced decrease in blood pressure, especially when the patient gets out of bed, which may be accompanied by lethargy, tachycardia, as well as a feeling of weakness and dizziness. In rare cases, with a pronounced decrease in blood pressure, signs of angina pectoris may increase (paradoxical increase in angina attacks). In extremely rare cases, collaptoid states are observed, accompanied by syncope (sudden loss of consciousness) and bradycardia;
Central nervous system: stiffness, blurred vision, drowsiness, decreased ability to fast motor and mental reactions (especially at the beginning of therapy); rarely - cerebral ischemia;
Digestive system: rarely - belching, nausea, dry mouth, vomiting, abdominal pain;
Allergic reactions: skin rash;
Others: exfoliative dermatitis, development of tolerance (including cross-tolerance to other nitrates), flushing of the skin of the face.

Overdose

Symptoms: pronounced decrease in blood pressure with vasodilation, headache, reflex tachycardia. Perhaps the appearance of pallor, "threaded" pulse, increased sweating, weakness, dizziness (including postural), nausea, vomiting, skin flushing, diarrhea. When taken in high doses (over 20 mg per 1 kg of body weight), there is a risk of cyanosis, methemoglobinemia, tachypnea, dyspnea (due to the formation of nitrite ions due to the metabolism of isosorbide mononitrate), anxiety, loss of consciousness, cardiac arrest. Probably, these symptoms may be the result of an overdose of isosorbide dinitrate. In the case of taking very high doses of Kardiket, an increase in intracranial pressure with cerebral symptoms is possible. Chronic overdose may cause an increase in methemoglobin.

Therapy: in the presence of symptoms of an overdose, oral administration of Kardiket should be discontinued, gastric lavage, activated charcoal should be prescribed.

In the case of a state of shock and / or a pronounced decrease in blood pressure, it is required to place the patient in a horizontal position, raise the legs and ensure that measures are taken to restore the volume of circulating blood (BCV). In exceptional cases, infusions of dopamine and / or norepinephrine (norepinephrine) are allowed to improve blood circulation. The introduction of adrenaline (epinephrine) and analogues is contraindicated.

With methemoglobinemia are assigned:

ascorbic acid - orally (1 g) or intravenously in the form of sodium salt [from 0.1 to 0.15 ml / kg of 1% solution (up to 50 ml)];
hemodialysis, oxygen therapy, exchange transfusion.

special instructions

For the relief of angina attacks, Kardiket should not be used.

During therapy, it is necessary to control blood pressure and heart rate.

With long-term continuous use of Kardiket, tolerance may develop, as well as the development of cross-tolerance to other drugs of the nitrate group. To prevent a decrease in its effectiveness, continuous therapy with high doses should be avoided.

In acute heart failure or acute myocardial infarction, Kardiket should be taken only with careful clinical observation of the patient.

In patients with primary pulmonary diseases during therapy, temporary hypoxemia may develop. In coronary heart disease, this can lead to the development of transient myocardial ischemia.

To avoid an increase in angina attacks, it is recommended to avoid abrupt discontinuation of therapy.

In the event of an attack of angina pectoris, it is necessary to additionally use fast-acting nitrates to stop it.

To prevent an undesirable decrease in blood pressure, the dose of Kardiket should be selected individually.

During therapy, it is possible to lower blood pressure and develop dizziness with a sharp transition from the "lying" or "sitting" position to a vertical position, against the background of the use of ethanol, during exercise and in hot weather, as well as increased angina pectoris with a sharp decrease in blood pressure, ischemia up to myocardial infarction and sudden death (paradoxical "nitrate reactions").

The intensity of the headache can be reduced by lowering the dose of Kardiket and / or concomitantly taking menthol-containing drugs (for example, validol).

With frequent use of Kardiket without interruption, addiction may develop, which requires an increase in dose. To prevent the development of tolerance, it is recommended to observe the "nitrate-free interval" daily for 8-12 hours, preferably at night. In most patients, this method of taking the drug is more effective than continuous therapy.

If dry mouth or blurred vision persist or are severe while taking Kardiket, therapy should be discontinued.

During treatment, alcohol should be excluded.

When using Kardiket from driving vehicles and performing potentially dangerous types of work that require a high concentration of attention and quick psychomotor reactions, you should refrain.

Use during pregnancy and lactation

In the treatment of pregnant and lactating the drug should be used with caution.

Since clinical studies of the use of Kardiket during pregnancy have not been conducted, the use of the drug during gestation is allowed only in cases where the potential risk to the fetus is less than the expected benefit to the mother. At the same time, careful monitoring of the condition of the pregnant woman and the fetus should be ensured.

There is information on the excretion of nitrates into breast milk, but the exact concentration of isosorbide dinitrate and its metabolites in breast milk has not been determined. There is evidence of the possibility of developing methemoglobinemia in infants, so Kardiket should be taken with caution during breastfeeding.

Application in childhood

It is forbidden to use Kardiket for the treatment of patients under the age of 18 years.

For impaired renal function

In severe renal failure, the drug should be used with caution.

For impaired liver function

In severe hepatic insufficiency, Kardiket should be used with caution.

Use in the elderly

In the treatment of elderly patients, dose adjustment of Kardiket is not required.

drug interaction

With the simultaneous use of Kardiket with certain drugs, undesirable effects may occur:

Beta-blockers, other vasodilators (vasodilators), antihypertensive drugs, slow calcium channel blockers, phosphodiesterase 5 inhibitors used in the treatment of erectile dysfunction, tricyclic antidepressants and antipsychotics, quinidine, novocainamide, and ethanol: increased hypotensive effect of isosorbide dinitrate;
Dihydroergotamine: an increase in its concentration in the blood and, thus, an increase in the hypotensive effect;
Sympathomimetic drugs, alpha-blockers: a decrease in the antianginal effect of isosorbide dinitrate;
M-anticholinergics (atropine): an increase in the likelihood of an increase in intraocular pressure;
Astringents, adsorbents and enveloping agents: reduced absorption of isosorbide dinitrate in the gastrointestinal tract.

In the treatment of coronary heart disease, it is rational to use Kardiket simultaneously with amiodarone and other drugs, such as slow calcium channel blockers (nifedipine, verapamil), propranolol.

The combined use of Kardiket and acetylsalicylic acid contributes to the improvement of coronary circulation.

Analogues

Kardiket's analogues are: Nitrosorbide, Nitrosorbide-Rusfar, Isoket, Isodinit, Iso-mic, Dikor Long.

Terms and conditions of storage

Keep out of the reach of children at temperatures up to 25 °C.

Shelf life - 5 years.