Cordinic, tablets 10 mg 60 pcs

Pharmacodynamics

Nicorandil has antianginal action, which is based on a combination of nitrate-like properties and the ability to open potassium channels. By opening potassium channels, nicorandil causes hyperpolarization of the cell membrane, and the nitrate-like
effect is to increase the intracellular content of cyclic guanylmonophosphate.

These pharmacological effects lead to relaxation of smooth muscle cells and cellular protection of the myocardium during ischemia. The hemodynamic effects are expressed as a balanced decrease in pre- and post-load (in contrast to nitrates and slow calcium channel blockers (SCBs), which act primarily on pre- or post-load, respectively).

In view of selective vasodilation of coronary arteries, the resulting load on the ischemic myocardium is minimal. Nicorandil does not affect myocardial contractility and practically does not change heart rate (HR).

Limits systemic blood pressure (BP) by less than 10%, has a beneficial positive effect on cerebral circulation in patients with ischemic stroke. Nicorandil does not affect indexes of lipid metabolism and glucose metabolism. Nicorandil stops an attack of angina pectoris with reduction of pain syndrome within 4-7 minutes after the intake under the tongue and its complete cessation within 12-17 minutes.

Pharmacokinetics

Nicorandil is rapidly and completely absorbed from the gastrointestinal tract, reaching maximum plasma concentration in 0.5-1 hours. It is not subject to intensive metabolism in the liver and has a half-life of 50 minutes. It is mainly excreted by the kidneys.
Nicorandil slightly binds with blood plasma proteins.

The free fraction in blood plasma is about 75%.
Pharmacokinetic parameters have little dependence on the patient’s age, presence of concomitant liver or renal pathology, prescription of concomitant therapy.

Indications

Angina

Capitation of angina attacks; prevention of stable angina attacks (in combination with other antianginal agents) and in monotherapy with intolerance to β-adrenoblockers and PBMCs.

Active ingredient

Nicorandil

Composition

1 tablet contains:

the active ingredient:

nicorandil 10 mg,

excipients:

potato starch, 5 mg;

MCC 102, 84 mg;

calcium stearate, 1 mg

How to take, the dosage

Ingestion. Drinking with water, take regardless of meals.

The dose of the drug is chosen individually depending on the severity and duration of the disease.

Cure an attack of angina.

The drug should be taken as soon as there is the first sign of an angina attack: A dose of 20 mg is placed under the tongue and held until completely dissolved, without swallowing.

Prevention of stable angina attacks (long-term therapy of stable angina).

The drug is usually prescribed in a dose of 10 to 20 mg 3 times daily.

The maximum daily dose is 80 mg.

The initial dose may be reduced if headache occurs.

Interaction

In concomitant use with antidepressants, phosphodiesterase-5 inhibitors (sildenafil, vardenafil, tadalafil), vasodilators, hypotensive drugs, tricyclic antidepressants, diuretics, beta-adrenoblockers, monoamine oxidase inhibitors (MAO) and ethanol – strengthening of antianginal action.

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Special Instructions

The drug should be withdrawn gradually.

At the time of therapy with the drug Cordinic, blood pressure, ECG values, the content of potassium ions and sodium ions in the blood should be monitored; the existing heart rhythm disturbances may worsen.

We should use caution when driving vehicles and engaging in other potentially hazardous activities requiring increased concentration and quick psychomotor reactions.

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Contraindications

• high sensitivity to the drug;
• acute myocardial infarction (and within 3 months after);
• cardiogenic shock, collapse;
• stable angina;

chronic heart failure III or IV functional class according to the NYHA classification;

• excited bradycardia (BCCF).unstable angina;
• chronic heart failure III or functional class IV by NYHA classification;
• expressed bradycardia (HR less than 50 beats/min;
• chronic heart failure.
• Atrioventricular block of degree II and III;
• Left ventricular failure with low filling pressure;
• arterial hypotension (systolic BP less than 100 mmHg.
• current use of phosphodiesterase-5 inhibitors (sildenafil, vardenafil, tadalafil);
• pregnancy and lactation;
• under 18 years of age (effectiveness and safety not established).

With caution: cardiac rhythm disorders, atrioventricular block of degree I, Prinzmetal angina, arterial hypotension, renal and/or hepatic function disorders, hypovolemia, pulmonary edema, closed-angle glaucoma, hyperkalemia, anemia.

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Side effects

Cardiovascular system: palpitations, tachycardia, decreased BP, “flushes” of blood to the face, peripheral edema.

Central nervous system: weakness, headache (does not require cancellation of the drug, can be mitigated by reducing the initial dose of the drug), dizziness, tinnitus, insomnia.

Gastrointestinal tract: nausea, vomiting, discomfort in the stomach, feeling of overflow in the stomach, stomatitis (very rare); in individual cases there may be increased activity of “liver” transaminases (alanine aminotransferase and aspartate aminotransferase), alkaline phosphotase.

High sensitivity reactions: allergic reactions possible.

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Overdose

Symptoms: pronounced decrease in BP, tachycardia.

Treatment: Gastric lavage, administration of activated charcoal (especially in the first 2 hours after overdose), maintenance of cardiovascular function, elevation of extremities, symptomatic and supportive therapy, intravenous calcium gluconate and dopamine.

Possible use of hemodialysis.

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