Coraxan tabs 5mg #56

User manual for Coraxan tablets

Reed more and buy Coraxan online

Composition

The amount of auxiliary substances practically does not differ in different forms of drug release, that is, the dosage of excipients corresponds to tablets with both 5 and 7.5 mg of ivabradine:
    lactose monohydrate - 62 mg;
    corn starch - 20 mg;
    maltodextrin - 10 mg;
    magnesium stearate - 0.5 mg;
    anhydrous, colloidal silicon dioxide - 0.2 mg.
The shell of each Coraxan tablet consists of:
    hypromellose - 1.5 mg;
    titanium dioxide (E 171) - 0.26 mg;
    macrogol 6000 - 0.09 mg;
    magnesium stearate - 0.087 mg;
    a yellow dye of iron oxide (E 172) 0.015 mg;
    red dye of iron oxide (E 172) - 0.00485 mg.

Form of issue

You can find the drug in two variations:
    Oval, biconvex tablets covered with orange-pink film with marks on two sides (on one "-", and on the other digit "5"). The dosage of the active substance is 5 mg.
    Triangular tablets with orange-pink film and engraving on different sides: one "-" to the other "7.5", which means 7.5 mg of the main active ingredient.

Pharmacological action

The medicine Coraxan is an antianginal remedy, that is, a pharmacological drug that prevents the development of angina pectoris (the disease in Latin sounds like "angina pectoralis", hence the name of the pharmaceutical group).
The mechanism of action directly depends on the biologically active component - ivabradine. The substance is a specific selective blocker of the If-channels of the sinoatrial node (initiating the excitation of the unit of the conduction system of the heart). Thus, ivabradine contributes to the stabilization of spontaneous depolarization during diastole and normalizes the heart rate.
Due to clinical studies, the main pharmacological advantage of Coraxan was noted in comparison with other antianginal drugs. Reducing the heart rate is a dose-dependent factor in conservative therapy with this drug. That is, with a constant increase in the daily dose to 40 mg / day, the therapeutic efficacy takes the form of a plateau, which greatly reduces the possibility of reducing the rhythm to 40 beats per minute (pathological bradycardia).
A positive feature of the drug is the absence of an effect on myocardial contractility (negative inotropic effect is not potentiated). Also, Coraxan does not affect:
    processes of ventricular repolarization;
    intracardiac conductivity of the myocardium;
    atrioventricular pause of excitation;
    adjusted QT intervals on the electrocardiogram.
In the human body, there are channels that are similar in chemical structure to If. These formations are in the conjunctiva of the eye and are called Ih-channels. They are involved in changing the visual perception of the retina in response to bright light stimuli. Being in the systemic blood stream ivabradine can get to the eyes and affect the data of education. In this case, the phenomenon of photopsy (transient distortions of light perception by the human eye in a limited field of view) will be observed in response to trigger factors, for example, with a rapid change in the brightness of the ambient light.

Pharmacodynamics and pharmacokinetics

The drug is recommended to be taken simultaneously with the use of food, as food increases the concentration in the plasma of the systemic blood flow from 20 to 30 percent, which manifests itself as a more complete action of the drug. That is, due to a longer absorption (food increases the time interval by 1 hour), the effectiveness of the drug increases significantly.
Getting into the systemic bloodstream, 70 percent of ivabradine binds to plasma proteins, which are delivered to the sinoarterial node of the conduction system of the heart. The drug is metabolized primarily in the liver and intestines by the action of cytochromes.
The drug substance is evacuated from the body by the kidneys. The half-life of the drug is 2 hours, but the effective half-life (the time interval when the action of the biologically active component is half the original) is 11 hours. Ivabradine's renal clearance is 70 ml / min, while the total clearance is maintained at 400 ml / min.
The linearity of the pharmacokinetic activity of Coraxan is observed in the concentration range of the active substance from 0.5 to 24 mg.

Indications for use

    Stable angina pectoris (with intolerance or absolute contraindications to the pharmacological preparations of the group of beta adrenoblockers);
    chronic heart failure (if the rhythm is sinusoidal, and the heart rate is kept at 70 beats per minute);
    symptomatic therapy of angina (sanative measures to reduce the needs of the heart muscle in oxygen);
    ischemic heart disease (in complex therapy and prevention courses for normalizing rhythm and frequency of myocardial contractions).

Contraindications

It is not recommended to use Coraxan in the scheme of conservative treatment of anginal attacks, if available:
    individual hypersensitivity or intolerance to the active ingredients of the drug;
    bradycardia below 60 beats per minute;
    acute myocardial infarction;
    cardiogenic shock;
    renal or hepatic insufficiency;
    arterial hypotension (systolic blood pressure below 90 mm Hg, and diastolic blood pressure below 50 mm Hg);
    complete blockade of the sinoatrial node;
    an artificial pacemaker of a non-adaptive nature (with constant impulse);
    Children under 18 years of age (clinicians do not have information about the use of the drug in this time period of individual development of a person).
There are also a number of situations when taking Coraxan should be in the therapeutic units under the strict supervision of medical personnel, in order to avoid the development of adverse effects and unexpected reactions:
    congenital lengthening syndrome QT;
    a recent ischemic stroke of the brain;
    pigmentary degeneration of the retina;
    atrioventricular block of the second degree;
    simultaneous use of drugs that block slow potassium pumps that extend the QT interval, inhibit or inhibit the action of cytochromes in the gastrointestinal tract.

Side effects

Clinical studies confirm that unwanted reactions of the human body to a pharmacological preparation is a dose-dependent phenomenon. Thus, at elevated concentrations of the active drug in the central and peripheral blood stream, the following can be observed:
    photopsy - a change in the light perception in a limited field of view, which is triggered by a rapid change in the brightness of illumination;
    subjective palpitation;
    atrioventricular blockade of І-ІІІ degrees;
    syndrome of acquired weakness of the sinus node;
    atrial fibrillation;
    severe headache, especially in the first month of conservative drug therapy;
    allergic reactions (skin itching, erythema, urticaria, angioedema);
    increased fatigue, malaise, persistent drowsiness.

Instructions for use of Coraxan (Method and dosage)

The medicine should be used at the time of food intake, so the efficiency factor of the active ingredient increases several times. The daily dose is divided into two times: in the morning hours at breakfast and evening - at dinner. The average amount of the drug is 2 tablets (with the concentration of ivabradine - 5 mg) per day, however, depending on the therapeutic effect, the dosage can be increased. In this case, after 3-4 weeks of a conservative course of treatment, the regimen changes to 2 tablets with the concentration of the biologically active component - 7.5 mg.
Instructions for the use of Coraxan also takes into account side effects and contraindications to the taking of the drug substance. First of all, if after a development of bradycardia signs (constant fatigue, dizziness, lowering of arterial pressure to pathological figures) a lower dosage does not promote the development of therapeutic effect, the course of treatment with this pharmaceutical preparation is immediately stopped.
It should be extremely cautious in the rehabilitation of elderly patients. Treatment of the age category over 75 years is carried out in a special way - the starting dosage is half the tablet (in terms of the mass balance - about 2.5 mg Iwabradine) and increases the daily amount of the drug to 5 mg only with signs of stable and benign conservative therapy.

Overdose

In the case of an overdose of a pharmacological drug, a stable, non-stopable bradycardia is not observed. To eliminate the state of increased drug concentration in the systemic circulation, effector antagonists of Coraxan-beta-adrenomimetics should be used. First of all, selective drugs that interact only with the heart muscle are used, however, in non-selective states, non-selective substances can also be used. In case of acute necessity, an overdose can be treated surgically - insert a temporary artificial pacemaker rhythm driver.

Interaction

During the conservative treatment with Coraxan, the inclusion of medications that extend the QT segment on the electrocardiogram should be avoided, since Ivabradine, the main active ingredient of the tablets, can cause an additional segment increase and a decrease in the heart rate. At absolute indices of the use of such drugs as Quinidine, Amiodarone, Sotalol, Erythromycin, Pimozide, it is worthwhile to conduct round-the-clock monitoring of electrocardiogram indicators in special therapeutic departments.
With caution, non-potassium-sparing diuretics can be used (the group consists of thiazides and loop diuretics), since hypokalemia (the result of combined action of Coraxan and pharmacological drugs increasing diuresis) can lead to severe arrhythmias that, in combination with bradycardia or the long QT syndrome, directly threatens undesirable side effects of patient treatment and even death. Therefore, to force urine or urinary output is recommended under the careful supervision of qualified medical personnel.
The simultaneous use of Coraxan and the following list of drugs is unequivocally contraindicated:
    pharmacological drugs that affect hepatic cytochrome;
    antifungal agents from the azole group (eg, ketoconazole or itraconazole);
    antibiotics related to macrolides (clarithromycin, erythromycin, telithromycin) or rifampicin groups;
    protease inhibitors of the human immunodeficiency virus;
    strong antidepressants (especially nefazodone);
    sedative normotimics (St. John's wort pitted);
    some drugs for anesthesia (in particular barbiturates).
An interesting feature of the main active substance, ivabradine, is an increase in the concentration in the systemic blood stream, depending on the drunk grapefruit juice. This natural drink can increase the relative amount of the active ingredient twice, which unambiguously requires a rational correction of the diet during the therapeutic course of taking the drug.

Terms of sale

To buy Coraxan you don't need a prescription form.

Storage conditions

To save medicine Coraxan should be in a warm, dry place, inaccessible to young children.
Shelf life - 3 years.

special instructions

Coraxan is used to stabilize sinus rhythm and prevent stenocardia, but the activity of the pharmacological drug tends to zero if it is used against tachycardia, atrial fibrillation, or ventricular flutter. In these situations ivabradine, as the main biologically active component of the drug, will not have a therapeutic effect, even on the contrary, the substance can worsen the patient's condition in heart failure of this genesis.
The inclusion of Coraxan in the course of conservative treatment is not recommended if there is a need for complex pharmacological therapy, since the safety profile can be corrected (the risk of side effects or unwanted reactions increases) due to the indirect interaction of the components. The drug should not be used in conjunction with calcium channel blockers or dihydropyridine derivatives, which reduce the heart rate. In particular, verapamil, diltiazem or amlodipine change the profile of the safety of the treatment performed to a large extent, therefore one should avoid their simultaneous administration with Coraxan.

In pregnancy and lactation

At present, there is a significant lack of information on the use of the drug during pregnancy and / or lactation, however, embryotoxic and teratogenic effects have been found in pre-clinical stages of the study. Because now the drug is banned for admission at such a critical period of life of a woman.

Reviews about Coraxan

Reviews about Coraxan are mostly positive, because the drug normalizes the work of the cardiac muscle of unclear etiology, that is, when the cause remains unknown to the doctor. The medicine is also called a "lifebuoy", as Coraxan helps when beta-blockers did not have the proper therapeutic effect and did not lead the rhythm of myocardial contractions to the sinus one.
Among the negative impressions after conservative sanation, the most frequent manifestation of side effects from the visual apparatus. Many complain about a strong photopsy, which significantly worsens the quality of life of patients.
The doctors' comments mostly favor the use of Coraxan, because the drug remains the only adequate drug of choice in numerous situations where other pharmacological products are unable to help the patient. Unwanted reactions on the part of the body are recommended to be treated with medication, as often when the drug is withdrawn, the symptoms of the underlying disease also return.