Isoket: instructions for use, contraindications, price, reviews of doctors and patients, analogues

This medication is often used in the treatment of SSS ailments as an antianginal agent. The drug belongs to the group of organic nitrates. This article will tell readers in more detail about the instructions for the use of tablets, spray, aerosol and solution in Isoket ampoules, the prices for it in pharmacies, reviews and analogues of the drug.

Features of the drug

It is an antianginal agent from the group of organic nitrates. In international medical practice, it is known as Isosorbide dinitrate.

Composition of

Isosorbide dinitrate( aka isosorbide dinitrate) is the active substance of the preparation. Auxiliary components can be:

• Spray, aerosol: sodium chloride and hydroxide, macrogol, hydrochloric acid( solution), ethyl alcohol.
• Solution for infusion: sodium chloride and sodium hydroxide, water for injection, solution of hydrochloric acid.

Dosage form

This vasodilator is supplied in several dosage forms:

• Spray sublingual is a clear solution, colorless, has a smell of alcohol. One dose( 1 spray) contains 1.25 milligrams of isosorbide dinitrate. As the packaging used a bottle of dark glass with a capacity of 15 ml, equipped with a dosing device.
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• Aerosol -1 injection of the drug in this form contains 1.25 mg of the active ingredient. The balloon is designed for 200 strokes.
• Infusion solution( 0.1%) concentrate contains 0.1% active ingredient, is available in ampoules, 10 ml each, placed in a cardboard box of 10 pieces each.
• Tablets - available in a mass of 2.5 mg for 10 pieces in a blister, in cardboard packages.

Keep the product out of the reach of children at temperatures not exceeding 25 ° C.Prices vary significantly, so, on average, the spray will have to give 389 rubles, and for ampoules - almost a thousand.

As already mentioned earlier, Isoket is an antianginal agent, and its active ingredient, Isosorbide dinitrate, has a vasodilating effect.

Pharmacodynamics

• This peripheral vasodilator mainly affects venous vessels. In their endothelium, it provokes, under the action of which increases cGMP.
• The need for cardiac muscle in oxygen is significantly reduced by reducing preload.
• The coronary dilatation effect of the drug, as well as its help in redistribution of coronary blood flow in those areas where blood circulation is reduced, is proved.
• Headaches may occur, as the drug dilates the vessels of the brain, as well as the dura mater.
• The flow of blood to the atrium( right) also decreases.
• Due to the action of the medication in a small circle of blood circulation, pressure decreases, regression of signs of an illness occurs with pulmonary edema.
• Also, the drug is able to increase tolerance to the physician in patients with ischemic heart disease, incl.thoracic toad.
• Doctors confirm and decrease diastolic pressure in the ventricles when taking the medication.
• There may be a slight decrease in blood pressure in the patient.
• After spraying the dose of aerosol, the spray effect should appear after 30 seconds, its effect lasts from 15 to 120 minutes.
• It is noticed that with the introduction of the drug, the load on the "motor" decreases, and the quality of life in people with heart failure also decreases.

Pharmacokinetics

• Absorption and distribution. shows a high level of absorption, bioavailability is 60 percent, and the connection with plasma proteins is 30 percent.
• Metabolism, excretion. It occurs in the liver to two active metabolites: isosorbide 5- and 2-mononitrate. In the form of them, it is excreted through the kidneys almost completely.

Indications

• Treatment:
  • Aerosol:
    • angina attacks( all kinds and forms);
    • myocardial infarction( acute form);
    • states after myocardial infarction;
  • Solution:
    • myocardial infarction( acute form) with left ventricular failure;
    • OCH( left ventricular);
    • unstable angina;
    • heart failure of all etiologies;
    • spasm of the coronary arteries( in case of cardiac catheterization).
• Prophylaxis:
  • angina and
  • coronary artery spasm( in the case of catheterization).

• During pregnancy and lactation, Isosorbide dinitrate is consumed with extreme caution, only by the doctor's prescription, if the expected benefit from such an intake is much greater than the potential danger to the health of the mother and future baby.
• Due to the lack of research on this topic, a minor is a contraindication to the use of this substance.

Instructions for use Isodeth

• Sublingually:
  • 1-3 spray aerosol spray, into the oral cavity with the order of 30 seconds with a delay in breathing - in order to stop the attack of angina, and also before the load( physical or emotional) that can lead to an attack.
  • 1-3 Sprays into the oral cavity with control of heart rate and arterial pressure in case of acute myocardial infarction or OCH.After 5 minutes under the control of the doctor, the dose can be repeated if the necessary effect was not achieved.
  • 1-2 Sputtering for the prevention of coronary spasm during catheterization.
  • 2.5-5 mg tablets, if necessary, then take every 2-3 hours for relief of an attack of angina pectoris( preferably chewed).
• Inside:
  • 10-20 milligrams 4-5 times a day for 1 hour before or 2 hours after meals, no chewing is required, but it is necessary to write down a glass of water.according to the doctor's prescription, the dose can be increased to 60-120 mg / day.
  • 10-20 milligrams 3-4 times a day - as part of the complex therapy of CHF.
• Parenterally:
  • 0.1 mg / ml Isoket intravenously, dropwise, at a rate of 3-4 cap / min, or 0.2 mg / ml at a rate of 1-2 cap / min. The speed can be increased every 5 minutes by 2-3 if the patient's condition allows. The maximum rate is 33 cap / min( conc. 0.1 mg / ml) or 17 cap / min( conc. 0.1 mg / ml 0.2 mg / ml).
• Spray for skin application:
  • 1-2 doses at a distance of 20 cm, followed by rubbing with fingers and coating the skin with clothing after drying of the treated area.

Contraindications

Solution for injection

So, Izoket has the following contraindications:

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The opinion of doctors. .. & gt; & gt;

• shock in acute vascular insufficiency;
• hypersensitivity to nitrate compounds;
• vascular collapse;
• cardiogenic shock;
• constrictive pericarditis;
• severe arterial hypotension;
• toxic pulmonary edema;
• cardiac tamponade;
• hypertrophic cardiomyopathy( obstructive type);
• certain pulmonary diseases;
• states in which there is an increase in intracranial pressure
• hemorrhagic stroke.

Aerosol

• Vascular collapse;
• hypersensitivity to nitrate compounds and drug components;
• glaucoma( closed-angle form);
• cardiogenic shock;
• severe arterial hypotension;
• deficiency of glucose-6-phosphate dehydrogenase;
• hyperthyroidism.

Side effects of

Depending on the frequency of development, such "unpleasant" effects from the use of the drug can be observed:

• Very often:
  • nitrate headaches.
• Often:
  • dizziness;
  • excessive drowsiness;
  • tachycardia;
  • orthostatic hypotension;
  • asthenia;
• Rarely:
  • exacerbation of angina pectoris;
  • heart failure;
  • nausea and vomiting;
  • heartburn;
  • redness of facial skin;
  • allergic reactions;
  • sills;
  • hypoxemia.
• Very rarely:
  • Quincke edema;
  • Stevens-Johnson syndrome.

Overdose of

Overdosage of the approved dosage of Isoket is indicated by such symptoms:

• convulsions,
• headache,
• dizziness,
• hyperthermia,
• nausea with vomiting,
• syncope,
• collapse,
• vision problems,
• diarrhea,
• bradycardia,
• coma,
• increased intracranial pressure and some others.

For methemoglobinemia, 1% methylene blue must be injected intravenously( dosage: 1-2 mg / kg).

Specific guidance and interaction with other drugs

• At the beginning of treatment, patients should abandon driving and interact with other mechanisms.
• It is advisable to refrain from drinking alcohol to prevent unwanted reactions;
• It is important to monitor the level of blood pressure and heart rate;
• Also usually doctors insist on ECG monitoring;
• Do not abruptly stop taking the drug, reducing the daily dose is carried out gradually.
• Simultaneous reception of Isoket with other medications can cause such reactions:
  • strengthening of hypotensive action - with vasodilators, antihypertensive agents, as well as beta-blockers and blockers of "slow" calcium channels;
  • enhanced antihypertensive action - with novocainamide and quinidine, with alcohol intake, Viagra, neuroleptics and tricyclic antidepressants;
  • increased antianginal effect - with nifedipine, amiodarone, verapamil, propranolol;
  • decrease in the expression of the antianginal effect - with alpha-adrenoblockers and sympathomimetics;
  • increased intracranial pressure - with m-holinoblokatorami.

Reviews

And now briefly about the feedback about the reception of Izoke from patients. They, in most cases, note the positive dynamics and quality of drug-induced stenocardia seizures. Also good for reducing pressure.

Adverse reactions are most often manifested as severe headaches and dizziness.

Analogues

By the presence of isosorbide dinitrate in their composition, it is possible to isolate such preparations:

• Dicor Long in the form of tablets;
• Nitrosorbide in the form of tablets;
• Isodinite in the form of tablets;
• Isodinitrate in the form of a solution for infusion;
• Iso-Meek in the form of tablets, incl.for sublingual administration, spray and concentrate d / infusion;
• Isacardin in the form of a spray.