Bravadin: indications for use, instructions, reviews about the drug, analogues, prices for it in pharmacies

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Bravadin in modern medicine is used as an antianginal remedy. Its action consists in a specific selective inhibition of If channels of the sinus node. They are known to be responsible for the regulation of heart rate and diastolic depolarization in such a node. This material will be devoted to the study of indications for use and instructions for Bravadin, its analogs, reviews about it and approximate prices for drugs in pharmacies in the country.

Features of the drug

Bravadin( Bravadin, known in the INN as Ivabradine( synonymous with active ingredient) has found its use in the therapy of stable angina.) ATD Code: C01EB17.

Its composition

Iwabradine is the main active ingredient of this medication. As an auxiliary, supplementing substances in the tablet formulation may also include lactose and cornstarch. Additionally applied:

• hypromellose;
• macrogol;
• silicon dioxide;
• titanium dioxide
• glycerium,
• magnesium stearate and some others

To impart a color to the pill, iron dyes are used yellow and red oxide

Form

Bravadin is available in the form of tablets of 5 and 7.5 mg. On the break of the pill observed a roughened mass of white with an orangeish sheath

Appearance of tablets:

• For 5 mg( contains 5.864 mg of active substance): oval form;on one of the sides of risk, the tablets are covered with a film pale orange shell.
• At 7.5 mg( 8.796 mg of active substance): rounded;there is a chamfer, the shell is also pale orange.

Both kinds of pills are placed in cellular packaging in cardboard boxes of 14-15 pieces. Keep them in places inaccessible to the child, at room temperature not more than 25 C. The price in the drugstores of the country on the tablets Bravadin ranges from 385 rubles for 1 pack of medicine.

Pharmacological action

Tablets have antiarrhythmic and antianginal effects on the patient.

Pharmacodynamics

• This medication is due to selective suppression of If sinus channels.node, is able to slow down the rhythm of the "motor" without influencing the time spent on carrying out the impulses along the corresponding conducting paths and on the contractile ability of the heart muscle.
• Sometimes it can affect visual perception by interacting with the Ih channels of the retina.
• Carries out a medication and a dose-dependent decrease in the frequency of the SS, thereby reducing the likelihood of developing severe bradycardia.

Pharmacokinetics

• Absorption and distribution. Iwabradine is completely( practically) and soon absorbed into the stomach. The tract after taking on an empty stomach. An hour later, Cmax is reached in the blood plasma. Absolute bioavailability is approximately 40%, which became possible due to the effect of "primary passage" through the liver. It should be borne in mind that food increases by 1 hour the amount of time needed to absorb the substance, and the plasma concentration( up to 30%) also rises. The active substance binds to plasma proteins by 70%.
• Metabolism, excretion. Occurs in the liver and intestines, the main metabolite is the N-desmethylated derivative. There is a withdrawal of the substance in an equal measure both through the kidneys and through the intestine, and only 4% go unchanged through the kidneys.

Indications

Usually, Bravadin is prescribed to patients with such ailments:

• A stable thoracic frog in patients with normal sinus rhythm:
  • when there is a ban on taking beta-blockers;
  • together with beta-blockers in inadequate control of a stable angina pectoris.
• CHF, in order to prevent the development of complications.

Instructions for the use of tablets Bravadin

Tablets are consumed twice a day, along with food( best done in the morning and evening).

Usual initial dose:

• 10 mg / day - with stable angina and CHF;
• 5 mg / day - for patients aged 75 years;

Further administration:

• Increase in dosage to 15 mg / day after 3-4 weeks - with stable angina;
• Increase in the dose to 15 mg / day after 14 days - with CHF.

In both cases, if the heart rate is below 50 bpm, the dosage should be adjusted by reducing the dose to 2.5 mg( or otherwise as directed by the physician).

Contraindications

Complete abolition of

As with any medication, such medication is undesirable for patients with increased sensitivity to its components. Contraindications to taking this medication today are such ailments:

• bradycardia;
• SSSU or presence of an artificial pacemaker, functioning with constant stimulation;
• myocardial infarction in acute form;
• OCH and unstable SN;
• unstable angina pectoris;
• arterial hypotension in severe form;
• cardiogenic shock;
• hepatic insufficiency in severe form( on the Child-Pugh scale is more than 9 points);
• sinoorthric block;
• AV-blockade of the 3rd degree.

In addition to disease, the patient should not take Bravadin:

• during pregnancy and feeding mother's milk;
• at the age of less than 18 years.

Admission with caution

These indications are:

• liver failure, which has less than 9 Child-Pugh scores;
• pigmentary degeneration of the retina;
• AB-blockade of the 2nd degree;
• renal failure with a CK of less than 15 mL / min);
• stroke, which was recently rescheduled;
• asymptomatic ventricular dysfunction( left);
• 4 pcs. CHF;
• congenital lengthening of the QT interval, as well as concomitant with medications that extend the QT interval;
• co-administration with moderate inhibitors and inducers of the isoenzyme CYP3A4 and grapefruit juice;
• co-administration with BCCCs that cut the frequency of the SS( eg, verapamil and diltiazem);
• joint reception with non-potassium-sparing diuretics.

Special instructions

• Medication is ineffective for the treatment of arrhythmias, and with emerging tachyarrhythmias, its effectiveness also decreases. Do not apply the medicine in the presence of ciliary and other types of rhythm disturbances associated with the function of the sinus node.
• Patients should strictly follow the doctor's prescriptions for clinical follow-up to detect atrial fibrillation, including ECG.
• Patients with Chronic HF are at risk of developing atrial fibrillation. If there is both CHF and blockage of the left / right leg of the bundle, a careful observation is necessary.
• The medicine can cause a temporary change in the perception of light, so you might want to give up for a while from driving the vehicle and working with some mechanisms.

Overdose

Its sign is a severe and prolonged bradycardia, the treatment of which is carried out:

• in stationary conditions;
• with the use of beta-adrenomimetics, when there is a bradycardia together with a violation of these hemodynamics.

In the most difficult situations it is possible to install an artificial driver.

Interaction with other medications

Not applicable at the same time:

• prolonging interval QT antiarrhythmic drugs( including disopyramide, sotalol, quinidine, amiodarone);
• not related to the previous, but extending QT( including ziprasidone, halofantrine).

Simultaneously apply with extreme caution:

• non-potassium-sparing diuretics;
• medicines with St. John's Wort;
• rifampicin, barbiturates, phenytoin;

Side effects of

Quite common:

• bradycardia;
• headaches;
• photopsy;
• ventricular extrasystole;
• AB-blockade 1 st.;
• blurred vision;
• dizziness.

Sometimes possible:

• constipation or vice versa diarrhea;
• muscle cramps;
• eosinophilia;
• supraventricular extrasystole;
• nausea;
• hypercreatininaemia;
• shortness of breath;
• hyperuricemia.

Reviews

Reviews of the drug Bravadin in doctors and patients in most cases, positive. It is marked by its effective antianginal effect. Often, patients experience side effects such as nausea and dizziness. Cardiologists insist on avoiding self-abrupt abstinence from taking medication.

Analogues

The most commonly used substitute for the described medication is Coraxan, and Iwabradine. About what is best, bravadin or cortex, your doctor will tell you. Also analogues of Bravadin can be named:

• Vivaroxan;
• Ivabradine hydrochloride.