Coraxan

Description overdue on 06/17/2014

• Latin name: Coraxan
• ATC code: S01EB17
• Active substance: Ivabradine (Ivabradine)
• Manufacturer: "Servier Laboratories Industry", France

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• Composition
• Product form
• Pharmacological action
• Pharmacodynamics and pharmacokinetics
• Indications
• Contraindications
• Side effects
• Instructions for use Coraxan (method and dosage)
• Overdose
• Cooperation
• Terms of sale
• Storage conditions
• Shelf life
• Cautions
• Analogs
• During pregnancy (and lactation)
• Reviews
• Price, where to buy

Composition

The amount of auxiliary substances hardly differ in various forms of release of the drug, i.e. dosage corresponds tablets excipients and 5, and 7.5 mg ivabradine :

• lactose monohydrate - 62 mg;
• Corn starch - 20 mg;
• maltodextrin   - 10 mg;
• magnesium stearate - 0.5 mg;
• Anhydrous colloidal silica   - 0.2 mg.

Sheath Coraxan each tablet comprises:

• hypromellose - 1.5 mg;
• dioxide Titanium   (E 171) - 0.26 mg;
• Macrogol 6000 - 0.09 mg;
• magnesium stearate - 0.087 mg;
• yellow dye oxide gland   (E 172) - 0.015 mg;
• pigment red iron oxide (E 172) - 0.00485 mg.

Product form

Find the drug can be in two variations:

• Oval, biconvex tablets covered with orange-pink tape with marks on both sides (one "-" and the next number "5"). The dosage of active ingredient - 5 mg.
• Triangular tablet with orange-pink film and engraved on opposite sides: on the one "-" on the other "7.5", which means that 7.5 mg of the main active component.

Pharmacological action

Medicine Coraxan - is antianginal agent, that is a pharmacological drug that prevents the development of angina   (a disease in Latin sounds like " angina pectoralis ", Hence the name of the pharmaceutical group).

The mechanism of action depends on the biologically active ingredient - ivabradine . The substance is a specific selective If-channel blocker of the sinoatrial node (initiating link excitement conduction system of the heart). In this way ivabradine   helps stabilize the spontaneous depolarization during diastole and normalizes heart rate .

Through clinical studies, it was noted the main pharmacological advantage Coraxan compared with other antianginal drugs. The decrease in heart rate is   dose-dependent factor   when conservative therapy with this drug. That is, by increasing the constant daily dose of   40 mg / day , Therapeutic effectiveness takes the form of a plateau, which greatly reduces the possibility of reducing the rate to 40 beats per minute (pathological bradycardia).

A positive feature of the drug is the lack of influence on myocardial contractility (negative inotropic effect is potentiated). Also Coraxan not affect:

• ventricular repolarization;
• intracardiac conduction infarction;
• atrioventricular excitation pause;
• corrected QT interval on the electrocardiogram.

In the human body there are channels that the chemical structure are similar to the If. These are in education conjunctiva and called Ih-TV . They take part in a change of visual perception of the retina in response to bright light stimuli. It is in the systemic circulation ivabradine can get to the eye and to work on these formations. In this case, a phenomenon is observed photopsias   (transient distortion svetovospriyatiya human eye to a limited field of view) in response to a trigger, for example, rapid change of the brightness of ambient light.

Pharmacodynamics and pharmacokinetics

The drug is recommended for use in conjunction with Food As food increases the concentration in plasma of systemic circulation from 20 to 30 percent, which is manifested in the form of a complete drug action. That is, due to a prolonged absorption (food increases the time period is 1 hour), the effectiveness of the drug increases significantly.

Getting into the systemic circulation, 70 percent ivabradine bound to plasma proteins, which are delivered to sinoarterialnogo node conduction system of the heart. Metabolised   drug predominantly in the liver and intestine by the action cytochromes .

Evacuated from the body drug kidney . The half-life of the drug is 2:00, however, the effective half-life (the time period when the effectiveness of the biologically active component is equal to half of the original) - 11 hours. Renal clearance ivabradine - 70 ml / min and the total body clearance is maintained at 400 ml / min.

Linearity Coraxan pharmacokinetic activity observed in the concentration range of active ingredient from 0.5 to 24 mg.

Indications

• Stable angina   (in case of intolerance or contraindications to pharmacological absolute drugs of beta-blockers);
• congestive heart failure   (if sinus rhythm and heart rate remains at 70 beats per minute);
• symptomatic treatment of angina   (Improved sanitation measures to reduce the demand of the heart muscle of oxygen);
• coronary artery disease   (in the treatment and prevention courses for the normalization of the rhythm and frequency of contractions of the myocardium).

Contraindications

Do not use Coraxan in the scheme of conservative treatment anginal attacks If available:

• individual hypersensitivity or intolerance to existing components of the drug;
• bradycardia   below 60 beats per minute;
• sharp myocardial infarction ;
• cardiogenic shock ;
• kidney or liver failure;
• hypotension   (systolic blood pressure below 90 mm Hg, and diastolic - less than 50 mm Hg);
• complete blockade of the sinoatrial node ;
• artificial pacemaker maladaptive nature (with constant impulses);
• Children up to age 18 years (clinicians do not have information about the use of the drug in a given time period of the individual human development).

Also, there are a number of situations where taking Coraxan be therapeutic departments under the strict supervision of medical personnel in order to avoid the consequences of adverse and unexpected reactions:

• congenital long QT syndrome ;
• recently transferred ischemic cerebral stroke ;
• retinitis pigmentosa eye;
• atrioventricular block   second degree;
• the simultaneous use of drugs that block potassium pumps slow, lengthening the interval QT, inhibit or inhibits the action of cytochrome gastrointestinal tract.

Side effects

Clinical studies suggest that adverse reactions of the human body to pharmacological drugs - it a dose-dependent effect . Since elevated concentrations of the active drug in the central and peripheral blood flow can be observed:

• photopsia   - Change svetovospriyatiya in a limited field of view, which is run quickly dimmed lighting;
• subjective sensation of heart;
• atrioventricular block   I-III;
• syndrome acquired sinus;
• Atrial fibrillation ;
• severe headache, especially in the first month of the conservative drug therapy;
• allergic reactions   ( itching . erythema . hives . angioedema );
• fatigue, malaise, constant drowsiness.

Instructions for use Coraxan (method and dosage)

The drug should be used during the meal, so the coefficient of efficiency of the active ingredient increases several times. The daily dose can be divided into two times: in the morning for breakfast and evening - for dinner. The average amount of the drug is 2 tablets (with a concentration ivabradine - 5 mg) per day, but, depending on the dosage of the therapeutic effect can be increased. In this case, after 3-4 weeks of conservative treatment regimen is changed to 2 tablets with a concentration of active ingredient - 7.5 mg.

Instructions for use Coraxan also allows for side effects and contraindications to receiving drug. First of all, if after development signs of bradycardia   (constant fatigue, dizziness, decreased blood pressure to pathological figures) lower dosage does not contribute to the development of a therapeutic effect, the treatment according to the pharmaceutical preparation is stopped immediately.

It should be very careful in the rehabilitation of older patients. Treatment of the age group over 75 years carried out in a special way - starting dose is half a tablet (based on the mass balance - about 2.5 mg ivabradine) and increases the daily amount of the drug to 5 mg only if signs of a stable and benign conservative therapy.

Overdose

In case of overdose there is a pharmacological drug resistant, do not respond to conventional methods bradycardia . To eliminate the state of high concentration of drug in the systemic circulation should be applied effector antagonists Coraxan - beta-agonists . Used primarily selective drugs that interact only with the cardiac muscle, but in urgent conditions can be applied to non-selective agents. With the urgent need to overdose can be treated surgically - to insert a temporary artificial pacemaker heart rate.

Cooperation

During conservative treatment coraxan avoid inclusion in the dosage regimen, which prolong the QT segment Electrocardiogram as Ivabradine, the main active component of the tablets may cause an additional increase in the segment and the slowing of the heart rate. When absolute terms the use of drugs such as Quinidine . Amiodarone . Sotalol . Erythromycin . Pimozide , Is carried out day and night monitoring of the electrocardiogram in special therapeutic departments.

Precautions can be used nekaliysberegayuschie diuretics   (group consisting of thiazides and "loop" diuretics) as hypokalemia   (the result of joint action Coraxan and pharmacological agents which increase urine output) can lead to severe arrhythmias That in combination with bradycardia or long QT syndrome directly faces undesirable side effects for treating a patient or even fatal. Because boost mocheproduktsiyu urination or recommended under the close supervision of qualified medical personnel.

Definitely contraindicated simultaneous use Coraxan and the following list of drugs:

• pharmacological agents that act on the hepatic cytochrome ;
• antifungals of the azole group (e.g. ketoconazole   or itraconazole );
• antibiotics related to macrolides ( clarithromycin . erythromycin . telithromycin ) Or a group rifampicin ;
• protease inhibitors of human immunodeficiency virus;
• strong antidepressants   (especially nefazodone );
• sedatives mood stabilizers   (St. John's wort)
• certain drugs for anesthesia (in particular barbiturates ).

An interesting feature of the primary active ingredient, ivabradine It is to increase the concentration in the systemic circulation according to the drunk grapefruit juice . This natural drink is capable of increasing the relative amount of the active ingredient in twice that clearly requires a rational correction ration during the therapeutic course of treatment.

Terms of sale

Coraxan in pharmacy dispensed only receptor Form.

Storage conditions

Coraxan-saving medication should be in a warm, dry place out of reach of young children.

Shelf life

3 years.

Cautions

Coraxan used to stabilize sinus rhythm and prevention of angina, but the pharmacological activity of the drug to zero if you use it on the background 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, on the contrary, the material may worsen the patient's condition at Heart Failure   such genesis.

Turning Coraxan in the course of medical treatment is not recommended if there is a need for a comprehensive pharmacological therapy because it can correct the safety profile (risk of side effects or adverse reactions increases) due to indirect interaction of the components. The drug should not be used in conjunction with calcium channel blockers or dihydropyridine derivatives, which slows the heart rate. In particular, Verapamil . Diltiazem   or Amlodipine   alter the safety profile of the treatment largely because they avoid simultaneous reception coraxan.

Analogs Coraxan

Analogs Coraxan represented only active substance in its pure form, that is kneaded in the conservative treatment of the drug can only be Ivabradine   hydrochloride or the active component. Because the price is not much different analogues of the market value Coraxan and is about 900-1000 rubles in the Russian Federation. In Ukraine, the spread of ivabradine have not gained wide popularity because it could not be found in the pharmacy.

During pregnancy and lactation

Currently, there is a significant lack of information on the use of the drug during pregnancy and / or lactation, but in preclinical studies it has been found embryotoxic and teratogenic. Because the drug is now forbidden to receive in such a critical period of life of women.

Reviews coraxan

Reviews coraxan mostly positive, because the drug normalizes the heart muscle of unknown etiology, that is, when the cause is unknown to the physician. The drug is also called " lifeline "As Coraxan helps when beta-blockers did not have the proper therapeutic effect and does not lead to myocardial contraction rhythm sinus.

Among the negative impressions after conservative rehabilitation is most common severity of side effects of the visual apparatus. Many complain of a strong photopsias Which significantly affects the quality of life of patients.

Reviews of doctors mostly approve of the use of Coraxan, because the drug is the only adequate treatment of choice in many situations where other pharmacological products are unable to help the patient. Adverse reactions on the part of the body is recommended to stop medication as often returned to remove the drug and symptoms of the underlying disease.

Price Coraxan

Price Coraxan 5 mg in Ukraine is 240 hryvnia, which significantly distinguishes the drug among other anti-anginal drugs on the pharmacy shelf. In the Russian Federation, the cost Korasan 5 mg is even higher - it is about 1000 rubles. Because the medicine is best to book in online pharmacies even with the services delivery it is considerably cheaper.

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