special instructions
Due to the fact that the components of the drug are vulnerable to the aggressive environment of gastric juice and pancreatic enzymes, it is recommended to take Panangin simultaneously with food. This will ensure that the acidity of the stomach is reduced, and most of the enzymes will be occupied with the breakdown of fats and proteins contained in food, which will ensure that potassium and magnesium enter the intestinal lumen, from where the substances are absorbed into the blood.
Taking Panangin should be accompanied by regular blood tests so that the doctor can monitor the content of potassium and magnesium in the cells. This will avoid hyperkalemia and other negative consequences of overdose.
Panangin forte (tab.pl/vol. 316mg+280mg No. 60)
A country
Hungary
The country of production may vary depending on the batch of goods. Please check with the operator for detailed information when confirming your order.
Active substance
Potassium and magnesium aspartate
Compound
For 1 tab. — potassium aspartate 316 mg; — in the form of potassium aspartate hemihydrate 332.6 mg; — magnesium aspartate 280 mg; - in the form of magnesium aspartate tetrahydrate 350 mg; Excipients: corn starch - 172.2 mg, talc - 20 mg, magnesium stearate - 8 mg, potato starch - 6.6 mg, povidone K30 - 6.6 mg, colloidal silicon dioxide - 4 mg. Film composition shells: talc - 7.3 mg, butyl methacrylate copolymer - 6 mg, titanium dioxide (color index: CI 77891, E171) - 5.3 mg, macrogol 6000 - 1.4 mg.
pharmachologic effect
The most important intracellular cations potassium and magnesium play a key role in the functioning of many enzymes, in the formation of bonds between macromolecules and intracellular structures and in the mechanism of muscle contractility. The intra- and extracellular ratio of potassium, magnesium, calcium and sodium ions affects myocardial contractility. Endogenous aspartate acts as a conductor of ions: it has a high affinity for cells, due to the slight dissociation of its salts, ions in the form of complex compounds penetrate into the cell. Potassium and magnesium aspartate improves myocardial metabolism. A lack of potassium and/or magnesium ions predisposes to the development of arterial hypertension, atherosclerosis of the coronary arteries and the occurrence of metabolic changes in the myocardium.
Indications for use
To eliminate potassium and magnesium deficiency as an adjunct: - for various manifestations of coronary artery disease, including acute myocardial infarction; - for chronic heart failure; - for cardiac arrhythmias (including arrhythmias caused by an overdose of cardiac glycosides)
Mode of application
Before use, you should consult your doctor. Orally, without chewing and with a sufficient amount of water. Panangin® Forte should be taken after meals, because the acidic environment of the stomach reduces its effectiveness. Recommended daily dose: 1 tablet 3 times/day. Maximum daily dose: 1 tablet 3 times/day.
Interaction
When used simultaneously with potassium-sparing diuretics (triamterene, spironolactone), beta-blockers, cyclosporine, heparin, ACE inhibitors, NSAIDs, the risk of developing hyperkalemia increases up to the appearance of arrhythmia and asystole. The use of potassium preparations together with GCS eliminates the hypokalemia they cause. Under the influence of potassium, observed reducing the undesirable effects of cardiac glycosides. Panangin® Forte enhances the negative dromo- and bathmotropic effects of antiarrhythmic drugs. Magnesium preparations reduce the effectiveness of neomycin, polymyxin B, tetracycline and streptomycin. Anesthetics enhance the inhibitory effect of magnesium preparations on the central nervous system. When used simultaneously with atracurium, dexamethonium, succinyl chloride and suxamethonium may enhance neuromuscular blockade. Calcitriol increases the concentration of magnesium in the blood plasma, calcium preparations reduce the effect of magnesium preparations. Pharmacokinetic interaction. Drugs with an astringent and enveloping effect reduce the absorption of potassium and magnesium aspraginate from the gastrointestinal tract, so it is necessary to observe 3- hour interval between oral administration of Panangin® Forte and the above medications.
Side effect
From the digestive system: possible nausea, vomiting, diarrhea, discomfort or burning sensation in the epigastric region (in patients with anacid gastritis or cholecystitis). From the cardiovascular system: possible AV blockade, paradoxical reaction (increased number of extrasystoles). aspects of water and electrolyte balance: hyperkalemia (nausea, vomiting, diarrhea, paresthesia), hypermagnesemia (facial redness, thirst, decreased blood pressure, hyporeflexia, respiratory depression, convulsions) are possible.
Contraindications
- hypersensitivity to the components of the drug; - acute and chronic renal failure; - hyperkalemia; - hypermagnesemia; - Addison's disease; - AV blockade of the I-III degree; - shock (including cardiogenic - AD Overdose. To date, cases of overdose have not been described. In case of overdose the risk of developing hyperkalemia and hypermagnesemia increases. Symptoms of hyperkalemia: increased fatigue, myasthenia gravis, paresthesia, confusion, heart rhythm disturbances (bradycardia, AV block, arrhythmias, cardiac arrest). Symptoms of hypermagnesemia: decreased neuromuscular excitability, nausea, vomiting, lethargy, decreased Blood pressure: With a sharp increase in the content of magnesium ions in the blood - inhibition of tendon reflexes, respiratory paralysis, coma.Treatment: discontinuation of the drug, symptomatic therapy (iv administration of 100 mg/min calcium chloride solution), if necessary, hemodialysis.
special instructions
Particular attention is required for patients with diseases accompanied by hyperkalemia: regular monitoring of potassium levels in the blood plasma is necessary. Impact on the ability to drive vehicles and machines. No studies have been conducted. No effect is expected on the ability to drive vehicles or operate mechanisms that require increased concentration and speed of psychomotor reactions.
Dispensing conditions in pharmacies
On prescription
Is it possible to combine Panangin and Riboxin?
It is necessary to combine medications with caution, having first consulted with your doctor. Riboxin, in addition to increasing cell metabolism and improving the absorption of drugs and other elements into the heart tissue, also enhances myocardial contraction. Taking them together can have a beneficial effect - potassium and magnesium best penetrate the fibers of the heart muscle. On the other hand, this may require adjustment of the dosage of Panangin to ensure that the required amounts of potassium and magnesium are not exceeded, in order to eliminate hyperkalemia.
Instructions for use of Panangin drugs
Pharmacodynamics:
the most important intracellular cations of potassium (K+) and magnesium (Mg++) play a key role in the functioning of numerous enzymes, in the formation of bonds between macromolecules and intracellular structures and in the mechanism of muscle contractility.
The intra- and extracellular ratio of potassium, calcium, sodium and magnesium ions affects myocardial contractility. Endogenous aspartate acts as a conductor of ions: it has a high affinity for cells, due to the slight dissociation of its salts, ions in the form of complex compounds penetrate into the cells. Magnesium and potassium aspartates improve myocardial metabolism. Lack of magnesium/potassium predisposes to the development of arterial hypertension, atherosclerosis of the coronary arteries, arrhythmias and metabolic changes in the myocardium. Taking magnesium and potassium aspartates helps compensate for the lack of these electrolytes in food. Pharmacokinetics:
Magnesium
The total supply of magnesium in the body of a person weighing 70 kg is on average 24 g (1000 mmol); more than 60% of magnesium comes from bone tissue and about 40% from skeletal muscle and other tissues. About 1% of the total magnesium reserve in the body is found in the extracellular fluid, mainly in the blood serum. In healthy adults, the content of magnesium in the blood serum is in the range of 0.7-1.10 mmol/l. Magnesium is absorbed from the gastrointestinal tract by active transport. The main regulator of magnesium balance in the body is the kidneys. 3-5% of ionized magnesium is excreted by the kidneys. An increase in urine volume (for example, during loop diuretic therapy) leads to an increase in the excretion of ionized magnesium. If magnesium absorption in the small intestine is reduced, subsequent hypomagnesemia leads to a decrease in its excretion (less than 0.5 mmol/day).
Potassium
The total potassium reserve in the body of a person weighing 70 kg is on average 140 g (3570 mmol). The total potassium reserve is slightly less in women than in men and decreases slightly with age. 2% of the total potassium reserve in the body is located outside the cells, and the remaining 98% is inside the cells. Potassium is absorbed in the gastrointestinal tract. The optimal intake of potassium from food is 3-4 g (75-100 mmol) per day. The main route of potassium excretion is renal (about 90% of potassium is excreted by the kidneys daily). The remaining 10% is excreted through the gastrointestinal tract. Thus, the kidneys are responsible for long-term potassium homeostasis as well as plasma potassium levels. In the short term, blood potassium levels are also regulated by the flow of potassium between the intracellular and extracellular spaces.
Panangin
The drug Panangin from the Hungarian pharmaceutical belongs to the group of drugs that correct deficiency conditions that develop as a result of a lack of potassium and magnesium ions in the body. Panangin is used mainly in cardiological practice (as a means of complex treatment of heart failure, myocardial infarction and some arrhythmias). The drug contains two components: potassium and magnesium aspartates. The role of these intracellular cations in the body is difficult to exaggerate: they participate in the functioning of a number of enzymes, are actively involved in the formation of connections between intracellular structures and macromolecules, and are one of the tools that ensure muscle contractility. Thus, the contractility of the heart muscle is largely determined by the ratio of potassium and magnesium ions, as well as calcium and sodium in the cells and in the intercellular space. Potassium and magnesium in panangin are contained in the form of aspartate. Endogenous aspartate functions as an ion carrier: it easily binds to cells, and due to the strength of the connection with ions, it penetrates into the cell without losing its valuable “burden”. Potassium and magnesium aspartate stimulate metabolic processes in the myocardium. The lack of these ions is fraught with the development of such cardiovascular pathologies as arterial hypertension, coronary atherosclerosis, not to mention guaranteed metabolic changes in the myocardium. If we talk about potassium, its main function is to maintain the resting membrane potential of nerve and muscle cells at a constant level. An imbalance between intracellular and extracellular potassium levels impairs myocardial contractility, causes cardiac arrhythmias, causes tachycardia, and potentiates the side effects of cardiac glycosides. The presence of magnesium is strictly necessary to ensure the occurrence of more than 300 enzymatic reactions, including energy metabolism and protein biosynthesis.
In addition, magnesium is a “guarantor” of normal heart function: it improves contractility and regulates heart rate, thereby reducing the myocardium’s need for oxygen. Among other extremely useful “options” of magnesium is an increase in coronary blood flow (which is a consequence of the dilation of arterioles), and, consequently, an anti-ischemic (antianginal) effect on myocardial tissue. The combination of potassium and magnesium ions in one preparation is due to the fact that potassium deficiency very often goes side by side with magnesium deficiency, resulting in the need for simultaneous correction of these two deficiency conditions.
Panangin is one of the most famous and, in a good sense, “promoted” potassium and magnesium preparations. Clinical studies have shown that the use of this drug increases the effectiveness of therapy for heart failure and reperfusion arrhythmias (ventricular extrasystoles and tachycardia, ventricular fibrillation). The same reperfusion processes increase the area of ischemic damage to the myocardium. As a result of multicenter trials of panangin, its effectiveness in preventing ischemia and reducing mortality in patients with acute coronary syndrome was confirmed. The role of panangin is also great in maintaining normal electrolyte balance while taking diuretics,
Panangin can be found in pharmacies in two dosage forms: tablets and solution for intravenous administration. It is recommended to take the tablets after meals, because... an aggressively acidic stomach environment will negatively affect the effectiveness of the drug. The duration of the medication course (as well as the need to repeat it) is determined by the doctor in each specific case. In conclusion, we should recall the need to regularly monitor the level of potassium ions in the blood when taking Panangin in patients with an increased risk of developing hyperkalemia.
Panangin forte 60 pcs. film-coated tablets
pharmachologic effect
Potassium and magnesium preparation.
Composition and release form Panangin forte 60 pcs. film-coated tablets
Tablets - 1 tablet:
- Active ingredients: potassium aspartate 316.00 mg (in the form of potassium aspartate hemihydrate 332.60 mg), magnesium aspartate 280.00 mg (in the form of magnesium aspartate tetrahydrate 350.00 mg);
- Excipients: corn starch 172.20 mg, talc 20.00 mg, magnesium stearate 8.00 mg, potato starch 6.60 mg, povidone KZO 6.60 mg, colloidal silicon dioxide 4.00 mg;
- Tablet shell: talc 7.30 mg, butyl methacrylate copolymer 6.00 mg, titanium dioxide (color index: CI 77891, E171) 5.30 mg, macrogol-6000 1.40 mg.
15 tablets in a blister made of PVC/PVDC and aluminum foil. 2, 4, 6 blisters along with instructions for use are placed in a cardboard box.
Description of the dosage form
Oval, biconvex, film-coated tablets, white or almost white, with a slightly glossy surface, engraved “A83” on one side, almost odorless. On a cross section it is white or almost white in color.
Directions for use and doses
Before use, you should consult your doctor.
Take orally, without chewing and with plenty of water.
Panangin Forte should be taken after meals, because... the acidic environment of the stomach reduces its effectiveness.
Recommended daily dose: 1 tablet 3 times a day. Maximum daily dose: 1 tablet 3 times a day.
Pharmacodynamics
The most important intracellular cations of potassium (K+) and magnesium (Mg++) play a key role in the functioning of numerous enzymes, in the formation of bonds between macromolecules and intracellular structures and in the mechanism of muscle contractility. The intra- and extracellular ratio of potassium, calcium, sodium and magnesium ions affects myocardial contractility. Endogenous aspartate acts as a conductor of ions: it has a high affinity for cells, due to the slight dissociation of its salts, ions in the form of complex compounds penetrate into the cell. Magnesium aspartate and potassium aspartate improve myocardial metabolism.
Lack of magnesium/potassium predisposes to the development of arterial hypertension, atherosclerosis of the coronary arteries, arrhythmias and metabolic changes in the myocardium.
Each tablet of the drug Panangin Forte contains 280 mg of magnesium aspartate and 316 mg of potassium aspartate, which is 2 times higher than the content of active ingredients in the drug Panangin, film-coated tablets. The daily dose of the drug Panangin Forte: 1 tablet 3 times a day, corresponds to the daily dose of the drug Panangin: 2 tablets 3 times a day. Taking a single dose of Panangin Forte in the form of one tablet makes treatment more convenient for the patient.
Pharmacokinetics
Potassium and magnesium aspartates are intensively absorbed in the intestine, mainly in the small intestine. Excreted by the kidneys.
Indications for use Panangin forte 60 pcs. film-coated tablets
To eliminate potassium and magnesium deficiency as part of combination therapy for various manifestations of coronary heart disease (including acute myocardial infarction); chronic heart failure; heart rhythm disturbances (including arrhythmias caused by an overdose of cardiac glycosides).
Contraindications
Hypersensitivity to any of the constituent components of the drug, acute and chronic renal failure, hyperkalemia, hypermagnesemia, Addison's disease, atrioventricular block I-III degree, shock (including cardiogenic) (blood pressure less than 90 mm Hg), metabolic disorders amino acids, myasthenia gravis, hemolysis, acute metabolic acidosis, dehydration state, age under 18 years (efficacy and safety have not been established). Pregnancy (especially in the first trimester of pregnancy) and the period of breastfeeding.
Application of Panangin forte 60 pcs. film-coated tablets during pregnancy and breastfeeding
Use is possible if the potential benefit to the mother outweighs the possible risk to the fetus.
Potassium and magnesium aspartate pass into breast milk. If it is necessary to take the drug during breastfeeding, breastfeeding should be stopped.
special instructions
Patients with diseases accompanied by hyperkalemia require special attention: regular monitoring of potassium levels in the blood plasma is necessary.
Overdose
The risk of symptoms of hyperkalemia and hypermagnesemia increases.
Symptoms of hyperkalemia: increased fatigue, myasthenia gravis, paresthesia, confusion, cardiac arrhythmia (bradycardia, atrioventricular block, arrhythmias, cardiac arrest).
Symptoms of hypermagnesemia: decreased neuromuscular excitability, nausea, vomiting, lethargy, decreased blood pressure.
With a sharp increase in the content of magnesium ions in the blood: inhibition of deep tendon reflexes, respiratory paralysis, coma.
Treatment: symptomatic therapy - intravenous administration of calcium chloride at a dose of 100 mg/min, if necessary - hemodialysis.
Side effects Panangin forte 60 pcs. film-coated tablets
Possible nausea, vomiting, diarrhea, discomfort or burning sensation in the epigastric region (in patients with anacid gastritis or cholecystitis), atrioventricular block, paradoxical reaction (increased number of extrasystoles), hyperkalemia (nausea, vomiting, diarrhea, paresthesia), hypermagnesemia (redness of the face , feeling of thirst, decreased blood pressure, hyporeflexia, respiratory depression, convulsions).
If any of the side effects listed become serious, or you notice side effects not listed in this leaflet, you should consult your doctor.
Drug interactions
Pharmacodynamic interaction
When used together with potassium-sparing diuretics (triamterene, spironolactone), beta-blockers, cyclosporine, heparin, angiotensin-converting enzyme (ACE) inhibitors, and non-steroidal anti-inflammatory drugs, the risk of developing hyperkalemia up to the development of arrhythmia and asystole increases. The simultaneous use of potassium supplements with glucocorticosteroids eliminates the hypokalemia caused by the latter. Potassium reduces the undesirable effects of cardiac glycosides. Panangin Forte enhances the negative dromo- and bathmotropic effects of antiarrhythmic drugs. Magnesium reduces the effects of neomycin, polymyxin B, tetracycline and streptomycin. Anesthetics increase the inhibitory effect of magnesium preparations on the central nervous system; when used simultaneously with atracuronium, decamethonium, succinyl chloride and suxamethonium, neuromuscular blockade may be enhanced. Calcitriol increases the content of magnesium in the blood plasma, calcium supplements reduce the effects of magnesium supplements.
Pharmacokinetic interaction
Medicines that have an astringent and enveloping effect reduce the absorption of magnesium aspartate and potassium aspartate in the gastrointestinal tract, therefore it is necessary to maintain a three-hour interval between oral administration of Panangin Forte with the above medications.
