Pharmacological properties of the drug Amiocordin
It has antiarrhythmic and antianginal activity. According to the Vaughan-Williams classification, amiodarone belongs to class III antiarrhythmic drugs, although it also has some properties of class I, II and IV antiarrhythmic drugs. It blocks predominantly potassium, as well as sodium and calcium channels and non-competitively inhibits the effect of stimulating α- and β-adrenergic receptors. The antiarrhythmic effect of amiodarone is associated with the ability to increase the duration of the action potential of cardiomyocytes, the effective refractory period of the atria and ventricles, the AV node and the conduction system of the heart, which is accompanied by a decrease in the automaticity of the sinus node, a slowdown in AV conduction, and a decrease in the excitability of cardiomyocytes. The antianginal effect is realized by reducing the myocardial oxygen demand (decreasing heart rate and reducing afterload) and reducing coronary vascular resistance. The antiarrhythmic effect of amiodarone develops approximately 7 days after the start of treatment and reaches a maximum after 15–30 days. After stopping treatment, the effect persists for another 10–30 days. Amiodarone is slowly absorbed when taken orally. Its bioavailability is approximately 40%. The maximum concentration in blood plasma is achieved 3–7 hours after a single dose; a constant therapeutic concentration is achieved after 90–150 days of administration. Amiodarone is metabolized primarily in the liver to form desethylamiodarone, which has similar pharmacological properties. It is excreted mainly in feces and only a small part in urine. The half-life averages from 3.2 to 20.7 hours both after a single oral dose and after intravenous administration; with long-term therapy, the half-life averages 53 ± 24 days. The drug binds to receptors in tissues, resulting in its accumulation.
DANGEROUS MEDICINE
A new remedy has appeared on the Internet, allegedly capable of relieving the buyer of hypertension, vascular problems, protecting the heart and preventing a heart attack in one course. It’s called a panacea (after all, there are no drugs with a similar effect) Micardin . Sold for free, but unfortunately these granules can only save money from your wallet, and here's why:
Looking for documents
The promotion of Micardin began around September 2021. There is simply no truthful and independent information about it, and this is more than strange for a “drug” with such fantastic effects. However, this is not at all strange for a divorce and Internet dummies, see for yourself:
We did not find any mention of a product with this name either in the register of drugs and dietary supplements, or even in the registers of ordinary food products.
Certificates on selling sites are unreadable and do not look real. Just beautiful pictures.
Sellers have no feedback telephone numbers, the manufacturer of Micardin is not indicated, contraindications, product specifications are not indicated, there is nothing but unrealistic promises of effectiveness.
There are fake customer reviews and fake recommendations from fictitious cardiologists, as well as false results of clinical studies with incredible numbers. It is clear that these studies have never been conducted.
However, found on the net
from which you can learn the following:
- Product: Food concentrate based on plant raw materials for the preparation of non-alcoholic drinks (not medicinal, not dietary supplements) labeled “7even”, “Kettox”, “Fruitalica”, “ Micardin ”.
- Reg. number: EAEU N RU D-RU.HB25.B.11551/20
- Manufacturer: Vostok Plus LLC Moscow, Sokolnicheskaya square, building 4a, 3rd floor, room 4, room 11.
- C meets the requirements: On food safety.
As you can see, Micardin is a food concentrate, probably manufactured specifically for trading via the Internet, and, according to this declaration, registered together with a pack of similar concentrates (mainly for weight loss). Micardin is definitely not a medicine, a dietary supplement, it is only called a drug in advertising, so it cannot cure anything, especially incurable diseases.
Unfortunately, scamming hypertensive patients is a very common practice of traders on the Internet; miracle concentrates have been treating us for many years. Such scams as Arterio and Normio , Hyperopril, Carditonus, Hypertox, Neocard, CardiOK do not leave the advertising platforms of social networks and even large advertising aggregators, be careful.
Special danger: Since Micardin is sold through call centers, the operator on the phone will try by all means to convince you of the need to be treated with this particular “drug”. Sometimes such consultants advise not to see a doctor, not to talk to relatives about the purchase, and even to stop taking prescribed medications. Such advice can simply destroy a truly sick person. Cardiovascular disease is the most common cause of premature death. Therefore, treating them with the help of Internet dummies is extremely dangerous.
Reviews
At the moment, there are no real reviews about Micardin, as well as no independent and non-advertising information. If you ordered this product, please share your impressions about the purchasing process, the price of the product and its actual effectiveness. We advise you to be especially careful and skeptical when ordering and purchasing these capsules, especially for people who have serious problems with the heart and blood vessels. It is dangerous to undergo treatment without consulting a real doctor, especially over the Internet.
Similar: Friocard, Metacardil, Cardiosoft, Arteriale,
Cardisen, Tensital, Cardipal, Cardineo
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Indications for use of the drug Amiocordin
Prevention and treatment of paroxysmal heart rhythm disturbances - sinus tachycardia, supraventricular tachyarrhythmia, including atrial flutter and fibrillation, ventricular tachyarrhythmia, ventricular and supraventricular extrasystoles, rhythm disturbances in patients with WPW syndrome; for the prevention of angina attacks (stable, unstable, spontaneous) in patients with cardiac arrhythmias in whom treatment with other antiarrhythmic drugs has proven ineffective or contraindicated; in the acute phase of myocardial infarction with an increased risk of heart rhythm disturbances. IV therapy is prescribed when it is necessary to obtain a rapid therapeutic effect or when it is impossible to take the drug orally, for the treatment and prevention of paroxysmal heart rhythm disturbances (sinus tachycardia, supraventricular tachycardia, including atrial flutter and fibrillation, ventricular tachyarrhythmia, ventricular and supraventricular extrasystoles , WPW syndrome) and recorded symptomatic heart rhythm disturbances.
Use of the drug Amiocordin
The dose is set individually. The tablet should be swallowed whole with a small amount of water. The tablets can be taken during or after meals. Initial treatment: usual dosage - from 600 to 1000 mg / day in 1 dose or divided into 2-3 doses. Initial treatment usually lasts 8 to 10 days. Maintenance treatment: used in the minimum effective dose, usually from 100 to 400 mg/day in 1–3 doses. An alternative is to take double the daily dose every other day or take a therapeutic dose for 5 days with a break on Saturday and Sunday. Injections: the dose is selected depending on the patient's condition. IV injection . The usual dose is 5 mg/kg body weight and should be administered over at least 3 minutes. Repeated intravenous injection should not be done earlier than 15 minutes after the first injection, even if only part of the contents of 1 ampoule was used. The therapeutic effect appears within the first minutes after administration of amiodarone and then gradually decreases. In this regard, to maintain a stable effect, intravenous infusion of the drug is necessary. IV infusion . The initial dose is usually 5 mg/kg body weight and is administered in 250 ml of 5% glucose solution over 20 minutes to 2 hours. The infusion rate is adjusted in accordance with the therapeutic effect of the drug. This dose can be repeated 2-3 times within 24 hours. The maximum daily dose should not exceed 1200 mg. A maintenance dose of 10–20 mg/kg/day (usually 600–800 mg/day, maximum 1200 mg/day) is administered in 250 ml of 5% glucose solution. Infusion therapy usually lasts 4–5 days. Oral therapy should begin on the first day of infusion.
Contraindications to the use of the drug Amiocordin
Hypersensitivity to any of the components of the drug or to iodine, sinus bradycardia or sinoatrial block, sick sinus syndrome (if a pacemaker is not installed), acute conduction disturbance (if a pacemaker is not installed), simultaneous use of drugs that can cause polymorphic ventricular tachycardia pirouette type, thyroid dysfunction, pregnancy (except when the drug is prescribed for health reasons) and breastfeeding. The IV form of the drug is contraindicated in hypotension, severe respiratory failure, decompensated cardiomyopathy and severe heart failure.
Side effects of the drug Amiocordin
Some patients have bradycardia (HR ≤55 beats/min). Amiodarone may worsen existing arrhythmias or cause new arrhythmias. If heart rate is ≤55 beats/min, treatment should be interrupted. Amiodarone can cause heart failure or aggravate existing heart failure (simultaneous administration of cardiotonics is necessary). Gastrointestinal side effects include nausea, vomiting, constipation, and anorexia; in isolated cases, transient liver failure is observed (accompanied by an increase in the activity of liver enzymes). Hepatotoxicity may also manifest itself in the form of acute liver failure (increased activity of liver enzymes, jaundice) and chronic liver failure (as a result of the development of pseudoalcoholic hepatitis, cirrhosis), therefore it is recommended to frequently monitor liver function, especially in patients with pre-existing liver failure, and interrupt amiodarone treatment if necessary. Treatment with amiodarone may be associated with the appearance of microsediment in the upper layers of the cornea (as a rule, this does not cause any visual impairment, but extremely rarely it can cause the appearance of a colored halo in the field of vision when looking against the light). There is no need to interrupt treatment, but the patient should undergo an ophthalmological examination. Hypothyroidism or hyperthyroidism may occur during or after discontinuation of amiodarone treatment. In this case, treatment with amiodarone should be discontinued. For hypothyroidism, replacement therapy is prescribed, and for hyperthyroidism, temporary thyreostatic therapy is carried out. Cough and progressive dyspnea indicate direct or indirect pulmonary toxicity of amiodarone. Conditions such as interstitial pneumonia, pneumosclerosis, pleurisy, and obliterating bronchitis may develop. These side effects are usually temporary. In case of hypersensitivity to amiodarone, treatment should be discontinued and GCS should be prescribed. Photosensitivity may develop during treatment with amiodarone and several weeks after stopping it, so sunscreen should be used on exposed areas of the body in summer. Neurological disorders are possible during amiodarone therapy in the form of paresthesia, tremor, ataxia, headache, optic neuritis, polyneuropathy, dizziness and auditory hallucinations. Other side effects include myopathy, epididymitis, taste in the mouth, hair loss, and fatigue.
Amiocordin
From the nervous system: headache, weakness, dizziness, depression, feeling of fatigue, paresthesia, auditory hallucinations, with long-term use - peripheral neuropathy, tremor, memory impairment, sleep, extrapyramidal manifestations, ataxia, optic neuritis, with parenteral use - intracranial hypertension.
From the senses: uveitis, lipofuscin deposition in the corneal epithelium (if the deposits are significant and partially fill the pupil - complaints of luminous spots or a veil before the eyes in bright light), retinal microdetachment.
From the cardiovascular system: sinus bradycardia (refractory to m-anticholinergics), AV block, with long-term use - progression of CHF, tachycardia of the "pirouette" type, intensification of existing arrhythmia or its occurrence, with parenteral use - decrease in blood pressure.
Metabolism: increased T4 levels with normal or slightly reduced T3 levels, hypothyroidism, thyrotoxicosis (drug discontinuation required).
From the respiratory system: with long-term use - cough, shortness of breath, interstitial pneumonia or alveolitis, pulmonary fibrosis, pleurisy, with parenteral use - bronchospasm, apnea (in patients with severe respiratory failure).
From the digestive system: nausea, vomiting, loss of appetite, dullness or loss of taste, feeling of heaviness in the epigastrium, abdominal pain, constipation, flatulence, diarrhea, rarely - increased activity of liver transaminases, with long-term use - toxic hepatitis, cholestasis , jaundice, liver cirrhosis.
Laboratory indicators: with long-term use - thrombocytopenia, hemolytic and aplastic anemia.
Allergic reactions: skin rash, exfoliative dermatitis.
Local reactions: with parenteral use - phlebitis.
Other: myopathy, epididymitis, decreased potency, alopecia, vasculitis, photosensitivity (skin hyperemia, weak pigmentation of exposed skin areas), lead-blue or bluish pigmentation of the skin, with parenteral use - fever, increased sweating. Overdose. Symptoms: bradycardia, AV block, decreased blood pressure.
Treatment: gastric lavage, administration of cholestyramine; for bradycardia - beta-adrenergic agonists or installation of a pacemaker; for tachycardia of the “pirouette” type - intravenous administration of Mg2+ salts, cardiac stimulation. Hemodialysis is ineffective.
Special instructions for the use of the drug Amiocordin
Treatment using the parenteral form of the drug should be carried out by a physician experienced in the treatment of arrhythmias, preferably in intensive care units under the monitoring of blood pressure, heart rate and ECG. The time of administration of the first dose should be at least 3 minutes. A repeated intravenous injection should be administered no earlier than 15 minutes after the first injection. If possible, the solution for injection should be administered as an intravenous infusion. Hypotension, bradycardia, and AV block may occur during infusion therapy, so the dose and rate of infusion must be carefully monitored. Since IV infusions of amiodarone may be accompanied by phlebitis, it is recommended to administer the drug through a central venous catheter. Before starting treatment, it is recommended to register an ECG, quantify TSH and determine the level of potassium in the blood serum. The incidence and severity of side effects are dose-dependent, so the drug should be used in the minimum effective dose. Since bradycardia may occur in older patients, the drug should be used with caution in them. Amiodarone may cause changes in the ECG, in particular prolongation of the QT (due to prolongation of repolarization) and the appearance of a U . These changes are not associated with cardiotoxic effects. If sinoatrial block, II-III degree AV block, or bifascicular block occurs, treatment with the drug should be discontinued. When treating with amiodarone, an ECG should be regularly monitored (once every 3 months, as well as when new attacks of arrhythmia occur or signs of exacerbation of the underlying disease). Progressive dyspnea and nonproductive cough may be signs of amiodarone pulmonary toxicity. It is recommended to carry out regular X-ray monitoring of the chest organs and functional breathing tests (once every 6 months or when signs of lung disease develop). Amiodarone may cause thyroid dysfunction, especially in patients with a history of thyroid disease (including a family history). Monitoring thyroid function is recommended before, during and for several months after stopping treatment. During treatment with amiodarone, the activity of liver enzymes in the blood serum should be regularly monitored. Considering the possibility of developing photosensitivity during this period, it is advisable to apply sunscreen to exposed skin in the summer. The effectiveness and safety of amiodarone in children have not been established. The use of amiodarone during pregnancy and breastfeeding is contraindicated. It can be prescribed to pregnant women only in emergency cases (if other antiarrhythmic drugs are ineffective), only when the expected benefit to the expectant mother outweighs the potential risk to the fetus. In some patients, amiodarone may impair the ability to drive or operate potentially dangerous machinery.
Amiocordin® (Amiokordin®)
Side effects of Amiocordin® are usually dose-dependent, therefore, to minimize the possibility of their occurrence, the minimum effective dose should be used.
Patients should be warned to avoid exposure to direct sunlight or to take protective measures (eg, use of sunscreen, wearing appropriate clothing) during treatment.
Cardiac reactions
The pharmacological effect of the drug Amiocordin® causes ECG changes: prolongation of the QT interval, QTc (corrected), associated with an extension of the period of repolarization of the ventricles of the heart, with the possible appearance of U waves. However, these changes are not a manifestation of the toxic effect of the drug Amiocordin®. It is permissible to increase the QTC interval by no more than 450 ms or by no more than 25% of the original value.
In elderly patients, a significant slowdown in heart rate may occur. If II and III degree atrioventricular block, sinoatrial block or double-fascicular intraventricular block develops, treatment with Amiocordin® should be discontinued. If first degree atrioventricular block occurs, monitoring should be intensified.
The occurrence of new rhythm disturbances or worsening of existing rhythm disturbances, sometimes with fatal outcome, has been reported. It is very important, but difficult, to make a differential diagnosis between the insufficient effectiveness of the drug and its arrhythmogenic effect, whether combined or not with an aggravation of the severity of cardiovascular pathology. When using Amiocordin®, arrhythmogenic effects were reported much less frequently than with other antiarrhythmic drugs and, as a rule, they were observed in the presence of factors that increase the duration of the QT interval, such as interactions with other drugs and/or electrolyte disturbances in the blood ( see sections “Side effects” and “Interaction with other drugs”). Despite the ability of Amiocordin® to increase the duration of the QT interval, it showed low activity in provoking torsade de pointes (TdP).
Hyperthyroidism
(see section "Side effects").
While taking Amiocordin® or for several months after stopping it, hyperthyroidism may develop. Clinical manifestations are usually mild, so symptoms such as weight loss, the occurrence of rhythm disturbances, angina attacks, and the development of chronic heart failure should alert the doctor. The diagnosis is confirmed by identifying a decrease in the concentration of thyroid-stimulating hormone (TSH) in the blood serum, determined using an ultrasensitive TSH test. In this case, taking Amiocordin® should be discontinued.
Recovery usually occurs within several months after discontinuation of treatment: first, the disappearance of clinical manifestations is observed, and then normalization of laboratory parameters of thyroid function occurs.
Severe cases of thyrotoxicosis, which can sometimes be fatal (both due to the thyrotoxicosis itself and due to a dangerous imbalance between myocardial oxygen demand and oxygen supply), require urgent treatment. Treatment should be selected individually in each specific case: antithyroid drugs (which may not always be effective), glucocorticosteroids, beta-blockers.
Neuromuscular disorders
(see section "Side effects")
Amiocordin® may cause peripheral sensorimotor neuropathy and/or myopathy.
Recovery usually occurs within several months after discontinuation of Amiocordin® but may sometimes be incomplete.
Visual disorders
If vision is blurred or visual acuity decreases, a complete ophthalmological examination, including examination of the fundus of the eye (funduscopy), is urgently necessary. If neuropathy and/or optic neuritis is detected, Amiocordin® should be discontinued due to the risk of their progression to the development of blindness.
Pulmonary disorders
The appearance of shortness of breath or dry cough may be associated with pulmonary toxicity, in particular the development of interstitial pneumonitis. If the development of interstitial pneumonitis is suspected in patients who experience severe shortness of breath, either isolated or in combination with a deterioration in general condition (fatigue, weight loss, fever), an X-ray examination of the lungs should be performed. The need to use Amiocordin® should be re-evaluated, since interstitial pneumonitis is usually reversible if it is discontinued early (clinical symptoms usually resolve within 3-4 weeks, followed by a slower improvement in radiographic appearance and pulmonary function over several months). Treatment with glucocorticosteroids should be considered.
In addition, in patients taking Amiocordin®, in very rare cases, usually immediately after surgery, a serious complication of the respiratory system (acute adult respiratory distress syndrome), sometimes fatal, has been observed, suggesting the possibility of its development being associated with interaction with high concentrations of oxygen (see section “Side effects”).
Liver disorders
Careful monitoring of liver function tests (monitoring the activity of liver transaminases) is recommended before starting the use of Amiocordin® and regularly during treatment with the drug. When taking Amiocordin®, acute liver dysfunction (including hepatocellular failure or liver failure, sometimes fatal) and chronic liver damage are possible. Therefore, if the activity of “liver” transaminases increases, 3 times higher than the ULN, the dose of Amiocordin® should be reduced or discontinued.
Clinical and laboratory signs of chronic liver failure when using the drug Amiocordin® orally can be minimally pronounced (hepatomegaly, increased transaminase activity 5 times higher than ULN) and reversible after discontinuation of the drug, but cases of death have been reported.
Severe bullous reactions
You should immediately stop treatment with Amiocordin® if symptoms and manifestations of life-threatening or even fatal reactions appear in the form of Stevens-Johnson syndrome, toxic epidermal necrolysis, namely the appearance of a progressive skin rash, often with the formation of blisters, or damage to the mucous membranes.
Drug interactions
The simultaneous use of Amiocordin® with the following drugs is not recommended: beta-blockers, blockers of “slow” calcium channels, slowing heart rate (verapamil, diltiazem), stimulating intestinal motility, laxatives that can cause hypokalemia.
Treatment monitoring
Before starting to take Amiocordin®, it is recommended to conduct an ECG study and determine the potassium content in the blood serum.
Hypokalemia should be corrected before using Amiocordin®. During treatment, it is necessary to regularly monitor the ECG, as well as the activity of “liver” transaminases and other indicators of liver function.
In addition, due to the fact that the drug Amiocordin® can cause hypothyroidism or hyperthyroidism, especially in patients with a history of thyroid diseases, before taking the drug Amiocordin®, a clinical and laboratory examination should be carried out to detect thyroid dysfunction (TSH concentration in serum, determined using an ultrasensitive TSH test). During treatment with Amiocordin® and for several months after its cessation, the patient should be regularly examined to identify clinical or laboratory signs of changes in thyroid function. If thyroid dysfunction is suspected, it is necessary to determine the concentration of TSH in the blood serum (using an ultrasensitive TSH test).
Increased rates of ventricular defibrillation and/or increased thresholds for pacemaker or implanted defibrillator response have been reported in patients receiving antiarrhythmic drugs over a long period of time, which may reduce the effectiveness of these devices. Therefore, before starting or during treatment with Amiocordin®, you should regularly check their correct functioning.
Regardless of the presence or absence of pulmonary symptoms during treatment with Amiocordin®, it is recommended to conduct an X-ray examination of the lungs and pulmonary function tests every 6 months.
Abnormalities in thyroid hormone concentrations
Since Amiocordin® contains iodine, its use may interfere with the absorption of radioactive iodine and distort the results of a radioisotope study of the thyroid gland, however, taking the drug does not affect the reliability of determining the concentration of free T3, T4 and TSH (using an ultrasensitive method for determining the concentration of TSH) in the blood serum. The drug Amiocordin® inhibits the peripheral conversion of T4 to T3 and can cause isolated biochemical changes (an increase in the concentration of free T4 in the blood serum, with a slightly reduced or even normal concentration of free T3 in the blood serum) in clinically euthyroid patients, which is not a reason to discontinue the drug Amiocordin ®.
The development of hypothyroidism can be suspected when the following clinical signs, usually mild, appear: weight gain, cold intolerance, decreased activity, severe bradycardia (see section “Side Effects”). The diagnosis is confirmed by a clear increase in the concentration of TSH in the blood serum, determined using an ultrasensitive method for determining the concentration of TSH. Normalization of thyroid function is usually observed within 1-3 months after cessation of treatment. In life-threatening situations, treatment with Amiocordin® can be continued with simultaneous additional use of L-thyroxine under the control of TSH concentration in the blood serum.
General and local anesthesia
Before surgery, the anesthesiologist should be informed that the patient is taking Amiocordin®.
While taking the drug Amiocordin®, it is possible to increase the hemodynamic risks inherent in local or general anesthesia (this especially applies to a decrease in heart rate, slower conduction and decreased contractility of the heart).
Drug interactions Amiocordin
Due to its long half-life, amiodarone may cause drug interaction effects even several months after stopping it. The simultaneous administration of amiodarone and antiarrhythmic drugs, including bepridil, class I antiarrhythmic drugs, drugs such as quinidine, sotalol, as well as some other drugs that do not belong to the group of antiarrhythmic drugs, such as vincamine, sultopride, erythromycin (iv) and pentamidine ( IV), as this can lead to the development of polymorphic ventricular tachycardia of the pirouette type. Due to the increased risk of bradycardia and AV block, it is not recommended to prescribe amiodarone concomitantly with the calcium antagonists diltiazem and verapamil, as well as with beta-adrenergic blockers. Due to the increased risk of developing ventricular arrhythmia, simultaneous administration of amiodarone and laxatives that can lead to hypokalemia is not recommended. The simultaneous administration of amiodarone and tricyclic antidepressants, phenothiazines, astemizole or terfenadine causes prolongation of the QT interval and increases the risk of developing ventricular arrhythmia, especially torsade de pointes. When taking amiodarone and warfarin, digoxin, phenytoin and cyclosporine simultaneously, the concentration of these drugs in the blood serum should be monitored and their dose reduced accordingly (warfarin by 1/3–1/2, and the dose of digoxin by 1/2). The simultaneous administration of amiodarone and diuretics that promote potassium excretion, corticosteroids or amphotericin B (iv) may, due to hypokalemia, cause a prolongation of the QT and increase the risk of developing ventricular arrhythmia, including torsades de pointes. The simultaneous administration of amiodarone and cimetidine leads to a slowdown in the metabolism of amiodarone and, accordingly, to an increase in its concentration in the blood serum. Amiodarone should be used with caution during anesthesia due to the risk of bradycardia, decreased blood pressure, conduction disturbances, and a decrease in stroke volume of the heart. Due to the risk of lung damage, it is recommended that amiodarone be used with caution during oxygen therapy in the postoperative period. Amiodarone may affect the results of functional tests when examining the thyroid gland, especially when determining the level of T1, T2 and TSH.
Instructions for use AMIOKORDIN
Simultaneous use of Amiocordin with antiarrhythmic drugs (bepridil, antiarrhythmic drugs of class IA, IB, IC, sotalol), as well as with vincamycin, sultopride, erythromycin for intravenous administration, pentamidine for intravenous administration is contraindicated due to the possibility of developing polymorphic ventricular tachycardia torsade de pointes (TdP), prolongation of the QT interval, predisposition to sinus bradycardia, sinus node block or AV block.
Tricyclic antidepressants, phenothiazines, astemizole and terfenadine, when used together with Amiocordin, further prolong the QT interval and increase the risk of developing ventricular arrhythmias (especially arrhythmias).
Amiocordin should be used with caution simultaneously with drugs that increase potassium excretion and cause hypokalemia (laxatives, stimulating intestinal motility, diuretics, systemic corticosteroids and mineralocorticoids, tetracosactide, amphotericin B (for intravenous administration), since the development of ventricular tachycardia is possible "pirouette" type.
Combination therapy with beta-blockers and some calcium channel blockers (including verapamil, diltiazem) is not recommended, because Automaticity disorders (manifested by bradycardia) and inhibition of AV conduction may develop.
With the simultaneous use of Amiocordin with indirect anticoagulants (warfarin, acenocoumarol) for oral administration, the risk of bleeding increases (therefore, it is necessary to control the level of prothrombin and reduce the dose of anticoagulants - warfarin to 66%, acenocoumarol to 50%).
With the simultaneous use of Amiocordin with digoxin, disturbances in automaticity (manifested by severe bradycardia) and disturbances in AV conduction may be observed. In addition, it is possible to increase the concentration of digoxin in the blood plasma due to a decrease in its clearance. In case of combined use, you should monitor the concentration of digoxin in the blood plasma, adjust its dose (reduce by 1/2) or, if necessary, discontinue digoxin.
With the simultaneous use of Amiocordin with phenytoin (diphenin), clinical signs of phenytoin overdose may appear due to an increase in its concentration in the blood serum. In this case, it is necessary to control the concentration of phenytoin and correspondingly reduce its dose (by 1/3-1/2).
When Amiocordin is used together with cyclosporine, the content of cyclosporine in the blood serum may increase due to a decrease in excretion of the drug. In this regard, the dosage must be adequately adjusted.
Amiodarone increases plasma concentrations of quinidine, procainamide, and flecainide.
Amiocordine may inhibit the uptake of sodium iodide (131-I, 123-I) and sodium pertechnetate (99mTc) by the thyroid gland.
Cholestyramine reduces the absorption, T1/2 and concentration of amiodarone in the blood plasma, cimetidine increases it.
Cases of bradycardia (resistant to atropine), arterial hypotension, AV conduction disturbances, and decreased cardiac output have been described in patients taking Amiocordine and undergoing general anesthesia.
When performing surgical interventions, it is necessary to inform the anesthesiologist about taking the drug (to avoid the development of acute respiratory distress syndrome after surgery).
Drugs that cause photosensitivity have an additive photosensitizing effect.
Amiocordin overdose, symptoms and treatment
The most common and severe side effects are usually a sign of a drug overdose. In most cases, it is sufficient to reduce the dose or temporarily stop taking amiodarone and conduct an examination of the patient (blood pressure, ECG). A significant overdose can lead to a decrease in blood pressure, bradycardia, impaired AV conduction, arrhythmias and impaired liver function. Treatment: gastric lavage, administration of activated charcoal or saline laxative. The patient should be under medical supervision (especially blood pressure and ECG monitoring). Treatment is symptomatic. There is no specific antidote. Bradycardia can be corrected with atropine, glucagon, or temporary pacing.
