The pharmacological tool "Norvask" contributes to the provision of antianginal and antihypertensive effects.
This medication is made in tablet form. The tablets are white, the shape of an octahedron with uneven edges, on one side there is the Pfizer logo, on the other side - AML-5 or AML-10 (depending on dosage). Packed in tablets of 10 pcs. in blisters (9, 4, 3 or one each) in a cardboard box. In addition, tablets can be packaged in blisters of 14 pcs. In each pack of this medication there is an instruction for the use of Norvask.
One tablet contains the main active element - amlodipine and additional substances - magnesium stearate, microcrystalline cellulose, sodium carboxymethyl starch, calcium hydrogen phosphate.
pharmachologic effect
According to the instructions for use with Norvask, the active substance of the pharmacological agent - amlodipine, is a derivative of dihydropyridine, is a slow type calcium channel blocker. The drug has an antianginal and antihypertensive effect, blocks calcium channels, inhibits the passage of calcium ions through cells (more to the cells of vascular smooth muscle than to cardiomyocytes). Antianginal effect is explained by the ability of the active element of the drug to expand peripheral and coronary arteries and arterioles.
With angina pectoris
As the instruction to “Norvask” indicates, with the development of angina pectoris, it reduces the total vascular peripheral resistance (as a result of the expansion of the gaps of the peripheral arterioles), reduces the severity of ischemia of the heart muscles, the need for myocardium in the supply of oxygen and the load on the heart. The medication prevents spasms of the coronary arteries, including those provoked by smoking. Due to the expansion of arterioles and coronary arteries in ischemic and unchanged areas of the myocardium, this medical device enhances the flow of oxygen into the myocardial cells, especially when vasospastic angina occurs. In cases of stable angina, the drug can increase exercise tolerance and reduce the consumption of nitroglycerin or other nitrates, significantly reduces the frequency of angina attacks, the development of ischemic depression of the ST segment.
In accordance with the instructions for use, Norvask exhibits a prolonged hypotensive dose-dependent effect, which is due to its ability to relax the smooth muscles of blood vessels.
With hypertension
With arterial hypertension, a single dosage of the drug can provide a significant decrease in blood pressure in the supine position while lying down and standing for a day.
Very often people ask, at what pressure is Norvask appointed. According to the instructions for use, it is advisable to use it at elevated pressure.
Orthostatic hypotension (lowering the pressure when moving to a vertical position from horizontal) when using amlodipine develops very rarely.
The Norvask medication reduces the degree of hypertrophy of the heart muscle of the left ventricle, without causing a decrease in the ejection fraction of this ventricle. It increases the glomerular filtration rate, inhibits platelet aggregation, and has a slight natriuretic effect. It does not contribute to a reflex increase in the frequency of contractions of the heart and does not affect the conduction and contractility of the heart muscles.
In patients with diabetic nephropathy, this medicine does not increase microalbuminuria and does not adversely affect lipid concentration and metabolism. It can be used in the presence of concomitant pathologies such as gout, diabetes mellitus, asthma. A significant decrease in pressure occurs after 7–9 hours and is observed within 24 hours.
The instruction to Norvask confirms this.
The use of this medication prevents the thickening of the intima-media of the carotid arteries, reduces the frequency of interventions aimed at normalizing coronary blood flow, unstable angina and the development of chronic heart failure. In addition, it significantly reduces mortality from coronary artery bypass grafting, transluminal angioplasty of arteries, stroke and heart attack in patients with heart and vascular diseases.
Norvask does not contribute to complications and does not increase the mortality rate in patients with heart failure during treatment with ACE inhibitors, diuretics and digoxin. However, with this pathology of non-ischemic nature, amlodipine increases the risk of pulmonary edema.
Pharmacokinetic data
What else can you learn from the instructions for use "Norvask"? Amlodipine, getting into the digestive system, is well absorbed and reaches its maximum concentration in 7–11 hours. The average bioavailability ranges from 65 to 82%. Food while taking absorption of the active substance is not affected. The medicine passes through the blood-brain barrier and is well bound to proteins - about 96.5%. Equilibrium concentration is achieved approximately 7–9 days after the start of treatment. Amlodipine is gradually but actively metabolized in the tissues of the liver, metabolites of the substance are not able to exhibit pharmacological activity. The half-life after taking the medication is 34–52 hours, with repeated administration - about 43 hours. It turns out: approximately 70% of the dosage is in the kidneys, 20% in the bile through the intestines. With hemodialysis, the substance is not removed. In patients after 65 years, the half-life of the active element increases to 60 hours, but this phenomenon does not matter.
Indications for appointment
The medicine "Norvask" is prescribed for the following pathologies:
- arterial hypertension;
- stable angina pectoris;
- vasospastic angina pectoris.
This medication can be used alone or in combination with other antianginal or antihypertensive drugs.
Contraindications
The list of contraindications for the prescription of this drug includes:
- severe stages of arterial hypotension (pressure less than 90 mm Hg. Art.);
- unstable heart failure after a heart attack;
- left ventricular outflow obstruction, including aortic stenosis;
- age less than 18 years;
- sensitivity to drug substances, as well as other derivatives of dihydropyridine;
- heart failure of a chronic nature of non-ischemic etiology;
- myocardial infarction;
- liver failure;
- obstructive hypertrophic cardiomyopathy;
- mitral and aortic stenosis;
- weakness of the sinus node, including severe tachycardia or bradycardia.
Dosage and method of use
The tablets are intended for oral use. Dosage regimen: 1 time per day 5 mg. Instructions for use with Norvask indicate that if necessary, a single dose can be increased to a maximum of 10 mg. For patients in old age, patients with functional impairment of the kidneys or liver, as well as with concomitant use of diuretics, β-blockers and angiotensin-converting enzyme inhibitors, correction of the use of this medication is not required.
Side effects
According to the instructions for use and reviews of "Norvask", side effects from taking the medicine are possible:
- Nervous system: drowsiness, excessive fatigue, dizziness, cephalgia, hypersthenia, general malaise, asthenia, peripheral neuropathy, increased irritability, paresthesia, tremor, sleep disturbance, mood swings, depression, strange dreams, tinnitus, taste change, anxiety, ataxia , amnesia, migraine, increased sweating, apathy, agitation.
- Cardiovascular system: palpitations, peripheral edema, excessive pressure drop, vasculitis, fainting, chest pain, orthostatic hypotension, shortness of breath, myocardial infarction, complication of heart failure, changes in heart rhythms (including bradycardia, atrial fibrillation, and ventricular tachycardia).
- Digestion: abdominal pain, thirst, nausea, diarrhea or constipation, vomiting, dyspepsia, flatulence, anorexia, increased appetite, gastritis, gum fibromatosis, jaundice, hepatitis, pancreatitis, increased bilirubin and liver enzyme activity.
- Musculoskeletal system: arthrosis, back pain, cramps, arthralgia, myasthenia gravis, myalgia.
- Respiratory organs: rhinitis, nosebleeds, dyspnea, cough.
- Hematopoietic system: leukopenia, thrombocytopenia, Verlhof disease.
- Genitourinary organs: nocturia, erectile dysfunction, dysuria, rapid urination, polyuria.
- Skin: dermatitis, xeroderma pigmentosa, alopecia, skin pigmentation.
- Sensory organs: impaired vision and accommodation, diplopia, conjunctivitis, xerophthalmia.
- Metabolism: hyperglycemia, change in body weight.
- Laboratory indicators: increase in blood glucose.
- Allergic phenomena: itching, skin rash, angioedema, erythema.
- Other: gynecomastia, violation of smell.
So it says in the instructions. We will review the reviews about Norvask below.
Overdose symptoms
In cases of overdose development, a marked decrease in pressure is observed, the occurrence of tachycardia and increased peripheral vasodilation is possible, which can provoke the appearance of persistent arterial hypotension with the development of shock and death. In case of an overdose, urgent hospitalization, gastric lavage, and sorbent administration are recommended. In stationary conditions, monitoring of blood volume, parameters of the heart and respiratory system, diuresis, and maintenance of the cardiovascular system is indicated. To restore tone, vasoconstrictor medications are prescribed.
Special recommendations
According to the instructions for use of the Norvask medicine, in order to avoid the development of hyperplasia, soreness and bleeding of the gums, it is necessary to maintain oral hygiene and be observed by the dentist. Elderly patients are advised to closely monitor the general condition. With a hypertensive crisis, this medication is not prescribed. With non-ischemic heart failure, there is an increase in the incidence of pulmonary edema.
Impact on the management of vehicles and other mechanisms
Due to the high likelihood of a pronounced decrease in pressure, drowsiness, cephalalgia and other negative phenomena when driving and performing other dangerous activities, patients need to be careful.
Drug interaction
In accordance with the instructions for use, the drug "Norvask", depending on the main indications, can be safely used in combination with the following medical devices:
- Arterial hypertension: α-blockers, thiazide-type diuretics, β-blockers, angiotensin-converting enzyme inhibitors.
- Angina pectoris: other antianginal drugs, prolonged or short-acting nitrates, β-blockers.
With the simultaneous use of the drug with anti-inflammatory non-steroidal medicines, oral hypoglycemic and antibiotic agents, no significant interaction was observed.
This confirms the instructions for use for Norvask tablets.
With combination therapy with some medications, the following phenomena may occur:
- α1-blockers, antipsychotics: increased antihypertensive effects.
- β-blockers, angiotensin-converting enzyme inhibitors, diuretics (loop and thiazide), nitrates (increased antihypertensive and antianginal effects).
- Simvastatin: increased exposure.
- Antiarrhythmic drugs that cause an increase in the QT interval: an increase in the severity of inotropic effects.
- Antipsychotics: an increase in the antihypertensive effects of Norvask.
- Antiviral agents: increased concentration of amlodipine.
Analogs
Structural analogues of the active substance are:
- "Agen";
- Amlovas
- Amlodigamma
- Amlodipine;
- "Amlodipine maleate";
- Amlokard Sanovel;
- Amlong;
- Amlonorm;
- "Kulchek";
- Cardilopin;
- Karmagip
- Corvadil;
- Cordy Kor;
- "Normodipine";
- "Omellar Cardio";
- Tenox.
A doctor should select a replacement.
Reviews
Since this drug is very specific and is not universally used, there are few reviews about it. Patients note that its effect is very noticeable in the first days of use. They characterize it as a very effective remedy for heart disease and high blood pressure. In the reviews, there is a lot of information about the negative effect of this drug in the form of side symptoms that occurred in almost every patient who used Norvask, but such phenomena, according to patients, gradually disappear on their own.
We examined the Norvask medication, analogues and instructions for use.