Arrhythmia is a type of heartbeat that is different from normal sinus rhythm. With arrhythmias, a person has one or several violations in the work of the heart. Pathology can manifest itself both in an increase in the frequency and strength of heart contractions (tachycardia), and, conversely, in their reduction (bradycardia). Interruptions in the functioning of the heart muscle occur in a healthy person. However, in most cases, arrhythmia occurs in combination with other cardiac diseases. This condition is risky in that the excitability of the heart tissue, the myocardium, increases, which can subsequently lead to heart failure if the disease is not treated.
To normalize the heart rhythm, there are special drugs, one of which is Sotageksal. Analogues of the drug are also widely used in medical practice. Such drugs belong to the group of drugs with antiarrhythmic action, and beta-blockers. When they enter the body, they block beta-adrenergic receptors, which are located in the smooth muscles, heart muscle and other tissues, and are responsible for the body's response to stress. The general cardiac effect is to reduce the frequency and intensity of heart contractions, and decrease cardiac conduction. As a systemic effect, a decrease in blood pressure on the walls of the coronary vessels is also observed.
The composition of the drug
"Sotalol" (Sotalol) - the internationally accepted international name for the drug "Sotageksal". Analogues of the composition may have a different, but similar antiarrhythmic effect. As the main active substance, Sotagexal contains sotalol hydrochloride. In addition, it includes a small number of auxiliary components. Among them are cellulose, lactose monohydrate, corn starch, magnesium stearate and other binders.
The shelf life of tablets or injection is 5 years.
Sotagexal, analogues and release form
One tablet of this drug contains 40, 80 or 160 mg of the active substance. It is produced mainly in the form of white round tablets, on the one hand a little convex and with an extruded abbreviation SOT. On the back, the tablet is divided in half using risks for ease of dosage. Everything is packed in blisters of 10 pieces and cardboard packs. Each pack can contain from 1 to 10 blisters (from 10 to 100 tablets in total).
Sotagexal is also available in the form of a solution for intravenous injection. Each ampoule contains 4 ml of the drug. In 1 ml of solution is 10 mg of pure basic substance. The drug must be stored in a dark and dry place protected from sunlight, in which children have limited access.
Analogs with the active substance sotalol hydrochloride are made in tablets:
- "Sotaleks" (160 mg each).
- Soritmic (0.16 g each).
- "Sotalol Canon" (80 and 160 mg each).
- “Darob” (80 and 160 mg each).
- "Tensol" (80 and 160 mg each).
pharmachologic effect
"Sotagexal", analogues and synonyms of the drug have a pronounced antiarrhythmic effect. This is achieved due to their ability to block β-adrenergic receptors and inhibit potassium channels. The drugs increase the duration of the pulses and reflex periods of the atria, as well as the ventricles. They increase the tone of the smooth muscles of the bronchi and the muscle layer of the walls of blood vessels. Reduce myocardial contractility.
Sotalol hydrochloride has a whole range of properties. It has a negative chronotropic, dromotropic, batmotropic and inotropic effect of the German drug Sotageksal. Analogs, the composition of which is identical, may have another trade name. They are also able to reduce heart rate and their strength. Due to this, the need for oxygen consumption by the myocardium is significantly reduced. And as a result, the load on the heart decreases.
Suction and excretion of the drug
The absorption of the drug occurs quickly. Its bioavailability is 90%, and absorption is about 80%. After 2.5-4 hours after administration in plasma, the maximum concentration of the active substance is reached. And after intravenous administration, the effect manifests itself after 5-10 minutes. Absorption occurs 20% better and faster if you take the medicine on an empty stomach. Due to the fact that the solubility of the substance in fats is very low, sotalol hydrochloride cannot be taken simultaneously with dairy products and animal fats.
Without contacting blood proteins, the drug is distributed evenly in tissues and peripheral organs for 3-4 days of regular intake. Then a positive effect is achieved with hypertension. In the cerebrospinal fluid, the concentration of the drug is not more than 20%. The action after the injection lasts up to 2 hours. Up to 12 hours, the effect persists after oral administration of Sotagexal tablets. Analogues of the drug, which contain sotalol hydrochloride, are also not subject to metabolism and are excreted through the kidneys with urine (up to 90%) and with feces on average after 10-20 hours.
That is why patients with impaired functioning of the kidneys and urinary system are shown taking the drug in a lower dosage. In older people, age-related impairment of kidney function is often observed. This contributes to the fact that the substance is excreted at a lower rate and can accumulate in the body. Therefore, the drug is prescribed with caution to this group of patients, and its dosage is determined individually.
The medicine contributes to the normalization of oxygen metabolism in tissues, eliminates increased nervous excitability, anxiety, stress and other factors affecting the frequency and intensity of heart contractions.
Sotagexal: instructions for use
Analogues of the drug and the drug with the original name are used for symptomatic violations of the heart rhythm, for the treatment of ventricular extrasystole. But the effect is different in patients with similar diagnoses. Therefore, it should be prescribed by a doctor after a thorough examination and strictly according to indications.
Rarely, the drug is used to treat patients who have suffered scaly lichen (psoriasis) or have diabetes with impaired carbohydrate metabolism. It is prescribed with caution to people who have a history of allergy, the Sotagexal agent. Its analogs are also able to suppress the sensitivity of the body to allergic irritants. Gently, the medicine is used in the treatment of people with heart failure, prone to frequent depression. Patients who have had myocardial infarction run the risk of exacerbating arrhythmia while taking Sotageksal.
Dosage and treatment period
Depending on the severity of the disease, the duration of therapy with Sotagexal is also determined. Instructions for use (analogues may have other instructions for admission) contains the following recommendations:
- swallow the tablet whole without chewing and drinking plenty of water;
- reception is carried out 1-2 hours before a meal;
- the drug is taken 2-3 times a day.
At the beginning of treatment, the daily dose should not exceed 80 mg (1 tablet) for hypertension and tachycardia. However, in the absence of the desired therapeutic effect, the dose is increased. Gradually, with an interval of 2-3 days, it is brought up to 240-320 mg per day, but only in a hospital setting. The most effective is considered a phased increase in dosage by 80 mg per week.
The maximum dose may be 6 tablets per day of Sotagexal. Analogs, the dosage of which can also be increased, if the doctor considers it necessary, are assigned individually. Even if there is a threat to life, the total amount of active substance should not exceed more than 480 mg per day.
If the patient has functional impairment of the kidneys, the treatment regimen is selected depending on the size of creatinine clearance. With its increase (up to 30 mg / min), the dose is usually reduced by two to four times.
Intravenous injections are done twice a day, dividing the ampoule into two injections of 2 ml. The solution is injected slowly over 5-7 minutes. During treatment, control of blood pressure, pulse, kidney and urinary system, and creatinine clearance in blood serum is mandatory.
Indications
The drug is prescribed for the treatment of such diseases:
- ventricular tachycardia;
- Wolff-Parkinson-White syndrome;
- cardiomyopathy;
- ventricular extrasystole;
- mitral valve prolapse;
- atrial paroxysmal atrial arrhythmia ;
- arterial hypertension (high blood pressure);
- prevention and treatment of myocardial infarction (in some cases).
In severe renal impairment, the doctor must constantly monitor the concentration of the active substance in the blood serum and adjust the dose of the drug “Sotageksal”. Analogs of indications for reception are similar. But, despite this, it is strictly forbidden to independently replace one drug with another. Cancellation of treatment should not occur immediately, but gradually. A sharp cessation of admission can lead to a worsening of the clinical condition.
Contraindications
Any antiarrhythmic drug may not always be prescribed to the patient, including Sotagexal. Analogs of contraindications are the same, they can not be used in the presence of the following conditions:
- hypersensitivity or individual intolerance to the main substance or auxiliary components;
- weak sinus angle;
- marked reduction in heart rate (bradycardia);
- chronic obstructive processes in the lungs;
- severe form of bronchial asthma;
- renal failure;
- acute myocardial infarction;
- acute or chronic heart failure;
- cardiogenic shock;
- extended QT interval syndrome;
- childhood;
- allergy, allergic rhinitis;
- pregnancy and breastfeeding;
- low blood pressure (arterial hypotension);
- general anesthesia;
- gangrene;
- pathology of peripheral vessels;
- development of the Pirouette type of tachycardia (the condition is diagnosed more often in women than in men).
There is no sufficient experience with the use of the drug during pregnancy. Only for vital indications, Sotagexal is prescribed. Analogs in the first trimester also pose a threat to the life of the fetus, and their use can lead to an abortion. There are still no reliable research data on the administration of the drug in women bearing a child.
In the last months, therapy is gradually canceled 2–4 days before the expected birth if the woman has taken it throughout the entire period of pregnancy. This is done so that the newborn does not experience respiratory depression, bradycardia or arterial hypotension due to the Sotagexal preparation.
Analogs based on sotalol hydrochloride must be stopped if a young mother is breastfeeding, since the substance has the ability to penetrate into breast milk and reach high concentrations there. If, according to the indications, treatment should be continued, then breastfeeding should be stopped by replacing milk with adaptive mixtures corresponding to the age of the child.
Side effect and overdose
It may have undesirable effects on the part of the cardiovascular, endocrine, genitourinary, respiratory, digestive and central nervous systems long-term use of the drug Sotageksal. Analogs side effects cause similar. The patient may experience:
- shortness of breath, increased attacks of angina pectoris, symptoms of heart failure, heart pain, angiospasm, Raynaud's syndrome;
- nausea, vomiting, diarrhea, stomach pain, increased gas, bloating, obstructed bowel movements, dry mucous membranes of the mouth;
- anxiety, anxiety, panic states, hallucinations, impaired coordination of movements, hearing, sudden changes in mood, tremor, fatigue, headache, dizziness, lack of sleep or, conversely, increased drowsiness, anxious dreams, depression;
- conjunctivitis, keratoconjunctivitis or dry eye syndrome (especially in patients who constantly wear contact lenses), inflammation of the cornea, decreased taste and smell, eye pain, photophobia, visual impairment, hearing impairment;
- hypoglycemia (in people with diabetes);
- bronchospasm, laryngitis, tracheitis;
- urticaria, dermatoses, itchy skin, redness, psoriasis, Quincke's edema, increased sweating;
- in men, a decrease in potency, pain during ejaculation, in women, a decrease in libido and a menstrual cycle;
- fever, muscle weakness, cramps, cyanosis of the limbs.
In case of an overdose, you may experience:
- oppression of cardiac functions;
- labored breathing;
- asystole, fainting, weakness, dizziness;
- limb cyanosis;
- muscle cramps;
- bradycardia until the heart stops completely;
- cardiovascular shock;
- bronchospasm;
- tachycardia.
Despite such serious symptoms of an overdose, death is quite rare. In case of drug poisoning, it is first necessary to stop taking Sotagexal. Analogs and generics of sotalol hydrochloride are effectively excreted from the gastrointestinal tract after taking absorbing drugs. In case of an overdose, symptomatic therapy is indicated. In case of serious poisoning, it is necessary to rinse the stomach and induce vomiting, maintaining the functions of internal organs that are important for life. Excessive doses are completely eliminated by hemodialysis. A metabolic decrease in blood sugar can be observed in those patients who adhere to a strict diet or starve.
Analogs and generics of Sotageksala
Sotalol hydrochloride is contained in a preparation made in Switzerland and Germany under the trade name Sotagexal. Its analogs are also represented by other drugs with a different composition, which, in addition to the antiarrhythmic effect, relieve muscle cramps, reduce pressure and improve atrial function. These include:
- "Anaprilin", "Inderal", "Obzidan", "Pranolol" (the active substance is propranolol) are used to treat ischemia, arrhythmia and hypertension.
- "Pumpan" is a homeopathic remedy based on herbal ingredients.
- "Magnerot" contains magnesium orotate dihydrate, is used to treat atherosclerosis, in case of lipid metabolism disorders.
- Corvitol (metoprolol tartrate) is effective for migraines.
- "Nebilet" (nebivolol hydrochloride) is prescribed for hypertension, coronary artery disease.
- Kudesan (drops) is a biological supplement based on coenzymes Q10 for the prevention and treatment of arrhythmia.
- "Etatsizin" (ethatsizin) is used for tachycardia;
- "Arrhythmil", "Amiodarone" (amiodarone hydrochloride) are used for cardiac arrest, tachycardia, atrial arrhythmias.
- "Propanorm" (propafenone hydrochloride) is used for ventricular and supraventricular extrasystoles.
- "Neo-Giluritmal" (primalia bitartrate) is prescribed for ventricular arrhythmia, tachycardia.
- "Korgard" (nadolol) is taken for the treatment of angina pectoris, migraine.
In Russia, Sotalol Canon and Tenzol are produced with the same active ingredient as Sotageksal. Analogues in Moldova, Ukraine and neighboring countries are easier to find in pharmacies than the original medicine. The cost of drugs depends on the country and company of the manufacturer. Domestic drugs, as a rule, have a price significantly lower than foreign ones.
Reviews
There is a significant decrease in the frequency of seizures with atrial fibrillation, if you take Sotageksal constantly. Analogues patient reviews are not so positive. Not always drugs from different manufacturers act similarly, even if they have the same composition. Many fear that unscrupulous manufacturers indicate a higher concentration of the active substance in one tablet than it actually is. Because of this, treatment may not bring the expected results. Reviews about Sotageksal, on the contrary, are more positive. It is effectively used in the complex treatment of heart and vascular diseases at different stages.
In most cases, there is a gradual improvement in the general condition of patients with complex treatment. The drug is indispensable both for stopping attacks and for prevention. Judging by the reviews of patients diagnosed with paroxysmal arrhythmia, the medicine helps to maintain normal heart rhythm (provided that it is taken continuously as maintenance therapy). However, patients note that they would not dare to independently raise the dose without the advice of a doctor because of the risk of serious side effects.
Some reviews do not have a very positive effect on the reputation of the medicine. It is believed that it is advertised and will not be able to cure anemia, microbial rhythm disturbances, hypokalemia and hypomagnesemia. It is noted that sotalol hydrochloride of foreign brands is difficult to find in domestic pharmacies. People who are accustomed to constantly use the tool have difficulty acquiring it. Therefore, before starting therapy, you should make sure that it will be possible to continue it for a long time.
What can not be combined with the reception of "Sotageksal"
It is advisable for patients to refuse to drive a car, ride a bicycle, or a motorcycle for the treatment period. Also dangerous are all types of activities that require increased attention, psychomotor concentration and concentration. When taking additional funds to reduce pressure, there is a possibility of hypotension. It is forbidden to combine Sotagexal with such medicines:
- insulin, since its content in the blood rises already;
- calcium ions and antagonists;
- agents for general or inhalation anesthesia;
- MAO inhibitors;
- iodine-containing substances;
- diuretics;
- ergot alkaloids;
- tetracyclic antidepressants.
The medicine is not prescribed simultaneously with antiarrhythmic drugs of I and III class. The use of narcotic drugs, sedatives and antihistamines, antipsychotics, coumarins, relaxants is also contraindicated. They further contribute to the suppression of the central nervous system. Simultaneous anesthesia leads to an increase in blood pressure and inhibits myocardial tissue. It is forbidden to do skin tests to determine the types of allergens. This increases the risk of anaphylactic shock, Quincke edema, and asphyxiation.
The drug "Sotageksal" is available in pharmacies by prescription. Self-treatment of arrhythmias with this remedy can cause serious adverse reactions. Therefore, before taking the medicine, you should definitely consult a doctor.