"Isoptin": instructions for use, reviews, analogues

In the article, we consider the instructions for use for the drug "Isoptin". This is a pharmacological agent that has a hypotensive, antiarrhythmic, antianginal effect. It is used to treat arrhythmia, angina pectoris and lowering blood pressure.

Release Forms

The medicine is available in 3 forms:

1. 40, 80 mg tablets.
2. Tablets SR (retard) 120 and 240 mg.
3. Ampoules with a solution for intravenous administration of 2 ml.

Consider these dosage forms in more detail:

1. In the form of tablets. Each tablet is film-coated, biconvex, has a round shape and white color. It happens in two dosages - 40 mg and 80. Instructions for use with "Isoptin" are in each pack.

In the first case, the inscription "40" is on one side of the tablet, and the engraving of the triangle is on the other. Tablets with a dosage of 80 mg on one side contain the inscription ISOPTIN 80, and on the other side there is an engraving of KNOLL and the risk for division. Tablets of any dosage are packaged in blisters of 10 and 20 pieces. Each cardboard pack may contain a different number of blisters.

As indicated by the instructions for use with Isoptin, each tablet contains 40 or 80 mg of verapamil hydrochloride as an active ingredient. As auxiliary ingredients are used: magnesium stearate, croscarmellose sodium, colloidal silicon dioxide, microcrystalline cellulose, calcium hydrogen phosphate dihydrate. The film membrane is made of titanium dioxide, macrogol 6000, talc, hypromellose, sodium lauryl sulfate.

2. Tablets CP (retard). According to the instructions for use with Isoptin SR 120 and 240 mg, the active ingredient in the drug is verapamil hydrochloride. Other components are: hypromellose, magnesium stearate, povidone, titanium dioxide, wax, talc, etc.

3. In the form of a solution, it is intended for intravenous administration. Means of color does not have, is transparent. The solution is packaged in ampoules of 2 ml. Each cardboard pack can contain 1 blister or a pallet containing 5, 10, 50 ampoules. Each ampoule of the solution contains 5 mg of verapamil hydrochloride. Auxiliary components are: injection water, sodium chloride, hydrochloric acid.

Indications for use

In accordance with the instructions for use, "Isoptin" in tablets is indicated for use in the treatment of diseases such as:

1. Supraventricular therapy of paroxysmal type.
2. Arterial hypertension.
3. Atrial flutter (flickering), accompanied by tachyartymia (with the exception of Wolf-Parkinson-White and Laun-Ganong-Levin syndromes).
4. Coronary heart disease, including unstable angina pectoris, chronic stable, Prinzmetal angina pectoris (caused by vasospasm).

According to the instructions for use, the Isoptin solution for intravenous administration is indicated in the treatment of supraventricular arrhythmia. He is appointed if there are the following indications:

1. In order to restore sinus rhythm, if a patient has supraventricular therapy of a paroxysmal type. Including in conditions associated with the presence of an additional pathway - Wolf-Parkinson-White syndrome, Launa-Ganoga-Levin.
2. Monitoring the frequency of ventricular contractions, if atrial flutter and flickering is observed, except in situations in which they are due to the presence of an additional pathway.

Contraindications

Instructions for use, Isoptin is not recommended for use:

1. In the presence of hypersensitivity to any of the components in the composition of the drug.
2. Under the age of 18 years. This prohibition is due to the lack of sufficient data on the effectiveness and safety of the drug in the treatment of patients of this age group.
3. In the presence of flutter or atrial fibrillation due to additional routes.
4. In a syndrome characterized by weak sinus node (with "tachycardia-bradycardia", with the exception of patients who have an artificial pacemaker).
5. With AV blockade in the second and third degree (with the exception of patients who have an artificial pacemaker).

According to the instructions for use with Isoptin tablets, there are also a number of additional contraindications, in the presence of which they should not be taken:

1. Concurrent use of colchicine.
2. The presence of cardiogenic shock.
3. The presence of acute myocardial infarction, complicated by pronounced left ventricular failure, bradycardia, arterial hypotension.
4. Chronic heart failure.

What else can you learn from the instructions for use with Isoptin in ampoules? Among the additional contraindications that prevent the use of a solution intended for intravenous administration, are indicated:

1. Period of pregnancy.
2. Concurrent use of beta-blockers in the form of solutions for intravenous administration.
3. Lactation period.
4. The use of disopyramide for two days before the introduction of "Isoptin".
5. Heart failure in a chronic form and is in the second or third stage (with the exception of chronic heart failure, which is provoked by supraventricular tachycardia and requires treatment with verapamil).
6. Ventricular tachycardia, in which wide QRS complexes are observed, constituting more than 12/100 seconds.
7. Sinoauricular block.
8. Morgagni-Adams-Stokes disease.
9. Cardiogenic shock, with the exception of it against the background of arrhythmia.
10. Arterial hypotension.

With caution, any form should be used in the first degree of AV blockade and in bradycardia.

Caution should also be exercised when taking the oral form of the medication if the patient has liver and kidney disorders, arterial hypotension, pathologies of neuromuscular transmission (including Lambert-Eaton syndrome, myasthenia gravis, Duchenne muscular dystrophy).

It is important to observe caution with intravenous administration if the patient is in old age and has diseases such as insufficiency of the kidneys or liver, myocardial infarction, accompanied by left ventricular failure, severe aortic stenosis, and heart failure. This confirms the instructions for use for the drug "Isoptin".

Dosage and administration

The tablet “Isoptin” should be taken orally as a whole, avoiding resorption, chewing, and grinding. It is necessary to wash down with water. The preferred time for taking the pills is directly with food, or immediately after it.

Isoptin is used according to a scheme determined individually taking into account the clinical picture of the pathology and its severity.

On average, for any indication, the daily dosage of the drug is from 240 to 480 mg. If the therapy is long, then a dosage of 480 mg is undesirable. The maximum daily dose can be taken exclusively in stationary conditions.

Therapy should be started with a minimum dosage of 40-80 mg, it is necessary to take the drug three or four times a day.

A single initial dosage for patients with functional renal impairment may not exceed 40 mg. Instructions for use with "Isoptin" indicates that in this case the drug is used twice or three times a day. Next, the dose is selected by the doctor individually based on the reaction of the patient.

The Isotine solution can be used exclusively for intravenous administration. It must be administered slowly, while monitoring blood pressure and ECG for at least the first two minutes (three minutes when administered to elderly patients). This will reduce the risk of adverse reactions.

The initial dosage of the solution may be 5-10 mg. If the answer is inadequate, then repeated administration after 30 minutes is allowed.

Isoptin Retard Tablets

Isoptin CP has a longer duration of action than conventional tablets. Instructions for use with "Isoptin" 120 and 240 mg confirms this.

So, this medicine has the following advantages:

• Improves the quality of life of patients with arterial hypertension.
• Effectively at least 24 hours.
• Normalizes the vital rhythm: sleep-wakefulness, body temperature, blood pressure.
• Reduces the activity of the sympathetic nervous system, due to which patients have normalized pulse, respiratory rate, blood sugar, insulin.
• Does not affect the metabolic process. That is, the drug does not upset the metabolism.
• Reduces the aggregation ability of platelets, thereby preventing deterioration in hypertension.

This drug should be prescribed when:

• Arterial hypertension is combined with type 2 diabetes.
• Together with hypertension, coronary heart disease is observed.
• There is stable angina pectoris and patients should not be prescribed beta-blockers.
• Together with hypertension, a violation of lipid metabolism is observed.

Instructions for use with "Isoptin" 240 mg reports that you need to take them after a meal, be sure to drink a glass of water. Depending on the type and severity of the disease, the patient may be prescribed a different dosage - from 120 to 360 mg per 1 time.

The drug can be taken continuously, but then the daily dose of the drug should not exceed 2 tablets. Typically, the specialist prescribes the patient to take the drug in the morning at a dosage of 120 mg or 240. The instructions for use with Isoptin contain such information. Additional reception is possible only in the evening.

Side effects

According to the instructions for use and reviews of Isoptin, various undesirable effects characteristic of any form of the drug and manifested by various organs and systems can develop during therapy. Among them:

1. Allergic manifestations are expressed by the development of multiforme exudative erythrem, hyperemia of the skin on the face, skin rash, itching, bronchospasm, Stevens-Johnson syndrome.
2. On the part of the NS, fatigue, excessive nervous excitability, lethargy, paresthesia, tremors, seizures with the administration of the drug, dizziness, drowsiness, headache, anxiety, depression, general weakness can be observed. The occurrence of extrapyramidal disorders, such as tremors of fingers and hands, difficulty swallowing, a masky face, shuffling gait, ataxia, stiffness of the limbs, is not excluded.
3. On the part of the CVS, negative reactions such as severe bradycardia, angina pectoris (capable of provoking myocardial infarction, in particular in patients with severe obstructive lesions of the coronary arteries), arrhythmia (including ventricular fibrillation and flutter), inhibition of the sinus node, tachycardia, may occur palpitations, symptoms of heart failure due to the use of high doses (especially in patients predisposed to this), lowering blood pressure, ventricular block, redness of the face.
4. From the gastrointestinal tract, painful and uncomfortable sensations in the abdomen, intestinal obstruction and constipation, nausea and vomiting, diarrhea, increased appetite, gingival hyperplasia, increased activity of alkaline phosphatase and liver transaminases in the blood plasma can occur.
5. Among other undesirable effects: myalgia, joint pain, increased sweat, muscle weakness, galactorrhea, impotence, gynecomastia, hyperprolactinemia, fatigue, peripheral edema, pulmonary edema, asymptomatic thrombocytopenia, transient blindness, agranulocytosis, arthritis, weight gain.

If any of the side effects occurs, it is important to consult a doctor immediately.

Special instructions for use

Do not abruptly stop taking Isoptin. If it is necessary to complete the therapy, then the dosage of the drug should be reduced gradually until it reaches zero.

With the intravenous administration of the drug, a transient decrease in blood pressure may occur, which, most often, does not manifest itself clinically, but dizziness may develop against its background.

If Isoptin therapy is required for a patient with circulatory failure (with the exception of severe or arrhythmia), it must be compensated with cardiac glycosides and diuretics before starting. During treatment, patients with moderate to severe heart failure may exacerbate circulatory failure.

The solution does not contain bacteriostatic and antimicrobial agents, it must be administered intravenously and simultaneously.

The stability of Isoptin is maintained during the day (if it is stored in a place protected from ultraviolet radiation, and the temperature is not higher than 25 degrees Celsius) in the vast majority of parenteral solutions. After taking the required amount of solution, the remaining volume should be destroyed. Using it becomes unacceptable.

It is not recommended to dilute Isoptin with a solution of sodium lactate in bags of polyvinyl chloride. This will maintain the stability of the drug. Avoid mixing the drug solution with sulfamethoxazole, trimethoprim, hydralazine hydrochloride, albumin, amphotericin B.

In any solution, the pH of which is more than 6, precipitation of verapamil hydrochloride occurs.

Isoptin is able to influence the reaction rate and change it, thereby violating the ability to drive a car and complex mechanisms.

Interaction with other substances and medicines

The simultaneous use of Isoptin and inhibitors of the CYP3A4 isoenzyme provokes an increase in the concentration of verapamil in the blood plasma. When used in conjunction with the inducers of the indicated isoenzyme, the concentration of verapamil decreases. This should be considered if the patient requires complex therapy involving the use of these substances.

The simultaneous use of Isoptin with certain medications and agents does not exclude the occurrence of undesirable effects:

1. The combined use of Isoptin with antiarrhythmic drugs and beta-blockers provokes stimulation of the effect on the circulatory system. Increased hypotension, a decrease in heart rate, and the occurrence of AV blockade are not ruled out.
2. With the parallel use of Isoptin with other anti-hypertension drugs, there is an increase in the therapeutic effect of the latter.
3. Additive hypotensive effect may occur when combined with prazosin and terazosin.
4. Verapamil metabolism is suppressed if "Ritonavir" or another antiviral agent is used, as a result of which its concentration in the blood increases.
5. Joint use with quinidine causes hypotension, in patients with obstructive hypotrophic cardiomyopathy, pulmonary edema may develop.
6. Simultaneous administration with carbamazepine increases the level of its content in the blood, enhances its neurotoxicity.
7. The neurotoxicity of lithium preparations increases if used together with Isoptin.
8. There is a weakening of the hypotensive effect of the drug if taken in conjunction with Sulfinpyrazone and Rifampicin.
9. The effect of muscle relaxants is enhanced when taken concomitantly with Isoptin.
10. Joint use with drugs based on acetylsalicylic acid causes an increase in prothrombin time.
11. Simultaneous administration with ethanol provokes the accumulation of the latter in plasma.
12. With parallel therapy with Lovastatin and Simvastatin, their concentration in the blood increases.
13. If the patient is taking varapamil and needs treatment with drugs that inhibit HMG-CoA reductase, it should be started with the lowest therapeutic doses. Further, with a normal reaction of the body, the dosage can be increased. If the opposite situation occurs when the patient takes drugs that inhibit HMG-CoA reductase and he is shown to use verapamil, the doctor should adjust the dosage of the first. A similar tactic should be observed with parallel therapy with atorvastatin.

This is stated in the instructions for use with Isoptin.

Analogs

Analogs for therapeutic effects are drugs: Finoptin, Lekoptin, Isoprtin SR, Verogalid ER 240, Verapamil Darnitsa, Verapamil Hydrochloride.

It is strictly forbidden to replace the drug recommended by the doctor with its analogue. As a result, a serious danger to the body can occur.

We will not consider in detail instructions for use with Isoptin analogues.

Reviews

There are a fairly large number of reviews that indicate the high effectiveness of the drug in the treatment of cardiological pathologies.He has established himself well among specialists. Using it can significantly improve the quality of life of many patients.

However, people who underwent treatment using this drug, note a large number of contraindications and unwanted effects that appear when using Isoptin. In this regard, drug treatment should be carried out strictly in accordance with the recommendations of a specialist and under his close supervision.

We examined the Isoptin medication for instructions for use, reviews and analogues.