Today, many specialists prescribe Isoket vasodilator spray to patients for prophylactic purposes or, if necessary, stopping an attack of angina pectoris.
This medicine has an extensive list of different indications for use. It is successfully used in the treatment of cardiovascular pathologies, including for the fight against acute conditions.
Pharmacology
The active substance of this angina pectoris medicine has pronounced vasodilating and vasodilating properties. Isosorbide dinitrate stimulates the formation of nitric oxide in the body and reduces oxygen demand and energy of the heart muscle, thereby reducing the load on the myocardium. It effectively reduces pressure in the pulmonary circulation, weakens blood flow to the right atrium, reduces the tension of the walls of the heart ventricles, lowering diastolic pressure and improving systolic function in them. The drug does not affect the frequency of contractions of the heart and well dilates cerebral vessels. It can also increase the vessels of the dura mater and the brain itself, thereby causing pain in the head.
The tool affects the redistribution of coronary blood flow in the area where blood circulation is reduced. With
coronary heart disease (coronary heart disease) and angina due to the action of the drug in patients, it becomes possible to increase permissible physical activity.
The Isoket spray is rapidly absorbed over the entire area of the oral mucosa, so the effect of its use occurs after 30 seconds and lasts up to 120 minutes. Due to its speed, it is often prescribed to patients for relief of emergency acute conditions.
Release form
The drug is a clear solution that has no color and has an alcohol smell. It is available in two varieties:
- Spray "Isoket" sublingual and metered. With one click on the dispenser, one dose is released in the form of tiny drops, which consists of 1.25 mg of the active ingredient - isosorbide dinitrate, as well as auxiliary elements: ethanol and macrogol 400. The aerosol does not contain freon, therefore, it refers to harmless preparations for the environment. Available in transparent 15 ml bottles, packed in a box with a dispenser and instructions. A glass bottle, designed for 300 clicks (doses), allows you to monitor the amount of the drug and timely purchase a replacement.
- A solution in the form of a concentrate intended for infusion. In 1 ml of this drug contains 1 mg of the active element of isosorbide dinitrate and additional substances: sodium chloride, sodium hydroxide, water. In one ampoule - 10 ml of solution for infusion. Available in cardboard packs of 10 pieces each.
Indications for use
Spray "Isoket" is prescribed by specialists for angina attacks of all forms and as a preventive measure to avoid them. It is also recommended for post-infarction conditions, acute myocardial infarction, increased tolerance in IMS, and therapy for coronary artery spasm. Aerosol "Isoket" is successfully used as a medicine for heart failure in the left ventricle.
According to the instructions, a concentrate for infusions is prescribed to patients with such pathologies of the cardiovascular system:
- unstable angina that occurs in a pre-infarction state or preceding myocardial infarction;
- vasospastic angina pectoris;
- acute myocardial infarction caused by failure of the left ventricle of the heart;
- coronary spasm during surgical interventions;
- heart failure of all kinds;
- acute left ventricular heart failure;
- pulmonary edema.
Aerosol uses
The drug in the form of a spray is sprayed into the patient's oral cavity, due to which it quickly enters the bloodstream. Each injection provides a single dose of the drug inside. Instructions for use indicate various ways of using the medication, depending on the symptoms.
In order to stop an angina pectoris, breathing is held before an upcoming physical or emotional stress that can cause an exacerbation, and the patient receives from 1 to 3 doses with an interval of 30 seconds between injections. Increasing the dosage without the supervision of a specialist is prohibited.
In case of suspected exacerbation of heart failure or acute myocardial infarction, the patient receives from 1 to 3 doses of the drug under strict control of both heart rate and blood pressure. If improvement has not occurred, then the procedure is repeated after five minutes by decision of the doctor. In the next ten minutes, the condition should stabilize. Otherwise, you can repeat the manipulation again under the supervision of a doctor.
Before the treatment procedure for the relief of coronary spasm (in the case of diagnostic or therapeutic catheterization), the patient is prescribed 1-2 injections. If necessary, the dosage can be repeated, but subject to monitoring of blood circulation.
Special recommendations for using the spray
In cases when a new aerosol is used for the first time, or after the last dose more than 24 hours have passed, it is recommended that the first press be directed into the air, as it may not contain the necessary dosage. To obtain a dose in accordance with the instructions, the atomizer is pressed continuously to the end and then released. During use, the spray bottle must be up and upright.
Care should be taken to prevent splashes in the eyes. During the entire treatment period, constant monitoring of blood pressure (BP) and an ECG are necessary. The value of blood pressure should not be less than 100 mm RT. Art. Abrupt withdrawal of the drug is prohibited by the instructions, so the prescribed doses are reduced gradually. Alcoholic beverages are contraindicated when taking Isoket aerosol.
Reviews of experts indicate that a high dosage of the drug, its frequent use or systematic use can lead to the development of tolerance in the patient. This feature also develops when using other drugs containing nitrates. In such situations, doctors recommend abolishing the use of the drug for 2-3 days, and after a course of regular therapy lasting 3-6 weeks, pause for 3-5 days, and replace it temporarily with other drugs of a similar effect. In most cases, after a break or cancellation of therapy, the patient's sensitivity recovers quite quickly. The components of the drug are excreted in the form of metabolites by the kidneys in almost full volume.
Dosage and use of solution
According to the instructions in the instructions, the drug "Isoket" (solution for infusion) is used intravenously. The dosage is prescribed by the attending physician individually, taking into account the hemodynamic and clinical parameters of the patient. Therapy should be started with low doses and slowly increasing, adjusted to the required amount. The recommended dosage is 2-7 mg / h, respectively, the average dose is about 7.5 mg / h. In cases of special need, the volume can be increased to 10 mg / h.
In most cases, people with heart failure need higher doses of the drug. The introduction of the drug should take place in a hospital treatment under the supervision of a specialist and using automatic systems for infusion. The whole procedure is accompanied by monitoring of blood circulation (blood pressure and heart rate).
The solution for intravenous administration is prepared under sterile conditions immediately before the procedure. The drug is stored for no more than 24 hours. Cooking Methods:
- for a concentration of 0.01% (100 μg / ml) - from 50 ml of a 0.1% drug can produce 500 ml of the drug, ready for administration;
- for a concentration of 0.02% (200 μg / ml) - from 100 ml of a 0.1% drug, you can make 500 ml of the drug, ready for administration.
Contraindications and Precautions
The drug is not prescribed for patients with hypersensitivity to nitrate compounds, as well as other elements of the Isoket aerosol. Application is also prohibited if the patient has the following diseases:
- severe hypotension, in which the value of systolic pressure falls below 90 mm Hg;
- vascular insufficiency in the acute stage, for example, with shock or vascular collapse;
- pericarditis and pericardial tamponade;
- with cardiogenic shock in cases where it is not possible to adjust the pressure in the left heart ventricle in another way;
- hypertrophic cardiomyopathy;
- angle-closure glaucoma.
In addition, the drug is not prescribed to persons under eighteen years of age. Instructions for use recommend the use of the medication with extreme caution and with constant monitoring in such cases:
- acute myocardial infarction in the presence of a patient with reduced filling pressure of the left heart ventricle;
- increased intracranial pressure;
- mitral and / or aortic stenosis;
- detection in a patient of the likelihood of an orthostatic disorder in the regulation of blood circulation;
- renal or liver failure.
Pregnancy and lactation
Scientists in the development of the drug conducted animal studies. The experiment on the subjects showed that no damaging effect on the fetus is produced.
However, during pregnancy and during the lactation period, aerosol administration is recommended only in situations where the intended benefits for the woman will significantly exceed the potential risk to the fetus or infant. Treatment in these cases should be carried out under the strict supervision of specialists who monitor blood circulation (blood pressure and heart rate), as well as the general condition of the patient.
Interaction with other medicines
The joint use of vasodilators and the drug "Isoket" (spray) is prohibited. Their use in combination can cause an increase in the hypotensive effect. The same consequence entails the simultaneous administration of Isoket aerosol and such medications: antihypertensive agents, calcium channel blockers, Quinidine or Novokainamide, antipsychotics, phosphodiesterase-5 inhibitors.
It is possible to enhance the antianginal effect when used in conjunction with drugs such as Amiodarone, Propranolol, Nifedipine, Verapamil, and with other calcium delayed channel blockers.
An increase in intracranial pressure in a patient may occur during combination therapy with atropine and other m-anticholinergic drugs.
An excessive decrease in blood pressure, leading to coronary perfusion, appears under the influence of alpha-blockers and sympathomimetics.
Side effects and reviews
The instructions describe the mass of side effects that can be caused by the drug "Isoket" (spray). Reviews of some patients who took this medication indicate the appearance of headaches, which in medicine are called "nitrate". As a rule, after 2-3 days the problem disappears on its own and does not require correction. Quite rarely, a medication can cause phenomena such as nausea, redness of the skin, vomiting, and dry mouth.
Some patients receiving the medication for the first time complain of general weakness, dizziness, decreased blood pressure, and a feeling of lethargy. This is caused by small disturbances in the functioning of the cardiovascular system. They occur during initial use or when exceeding the recommended dosage.
However, according to reviews, patients noticed the effectiveness of the drug. And when taken in accordance with the prescription of a specialist, side effects do not occur so often. The exception is a headache in the first days of use, which accompanies most cases, but, as a rule, disappears in a few days.
Exceeding Maximum Volume
An overdose of this medication can cause a number of serious deviations: fainting, collapse, high intracranial pressure, hyperthermia, cramps, visual disturbances, increased sweating, methemoglobinemia, bradycardia, paralysis, and coma. That is why it is important not to self-medicate the heart, but to take the drug strictly according to the instructions of a specialist!
With the described symptoms, drug withdrawal and therapy aimed at stabilizing the patient's condition are required.
Analogs
The drug “Cardiket” (CHWARZ PHARMA, Germany) is one of the common generics (analogues) of the drug “Isoket” (spray). The price of this substitute depends on the concentration of the active substance and the number of pills in the package.
For example, the drug in 20 mg tablets “Cardiket Retard” (20 pcs. Per pack) costs from 62 to 72 rubles, and the same drug, only with a dosage of 40 mg tablets and an amount of 50 pieces, has a cost of 210-220 rubles.
The Nitrosorbide medication group, manufactured by several Russian companies and having various forms of release, is also a substitute for the Isoket medication. The analogs of this group have the following names: “Nitrosorbide-Rusfar”, “Nitrosorbide”, “Nitrosorbide N.S.”, “Nitrosorbide-UVI”.
Cost
In Russian pharmacies, you will have to pay from 365 to 470 rubles for one dosed Isoket drug (spray). The price is formed depending on the location of the outlet and its status. On sites selling drugs, it can be purchased at a lower cost than in a regular pharmacy near the house. But when ordering via the Internet, you will have to pay about 200 rubles for delivery or get the tool for free at the pick-up point, which is not always geographically conveniently located.
Also, in any pharmacy, you can purchase a package (10 ampoules) of concentrated Isoket infusion solution. The price for it ranges from 906-980 rubles.
General information
The drug was produced by the German company "USB Pharma GmbH." Shelf life is five years. The condition for the sale is a doctor’s prescription. In case of prolonged interruption in use, it is recommended to check the operation of the sprayer. An arrow is drawn on the bottom of the aerosol label. When the liquid reaches its level, you should purchase a new drug, since the use of an existing bottle is possible only with a slight slope, in which the suction tube is immersed in the liquid.