Cordaflex is a medicine for the treatment of cardiovascular disorders. Blood pressure regulator Kordaflex: instructions for use, price, analogues and reviews of effectiveness

Arena Pharmaceuticals GmbH/Egis pharmaceutical plant for Arena Pharmaceuticals GmbH/Egis pharmaceutical plant JSC Siegfried Ltd Egis JSC pharmaceutical plant Egis pharmaceutical plant JSC Egis Pharmaceutical plant JSC Egis Pharmaceutical plant JSC

Country of origin

Hungary Hungary/Switzerland Switzerland Switzerland/Hungary

Product group

Cardiovascular drugs

Blocker calcium channels

Release forms

  • 30 or 60 tablets in brown glass bottles, sealed with polyethylene caps with first opening control and equipped with an accordion shock absorber. 1 bottle along with instructions for use is packed in a cardboard box. 30 tablets in brown glass bottles, sealed with polyethylene caps with first opening control and equipped with an accordion shock absorber. 1 bottle along with instructions for use is packed in a cardboard box. Controlled-release film-coated tablets 40 mg. 10 tablets in a blister made of PVC/PVDC/alfoil. 1 or 3 blisters in a cardboard box along with instructions for use. Film-coated tablets, 10 mg. 100 tablets in a brown glass bottle. 1 bottle is placed in a cardboard box along with instructions for use.

Description of the dosage form

  • : round biconvex film-coated tablets, brown-red in color, beveled, odorless. biconvex round tablets, film-coated, brownish-violet in color with a matte or slightly shiny surface. Odorless or with a weak characteristic odor. Broken appearance: yellow along the edges with a narrow stripe of brownish-violet color. Biconvex round, matte or slightly shiny tablets, yellow color, with a weak characteristic odor

pharmachologic effect

The active ingredient of the drug Cordaflex® RD is nifedipine. Nifedipine is a selective blocker of “slow” calcium channels, a 1,4-dihydropyridine derivative. Has antihypertensive and antianginal effects. Reduces the flow of extracellular calcium ions into cardiomyocytes and smooth muscle cells of the coronary and peripheral arteries. In therapeutic doses, it normalizes the transmembrane current of calcium ions, disturbed by a number of pathological conditions, first of all, with arterial hypertension. Reduces spasm and dilates coronary and peripheral arterial vessels, reduces overall peripheral resistance, reduces afterload and myocardial oxygen demand. At the same time, it improves blood supply to ischemic areas of the myocardium without developing the “steal” syndrome, and also activates the functioning of collaterals. It has virtually no effect on the sinoatrial and atrioventricular nodes and does not have either pro- or antiarrhythmic action. Does not affect the tone of the veins. Nifedipine increases renal blood flow, causing moderate natriuresis. In high doses, it inhibits the release of calcium ions from intracellular stores. Reduces the number of functioning calcium channels without affecting the time of their activation, inactivation and recovery.

Pharmacokinetics

Absorption Nifedipine is rapidly and almost completely (90%) absorbed from the gastrointestinal tract after oral administration. The duration of the effect after a single oral dose exceeds 24 hours. During development active substance Cordaflex® RD has zero-order release kinetics to ensure a constant release rate. The relative bioavailability of the drug is about 60%. Maximum concentration(Cmax) in blood plasma is 29.4 ± 12.0 mg/ml (x ± SD); the concentration of the drug in the blood plasma reaches a plateau 7.4 ± 6.4 hours after taking each dose. Maximum levels of the drug in blood plasma are achieved when it is taken in combination with food. However, at the end of the dosing interval, the concentration of the drug in the blood plasma does not change. Distribution: The connection with blood plasma proteins (albumin) is 94-97%. Studies with labeled nifedipine in animals have shown that unbound nifedipine is distributed in all organs and tissues. Nifedipine concentrations were found to be higher in the myocardium than in skeletal muscles. There is no cumulative effect. Metabolism Nifedipine is mainly metabolized in the liver to inactive metabolites. Excretion 60-80% of the drug dose taken orally is excreted in the urine in the form of inactive metabolites, the remaining part is excreted in bile and feces. The half-life of nifedipine from blood plasma is approximately 2 hours. However, the release of the drug Cordaflex®RD is longer - up to 14.9 ± 6.0 hours in the equilibrium concentration phase. The concentration of the drug in the blood plasma reaches a minimum of 12.0±6.5 ng/ml 24 hours after administration, which is twice the concentration achieved after taking 20 mg of nifedipine 2 times a day. If renal function is impaired, the pharmacokinetics of nifedipine does not change (nifedipine is excreted in the urine in small quantities). With a significant decrease in liver function, the clearance of nifedipine is reduced, so it is not recommended to exceed the daily dose.

Special conditions

Do not take to relieve an attack of angina! Particular caution is required when prescribing Cordaflex® to patients with significant arterial hypotension (systolic blood pressure below 90 mmHg). The antihypertensive effect of Cordaflex® is enhanced by hypovolemia. For kidney disease, the dose of nifedipine does not need to be specified. Reduced pressure in pulmonary artery and hypovolemia after dialysis may enhance the effects of Cordaflex®, and therefore a dose reduction is recommended. Despite the absence of withdrawal syndrome with Cordaflex®, a gradual dose reduction is recommended before stopping treatment. Regularity of treatment is important, regardless of how you feel, since the patient may not feel the symptoms of arterial hypertension. The simultaneous administration of beta-blockers must be carried out under conditions of careful medical supervision, since this may cause an excessive decrease in blood pressure, and in some cases, aggravation of heart failure. It is not recommended to simultaneously administer IV therapy with beta-adrenergic blockers and intracoronary administration of nifedipine. During treatment it is possible positive results when performing direct Coombs reaction and laboratory tests for antinuclear antibodies. If during therapy the patient requires surgical intervention under general anesthesia, it is necessary to inform the anesthesiologist about the nature of the therapy being performed. Caution should be exercised in elderly patients due to the greater likelihood of age-related renal impairment. Caution is required when using Cordaflex® in patients with liver disease. For portal hypertension and cirrhosis, the dose should be reduced. In rare cases, chest pain (angina due to paradoxical ischemia) may occur at the beginning of a course of treatment with nifedipine or when its dose is increased soon after taking the drug. If a causal relationship is found between taking Cordaflex® and angina, the drug should be discontinued. Sick diabetes mellitus require close medical supervision while taking Cordaflex®. During the course of treatment with the drug, you should avoid drinking alcohol. Each tablet contains 30 mg of lactose monohydrate. This drug should not be prescribed to patients with lactase deficiency, lactose intolerance, or glucose-galactose malabsorption. Effect on the ability to drive vehicles During the treatment period, care must be taken when driving vehicles and engaging in other potentially dangerous species activities requiring increased concentration attention and speed of psychomotor reactions. Overdose: In addition to the side effects listed above, the following symptoms may occur, depending on the severity of intoxication: marked decrease in blood pressure, tachycardia, chest pain, fainting and loss of consciousness due to disturbances heart rate: oppression sinus node, bradycardia, prolongation of AV conduction, ventricular extrasystole; inhibition of insulin secretion. In more severe cases– confusion may occur, leading to coma, hyperkalemia, metabolic acidosis, hypoxia and cardiogenic shock with pulmonary edema. Treatment of overdose: There is no specific antidote for an overdose of nifedipine, therefore, first of all, measures should be taken to eliminate nifedipine and maintain function of cardio-vascular system. In case of overdose, as first therapeutic event gastric lavage should be performed, activated carbon; if necessary, with colon lavage. Complete removal unabsorbed nifedipine by gastric and colon lavage is especially important in case of overdose with sustained-release drugs in order to prevent further absorption. Laxatives can be prescribed, however, in the case of blockers of “slow” calcium channels, inhibition of intestinal motility up to atony should be taken into account. Nifedipine is not excreted by dialysis, therefore, hemodialysis is ineffective, however, plasmapheresis is recommended (given the high percentage of nifedipine binding to plasma proteins and the relatively small volume of distribution). As symptomatic treatment bradycardia, atropine and/or beta-agonists can be prescribed. At life threatening bradycardia, a temporary pacemaker should be installed. With a pronounced decrease in blood pressure due to cardiogenic shock and vasodilation of the arteries, calcium (1-2 g of calcium gluconate intravenously), dopamine (maximum 25 mcg/kg body weight/min), dobutamine (maximum 15 mcg/kg body weight/min) and epinephrine or norepinephrine. The dose of these drugs should be determined according to patient response. Serum calcium may be normal or slightly elevated. Additional fluid administration should be done with caution under the control of hemodynamic parameters to prevent cardiac overload.

Compound

  • 1 tablet contains: active ingredient - nifedipine 20 mg, excipients: tablet core: microcrystalline cellulose 99 mg, lactose monohydrate 30 mg, croscarmellose sodium 26 mg, methyl methacrylate and ethyl acrylate copolymer 1.9 mg, talc 2 mg, magnesium stearate 0.6 mg, hyprolose 0.5 mg; tablet shell: hypromellose 5.26 mg, titanium dioxide 1.64 mg, red iron oxide dye (E 172) 0.6 mg, magnesium stearate 0.5 mg. : 1 tablet contains 40 mg of the active substance - nifedipine, as well as excipients: cellulose, microcrystalline cellulose, lactose, hypromellose 4000, magnesium stearate, colloidal anhydrous silicon dioxide. The tablet shell contains: hypromellose 15, macrogol 6000, macrogol 400, red iron oxide E 172, titanium dioxide E 171, talc. : 1 tablet contains: active ingredient - nifedipine 20 mg, excipients: tablet core: microcrystalline cellulose 99 mg, lactose monohydrate 30 mg, croscarmellose sodium 26 mg, methyl methacrylate and ethyl acrylate copolymer 1.9 mg, talc 2 mg, magnesium stearate 0, 6 mg, hyprolose 0.5 mg; tablet shell: hypromellose 5.26 mg, titanium dioxide 1.64 mg, red iron oxide dye (E 172) 0.6 mg, magnesium stearate 0.5 mg. Each film-coated tablet contains active substance: nifedipine 10 mg, as well as excipients: polyvinyl butyral, magnesium stearate, talc, hydroxypropyl cellulose, croscarmellose sodium, lactose monohydrate, microcrystalline cellulose, titanium dioxide, yellow iron oxide, hypromellose.

Cordaflex indications for use

  • Arterial hypertension, including hypertensive crises Ischemic disease hearts: stable angina(angina pectoris), vasospastic angina (Prinzmetal angina)

Cordaflex contraindications

  • - acute stage myocardial infarction; - cardiogenic shock; - severe arterial hypotension (systolic blood pressure below 90 mm Hg); - severe aortic or mitral stenosis, idiopathic hypertrophic subaortic stenosis; - severe heart failure; - I trimester of pregnancy; - lactation period ( breastfeeding); - children's and adolescence up to 18 years old; - increased sensitivity to nifedipine and other components of the drug. Cordaflex® should be used with caution in chronic heart failure, hypertrophic obstructive cardiomyopathy, severe violations cerebral circulation, SSSU, severe tachycardia, with severe impairment of liver and/or kidney function, malignant arterial hypertension, in patients on hemodialysis (due to the risk of severe arterial hypotension against the background of peripheral vasodilation), with lactose intolerance, as well as in elderly patients .

Cordaflex dosage

  • 10 mg 10 mg, 5 mg 20 mg 20 mg 40 mg

Cordaflex side effects

  • The frequency of side effects is adjusted to the following categories: very common (? 1/10); often (?1/100 -

Drug interactions

Rifampicin is a powerful inducer of the CYP3A4 isoenzyme. When used simultaneously with rifampicin, the bioavailability of nifedipine is significantly reduced and, accordingly, its effectiveness is reduced. The use of nifedipine in combination with rifampicin is contraindicated (see section "Contraindications"). Since rifampicin and phenytoin - through enzyme induction - significantly reduce the plasma level of nifedipine, it cannot be excluded similar action barbiturates and carbamazepine. When taken simultaneously with others antihypertensive drugs (ACE inhibitors, diuretics, etc.), nitrates, psychotropic drugs and drugs containing magnesium may enhance the hypotensive effect. Simultaneous use with beta-blockers enhances the hypotensive and antianginal effects, which is generally beneficial; however, the use of such a combination of drugs requires special caution due to the possibility of an excessive decrease in blood pressure, the development of arterial hypotension and heart failure. At joint use Severe orthostatic hypotension may occur with prazosin. Concomitant use of nifedipine with digoxin may lead to increased plasma concentrations of digoxin. When used simultaneously with theophylline, the concentration of theophylline in plasma may increase. The use of nifedipine simultaneously with quinidine requires special caution, since when taken simultaneously, the concentration of quinidine in plasma may decrease, and when nifedipine is discontinued, it may increase: simultaneous use of these drugs can lead to the occurrence of malignant ventricular arrhythmia(pathological increase in the QT interval on the ECG). Diltiazem increases plasma concentrations of nifedipine. Nifedipine may increase the anticoagulant effect of coumarin derivatives. Since nifedipine is metabolized with the participation of the CYP3A4 isoenzyme, any inhibitor or inducer of this enzyme can alter the metabolism of nifedipine: Grapefruit juice, erythromycin, antifungal drugs from the azole group (for example, ketoconazole), some fluoroquinolones, norfloxacin, ciprofloxacin, oral contraceptives containing progestogen, and HIV protease inhibitors (for example, indinavir, ritonavir) can inhibit the metabolism of nifedipine and increase its effect. In a similar way, simultaneous administration of nifedipine and cimetidine increases its concentration in the blood plasma and, thus, the effect of nifedipine, however, the joint administration of ranitidine does not lead to a significant increase in the level of nifedipine in plasma. Cyclosporine is also a substrate for the CYP3A4 isoenzyme, therefore, when taken simultaneously, the duration of action of both drugs may increase. Simultaneous use nifedipine with weak and moderate inhibitors of the CYP3A4 isoenzyme requires regular monitoring of blood pressure and, if necessary, a reduction in the dose of nifedipine. These drugs include: macrolide antibiotics (azithromycin, which belongs to the macrolide group, is not an inhibitor of the CYP3A4 isoenzyme). Nifedipine reduces the excretion of vincristine, thereby increasing its side effects. The need to reduce the dose of vincristine should be considered. Concomitant use of cisapride and nifedipine may lead to an increase in the concentration of nifedipine in the blood plasma. Blood pressure should be monitored and, if necessary, the dose of nifedipine should be reduced. Concomitant use of quinupristin/dalfopristin and nifedipine may lead to increased plasma concentrations of nifedipine. Blood pressure should be monitored and, if necessary, the dose of nifedipine should be reduced. Clinical researches There were no interactions between nifedipine and valproic acid. Since it has been shown that valproic acid increases the plasma concentration of nimodipine, a structurally similar BMCC to nifedipine, due to inhibition of microsomal liver enzymes, the possibility of an increase in the concentration of nifedipine in the blood plasma cannot be excluded. The following drugs do not affect the pharmacokinetics of nifedipine: ajmaline, benazepril, debrisoquine, doxazosin, irbesartan, omeprazole, orlistat, pantoprazole, ranitidine, rosiglitazone, talinolol, triamterene/hydrochlorothiazide, acetylsalicylic acid and candesartan

The page contains instructions for use Cordaflexa. It is available in various dosage forms drug (tablets 10 mg, 20 mg retard, 40 mg RD), and also has a number of analogues. This abstract has been verified by experts. Leave your feedback on using Cordaflex, which will help other site visitors. The drug is used for various diseases(arterial hypertension or low blood pressure, angina pectoris, Raynaud's syndrome). The product has a number of side effects and interactions with other substances. Doses of the drug differ for adults and children. There are restrictions on the use of the medicine during pregnancy and breastfeeding. Treatment with Cordaflex can only be prescribed qualified doctor. The duration of therapy may vary and depends on specific disease. Composition of the drug.

Instructions for use and dosage regimen

The dosage regimen is set individually, depending on the severity of the disease and the patient’s response to the therapy.

For adults, Cordaflex in the form of film-coated tablets is prescribed 10 mg (1 tablet) 3 times a day. If necessary, the dose of the drug can be increased to 20 mg (2 tablets) 1-2 times a day. The maximum daily dose is 40 mg. The interval between doses of the drug is at least 2 hours.

To speed up the action of the drug at the beginning of an attack of angina or hypertensive crisis, the tablet should be chewed, held in the mouth for a while, and then swallowed with a small amount of water.

If it is necessary to increase the dose to 80-120 mg per day for the treatment of angina pectoris or arterial hypertension, it is recommended to transfer the patient to taking the drug in the form of extended-release tablets.

When carrying out a course of therapy, it is recommended to use Cordaflex in the form of prolonged-release tablets. The initial dose is 20 mg (1 tablet) 2 times a day with an interval of 12 hours. If necessary, the dose of the drug is gradually increased until the optimal clinical effect is achieved. For long-term maintenance therapy, as a rule, it is enough to take 20-40 mg (1-2 tablets) 2 times a day. The maximum daily dose is 120 mg.

At moderate violations liver or kidney function, no adjustment of the dosage regimen is required. In case of severe liver dysfunction, the maximum daily dose should not exceed 40 mg.

The drug in the form of tablets containing 10 mg of nifedipine is taken orally before meals, in the form of prolonged-release tablets - regardless of meals, without chewing, with a small amount of water.

Cordaflex RD

The dose should be selected individually, depending on the severity of the patient's condition and the effectiveness of treatment.

For arterial hypertension, Cordaflex RD is prescribed 40 mg (1 tablet) 1 time per day. If necessary, the dose can be increased to 80 mg (2 tablets in 1-2 doses). Dose increases beyond 80 mg are not recommended.

For ischemic heart disease, 40 mg (1 tablet) is prescribed once a day. If necessary, the dose can be increased to 80 mg (2 tablets in 1 or 2 doses). Doses greater than 80 mg can be given in exceptional cases under medical supervision. The daily dose should not exceed 120 mg.

The tablets should be taken with a meal (such as breakfast), swallowed whole and with plenty of water.

In case of impaired renal or liver function, the drug is recommended to be used with caution in the same doses as for normal function kidneys or liver. Tolerance may develop. If there is a significant decrease in liver function, the dose should not exceed 40 mg per day.

Compound

Nifedipine + excipients.

Release forms

Film-coated tablets 10 mg.

Extended-release, film-coated tablets 20 mg (retard).

Controlled-release film-coated tablets 40 mg (Cordaflex RD).

Cordaflex- selective blocker of slow calcium channels, a derivative of 1,4-dihydropyridine. Has antihypertensive and antianginal effects.

Nifedipine (the active ingredient of the drug Cordaflex) reduces the flow of extracellular calcium ions into cardiomyocytes and smooth muscle cells of the coronary and peripheral arteries. In therapeutic doses, it normalizes the transmembrane current of calcium ions, which is disturbed in a number of pathological conditions, primarily in arterial hypertension. Reduces spasm and dilates coronary and peripheral arterial vessels, reduces peripheral vascular resistance, reduces afterload and myocardial oxygen demand. At the same time, it improves blood supply to ischemic areas of the myocardium without the development of “steal” syndrome, and also increases the number of functioning collaterals.

Cordaflex has virtually no effect on the sinoatrial and AV nodes and does not have either pro- or antiarrhythmic effects. Does not affect the tone of the veins. Nifedipine increases renal blood flow, causing moderate natriuresis. In high doses, it inhibits the release of calcium ions from intracellular stores. Reduces the number of functioning calcium channels without affecting the time of their activation, inactivation and recovery.

After a single dose of Cordaflex, the duration of the effect exceeds 24 hours.

Pharmacokinetics

When taken orally, it is quickly and almost completely (more than 90%) absorbed from the gastrointestinal tract. Bioavailability - 40-70%. After oral administration of 1 tablet of prolonged action 20 mg (retard), the therapeutic concentration of nifedipine in the blood plasma is achieved after 1 hour and remains at a constant level for up to 6 hours (plateau of prolonged action), and gradually decreases in the next 30-36 hours. Binding to blood plasma proteins (albumin) is 94-97%. Unbound nifedipine is distributed in all organs and tissues. Penetrates the blood-brain barrier (BBB) ​​(less than 5%), through the placental barrier, excreted from breast milk. Does not accumulate. Nifedipine is extensively metabolized in the liver with the formation of 3 metabolites that do not have pharmacological activity. 60-80% of the dose of the drug taken orally is excreted in the urine in the form of inactive metabolites, the remaining part is excreted in bile and feces. In elderly patients, the metabolism of nifedipine in the liver is reduced.

Indications

  • arterial hypertension of various origins, including hypertensive crises (for tablets 10 mg);
  • IHD: to prevent attacks during various forms angina pectoris (stable and post-infarction), incl. angiospastic (Prinzmetal's angina);
  • Raynaud's syndrome (for extended-release tablets).

Contraindications

  • acute stage of myocardial infarction;
  • cardiogenic shock;
  • severe arterial hypotension (systolic blood pressure below 90 mm Hg);
  • severe aortic or mitral stenosis, idiopathic hypertrophic subaortic stenosis;
  • severe heart failure;
  • 1st trimester of pregnancy;
  • lactation period (breastfeeding);
  • children and adolescents up to 18 years of age;
  • hypersensitivity to nifedipine and other components of the drug.

special instructions

The antihypertensive effect of Cordaflex is enhanced by hypovolemia. A decrease in pulmonary artery pressure and hypovolemia after dialysis may also enhance the effects of the drug, and therefore a dose reduction is recommended.

In rare cases, at the beginning of a course of treatment with Cordaflex or when its dose is increased, chest pain (angina due to paradoxical ischemia) may occur soon after taking the drug. If a causal relationship is found between taking the drug and angina pectoris, treatment should be discontinued.

For hypertension or illness coronary vessels Abrupt withdrawal of nifedipine can cause a hypertensive crisis or myocardial ischemia (rebound phenomenon).

If during therapy the patient requires surgical intervention under general anesthesia, it is necessary to inform the anesthesiologist about the Cordaflex therapy being carried out.

Elderly patients are more likely to have decreased cerebral blood flow due to acute peripheral vasodilation.

During course treatment Cordaflex is not recommended for use alcoholic drinks due to the risk of excessive reduction in blood pressure.

Impact on the ability to drive vehicles and operate machinery

During the initial, individually determined period of use of Cordaflex, driving vehicles and engaging in other potentially hazardous activities that require rapid psychomotor reactions are not allowed. In progress further treatment the degree of restrictions is determined depending on the patient’s individual response to the drug.

Side effect

  • facial skin hyperemia;
  • severe arterial hypotension;
  • peripheral edema;
  • tachycardia;
  • increased angina attacks (requires discontinuation of the drug);
  • increased heart failure;
  • fainting;
  • headache;
  • dizziness;
  • increased fatigue;
  • sleep disorders (drowsiness or insomnia);
  • visual impairment;
  • paresthesia in the limbs;
  • tremor;
  • diarrhea;
  • constipation;
  • nausea;
  • heartburn;
  • dry mouth;
  • flatulence;
  • gingivitis;
  • anorexia;
  • thrombocytopenia, thrombocytopenic purpura, leukopenia, anemia;
  • increased daily diuresis;
  • deterioration of kidney function in patients with chronic renal failure;
  • myalgia;
  • gynecomastia;
  • hyperglycemia (completely disappear after discontinuation of the drug);
  • change in body weight;
  • galactorrhea;
  • hives;
  • exanthema;
  • skin itching;
  • autoimmune hepatitis;
  • feeling of heat;
  • weakness;
  • sweating;
  • fever;
  • chills;
  • photodermatitis.

Drug interactions

From the point of view of enhancing the antihypertensive and antianginal effect, the combination of Cordaflex with beta-blockers, diuretics, ACE inhibitors, and nitrates is rational. All of the above combinations are safe and effective in most clinical situations, since they lead to summation or potentiation of effects, however, in some cases there is a risk of a pronounced decrease in blood pressure and increased symptoms of heart failure.

The combination of Cordaflex with clonidine, methyldopa, octadine, prazosin is possible according to indications, but can cause severe orthostatic hypotension.

An increase in the hypotensive effect is also observed with combination therapy with cimetidine, ranitidine and tricyclic antidepressants.

Nifedipine increases the concentration of digoxin and theophylline in the blood plasma, and therefore the clinical effect and/or the content of digoxin and theophylline in the blood plasma should be monitored.

Procaine, quinidine and other drugs that cause QT prolongation enhance the negative inotropic effect and increase the risk of QT prolongation. Under the influence of nifedipine, the concentration of quinidine in the blood serum is significantly reduced, which is apparently due to a decrease in its bioavailability, as well as the induction of enzymes that inactivate quinidine. When nifedipine is discontinued, a transient increase in quinidine concentration is observed (approximately 2 times), which reaches a maximum level on days 3-4. Caution should be exercised when using such combinations, especially in patients with impaired left ventricular function.

Nifedipine can displace drugs characterized by high degree binding (including indirect anticoagulants - coumarin and indanedione derivatives, non-steroidal anti-inflammatory drugs (NSAIDs)), as a result of which their concentrations in the blood plasma may increase.

When administered simultaneously with rifampicin, phenytoin and calcium preparations, the effect of nifedipine is weakened.

Nifedipine inhibits the elimination of vincristine from the body and may cause increased side effects of vincristine; if necessary, the dose of vincristine is reduced.

Diltiazem inhibits the metabolism of nifedipine in the body; if necessary, reduce the dose of nifedipine.

Grapefruit juice, erythromycin and azole antifungals (fluconazole, itraconazole, ketoconazole) may inhibit the metabolism of nifedipine and therefore enhance its effects.

Alcohol enhances the hypotensive effect of Nifedipine.

Similarly, the simultaneous use of Cordaflex and cimetidine increases the concentration of nifedipine in the blood plasma and enhances its effects; however, simultaneous use with ranitidine does not lead to a significant increase in the concentration of nifedipine in the blood plasma.

Since nifedipine is metabolized by the CYP3A4 isoenzyme, any inhibitor or inducer of this enzyme may affect the metabolism of nifedipine. Cyclosporine is also a CYP3A4 substrate; therefore, when cyclosporine and nifedipine are used together, each may increase the duration of the effect of the other.

Analogs medicinal product Cordaflex

Structural analogues of the active substance:

  • Adalat;
  • Calcigard retard;
  • Cordafen;
  • Cordaflex RD;
  • Cordipin;
  • Cordipin retard;
  • Corinfar;
  • Corinfar retard;
  • Corinfar UNO;
  • Nicardia;
  • Nicardia SD retard;
  • Nifadil;
  • Nifebene;
  • Nifehexal;
  • Nifedex;
  • Nifedicap;
  • Nifedicor;
  • Nifedipine;
  • Nifecard;
  • Nifelate;
  • Nifesan;
  • Osmo Adalat;
  • Sanfidipin;
  • Sponif 10;
  • Phenigidine.

Use in elderly patients

In elderly patients, the pharmacokinetics of nifedipine changes, and therefore the initial dose of the drug is reduced by 2 times and to maintain therapeutic effect Lower doses may be required.

Use in children

Due to the lack of sufficient clinical data, the drug is not recommended for use in children and adolescents under 18 years of age.

Use during pregnancy and breastfeeding

Cordaflex – medicine to lower systolic pressure. The active ingredient of the drug, Nifedipine, is the basis for the production of not only Cordaflex, but also other popular drugs - Corinfar, Cordafen, etc. Therefore, today we will talk about the instructions for use and prices for Cordaflex, reviews about it and analogues of the drug.

Features of the medicine

Cordaflex and its analogues close calcium channels and reduce the tone of the smooth muscles of large arteries. These include the aorta, celiac trunk, vessels of the extremities, carotid arteries And coronary arteries hearts. The need for oxygen supply to the muscle layer of the heart decreases.

Kordaflex also has a relaxing effect on smooth muscle cells of the conduction pathways respiratory system. The associated effect is associated with relaxation of the vessels supplying the myometrium, as well as a decrease in blood viscosity and coagulability.

Composition of the drug

The active component of Cordaflex is nifedipine. The tablets contain fillers and other substances to form a solid consistency, soluble under the action of enzymes and gastric juice: titanium dioxide, yellow iron oxide, magnesium stearic, talc, polyvinyl butyral, microcrystalline cellulose and its analogs and derivatives.

Like , Cordaflex is a dihydropyridine derivative at ring positions 1 and 4.

Release forms

The drug Cordaflex is available in the form of yellow pressure tablets. The matte coating of the tablets is dark in color, tinged with brown and purple colors.

The tablets are packaged in dark glass bottles of 30 and 60 pieces. The weight of one tablet is 20 mg, the weight of the active substance in one tablet is 10 mg. The bottles are packed in cardboard boxes.

pharmachologic effect

  • Cordaflex has a selective effect on closing calcium channels. Has an antihypertensive effect. When the drug acts, the uptake of calcium ions from the blood and intercellular fluid through the membranes of smooth muscle cells of arterial vessels and striated muscles of the heart decreases. At the dosage specified in the instructions, the conduction of calcium ions through cell membranes is normal, if disturbances in the transmembrane transport of calcium have occurred.
  • Has a vasodilating effect for peripheral, coronary and great vessels, reduces spasmodic processes in these vessels. The oxygen demand of the heart muscle decreases during the action of the drug. Heart lesions subjected to ischemic processes, begin to receive sufficient blood supply evenly. Spares blood vessels hearts are included in the process of normal blood supply.
  • Cordaflex has the described effect only on arterial vessels, without affecting the condition and functioning of venous vessels. The conduction system of the heart (sinoatrial and atrioventricular nodes, Hiss bundles and Purkinje fibers) remain without any influence of the drug. Cordaflex has an enhancing effect on the functioning of the renal capillary glomeruli, increasing the diuretic process.
  • At a high dose, Cordaflex closes more channels for calcium ions without affecting their activity. It also promotes the release of calcium ions from cellular reserves.

Pharmacodynamics

Tablets of the drug have a long-lasting effect on the body, the effect lasts for one day. Start of action therapeutic effect– 20 minutes after taking the tablets.

Pharmacokinetics

The bioavailability of the drug reaches 70%, but not lower than 40%. The drug is almost completely absorbed in the intestinal microvilli (more than 90%). The most high concentration Cordaflex in the blood was registered 40-60 minutes after administration. A slight decrease in drug concentration occurs 6 hours after administration of the drug, a significant decrease is observed after 30 hours.

The half-life of the drug varies from 4 to 17 hours. Cordaflex in small quantities is able to penetrate the hemato-milk, hematoplacental and blood-brain barriers.

Most of the drug is excreted through the urinary system, and to a lesser extent through the intestines. Next we will talk about how to take Cordaflex.

Indications for use of Cordaflex

The use of the drug is included in the treatment regimen for:

  • with different etiologies;
  • as prophylactic angina attacks;
  • vasospasmodic syndrome with damage to the peripheral end parts of the circulatory system.

Instructions for use

I take Cordaflex tablets orally, washing down the tablet with a sufficient amount of liquid. Best time intake - while eating. I dissolve the tablet in the mouth.

If the doctor has not prescribed a different dosage, then the drug is used once a day, 10 mg. Serious condition The patient can change the treatment regimen by increasing the drug intake to 40 mg per day, but no more. The drug is not recommended for use during hepatic and renal failure. For elderly people, the dosage may be reduced below 10 mg (tablet divisions).

Cordaflex also has contraindications, we will talk about them later.

Contraindications

Cordaflex is not prescribed to children, adolescents and young adults under 18 years of age. They are not indications of various etiogenesis, in the decompensated stage, conditions in a severe stage. Patients with individual intolerance to the components of the drug, including lactase deficiency, should receive drug substitutes.

Side effects

Side effects when Cordaflex acts on the body are noted in the initial stage of use. If over time symptoms side effects decrease or disappear, the effect of the drug continues. Intense manifestation side effects medication requires discontinuation of the drug and replacement with other antihypertensive drugs.

Appearance the following symptoms requires consultation with a doctor regarding further use:

  • hypotension;
  • facial redness;
  • swelling;
  • increased urine output up to repeated urination at night;
  • dry mouth;
  • angina pectoris;
  • heart failure;
  • diarrhea;
  • exacerbation of arthritis;
  • pain in the head, muscles and joints;
  • frequent mood changes;
  • hot flash;
  • excessive sweating;
  • weakness;
  • insomnia;
  • nausea and vomiting;
  • skin itching;
  • fever;
  • other deviations from the normal state.

special instructions

Driving a vehicle in initial stages Taking the drug is prohibited due to inhibition of reaction speed. Further use of Cordaflex does not limit its use, but the patient’s condition for driving should be assessed individually.

If necessary radical treatment the anesthesiologist must be aware of the drug being taken. Drinking alcohol can aggravate the decline blood pressure Therefore, during treatment, drinking even small doses of alcohol is not recommended.

In order to prevent heart attacks, it is not recommended to discontinue the drug abruptly.

Coated tablets contain 10 mg nifedipine in each as an active substance. TO excipients: polyvinyl butyral in an amount of 0.7 mg; talc (1 mg); 0.3 mg magnesium stearate ; 4 mg hydroxypropylcellulose ; lactose monohydrate (15 mg); croscarmellose sodium (13 mg); microcellulose (46 mg). The shell consists of hypromellose - 2.63 mg; titanium dioxide C.I. 77891 - 0.82 mg; yellow iron oxide - 0.3 mg and magnesium stearate - 0.25 mg.

Long-acting film-coated tablets contain the same active substance, but in a dose of 20 mg. Each of them contains the following substances as auxiliary substances: microcellulose (99 mg); lactose monohydrate (30 mg); croscarmellose sodium (26 mg); copolymers of methyl methacrylate and ethyl methacrylate in a ratio of 1:2 (1.9 mg); talc (2 mg); magnesium stearate (0.6 mg); hyprolose (0.5 mg). The film casing is made of hypromellose - 5.26 mg; titanium dioxide - 1.64 mg; red iron oxide - 0.6 mg; magnesium stearate - 0.5 mg.

Release form

There are two options for the release form of the drug:

  • Coated tablets, weighing 10 mg. Every 100 tablets are placed in a brown glass bottle. The bottles are individually packaged in cardboard boxes.
  • Film-coated tablets, having a prolonged action. Each tablet weighs 20 mg. Place 30 or 60 tablets in brown glass bottles. Vials must be sealed with polyethylene caps that have a first-opening control. The bottle is packed in a cardboard box.

pharmachologic effect

Contraindications

Contraindications are:

  • intolerance nifedipine , other derivatives 1,4-dihydropyridine , additional components included in the tablets;
  • arterial hypotension ;
  • unstable angina ;
  • the presence at the moment or very recently of acute, pronounced aortic stenosis ;
  • idiopathic subaortic stenosis ;
  • chronic heart failure during the period of decompensation;
  • childhood.

It is prescribed with extreme caution to elderly patients, those with impaired renal function, and patients.

Side effects

Cordaflex is usually well tolerated. Side effects appear rarely, more often at the beginning of treatment (then they may become weaker or disappear).

There are such side effects:

  • On the heart and blood vessels: lowering blood pressure, hyperemia face and torso, swelling in the limbs , accelerated heart rate, paradoxical angina attack , development acute heart failure .
  • On nervous system : increased fatigue , emotional lability , sleep disturbances, headache, .
  • On gastrointestinal tract : occurrence, nausea , vomit , stool disorders, dryness or inflammation of the oral mucosa, intrahepatic cholestasis , as well as increased activity of certain liver enzymes.
  • On the circulatory system: thrombocytopenia , leukopenia , anemia .
  • On urinary system : increased daily diuresis, decreased renal function.

There may be allergic reactions as , exanthema , .

Instructions for use of Cordaflex (Method and dosage)

The drug is taken orally. 10 mg film-coated tablets are swallowed whole before meals with water.

The dosage is set individually, as it very much depends on the severity of the disease, the type of disease and the body’s response to the therapy. Start with 1 tablet (10 mg) 3 times a day. There should be at least 2 hours between doses of the drug. The maximum dose per day is 40 mg.

Long-acting film-coated tablets are swallowed whole and washed down with water. In this case, the initial dose is 1 tablet 2 times a day. Daily dose in any case, divided into 2 doses, between which a 12-hour interval must be observed.

According to the instructions for use of Cordaflex, discontinuation of the drug should be carried out gradually.

Overdose

In case of overdose nifedipine the following consequences may occur:

  • arterial hypotension ;
  • pain behind the sternum (like an attack angina pectoris );
  • loss of consciousness;
  • collapse ;
  • ventricular or nodular extrasystole ;
  • bradycardia .

Interaction

Cordaflex should not be administered with alcohol-containing medications.

Possible development orthostatic hypotension when used with methyldopa , , and also with And octadine .

Cimetidine ,

Hot flashes or chills and many other manifestations of the disease will in no way contribute to performance and good mood.

But it's not only that. The listed symptoms indicate a course in the body irreversible processes, which may pose a danger to the health and life of the patient. Therefore, it is advisable to take medications in a timely manner to stabilize a person’s condition. One of them is Cordaflex.

Cordaflex is a medicine recommended for use for the following diagnoses:

  • increased (origin may be different);
  • treatment of consequences and prevention;
  • Raynaud's syndrome;
  • ischemic disease.

For each individual case, the attending physician will choose a separate dosage of the medicine and individually determine the intensity of taking Cordaflex.

Compound

The basic ingredient in the drug, which provides the drug with the appropriate properties, is nifedipine.

In the regular version of the drug, the active substance is contained in an amount of 10 mg, and in the long-acting version of the drug – 20 mg.

The remaining components present in the tablets do not have any individual effects on the body, but only facilitate the absorption of the main component of the drug.

Minor ingredients include lactose monohydrate, titanium dioxide, microcrystalline cellulose, yellow iron oxide and several other ingredients. The set of minor components of regular and extended-release tablets varies.

Release form and packaging

Cordaflex is available in the form of tablets of two types:

  • standard action tablets (10 mg). The doses are round in shape and covered with a matte yellow coating on both sides. They emit virtually no odor. The tablets are sold in dark glass bottles containing 100 doses;
  • extended-release tablets (20 mg). They have an elongated shape and are covered with a brownish-purple film shell. They go on sale in dark transparent glass bottles containing 30 or 60 doses.

Each bottle, regardless of volume, is packed in a cardboard box with the name of the drug indicated on its surface.

Instructions for use

Cordaflex blood pressure tablets are taken orally with the required volume of liquid. The drug containing 10 mg of the active substance is taken before meals.

As for the long-acting agent, in this case taking pills is not tied to meals, since the pills contain sufficient quantity nifedipine to obtain the desired effect even after eating.

Cordaflex blood pressure tablets

The instructions for use that accompany the Cordaflex tablets also clearly indicate at what pressure to use them - at elevated pressures. This is where the general prescriptions for patients end, and the dosage, duration and intensity of taking the drug is determined by the attending doctor.

Adult patients suffering from are prescribed 10 mg of the drug 3 times a day. If the desired effect is absent, 1-2 times a day it is allowed to increase the volume of consumption to 20 mg (2 tablets). In this case, it is necessary to ensure that the maximum daily volume of medication consumed does not exceed 40 mg.

It is also necessary to observe a 2-hour interval between doses.

In some clinical cases When hypertension or angina pectoris does not go away after taking the dosage options listed above, it is allowed to increase the amount of drug consumption to 80-120 mg per day.

In such a situation, the patient is transferred to Cordaflex prolonged action. If it is necessary to undergo a course of treatment with Cordaflex, it is recommended to take 1 tablet of prolonged action 2 times a day.

To speed up the effect of the drug (this is necessary when hypertensive crisis and attacks of angina pectoris), the tablet is chewed, kept in the mouth for several minutes and only then swallowed.

The interval between doses should be 12 hours. If this amount of the drug is not enough, the dosage can be increased to 120 mg or up to 6 tablets. If there is a need to carry out long-term therapy of a supportive nature, take 1-2 tablets twice a day.

The duration of the therapy period is determined by the attending physician.

need to reduce the dosage of the drug by 2 times.

If the patient suffers intensely pronounced violations in liver function, maximum dose medication should be 40 mg per day.

In order to avoid side effects, you should not self-medicate and determine the dosage yourself without undergoing an examination and consulting a doctor.

Contraindications

Cordaflex is a drug that should be taken with caution due to the presence of various side effects.

Thus, it is extremely undesirable to use the medicine for the following diagnoses and conditions:

  • myocardial infarction at the acute stage;
  • cardiogenic shock;
  • some types of stenosis;
  • chronic low blood pressure;
  • severe manifestations of heart failure;
  • age group of patients under 18 years of age;
  • pregnancy period (first trimester);
  • lactation;
  • individual intolerance to individual components of the drug.

In order not to harm your health, a doctor should prescribe Cordaflex, basing his conclusions on the results of an examination and a comprehensive examination.

There are also conditions in which Cordaflex should be taken with caution, since they are conditional contraindications to the use of tablets. Among them:

  • impaired liver or kidney function;
  • weakness of the sinus node;
  • pronounced tachycardia;
  • heart failure of chronic origin;
  • elderly age;
  • inability to tolerate lactose;
  • disruption of cerebral circulation processes;
  • some other conditions.

Side effects

The side effects that the drug can have are quite extensive. We are talking about negative, more or less pronounced manifestations on the part of different systems body organs:

  • headaches, increased fatigue, insomnia;
  • swelling, a sharp decline Blood pressure, tachycardia, fainting, dizziness;
  • urticaria, skin itching;
  • heartburn, constipation, nausea, diarrhea, dry mouth;
  • increased urination;
  • arthritis;
  • anemia;
  • some other individual reactions of the body.

In most cases, provided that the dosage regimen and dosage prescribed by the doctor are followed, side effects almost never occur.

If found side effects It is recommended to immediately seek help from your doctor, who will help you choose an analogue with a gentle composition or reduce the amount of product consumed.

Price and where to buy

The approximate cost of drugs in pharmacies in Russian cities is 81-94 rubles. The price of the tablets will depend on the type and quantity in the package.

Analogs

Today there are a sufficient number of Cordaflex analogues of domestic and foreign production on sale. Among them:

  • Adalat;
  • Cordaflex Retard;
  • Cordafen;
  • Zanifed;
  • Cordipin HL;
  • some other medication options.

In order to avoid side effects, the choice of an analogue should be made by a doctor. In this case, not only the cost of the medicine, but also its composition and properties will be taken as a basis.

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