Strophanthin release form. Drugs with similar effects

Active ingredient

Strophanthin K

Release form, composition and packaging

Solution for intravenous and intramuscular administration transparent, colorless or slightly yellowish.

Excipients: ethanol 96% - 20 µl, water for injection - up to 1 ml.

1 ml - colorless glass ampoules (10) - cardboard boxes.
1 ml - colorless glass ampoules (10) - contour cell packaging (1) - cardboard packs.

Pharmacological action

Strophanthin K - short-acting cardiac glycoside, blocks the transport Na+/K+-ATPase, as a result, the content of sodium ions in cardiomyocytes increases, which leads to the opening of calcium channels and the entry of calcium ions into cardiomyocytes. An excess of sodium ions leads to an acceleration of the release of calcium ions from the sarcoplasmic reticulum, i.e. the intracellular concentration of calcium ions increases, which leads to blockade of the troponin complex, which has an inhibitory effect on the interaction of actin and myosin.

Increases the force and speed of myocardial contraction, which occurs by a mechanism different from the Frank-Starling mechanism, and does not depend on the degree of preliminary stretching of the myocardium; systole becomes shorter and energy-efficient. As a result of increased myocardial contractility, stroke and minute blood volume increases.

Reduces the end-systolic volume and end-diastolic volume of the heart, which, along with an increase in myocardial tone, leads to a reduction in its size, etc. to reduce myocardial oxygen demand.

The negative dromotropic effect manifests itself in increased refractoriness of the atrioventricular node, which allows the drug to be used for paroxysms of supraventricular tachycardia and tachyarrhythmias. With atrial fibrillation, it slows down the heart rate, lengthens diastole, improving intracardiac and systemic hemodynamics. A decrease in heart rate occurs as a result of direct and indirect effects on the regulation of heart rate. It has a direct vasoconstrictor effect (in the event that the positive inotropic effect of cardiac glycosides is not realized - in patients with normal contractility or with excessive stretching of the heart); in patients with chronic heart failure, it causes an indirect vasodilating effect, reduces venous pressure, increases diuresis: reduces swelling, shortness of breath. Positive bathmotropic effect is manifested in subtoxic and toxic doses. IN minor degree has a negative chronotropic effect. When administered intravenously (IV), the effect begins within 10 minutes and reaches a maximum after 15-30 minutes.

Pharmacokinetics

There is virtually no cumulative effect.

Distribution relatively uniform; is concentrated to a slightly greater extent in the tissues of the adrenal glands, pancreas, liver, and kidneys. 1% of the drug is found in the myocardium. Communication with blood proteins - 5%.

Removal. It does not undergo biotransformation and is excreted unchanged by the kidneys. 85-90% of the drug is eliminated within 24 hours; plasma concentration decreases by 50% after 8 hours; It is completely eliminated from the body after 1-3 days.

Indications

- included complex therapy acute and chronic heart failure of functional class II (if there is clinical manifestations), III-IV functional class according to the NYHA classification;

- tachysystolic form of atrial fibrillation and flutter of paroxysmal and chronic course(especially in combination with chronic heart failure).

Contraindications

- glycoside intoxication;

- Wolff-Parkinson-White syndrome;

— atrioventricular block of the second degree;

- intermittent atrioventricular or sinoatrial complete blockade;

— increased sensitivity to the drug.

With caution:(comparing benefit/risk): first degree atrioventricular block, weakness syndrome sinus node without an artificial pacemaker, the likelihood of unstable conduction through the atrioventricular node, a history of Morgagni-Adams-Stokes attacks, hypertrophic obstructive cardiomyopathy, isolated mitral stenosis with a rare heart rate, cardiac asthma in patients with mitral stenosis(in the absence of tachysystolic form atrial fibrillation), acute heart attack myocardium, unstable angina, arteriovenous shunt, hypoxia, constrictive pericarditis, heart failure with impaired diastolic function ( restrictive cardiomyopathy, cardiac amyloidosis, constrictive pericarditis, cardiac tamponade), ventricular extrasystole, severe dilatation of the heart cavities, “pulmonary” heart. Atrial extrasystole due to the possibility of its transition to atrial fibrillation.

Electrolyte disturbances: hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia. Hypothyroidism, alkalosis, myocarditis, old age, renal-liver failure, thyrotoxicosis.

Dosage

Strophanthin K is used intravenously, intramuscularly, only in emergency situations if it is impossible to use cardiac glycosides orally. For intravenous administration, use a 0.025% solution of the drug. It is diluted in 10-20 ml of a 5% dextrose (glucose) solution or a 0.9% solution. The introduction is carried out slowly, over 5 - 6 minutes (since rapid administration can cause shock). Strophanthin K solution can also be administered dropwise (in 100 ml of 5% dextrose (glucose) solution or 0.9% sodium chloride solution), since with this form of administration the development of toxic effect.

Higher doses of Strophanthin K for adults intravenously: single - 2 ml (2 ampoules), daily - 4 ml (4 ampoules).

If intravenous administration is not possible, the drug is used intramuscularly. To reduce severe pain during intramuscular injection first inject 5 ml of a 2% procaine solution, and then through the same needle - the required dose of Strophanthin K, diluted in 1 ml of a 2% procaine solution. When administered intramuscularly, the dose is increased by 1.5 times.

For children: daily doses, they are also saturation doses when using a 0.025% solution of Strophanthin K; newborns- 0.06-0.07 ml/kg; up to 3 years- 0.04-0.05 ml/kg; from 4 to 6 years- 0.4-0.5 ml/kg; from 7 to 14 years- 0.5-1 ml. The maintenance dose is 1/2-1/3 of the saturation dose.

Side effects

From the gastrointestinal tract: loss of appetite, nausea, vomiting, diarrhea.

bradycardia, extrasystole, atrioventricular block, ventricular paroxysmal tachycardia, ventricular fibrillation.

From the side of the central nervous system: headache, dizziness, sleep disturbances, fatigue, impaired color perception, depression, drowsiness, psychosis, confusion.

Other: allergic reactions, urticaria, petechiae, thrombocytopenia, thrombocytopenic purpura, nosebleeds, gynecomastia. With the intramuscular route of administration, pain at the injection site.

Overdose

Symptoms:

From the outside cardiovascular system: arrhythmias, including bradycardia, atrioventricular block, ventricular paroxysmal tachycardia, ventricular fibrillation, ventricular extrasystole (bigeminy, polytopic), nodal tachycardia, sinoatrial block, atrial fibrillation and flutter.

From the gastrointestinal tract: anorexia, nausea, vomiting, diarrhea.

From the central nervous system and sensory organs: headache, increased fatigue, dizziness, rarely - coloring of surrounding objects green and yellow colors, sensation of flies flickering before the eyes, decreased visual acuity, scotoma, macro- and micropsia; very rarely - confusion, syncope.

Treatment: discontinuation of the drug or reduction of subsequent doses and increasing the time intervals between drug administrations, administration of antidotes (sodium dimercaptopropanesulfonate), symptomatic therapy (antiarrhythmic drugs- lidocaine, phenytoin, amiodarone; potassium preparations; m-anticholinergics -). Class I drugs (lidocaine, phenytoin) are used as antiarrhythmic drugs. For hypokalemia - intravenous administration of potassium chloride (6-8 g/day at the rate of 1-1.5 g per 0.5 l of 5% dextrose (glucose) solution and 6-8 units of insulin; administered by drip over 3 hours). For severe bradycardia, atrioventricular block - m-anticholinergic blockers. It is dangerous to administer beta-adrenergic agonists due to the possible enhancement of the arrhythmogenic effect of cardiac glycosides. In case of complete transverse blockade with Morgagni-Adams-Stokes attacks - temporary cardiac pacing.

Drug interactions

When Strophanthin K is used together with barbiturates (phenobarbital, etc.), the cardiotonic effect of the glycoside is reduced. Simultaneous use Strophanthin K with sympathomimetics, methylxanthines, reserpine and
tricyclic antidepressants increases the risk of developing arrhythmias. The concentration of Strophanthin K in the blood plasma increases with the simultaneous use of quinidine, methyldopa, amiodarone, captopril, calcium antagonists,
erythromycin and tetracycline. Against this background, the possibility of slowing down conduction and the occurrence of atrioventricular heart block increases. Diuretics (mostly thiazide and carbonic anhydrase inhibitors), corticotropin (adrenocorticotropic hormone), glucocorticosteroids, insulin, calcium preparations, laxatives, carbenoxolone, benzylpenicillin, salicylates increase the risk of developing glycoside intoxication. Beta-blockers, antiarrhythmic drugs, verapamil can not only increase the severity of the decrease in atrioventricular conduction (negative dromotropic effect), but also potentiate the negative chronotropic effect of the drug Strophanthin K (decrease in heart rate). Inducers of microsomal liver enzymes (phenytoin, rifampicin, phenobarbital, phenylbutazone), as well as neomycin and cytostatic agents reduce the concentration of Strophanthin K in the blood plasma. Carbonic anhydrase inhibitor and mineralocorticoids can cause glycoside intoxication due to the development of hypokalemia, therefore, when used simultaneously with cardiac glycosides, it is necessary to regularly determine the potassium content in the blood plasma. Potassium salt preparations cannot be used if, under the influence of cardiac glycosides, conduction disturbances appear on the electrocardiogram, however, potassium salts are often prescribed together with digitalis preparations to prevent cardiac arrhythmias.

Anticholinesterase drugs increase bradycardia when used simultaneously with cardiac glycosides; edetic acid reduces the effectiveness and toxicity of cardiac glycosides; Trifosadenine should not be used in conjunction with cardiac glycosides; hypervitaminosis caused by vitamin D enhances the effect of cardiac glycosides due to the development of hypercalcemia; There is evidence of a decrease in the excretion of cardiac glycosides by the kidneys under the influence of paracetamol. Glucocorticosteroids and diuretics increase the risk of developing hypokalemia and hypomagnesemia, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers reduce it.

Special instructions

Use with extreme caution in patients with thyrotoxicosis and atrial extrasystole.

Given the small therapeutic index, careful medical supervision and individual dose selection.

In case of violation excretory function kidneys, the dose should be reduced (prevention of glycoside intoxication).

The likelihood of overdose increases with hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia, severe dilatation of the heart cavities, pulmonary heart disease, alkalosis, and in elderly patients. Particular caution and electrocardiographic monitoring are required in case of atrioventricular conduction disturbance.

With severe mitral stenosis and normo- or bradycardia, chronic heart failure develops due to a decrease in diastolic filling of the left ventricle. Strophanthin K, increasing the contractility of the right ventricular myocardium, causes a further increase in pressure in the system pulmonary artery, which can provoke pulmonary edema or aggravate left ventricular failure. For patients with mitral stenosis, cardiac glycosides are prescribed when right ventricular failure occurs or in the presence of atrial fibrillation. Strophanthin K in Wolff-Parkinson-White syndrome, reducing atrioventricular conduction, promotes the conduction of impulses through accessory pathways - bypassing the atrioventricular node, provoking the development paroxysmal tachycardia. Monitoring the plasma concentration of cardiac glycosides is used as one of the methods for controlling digitalization.

With rapid intravenous administration, bradyarrhythmia, ventricular tachycardia, atrioventricular block and cardiac arrest may develop. At the maximum of action, extrasystole may appear, sometimes in the form of bigeminy. To prevent this effect, the dose can be divided into 2-3 intravenous doses, or the first dose can be administered intramuscularly. If the patient has previously been prescribed other cardiac glycosides, it is necessary to take a break before intravenous administration of Strophanthin K (5-24 days - depending on the severity of the cumulative properties of the previous medicine).

Impact on the ability to drive vehicles and operate machinery

During the treatment period, it is necessary to refrain from driving vehicles and potentially engaging in activities dangerous species activities that require increased concentration and speed of psychomotor reactions (driving a car, etc.).

Use in old age

Use with caution in elderly people.

Conditions for dispensing from pharmacies

According to the recipe.

Storage conditions and periods

Store at a temperature not exceeding 25°C. Keep out of the reach of children. Shelf life - 3 years.

Cardiac glycosides include: strophanthin, korglykon, digoxin. Available in ampoules and tablets. Used for acute and chronic circulatory failure. In emergency cases, use strophanthin or korglykon. Administered intravenously in a stream, dropwise from 0.1 ml. up to 1.0 ml.

Rules for intravenous injection:

1. Draw the prescribed amount of the drug into the syringe (strictly observe the accuracy of the dosage);

2. Fill the syringe with the prescribed dose up to 10-20 ml. isotonic solution (0.9% NaCl).

3. Inject slowly over 5-6 minutes, monitor the patient’s condition, because If the drug is administered quickly, shock may develop.

When administering the drug by drip, you need to know:

Draw the prescribed dose of the drug into the syringe (maintain the accuracy of the dosage);

Add the drug to a bottle containing 100-200 ml. isotonic solution (0.9% NaCl);

Administer slowly, dropwise, monitoring the patient’s condition.

Complications

1. Hematoma (subcutaneous hemorrhage).

2. Air embolism.

3. Phlebitis.

4. Puncture the vein and inject the solution subcutaneously.

6. Allergic reactions.

7. Toxic reactions.

8. Pyrogenic reactions: chills, high fever, headache.

9. Vein thrombosis.

Help with complications.

Stop administering the drug by closing the clamp.

Urgently call a doctor without leaving the patient.

Provide assistance as prescribed by a doctor.

Nursing process for the problem of “Patient’s fear of intravenous injections”

As prescribed by the doctor, the nurse in the treatment room should administer 0.5 ml to the patient. strophanthin solution intravenously, diluted by 10 ml. 0.9% NaCl.

Stage 1 - collecting information : Ivanova Maria Ivanovna, 52 years old, disabled group 2 with heart disease. Suffers from frequent attacks of chest pain, shortness of breath, and swelling. Emotional lability is noted. In a conversation with the nurse, he says that he is afraid of the injection, his veins are bad. “The sight of blood scares me. You can cause an infection. I refuse. I’d rather take the pills. I’ll have a seizure during the injection.” Allergy history is unremarkable; 5 years ago she suffered from Botkin's disease. The reaction to the presence of antibodies and HIV is negative. He is in ward mode. Objective data: clear consciousness, pale face, shortness of breath at rest, bluish lips. The arms are full, the ulnar veins are not contoured, but are well defined on the back of the hand. NPV - 26 per minute. PS – 82 beats per minute. Blood pressure - 150/100, swelling of the feet and legs. Satisfaction of the need to breathe, excrete, and avoid danger is impaired. Stage 2 – identifying the patient’s problems:

Shortness of breath at rest; - peripheral edema. - frequent attacks of chest pain. - feeling of fear before injections and IV infusions. - risk of deterioration of the condition due to refusal of injection. Priority nursing problem:- a feeling of fear of the pain of intravenous infusion; - a feeling of fear of a possible complication. Stage 3 – planning: Short-term goal: The patient, with the help of the nurse, will overcome her fear of injections and consent to the 1st injection. Long-term goal: the patient will have no fear of injections and no complications throughout the entire course of injections. Plan: 1. The nurse in the conversation focuses on the following aspects:

The importance of strophanthin injection for heart disease.

Relative painlessness.

A disposable syringe and sharp needles are used.

Impeccable adherence to aseptic rules for all injections.

Personal experience of a nurse. 2. Psychological preparation: “Your fears are in vain, believe me. I use disposable instruments for injection, so infection is excluded. Look how sharp and thin the needle is. Like a “mosquito bite,” I promise you. The veins are not bad at all. I have been working in the treatment room for 13 years years. Let's try it. Your heart really needs it. It will immediately feel better." 3. The nurse takes a disposable syringe. 4. Given that the sight of blood frightens her, the nurse asks her to turn away. 5. The nurse will use distraction and relaxation techniques.

6. Considering stressful situation the nurse will have nitroglycerin with her.

4th stage.

The nurse administers the injection according to the planned plan.

Stage 5 – assessment.

The patient’s state of health is satisfactory, nothing goes beyond the usual, the patient thanked the nurse, expressed consent for full course injections. Goals achieved.

Strophanthin-G: instructions for use

Compound

active substance: ouabain;

1 ml of solution contains ouabain (strophanthin G) 0.25 mg;

excipients: citric acid, monohydrate: sodium hydroxide: water for injection.

Description

clear, colorless liquid.

Pharmacological action

Strophanthus in-G (ouabain) is a cardiac glycoside. which is obtained from the seeds of Strophanthus grata. Strophanthin-1 exhibits high cardioton and cellular activity (1 g of the drug contains 4,3000 - 5,4000 LHD. 5,800 - 7,100 COD), has a pronounced positive inotropic effect. exhibits negative chronotropic. dromotropic effects, as a result of which it has a significant systolic effect (in the experiment it is slightly inferior to the effect of strophanthin K), slightly slows down heart rate. The mechanism of the cardiotonic action of the glycoside is based on the effect on the potassium-sodium pump of cardiomyocytes. exchange of calcium ions, release of catecholamines from labile depots, level of cyclic adenosine monophosphate. energy supply for myocardial contraction. In patients with acute heart failure, Strophantin-G reduces venous pressure, increases diuresis, reduces swelling and shortness of breath.

Pharmacokinetics

After intravenous administration, the effect is observed within 2-10 minutes. reaches a maximum after 30 - 60 - 120 minutes and begins to decrease after 2 - 3 hours. Duration actions of Strophanthin-G ranges from 1 to 3 days. The drug binds to blood plasma proteins (40%) more powerfully than strophanthin-K. does not biotransform, is excreted mainly by the kidneys in unchanged form. The drug accumulates to a small extent. The half-life from blood plasma averages 23 hours: it increases with impaired renal function and in elderly patients.

Indications for use

Cardiovascular insufficiency II - 111 degrees (111 - IV degrees according to the NYHA classification). especially if digitoxin preparations are ineffective. supraventricular tachycardia, atrial fibrillation and flutter.

Contraindications

Organic lesions of the heart and blood vessels, acute myocarditis, endocarditis, severe cardiosclerosis, acute myocardial infarction, atrioventricular block of 11 - 111 degrees, severe bradycardia. hypertrophic obstructive cardiomyopathy and constrictive pericarditis, hypercalcemia. hypokalemia. carotid sinus syndrome, aneurysm thoracic aorta, glycoside intoxication. WPW syndrome, pulmonary hypertension. The period of pregnancy and lactation. Childhood up to 15 years.

Pregnancy and lactation

The drug is contraindicated in women during pregnancy and breastfeeding.

Directions for use and doses

Used in adults and children over 15 years of age as a slow intravenous injection. I dissolve a single dose of the drug! in 10 - 20 ml of 0.9% sodium chloride solution and injected over 5 - 6 minutes.

The dose is set individually. Maximum single dose is 0.25 mg. daily 1 mg. The drug is administered in low doses of 0.1 - 0.15 mg at intervals of 30 minutes to 2 hours. At an average rate of digitalization during the period of saturation, adults are usually administered 0.25 mg 2 times a day with an interval of 12 hours. Average duration of saturation period

1 day. The maintenance dose of Strophanthin-1" should not exceed 0.25 mg per day. The duration of the saturation period and the adequacy of the dose are assessed by clinical effects drug and the appearance of signs of icosid intoxication.

Side effect

Strophanthin-G has a narrow spectrum therapeutic action, causes disturbances in heart rhythm due to the effect on automaticity and conductivity (over ventricular tachycardia, extrasystole. atrioventricular block, etc.). possible nausea, vomiting, diarrhea, weakness, insomnia, myocardial infarction, headache, depression, hallucinations, psychosis, color vision disorders, gynecomastia, allergic reactions; rarely - mesenteric infarction.

Overdose

Overdose symptoms are varied.

From arrhythmias, including bradycardia.

atrioventricular block, ventricular tachycardia or extrasystole. ventricular fibrillation.

From the outside digestive tract: anorexia, nausea. vomiting, diarrhea.

From the central itepeuoii system and sensory organs, headache, increased fatigue, rarely impaired color vision, decreased visual acuity, scotoma, macro- and micropsia. very rarely, confusion, syncope.

If glycoside intoxication develops, the drug must be discontinued, potassium supplements prescribed, nithiol administered parenterally (the first 2 days 0.05 g per 10 kg of body weight 3 - 4 times a day, then 1 - 2 times until the cardiotoxic effect ceases), symptomatic therapy (lidocaine phenytoin).

Interaction with other drugs

Calcium antagonists (especially verapamil). Quinidine erythromycin, tetracycline, amiodarone slow down elimination and increase plasma concentrations (if necessary joint application the dose of Strophanthin-G is reduced by 2 times). Sympathomimetics. calcium salts, methylxanthine (theophylline, etc.). Antiarrhythmic drugs increase the risk of arrhythmia. When using magnesium sl.tfate, the possibility of decreased conductivity and atrioventricular heart block increases. Diuretics, glucocorticoids. Inosine increases the risk of developing glycemic intoxication.

Features of application

I use it with extreme caution! drug for patients with thyrotoxicosis and atrial extrasystole. elderly people and those with impaired renal function.

During intravenous administration of Strophanthin-G and within 1 hour after administration, it is necessary to carry out OKG monitoring. If frequent, group or polytopic ventricular extrasystole administration must be stopped, and the next dose must be reduced by 2 times. For impaired renal function and elderly and old age the drug is recommended to be administered in lower doses, starting from 0.125 - 0.15 - 0.2 mg. and in the future do not exceed the dose of 0.25 mg per day (except for urgent conditions). With rapid intravenous administration, bradyarrhythmia may develop. ventricular tachycardia, atrioventricular block, cardiac arrest. To prevent this effect, the daily dose is divided into 2-3 injections or one of the doses is administered intramuscularly. The patient had previously been treated with other cardiac glycosides. necessary before intravenous administration of Strophanthin-G, a break of 5 - 24 days. depending on the severity of cumulative properties. Treatment is carried out with constant ECG monitoring.

Particular caution and ECG monitoring are necessary in case of first degree atrioventricular block, severe dilatation of the heart cavities, pulmonary heart, alkalosis and elderly patients.

Precautions

The ability to influence the reaction rate when driving a vehicle or working with other mechanisms.

During treatment, you should refrain from driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Release form

1 ml in ampoules, 10 ampoules in packs.

Storage conditions

Store in a place protected from light at a temperature of 15 °C to 25 °C.

Best before date

Self-medication can be harmful to your health.
You should consult your doctor and read the instructions before use.

Manufacturer: Arterium (Arterium) Ukraine

ATS code: C01AC01

Farm group:

Release form: Liquid dosage forms. Solution for injection.

General characteristics. Compound:

1 ml of solution contains strophanthin K - 0.25 mg; excipients: ethyl alcohol, water for injection.

Pharmacological properties:

Pharmacodynamics. Strophanthin K is a mixture of cardiac glycosides (K - strophanthin - , K - strophanthoside, etc.) from the seeds of the tropical liana Strophathus Kombe Oliver and belongs to the group of so-called polar (hydrophilic) cardiac glycosides, poorly soluble in lipids and poorly absorbed from gastrointestinal tract. The mechanism of action is associated with the blockade of Na+-K+-ATP-azi, the effect on Na+-Ca2+ metabolism, which improves contractility myocardium. The drug potentiates the strength and speed of heart contraction, lengthens diastole, improves blood flow to the ventricles of the heart,
increases its stroke volume, has little effect on the function n. vagus

Pharmacokinetics. Therapeutic effect observed within 5-10 minutes after intravenous administration and reaches a maximum after 15-30 minutes. The half-life of Strophanthin K from blood plasma is on average 23 hours. There is virtually no cumulative effect.

Indications for use:

Directions for use and dosage:

Strophanthin K is used intravenously (sometimes intramuscularly). For intravenous administration, the drug is diluted in 10 - 20 ml of isotonic sodium chloride solution. The introduction is carried out slowly, over 5-6 minutes. A solution of Strophanthin K can also be administered dropwise (in 100 ml of isotonic sodium chloride solution), since toxic effects are less likely to develop with this form of administration. If Strophanthin K cannot be administered into a vein, then it is prescribed intramuscularly. Due to the pain of this procedure, a 2% solution of novocaine (5 ml) is first injected into the muscle, and then through the same needle - the prescribed dose of Strophanthin K in 1 ml of a 2% solution of novocaine. In this case, the dose of the drug is increased by 1.5 times.
Higher doses of Strophanthin K for adults intravenously: single - 0.0005 g (0.5 mg), daily - 0.001 g (1 mg). Children: daily doses, also known as saturation doses when using a 0.025% solution of Strophanthin K: newborns - 0.06 - 0.07 ml/kg; up to 3 years - 0.04 - 0.05 ml/kg; from 4 to 6 years - 0.4 -0.5 ml/kg; from 7 to 14 years - 0.5 - 1 ml. The maintenance dose is ½ -⅓ of the saturation dose.

Features of application:

The drug should be prescribed with caution in cases of hypothyroidism, severe dilatation of the heart cavities, “pulmonary” heart, myocarditis, obesity and old age, since in these cases the likelihood of occurrence increases.
With rapid intravenous administration of the drug, the development of bradyarrhythmia, ventricular, atrioventricular block, etc. is possible. At maximum action it may appear, sometimes in the form of bigemenia. To prevent this effect from occurring, the dose can be divided into 2-3 intravenous injections or the first dose can be administered intramuscularly. In case of previous treatment with other cardiac glycosides, before intravenous use Strophanthin K is given a break (a toxic effect of summation of the action of glycosides may occur). The duration of the break is from 5 to 24 days, depending on the severity of the cumulative properties of the previous drug. Due to the pronounced cardiotropic effect of the drug and its rapid action, maximum accuracy in dosage and indications for use is necessary. Treatment is carried out under constant ECG monitoring. There are no data on the use of the drug during pregnancy and lactation.

Side effects:

From the outside digestive system: loss of appetite, . From the cardiovascular system: atrioventricular block. From the outside nervous system: sleep disturbance, rarely - color vision disturbance. Others: allergic reactions, thrombocytopenic purpura, nasal, petechiae,.

Interaction with other drugs:

When Strophanthin K is used together with barbiturates (phenobarbital, etaminal sodium, etc.), the cardiotonic effect of the glycoside is weakened. The simultaneous use of Strophanthin K with sympathomimetics, methylxanthines, reserpine and tricyclic antidepressants increases the risk of developing arrhythmia. The concentration of Strophanthin K in the blood plasma increases with the simultaneous administration of quinidine, amiodarone, captopril, calcium antagonists, erythromycin and tetracycline. Against the background of magnesium sulfate, the possibility of decreased conductivity and the occurrence of atrioventricular heart block increases. Saluretics, adrenocorticotropic hormones, glucocorticosteroids, insulin, calcium preparations, laxatives, carbenoxolone, amphotericin B, benzylpenicillin, salicylates increase the risk of developing glycoside intoxication. Antiarrhythmic drugs, including β-adrenergic receptor blockers, potentiate the negative chrono- and dromotropic effects of the glycoside. Inducers of microsomal liver enzymes (phenytoin, rifampicin, phenobarbital, phenylbutazone, spironolactone), as well as neomycin and cytostatic agents reduce the concentration of Strophanthin K in the blood plasma. Calcium supplements increase sensitivity to cardiac glycosides.

Overdose symptoms are varied. From the cardiovascular system: arrhythmias, including bradycardia, atrioventricular block, ventricular tachycardia, or extrasystole, fibrillation
ventricles.
From the digestive tract: nausea, vomiting, diarrhea.
From the central nervous system and sensory organs: headache, increased fatigue, very rarely - confusion, syncope.
Treatment: discontinuation of the drug or reduction of subsequent doses and increasing the time intervals between administrations, administration of antidotes (unitol, EDTA), symptomatic therapy (antiarrhythmic drugs - lidocaine, phenytoin, amiodarone; potassium preparations: potassium chloride, Asparkam tablets; anticholinergics).

Storage conditions:

Store in a place protected from light and out of reach of children, at a temperature of + 15 - + 25 ° C. Shelf life - 2 years.

Vacation conditions:

By prescription

Package:

10 ampoules of 1 ml each in a box or pack.

Strophanthin is a glycoside that was previously used to treat cardiovascular diseases. On at the moment it is used most often in veterinary medicine. Strophanthin acts on sodium-potassium ATPase receptors and can be fatal in high doses. In some parts of Africa it is used as an ingredient in poison arrows.

Attention! Only the attending physician can prescribe the drug. Under no circumstances should you take strophanthin yourself.

G-strophanthin is one of the first species of strophanthins found in the seeds of various African creeping plants of the genus Strophanthus from the family Kutrov. The Latin letter g stands for the species Strophanthus gratus, in which strophanthin was first found. G-strophanthin can also be found in the Acokanthera plant, which is sometimes cultivated.

Strophanthus

Strophanthin was previously considered an endogenous glycoside in mammals; It is believed that humans synthesize it in the adrenal cortex. Exercise stimulate the synthesis of endogenous strophanthin, causing contraction blood vessels and increase blood pressure. In mammals, with the exception of humans, this substance is found in the spleen.

What is strophanthin K?

Strophanthin K is a cardenolide found in mature seeds of Strophanthus kombe. It is a drug whose mechanism of action is similar to g-strophanthin and digitoxin.

Pharmacological mechanism of action

Ouabain is a cardiac glycoside that acts by inhibiting the sodium-potassium pump. Once ouabain binds to the pump, the enzyme stops functioning, resulting in an increase in intracellular sodium. This reduces the activity of the sodium-calcium pump, which pumps one calcium ion out of the cell and pumps three sodium ions into the cell along a concentration gradient.

Strophanthin

Therefore, the decrease in the sodium concentration gradient in the cell, which occurs when sodium-potassium ATPase is suppressed, increases intracellular calcium. This leads to increased cardiac contractility and tone vagus nerve. Changes in ion gradients caused by ouabain may also influence membrane potential cells and lead to cardiac arrhythmias.

Important! The radar manual describes in detail the formula, pharmacological group and the mechanism of action of the substance, its effect on the child.

Overdose symptoms

An overdose of the drug manifests itself the following symptoms:

• Rapid twitching of neck muscles and joints;
• Respiratory distress;
• Fast and irregular heartbeat;
• Increased blood pressure;
• Convulsions;
• Suffocation;
• Heart failure.

Toxicology

Strophanthin is considered a highly toxic compound with an LD50 of 5 mg/kg at oral administration to rodents. However, the substance has low bioavailability and is poorly absorbed from the gastrointestinal tract, so most of the oral substance is destroyed by enzymes. Intravenous administration results in increased available concentrations and has been shown to reduce the LD50 to 2.2 mg/kg. After intravenous administration, action begins within 3-10 minutes in people maximum effect achieved after 1.5 hours. Strophanthin is excreted unchanged through the kidneys.

Side effects

When using this substance, adverse effects may occur, which disappear within a certain period (2-3 hours). The drug may cause ventricular extrasystoles, bigeminy, severe bradycardia, nausea, incessant vomiting, disrupt the heart rhythm, the functioning of the heart valves (especially in case of overdose).

Strophanthin: instructions for use, in ampoules and tablets

The dosage of the drug is selected individually and under the supervision of the attending physician. When administered intravenously, the medicine is initially administered in low doses and then gradually increased. When using tablets daily dose should not exceed 0.001 grams. Oral tablets taken two to three times a day.

Release form

The drug is available in the form of ampoules with a 0.026% solution for intravenous injections and 250 microgram tablets under the tongue. The active substance has not been produced in drops for almost 80 years.

Strophanthin: recipe

The medicine is prescribed strictly by the attending physician and is issued on an official form. You should not self-medicate and look for plants with high content of this substance. The effect of glycosides on different people not fully studied. It is important to consult with your attending cardiologist before use, because there are contraindications for use.

Strophanthin: analogues

The following drugs are considered analogues of this drug:

• Digoxin;
• Amrion;
• Strophanthin acetate;
• Dobutamine;
• Korglykon.

History of discovery

In western parts of Africa, an extract from the seeds of Strophanthus was traditionally used as an arrow poison for hunting elephants. After botanist John Kirk discovered the Ouabaio tree during an expedition in 1859, Scottish pharmacologist and physician Thomas Richard Fraser isolated the active ingredient in 1862 as k-ouabain.

Africa

Since 1865 as total extract were used alcohol tinctures strophanthus seeds. Since 1885, tinctures began to be used everywhere. However, uncertain concentrations and associated laxative properties have made therapy difficult, but strophanthin has been used by many clinicians. Since 1904, a standardized tincture of g-strophanthin has been available in pharmacies.

After studying animals in Heidelberg in 1900, Dr. Baden tested strophanthin on a sick person. The success attracted the attention of the people, and within a year the therapy was widespread. Rudolf Gottlieb and pharmacist Hans Horstmeyer wrote in 1910 in the first edition of their pharmacology textbook that intravenous administration it turned out to be strophanthin important achievement in the treatment of diseases of various etiologies.

Areas of application: heart failure, arrhythmias, acute myocardial diseases, influenza, diphtheria, angina pectoris, myocardial infarction and hypertension.

Diphtheria

During the National Socialist dictatorship, strophrantine was used in isolation in concentration camps to kill prisoners.

Modern medicine: indications for use

Intravenous strophanthin was recommended for acute heart failure until 1992 because it is the fastest-acting glycoside. Today, international guidelines do not recommend the use of strophanthin. The use of the drug is possible in case of intolerance to other, safe glycosides.

G-strophanthin, according to some doctors, has a positive inotropic effect, which has been used in the prevention of acute angina and heart attack. However, no study has been able to prove this effect in clinical practice. Therefore, today, neither in case of acute coronary syndrome, nor at coronary disease heart this substance is not recommended for long-term use.

Ouabain

However limited use the drug still has. Small doses of ouabain can be used to treat hypotension and cardiac arrhythmias. Although this substance is no longer approved for use in the US, France and Germany, intravenous ouabain has long history treatment of heart failure, and some continue to use it for angina and suffered a heart attack, despite him poor tolerance. Positive properties Ouabain in relation to the prevention and treatment of these two diseases has been documented by many studies.

Attention! Recently, the use of ouabain as a contraceptive has been proposed based on the observation that it can greatly reduce sperm motility.

More:

Indications for the use of hawthorn tincture, contraindications, side effects and instructions for use