Kordipin HL: keeping blood pressure under control has become easy! Cordipin chl - instructions for use Contraindications to the drug.

General characteristics. Compound:

Active ingredient: 40.0 mg nifedipine

Excipients: microcrystalline cellulose, cellulose, lactose, hypromellose (methylhydroxypropylcellulose), magnesium stearate, colloidal silicon dioxide, anhydrous.

Shell: hypromellose (methylhydroxypropylcellulose), macrogol 6000, macrogol 400, red iron oxide dye, E172, titanium dioxide, E171, talc.

Cordipine is a calcium antagonist that blocks calcium channels in the muscle cells of the heart and blood vessels. It has hypotensive (lowers blood pressure), vasodelating, antianginal and anti-ischemic effects.

Pharmacological properties:

Pharmacodynamics. Cordipin® XL is a drug from the group of “slow” calcium channel blockers.It blocks the flow of calcium ions through the membrane of cardiac muscle cells and vascular smooth muscles. Blockade of the entry and accumulation of calcium ions inside cells leads to dilation of peripheral and coronary vessels, reduces total peripheral vascular resistance (TPVR), reduces afterload on the heart, reduces coronary blood flow and reduces myocardial oxygen demand.

Mainly at the beginning of therapy, heart rate and cardiac output may decrease as a result of activation of the baroreceptor reflex. With long-term therapy with nifedipine, heart rate and cardiac output return to the values they had before the start of therapy. Patients with arterial hypertension experience a more pronounced decrease in blood pressure.

Pharmacokinetics.The release of nifedipine from Cordipine® XL tablets is very slow, almost linear, i.e. release occurs at a constant level. Nifedipine released from the tablets is quickly and almost completely absorbed. The lower value of the equilibrium concentration level is achieved after taking the first dose of Cordipine® CL (after 24 hours). When the equilibrium state has already been achieved, the maximum concentration of the drug is reached 5  2.7 hours after oral administration. The effect of the drug lasts 24 hours, so a single dose per day is sufficient. Protein binding of nifedipine is 94-99%. Nifedipine is almost completely metabolized. The half-life (T 1/2) of the drug is 14.9  6.0 hours, less than 1% of the drug dose is excreted unchanged in the urine. 70-80% of the dose taken is excreted in the urine in the form of metabolites. The elimination of nifedipine may be slower if renal function is impaired.

Indications for use:

Cordipin® XL is used to treat:

Arterial hypertension
.Stable (angina pectoris)
.Vasospastic angina

Important! Get to know the treatment

Directions for use and dosage:

The dosage regimen for Cordipin® HL is individual. The usual dose of Cordipin® XL, modified release, both at the beginning of therapy and during ongoing treatment, is one 40 mg tablet taken once a day; The maximum recommended dose is two tablets (80 mg) per day in one or two divided doses.

Cordipin® CL tablets should be taken after meals, they should be swallowed whole with a glass of water, the tablets should not be broken or chewed.

If the patient forgot to take the next dose of Cordipine® CL, the next time he takes it, he should not double the dose of the drug.

Features of application:

It is recommended to discontinue treatment with Cordipin® CL gradually.It should be borne in mind that angina pectoris may occur at the beginning of treatment, especially after recent abrupt withdrawal of beta-blockers (the latter should be withdrawn gradually).

The simultaneous administration of beta-blockers must be carried out under conditions of careful medical supervision, as this may cause an excessive decrease in blood pressure, and in some cases, aggravation of symptoms.

In case of severe heart failure, the drug is dosed with great caution.

The diagnostic criteria for prescribing the drug for vasospastic angina are: a classic clinical picture, accompanied by an increase in the ST segment, the occurrence of ergonovine-induced angina or coronary artery spasm, detection of coronary spasm with or detection of an angiospastic component without confirmation (for example, with a different voltage threshold or when electrocardiogram data indicate transient vasospasm).

For patients with severe obstructive cardiomyopathy, there is a risk of increased frequency, severity and duration of angina attacks after taking nifedipine; in this case, discontinuation of the drug is necessary.

In patients on hemodialysis with high blood pressure and irreversible kidney failure with a reduced total blood volume, the drug should be used with caution; a sharp drop in blood pressure may occur.

Patients with impaired liver function are closely monitored and, if necessary, reduce the dose of the drug and/or use other dosage forms of nifedipine. If during therapy the patient requires surgery under general anesthesia, it is necessary to inform the anesthesiologist about the nature of the therapy being performed.

During treatment, positive results are possible with direct Coombs test and laboratory tests for antinuclear antibodies.

Caution should be used when coadministering disopyramide and flecainamide due to a possible increase in inotropic effect.

Prescription of nifedipine for pregnant women is indicated only if the expected benefit to the mother outweighs the potential risk to the fetus. Nifedipine is not recommended for use in the 1st trimester of pregnancy.
The drug is excreted in breast milk, so it is recommended to stop breastfeeding while taking the drug.

In some patients, especially at the beginning of treatment, the drug may cause pain, which reduces the ability to drive a car or use other machinery. In the future, the degree of restrictions is determined depending on the individual tolerability of the drug.

Side effects:

From the cardiovascular system: manifestations of excessive vasodilation (asymptomatic decrease in blood pressure, “flushes” of blood to the skin of the face, flushing of the skin of the face, feeling of heat), palpitations, peripheral, development or worsening of heart failure (HF) (usually worsening of an existing one), chest pain; rarely - excessive decrease in blood pressure (BP), fainting,In some patients, especially at the beginning of treatment, angina attacks may occur, which requires discontinuation of the drug. Isolated cases of myocardial infarction have been described.

From the central nervous system: dizziness, increased fatigue, weakness, drowsiness. With long-term ingestion in high doses - limbs, feeling, with long-term ingestion in high doses - extrapyramidal (parkinsonian) disorders (ataxia, “mask-like” face, shuffling gait, stiffness of movements of the arms and legs, hands and fingers, difficulty swallowing).

From the digestive system: dry mouth, loss of appetite (nausea, or); rarely - gum hyperplasia (bleeding, pain, swelling), with long-term use - liver dysfunction (intrahepatic, increased activity of "liver" transaminases).

From the hematopoietic organs: , asymptomatic, thrombocytopenic purpura, .

Allergic reactions: rarely - exfoliative, photodermatitis; very rarely - .

From the musculoskeletal system: rarely - swelling of the joints, upper and lower extremities.

From the urinary system: increased daily diuresis, deterioration of renal function (in patients with renal failure).

Other: rarely - difficulty breathing; very rarely - visual impairment (including transient blindness at the maximum concentration of nifedipine in the blood plasma), (in elderly patients, completely disappearing after discontinuation of the drug), weight gain.

Interaction with other drugs:

Medicines from the BMCC group can further enhance the negative inotropic effect (lowering the force of heart contraction) of antiarrhythmic drugs such as amiodarone and quinidine.

Nifedipine causes a decrease in the concentration of quinidine in the blood plasma; after discontinuation of nifedipine, a sharp increase in the concentration of quinidine may occur.

Increases the plasma concentration of digoxin and theophylline, and therefore the clinical effect and the content of digoxin and theophylline in the blood plasma should be monitored.

Inducers of microsomal liver enzymes (rifampicin, etc.) reduce the concentration of nifedipine. In combination with nitrates, tachycardia increases. The hypotensive effect is reduced by sympathomimetics, nonsteroidal anti-inflammatory drugs, estrogens, and calcium supplements.

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

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.

Lithium preparations can increase toxic effects (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus). With the simultaneous administration of cephalosporins (for example, cefixime) and nifedipine in probands, the bioavailability of the cephalosporin increased by 70%. Grapefruit juice suppresses the metabolism of nifedipine in the body, and therefore their simultaneous use is contraindicated.

Suppresses the metabolism of prazosin and other alpha-blockers, as a result of which the hypotensive effect may be enhanced. Procainamide, quinidine, and other drugs known to prolong the QT interval potentiate the negative inotropic effect and may increase the risk of significant QT prolongation.

Contraindications:

Hypersensitivity to nifedipine or other dihydropyridine derivatives, other components of the drug (each Cordipine CL tablet contains 30 mg of lactose, so the drug is not recommended for lactase deficiency, malabsorption syndrome), (risk of myocardial infarction), severe aortic valve stenosis (in the stage of decompensation ), severe (systolic blood pressure below 90 mm Hg), acute period of myocardial infarction (during the first 4 weeks), pregnancy (first trimester), lactation period, age up to 18 years (efficacy and safety have not been established) .

With caution: severe stenosis of the aortic orifice or mitral valve, hypertrophic obstructive tachycardia, severe tachycardia, malignant, myocardial infarction with left ventricular failure, chronic heart failure, unstable angina, simultaneous administration of beta-blockers or cardiac glycosides, obstruction of the gastrointestinal tract (GIT) , pregnancy II - III trimester, mild or moderate arterial hypotension, simultaneous use of rifampicin, severe cerebrovascular accidents, impaired liver and/or kidney function (risk of arterial hypotension), old age.

Overdose:

Symptoms: causes peripheral vasodilation with severe and possibly prolonged systemic arterial hypotension: headache, flushing of the facial skin, prolonged pronounced decrease in blood pressure, depression of the sinus node, bradycardia and/or tachycardia, bradyarrhythmia. In severe poisoning, loss of consciousness, coma.

Treatment of overdose consists of standard procedures for removing the drug from the body (administration of activated carbon), restoration of stable hemodynamic parameters, careful monitoring of the activity of the heart, lungs and excretory system.

The antidote is calcium preparations; intravenous administration of a 10% solution of calcium chloride or calcium gluconate is indicated, followed by switching to a long-term infusion.

Due to the high degree of binding to plasma proteins, hemodialysis is not effective.

The clearance of nifedipine is increased in patients with impaired liver function.

Storage conditions:

Store at a temperature not exceeding 25 °C.Keep out of the reach of children.

Vacation conditions:

By prescription

Package:

Modified-release film-coated tablets, 40 mg. 10 tablets in a blister. 2 blisters in a cardboard box along with instructions for use.

Description of the dosage form

Round, biconvex tablets, film-coated, reddish-brown in color.

Pharmacodynamics

Kordipin ® CL blocks the flow of calcium ions through the membrane of cardiac muscle cells and vascular smooth muscles. Blockade of the entry and accumulation of calcium ions inside cells leads to dilation of peripheral and coronary vessels, a decrease in peripheral vascular resistance, a decrease in afterload on the heart, an increase in coronary blood flow and a decrease in myocardial oxygen demand.

Mainly at the beginning of therapy, heart rate and cardiac output may decrease as a result of activation of the baroreceptor reflex. With long-term therapy with nifedipine, heart rate and cardiac output return to the values they had before the start of therapy. In patients with arterial hypertension, a more pronounced decrease in blood pressure is observed.

Pharmacokinetics

The release of nifedipine from Cordipin ® CL tablets is very slow, almost linear, i.e. release occurs at a constant level. Nifedipine released from the tablets is quickly and almost completely absorbed. The lower value of the equilibrium concentration level is achieved after taking the first dose of Cordipine ® CL (after 24 hours). When the equilibrium state has already been achieved, Cmax of the drug is achieved 5 hours ± 2.7 hours after oral administration. The effect of the drug lasts 24 hours, so a single dose per day is sufficient. Protein binding of nifedipine is 94–99%. Nifedipine is almost completely metabolized. T1/2 - 14.9 hours ± 6 hours, less than 1% of the drug dose is excreted unchanged in the urine. 70–80% of the dose taken is excreted in the urine in the form of metabolites. The elimination of nifedipine may be slower if renal function is impaired.

Cordipin XL: Indications

arterial hypertension;

stable angina (angina pectoris);

vasospastic angina.

Kordipin XL: Contraindications

Hypersensitivity to nifedipine or other dihydropyridine derivatives, other components of the drug (each Cordipine ® CL tablet contains 30 mg of lactose, so the drug is not recommended for lactase deficiency, galactosemia, malabsorption syndrome), cardiogenic shock (risk of myocardial infarction); porphyria, severe aortic valve stenosis, chronic heart failure (in the stage of decompensation), severe arterial hypotension (systolic blood pressure<90 мм рт. ст.), острый период инфаркта миокарда (в течение первых 4 нед), беременность (I триместр), период грудного вскармливания, возраст до 18 лет (эффективность и безопасность не установлены).

With caution: severe stenosis of the aortic orifice or mitral valve, hypertrophic obstructive cardiomyopathy, severe bradycardia and tachycardia, sick sinus syndrome, malignant arterial hypertension, myocardial infarction with left ventricular failure, chronic heart failure, unstable angina, simultaneous administration of beta-blockers or cardiac glycosides, obstruction CT , pregnancy (II–III trimester), mild or moderate arterial hypotension, simultaneous use of rifampicin, severe cerebrovascular accidents, impaired liver and/or kidney function, hemodialysis (risk of arterial hypotension), old age.

Use during pregnancy and breastfeeding

The drug is excreted in breast milk, so it is recommended to stop breastfeeding while taking the drug.

Directions for use and doses

Inside, after eating, swallow whole, with a glass of water, without breaking or chewing.

The dosage regimen of the drug is individual. The usual dose of Cordipin ® CL with modified release, both at the beginning of therapy and during long-term treatment, is 1 table. (40 mg), taken once a day; the maximum recommended dose is 2 tablets. (80 mg) per day in 1 or 2 doses.

If the patient forgot to take the next dose of Cordipin ® CL, the next dose should not be doubled.

Cordipin XL: Side effects

From the cardiovascular system: manifestations of excessive vasodilation (asymptomatic decrease in blood pressure, flushing of the face, facial skin flushing, feeling of heat), tachycardia, palpitations, arrhythmia, peripheral edema, development or worsening of heart failure (usually worsening of existing ones), chest pain; rarely - excessive decrease in blood pressure, fainting; in some patients, especially at the beginning of treatment, angina attacks may occur, which requires discontinuation of the drug. Isolated cases of myocardial infarction have been described.

From the side of the central nervous system: headache, dizziness, increased fatigue, weakness, drowsiness. With long-term oral administration in high doses - paresthesia of the limbs, depression, anxiety; with prolonged use in high doses - extrapyramidal (parkinsonian) disorders (ataxia, “mask-like” face, shuffling gait, stiffness of movements of the arms and legs, tremor of the hands and fingers , difficulty swallowing).

From the digestive system: dry mouth, loss of appetite, dyspepsia (nausea, diarrhea or constipation); rarely - gum hyperplasia (bleeding, pain, swelling), with long-term use - liver dysfunction (intrahepatic cholestasis, increased activity of liver transaminases).

From the hematopoietic organs: anemia, asymptomatic agranulocytosis, thrombocytopenia, thrombocytopenic purpura, leukopenia.

Allergic reactions: rarely - skin itching, exanthema, exfoliative dermatitis, photodermatitis; very rarely - autoimmune hepatitis.

From the musculoskeletal system: arthritis, rarely - arthralgia, swelling of the joints, myalgia, convulsions of the upper and lower extremities.

From the urinary system: increased daily diuresis, deterioration of renal function (in patients with renal failure).

Other: rarely - difficulty breathing, cough; very rarely - visual impairment (including transient blindness at the maximum concentration of nifedipine in the blood plasma), gynecomastia (in elderly patients, completely disappearing after discontinuation of the drug), hyperglycemia, galactorrhea, pulmonary edema, bronchospasm, weight gain.

Overdose

Symptoms: causes peripheral vasodilation with severe and possibly prolonged systemic arterial hypotension: headache, facial skin flushing, prolonged pronounced decrease in blood pressure, depression of the sinus node, bradycardia and/or tachycardia, bradyarrhythmia. In case of severe poisoning - loss of consciousness, coma.

Treatment: standard procedures for removing the drug from the body (prescription of activated carbon, gastric lavage), restoration of stable hemodynamic parameters, careful monitoring of the activity of the heart, lungs and excretory system.

The antidote is calcium preparations; intravenous administration of a 10% solution of calcium chloride or calcium gluconate is indicated, followed by switching to a long-term infusion.

Due to the high degree of binding to plasma proteins, hemodialysis is not effective.

The clearance of nifedipine is increased in patients with impaired liver function.

Interaction

The severity of the decrease in blood pressure increases with the simultaneous use of other antihypertensive drugs, beta-blockers, nitrates, cimetidine (to a lesser extent ranitidine), inhalational anesthetics, diuretics and tricyclic antidepressants. Drugs from the BMCC group can further enhance the negative inotropic effect (decrease in the force of cardiac contraction) of antiarrhythmic drugs such as amiodarone and quinidine.

Nifedipine causes a decrease in the concentration of quinidine in the blood plasma; after discontinuation of nifedipine, a sharp increase in the concentration of quinidine may occur.

Increases the plasma concentration of digoxin and theophylline, and therefore the clinical effect and the content of digoxin and theophylline in the blood plasma should be monitored.

Inducers of microsomal liver enzymes (rifampicin, etc.) reduce the concentration of nifedipine. In combination with nitrates, tachycardia increases.

The hypotensive effect is reduced by sympathomimetics, NSAIDs, estrogens, and calcium supplements.

Nifedipine can displace drugs characterized by a high degree of binding from protein binding (including indirect anticoagulants - coumarin and indanedione derivatives, anticonvulsants, NSAIDs, quinine, salicylates, sulfinpyrazone), as a result of which their concentration in the blood plasma may increase.

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.

Lithium preparations can increase toxic effects (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus). With the simultaneous administration of cephalosporins (for example, cefixime) and nifedipine in probands, the bioavailability of cephalosporin increased by 70%. Grapefruit juice suppresses the metabolism of nifedipine in the body, and therefore their simultaneous use is contraindicated.

Suppresses the metabolism of prazosin and other alpha-blockers, as a result of which the hypotensive effect may be enhanced. Procainamide, quinidine and other drugs that cause prolongation of the QT interval enhance the negative inotropic effect and may increase the risk of significant prolongation of the QT interval.

Special instructions

It is recommended to discontinue treatment with Cordipin ® CL gradually.

It should be borne in mind that angina pectoris may occur at the beginning of treatment, especially after recent abrupt withdrawal of beta-blockers (the latter should be withdrawn gradually).

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 symptoms of heart failure.

In case of severe heart failure, the drug is dosed with great caution.

Diagnostic criteria for prescribing the drug for vasospastic angina are: a classic clinical picture, accompanied by an increase in the ST segment, the occurrence of ergonovine-induced angina or coronary artery spasm, detection of coronary spasm during angiography or identification of an angiospastic component without confirmation (for example, with a different voltage threshold or with unstable angina, when electrocardiogram data indicate transient vasospasm).

In patients on hemodialysis with high blood pressure and irreversible kidney failure with a reduced total blood volume, the drug should be used with caution; a sharp drop in blood pressure may occur.

Patients with impaired liver function are closely monitored and, if necessary, the dose of the drug is reduced and/or other dosage forms of nifedipine are used. If during therapy the patient requires surgery under general anesthesia, it is necessary to inform the anesthesiologist about the nature of the therapy being performed.

During treatment, positive results are possible with direct Coombs test and laboratory tests for antinuclear antibodies.

Caution should be used when co-administering disopyramide and flecainamide due to a possible increase in negative inotropic effect.

1 film-coated tablet contains: active substance: nifedipine 40 mg

Pharmacological action

Nifedipine belongs to the group of “slow” calcium channel blockers, a 1,4-dihydropyridine derivative. It has antianginal and antihypertensive activity. Dilates coronary and peripheral arterial vessels, reduces myocardial oxygen demand by reducing afterload on the heart and oxygen delivery. Strengthens coronary blood flow, improves blood supply to ischemic areas without developing the “steal” phenomenon, and activates the functioning of collaterals. By dilating peripheral arteries, it reduces total peripheral vascular resistance (TPVR), myocardial tone, afterload, myocardial oxygen demand and increases the duration of diastolic relaxation of the left ventricle (LV). Does not have antiarrhythmic activity.

Indications

Arterial hypertension
Stable angina (angina pectoris)
Vasospastic angina

Directions for use and doses

The dosage regimen for Cordipin HL is individual. The usual dose of Cordipin XL, modified release, both at the beginning of therapy and during ongoing treatment, is one 40 mg tablet taken once a day; The maximum recommended dose is two tablets (80 mg) per day in one or two divided doses.

Cordipin HL tablets should be taken after meals, they should be swallowed whole with a glass of water, the tablets should not be broken or chewed.

If the patient forgot to take the next dose of Cordipine® CL, the next time he takes it, he should not double the dose of the drug

Contraindications

Hypersensitivity to nifedipine or other dihydropyridine derivatives, other components of the drug (each Cordipine CL tablet contains 30 mg of lactose, so the drug is not recommended for lactase deficiency, galactosemia, malabsorption syndrome),
cardiogenic shock (risk of developing myocardial infarction),
porphyria,
severe stenosis of the aortic valve,
chronic heart failure (in the stage of decompensation),
severe arterial hypotension (systolic blood pressure below 90 mm Hg),
acute period of myocardial infarction (during the first 4 weeks),
pregnancy (first trimester), lactation period,
age under 18 years (efficacy and safety have not been established).

Special instructions

You should refrain from using the drug in pediatric practice, since the safety and effectiveness of its use in children have not been determined.

Use with caution while working for vehicle drivers and people whose profession involves increased concentration of attention. The drug should be discontinued gradually (withdrawal syndrome may develop).

Storage conditions

In a dry place, protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children.

An increasing number of people are suffering from high blood pressure. Cordipine XL (XL) belongs to the group of calcium antagonists and is an effective remedy against this pathology. The drug is produced in Slovenia.

The medicine has contraindications and features of combination with other medications. There are analogs that can replace it.

Composition of Cordipin CL 40 mg

Cordipine XL 40 mg is produced in the form of round tablets of a red-brown hue. The medicine has a modified effect - the release of the nucleus occurs gradually, over a given period of time. One Cordipine CL tablet contains 40 mg of the active ingredient nifedipine. Among the additional components in the medicine there is lactose.

After release, nifedipine is absorbed quite quickly, binding to blood plasma by 94-99%. The main part of the substance is excreted through the kidneys in the form of metabolites (70-80%). The drug has a number of serious side effects and contraindications; it should be used only as prescribed by a doctor.

Cordipin

The active ingredient of the drug is nifedipine. One tablet contains 10 mg. Indications for use:

Raynaud's disease;
arterial hypertension;
angina attacks;
hypertensive crisis.

It is possible to use medication to prevent angina attacks. It differs from Cordipine HL in a lower dose of nifedipine per 1 tablet, as well as a sharp and rapid action. If necessary, speed up the effect, the medicine can be chewed. The maximum daily dose is 9-12 tablets per day, divided into 3-4 doses.

Cordipin retard

One tablet of Cordipin retard contains 20 mg of nifedipine. Does not contain lactose. It is recommended to take 1-2 tablets 2 times a day. The maximum dose should not exceed 60 mg. With a diagnosis of Prinzmetal angina, an increase to 4-6 tablets per day is likely.

All three drugs are analogues with the same active ingredient. Doctors make their choice based on the required dose of nifedipine for a particular patient, his individual sensitivity to additional components and other characteristics.

What are these pills for?

Cordipin CL 40 mg, according to the instructions for use, is prescribed to lower blood pressure for the following diagnoses:

arterial hypertension;
cardiac ischemia.

It is also used to prevent attacks in stable angina. The action of Cordipine 40 is due to the ability of nifedipine to prevent the movement of calcium ions through the membrane of cardiac muscle cells and blood vessels. As a result, the following effects are observed:

TPVR (total peripheral vascular resistance) decreases;
coronary blood flow decreases;
coronary and peripheral vessels dilate;
the myocardium's need for oxygen is reduced.

The beginning of treatment with Cordipine 40 mg is characterized by a decrease in cardiac output and heart rate. Long-term use of the drug helps to return these indicators to their original values. The drug is effective in lowering blood pressure in people suffering from hypertension.

Vessels in cardiac ischemia

Instructions for use

The official instructions for use of Cordipin XL warn that the drug cannot be used in pediatric practice. Other contraindications:

hypotension;
hypovolemia;
hypersensitivity to nifedipine or auxiliary components of the tablets;
cardiogenic shock;
liver failure;
collapsed states;
severe degree of myocardial insufficiency;
severe degree of stenosis of the aortic vessels.

The drug is prescribed to older people with caution. If chest pain appears as a result of use, the medicine should be discontinued and consult a cardiologist. In combination with alcohol, nifedipine can provoke a dangerous drop in blood pressure.

How to take?

Cordipine 40 mg, according to the official instructions for use, is taken once a day. Do this after a meal, swallowing the tablet whole. You should take the medicine with a sufficient amount of liquid. It should not be chewed or broken.

Dosage

The dose of the drug is determined by the attending physician, based on the severity of the disease, the patient’s age and other individual characteristics. Usually prescribed 40 mg once a day. In case of complicated course of the disease, the dosage is increased to 80 mg per day. It is taken at one time, or divided into two doses.

Duration of admission

The duration of use of Cordipin HL is determined by the doctor. The course of treatment is selected individually. The effect after taking the drug lasts throughout the day.

Special instructions

Cordipin HL sometimes causes dizziness. This provokes difficulties in driving transport and performing other types of work that require quick reaction and attention. The medicine contains lactose, as a result of which it is contraindicated for persons with glucose-galactose malabsorption syndrome, lactase deficiency, or lactose intolerance.

Some medications can increase the concentration of nifedipine in the blood. These include macrolide antibiotics, antidepressants Fluoxetine and Nefazodone, azole antifungals, valproic acid, HIV protease inhibitors, cimetidine, quinupristin.

Features of using Cordipin 40:

The beginning of a course of therapy may be marked by angina pectoris.
Simultaneous use of beta-blockers and Cordipine requires specialist supervision. This combination of medications increases the likelihood of worsening the symptoms of chronic heart failure and provokes a significant drop in blood pressure.
Cordipin HL 40 mg is not used for patients after myocardial infarction. Prevention of complications and treatment of angina attacks in them should be carried out with other drugs.
Severe obstructive cardiomyopathy may be complicated by increased angina attacks when the patient uses nifedipine.
The use of Cordipine HL in patients with impaired liver function should be carried out with caution. It is possible to reduce the dose or switch to another medicine.
In patients with irreversible renal failure, the drug can provoke a sharp drop in blood pressure.

Exceeding the permissible dose of nifedipine causes headache, heart rhythm disturbances, redness and swelling of the face, and a significant decrease in blood pressure for a long period. Severe poisoning is characterized by fainting and coma. Therapy consists of measures to remove the substance from the body and alleviate symptoms. A specific antidote is calcium preparations.

Before prescribing Cordipin XL 40, you need to warn your doctor about taking other medications. Grapefruit juice increases the concentration of nifedipine in the blood. During treatment, it is recommended to exclude this drink from the diet. The drug is discontinued by gradually reducing the dosage.

Is it possible to use during pregnancy?

Based on the results of studies conducted on animals, a detrimental effect of nifedipine on the fetus was suggested. The following phenomena were observed in the experimental subjects:

premature birth;
the need for a caesarean section;
asphyxia in the embryo;
delayed perinatal development.

Cordipin HL, as the instructions for use indicate, is contraindicated for treatment during pregnancy. It can be used only if there is a threat to the life of the mother, when other methods of therapy do not produce positive results.

Nifedipine passes into breast milk. During lactation you should refrain from taking Cordipine. If its use is necessary, the mother is advised to express within 3-4 hours after taking the medicine.

Excipients: microcrystalline cellulose, cellulose, lactose, methylhydroxypropylcellulose, magnesium stearate, colloidal anhydrous silicon, macrogol, iron oxide (E172), titanium dioxide (E171), talc.

10 pcs. - blisters (2) - cardboard boxes.

Description of the drug CORDIPIN ® HL based on officially approved instructions for use of the drug and made in 2008. Update date: ..0

Pharmacological action

Calcium channel blocker. Inhibits the flow of calcium ions through the membrane of cardiomyocytes and vascular smooth muscles. Blockade of the entry and accumulation of calcium ions inside cells leads to dilation of peripheral and coronary vessels, a decrease in peripheral vascular resistance, a decrease in afterload on the heart and myocardial oxygen demand.

Mainly at the beginning of therapy, heart rate and cardiac output may decrease as a result of baroreceptor activation. With long-term therapy with nifedipine, heart rate and cardiac output return to the values they had before the start of therapy.

In patients with arterial hypertension, a more pronounced decrease in blood pressure is observed.

Pharmacokinetics

Suction and distribution

The release of nifedipine from Cordipin CL tablets is slow and almost linear, i.e. release occurs at a constant level. After release, nifedipine is quickly and almost completely absorbed from the gastrointestinal tract.

The minimum C ss value is achieved after the first dose of Cordipine CL (after 24 hours). When the equilibrium state has already been achieved, C ss max of nifedipine in the blood is observed after 5.0 ± 2.7 hours.

The binding of nifedipine to plasma proteins is 94-99%.

Metabolism and excretion

Nifedipine is almost completely biotransformed in the body.

T1/2 is 14.9±6 hours. Less than 1% of the dose is excreted in the urine unchanged, 70-80% of the dose is excreted in the form of metabolites.

Pharmacokinetics in special clinical situations

If renal function is impaired, T1/2 may increase.

Dosage regimen

Installed individually.

The drug is prescribed in an average dose of 40 mg (1 tablet) 1 time/day both at the beginning of therapy and during long-term treatment. If necessary, the dose is increased to a maximum of 80 mg (2 tablets)/day in 1 or 2 doses.

If the patient forgets to take the next dose of the drug, the next dose should not be doubled.

U patients with impaired renal function Dose adjustment is usually not required.

The tablets should be taken after meals and should be swallowed whole, without breaking or chewing, with a glass of water.

Side effects

From the cardiovascular system: possible headache, redness of the face, swelling of the ankles;

rarely - orthostatic hypotension, cardiac arrhythmia, chest pain.

From the side of the central nervous system: rarely - dizziness, increased fatigue.

From the digestive system: rarely - nausea, heartburn, constipation, diarrhea, increased activity of liver transaminases;

in some cases - gum hyperplasia.

From the musculoskeletal system: rarely - muscle weakness, muscle cramps.

Allergic reactions: rarely - skin rash, urticaria, itching.

Use during pregnancy and breastfeeding

To date, the safety of using Cordipine CL during pregnancy has not been established, and therefore the drug should not be prescribed to pregnant women.

Nifedipine is excreted in breast milk, so if it is necessary to use the drug during lactation, breastfeeding should be stopped.

Special instructions

At the beginning of treatment with Cordipine HL, especially when used simultaneously with beta-blockers, arterial hypotension is possible. In such cases, patients must be closely monitored.

Physician supervision, especially at the beginning of treatment, is required for patients with hypertrophic cardiomyopathy, unstable angina, diabetes mellitus, severe liver dysfunction, pulmonary hypertension, as well as elderly patients.

During treatment with Cordipin CL in patients with acute coronary insufficiency due to reflex tachycardia, the course of coronary artery disease may worsen (more frequent attacks of angina).

When using nifedipine, changes in alkaline phosphatase, ALT, AST, and LDH levels are possible. These changes are most often not associated with clinical manifestations, although symptoms of cholestasis and jaundice have been observed in some cases.

Cordipin HL should be discontinued 36 hours before planned anesthesia with fentanyl.

Before performing an inhalation test with methacholine to determine bronchial hyperreactivity, Cordipin CL should also be discontinued.

If it is necessary to discontinue therapy, the dose of the drug should be reduced gradually, since abrupt cessation of administration (especially after long-term treatment) may lead to the development of withdrawal syndrome.

During the treatment period, you should avoid drinking grapefruit juice and alcohol.

Impact on the ability to drive vehicles and operate machinery

In some patients, especially at the beginning of treatment, the drug may cause dizziness, which is reversible. Therefore, until the patient’s individual response to treatment is established, you should refrain from driving and engaging in other potentially hazardous activities.

Overdose

Symptoms: excessive arterial hypotension;

when taking a large number of tablets, tachycardia, bradycardia, arrhythmia, nausea, vomiting, weakness, redness of the skin, dizziness, drowsiness, lethargy, color perception disorders, metabolic acidosis, convulsions, loss of consciousness may occur.

Treatment: If the patient is conscious, vomiting should be induced. Careful monitoring of hemodynamic status and symptomatic therapy are necessary.

Drug interactions

With simultaneous use of Cordipin HL with other antihypertensive drugs, beta-blockers, diuretics, nitroglycerin and long-acting isosorbide mononitrate or dinitrate, a synergistic effect on blood pressure is observed.

With the simultaneous use of Cordipine CL and fentanyl, an additional decrease in blood pressure is possible.

With simultaneous use of Cordipine CL with cimetidine, tricyclic antidepressants, ranitidine, the antihypertensive effect of nifedipine may be enhanced.

Rifampin induces the activity of liver enzymes, accelerating the metabolism of nifedipine, which leads to a decrease in the effectiveness of the latter.

When used simultaneously with calcium supplements, the therapeutic effectiveness of Cordipin HL is reduced.

With the simultaneous use of Cordipine CL and digoxin, carbamazepine, phenytoin and theophylline, the concentrations of the latter in the blood plasma increase.

With the simultaneous use of Cordipine CL and quinidine, the concentration of the latter in the blood plasma decreases.

It is possible to enhance the effect of Cordipin HL when used simultaneously with grapefruit juice and ethanol.