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Tablets nifedipine from what. Reliable assistant in the treatment of cardiovascular pathologies Nifedipine: what is prescribed and how to take the medicine correctly

Nifedipine: instructions for use and reviews

Nifedipine is a blocker calcium channels.

Release form and composition

Dosage form - dragee yellow color(10 pieces in blisters, in a carton pack of 5 blisters).

Active substance: nifedipine, in 1 tablet - 10 mg.

Excipients: wheat starch, gelatin, magnesium stearate, lactose, microcrystalline cellulose PH101, talc.

Shell composition: isopropanol, glycerol, carmellose 7MF, acetone, arlacel 186, purified water, ethylcellulose N22, titanium dioxide, povidone K30, sugar, ethanol 96%, macrogol 6000, talc, polysorbate 20, colloidal silicon dioxide, Eurolake Quinoline Yellow 21 ( E104) and Eurolake Sunset Yellow 22 (E110).

Pharmacological properties

Pharmacodynamics

Nifedipine is a selective blocker of slow calcium channels, belongs to 1,4-dihydropyridine derivatives. The drug has antianginal, hypotensive and vasodilating effects. It reduces the flow of calcium ions into cells smooth muscle peripheral and coronary arteries and also inside cardiomyocytes. In high doses, nifedipine inhibits the release of calcium ions from the depot inside the cells. It reduces the number of functioning calcium channels without affecting the time of their recovery, inactivation and activation.

Nifedipine uncouples the processes of contraction and excitation in smooth muscles blood vessels mediated by calmodulin and in cardiac muscle mediated by troponin and tropomyosin. In therapeutic doses, the drug normalizes the transport of calcium ions through the membrane, which is disturbed in some pathological conditions such as hypertension.

Nifedipine does not affect the tone of the veins. It reduces spasm, expands the peripheral and coronary vessels(mainly arterial), lowers blood pressure and total peripheral vascular resistance, reduces myocardial tone, afterload and myocardial oxygen demand, prolongs diastolic relaxation of the left ventricle. Under his influence increases coronary blood flow, improves blood supply to ischemic areas of the myocardium, activates the functioning of collaterals. Almost no effect on the atrioventricular and sinoatrial nodes and does not antiarrhythmic action. Increases blood flow in the kidneys, causes a moderate excretion of sodium in the urine.

The clinical effect occurs after 20 minutes and lasts from 4 to 6 hours.

Pharmacokinetics

Nifedipine is rapidly and almost completely (92–98%) absorbed into the digestive tract. The bioavailability of the drug after oral administration ranges from 40 to 60% (reception simultaneously with food increases this indicator). Nifedipine undergoes a first pass effect through the liver. In plasma, the maximum concentration of the substance is 65 ng / ml and is observed after 1-3 hours. 90% bound to plasma proteins. Nifedipine crosses the placental and blood-brain barrier and is secreted in breast milk.

Metabolized completely. Metabolism occurs in the liver with the participation of isoenzymes CYP3A5, CYP3A7 and CYP3A4.

About 80% taken dose excreted in the form of inactive metabolites by the kidneys and another 20% - with bile. The half-life is from 2 to 4 hours. With insufficiency of liver function, the total clearance decreases, the half-life is prolonged.

Nifedipine does not accumulate in the body. chronic insufficiency renal function, peritoneal dialysis and hemodialysis do not affect pharmacokinetic parameters. Long-term use (2-3 months or more) leads to the development of tolerance to the drug. Plasmapheresis may accelerate elimination.

Indications for use

Angina at rest and exertion (including variant) in coronary heart disease;
Arterial hypertension (as a single drug or in combination with other antihypertensive drugs).

Contraindications

Cardiogenic shock, collapse;
weakness syndrome sinus node;
Decompensated heart failure;
Severe aortic/mitral stenosis;
Arterial hypotension with systolic blood pressure below 90 mm Hg;
Idiopathic hypertrophic subaortic stenosis;
Tachycardia;
Period 4 weeks after acute myocardial infarction;
Age up to 18 years;
Hypersensitivity to the drug or other derivatives of dihydropyridine.

Nifedipine is also contraindicated during pregnancy and lactation.

Due to the risk of complications, the drug should be used with caution in the following cases:

Diabetes;
Severe violations cerebral circulation;
Severe violations of kidney / liver function;
Chronic heart failure;
Malignant arterial hypertension.

Caution requires the use of the drug by patients on hemodialysis.

Instructions for use of Nifedipine: method and dosage

Nifedipine is taken orally by swallowing the tablets whole and drinking enough fluids during meals or after meals.

Doses are set individually depending on the severity of the course of the disease and the patient's response to the drug.

At the beginning of treatment, 1 tablet is prescribed 2-3 times a day, if necessary, the dose is increased to 2 tablets 1-2 times a day.

Maximum allowable daily dose is 40 mg of nifedipine (4 tablets).

Dose reduction is required for the elderly, patients with impaired liver function, severe cerebrovascular accident, as well as patients receiving combination therapy(hypotensive or antianginal).

Side effects

Cardiovascular system: feeling of heat, flushing of the face, peripheral edema (ankles, feet, legs), tachycardia, syncope, excessive decrease blood pressure, heart failure; in some cases, especially at the beginning of treatment - the appearance of angina attacks, requiring discontinuation of the drug;
Central nervous system: fatigue, drowsiness, dizziness, headache; at long-term use in high doses ah - tremor, paresthesia of the limbs;
Gastrointestinal tract, liver: dyspeptic disorders; with long-term treatment - abnormal liver function (increased activity of hepatic transaminases, intrahepatic cholestasis);
Musculoskeletal system: myalgia, arthritis;
Urinary system: increase daily diuresis, in patients with kidney failure- deterioration of kidney function;
Organs of hematopoiesis: thrombocytopenia, leukopenia, thrombocytopenic purpura, anemia;
Allergic reactions: exanthema, urticaria, pruritus, autoimmune hepatitis;
Others: gum hyperplasia, hyperglycemia, changes in visual perception, flushing of the skin of the face, in the elderly - gynecomastia (completely disappearing after discontinuation of the drug).

Overdose

With an overdose of Nifedipine, a headache appears, arrhythmia and bradycardia develop, the activity of the sinus node is inhibited, blood pressure decreases, the skin of the face becomes red.

As first aid recommended gastric lavage and activated carbon. Conducted symptomatic therapy aimed at stabilizing of cardio-vascular system. Nifedipine's antidote is calcium. Requires slow intravenous administration of calcium gluconate or 10% calcium chloride at a dose of 0.2 ml / kg (total no more than 10 ml) for 5 minutes. If the effect is not achieved, it is possible to conduct a repeated infusion under the control of serum calcium concentration. The resumption of symptoms of poisoning is an indication for continuous infusion at a rate of 0.2 ml / kg / h, but not more than 10 ml / h.

With a serious decrease in blood pressure, the patient is administered dopamine or dobutamine intravenously. If cardiac conduction is impaired, the administration of isoprenaline, atropine, or the establishment of a pacemaker (artificial pacemaker) is indicated. Developing heart failure should be compensated intravenous administration strophanthin. Catecholamines are allowed to be used only in case of circulatory failure, life-threatening. It is desirable to control the level of electrolytes (calcium, potassium) and blood glucose.

Carrying out hemodialysis is ineffective.

special instructions

In case of abrupt discontinuation of treatment, there is a risk of withdrawal syndrome, so the dose should be reduced gradually.

During treatment with Nifedipine, it is necessary to refrain from drinking alcohol, driving vehicles and performing potentially hazardous types of work that require quick psychophysical reactions and increased concentration.

Influence on the ability to drive vehicles and complex mechanisms

During treatment with Nifedipine, you should refrain from performing potentially hazardous work requiring high concentration attention and speed of psychomotor reaction.

Use during pregnancy and lactation

According to the instructions, Nifedipine is contraindicated during pregnancy and lactation.

Application in childhood

Nifedipine should not be used in children and adolescents under 18 years of age, as the safety and efficacy of the drug in this age group not installed.

For impaired renal function

Nifedipine should be used with caution in patients with severe renal impairment.

For impaired liver function

Nifedipine should be used with caution in patients with severe hepatic impairment.

Use in the elderly

For elderly patients, the drug is prescribed in reduced doses.

drug interaction

Other antihypertensive drugs, diuretics, tricyclic antidepressants, ranitidine, cimetidine: increased severity of lowering blood pressure;
Nitrates: increased tachycardia and hypotensive action nifedipine;
Beta-blockers: the risk of a pronounced decrease in blood pressure, in some cases - aggravation of heart failure (such combined treatment should be carried out under close medical supervision).
Quinidine: decrease in its concentration in blood plasma;
Theophylline, digoxin: an increase in their concentration in blood plasma;
Rifampicin: acceleration of metabolism and, as a result, weakening of the action of nifedipine.

Analogues

Analogues of Nifedipine are: Cordaflex, Cordipin HL, Cordipin Retard, Nifecard HL.

Terms and conditions of storage

Store at temperatures up to 25 ºC in a place protected from light and moisture, out of the reach of children.

Shelf life - 3 years.

The drug Nifedipine belongs to the drugs used in medical practice with hypertension, other pathologies of the heart and blood vessels. The drug belongs to calcium antagonists. Entering the body active ingredients Nifedipine has an anti-ischemic effect, lowers blood pressure, and increases coronary blood flow. In addition to tablets and solutions for injection, there is Nifedipine ointment and a drug in the form of a gel, which are used to treat varicose veins veins in the rectum.

Release form and composition of the drug

The main active ingredient of the drug is nifedipine. Auxiliary components include milk sugar, potato starch, cellulose, magnesium stearate, talc, hypromelose, other substances. international name- Nifedipine.

The release form of Nifedipine is as follows:

tablets short action coated, containing 10 mg active component. Mainly used for periodic use to reduce pressure, eliminate chest pain;
tablets Nifedipine retard - contain 20 mg of the active ingredient. This is long acting nifedipine. The drug is prescribed for daily intake patients with hypertension. This scheme allows you to maintain pressure on normal level, avoid other complications in patients;
infusion solution in 50 ml ampoules;
ampoules for intravascular injection of 2 ml.

A separate drug group is Nifedipine gel and a medicine in the form of a cream. These drugs are used in complex therapy hemorrhoids, contain 0.2% nifedipine, isosorbitol dinitrate and lidocaine.

Pharmacological effect of tablets and injections

What is the mechanism of action of the drug? Nifedipine retard and other forms of the drug block the activity of calcium channels cell membranes. This reduces the intake of calcium ions into the peripheral vessels, arteries of the heart muscle, muscle fibers of the whole organism. These complex processes at a deep cellular level allow you to achieve the following effect:

improve the blood supply to the heart;
expand the lumen of arterial and coronary vessels;
enhance renal circulation;
activate the process of removing sodium and water from the body;
reduce blood pressure, vascular smooth muscle tone.

Once in the body, the drug Nifedipine is rapidly absorbed by the organs. digestive system. The active components of the drug bind to blood proteins, long time are in the body. The substance is metabolized in the liver, excreted by the kidneys.

Important! You can use the drug only as directed by your doctor. Self-medication often causes Negative consequences sometimes incompatible with life.

The action of the ointment

Nifedipine gel emulsion and ointment are used in combination with other medicines to treat hemorrhoids. The drug can be used to treat all forms and stages of the disease. Manufacturers medicinal product claim that the use of Nifedipine is an excellent alternative surgical intervention with pathology of the vessels of the anus.

Nifedipine gel is used for hemorrhoids

Thanks to active substances means, during the use of the drug, the smooth muscles of the vessels relax, local blood pressure decreases, disappears pain syndrome. Additional components help get rid of cracks and microdamages, have an antibacterial, anti-inflammatory effect, eliminate discomfort, itching and burning.

Indications for the use of injections and tablets

Instructions for use include such indications for the use of Nifedipine:

hypertrophic cardiomyopathy;
all degrees of hypertension;
cardiopulmonary insufficiency, accompanied by congestive processes;
Raynaud's syndrome;
conditions that entail spasm of the coronary arteries;
angina.

The drug Nifedipine is also used in cardiologists for the treatment of cerebrovascular disorders, upon the onset of hypertensive crisis, during the treatment of heart failure, coronary heart disease, for the treatment of bronchospasm, atherosclerosis peripheral arteries and other conditions.

Indications for the use of gel and ointment

The form of release of the drug for topical application is used in the following conditions:

acute and chronic hemorrhoids;
hemorrhoidal fissures;
the presence of external and internal cavernous formations;
bleeding;
prolapse of hemorrhoidal cones;
thrombosis;
pain syndrome;
hyperemia, itching, burning, irritation of the rectal mucosa.

Nifedipine and auxiliary components, which are part of the drug, quickly relieve the main manifestations of hemorrhoids, facilitate the patient's well-being, and help prevent complications.

Contraindications

The drug Nifedipine can only be taken if the patient has no contraindications to its use. The ban on therapy with Nifedipine is following states in the patient:

hypotension, other diseases accompanied by low blood pressure;
offensive;
vascular collapse;
acute heart failure;
recent myocardial infarction (less than 30 days ago);
the first 4 weeks of pregnancy;
the age of the patient is under 18 years;
period of breastfeeding;
allergy to any of the components of the product.

When prescribing a remedy, the doctor must take into account contraindications

If the contraindications of the drug are not taken into account, taking the medicine can provoke severe consequences for the body.

Important! The drug in the form of a cream and gel has no serious contraindications, except for personal intolerance, it is used among children and women in position.

Instructions for use

How to take Nifedipine? Use any drug form prescription medications. The dosage and dosage regimen is set by a specialist based on the patient's medical history and diagnosis.

Taking pills

At different states the dose of the drug is usually 1 tablet three times a day. It is recommended to take the medicine after meals. Wash down the tablet with water. If necessary, the dose is increased by the attending physician. This is possible with good tolerability of the drug and the absence of side effects. For elderly patients or patients suffering from kidney pathologies, the dose is reduced.

Use of injections

Indications for the use of Nifedipine injections include severe conditions in patients. Injections are used exclusively in a hospital during the period intensive care. Nifedipine is administered to patients intravenously or with a dropper.

The solution is released in ready-made, dilution of the drug is not required. Before administration to a person, a sensitivity test to the drug component is carried out. If there is no reaction, the drug can be used. The dose is determined by the doctor. Usually it is from 15 to 30 mg for 24 hours.

Application of ointment

The use of the drug Nifedipine in the form of an ointment or gel can be carried out at home. Before applying the medicine, it is recommended to hygiene procedures, cleanse the intestines. With external hemorrhoids, cavernous formations are treated with a small amount of ointment or gel, gently rubbing the agent into the skin. At internal form pathology ointment must be treated hemorrhoids located inside.

In some cases, the drug is used for setting compresses. To do this, a small amount of the product is applied to a linen or cotton fabric, applied to the affected area. This method is suitable for the treatment of external hemorrhoids.

How long does the drug take to work

Many patients are interested in how long Nifedipine begins to act? The therapeutic effect depends on the dose of the drug taken and individual characteristics organism. Tablets begin to act more slowly compared to injections. This is explained by the fact that during the injection, the active components immediately enter the bloodstream. Usually this time is from 40 minutes to an hour. The effect of the drug in the form of a gel or ointment is observed within a few minutes after application.

The effect of the drug comes in half an hour

special instructions

To prevent side effects and complications, patients should adhere to special instructions during treatment with Nifedipine. You can not combine the drug with alcoholic beverages. Such an interaction can provoke serious side effects, up to a fatal outcome.

Termination of therapy with the drug should be according to a certain scheme. Despite the fact that the drug does not have a withdrawal syndrome, treatment should not be abruptly interrupted.

Together with Nifedipine, beta-blockers should be used carefully. They combine medicines exclusively under the strict supervision of a doctor, since this union often provokes a rapid decrease in blood pressure.

Many patients stop taking the remedy, feeling relieved. This can not be done, because hypertension often occurs without visible symptoms.
Among patients with severe renal insufficiency and patients on hemodialysis, nifedipine is used very carefully, since therapy can lead to sharp drop pressure.

The standard dose of the drug for people with liver pathologies should be selected on an individual basis. If necessary, the dosage is reduced.

Important! The drug can affect the concentration of memory and attention of a person, so drive vehicles and deal with others dangerous species activities should be done with extreme caution.

drug interaction

intensifies therapeutic effect the drug while used with drugs such as nitrates, diuretics, tricyclic antidepressants, inhalation antiseptics.

The effectiveness of Nifedipine is reduced when combined with Rifampicin. With mutual use with nitrates, the patient has an increase in tachycardia. Fluoxetine increases the likelihood of developing side effects of the drug. With prolonged use with beta-blockers, the patient may experience heart failure.

Use in pregnant women

In the first weeks after the onset of conception, it is forbidden to drink Nifedipine. Studies on the effect of the drug on the fetus have not been conducted. Papaverine is used to reduce the tone of the uterus. From the 16th week, the medicine is prescribed to women if the mother's condition requires it and the risk to her health is higher than the risk of exposure to Nifedipine on the fetus.

Pregnant women are prescribed with extreme caution

Pediatric use

Among patients under 18 years of age, Nifedipine is contraindicated.

Overdose and side effects

Side effects of Nifedipine are more often associated with impaired activity of the cardiovascular system. Complications associated with the functioning of the respiratory, digestive and musculoskeletal systems are less common.

From the side of the heart and blood vessels:

redness of the dermis of the face;
reflex tachycardia;
rapid heartbeat;
chest pain;
rapid pressure drop.

From the side of the central nervous system:

migraine;
feeling of goosebumps on the body;
dizziness;
nausea.

From the side of digestion:

violation of the chair;
pain in the stomach and intestines;
nausea;
flatulence.

From the bone and muscular systems muscle pain, trembling of the limbs can be observed. On the part of breathing - shortness of breath, bronchospasm.

An overdose of Nifedipine causes such serious complications like bradycardia, sudden jump pressure, bradyarrhythmia. In severe cases, there is an onset vascular collapse. The most pronounced signs of an overdose are a few hours after taking a large dose of the drug. The patient develops a coma cardiogenic shock, hypoxia, convulsions and other manifestations.

Important! With the development of even minor signs of an overdose, it is necessary to call ambulance. With absence necessary treatment death comes.

Other names for Nifedipine

The RLS drug database includes several names of the drug Nifedipine. The Nifedipine group includes the following agents:

Kordafen;
Corinfar;
Captopril;
Nifedipine farm;
Fenigidin;
Nifedipine elevit;
Farmadipin;
Nikardia and others.

Many modern companies produce drug analogues that have a fast or prolonged action. Information about these drugs can be found in the table.

Many patients are interested in how to choose an analogue, which medicine to choose, Fenigidin or Kapoten, Cardofen, Krinpharm and others. In order to choose the right one or another analogue, you need to figure out what a short or prolonged effect of the drug means. A short-acting drug is not recommended for the treatment of hypertension and other pathologies of the heart and blood vessels. This option is suitable for emergency care. An extended-release agent is suitable for use among patients during the period long-term treatment. Such drugs are taken in courses, they slowly and safely reduce pressure.

Price and where to buy

Buy medication can be in any of the pharmacies by prescription. The approximate cost of the drug is from 20 to 30 rubles.

Nifedipine (Nifedipin)

Compound

2,6-Dimethyl-4-(2-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxylic acid dimethyl ester.
Yellow crystalline powder. Practically insoluble in water, hardly soluble in alcohol.
Nifedipine (fenigidin) is the main representative of calcium ion antagonists - derivatives of 1,4-dihydropyridine.

pharmachologic effect

Like verapamil and other calcium antagonists, nifedipine dilates coronary and peripheral (mainly arterial) vessels, has a negative inotropic effect, and reduces myocardial oxygen demand. Unlike vera, pamila does not have a depressing effect on the conduction system of the heart and has weak antiarrhythmic activity. Compared with verapamil, it reduces peripheral vascular resistance more strongly and lowers blood pressure more significantly.
The drug is rapidly absorbed when taken orally. The maximum concentration in blood plasma is observed after 1/2 - 1 hour after administration.
It has a short half-life - 2 - 4 hours. About 80% is excreted by the kidneys in the form of inactive metabolites, about 15% - with feces. It has been established that at long-term use(2 - 3 months) develops tolerance (unlike verapamil) to the action of the drug.

Indications for use

Nifedipine (fenigidin) is used as an antianginal agent for ischemic heart disease with angina attacks, to reduce blood pressure with various types hypertension, including renal hypertension. There are indications that nifedipine (and verapamil) in nephrogenic hypertension slows the progression of renal failure.
It is also used in the complex therapy of chronic heart failure. It was previously believed that nifedipine and other calcium ion antagonists are not indicated in heart failure due to negative inotropic effect. AT recent times It has been established that all these drugs, due to their peripheral vasodilator action, improve the function of the heart and contribute to a decrease in its size in chronic heart failure. There is also a decrease in pressure in pulmonary artery. However, the possibility of a negative inotropic effect of nifedipine should not be excluded, and caution should be exercised in severe heart failure. Recently, there have been reports of the inappropriate use of nifedipine in hypertension, due to an increased risk of myocardial infarction, as well as the possibility of increasing the risk deaths in patients ischemic disease heart with long-term use of idenfat.
This concerns mainly the use of "regular" nifedipine (short-acting), but not its prolonged dosage forms and dihydropyridines long-acting(for example, amlodipine). This question, however, remains debatable.
There are data on positive influence nifedipine on cerebral hemodynamics, its effectiveness in Raynaud's disease. In patients bronchial asthma no significant bronchodilatory effect was noted, but the drug can be used in combination with other bronchodilators (sympathomimetics) for maintenance therapy.

Mode of application

Take nifedipine orally (regardless of meal times) at 0.01-0.03 g (10-30 mg) 3-4 times a day (up to 120 mg per day). The duration of treatment is 1-2 months. and more.
For the relief (removal) of a hypertensive crisis (a rapid and sharp rise in blood pressure), and sometimes with angina attacks, the drug is used sublingually. A tablet (10 mg) is placed under the tongue. Nifedipine tablets, placed under the tongue without chewing, dissolve within a few minutes. To speed up the effect, the tablet is chewed and held, without swallowing, under the tongue. With this method of administration, patients should be in the supine position for 30-60 minutes. If necessary, after 20-30 minutes, repeat the drug; sometimes increase the dose to 20-30 mg. After stopping the attacks, they switch to taking the drug inside.
Retard tablets are recommended for long-term therapy. Assign 20 mg 1-2 times a day; less often 40 mg 2 times a day. Retard tablets are taken after meals, without chewing, with a small amount of liquid.
For the relief (removal) of a hypertensive crisis (a rapid and sharp rise in blood pressure), the drug is recommended to be administered at a dose of 0.005 g for 4-8 hours (0.0104-0.0208 mg / min). This corresponds to 6.3-12.5 ml of infusion solution per hour. Maximum dose the drug - 15-30 mg per day - can be used for no more than 3 days.

Side effects

Nifedipine is generally well tolerated. However, reddening of the face and skin of the upper body, headache are relatively common, probably associated with a decrease in the tone of the cerebral (cerebral) vessels (mainly capacitive) and their stretching due to an increase in blood flow through arteriovenous anastomoses (connections of the artery and vein). In these cases, the dose is reduced or the drug is taken after meals.
There may also be palpitations, nausea, dizziness, swelling lower extremities, hypotension (lowering blood pressure), drowsiness.

Contraindications

Severe forms of heart failure, unstable angina, acute infarction myocardium, sick sinus syndrome (heart disease, accompanied by rhythm disturbance), severe arterial hypotension(low blood pressure). Nifedipine is contraindicated in pregnancy and lactation.
Caution is needed when prescribing the drug to drivers of transport and other professions that require a quick mental and physical reaction.

Release form

Coated tablets containing 0.01 g (10 mg) of the drug. Long-acting tablets nifedipine retard 0.02 g (20 mg). Solution for infusion (1 ml contains 0.0001 g of nifedipine) in 50 ml vials, complete with a Perfusor (or Injectomat) syringe and a Perfusor (or Injectomat) polyethylene tube. Solution for intracoronary administration (1 ml contains 0.0001 g of nifedipine) in 2 ml syringes in a pack of 5 pieces.

Storage conditions

List B. In a dark place.

Synonyms

Adalat, Cordafen, Cordipin, Corinfar, Nifangin, Nifecard, Nificard, Adarat, Calcigard, Nifacard, Nifelat, Procardia, Fenigidin, Cordaflex, Nifesan, Apo-Nifed, Depin E, Dignoconstant, Nifadil, Nifebene, Nifehexal, Nifedipat, Novo-Nifidin , Pidilat, Ronian, Sanfidipin, Fenamon, Ecodipin.
See also Attention!
Description of the drug Nifedipine"on this page is a simplified and expanded version official instructions by application. Before purchasing or using the drug, you should consult your doctor and read the annotation approved by the manufacturer.
Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide on the appointment of the drug, as well as determine the dose and methods of its use.

And The history of the use of nifedipine in cardiology exceeds 30 years. In the 70-80s, it was one of the most popular cardiological drugs. However, in the mid-90s, English-language literature appeared significant amount publications indicating the unsafe use of nifedipine in patients with coronary heart disease (CHD). A higher incidence of myocardial infarction was established compared with patients receiving other antihypertensive drugs. In addition, nifedipine therapy has been shown to increase the risk of bleeding and even oncological diseases. These works caused a wide discussion not only among doctors, but also in the media. mass media. Attention was drawn to the serious shortcomings of these studies. First, in a meta-analysis of published papers, it was not known the initial state patients. It is possible that nifedipine was prescribed more frequently than other drugs to patients with hypertension (AH) who had angina pectoris. Secondly, very high doses (up to 120 mg of nifedipine per day, with an average of 80 mg per day) were used in the analyzed studies. Third, all patients received a rapidly absorbed form of short-acting nifedipine. Since nifedipine is a vasodilator, when taking its high doses, vasodilation was maximum, which was accompanied by a pronounced compensatory stimulation of the sympathetic nervous system and, of course, could lead to an exacerbation of coronary artery disease. The result of this discussion was a revision of the indications for the appointment of short-acting nifedipine, in particular, it was not recommended to prescribe it to patients with myocardial infarction and unstable angina pectoris.

The results of subsequent studies indicate good tolerability and high efficiency prolonged forms of nifedipine. In a number of works, they have been identified favorable influence on the structural and functional state of the heart, blood vessels and kidneys, both in GB and in parenchymal arterial hypertension.

Our application experience nifedipine retard (Corinfar-retard AVD GmbH, Germany) is based on an analysis of the results obtained in 1311 patients with arterial hypertension(AH) and IHD-stenocardia of a stable course. Among them there were 174 patients with hypertension disease I-II stages (WHO classification, 1962), 16 patients with AH with chronic pyelonephritis, 261 patients with stable angina pectoris of II-IV functional classes (FC) and 722 patients with stable angina pectoris, combined with HT. The vast majority of patients received the drug on an outpatient basis and were observed by cardiologists of St. Petersburg polyclinics. Patients received the drug free of charge. All patients kept diaries, which reflected the dynamics of well-being, the number of angina attacks per day, the number of nitroglycerin tablets taken, the presence of side effects. During the first month, visits to the doctor were weekly, thereafter - once every 2 weeks. The duration of observation was 3 months. For 6 months, 21 patients with HD received nifedipine retard. In all patients with GB, the drug was prescribed as monotherapy. In the absence of a proper antihypertensive effect, a month later, patients were transferred to combination therapy. Almost all patients with angina pectoris received nitrosorbide for a long time, and persons with angina pectoris III-IV FC also received b-blockers (including those with concomitant hypertension). The indication for the appointment of nifedipine-retard was the persistence of angina attacks.

The study did not include patients with diabetes, heart defects, atrial fibrillation, heart failure, as well as persons who have suffered a violation of cerebral circulation.

With GB, the initial dose of the drug was 20 mg 2 times a day. In the future, taking into account the effect achieved, the dose was reduced (up to 20 mg 1 time per day). However, in 5 (2.6%) patients, normalization of blood pressure (BP) values was achieved only with the appointment of 60 mg per day (in 3 divided doses). In patients with coronary artery disease, the effectiveness of therapy was compared when prescribing the drug at a dose of 20 mg 1 and 2 times a day.

In patients with hypertension who received the drug for 6 months before therapy and 6 months after its initiation, systemic and renal hemodynamics were assessed.

The results of the studies indicate a clear antihypertensive efficacy of nifedipine retard both in patients with isolated hypertension and in its combination with coronary artery disease (Table 1). In patients who needed to normalize blood pressure large dose drug, its initial level was higher, as well as in persons who received nifedipine 2 times a day. The decrease in blood pressure in all regimens of therapy was not accompanied by a statistically significant increase in heart rate.

Long-term therapy with nifedipine retard resulted in significant changes in central and regional renal hemodynamics. In particular, total peripheral vascular resistance (TPVR) decreased by 16.7% (p<0,05), одновременно на 16,4% увеличился сердечный индекс (р <0,05). Почечное сосудистое сопротивление (ПСС) снизилось в большей мере, чем ОПСС; снижение ПСС закономерно привело к увеличению эффективного почечного кровотока (рис. 1).

*EPK stands for Efficient Renal Blood Flow.
Rice. 1. Changes in systemic and renal hemodynamics during 6-month therapy with nifedipine retard

Six-month therapy was accompanied by a decrease in the mass index of the left ventricular myocardium (LVMI) by 9.3%, the thickness of the posterior wall (VCW) of the left ventricle by 9.8% and the interventricular septum (VVS) by 6.5% in the absence of significant changes in the size of the cavity of the left ventricle and ejection fraction of the left ventricle (Table 2).

The decrease in LVMI was maximal in individuals with the highest initial values and did not correlate with the degree of BP decrease. Indicators of diastolic function (isovolumic relaxation time, E/A ratio) did not change significantly, only a tendency to their improvement was noted. At the same time, the time of isovolumic relaxation decreased to a greater extent in patients with the most significant decrease in LVMI (r = 0.65, p< 0,005).

Nifedipine retard also had a favorable effect on the course of angina pectoris, which was manifested in a decrease in the number of angina attacks. Initially, in patients without hypertension, the number of angina attacks was 29.38 ± 2.18 per month, in patients with concomitant hypertension - 30.1 ± 1.7 per month. After 12 weeks of therapy, it decreased to 11.6 ± 1.37 and 11.9 ± 1.2 per month, respectively. The greatest antianginal effect was obtained with initially non-severe exertional angina (FC II), while at the same time, with severe exertional angina (FC III-IV), the effectiveness of therapy was less.

In 257 patients with coronary artery disease without hypertension, the effectiveness of nifedipine-retard therapy was compared with single and double doses (20 mg 1 time and 2 times a day). A double dose of the drug had a more pronounced antianginal effect, not accompanied by a significant increase in the number of side effects.

In 58 out of 722 patients with coronary artery disease, combined with hypertension, rhythm disturbances (extrasystoles of low gradations) were registered on the initial electrocardiograms. Therapy with nifedipine retard did not lead to an increase in the number of extrasystoles. On the contrary, in 32 patients who initially had extrasystole, it ceased to be detected.

It should be noted the good tolerability of the drug. Among the observed side effects, palpitations (3.8%), headache (3.5%), flushing of the face (3.9%), dizziness (1.28%), feeling of heat (1.28%), increased diuresis (1.5%) and edema (1.14%). The severity of side effects was maximum in the early stages after the start of therapy. In the majority of patients (n = 64), the tolerability of the drug subsequently improved while maintaining the same dose; in 14 patients, due to side effects, the dose of nifedipine was reduced; 2.1% of patients were forced to stop taking the drug due to poor tolerance.

Thus, the results of the performed study indicate a high antihypertensive and antianginal efficacy of nifedipine retard. The basis of the blood pressure-lowering action of nifedipine is a decrease in peripheral vascular resistance . It is known that when using calcium antagonists, the degree of vasodilation in different vascular regions is different. Maximum vasodilation is noted in the vessels of the skeletal muscles and coronary arteries, to a lesser extent - in the kidneys. Skin vessels are practically insensitive to the action of dihydropyridines. H. Struyker-Bodier et al. indicate that differences in vascular sensitivity are determined by the initial vascular tone and the number of voltage-gated calcium channels. In the kidneys, the maximum sensitivity to the action of calcium antagonists is inherent in afferent arterioles. In addition, these drugs inhibit the ability of preglomerular arterioles to constrict in response to both increased transmural pressure and impulses from the macula densa.

The antianginal effect of dihydropyridines is due to coronary dilatation and a decrease in the work of the heart due to a decrease in pre- and afterload. Long-acting drugs and long-acting forms of short-acting compounds, including nifedipine, have a minimal ability to stimulate the sympathetic nervous system, which can explain their lack of arrhythmogenic effect and a beneficial effect on the course of angina pectoris.

The beneficial effect of these drugs on the internal organs is due not only to the improvement of regional blood flow. The results of experimental studies indicate the ability of these compounds to cause relaxation of mesangial cells, reduce collagen synthesis by fibroblasts, increase tissue tolerance to ischemia, and improve intracellular calcium metabolism (reduction of mitochondrial overload). The result of these changes is a slow progression of experimental nephrosclerosis.

So, long-acting nifedipine preparations can be recommended for patients with various forms of hypertension . They can be used both for monotherapy and in combination with other drugs with a vasodilatory effect (myotropic drugs, a-blockers). In chronic renal failure, as well as in patients with bilateral renal artery stenosis and Conn's syndrome, they have advantages over angiotensin-converting enzyme inhibitors.

In IHD, their use is justified in stable angina . P. Heidenreich et al. performed a meta-analysis of 90 studies on the use of long-acting nitrates, b-blockers and calcium antagonists. The duration of observation in all studies exceeded a week, but only in two of them - 6 months. The authors did not reveal differences in the antianginal efficacy of calcium antagonists with b-blockers. When taking short-acting nifedipine, less antiangial activity was noted, although the number of nitroglycerin tablets taken and exercise tolerance changed equally with all drugs. The differences concerned only the rarer withdrawal of b-blockers compared to calcium antagonists due to side effects, which allowed the authors to recommend b-blockers as first-line drugs in the treatment of stable angina pectoris.

The results of the meta-analysis revealed another interesting feature - in the United States, long-acting nitrates are more often used in the monotherapy of stable angina pectoris, in Europe - calcium antagonists. Among patients with stable angina pectoris, there are patients in whom the appointment of calcium antagonists has certain advantages over therapy with b-blockers. In particular, calcium antagonists are most effective in vasospastic angina , as well as with a combination of dynamic and fixed coronary obstruction. The combination of prolonged nifedipine with b-blockers and nitrates is quite acceptable. In addition, these compounds should be prescribed to patients with contraindications to b-blockers (bronchial asthma, slowing of atrioventricular and sinoatrial conduction, intermittent claudication, Raynaud's syndrome, type I diabetes mellitus, etc.). They are preferable to b-blockers in individuals with severe dyslipidemia and metabolic syndrome. Another initial indication for the appointment of drugs in this group are bradycardia and sick sinus syndrome.

References can be found at http://www.site

Nifedipine-retard -

Corinfar-retard (trade name)

(AWD)

Literature:

1. B. M. Psaty, S. R. Neckbert, T. D. Kalpsell. et al. The risk of myocardial infarction associated with antihypertensive drug therapy// JAMA, 1995; 274:620-5.

2. C. D. Furberg, M. Pahor, B. M. Psaty. The unnecessary controversy//Eur. J.Heart. 1996; 17:1142-7.

3. C. D. Furberg, B. M. Psaty. Calcium antagonists: not appropriate as first-line antihypertensive agents// Am. er., J. Hepertension, 1995; 9:122-5.

4. Almazov V.A., Shlyakhto E.V. Arterial hypertension and kidneys. Publishing house of St. Petersburg State Medical University. acad. Pavlova I.P. SPb. 1999; 296 p.

5. Andreev N.A., Moiseev V.S. Calcium antagonists in clinical medicine. M., // RC “Pharmmedinfo”. 1995; 162 p.

6. Ivleva A.Ya. Influence of calcium antagonists on hemodynamics and kidney function in arterial hypertension //Clin., Pharmacol., ter., 1992; 1:49-55.

7. Kukes V.G., Rumyantsev A.S., Taratuta T.V., Alekhin S.N. Adalat, twenty years in the clinic: past, present, future // Cardiology, 1996; 1:51-6.

8. Dyadyk A.I., Bagriy A.E., Lebed I.A. Changes in myocardial mass and diastolic function of the left ventricle in patients with chronic nephritis and arterial hypertension under the influence of therapy with calcium channel blockers // Nephrological Seminar-95. TNA, St. Petersburg, 1995; 170-1.

9. T.Yamakogo, S.Teramuro, T.Oonisti. et al. Regression of left ventricular hypertrophy with long-term treatment of nifedipine in systemic hypertension//Clin., Cardiol., 1994; 17:615-8.

10. H. A. Struyker-Boudier, J. F. Smith, J. G. DeMey. Pharmacology of calcium antagonists: a review, 1990; 5(4): 1-0.

11. R. D. Loutzenhiser, M. Epstein. The renal hemodynamic effects of calcium antagonists. Calcium Antagonists and the Kidney// Hanley a. Belfas., Philadelphia, 1990; 33-74.

12. H. L. Elliot. Calcium antagonism: aldosteron and vascular responses to catecholamines and angiotensin II in man// J. Hypertension. 1993; V.11. suppl.6:13-6.

13. T.Satura. Efficacy of amlodipine in the treatment of hypertension with renal impairment//J.Cardiovasc, Pharmacol, 1994; 24(B): 6-11.

14. P.A.Heidenreich, K.M.McDonald, T.Hastie. et al. Meta-analysis of trials comparing B-blockers, calcium and nitrate antagonists in stable angina //JAMA, Russia, 2000, (3): 14-23.

The cardiological and antihypertensive drug Nifedipine is quite popular among patients with arterial hypertension. It is used as monotherapy and as part of complex treatment.

There are several dozen analogues and trade names, the active ingredient of which is nifedipine. Instructions for use provides information about the rules and methods of using the medication.

The therapeutic effect of this drug (LS) is provided by the composition of Nifedipine. The active ingredient is a derivative of 1,4-dihydropyridine - the chemical compound nifedipine.

The auxiliary ingredients, in addition to calcium stearate, povidone, cellulose and potato starch, contain milk sugar lactose. This should be taken into account for people suffering from intolerance to this carbohydrate or a deficiency of an enzyme that helps to absorb it (lactase).

Nifedipine release form - tablets.

Pharmacological group and mechanism of action

The instructions for use indicate which pharmacotherapeutic cluster Nifedipine belongs to. This is a selective (that is, selective) pharmacological group, which is usually denoted by the abbreviation BMKK.

Pharmacodynamics (mechanism of action) of Nifedipine and medications of this group is based on a decrease in the leakage of calcium ions into myocardial cells and the smooth muscle layer of the coronary and peripheral vessels.

The drug does not have an effect on venous vessels, sinoatrial and atrioventricular nodes, and does not have an antiarrhythmic effect.

Helps reduce:

total peripheral vascular resistance (OPSS);
cardiac muscle tone and afterload;
myocardial needs for oxygenation (oxygen saturation),

as well as an increase in the duration of left ventricular diastole.

In response to a negative inotropic effect (decrease in the strength of heart contractions), Nifedipine causes a reflex acceleration of the pulse.

What are these pills for?

The medication Nifedipine is prescribed for high blood pressure. Moreover, it is prescribed by a medical specialist, subject to a preliminary diagnostic examination of the patient. It is impossible to take Nifedipine, from which the patient or his relatives, at their own discretion, consider it right. For example, you can not give these pills to hypotension with a single episode of physiological increase in blood pressure (BP), say, if it jumped from the use of tonics.

Indications

Let us clarify what specific pathologies are indicated in the instructions for use for Nifedipine in the indications for use. Like many other antihypertensive drugs, this medication is indicated not only for the treatment of hypertension, but also for diseases that often accompany hypertension. Therefore, the annotation to Nifedipine indicates:

, manifested by angina pectoris, including variant.

These are the pathological conditions from which Nifedipine tablets are prescribed as a monotherapeutic agent or one of the complex therapy medications.

Why is hypertension dangerous?

At what pressure and pulse is it used?

In the description of the drug Nifedipine, the instructions for use do not indicate at what pressure it is prescribed. Obviously - with such indicators of blood pressure, which give reason to the doctor to diagnose arterial hypertension (AH).

If the medication is prescribed for, then the value of blood pressure should also be taken into account here. According to the instructions for Nifedipine, it should not be< 90 мм рт.ст. по систолическому показателю.

Can it be used in hypertensive crisis?

In the official instructions for Nifedipine, it is not indicated in the indications for use. Patients with hypertension should receive continuous antihypertensive therapy to prevent a rise in pressure, and not use drugs episodically in emergency cases.

However, practical experience of use has confirmed the ability of this medication to quickly and effectively reduce high blood pressure when taken sublingually (sublingually).

To reduce blood pressure with Nifedipine in a hypertensive crisis, you should put 1 tablet of Nifedipine 10 mg under the tongue and wait for its complete dissolution (usually the effect occurs within a few minutes).
At this time, it is desirable for the patient to be in a prone or reclining position (dizziness may occur).
If there is no effect, it is allowed to take the pill again no earlier than half an hour after the first dose.
The maximum dose for hypertensive crisis is 30 mg taken in 3 doses with an interval of 30 minutes.

Before each subsequent dose, it is necessary to measure blood pressure and, if it normalizes, stop taking Nifedipine tablets.

Instructions for use of the drug

Before using Nifedipine tablets, the instructions for use should be studied with particular care.

Perhaps, during a visit to the doctor, you forgot about some concomitant diseases in which the medication is contraindicated. Or you are simultaneously taking other medicines that can weaken or, conversely, enhance the effect of BMCC.

None of the information contained in the instructions for use for drugs should be neglected.

How to use?

The method of use for Nifedipine pressure is standard for tablets from the BMKK group. They are drunk during a meal or immediately after it, using clean water for drinking. This is important, since it is impossible to take Nifedipine with certain liquids, in particular, grapefruit juice - it completely suppresses the metabolism of BMCC.

Is it possible under the tongue?

For cases of emergency care for a hypertensive crisis, you can put Nifedipine under the tongue - this will accelerate its action and lead to a decrease in blood pressure. But with prolonged therapy, Nifedipine tablets to lower blood pressure should be swallowed whole.

Dosage

With regard to the dosage, one should strictly adhere to the prescriptions of the doctor, who will select it on an individual basis.

The starting dose of Nifedipine is usually 5-10 mg (½-1 tablet), the number of doses per day is 2-3 times. A week later, you can bring the therapeutic dose to a value of 20 mg, taking Nifedipine 20 mg 1-2 times a day, or 2 tablets in the morning and evening of Nifedipine 10 mg. Instructions for use indicates the maximum daily dose - 40 mg.

Nifedipine dosage adjustment is required for patients:

taking other antihypertensive and antianginal drugs;
with severe disorders of cerebral perfusion;
with impaired hepatic function;
old age.

Any changes in doses and regimen should be agreed with the doctor.

How long does it take to start working?

When describing the pharmacodynamic properties of Nifedipine, the instructions for use provide the following information on the question of how long Nifedipine begins to act:

when taken orally - 20 minutes;
with sublingual - 5-10 minutes.

The duration of the effect is 4-6 hours for short-acting tablets and 12-24 hours for prolonged ones.

special instructions

The section of the instructions for use on special instructions for Nifedipine pressure tablets begins with a warning.

It is forbidden to drink alcohol during treatment with Nifedipine. The active substance of these tablets, belonging to the BMKK pharmaceutical group, is absolutely incompatible with ethanol.
Instructions for use warns that at the initial stage of administration, the development of angina pectoris is possible, and against the background of the simultaneous use of beta-blockers - increased signs of heart failure.
With caution, Nifedipine should be taken in patients on hemodialysis, with hypovolemia and irreversible renal failure.

As indicated in the instructions for use, if surgical intervention is necessary, the doctor should be informed about Nifedipine therapy.

A separate paragraph in the instructions for use provides information on the use of the medication in the perinatal and lactation periods. Until the 20th week of pregnancy, the medication is clearly contraindicated. If necessary (and only under the supervision of a doctor), this medicine is allowed to be taken by women in position in the minimum therapeutic doses. But the instructions for use warn that such drugs as Nifedipine should be used by pregnant women with caution and only in consultation with the doctor.

Contraindications

There is a medication Nifedipine and contraindications. This is a standard list of conditions for BMCC in which the use of drugs can provoke life-threatening and health-threatening effects. It is forbidden to be treated with Nifedipine when:

(and within 4 weeks after it);
pregnancy and lactation period;
decompensated CHF;
simultaneous treatment with Rifampicin;
(GARDEN< 90 мм);
cardiogenic shock, collapse;
intolerance to any of the ingredients of the drug.

Due to the lack of clinical data on the safety and efficacy of use in people under 18 years of age, Nifedipine is contraindicated for them.

Possible overdose

As already mentioned, drugs should be taken strictly in the dosage that the attending physician will select for the Nifedipine medication. An overdose, the symptoms of which can occur even if the maximum dose is slightly exceeded, usually manifests itself:

bradycardia (significant slowing of the pulse);
suppression of the function of the sinus node, which is expressed by the inadequacy of the heart rate, the deterioration of the blood supply to the myocardium;
a strong and prolonged decrease in blood pressure;
redness of the face;
headache.

With severe intoxication with Nifedipine, you need:

gastric lavage;
receiving activated charcoal;
slow, within 5 minutes, the introduction of antidotes - 10% chloride or calcium gluconate under the control of its concentration in plasma.

With severe hypotension - the introduction of dobutamine or dopamine intravenously, with AHF - strophanthin. The hemodialysis procedure in such a situation is ineffective. Treatment of an overdose should be carried out in a hospital setting.

Side effects

The following table will tell you about the side effects of Nifedipine and the frequency of their manifestation.

Often	Infrequently	Occasionally
Heart and blood vessels: cardiac arrhythmias (tachycardia, etc.), "fever" of the face, "hot flashes"	Excessive vasodilation (vasoconstriction leading to a drop in blood pressure), heart failure	Fainting, angina attacks (especially at the beginning of therapy), extremely rarely - to the state of a heart attack
CNS: dizziness, headaches, nervousness, fatigue	General weakness, sleep disturbances (drowsiness or insomnia)	Tremor and paresthesia (tingling, burning, goosebumps) of the extremities, depressive states
Circulatory system: various anemias, thrombocytopenia, leukopenia	Purpura thrombocytopenic	Agranulocytosis asymptomatic
Digestive system: dry mouth, increased appetite, dyspepsia	Swollen, sore, or bleeding gums	Increased activity of hepatic transaminases, stagnation of hepatic bile
Musculoskeletal system:	Myalgia (muscle pain)	Swelling and pain in the joints
Urinary system:	Increase in daily urine output	Kidney dysfunction (usually with kidney failure)
Other:	Allergic manifestations in the form of autoimmune hepatitis, exanthema, urticaria, itching of the skin	Visual disturbances, weight gain, pulmonary edema, increased blood sugar levels, spontaneous leakage of colostrum from the nipples outside the lactation period, breast enlargement in men (transient)

Most undesirable effects are transient (transient) in nature and are quickly eliminated when the drug is discontinued.

Can it be combined with Elevit?

The multivitamin and mineral-containing remedy Elevit is often prescribed to pregnant and lactating women for the treatment and prevention of micro- and macronutrient deficiencies, hypovitaminosis. Women who are forced to take BMCK even during this period are interested in whether Nifedipine can be taken with Elevit, and what the instructions for use say about the compatibility of these drugs.

An impressive list of restrictions on the compatibility of Nifedipine casts doubt on the possibility of its simultaneous administration with Elevit.

Elevit contains the trace element magnesium in the form of oxide, stearate and hydrophosphate trihydrate. And the instructions for the use of Nifedipine indicate that simultaneous administration with preparations containing magnesium sulfate can provoke a blockade of neuromuscular synapses (points of contact between neurons and effector cells) in women in the position. Clinical studies on the safety of such a combination have not been conducted, and the lack of data can be considered a weighty argument against combining drugs, especially when it comes to the treatment of pregnant women.

Which is better when compared with other drugs?

Let's try to compare Nifedipine with other antihypertensive or similar medications. Long-term therapy sometimes requires the rotation of the drugs used, so familiarization with the most common drugs will not be superfluous.

The basis of white cylindrical tablets Amlodipine of prolonged action is amlodipine besilate - a substance related to the second generation BMCC.

This is also a derivative of dihydropyridine, the action of which is to block calcium channels, reducing the transmembrane penetration of Ca ions into the cell. According to the instructions for use, it has not only a hypotensive, but also an anti-ischemic effect. Available in dosages of 5 and 10 mg, contains lactose. Comparing which is better - Nifedipine or Amlodipine, it is necessary to remember the duration of action of both drugs.

Andipal

Instructions for use Andipal calls this drug a combined analgesic drug, the active core of which consists of a non-narcotic analgesic (metamisole sodium), an antispasmodic (papaverine), a vasodilator (bendazole or dibazol) and a barbiturate (phenobarbital). A slight vasodilating effect has an effect on the smooth muscle layer of the walls of blood vessels; migraines, all kinds of colic and other pain syndromes are indicated in the indications for use. The section of the instructions for use on interactions refers to the ability of Andipal tablets to enhance the hypotensive effect of BMCC, ACE inhibitors, nitrates and other antihypertensive drugs. Therefore, it is not correct to compare Nifedipine or Andipal, which is better.

Ginipral

Ginipral tablets are prescribed for the threat of premature termination of pregnancy (uterine tone), starting from the 20th week. Today, this medicine is difficult to find in pharmacies, and it is not uncommon to hear that Nifedipine is prescribed to women instead of Ginipral. Hence their question arises - which is better, Ginipral or Nifedipine. If we compare these medicines in terms of their effect on the tone of the uterus, then Ginipral is undoubtedly preferable. But some women (noted - if they have hypertension) tolerate Nifedipine well. Others, judging by the reviews, are advised to refrain from taking it, as they have encountered side effects. So, you need to select a medication individually. We should not forget that these medicines, according to their instructions for use, have completely different indications for use, so it is wrong to talk about their interchangeability.

The drug Kapoten belongs to the pharmacological group (ACE) of prolonged action. It is indicated for hypertension, dysfunction of the left ventricle in the post-infarction period, chronic heart failure, diabetic nephropathy accompanying type 1 diabetes mellitus.

It is the drug of choice for a huge number of patients with arterial hypertension, not aggravated by severe kidney or liver failure and other severe pathologies. The active substance is captopril. In patients with bronchial obstruction or a tendency to bronchospasm, taking an ACE inhibitor may cause a side effect in the form of a dry, hysterical cough. In this case, when choosing Kapoten or Nifedipine, which is better preferred BMCC Nifedipine.

The same active substance is the core of the medicine of the same name - Captopril. To compare Nifedipine or Captopril, which is better, you should focus on the lists of contraindications and side effects, as well as the individual tolerance of the components, and select the medicine in accordance with these factors. Another factor worth paying attention to is the possibility of using Nifedipine in the treatment of pregnant women from the 20th week, which cannot be said about Captopril. ACE inhibitors for women in position are contraindicated at any time.

One thing can be said about the Cordaflex preparation - it is a direct, or structural, analogue of Nifedipine, and all indications for use, lists of side effects and warnings in the instructions for use of this medication are presented for the active substance nifedipine. True, in the indications, in addition to hypertension and coronary artery disease, Raynaud's syndrome is indicated, as well as the prevention of Prinzmetal's angina. Those who prefer European manufacturers can pay attention to Hungarian or Swiss-made Kordaflex.