Strofantin analogues instructions for use. Method of application of strophanthin in medicine and its dose to a person

Injection.

Pharmacological group"type="checkbox">

Pharmacological group

cardiac glycosides.

Indications

Acute cardiovascular failure, chronic heart failure II B-III stages(supraventricular tachycardia, atrial fibrillation and flutter).

Contraindications

organic defeat heart and blood vessels, acute myocarditis, endocarditis, severe cardiosclerosis, acute infarction myocardial blockade II-III degree, severe bradycardia, hypertrophic obstructive cardiomyopathy, constrictive pericarditis, hypercalcemia, hypokalemia, carotid sinus syndrome, aneurysm thoracic aorta, weakness syndrome sinus node, WPW syndrome, glycoside intoxication, pregnancy and lactation.

Dosage and administration

Strofantin K is used intravenously (sometimes intramuscularly). For intravenous administration the drug is diluted in 10-20 ml of isotonic sodium chloride solution. The introduction is carried out slowly, for 5-6 minutes. In the first 2 days, you can enter 2 times a day.

A solution of Strophanthin K can also be administered intravenously (in 100 ml of isotonic sodium chloride solution), since with this form of administration less often develops toxic effect. If Strofantin K cannot be injected into a vein, then it is prescribed in. In this way, the dose of the drug is increased by 1.5 times.

The maximum doses of Strofantin K for adults intravenously: single - 0.0005 g (0.5 mg), daily - 0.001 g (1 mg).

Daily doses, they are also saturation doses when using 0.25 mg / ml Strofantina K: from birth to 2 years - 0.01 mg / kg / day (0.04 ml / kg); from 2 years old - 0.007 mg / kg / day (0.03 ml / kg).

The maintenance dose is ½-⅓ of the saturation dose.

Adverse reactions

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

From the side of cardio-vascular system: ventricular arrhythmia, bradycardia, blockade.

From the side nervous system: headache, dizziness, sleep disturbance, fatigue, rarely - a violation color vision, depression, psychosis.

Other: allergic reactions, urticaria, thrombocytopenia, thrombocytopenic purpura, epistaxis, petechiae, gynecomastia.

Overdose

Symptoms of an overdose are varied.

From the side of the cardiovascular system: arrhythmias, including bradycardia, blockade, ventricular tachycardia or extrasystole, ventricular fibrillation.

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

From the nervous system and sensory organs: headache, fatigue, very rarely - confusion, syncope.

Treatment: withdrawal of the drug or reduction of subsequent doses and an increase in the time intervals between doses of the drug, the introduction of antidotes (unithiol, EDTA), symptomatic therapy (antiarrhythmic drugs- lidocaine, phenytoin, amiodarone, potassium anticholinergic drugs - atropine sulfate).

Use during pregnancy or lactation

The drug is contraindicated during pregnancy and lactation due to the lack of data on the safety of use.

Children

By strict indications used from birth.

Application features

With caution, the drug should be prescribed for hypomagnesemia, hypernatremia, hypothyroidism, severe dilatation of the heart cavities, cor pulmonale, myocarditis, obesity and the elderly, since in these cases the likelihood of intoxication increases.

With the rapid introduction of the drug may develop bradyarrhythmia, ventricular tachycardia, AV blockade and cardiac arrest. At the maximum of action, extrasystole may appear, sometimes in the form of bigeminy. To prevent the occurrence of this effect, the dose can be divided into 2-3 intravenous injections or the first of the doses should be administered intramuscularly. In the case of previous treatment with other cardiac glycosides before intravenous administration Strofantina K take a break (otherwise there may be a toxic effect of the summation of the action of glycosides). The duration of the break is from 5 to 24 days, depending on the detection of the cumulative properties of the previous drug.

Due to the pronounced cardiotropic effect of the drug and its rapid action, maximum accuracy in dosage and indications for use is required.

Treatment is carried out under constant ECG control.

The ability to influence the reaction rate when driving vehicles or operating other mechanisms

Interaction with others medicines and other types of interactions. When using Strophanthin K with barbiturates (phenobarbital, etaminal sodium, etc.), the cardiotonic effect of the glycoside is reduced. Simultaneous use of Strophanthin K with sympathomimetics, methylxanthines, reserpine and tricyclic antidepressants increases the risk of arrhythmias. The concentration of Strophanthin K in plasma increases with the simultaneous administration of quinidine, amiodarone, captopril, calcium antagonists, erythromycin and tetracycline. Against the background of magnesium sulfate, the possibility of a decrease in conductivity and the occurrence of AV heart block increases.

Saluretics, ACTH, GCS, insulin, calcium preparations, laxatives, carbenoxolone, amphotericin B, benzylpenicillin, salicylates increase the risk of developing glycoside intoxication. Antiarrhythmic drugs, including beta-adrenergic receptor blockers, potentiate the negative chrono- and dromotropic effect of the glycoside. Inducers of microsomal liver enzymes (phenytoin, rifampicin, phenobarbital, phenylbutazone, spironolactone), as well as neomycin and cytostatic agents reduce the concentration of Strofantin K in blood plasma. Calcium preparations increase sensitivity to cardiac glycosides.

Pharmacological properties"type="checkbox">

Pharmacological properties

Pharmacological. Strophanthin It is a mixture of cardiac glycosides (K-strophanthin-b, K-strophanthoside), from the seeds of the tropical liana Strophathus Kombe Oliver and belongs to the group of so-called polar (hydrophilic) cardiac glycosides, are slightly soluble in lipids and poorly absorbed in the gastrointestinal tract. The mechanism of action is associated with the blockade of Na + -K + -ATPase, the effect on Na + -Ca 2+ metabolism, improves contractility myocardium. The drug potentiates the strength and speed of contraction of the heart, lengthens diastole, improves blood flow to the ventricles of the heart, increases stroke volume, has little effect on the function of n. vagus.

Strofantin K is a medicinal pharmaceutical product from the group of so-called cardiac glycosides. The medication is used for cardiac pathology. For readers of "Popular about health" I will consider this tool.

So, the instruction Strofantin K:

Strofantin K composition and release form

The pharmaceutical industry produces Strofantin K in a slightly yellowish or in colorless solution for parenteral use, namely, medicine administered intravenously and intramuscularly. Active substance at a dose of 250 μg, it is represented by strophanthin K. Among the auxiliary compounds, water for injection and ethanol 96% can be noted. It is supplied to the pharmaceutical market in ampoules.

Pharmacological action Strofantin K

Strofantin K is a cardiac glycoside with a so-called short-acting effect. Under the influence of the drug in cardiomyocytes, the sodium content increases, which leads to the opening of calcium channels and the so-called entry of calcium into cardiomyocytes.

The pharmaceutical product increases the force of myocardial contraction, as a result, the volume of blood increases both shock and minute. The so-called cumulative effect of this medication is practically absent. The distribution is uniform, more concentrated in the adrenal glands, kidneys, pancreas, and also in the liver, in the myocardium itself, up to one percent of the pharmaceutical is determined. Communication with proteins - 5%. Excreted by the kidneys.

Indications Strofantin K for use

Means Strofantin K is indicated for use in heart failure, with atrial fibrillation in tachysystolic form, as well as with atrial flutter of the so-called paroxysmal flow.

Contraindications Strofantin K for use

I will list the conditions in which the pharmaceutical Strofantin K is contraindicated for use:

With diagnosed glycoside intoxication;
With hypersensitivity to the components of the drug;
With the so-called Wolf-Parkinson-White syndrome;
With complete sinoatrial blockade;
With 2 degrees of atrioventricular blockade.

With caution, the drug Strofantin K is used for 1 degree of atrioventricular blockade, with diagnosed attacks of Morgagni-Adams-Stokes, ventricular extrasystole, unstable angina, with hypoxia, with hypertrophic cardiomyopathy obstructive nature, cardiac asthma, as well as isolated mitral stenosis, myocardial infarction, with arteriovenous shunt, with constrictive pericarditis, with amyloidosis of the heart, with a pronounced expansion of the heart cavities with the so-called dilatation, with thyrotoxicosis, hypokalemia, myocarditis, hypomagnesemia, hypercalcemia, in the elderly age.

Application Strofantin K and dosage

The medicine Strofantin K is used in emergency situations parenterally. A 0.025% solution of the pharmaceutical preparation is used intravenously, it should be diluted in 20 milliliters of 5% dextrose or 0.9% sodium chloride. The introduction of the drug should be carried out slowly, for about five minutes.

In addition, the solution can also be applied drip, while it is dissolved in one hundred milliliters of 5% dextrose or 0.9% sodium chloride. Higher doses medication Strophanthin K - single - 2 ml, and daily - 4 milliliters.

If it is impossible intravenous use the drug is administered intramuscularly, having previously dissolved Strofantin K in 5 milliliters of a 2% solution of procaine. The remedy should be used only on the advice of a doctor.

Side effects Strofantin K

The medicine Strofantin K can cause the following side effects: diarrhea, bradycardia, loss of appetite, extrasystole, nausea, vomiting, atrioventricular block, headache, ventricular tachycardia, dizziness, ventricular fibrillation, sleep disturbances, psychosis, fatigue, confusion.

In addition, the following are observed adverse reactions: impaired color perception, depression, drowsiness, allergic reactions, petechiae, gynecomastia, thrombocytopenia, nose bleed, thrombocytopenic purpura. With identified negative reactions you should contact your doctor.

Overdose Strofantin K

In case of an overdose of Strofantin K, the patient experiences arrhythmia, bradycardia, atrioventricular blockade is observed, ventricular paroxysmal tachycardia, nodal tachycardia, ventricular fibrillation, flutter and atrial fibrillation are possible, ventricular extrasystole, sinoatrial blockade, nausea, vomiting, fatigue, decreased visual acuity, dizziness, flies before the eyes, fainting in rare situations.

In a similar situation, with an overdose of Strofantin K, the introduction of an antidote, represented by sodium dimercaptopropanesulfonate, is recommended. In addition, symptomatic therapy is prescribed when the patient is shown antiarrhythmic pharmaceuticals - phenytoin, amiodarone, lidocaine; potassium preparations are effective; atropine sulfate.

special instructions

With extreme caution, Strofantin K should be used for atrial extrasystole, as well as for the so-called thyrotoxicosis.

Analogues Strofantin K

At present, there are no analogues of Strofantin K.

Conclusion

Clinico-pharmacological group:

Included in medications

ATH:

C.01.A cardiac glycosides

Pharmacodynamics:

Strofantin K - short-acting cardiac glycoside, blocks the transport Na + / K + -ATPase, as a result, the content of sodium ions in cardiomyocytes increases, which leads to the opening calcium channels and entry of calcium ions into cardiomyocytes. Increases the strength and speed of myocardial contraction, which occurs according to a mechanism different from the Frank-Starling mechanism, and does not depend on the degree of preliminary myocardial stretching; systole becomes shorter and energy efficient. As a result of an increase in myocardial contractility, the stroke and minute volume of blood increases.

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

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

Pharmacokinetics:

The cumulative effect is practically absent.

The distribution is relatively uniform; somewhat more concentrated in the tissues of the adrenal glands, pancreas, liver, kidneys. 1% of the drug is found in the myocardium. Communication with blood plasma proteins - 5%.

Does not undergo biotransformation, excreted by the kidneys unchanged. For 24 hours, 85-90% of the drug is excreted; plasma concentration decreases by 50% after 8 hours; completely excreted from the body after 1-3 days.

Indications:

As part of complex therapy acute and chronic heart failure of the II functional class (in the presence of clinical manifestations), III-IV functional class according to NYHA classification;

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

IX.I30-I52.I48 Fibrillation and atrial flutter

IX.I30-I52.I50.0 Congestive heart failure

IX.I30-I52.I50.1 Left ventricular failure

Contraindications:

Hypersensitivity, glycoside intoxication.

Carefully:

Bradycardia, AV block and sick sinus syndrome without a pacemaker, paroxysmal ventricular tachycardia, hypertrophic obstructive cardiomyopathy, isolated mitral stenosis, acute myocardial infarction, unstable angina, WPW syndrome, chronic heart failure with impaired diastolic function ( restrictive cardiomyopathy, cardiac amyloidosis, constrictive pericarditis, cardiac tamponade), extrasystole, cardiac asthma in patients with mitral stenosis(in the absence of tachysystolic form atrial fibrillation), pronounced dilatation of the cavities of the heart, "pulmonary" heart. Electrolyte disorders (state after dialysis, diarrhea, taking diuretics or other drugs that cause electrolyte disturbances, malnutrition, prolonged vomiting, etc.): hypokalemia, hypomagnesemia, hypercalcemia, hypocalcemia. Hypothyroidism, alkalosis, myocarditis, obesity, elderly age, arteriovenous shunt, hypoxia, CRF.

Pregnancy and lactation:

Use during pregnancy and during breastfeeding contraindicated.

Dosage and administration:

Strofantin K is used intravenously, intramuscularly, only in emergency situations when it is impossible to use cardiac glycosides inside. For intravenous administration, a 0.025% solution of the drug is used. It is diluted in 10-20 ml of 5% dextrose (glucose) solution or 0.9% sodium chloride solution. The introduction is carried out slowly, for 5 to 6 minutes (because a quick introduction can cause shock). A solution of strophanthin K can also be administered drip (in 100 ml of a 5% dextrose (glucose) solution or 0.9% sodium chloride solution), since this form of administration rarely develops a toxic effect.

The highest doses of strophanthin K for adults intravenously: single - 2 ml (2 ampoules), daily - 4 ml (4 ampoules).

If intravenous administration is not possible, the drug is used intramuscularly. To reduce acute pain in intramuscular injection 5 ml of a 2% solution of procaine is first injected, and then through the same needle - the desired dose of strophanthin K, diluted in 1 ml of a 2% solution of procaine. With intramuscular injection, the dose is increased by 1.5 times.

Side effects:

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

From the side of the cardiovascular system: bradycardia, extrasystole, atrioventricular blockade, ventricular paroxysmal tachycardia, ventricular fibrillation.

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

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

Overdose:

Symptoms:

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

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

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

Treatment: drug withdrawal or reduction of subsequent doses and an increase in the time intervals between injections of the drug, the introduction of antidotes (), symptomatic therapy (antiarrhythmic drugs -, potassium preparations; m-anticholinergics - atropine sulfate). As antiarrhythmic drugs - class I drugs (,). With hypokalemia - in / in the introduction of potassium chloride (6-8 g / day at the rate of 1-1.5 g per 0.5 l of 5% dextrose (glucose) solution and 6-8 units of insulin; injected drip for 3 hours). With severe bradycardia, atrioventricular blockade - m-anticholinergics. It is dangerous to administer beta-agonists, due to the possible increase in the arrhythmogenic effect of cardiac glycosides. With a complete transverse blockade with Morgagni-Adams-Stokes attacks, temporary pacing is indicated.

Interaction:

When using strophanthin K together with barbiturates (and others), the cardiotonic effect of the glycoside decreases. Simultaneous use of strophanthin K with sympathomimetics, methylxanthines, reserpine and tricyclic antidepressants increases the risk of arrhythmias. The concentration of strophanthin K in blood plasma increases with simultaneous application quinidine, amiodarone, captopril, calcium antagonists, erythromycin and tetracycline. Against the background of magnesium sulfate, the possibility of slowing down the conduction and the occurrence of atrioventricular heart block increases. Diuretics (mostly thiazide and carbonic anhydrase inhibitors), corticotropin preparation (adrenocorticotropic hormone), glucocorticosteroids, insulin, calcium preparations, laxatives, amphotericin B, salicylates increase the risk of developing glycoside intoxication. beta blockers, antiarrhythmic drugs, can not only enhance the severity of the decrease in atrioventricular conduction (negative dromotropic effect), but also potentiate the negative chronotropic effect of strophanthin K (decreased heart rate). Inducers of microsomal liver enzymes (,), as well as cytostatic agents, reduce the concentration of strophanthin K in blood plasma. Glycoside intoxication can be caused due to the development of hypokalemia, a carbonic anhydrase inhibitor, mineralocorticoids, therefore, when used simultaneously with cardiac glycosides, it is necessary to regularly determine the content of potassium in the blood plasma. Preparations of potassium salts should not be used if, under the influence of cardiac glycosides, conduction disturbances appeared on the electrocardiogram, however, potassium salts are often prescribed together with digitalis preparations to prevent heart rhythm disturbances.

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

Special instructions:

ECG monitoring.

distinctive characteristics.

Cardiac glycoside of low lipophilicity, unstable, ineffective when taken orally, slightly cumulates.

With rapid intravenous administration, bradyarrhythmia, ventricular tachycardia, AV block and cardiac arrest may develop. At the peak of the effect, extrasystoles may appear, sometimes in the form of bigeminy. To prevent this effect, the dose can be divided into 2-3 intravenous injections or one of the doses should be administered intramuscularly. If the patient was previously prescribed other cardiac glycosides, it is necessary to take a break before the intravenous administration of strophanthin-K (5-24 days, depending on their cumulative properties).

Instructions

Name:

Strophanthin K (Strophantinum K)

Pharmachologic effect:

Strofantin K is a cardiac glycoside. Increases the strength and speed of contraction of the myocardium (heart muscle) (positive inotropic effect), lowers the heart rate (negative chronotropic effect).

In heart failure, it increases stroke (the amount of blood that the heart ejects into the bloodstream in one contraction) and minute (the amount of blood that the heart ejects into the bloodstream per minute) heart volume, improves ventricular emptying, which leads to a decrease in heart size.

The effect of the drug appears 3-10 minutes after intravenous injection. Maximum effect develops 30-120 minutes after reaching saturation. The duration of action of strophanthin K is from one to three days.

Indications for use:

Chronic heart failure stage 2-3, heart rhythm disturbances: supraventricular tachycardia, atrial fibrillation.

Application method:

Strophanthin is injected into a vein in the form of a 0.025% solution, usually 0.25 mg (1 ml), less often 0.5 mg. A solution of strophanthin is diluted in advance in 10-20 ml of 5%, 20% or 40% glucose solution or isotonic sodium chloride solution. Enter slowly (within 5-6 minutes), as a quick introduction can cause shock. Enter once (rarely 2 times) a day. You can enter a solution of strophanthin drip in 100 ml of isotonic sodium chloride solution or 5% glucose solution. At drip injection toxic effects are less common.

If intravenous administration is not possible, strophanthin is sometimes prescribed intramuscularly. To reduce soreness intramuscular injections sharply painful) pre-inject 5 ml of a 2% solution of novocaine, and then through the same needle - the desired dose of strophanthin diluted in 1 ml of a 2% solution of novocaine. With intramuscular injection, the dose is increased by 1/2 times.

The highest doses of strophanthin K for adults in a vein: single -0.0005 g (0.5 mg), daily -0.001 g (1 mg) or, respectively, 2 and 4 ml of a 0.025% solution.

Due to the high activity and fast action strophanthin requires caution and accuracy in dosage and indications.

Undesirable phenomena:

With an overdose of strophanthin, extrasystole, bigeminia (heart rhythm disturbances), rhythm dissociation (change in the source of the heart rhythm) may appear, in these cases it is necessary to reduce the dose with successive injections and increase the intervals between individual infusions, prescribe potassium preparations. With a sharp slowdown in the pulse, the injections are stopped. Nausea and vomiting are possible.

Contraindications:

Sharp organic changes heart and blood vessels, acute myocarditis (inflammation of the muscles of the heart), endocarditis (disease internal cavities heart), severe cardiosclerosis ( destructive changes in the heart muscle). Caution is required in thyrotoxicosis (disease thyroid gland) and atrial extrasystole (a type of heart rhythm disturbance).

Release form of the drug:

0.025% solution for injection in ampoules of 1 ml.

Storage conditions:

List A. In a dark place.

Additionally:

The mixture of cardiac glycosides isolated from the seeds of Kombe strophanthus (Strophantus Kombe) contains mainly Kstrophanthin and Kstrophanthiside.

Similar drugs:

Acetyldigoxin beta (Acetyldigoxinbeta) Digitalis purple leaves in powder (PulvisfoliorumDigitalis) Lily of the valley-valerian drops with sodium bromide (Guttae ConvallariaeetValeriani cumNatriibromidi) Lily of the valley-valerian drops with adonizide and sodium bromide (Guttae Convallariae et Valeriani cum Adonisidi et Natrii bromidi) Lily of the valley-valerian drops with adonizide (Guttae Convallariae et Valeriani cum adonisidi)

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Active substance

Strophanthin K

Release form, composition and packaging

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

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

1 ml - colorless glass ampoules (10) - cardboard boxes.
1 ml - colorless glass ampoules (10) - blister packs (1) - cardboard packs.

pharmachologic effect

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

Increases the strength and speed of myocardial contraction, which occurs according to a mechanism different from the Frank-Starling mechanism, and does not depend on the degree of preliminary myocardial stretching; systole becomes shorter and energy efficient. As a result of an increase in myocardial contractility, the stroke and minute volume of blood increases.

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

Pharmacokinetics

The cumulative effect is practically absent.

Distribution relatively uniform; somewhat more concentrated in the tissues of the adrenal glands, pancreas, liver, kidneys. 1% of the drug is found in the myocardium. Communication with blood proteins - 5%.

breeding. Does not undergo biotransformation, excreted by the kidneys unchanged. For 24 hours, 85-90% of the drug is excreted; plasma concentration decreases by 50% after 8 hours; completely excreted from the body after 1-3 days.

Indications

- as part of the complex therapy of acute and chronic heart failure of functional class II (in the presence of clinical manifestations), III-IV functional class according to the NYHA classification;

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

Contraindications

- glycosidic intoxication;

- Wolff-Parkinson-White syndrome;

- atrioventricular block II degree;

- intermittent atrioventricular or sinoatrial complete blockade;

— hypersensitivity to the drug.

Carefully:(comparing benefit/risk): first-degree atrioventricular block, sick sinus syndrome without artificial pacemaker, chance of unstable conduction through the atrioventricular node, history of Morgagni-Adams-Stokes attacks, hypertrophic obstructive cardiomyopathy, isolated mitral stenosis with rare heart rate contractions, cardiac asthma in patients with mitral stenosis (in the absence of tachysystolic atrial fibrillation), acute myocardial infarction, unstable angina pectoris, arteriovenous shunt, hypoxia, constrictive pericarditis, heart failure with impaired diastolic function (restrictive cardiomyopathy, cardiac amyloidosis, constrictive pericarditis, tamponade heart), ventricular extrasystole, pronounced dilatation of the heart cavities, "pulmonary" heart. Atrial extrasystole due to the possibility of its transition to atrial fibrillation.

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

Dosage

Strofantin K is used intravenously, intramuscularly, only in emergency situations when it is impossible to use cardiac glycosides inside. For intravenous administration, a 0.025% solution of the drug is used. It is diluted in 10-20 ml of a 5% dextrose (glucose) solution or a 0.9% solution. The introduction is carried out slowly, for 5 to 6 minutes (because a quick introduction can cause shock). A solution of Strofantin K can also be administered drip (in 100 ml of a 5% dextrose (glucose) solution or 0.9% sodium chloride solution), since this form of administration rarely develops a toxic effect.

The highest doses of Strofantin K for adults intravenously: single - 2 ml (2 ampoules), daily - 4 ml (4 ampoules).

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

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

Side effects

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

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

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

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

Overdose

Symptoms:

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

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

From the side of the central nervous system and sensory organs: headache, fatigue, dizziness, rarely - staining of surrounding objects in green and yellow, a feeling of flies flickering before the eyes, decreased visual acuity, scotoma, macro- and micropsia; very rarely - confusion, syncope.

Treatment: discontinuation of the drug or a decrease in subsequent doses and an increase in the time intervals between injections of the drug, the introduction of antidotes (sodium dimercaptopropanesulfonate), symptomatic therapy (antiarrhythmic drugs - lidocaine, phenytoin, amiodarone; potassium preparations; m-anticholinergics -). As antiarrhythmic drugs - class I drugs (lidocaine, phenytoin). With hypokalemia - in / in the introduction of potassium chloride (6-8 g / day at the rate of 1-1.5 g per 0.5 l of 5% dextrose (glucose) solution and 6-8 units of insulin; injected drip for 3 hours). With severe bradycardia, atrioventricular blockade - m-anticholinergics. It is dangerous to administer beta-agonists, due to the possible increase in the arrhythmogenic effect of cardiac glycosides. With a complete transverse blockade with attacks of Morgagni-Adams-Stokes - temporary pacing.

drug interaction

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

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

special instructions

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

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

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

The likelihood of overdose increases with hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia, severe dilatation of the heart cavities, cor pulmonale, alkalosis, in elderly patients. Special care and electrocardiographic monitoring are required in violation of atrioventricular conduction.

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

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

Influence on the ability to drive vehicles and control mechanisms

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

Use in the elderly

Use with caution in the elderly.

Terms of dispensing from pharmacies

On prescription.

Terms and conditions of storage

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