Arrhythmia drugs

Cardiac arrhythmia is a condition of the heart muscle that shows irregularities in the frequency and synchronicity of muscle contractions. Such a clinical picture is pathological and requires immediate medical intervention. The problem can be solved with anti-arrhythmia drugs, innovative units of which are developed annually by modern pharmaceutical companies, presenting them to the judgment of doctors and patients.

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Indications for the use of drugs for arrhythmia

Disruptions in the rhythm of the heart muscle are a symptom of many diseases, causing discomfort to a person's health. Indications for the use of drugs for arrhythmia are different. Medicines of this group are also prescribed depending on the clinical manifestations of the discord in the rhythm of beats.

The source of arrhythmia may be:

• Functional changes in the patient's body.
• The pathogenesis of the problem may have organic roots. That is, disorders caused by prolonged refusal of food, defectiveness of the heart muscle of an infectious nature, myocardiopathy.
• Poisoning with toxic substances, cardiac glycosides, and other similar drugs can lead to such disorders.
• Arrhythmia can be caused by hypo- or hyperkalemia. That is, a decreased or increased content of such a chemical element as potassium in the patient's body. Both deviations from the norm are dangerous for a person.
• Hormonal imbalances caused by one of the corresponding diseases, such as thyroid disease, can lead to changes.
• Problems may arise after surgery, as well as mechanical trauma.
• It is also worth noting the congenital rhythm disorder, which in medicine is referred to as Wolff-Parkinson-White syndrome.

Release form

Today, on the shelves of modern pharmacies, you can find a large number of drugs of this type of action. The form of release is also varied. These are tablets, which, depending on the active substance that makes up its basis, have different dosages. One drug is usually presented in a number of concentrations, increasing the ease of use and the ability to more accurately maintain the dosage.

To more quickly stop an attack, the attending physician may prescribe drugs of this group for intravenous or intramuscular administration, which is provided by various solutions for injection, of varying degrees of concentration.

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Pharmacodynamics

Medicines of this group have diverse coronary dilating characteristics. This factor, when used, makes it possible to increase the cross-section of the heart vessels, which improves blood flow. This characteristic is attractive for solving the problem discussed in this article, so the pharmacodynamics of antiarrhythmic drugs is what a patient with a heart rhythm disorder needs.

All these medications have different degrees of antispasmodic properties, allowing to moderate spasms. They also have an M-anticholinergic effect.

For example, anaprilin belongs to the group of non-selective drugs used as β-blockers, similar in their action to β1- and β2-adrenoreceptors. The action of the drugs can be both systemic and targeted.

The drugs under consideration have antiarrhythmic, membrane-stabilizing, antianginal and antihypertensive properties.

By blocking β-adrenoreceptors of the myocardium, the administered drug reduces their sympathetic pulsation, which leads to a decrease in the frequency and amplitude of contractions of the heart muscle. At the same time, the ionotropic, dromotropic, bathmotropic and chronotropic functions of ketacholamines are suppressed.

The drugs reduce the need of the cardiovascular system, in this case the heart, for oxygen. When administered, the drug lowers blood pressure, while the tension of the bronchial muscles increases and this is due to the suppression of β2-adrenoreceptors. The drugs reduce the reaction of sudden excitation of the ectopic and sinus conductor of rhythmicity, and slows down AV conduction.

If the drug has a systemic effect, then the muscle tissues of the gastrointestinal tract and uterus are subject to a similar effect, and their motor and secretory activity increases.

Pharmacokinetics

The preparations of this pharmacological orientation show excellent speed characteristics in the adsorption procedure of their components. The pharmacokinetics of antiarrhythmic drugs shows both a high absorption rate and a fairly short period of their elimination.

The maximum amount of the active substance of the drug (Cmax) can usually be observed in the blood after an hour and a half after its administration. Binding to blood proteins usually shows 90 - 95%.

The half-life (T1/2) of medicinal components is on average three to five hours. With prolonged use of the drug, this component can be determined by the figure of 12 hours.

Pharmacological products of this group freely penetrate the placental and blood-brain barriers. During studies, traces of the drugs were also found in mother's milk during lactation.

The drug is partially (up to 90%) excreted in the form of metabolites in the urine, and only a small amount is excreted from the patient’s body unchanged.

Names of drugs for arrhythmia

Despite the common goal and work on a positive result, the drugs of this category have their own classification. There are quite a lot of drugs for arrhythmia and they are divided into classes and subclasses.

• The first are membrane-stabilizing agents, which show high clinical results in the manifestation of arrhythmia in the ventricular and atrial zones.
  • 1a) They prolong the action potential time, moderately inhibit the possibilities of impulse passage. Such drugs include: quinidine, procainamide, rhythmilene, ajmaline, disopyramide, kinilentin, norpace, novocainamide, giluritmal.
  • 1c) Reduce the action potential time, do not affect the possibilities of impulse passage. Such drugs include: phenytoin, tocainide, xylocaine, diphenylhydantoin, lidocaine, caten, lignom, mexiletine, mexitil, trimecaine, xycaine.
  • 1c) The impulse conduction process is significantly inhibited. The action potential is not affected in any way. Such drugs include: encainide, etmozine, propanorm, bonnecor, flecainide, rhythmonorm, allapinine, moricizine, etacizine, propafenone.
• The second category is beta-adrenergic receptor blockers, which work by inhibiting passage through the atrioventricular node. Drugs of this subclass are prescribed when diagnosing pathology associated with atrial fibrillation or sinus tachycardia. Medicines representing this subclass:
  • Selective action: acebutolol, bimoprolol, betaloc, nebivolol, metoprolol, tenormin, vasocardin, esmolol, atenolol, specicor.
  • Systemic effects: anaprilin, propranolol, pindolol, obzidan.
  • The third category - potassium channel blockers - are mainly prescribed in case of ventricular or atrial arrhythmia diagnosis. Representatives of this category: bretylium, nibentan, ibutilide, dronedarone, cordarone, tedisamil, sotalol, amiodarone.
  • The fourth category - slow calcium channel blockers - inhibit the patency of the atrioventricular segment. They are prescribed in the treatment protocol for rhythm failure in the atrioventricular node. The drugs of this class include: finoptin, dilzem, lekoptin, isoptin, cardil, verapamil, diltiazem, cordium, bepridil, procorum, gallopamil, dilren.
  • Unclassified antiarrhythmic drugs:
    • Primary action drugs: magnerot, cardiac glycosides, ivabradine, adenosine triphosphate (ATP), alindine, adenosine, digoxin, asparkam, magne B6, strophanthin, panangin.
    • Secondary action drugs: captopril, atorvastatin, enalapril, omacor, statins.

It should be noted that if signs of a heart rhythm disorder appear, self-medication should not be done - this should be done by a specialist, because there are cases when the administration of medications is not required. And self-prescribing therapy can only aggravate the situation, worsen the quality of life and lead to loss of ability to work.

Method of administration and dosage

Only a qualified doctor - cardiologist can determine the method of application and doses adequately, in accordance with the situation. But we will still provide some recommended schedules of administration.

A medicinal product used for disorders of excitability and automatism of the heart and related to class 1 in the classification - quinidine is prescribed for oral administration half an hour before meals. Maximum therapeutic effectiveness is observed two to three hours after administration. The recommended starting dosage is 0.2 g three to four times a day. Quinidine is introduced into the treatment protocol for ventricular or supraventricular tachycardia, atrial fibrillation, atrial flutter.

For prevention or restoration of normal heart rhythm, Rhythmilen is prescribed, the recommended dosage of which is 0.1–0.2 g four times a day. The quantitative component of the load corresponds to 0.3 g of the drug.

This also includes mexiletine, which has a starting dosage similar to rhythmilene.

Bonnecor, which belongs to the first class of drugs of the considered direction. The drug is prescribed by the doctor both for intravenous injections in a dosage of 0.4 mg, calculated for each kilogram of the patient's weight, and in the form of tablets taken orally at 0.2 - 0.225 g, spaced over four doses.

In case of acute attack of arrhythmia, the amount of administered drug is increased to doses of 0.6 mg, calculated for each kilogram of the patient's weight. If medically necessary, the administration is repeated six hours after the previous dose. Betaloc-Zok - the daily dosage of the drug is taken from 0.1 to 0.2 g per day. Its therapeutic level in the blood is maintained at the proper level throughout the day. Non-selective beta-blocker obzidan is prescribed for oral administration in a daily dosage of 80 to 160 mg, spaced over three to four doses throughout the day. In especially exceptional cases, the drug may be administered in an amount of up to 0.32 g.

The medicine that regulates the level of arterial pressure pindolol is prescribed initially in the amount of 5 mg, taken two to three times a day. In case of therapeutic necessity, this amount can be gradually increased to 45 mg daily, divided into three doses.

Universal antiarrhythmic drug amiodarone, which refers to drugs that mainly affect the adrenergic systems of the heart. The drug is administered orally in the form of pills or tablets. The starting recommended dosage is 0.2 g, taken two to three times a day. The most effective time for taking is during meals. Gradually, the dose of the drug is reduced.

Ibutilide - this medicine is administered to the patient only in a hospital setting, only under close supervision of medical workers and only intravenously. The dosage of the administered substance is determined depending on the patient's body weight: at 60 kg and more, 1 mg is prescribed. If after 10 minutes the therapeutic result is not observed, repeated administration of the drug in the volume of the initial dosage is allowed.

If the patient's body weight is less than 60 kg, the amount of ibutilide administered corresponds to the amount calculated using the formula 10 mcg for each kilogram of the patient's weight.

The calcium ion antagonist verapamil is prescribed with a starting dosage of 40-80 mg, taken three to four times a day. In case of medical indications, the quantitative component of the dose can be increased to 0.12-0.16 g. The maximum permissible amount taken per day is 0.48 g.

Parenteral administration of the drug is also possible.

The cardiac glycoside digoxin is prescribed in individual dosage. The recommended starting single dose is 0.25 mg, which corresponds to one tablet. The drug is administered starting with four to five daily doses, gradually reducing their number. The intervals between doses must be maintained.

A medicine containing calcium and potassium – asparkam is used as an injection, for introducing a solution into a vein. For one procedure, one to two ampoules of 10 ml volume are used, or two to four, with a volume of 5 ml. The medicine is diluted with 100-200 ml of 5% glucose solution or sterile 0.9% sodium chloride solution.

Angiotensin-converting enzyme inhibitor - captopril is a drug that affects the renin-angiotensin system. The amount of the prescribed drug is selected individually for each patient. This indicator varies from 25 to 150 mg, divided into three daily doses. The maximum permissible daily amount of captopril administered is 150 mg.

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Antiarrhythmic drugs for atrial fibrillation

The name itself - atrial fibrillation - speaks for itself. This term refers to a condition in which there are periodic interruptions in the heart rhythm, causing problems with the supply of blood, and, accordingly, nutrients, to various systems and organs of the patient's body.

Atrial fibrillation has another name - atrial fibrillation. The symptoms of this disease are chaotic contraction, with increased tone, of some muscle group of atrial fibers. The clinical picture is such that each muscle is a local ectopic focus of impulses. When this pathological picture appears, urgent medical intervention is necessary.

Therapeutic measures for this pathology vary depending on the nature of its manifestation, since the disease in question is graded into tachyarrhythmia, paroxysmal, or constant arrhythmia. If necessary, surgical intervention is also possible, on the eve of which ß-adrenoblockers are necessarily prescribed.

The most effective antiarrhythmic drugs for atrial fibrillation are quinidine, amiodarone, propafenone, novocainamide, sotalol, ajmaline, etacizine, disopyramide and flecainide.

A medicinal preparation prescribed for pathology of the excitability and automatism process of the heart, belonging to class 1 - novocainamide (Novocainamidum).

In case of ventricular extrasystole diagnosis, the drug in question is administered orally in a starting dosage of 250, 500 or 1000 mg (adult dose). Repeated administration of the drug is carried out in a quantitative component of the drug from 250 to 500 mg with an interval of four to six hours. If a severe pathological picture occurs, the doctor may decide to increase the daily dosage to 3 g or even 4 g. The duration of the course directly depends on the level of sensitivity of the patient's body to the drug and its effectiveness in achieving a therapeutic result.

If it is necessary to solve the problem with paroxysmal ventricular tachycardia, the cardiologist prescribes the patient a drug in a solution for intravenous administration in an amount of 200 to 500 mg. The drug is administered slowly, 25-50 ml should be administered over the course of a minute. Sometimes it is necessary to administer a "shock dose", which is determined at the rate of 10-12 mg per kilogram of the patient's weight. This amount of the drug is administered to the human body over 40-60 minutes. Then the patient receives a maintenance infusion of 2-3 mg over the course of one minute.

The starting dosage in case of an attack of paroxysmal atrial fibrillation is prescribed as 1.25 g. If it does not show a therapeutic effect, an additional 0.75 g of the drug can be administered an hour later. Then, at intervals of two hours, 500-1000 mg of novocainamide is administered.

It is possible to administer the drug in question by intramuscular injection of a 10% solution. In this case, the amount of the drug is 5-10 ml three to four times a day.

The attending cardiologist faces a rather difficult task even after the attack has been stopped. Prevention of relapses of atrial fibrillation consists in the advisability of long-term use of maintenance doses of β-adrenoblockers. For example, this may be anaprilin (obzidan), which the patient takes daily for a long time at 10-20 mg once or twice a day.

Recently, doctors have been trying to combine β-blockers with drugs of the aminoquinoline group. Such drugs may include, for example, pelaquenil, chloroquine or delagil, which are taken before bedtime in the amount of 250 mg.

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Drugs for sinus arrhythmia

There is a clinic where medical intervention is not required, but in case of a pronounced clinical picture, drug treatment is indispensable. Drugs for sinus arrhythmia are selected by a cardiologist individually for each patient. Sedatives may be prescribed if the source of the attack was the patient's emotional instability. This may be Novopassit, which is prescribed to the patient two capsules three times a day. Or drops (tablets) of valerian or motherwort, taken two pieces four times a day. You can take 25 drops of Corvalol three times a day. In case of an attack, it is advisable to put a glycerin tablet under the tongue, or take cetirizine or pantogam one tablet three times a day, or 40 mg of picamelon twice a day.

In special cases, stronger drugs may be prescribed: neuroleptics and tranquilizers. But such medications should only be prescribed by a doctor - a psychiatrist. It may be necessary to decide on the installation of a pacemaker.

The patient with this category of disease is also given some other recommendations related to reducing physical and emotional stress, adjusting the daily routine and diet.

Anti-arrhythmia drugs for the elderly

Modern research shows a rather sad picture of human health. Over the past few decades, almost all diseases have become younger. Today, it is not difficult to find a patient who has had a heart attack at the age of under 30. However, most of the pathologies, and more severe cases of their manifestation, begin to bother people of age. At the same time, against the background of age-related changes, it is difficult for such patients to choose adequate effective treatment, and one that will not bring the patient other pathological complications. Anti-arrhythmia drugs for the elderly are prescribed similarly to those for younger patients, but with the only difference that the administered dosage is prescribed in a slightly lower amount.

Also, these medications must be administered very carefully and, preferably, under constant medical supervision.

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Drugs for arrhythmia and pressure

In case of hypertension present in the patient's medical history, the first blow falls on the vascular system of the body and the heart. Therefore, a rise in pressure and a failure in the rhythm of the heart are a fairly common combination of symptoms that must be stopped together. The danger of such a situation is that the clinical picture of this pathological tandem can lead to ventricular fibrillation. Therefore, at the first symptoms of an attack, it is advisable to seek medical help.

Medicines for arrhythmia and pressure are prescribed based on the established cause of the attack. If it was provoked by an emotional breakdown, a stressful situation or long-term experiences - these can be sedatives such as valerian, persen, novopassit, motherwort and many other modern drugs.

It is also possible to take tranquilizers that can effectively normalize the heart rhythm and also have hypotensive properties. These can be: phenazepam, elenium, seduxe, diazepam, grandaxin, medazepam, xanax.

Use of antiarrhythmic drugs during pregnancy

As noted above, drugs of this pharmacological focus quite easily penetrate the placental and blood-brain barriers, and a significant amount of them is also found in breast milk. Therefore, there is only one conclusion - the use of drugs for arrhythmia during pregnancy is contraindicated. Since the prescription of a drug with the pharmacodynamics described above can cause a negative effect on fetal development. For example, such as bradycardia, hypoglycemia, intrauterine growth retardation.

For serious medical reasons, the drug may be included in the protocol of a pregnant woman if the need to relieve a woman's health problem outweighs the risk to which the baby's body is exposed during this period. Throughout the entire course of treatment, the condition of the mother and fetus must be kept under constant control.

The medication should be discontinued two to three days before the expected birth.

If the need to administer the drug arises during the lactation period, then for this time the newborn should be weaned from breastfeeding and the baby should be transferred to artificial feeding.

Contraindications to the use of drugs for arrhythmia

The drugs in question are synthetic and semi-synthetic chemical compounds, so when prescribing them, it should be taken into account that any of them has contraindications for the use of drugs for arrhythmia, ignoring which can only significantly worsen the patient's health, or even lead to death.

The following factors limit or completely prevent the intake:

• Severe hepatic, cardiac and renal dysfunction.
• Increased individual intolerance to the components of the drug.
• AV block II–III degree.
• Endocarditis.
• Intraventricular conduction disturbance.
• Arterial hypotension.
• A failure in the process of hematopoiesis.
• Metabolic acidosis.
• Myocardial infarction in the acute phase.
• Attacks of bronchial asthma.
• Atrioventricular block.
• Diabetes mellitus.
• Aortic aneurysm.
• Cardiac glycoside intoxication.
• Sinus bradycardia (heart rate less than 55 beats per minute).
• Raynaud's disease.
• Myocarditis.
• Hypotension.
• Pregnant women are prescribed the drug only for vital indications.
• Vasomotor rhinitis.
• Subaortic stenosis.
• Cardiogenic shock.
• Failure of the excretory function of the kidneys.
• Severe cardiosclerosis.
• And some other clinical conditions.

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Side effects of antiarrhythmia drugs

Even if one of the drugs used to stop arrhythmia is administered, the medicine affects, in addition to the pathologically altered area, other organs and systems of the human body. Therefore, there is a high probability that side effects of arrhythmia drugs may occur as a response of the body to their effects.

Such pathological symptoms may include:

• Bradycardia.
• Decreased muscle tone.
• Pain in the epigastric region.
• Nausea that can provoke a gag reflex.
• Bronchodilator spasms.
• Cardiac dysfunction.
• AV block.
• Loss of appetite.
• Changes in taste preferences.
• Decreased overall tone of the body.
• Dizziness.

Somewhat less frequently one can observe:

• Headaches.
• Decreased temperature readings in the lower and upper extremities.
• The emergence of sleep problems.
• Exacerbation of psoriasis.
• Heavy dreams.
• Spasm of peripheral arteries.
• Tremor.
• Vision problems.
• A condition characterized by increased fatigue and exhaustion.
• Depressive state.
• Paresthesia is a disturbance of skin sensitivity.
• Symptoms of diarrhea or constipation.
• Skin manifestations of an allergic reaction.
• Hypoglycemia (patients with insulin-dependent diabetes mellitus).
• Hyperglycemia (patients with non-insulin-dependent diabetes mellitus).

Overdose

Any chemical compound does not affect each organism in the same way, because it is individual, therefore, when the amount of the administered drug is exceeded, one person is able to feel only a slight deterioration in the condition, and another simply risks his life. An overdose of drugs of this group can cause a response from the patient's body with the following symptoms:

• Psychomotor agitation.
• Dizziness.
• Tremor.
• Lowering blood pressure.
• Nausea, sometimes leading to vomiting.
• Symptoms of diarrhea.
• Central nervous system depression.
• Gynecomastia is an enlargement of the mammary glands in men.
• Asthenia, in which the patient's body is holding on with its last strength.
• Spasms of facial muscles.
• The appearance of "flickering midges" before the eyes.
• The appearance of signs of asystole and bradycardia.
• The emergence of memory problems.
• Psychosis, depressive state.
• Constant desire to sleep.
• Collapse is possible – a special clinical picture in which there is a sharp decrease in blood pressure, threatening the patient’s life.
• Respiratory arrest may occur.
• Erectile dysfunction, loss of libido.
• Possible AV block.
• People of retirement age may experience confusion.
• And some other individual manifestations of overdose.

Interactions with other drugs

Quite rarely, the treatment protocol for a particular disease is limited to monotherapy; it usually includes several drugs. Therefore, the attending physician must thoroughly know the specifics of taking antiarrhythmic drugs and their interaction with other drugs. This is the only way to achieve maximum effectiveness without causing harm to the patient's body in the form of severe complications.

With a tandem of an antiarrhythmic drug and drugs related to vasoconstrictors, there is an increase in the duration of local anesthetic action. Progression of hypoglycemia may occur with tandem administration of the drugs in question together with hypoglycemic agents.

Used in the same protocol with amiodarone, the drug tandem can provoke quite severe symptoms: ventricular fibrillation, hypotension, asystole, bradycardia.

MAO inhibitors and drugs that stop arrhythmia, when administered simultaneously, can cause undesirable consequences in the form of an attack of bradycardia. If inhalation anesthesia is administered to a patient during treatment with antiarrhythmic drugs, the probability of blocking the work of the myocardium and progression of arterial hypotension increases.

Parallel administration with hydralazine allows for an increase in AUC and Cmax in blood plasma. There are data that indicate a decrease in blood flow in the kidney area and a decrease in inhibition of liver enzyme activity. This scenario of therapy development disrupts metabolic processes, slowing down their flow.

Co-administration with verapamil or diltiazem can provoke the development of bradycardia (heart rate below 60 beats per minute), arterial hypotension and dyspnea (impaired frequency and depth of breathing, accompanied by a feeling of shortness of breath). Against the background of the work of both drugs, an increase in the concentration of the antiarrhythmic drug in the patient's blood is observed, as well as a decrease in clearance and an increase in AUC. Severe consequences can be observed in the form of acute arterial hypotension in the case of simultaneous administration with haloperidol.

The combined administration of antiarrhythmic drugs can reduce the rate of chemical reactions or suppress their course for active chemical substances of such drugs as tolbutamide, glibenclamide, chlorpropamide, glyburide and other analogs. This situation occurs due to the ability of β2-adrenergic blockers to inhibit β2-adrenergic receptors located in the pancreas and responsible for insulin levels.

Concomitant administration with doxorubicin alters the clinical picture, increasing cardiotoxicity.

Cases of observation of higher amounts of phenindione, imipramine and warfarin in the patient's blood are described. When administered in tandem, the drugs in question block the bronchodilatory pharmacodynamics of terbutaline, salbutamol and isoprenaline.

Violation of the antihypertensive properties of antiarrhythmic drugs is observed with combined use with acetylsalicylic acid, ketanserin, clonidine, naproxen, piroxicam, indomethacin. Caffeine reduces the pharmacodynamics of antiarrhythmic drugs. There are known cases of progressive bradycardia occurring with parallel work with lithium carbonate.

A hypotensive effect can be observed when working simultaneously with ketanserin. And vice versa, the characteristics of bupivacaine, maprotiline and lidocaine are enhanced. The introduction of morphine against the background of arrhythmia-stopping therapy causes depression of the receptors of the central nervous system.

Cases of cardiac arrest have been reported with concomitant use with mefloquine or prenylamine, with an increase in the QT interval also observed. Sodium amidotrizoate and nisoldipine can cause an attack of acute arterial hypotension. Their concentration in the blood also increases. Increased activity of β-blockers is observed.

Nicardipine allows to increase the concentration of antiarrhythmic drug in blood plasma and its AUC, but this may cause arterial hypotension and decrease heart rate.

If the patient has a history of ischemic heart disease, there is a high probability of developing myocardial infarction, as well as acute heart failure and arterial hypotension, when administered together with nifedipine.

Propafenone provides high levels of antiarrhythmic drugs in the blood plasma, increasing their toxicity. Inhibition of the metabolism of antiarrhythmic drugs in the liver is observed, reducing their clearance.

The risk of developing arterial hypotension and bradycardia increases with co-administration with propranolol or reserpine. Cases of bleeding have been described that occurred with the tandem use of antiarrhythmic drugs and phenindione, which changes blood clotting parameters.

Cimetidine reduces the rate of chemical reactions and the activity of liver microsomal enzymes or suppresses their manifestations when used in parallel with antiarrhythmic drugs. The rate of metabolism decreases, and an increase in the cardiodepressant effect of drugs is observed.

There are known cases of violation of hemodynamic characteristics of drugs used in the therapy of stopping arrhythmia with ethanol. And joint work with ergotamine significantly reduces the effectiveness of the latter.

Storage conditions

In order to maintain high pharmacological characteristics throughout the entire permissible period of use, the manufacturer recommends that all points of the storage conditions of the drug be met. They are similar to the requirements that apply to the storage of many other pharmacological agents.

• The storage location should be protected from direct sunlight and moisture.
• Should not be accessible to children.
• The temperature at which the medicine is stored should not be higher than 25 ºС.

Best before date

The shelf life of drugs of this pharmacological group is very different in time and can be from two to five years. Therefore, when buying and before taking the drug, it is necessary to clarify the final period of their effective use, since in case of expiration of the guaranteed time, taking this drug is unacceptable in order to avoid an undesirable reaction of the patient's body and severe complications.

Our technogenic age, providing us with technical excesses, has a detrimental effect on the immune status of a person and his health in general. The situation is catastrophic in the field of cardiology medicine. The number of such patients is growing every year, and the average statistical age of patients is getting younger. A large percentage of patients also suffer from heart rhythm disorders. Therefore, drugs for arrhythmia are quite in demand today. But we should not forget that only an experienced qualified specialist should prescribe drugs of this group, having previously conducted a comprehensive examination of the patient, having received a complete clinical picture and having established the source of the pathology. Otherwise, self-medication can only aggravate the situation and lead to loss of working capacity, or even death.