Effective pills that relieve pain in the heart

The main indications for the use of pain relievers in the heart are the relief of seizures and the intensification of pain syndrome of anginal etiology in cardiological diseases such as angina pectoris (including on the background of coronary insufficiency), ischemic heart disease, myocardial infarction.

[1], [2], [3], [4], [5], [6], [7], [8]

Indications for the use of tablets from pain in the heart

To relieve pain during an attack of angina help sublingual tablets Validol or Molsidomine, and they are effective in cases of cardiovascular failure, supraventricular tachycardia and cardiac atrial fibrillation. And Molsidomin can replace Nitroglycerin with individual intolerance of the latter.

Tablets from pain in the heart of a group of cardiac blockers adrenaline are prescribed for stenocardia with spasms of small coronary vessels, tachycardia and extrasystole. And with myocardial ischemia, antiarrhythmic drugs of the nitrate group, calcium channel blockers and beta adrenoblockers are needed. Nitrates relieve vasospasm and promote their expansion. And the blockers, although they do not relieve the pain directly, but the consequences of their biochemical and physiological effects make it possible to relieve the oxygen starvation of the heart muscle, reduce the frequency of contractions of the heart (which is caused by an excess of adrenaline) and thereby stop the pain.

In cardiology, indications for the use of tablets from heart pain include a wide range of pathologies. Preparations of these groups of physicians are classified as antianginal and they are used in the treatment of concomitant and stable angina pectoris, in the complex therapy of chronic heart failure, and also for the normalization of heart function after myocardial infarction.

Pharmacodynamics tablets from pain in the heart

The mechanism of action of calming tablets Validol is due to the nonspecific reflex dilatation of the vessels, which occurs in response to local irritation of the oral mucosa receptors with menthol, dissolved in menthol 3-methylbutanoic (isovaleric) acid. As a result of irritation of nerve endings in the body, the synthesis of neuropeptides and hormones responsible for the vascular tone and inhibition of the transmission of pain sensations is enhanced.

Pharmacodynamics tablets from pain in the heart Molsidomin is provided by its active substance ethyl ester of N-carboxy-3-morpholino-sydnonimina, which weakens the tension of the heart veins and reduces the flow of venous blood in the heart. Due to this, the left ventricular hemorrhage and the overall tone of the myocardium decrease.

All pills from heart pain based on nitrates act on the vascular system of the whole body and in a few minutes dilate the vessels of the heart. The biochemical mechanism of this reaction is not fully understood.

Drugs of this group contribute to reducing the stress of the walls of the coronary vessels and increasing the flow of blood into the myocardial tissue (which reduces their need for oxygen) - while reducing the flow of venous blood (which lowers the pressure in the right atrium). Thus, there is a kind of redistribution of blood flow in the vessels of the heart with activation of arteriolovenous blood supply to pathologically altered areas of the myocardium.

The increase in contractile force of the myocardium under the action of cardiac glycosides is explained by the increased electrical activity (membrane action potential) of muscle cells (cardiomycetes), in the cytoplasm of which there is accumulation of Na ions and an increase in the level of Ca ions. In addition, the conduction system of the heart (PSS) in particular, the atrioventricular node in the interatrial septum - begins to transmit excitation slowly to the muscle fibers of the myocardium, which reduces the heart rate.

Pharmacodynamics of beta-blockers used in cardiology is associated with a decrease in the effect of neurotransmitters adrenaline and norepinephrine on their specific receptors in the cardiac muscle. This provides the active substance metoprolol tartrate, and due to it the synthesis of cyclic adenosine monophosphate (cAMP) and the level of calcium ions in the cells of the MSS are reduced. The result of all biochemical changes is a decrease in the intensity of cardiac contractions, stabilization of vascular tone (and blood pressure), as well as a sufficient supply of oxygen to the cells of the myocardium.

The principle of action of calcium channel blockers of the sinoatrial and atrioventricular nodes is to neutralize the contractile action of calcium ions on the walls of the blood vessels of the myocardium. As a result, spasm of coronary vessels ceases, and muscle fibers do not experience oxygen deficiency. This positively affects the mechanics of the heart: the normal rhythm of its contractions is restored.

Pharmacokinetics of pills for heart pain

Nitroglycerin and all the preparations of the nitrate group with the sublingual method of administration immediately get into the blood, so these pills from pain in the heart act very quickly - after 1.5-2 minutes.

The pharmacokinetics of cardiac glycosides - digoxin - is characterized by rapid absorption in the gastrointestinal tract, accumulation in muscle tissues and medium bioavailability within 65-75% of the dose. The maximum level of the active substance of drugs in the blood is reached after 90 minutes from the moment of application. 20% of glycosides are metabolized in the liver, and the rest is excreted from the body in its original form; the half-life is 1.5-3 days.

The active substance of metoprolol and other cardiac beta-blockers (metoprolol tartrate) is adsorbed in the digestive tract by 90%, but its bioavailability does not exceed 50%. After a maximum of 120 minutes after oral administration, the maximum concentration of the active substance in the blood plasma is determined. Biotransformation occurs in the liver, metabolites after 7-10 hours are completely excreted in the urine.

Pharmacokinetics of tablets from pain in the heart Verapamil: adsorbed in the digestive tract and binds to blood plasma proteins; the highest concentration of verapamil hydrochloride in the plasma is achieved 60-100 minutes after ingestion. Bioavailability does not exceed 35%; metabolism is exposed in the liver; is excreted by the kidneys and through the intestine.

Names of tablets from pain in the heart

Depending on the nature of the therapeutic effect, cardiac drugs for pain relief are divided into peripheral vasodilators (this includes nitrates), cardiac glycosides, selective beta-blockers and calcium channel blockers.

Vasodilators (vasodilators) include Validol (Corvalment), Molsidomin (Corvaton, Sidnofarm), as well as an extensive group of glycerol-esterified nitrate salts of nitrates and their derivatives.

The names of tablets from heart pain based on nitrates: Nitroglycerin (Nitromint, Nitrocore, Nitrocarardiol, Sustak); nitroglycerin derivatives of isosorbide mononitrate (Monizide, Monosan, Olicard, Pentrol, Pentacard) and isosorbide dinitrate (Izacardin, Cardicet, Cardonite, Cardix); and Pentaerythrityl tetrath (Pentral, Pentrite, Nitropentor, Vasocor, Vazodilatol, Erinit, etc.) - based on tetranitropentaerythritol.

The group of cardiac glycosides (cardiotonic drugs) includes tablets based on digoxin digitalis glycoside: Digoxin, Gitoxin, Digicor, Izolanid, Celanid, Medilazide, Medigoxine, Methylldioxin, Acetyl-digoxin Beta and other trade names.

A group of selective cardiac β1-blockers is represented by such drugs as Metoprolol (Vazocardine, Corvitol, Lopressor, Betaloc, Serdol Egalok).

Tablets with verapamil hydrochloride verapamil (Veracard, Lekoptin, Finoptin), as well as tablets based on benzothiazepine derivatives Diltiazem (Angizem, Ditrien, Diazem, Diakordin, Cardil and other trade names) are part of a fairly extensive pharmacological group of cardioselective calcium channel blockers.

Dosing and Administration

The method of application of Validol, Molsidomine and Nitroglycerin is sublingual (that is, under the tongue). Separate recommendation regarding the dose of Nitroglycerin: in the absence of the effect on the withdrawal of an accompanying attack of angina pectoris after the first administration of the drug (1-2 tablets of 0.5 mg), it should be repeated only five minutes later - not earlier.

Molsidomine can be taken orally in half or a whole tablet 2-3 times a day (after a meal), but the therapeutic effect manifests itself in 20-25 minutes, that is 2-3 times longer than with the sublingual method.

Doses of cardiac glycosides and calcium channel blockers are determined strictly individually - according to the results of a cardiac examination. The standard single dose of Digoxin is 0.25 mg, and the daily dose should not exceed 1.25 mg. And tablets of Verapamil are recommended to take in the volume of 160-480 mg during the day; the course of treatment can last from 2 to 24 months.

Metoprolol is prescribed 50 mg 2-4 times a day (depending on the patient's condition), the tablet should be swallowed whole during or immediately after meals.

[16], [17], [18], [19]

Contraindications for use

The following contraindications for use are noted:

• Validol: complication of myocardial infarction in the form of cardiogenic shock, severe form of arterial hypotension.
• Nitroglycerin (and all nitrates): shock, increased intracranial pressure and cerebral circulation, lowered blood pressure, glaucoma (closed-angle).
• Cardiac glycosides: tachycardia-bradycardia syndrome with weakness or dysfunction of the sinus node, atrioventricular block (1-2 degrees), violations of the rhythm of ventricular contraction of the heart, hypertrophic changes in the myocardium, stenosis of the aorta or mitral valve.

Metoprolol and other cardiac beta-blockers: acute myocardial infarction, blockade of sinoatrial or atrioventricular nodes, heart failure (acute or chronic), reduction in heart rate below 60 beats per minute, low blood pressure, peripheral circulation problems (endarteritis, thrombophlebitis). And also chronic obstructive bronchitis and bronchial asthma.

Calcium channel blockers (Verapamil and others) are contraindicated to use at low arterial pressure and a reduced heart rate.

The use of pills from pain in the heart during pregnancy is prohibited. Validol is contraindicated in the first trimester of pregnancy.

[9], [10], [11], [12], [13], [14], [15]

Side effects

Vasodilating and pain-relieving heart pills Validol and Molsidomine have side effects in the form of headaches and lowering blood pressure. The most common undesirable effects when using Nitroglycerin are: a headache of a pulsating nature and dizziness; a feeling of heat in the upper part of the body, skin hyperemia on the face and general hyperhidrosis; increased heart rate; significant reduction in blood pressure.

Loss of appetite, nausea, vomiting, and headache can accompany the intake (especially frequent) of cardiac glycosides.

The use of cardiac blockers of adrenaline receptors (Metoprolol, etc.) can cause such side effects as sinus arrhythmia, dyspnea, arterial hypotension, swelling of the soft tissues of the extremities, dyspepsia, increased blood sugar levels, etc.

In addition to those characteristic of Nitroglycerin and nitrates, the list of side effects of drugs blocking the calcium channels of the conduction system of the heart also includes a feeling of dry mouth, nausea and vomiting, problems with the intestines, increased liver transaminases, paresthesia of the limbs, sleep disorders, depressive state and mental disorders .

Overdose

It should be borne in mind that an overdose of Nitroglycerin can lead not only to an increase in side effects, but also to collapse.

As noted in the instructions, the symptoms of an overdose of cardiac glycosides (glycoside intoxication) are expressed in the aggravation of side effects, which are associated with cardiac rhythm disturbance, ventricular fibrillation, muscle weakness, visual impairment and color perception, euphoria and the state of psychosis. In this situation, taking drugs stop, give a laxative (saline) and conduct symptomatic treatment of cardiac manifestations.

Exceeding the prescribed dosage of metoprolol causes a drop in blood pressure, convulsions, blueing of the mucous membranes, a state of acute heart failure, up to cardiogenic shock and cardiac arrest. In such cases, urgent medical care is required with gastric lavage and intravenous administration of appropriate medications.

Overdose of verapamil may also lead to a decrease in heart rate and blood pressure, blockage of the atria and ventricles, and loss of consciousness. The condition may cause the need for an electrocardiostimulation.

Interactions with other drugs

Simultaneous use of Nitroglycerin with beta-adrenoreceptor blockers, vasodilator drugs, diuretics, Aspirin and alcohol tinctures increases the decrease in blood pressure. The anti-anginal effect is increased when combined with beta-blockers and calcium channel blockers.

Features of interaction with other preparations of cardiac glycosides:

• an increase in changes in myocardial contraction in combination with group B vitamins,
• decrease in heart rate in combination with hypnotics, magnesium sulfate and local anesthetic agents,
• improvement of hemodynamics with concurrent administration of curetil,
• increased coagulability of blood in combination with aminazine and heparin.

Interaction of cardiac beta-blockers (Metoprolol, etc.): it is forbidden to use together with Nitroglycerin, barbiturates, diuretics and agents containing alcohol; the effect of antihypertensive drugs increases; with the combined use of cardiac glycosides, there is an excessive decrease in heart rate and a slowing down of the cardiac conduction system.

Interaction of calcium channel blockers (verapamil hydrochloride) with other drugs:

• strengthen the blockade of the sinoatrial and atrioventricular nodes when combined with beta-blockers,
• increases the effect of drugs to reduce blood pressure and relieve muscle spasms,
• potentiates the action of verapamil concurrent use of antipsychotics and antidepressants.

Storage conditions

According to the instruction, Nitroglycerin should be stored in a dark place, protected from possible contact with fire, at a moderate temperature (+ 18-20 ° C). The remaining tablets from pain in the heart are kept in a dark place, at a temperature not exceeding + 25 ° C.

The shelf life of the products is indicated on the packaging, where there is information and the date of their manufacture.