Isodynite

Cardiovascular diseases are among the most common health pathologies in the modern world with its tense, restless rhythm of life and deficiency of substances necessary for the normal functioning of the heart and circulatory system. That is why our heart so often requires professional help to fully implement its functions. And medical science considers the drug "Izodinit" to be such an assistant, improving blood supply and metabolism of various tissues and organs, including the myocardium.

Indications Isodynite

• painful sensations and discomfort in the chest caused by insufficient oxygen supply to the heart (angina, including unstable).

The drug is used mainly in tablet form for both treatment and prevention.

• acute forms of myocardial infarction, including infarction developing against the background of left ventricular failure, as well as conditions after a previous infarction,
• high pressure in the pulmonary artery, causing an enlargement of the right chambers of the heart, arising as a result of pathologies of the lungs and bronchi (pulmonary heart disease),
• pulmonary edema (accumulation of extravascular fluid in the lungs), accompanied by shortness of breath,
• chronic heart failure (treatment), which causes a disruption in the blood supply to human tissues and organs.

"Izodinit" is also used for the prevention and treatment of spasms of the coronary (going to the heart) and peripheral vessels.

Release form

For ease of use and to increase the effectiveness of the drug for various pathologies, several forms of the drug "Izodinit" can be found in the pharmacy network:

• regular pills
• prolonged-release tablets with a longer therapeutic effect (retard)
• long acting capsules
• spray
• aerosol dosed for injection of medicine under the tongue
• concentrate from which a solution for IV drips is prepared
• films that are attached to the gums according to indications
• in the form of a transdermal therapeutic system (TTS) - a special patch with a slow release of the drug
• ointment

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Pharmacodynamics

The drug "Izodinit" belongs to a group of drugs called vasodilators. Isosorbide dinitrate, which is the main active ingredient of the drug, promotes relaxation (reduction of tone) of the smooth muscles of blood vessels and an increase in the lumen inside them (vasodilation).

Thus, the drug promotes vasodilation, in particular peripheral arteries and veins, as a result of which the capacity of the veins increases, and the return of blood from the veins to the heart decreases. This leads to a decrease in diastolic pressure in the left ventricle of the heart.

In increased doses, "Izodinit" already affects arterial vessels and arterioles. This reduces their resistance to blood flow and facilitates the work of the heart.

The simultaneous action on veins and arteries helps to reduce oxygen consumption by the myocardium (the internal muscle mass of the heart).

In addition, the active substance of the drug is able to redistribute the blood flow to the area of the anterior wall of the myocardium (sudendocardial layer), if coronary blood flow is reduced due to atherosclerotic plaques. Since isosorbide dinitrate belongs to the class of nitrates, it can expand eccentric coronary stenosis (narrowing of the coronary arteries), which facilitates the passage of blood and biologically active substances through the vascular system of the myocardium, located further behind the narrow section. Nitrates facilitate the movement of blood through the vessels in patients with heart failure, both at rest and under load.

The active substance of the drug also affects other organs and systems of the body: it promotes relaxation of the muscles of the bronchi and gastrointestinal tract, reduces the tone of the muscles of the biliary and urinary tract, and dilates the blood vessels of the brain.

It is addictive, but after a break in treatment, sensitivity to it quickly returns.

Pharmacokinetics

The onset of action of the drug depends on the form of the drug and the method of its use. Taking tablets:

• If you put the tablets under your tongue or chew them, the drug starts to work after 2-5 minutes,
• If the tablets or capsules are swallowed whole, the onset of action will vary from 15 to 40 minutes,
• For prolonged-release tablets, this figure is half an hour.

If the drug is sprayed into the oral cavity or administered intravenously, it begins to act almost immediately, after half a minute. The same applies to films and TTS.

Absorption of isosorbide dinitrate into the blood when taken orally (through the mouth) is virtually complete, but its digestibility (bioavailability) can range from 10 to 90% (on average 25% with a high probability of increasing with long-term use of the drug).

The drug undergoes a major transformation with a change in structure (metabolized) already during the first passage through the liver. Only a small part of the drug is excreted in the same form with urine and feces.

Its highest concentration in plasma is observed after about an hour. The half-life of the drug, during which its effectiveness is halved, ranges from 1 to 12 hours.

Dosing and administration

There are several ways to take the drug "Izodinit":

• sublingual - in the form of tablets under the tongue or a spray that is sprayed into the oral cavity,
• oral - through the mouth (tablets and capsules),
• parenteral - in the form of droppers with slow administration of the drug,
• transbuccal - in the form of plates that are glued to the gums,
• TTS is identical to the previous one, but the films or patches are glued to different symmetrical areas of the skin.
• Externally - in the form of a spray applied to the skin or an ointment.

When sublingually administering the spray, 1 to 3 injections are made at half-minute intervals, while holding your breath. Relief should occur within 5 minutes, otherwise the procedure is repeated. This treatment requires constant monitoring of blood pressure and pulse.

Prevention of coronary spasm is carried out by means of 1-2 injections the day before the procedure.

A single dose of sublingual tablets is 2.5-5 mg. They should be taken 2 to 3 times a day. In order to stop an attack of angina, it is advisable to chew the tablets.

Regular tablets or capsules are taken orally, without chewing, 4 to 5 times a day. A single dose is 10-20 mg. It is advisable to take the tablets an hour before meals, but it is possible to take the drug 2 hours after meals. If necessary, the daily dose can be increased to 120 mg per day, but this can be done no earlier than 3 days after the start of therapy with the drug.

The frequency of taking the tablets depends on their duration of action and dosage. For regular tablets weighing 5-20 mg - from 3 to 4 times a day. For prolonged-release tablets (retard) weighing 20 mg - from 2 to 3 times, weighing 40-60 mg - strictly 2 times, weighing 120 mg - once a day is enough.

For the treatment of chronic heart failure, the dose is 10 or 20 mg 3 to 4 times a day.

The rate of administration of the drug in the form of a dropper depends on the concentration of the active substance in the solution. For a solution of 0.1 mg / ml, the initial rate is 3-4 drops per minute, the maximum is 33 drops per minute. For a solution with a concentration of 0.2 mg per 1 ml, the initial rate is 1-2 drops per minute, and the maximum is 17 drops per minute. The rate should be gradually increased by 2 or 3 drops every 5 minutes.

Films (20-40 mg) are attached to the anterior surface of the gum in the area of the incisors 1 to 3 times a day, alternately on one side and then on the other.

To install a transdermal system, the area of skin to which it will be attached is pre-treated with alcohol, after which the protective film is removed and the patch is firmly attached to the skin in a place where there is no hair and the risk of mechanical impact on the skin is minimal. This is the chest area, back or inner forearm. It is recommended to stick the next system to an area symmetrical to the previous one.

The dosage of the drug depends on the size of the patch, which can be cut into the necessary pieces. The patch can be on the skin from 12 hours to 1 day. Treatment is carried out for 2 weeks with gradual withdrawal of this form of the drug.

If external use of the preparation in the form of a spray is indicated, it is necessary to know that "Izodinit" is applied to the skin by spraying from a distance of about 20 cm by means of 1-2 presses on the sprayer. Then the composition is carefully distributed over the skin with the fingers. The duration of action is 20 minutes, after which the solution can be washed off.

The ointment can be used in the chest, abdomen and inner forearm area. Single dose – from 1 g, area of use no more than 20 cm ².

Use Isodynite during pregnancy

The use of "Izodinit" during pregnancy and breastfeeding is prohibited, since the drug can affect the hemodynamics of the fetus, which is undesirable and even dangerous. The doctor can prescribe the drug during pregnancy only according to strict indications, if there is a danger to the patient's life.

Contraindications

Despite all the benefits of the drug, especially in the treatment of cardiovascular pathologies, the possibilities of its use are somewhat limited.

In addition to hypersensitivity to the components of the drug, there are other contraindications to the use of Izodinit, concerning both the use of its individual forms and the drug as a whole. For example, in case of hemorrhagic stroke, craniocerebral trauma, high intracranial pressure, hemodynamic disturbances in cardiac tamponade, constructive pericarditis, decreased blood volume in hypovolemia, intravenous administration of the drug is not practiced and is used only in rare cases.

In the first 2 pathologies, as well as in acute myocardial infarction, therapy with other drugs is preferable.

With special caution, if the beneficial effect of the drug significantly exceeds the risk of developing undesirable consequences, the drug is taken for glaucoma (there is a certain risk of increasing eye pressure), severe anemia, thyrotoxicosis, with consistently low systolic pressure (can cause a decrease in heart rate and angina attacks), hypertrophic cardiopathy, chronic severe heart failure.

In case of increased gastrointestinal peristalsis and malabsorption syndrome (impaired absorption of nutrients), oral administration of the drug is contraindicated.

In addition, the drug is contraindicated in cases of liver failure and in childhood (only as prescribed by a doctor).

Side effects Isodynite

Like any synthetic drug, Izodinit, in addition to its main therapeutic effects, may also exhibit some side effects.

Its use may be accompanied by pain in the head and dizziness. Painful sensations are especially strong in the first days of taking the drug, gradually their intensity decreases. If this does not happen, a dose adjustment is necessary.

Sometimes the skin on the patient's face turns red, and he feels hot. While taking the medicine, blood pressure may decrease and the heart rate may increase. This condition is often accompanied by dizziness, even loss of consciousness.

The drug may adversely affect the gastrointestinal tract, causing nausea and vomiting. Sometimes a slight burning sensation is felt in the tongue area, and dryness of the oral mucosa is felt.

Patients experience increased drowsiness, some stiffness of movement, inhibition of mental and physical reactions, and visual acuity disorders. Rarely, ischemia (impaired blood supply) of the brain is diagnosed.

When the drug is applied externally, skin reactions such as burning, itching and redness of the skin at the site of application are sometimes observed, and Ritter's dermatitis sometimes develops. Allergic reactions are also possible when the drug is administered internally.

Overdose

If the therapy is not carried out correctly in high doses, an overdose of the drug may be observed, which is accompanied by increased heart rate, visual disturbances, a drop in temperature, convulsive reactions, a change in skin color towards redness or cyanosis, hyperhidrosis, increased intracranial pressure, digestive and stool disorders, fainting and other symptoms. In some cases, if the patient is not given the necessary assistance, paralysis and coma may occur.

If symptoms of overdose appear, the patient must be given immediate first aid. If the medicine was taken orally in the form of tablets or capsules, a quick gastric lavage will be required. When using films, sprays and patches - wipe and wash the place of their use, including the gums.

If methemoglobinemia develops due to incorrect use of the drug, it will be necessary to administer a 1% solution of methylthioninium chloride intravenously at a rate of 1-2 mg per kilogram of weight.

If blood pressure drops significantly, intravenous administration of Epinephrine or similar drugs will help.

When treating with the drug "Izodinit", constant monitoring of blood pressure and pulse is a mandatory condition. The drug is discontinued with a gradual reduction in doses and frequency of administration.

Long-term use of the drug or large doses can cause addiction to it, as a result of which the effectiveness of the drug is reduced. Therefore, it is recommended to take a short (3 to 5 days) break in treatment after 3-6 weeks from the start of therapy. Another option is to discontinue the drug for 1-2 days.

During therapy with the drug, it is not advisable to engage in activities that require concentration, since Izodinit negatively affects the speed of psychomotor reactions, exerting an inhibitory effect on them.

Interactions with other drugs

In case of various pathological processes in the body, the drug should be taken in accordance with the data on drug interactions with other drugs.

The main contribution of the active substance of the drug "Izodinit" to the therapy of heart diseases is the improvement of hemodynamics due to the expansion of blood vessels. But the parallel use of this drug with beta-adrenergic stimulants and alpha-adrenergic blockers can significantly reduce the effectiveness of the drug, i.e. cause tachycardia or a dangerous decrease in pressure below normal.

The drugs "Amiodarone", "Propranolol", as well as calcium channel blockers and amino-salicylic acid drugs, on the contrary, are able to enhance the antianginal function of "Izodinit".

Concomitant use of Izodinit with drugs to lower blood pressure, other vasodilators, antipsychotics, some antidepressants, beta-blockers and calcium channel blockers can cause a strong decrease in blood pressure. The same applies to the following drugs: Quinidine, Procainamide, Dihydroergotamine, Sildenafil and ethanol.

The combined use of Izodinit and m-anticholinergics such as Atropine may lead to an increase in intraocular pressure.

When taking the drug orally, it should be taken into account that adsorbents, as well as agents with an astringent and enveloping effect, can negatively affect the absorption of the drug in tablet form in the gastrointestinal tract.

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Storage conditions

The various dosage forms of the drug must be stored according to the requirements specified in the instructions for them. In any case, the storage temperature should not exceed 25 degrees, otherwise it will negatively affect the effectiveness of the drug. And protection from sunlight and children's curiosity will help not only to preserve the drug in its original form, but also to avoid tragedy, after all, "Izodinit", like any other drug, and especially a cardiological drug, is not a toy for children.

Shelf life

When storing and using Izodinit, it is necessary to take into account the storage conditions of the drug so that it retains its properties and safety for health throughout its rather long shelf life (5 years from the date of manufacture).