Ritmonorm

Propafenone, sold under the brand name Ritmonorm, is an antiarrhythmic drug that is used to treat certain types of heart arrhythmias. It belongs to the class of class Ic antiarrhythmic drugs, which acts on the heart's ion channels to slow the conduction of impulses and stabilize the heart rhythm.

The main indications for the use of Ritmonorm (propafenone) include the treatment of:

1. Atrial fibrillation: This is a heart condition in which the atria of the heart contract irregularly and at an extremely high rate, which can lead to a decrease in the efficiency of the heart pump and the development of thromboembolism.
2. Atrial flutter: This is a condition in which the atria of the heart contract more rapidly than normal, but more regularly than in atrial fibrillation.

Propafenone may be used in other cases on the advice of a physician, but it is important to remember that it should only be used under the strict supervision of a physician, as its use can be associated with serious side effects and requires constant monitoring of heart rate and cardiac function.

Indications Ritmonorma

1. Atrial fibrillation: Ritmonorm may be prescribed to restore normal heart rhythm in patients with atrial fibrillation. Atrial fibrillation is an arrhythmia in which the atria of the heart contract very rapidly and uncoordinatedly.
2. Atrialflutter (atrial fibrillation): Ritmonorm may also be used to treat atrial fibrillation, which is another type of arrhythmia in which the atria of the heart contract irregularly and excessively fast.
3. Superventricular tachycardia: This is a condition in which the heart beats too fast because of a problem with the heart's electrical system. Ritmonorm may be used to manage superventricular tachycardia.
4. Other forms of arrhythmias: Less frequently, propafenone may be used to treat other types of cardiac arrhythmias if its administration is justified by the clinical situation.

Release form

1. Tablets: The most common form of Ritmonorm is oral tablets. They can come in different dosages, such as 150 mg, 300 mg, or other variants depending on the manufacturer and country. The tablets may be taken several times a day depending on the medical purpose.
2. Prolonged (retard) tablets: These are prolonged-acting tablets that provide a more even release of the active ingredient and can be used once or twice a day. The dosage may also vary.
3. Solution for injection: In some cases, Ritmonorm is available in the form of a solution for intravenous injection, which is used in inpatient settings under the supervision of medical personnel, especially when rapid control of arrhythmias is needed.

Pharmacodynamics

1. Blocking of sodium channels: Propafenone is a blocker of sodium channels, which leads to delayed excitation in cardiomyocytes and decreased rate of conduction of impulses through the heart.
2. QRS interval prolongation: Propafenone causes prolongation of the QRS interval, indicating its effect on the cardiac conduction system.
3. Antiarrhythmic action: Propafenone is used in the treatment of various types of arrhythmias, including ventricular and atrial arrhythmias. It may help in restoring normal heart rhythm and preventing recurrence of arrhythmias.
4. Reduction of excitability: Propafenone may reduce the excitability of cardiac tissue, which also helps prevent arrhythmias.

Pharmacokinetics

1. Absorption: Propafenone is usually well absorbed after oral administration, but its absorption may be reduced by concomitant ingestion.
2. Metabolism: Propafenone is metabolized in the liver to form several active metabolites, including 5-hydroxypropafenone and H-despropylpropafenone. Metabolism of propafenone occurs primarily via CYP2D6 and CYP3A4.
3. Excretion: The excretion of propafenone occurs mainly through the kidneys in the form of metabolites and their conjugates, as well as through the intestine. About 40-50% of the dose is excreted through the kidneys.
4. Half-life: The half-life of propafenone is about 3-6 hours.

Dosing and administration

Pills

• Thestarting dose for adults is usually 150 mg three times a day. Depending on the patient's response and tolerance to the drug, the dose may be gradually increased.
• Themaximum dose should not exceed 900 mg per day.
• Tablets should be taken during or after meals to reduce stomach irritation.

Prolonged-release tablets

• Thestarting dose is usually 225 mg twice daily.
• Depending on clinical response and tolerability, the dosage may be adjusted. The exact dosage and dosing regimen should be determined by the attending physician.

Solution for injection

• The solution for injection is usually used in hospitalized patients to quickly control cardiac arrhythmias.
• The dosage and rate of administration should be strictly monitored by medical personnel.

Special Instructions

• When using Ritmonorm, regular medical control is necessary, including monitoring of heart function and checking the level of electrolytes in the blood.
• An ECG is recommended before starting treatment with Ritmonorm and at each dose adjustment.
• Alcohol consumption should be avoided during treatment and the interaction of Ritmonorm with other drugs should be carefully considered.
• When discontinuing treatment, the dose should be reduced gradually to avoid possible worsening of arrhythmias.

Use Ritmonorma during pregnancy

Propafenone, a drug sold under the trade name Ritmonorm, is an antiarrhythmic drug used to treat certain heart rhythm disorders. However, like many other medications, its use during pregnancy may be undesirable.

Contraindications

1. Hypersensitivity: People with known hypersensitivity to propafenone or any other component of the drug should not use it.
2. Cardiac conduction blockade: Propafenone should be used with caution in patients with AV conduction blockade or other cardiac conduction abnormalities.
3. Heart failure: The use of propafenone may be undesirable in patients with severe heart failure.
4. Cardiac arrhythmias: Propafenone may worsen some types of arrhythmias, so its use may not be desirable in patients with certain arrhythmias.
5. Prolonged QT-interval syndrome: The use of propafenone should be avoided in patients with prolonged QT-interval syndrome or other heart rhythm disorders that may predispose to this condition.
6. Pregnancyand breastfeeding: The use of propafenone during pregnancy or breastfeeding should be done only when strictly necessary and under medical supervision.
7. Pediatric age: Propafenone use in children should only be administered and supervised by a physician.
8. Hepatic insufficiency: Use of propafenone may be undesirable in patients with severe hepatic insufficiency due to possible worsening of drug metabolism.

Side effects Ritmonorma

1. Cardiac arrhythmias: Propafenone, being an antiarrhythmic drug, may cause or increase cardiac arrhythmias in some patients.
2. Dizziness and drowsiness: These side effects may occur due to changes in heart rhythm caused by propafenone.
3. Malaise and weakness: Some patients may feel faint or have a general feeling of malaise.
4. Tremor (shaking): Propafenone may cause tremor in some patients.
5. Headache: Headache or migraine can also be a side effect of taking propafenone.
6. Changes in blood pressure: Propafenone may cause changes in blood pressure in some patients.
7. Dyspepsia (digestive disorder): Stomach disorders such as nausea, vomiting, diarrhea, or dyspepsia may occur.
8. Allergic reactions: Rarely, allergic reactions such as skin rash, itching, hives, or swelling of the face and throat may occur.
9. Increased risk of thromboembolism: In some patients, especially those with atrial fibrillation, propafenone may increase the risk of thromboembolism.

Overdose

1. A severe drop in blood pressure.
2. An increase or decrease in heart rate.
3. Cardiac arrhythmias, including tachycardia, atrial fibrillation, or ventricular fibrillation.
4. Pulmonary edema.
5. Seizures.
6. Consciousness may be impaired, up to and including coma.

Interactions with other drugs

1. Drugs inhibiting CYP2D6 and CYP3A4: Propafenone is metabolized in the liver with the participation of CYP2D6 and CYP3A4 enzymes. Therefore, drugs that inhibit these enzymes can increase the concentration of propafenone in the body, which can lead to an increase in its action and an increased risk of side effects. Such drugs include protease inhibitors (e.g., ritonavir), antidepressants (e.g., fluoxetine, paroxetine), antiarrhythmic drugs (e.g., amidarone), antibiotics (e.g., clarithromycin, erythromycin), and others.
2. QT-interval prolonging drugs: Propafenone may prolong the QT interval, therefore concomitant use with other drugs such as antiarrhythmic drugs (e.g., sotalol, amidarone), some antidepressants (e.g., citalopram, escitalopram), antibiotics (e.g., moxifloxacin), etc., which may also prolong the QT interval, may increase the risk of serious arrhythmias.
3. Drugs that reduce heart rhythm: Concomitant use of propafenone with other antiarrhythmic drugs (e.g., amidarone, beta-blockers, calcium blockers) may result in increased heart rate reducing effects and increased depression of cardiac output.
4. Drugs that increase the risk of bleeding: Propafenone may increase the risk of bleeding when taken concomitantly with anticoagulants (e.g., warfarin) and nonsteroidal anti-inflammatory drugs (NSAIDs).