Nifecard XL, 30 pcs., 30 mg, modified-release film-coated tablets

Nifecard: composition and origin of the drug

The drug Nifecard is one of the retard forms of dihydropyridine derivatives from the class of slow calcium channel blockers (CCBs).
The main effect is realized through disruption of the conduction of calcium into cells, relaxation of smooth muscle fibers, and a decrease in peripheral resistance in blood vessels. Nifecard INN (international nonproprietary name of the drug) is Nifedipine.

The drug is available in the form of transformed-release tablets. The peculiarity of the structure of the surface film of the drug ensures a slow increase in the concentration of active molecules in the blood plasma, prolonging the effect up to 24 hours.

The composition of 1 tablet of Nifecard, depending on the form of release, is presented in the table.

The drug is available in cardboard packaging containing 10 aluminum blisters of 10 tablets each. The product is round, convex on both sides, with the symbols NDP 30 (NDP 60 - depending on the dosage) stamped on the surface. The color can vary from light yellow to orange, light brown.

Approved analogues of Nifecard: Corinfar, Cordipin, Cordaflex, Nicardia.

Nifecard HL

Nifecard CL (INN - nifedipine) is a blocker of the so-called “slow” calcium channels or, as representatives of this pharmacological group are also called, a calcium antagonist. Calcium channel blockers are first-line drugs in the treatment of most cardiovascular diseases. Thus, dihydropyridine derivatives, including drugs with a short period of action, are widely used in the treatment of arterial hypertension. The history of the use of these drugs in cardiological practice has its ups and downs, and when long-acting dosage forms (with modified or controlled release) were created, this became a real breakthrough, because This ensured convenience and safety of use due to the gradual increase and stability of the concentration of the active substance in the blood. Data from clinical trials indicate not only the antihypertensive effectiveness of second-generation ihydropyridine derivatives, but also their positive effect on the organs that suffer most from arterial hypertension. Nifecard CL is a three-phase dosage form SR/GITS (slow release and gastrointestinal therapeutic system). It has antianginal (anti-ischemic) and antihypertensive effects. Inhibits the “traffic” of calcium ions from the extracellular space into the cells of the heart and blood vessels. At high therapeutic concentrations, it suppresses the release of calcium ions from intracellular stores. Turns off “extra” calcium channels from work, without affecting the time of their activation, inactivation and regeneration. As a result of the action of Nifecard CL, the processes of excitation reduction in the myocardium and vascular smooth muscles are uncoupled.

The drug has virtually no effect on the tone of the veins. Intensifies coronary blood flow, while improving blood supply to ischemic areas of the myocardium without the occurrence of the so-called. the “steal” phenomenon (worsening ischemia due to the outflow of blood into nearby, non-ischemic areas), activates collateral blood flow in the myocardium. While taking the drug, the functional characteristics of the myocardium improve, the heart no longer contracts so much, which reduces its need for oxygen. By increasing the lumen of peripheral arteries, Nifecard CL lowers blood pressure and reduces total peripheral vascular resistance and afterload. Has virtually no effect on the sinoatrial and atrioventricular nodes. Activates blood flow in the kidneys, slightly increasing sodium excretion from the body. Suppresses platelet aggregation (sticking together) and exhibits an antiatherogenic effect with long-term use. “Blows off steam” in the pulmonary artery, reducing the pressure in it. Improves blood supply to cerebral vessels.

After oral administration, Nifecard ChL is almost completely (92-98%) absorbed in the gastrointestinal tract. The slow release of the active substance ensures a smooth increase and subsequent stability of the concentration of nifedipine in the blood plasma. The drug is taken 1 time per day. The standard “starting” dose of nifecard CL is 30 mg. If necessary, this can be done gradually. at 1-2 week intervals, increase to the permissible maximum of 90 mg.

Indications for use

The entire group of CCB drugs is used primarily in cardiological or neurological practice due to its effect on the vascular system. Dihydropyridine derivatives have a greater effect on the vessels of the brain, and less on the coronary arteries.

Instructions for use of Nifecard highlight the main indications:

• 
  hypertension (persistent increase in blood pressure above 140/90 mmHg);

• stable form of angina pectoris;
• vasospastic (variant) Prinzmetal angina;
• Raynaud's syndrome;
• vegetative-vascular dystonia, which occurs in the hypertensive variant;
• prevention of ischemic strokes in patients with hypertension;
• diffuse spasm of the esophagus.

At what pressure should I take it and in what dose?

Selection of treatment for arterial hypertension is carried out by titration (continuous adjustment of the drug dose) depending on the patient’s sensitivity and target parameters.

Approximate start of Nifecard therapy for the treatment of hypertension:

• 1st degree (systolic 140-160 mmHg / diastolic 90-100 mmHg) – 30 mg (1 tablet) 1 time per day;
• 2nd degree (160-180/100-110 mmHg) – 30 mg 1 time per day, if ineffective – 2 times per day;
• 3rd degree (more than 180/110 mmHg) – 60 mg 1 time per day, if ineffective – 60+30 mg 1 time per day. Alternative management – ​​60 mg Nifecard + a drug from the group of beta blockers.

Nifecard belongs to the group of modern retard drugs, the use of which involves monotherapy (1 drug) 1-2 times a day.

When to take 30 mg?

The dosage of the drug 30 mg is considered the starting therapy for the treatment of patients with:

• 
  stable angina pectoris;

• mild arterial hypertension of the 1st degree (without complications from target organs);
• Prinzmetal's angina;
• vegetative-vascular dystonia;
• Raynaud's syndrome;
• liver pathology, including alcohol consumption (the ability to eliminate the drug decreases, which leads to increased concentration and prolonged circulation in the blood);
• patients over 65 years of age;
• diabetes mellitus (medium and high doses contribute to an increase in hyperglycemia).

In addition, simultaneous use with other drugs slows down the administration of the drug. The use of Nifecard 30 is recommended when taking Azithromycin, Cimetidine, Fluoxetine, Diltiazem, Ketoconazole, and medications for the treatment of HIV infection.

In what cases should I use a dose of 60 mg?

Treatment with medium and high doses of Nifedipine is recommended for:

• arterial hypertension 2 and 3 degrees;
• if beta blockers and ACE inhibitors (angiotensin-converting enzyme) are ineffective or have contraindications;
• when taken simultaneously with Valproic acid, Phenobarbital, Rifampicin (drugs that accelerate the elimination of Nifecard from the body).

Treatment of angina pectoris with high doses of nifedipine, according to studies, increases the risk of complications and death.

The dose of the drug is selected under the supervision of a physician, monitoring the patient’s condition and the results of paraclinical studies.

Buy Nifecard HL tablets p.o 30 mg No. 30 in pharmacies

Instructions for use Nifecard HL tab p.o 30 mg No. 30

Dosage forms tablets 30 mg Synonyms Adalat Vero-Nifedipine Calcigard retard Cordafen Cordaflex Cordaflex RD Cordipin Cordipin retard Cordipin HL Corinfar Corinfar retard Corinfar Uno Nifedipine-FPO Nifecard CL Osmo-Adalat Phenigidine Group Calcium channel blockers of the dihydropyridine group International nonproprietary name Nifedipine Co becoming the Active substance - nifedipine. Manufacturers Lek DD (Slovenia) Pharmacological action Antianginal, hypotensive. Blocks calcium channels, inhibits the transmembrane flow of calcium ions into smooth muscle cells of arterial vessels and cardiomyocytes. Dilates peripheral, mainly arterial vessels, incl. coronary, lowers blood pressure, reduces total peripheral vascular resistance and afterload on the heart. Increases coronary blood flow, reduces the strength of heart contractions, heart function and myocardial oxygen demand. Improves myocardial function and helps reduce heart size in chronic heart failure. Reduces pressure in the pulmonary artery and has a positive effect on cerebral hemodynamics. Inhibits platelet aggregation, has antiatherogenic properties, improves post-stenotic circulation in atherosclerosis. Increases the excretion of sodium and water, reduces myometrial tone. When taken orally, it is quickly and completely absorbed. The bioavailability of all dosage forms is 40-60%. About 90% of the dose taken is bound to plasma proteins. After oral administration, the maximum concentration in plasma is created after 30 minutes, the half-life is 2-4 hours. It is excreted by the kidneys in the form of inactive metabolites and with feces. In small quantities it passes through the blood-brain barrier and the placental barrier and penetrates into breast milk. Does not have mutagenic or carcinogenic activity. Side effects From the cardiovascular system and blood (hematopoiesis, hemostasis: facial flushing with a feeling of heat, palpitations, tachycardia, hypotension (up to fainting), angina-like pain, very rarely - anemia, leukopenia, thrombocytopenia, thrombocytopenic purpura. With from the nervous system and sensory organs: dizziness, headache, stunnedness, changes in visual perception, impaired sensitivity in the arms and legs. From the gastrointestinal tract: constipation, nausea, diarrhea, gum hyperplasia (with long-term treatment), increased activity of liver transaminases. side of the respiratory system: bronchospasm. From the musculoskeletal system: myalgia, tremor. Allergic reactions: itching, urticaria, exanthema, exfoliative dermatitis. Others: swelling and redness of the hands and feet, photodermatitis, hyperglycemia, gynecomastia (in elderly patients) , burning sensation at the injection site (with intravenous administration) Indications for use Arterial hypertension, including hypertensive crisis, prevention of angina attacks (incl. Prinzmetal's angina), hypertrophic cardiomyopathy (obstructive, etc.), Raynaud's disease, pulmonary hypertension, broncho-obstructive syndrome. Contraindications Hypersensitivity, acute period of myocardial infarction (first 8 days), cardiogenic shock, severe aortic stenosis, heart failure in the stage of decompensation, severe arterial hypotension, tachycardia, pregnancy, breastfeeding. Restrictions on use: You should refrain from using the drug in pediatric practice, since the safety and effectiveness of its use in children have not been determined. Method of administration and dosage Orally, during or after meals, in the form of tablets, capsules, dragees, adults - 10 mg 3-4 times a day. In special cases (variant angina, severe arterial hypertension), it is possible to increase the dose to 20 mg 4-6 times a day for a short time. The maximum daily dose is 120 mg. For arterial hypertension - 10 mg 3 times a day (if necessary, the dose is increased over 7-14 days to 20-30 mg per dose. To relieve a hypertensive crisis and an attack of angina, 10-20 mg sublingually or orally once, if necessary - through 10 minutes repeatedly in the form of capsules and tablets of prolonged action (it is recommended to first bite or puncture the capsule) - 20-40 mg 2 times a day (for Prinzmetal's angina - up to 120 mg / day); in the form of ultraretard tablets - 40-80 mg 1 once a day (the tablet is not chewed). Overdose Symptoms: severe bradycardia, bradyarrhythmia, arterial hypotension, in severe cases - collapse, conduction slowdown. When taking a large number of retard tablets, signs of intoxication appear no earlier than 3-4 hours later and may additionally expressed in loss of consciousness up to coma, cardiogenic shock, convulsions, hyperglycemia, metabolic acidosis, hypoxia.Treatment: gastric lavage, intake of activated charcoal, administration of norepinephrine, calcium chloride or calcium gluconate in atropine solution intravenously. Hemodialysis is ineffective. Interaction The hypotensive effect is enhanced by nitrates, diuretics, beta-blockers, tricyclic antidepressants, fentanyl, and alcohol. Increases the activity of theophylline, reduces the renal clearance of digoxin. Increases the side effects of vincristine (reduces excretion). Increases the bioavailability of cephalosporins (cefixime). Cimetidine and ranitidine increase plasma levels. Diltiazem slows metabolism (requires a reduction in the dose of nifedipine). Incompatible with rifampicin (accelerates biotransformation and does not allow creating effective concentrations). Grapefruit juice (large quantities) increases bioavailability. Increases the concentration of cardiac glycosides in the blood. Special instructions: Elderly patients are advised to reduce the daily dose (decreased metabolism). Use with caution while working for vehicle drivers and people whose profession involves increased concentration. The drug should be discontinued gradually. In patients with stable angina, at the beginning of treatment, a paradoxical increase in anginal pain may occur; with severe coronary sclerosis and unstable angina, aggravation of myocardial ischemia may occur. It is not recommended to use short-acting drugs for long-term treatment of angina or hypertension, because the development of unpredictable changes in blood pressure and reflex angina is possible. Storage conditions Store at room temperature, in a cool, dry place, away from children.

Contraindications to the use of the drug

The peculiarities of the action of the active substance on human organs and systems, the stages of transformation determine the presence of contraindications for the use of Nifecard.

The drug is prohibited for patients with:

• 
  arterial hypotension (systolic pressure below 90 mmHg);

• stenosis of the aortic orifice or mitral valve grade 3-5;
• hypertrophic cardiomyopathy (obstructive variant);
• left ventricular systolic dysfunction (ejection fraction on ultrasound - less than 45%);
• unstable angina;
• pregnancy (after 20 weeks, the appointment is carried out when the benefit exceeds the risk for the child);
• acute myocardial infarction (period up to 28 days);
• decompensation of myocardial contractile function (in chronic diseases) with the development of pulmonary edema, ascites, hydropericardium;
• lactase deficiency and other forms of enzymopathies associated with intestinal absorption.

Careful use of Nifecard is recommended for patients with impaired liver function, resistant arterial hypertension, diabetes mellitus, sinus bradycardia and sinus arrest syndrome.

Side effects when using the medication

Adverse reactions after consuming Nifecard are associated with activation of the sympathetic nervous system and a generalized decrease in blood pressure.

The main side effects of the drug:

• tachycardia (rapid heartbeat);
• feeling of heat, redness of the face and neck;
• supraventricular arrhythmias (most often atrial fibrillation);
• swelling of the ankles, legs and back of the hand;
• hypotension (low blood pressure), manifested by headache, dizziness, weakness;
• dyspeptic manifestations: diarrhea, anorexia, nausea, vomiting and dry mouth;
• depression, fatigue, insomnia.

Often, after stopping the drug, withdrawal syndrome develops with a sharp increase in blood pressure and chest pain. In this case, it is recommended to gradually reduce the dose or switch to low-dose substitutes.