All about Corinfar: instructions for use, indications, reviews and substitutes

Instructions for use

The purpose of Corinfar in therapeutic practice is due to the complex effect of the drug on the pathogenesis of cardiovascular diseases.
Pharmacological effects of the drug:

• decreased tone of the smooth muscles of the arterial wall (due to blockade of the flow of calcium ions into the fibers necessary for adequate contraction);
• stabilization of normal heart rhythm, due to the influence on the driver (sinoatrial node) and conduction system;
• improving the filtration capacity of the kidneys by restoring blood flow in the glomeruli;
• moderate diuretic effect;
• lowering blood pressure (antihypertensive effect);
• maintaining the rheological state of the blood (decreasing thromboxane synthesis, slowing platelet aggregation);
• antianginal effect - elimination of pain during angina attacks (due to the restoration of impaired blood flow in the coronary vessels).

The drug is available in tablet form for oral administration. For the convenience of patients, there are options with different dosages of the active substance and release rate (Corinfar Retard).

The drug enters the systemic circulation after absorption in the cavity of the small intestine. The antihypertensive effect develops within 20-30 minutes after consumption and lasts 4-6 hours (for prolonged forms - more than 12). Exchange and transformation of the drug occurs in the liver. Nifedipine is excreted in the form of metabolites in the urine, so Corinfar is not prescribed to patients with decreased filtration function of the kidneys who are on hemodialysis.

Indications

The drug has a wide range of therapeutic effects, so monotherapy with the drug is often prescribed for the treatment of cardiac patients. Indications for use of Corinfar:

• hypertension (essential);
• symptomatic arterial hypertension in pathologies of the kidneys, thyroid and adrenal glands;
• chronic forms of coronary heart disease (CHD): exertional angina, Prinzmetal, diffuse cardiosclerosis;
• hypertrophic cardiomyopathy (with intolerance to beta-blockers);
• heart rhythm disturbances (supraventricular and ventricular extrasystoles, paroxysmal tachycardia);
• Raynaud's disease (angiotrophoneurosis), vascular spasm in the clinic of systemic connective tissue diseases (scleroderma, lupus erythematosus);
• hypertension in the pulmonary circulation (with chronic broncho-obstructive pathologies).

Corinfar during pregnancy is prescribed in the later stages, when the benefit to the mother outweighs the threat to the child. The greatest risk of complications was recorded when taken in the first and second trimester.

Composition, dosage and release forms

In the description of the drug, the active ingredient of Corinfar is Nifedipine, the concentration of which differs in different versions.

The name and dosage of the active component is indicated in the table.

Auxiliary ingredients that stabilize the active substance and form the tablet form:

• lactose;
• starch;
• magnesium stearate;
• macrogoal

Contraindications

An additional effect on the blood condition, liver and kidney function determines the list of restrictions on the prescription of the medication. Corinfar is not recommended for:

1. Previously identified drug intolerance, hypersensitivity to the main and auxiliary components of the drug.
2. Allergies to BMCC of the dihydropyridine series.
3. Dangerous cardiac pathology: acute coronary syndrome (ACS), cardiogenic shock, myocardial infarction (MI), unstable angina.
4. Persons under 18 years of age.
5. Women during pregnancy or breastfeeding. The exception is situations when the benefits of taking Corinfar outweigh the possible risks to the fetus. Prescribed by a doctor according to indications and taking into account the medical history and condition of the patient.
6. Severe heart defects (congenital or acquired stenosis of the aortic valve, calcification and fusion of the leaflets).
7. Hepatobiliary insufficiency due to chronic toxic (alcohol) or viral damage, cirrhosis, malignant neoplasms.
8. Decompensated diabetes mellitus.
9. Hypotension (blood pressure (BP) less than 90/40 mmHg).
10. Circulatory failure with stagnation in the pulmonary circulation (more often with defects of the left side).
11. Rhythm disturbances, sick sinus syndrome.
12. Patients on hemodialysis with low blood pressure due to hypovolemia (reduced amount of intravascular fluid). Corinfar increases the risk of collapse and orthostatic hypotension.
13. For people operating dangerous mechanisms and vehicles: causes retardation, impaired concentration, visual and auditory hallucinations.

The peculiarities of drug metabolism in the liver limit the use of medications for the treatment of concomitant pathologies. Groups of medications prohibited for simultaneous use with Corinfar are presented in the table.

Adverse reactions

The occurrence of undesirable consequences of taking Corinfar is associated with the body’s adaptation to new conditions: reactions occur in the first 2-3 weeks of treatment.

The main clinical signs are presented in the table.

The most rare side effects are visual disturbances and muscle weakness.

In men - decreased potency, reversible erectile dysfunction, gynecomastia (enlargement of the mammary glands), which disappears after discontinuation of the medication.

With a sharp reduction in dosage, there is a risk of “rebound syndrome” - a significant increase in blood pressure. It is not recommended to change the dosage regimen without consulting a doctor.

Alcohol compatibility

Drinking alcohol during treatment with Corinfar is undesirable due to the chemical and biological interaction of alcoholic beverages and Nifedipine.

Pharmacological features:

• ethanol-containing drinks cause dilation of the lumen of the arteries (decrease in vascular tone);
• activation of the parasympathetic division of the autonomic nervous system (decrease in the frequency and strength of heart contractions under the influence of the vagus nerve).

The simultaneous use of ethanol and Nifedipine is accompanied by a risk of sudden hypotension and collapse with loss of consciousness.

The clinical picture of substance intoxication is represented by a rapid pulse of reduced amplitude, dizziness, and instability when walking. The patient’s neurological status is characterized by stages: euphoric excitement (joy, increased physical activity), which gradually turns into an “inhibitory” stage (workload, slowness of reactions and responses to stimulation).

The use of more than 20 mg of the drug simultaneously with alcohol is accompanied by a risk of acute cardiovascular failure and patient death.

The main stages of drug therapy for poisoning are presented in the table.

An overdose of Corinfar is accompanied by severe symptoms of arterial hypotension. Treatment involves the administration of a specific antidote (“antidote”) – a 10% solution of “Calcium chloride” or “Calcium gluconate”.

Corinfar®

Pharmacokinetic interactions

Medicines that affect the metabolism of nifedipine

Nifedipine is metabolized by CYP3A4/5 isoenzymes, which are located in the intestinal mucosa and liver. Drugs that inhibit or induce this enzyme system may affect the first pass effect through the liver (after oral administration) or the clearance of nifedipine.

Inducers of the CYP3A4 isoenzyme

Rifampicin

Rifampin is a potent inducer of the CYP3A4 isoenzyme. When used simultaneously with rifampicin, the bioavailability of nifedipine is significantly reduced and, accordingly, its effectiveness is reduced. Therefore, the simultaneous use of nifedipine with rifampicin is contraindicated.

Antiepileptic drugs that induce CYP3A4 (eg, phenytoin, carbamazepine, phenobarbital)

Phenytoin induces the CYP3A4 isoenzyme. With the simultaneous use of nifedipine and phenytoin, the bioavailability of nifedipine is reduced and its effectiveness is reduced. When using this combination simultaneously, it is necessary to monitor the clinical response to nifedipine therapy and, if necessary, increase its dose. If the dose of nifedipine is increased with simultaneous use of both drugs, the dose of nifedipine should be reduced after discontinuation of phenytoin.

Clinical studies examining the potential interaction between nifedipine and carbamazepine or phenobarbital have not been conducted. Since both drugs reduce the concentration of nimodipine in the blood plasma, which is structurally similar to BMCC, the possibility of a decrease in the concentration of nifedipine in the blood plasma and a decrease in its effectiveness cannot be excluded.

CYP3A4 isoenzyme inhibitors

Macrolide antibiotics (for example, erythromycin)

Clinical studies on the interaction of nifedipine and macrolide antibiotics have not been conducted. Some macrolides are known to inhibit the CYP3A4 isoenzyme. As a result, the possibility of an increase in the concentration of nifedipine in the blood plasma cannot be excluded with the simultaneous use of nifedipine and macrolide antibiotics.

Azithromycin, a macrolide antibiotic, does not inhibit the CYP3A4 isoenzyme.

HIV protease inhibitors (eg, ritonavir)

Clinical studies examining the interaction of nifedipine and HIV protease inhibitors have not been conducted. It is known that drugs of this class inhibit the CYP3A4 isoenzyme. In addition, drugs of this class have been shown to suppress the metabolism of nifedipine mediated by the CYP3A4 isoenzyme in vitro. When used simultaneously with nifedipine, a significant increase in the concentration of nifedipine in the blood plasma cannot be ruled out due to a decrease in the effect of “first pass” through the liver and slower elimination.

Azole antifungals (eg, ketoconazole)

Clinical studies examining the interaction of nifedipine and azole antifungals have not been conducted. It is known that drugs of this class inhibit the CYP3A4 isoenzyme. When used simultaneously with nifedipine, a significant increase in the systemic bioavailability of nifedipine is possible by reducing the effect of “first pass” through the liver.

Cimetidine and ranitidine

It has been established that cimetidine and ranitidine inhibit the CYP3A4 isoenzyme and cause an increase in the concentration of nifedipine in the blood plasma (by 80% and 70%, respectively), thereby enhancing its antihypertensive effect.

Diltiazem

Diltiazem reduces the clearance of nifedipine. This combination should be used with caution. A dose reduction of nifedipine may be required.

Fluoxetine

Clinical studies examining the interaction of nifedipine and fluoxetine have not been conducted. It is known that fluoxetine in vitro suppresses the metabolism of nifedipine, mediated by the action of the CYP3A4 isoenzyme. Therefore, the possibility of an increase in the concentration of nifedipine in the blood plasma cannot be excluded with the simultaneous use of nifedipine and fluoxetine.

Nefazodone

Clinical studies examining the interaction between nifedipine and nefazodone have not been conducted. Nefazodone is known to inhibit the metabolism of other drugs mediated by the CYP3A4 isoenzyme. Therefore, the possibility of increased plasma concentrations of nifedipine cannot be excluded with simultaneous use of nifedipine and nefazodone.

Quinidine

Increased plasma concentrations of nifedipine have been reported when administered concomitantly with quinidine. Therefore, careful monitoring of blood pressure is necessary when using quinidine and nifedipine simultaneously. If necessary, the dose of nifedipine should be reduced.

Quinupristin/dalfopristin

Concomitant use of quinupristin/dalfopristin may lead to increased plasma concentrations of nifedipine.

Valproic acid

Clinical studies examining the interaction of nifedipine and valproic acid have not been conducted. Since valproic acid increases the concentration of nimodipine in the blood plasma, which is structurally similar to BMCC, the possibility of increasing the concentration of nifedipine in the blood plasma and enhancing its effectiveness cannot be excluded.

Grapefruit juice

Grapefruit juice inhibits the CYP3A4 isoenzyme and suppresses the metabolism of nifedipine. The simultaneous use of the drug with grapefruit juice leads to an increase in the concentration of nifedipine in the blood plasma and a prolongation of its action due to a decrease in the “first pass” effect through the liver and a decrease in clearance. This may enhance the antihypertensive effect of nifedipine. With regular consumption of grapefruit juice, this effect can last for 3 days after the last consumption of the juice. Consumption of grapefruit/grapefruit juice during treatment with nifedipine is contraindicated.

CYP3A4 isoenzyme substrates

Substrates of the CYP3A4 isoenzyme (for example, cisapride, tacrolimus, benzodiazepines, imipramine, propafenone, terfenadine, warfarin), when used simultaneously with nifedipine, may act as CYP3A4 inhibitors and increase the concentration of nifedipine in the blood plasma.

Cisapride

Concomitant use of cisapride and nifedipine may lead to increased plasma concentrations of nifedipine.

Effect of nifedipine on other drugs

Quinidine

Nifedipine causes a decrease in the concentration of quinidine in the blood plasma. After discontinuation of nifedipine, a sharp increase in the concentration of quinidine in the blood plasma may occur. Therefore, when using nifedipine as additional therapy or discontinuing nifedipine, the concentration of quinidine in the blood plasma should be monitored and, if necessary, its dose should be adjusted.

Digoxin

The simultaneous use of nifedipine and digoxin may lead to a decrease in the clearance of digoxin and, consequently, to an increase in the concentration of digoxin in the blood plasma. The patient should be carefully monitored for symptoms of glycoside overdose and, if necessary, reduce the dose of digoxin, taking into account its concentration in the blood plasma.

Theophylline

Nifedipine increases the concentration of theophylline in the blood plasma, and therefore the concentration of theophylline in the blood plasma should be monitored. The clinical effect of both drugs when used together does not change.

Tacrolimus

Tacrolimus is metabolized with the participation of the CYP3A4 isoenzyme. Recently published data indicate the possibility of increased tacrolimus concentrations in selected cases when administered concomitantly with nifedipine. When using tacrolimus and nifedipine simultaneously, the concentration of tacrolimus in the blood plasma should be monitored and, if necessary, its dose should be reduced.

Vincristine

Nifedipine slows down the elimination of vincristine from the body and may cause increased side effects of vincristine. If simultaneous use is necessary, reduce the dose of vincristine.

Drugs that bind to blood proteins

Nifedipine can displace drugs characterized by a high degree of binding from protein binding (including indirect anticoagulants - coumarin and indanedione derivatives, anticonvulsants, non-steroidal anti-inflammatory drugs, quinine, salicylates, sulfinpyrazone), as a result of which their concentration in the blood plasma may increase .

Cephalosporins

With the simultaneous administration of cephalosporins (for example, cefixime) and nifedipine in probands, the bioavailability of the cephalosporin increased by 70%. Pharmacodynamic interactions

Blood pressure lowering drugs

The antihypertensive effect of nifedipine may be enhanced when used simultaneously with antihypertensive drugs, such as diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARI), other BMCCs, alpha-blockers, phosphodiesterase-5 inhibitors, methyldopa.

When using nifedipine and beta-blockers simultaneously, it is necessary to carefully monitor the patient's condition, since in some cases the course of chronic heart failure may worsen.

The severity of the decrease in blood pressure increases with the simultaneous use of inhalational anesthetics and tricyclic antidepressants.

Nitrates

When used simultaneously with nitrates, tachycardia increases.

Antiarrhythmic drugs

BMCCs can enhance the negative inotropic effect of antiarrhythmic drugs such as amiodarone and quinidine. Nifedipine should be co-administered with disopyramide and flecainide with caution due to a possible increase in negative inotropic effect.

Magnesium sulfate

It is necessary to carefully monitor blood pressure in pregnant women while using nifedipine with intravenous magnesium sulfate due to the possibility of an excessive decrease in blood pressure, which poses a danger to both the mother and the fetus.

Fentanyl

The simultaneous use of nifedipine and fentanyl can lead to severe arterial hypotension. If possible, it is recommended that nifedipine be discontinued at least 36 hours before fentanyl-based anesthesia.

Calcium preparations

Reduced effectiveness of nifedipine.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs reduce the antihypertensive effect of nifedipine due to suppression of prostaglandin synthesis, as well as sodium and fluid retention in the body.

Sympathomimetics

Sympathomimetic agents reduce the antihypertensive effect of nifedipine.

Estrogens

Estrogens reduce the antihypertensive effect of nifedipine due to fluid retention in the body.

Lithium preparations

When BMCC is used together with lithium drugs, it is possible to increase the manifestation of the neurotoxicity of the latter (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus).

Analogues and substitutes

"Corinfar" is an original drug produced by . If the medicine is not available in the pharmacy chain, patients are prescribed analogues - products with the same chemical composition, which differ in cost, name and manufacturer.

Drugs that replace Corinfar:

• "Nifekard" (Slovenia);
• "Kordaflex" (Hungary);
• "Nifebene" (Germany), available in the form of drops and capsules for oral administration;
• "Kordafen" (Poland);
• "Kordipin" (Slovenia);
• "Phenigidin" (Ukraine);
• "Nifedipine" (domestic drug).

In case of intolerance or contraindications to Corinfar, it is recommended to use substitutes - drugs with a similar therapeutic effect.

Permitted groups of drugs (according to the current register of medicines - RLS) are presented in the table.

Corinfar®

During the treatment period it is necessary to refrain from taking ethanol. It is recommended to stop treatment with the drug gradually.

It should be borne in mind that angina pectoris may occur at the beginning of treatment, especially after recent abrupt withdrawal of beta-blockers (the latter should be withdrawn gradually).

The simultaneous administration of beta-blockers must be carried out under conditions of careful medical supervision, as this may cause an excessive decrease in blood pressure, and in some cases, aggravation of symptoms of heart failure.

In case of severe heart failure, the drug is dosed with great caution.

Diagnostic criteria for prescribing the drug for vasospastic angina are: a classic clinical picture, accompanied by an increase in the ST segment, the occurrence of ergonovine-induced angina or coronary artery spasm, detection of coronary spasm during angiography or identification of an angiospastic component without confirmation (for example, with a different voltage threshold or with unstable angina, when ECG data indicate transient vasospasm).

For patients with severe obstructive cardiomyopathy, there is a risk of increased frequency, severity and duration of angina attacks after taking nifedipine; in this case, discontinuation of the drug is necessary.

In patients with irreversible renal failure who are on hemodialysis, have high blood pressure and reduced blood volume, the drug should be used with caution, because a sharp drop in blood pressure is possible. Patients with impaired liver function are closely monitored; if necessary, reduce the dose of the drug and/or use other dosage forms of nifedipine.

If surgical intervention under anesthesia is necessary, it is necessary to inform the anesthesiologist about the patient's treatment with nifedipine.

During in vitro fertilization, in some cases, BMCC caused changes in the head part of the sperm, which can lead to dysfunction of the sperm. In cases in which repeated in vitro fertilization has not been carried out for an unclear reason, the use of BMCC, including nifedipine, can be considered a possible reason for failure.

During treatment, it is possible to obtain a false-positive result from the direct Coombs test and laboratory tests for antinuclear antibodies.

In the spectophotometric determination of vanillyl-mandelic acid in urine, nifedipine may cause a falsely high result, however, nifedipine does not affect the results of tests carried out using HPLC.

Caution should be exercised during simultaneous treatment with nifedipine, disopyramide and flecainamide due to a possible increase in inotropic effect.

Impact on the ability to drive a car and other mechanisms

During the treatment period, patients must be careful when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Reviews from patients taking Corinfar

Drugs used in cardiology require caution in use. Basic principles of taking Corinfar:

• selection of an individual dosage by the attending physician during dynamic observation;
• tablets for oral administration, washed down with clean water (at least 100 ml);
• the drug is used 30 minutes before or 60 after a meal (the presence of food in the stomach slows down the absorption of Nifedipine).

Patients taking the drug for a long time note the main advantages and disadvantages of Corinfar, presented in the table.

Positive reviews about Corinfar, the safety of the drug and the quick results from its use determine the widespread use of the drug in cardiovascular patients.

Corinfar retard 20 mg 30 pcs. extended-release film-coated tablets

pharmachologic effect

Selective blocker of slow calcium channels (SCBC), a derivative of 1,4-dihydropyridine.
Has antianginal and hypotensive effects. Reduces the flow of extracellular Ca2+ into cardiomyocytes and smooth muscle cells of the coronary and peripheral arteries; in high doses inhibits the release of Ca2+ from intracellular stores. In therapeutic doses, it normalizes the transmembrane Ca2+ current, which is disturbed in a number of pathological conditions, primarily in arterial hypertension. Does not affect the tone of the veins. Strengthens coronary blood flow, improves blood supply to ischemic areas of the myocardium without developing the “steal” phenomenon, and activates the functioning of collaterals.

By dilating peripheral arteries, it reduces peripheral vascular resistance, myocardial tone, afterload and myocardial oxygen demand. It has virtually no effect on the sinoatrial node and AV node, and has weak antiarrhythmic activity.

Increases renal blood flow, causes moderate natriuresis.

The negative chrono-, dromo- and inotropic effects are overlapped by reflex activation of the sympathoadrenal system and an increase in heart rate in response to peripheral vasodilation.

The onset of the clinical effect is 20 minutes and its duration is 4-6 hours.

With long-term use (2-3 months), tolerance to the action of the drug develops.

Composition and release form Corinfar retard 20 mg 30 pcs. extended-release film-coated tablets

Tablets - 1 tablet:

• Active substance: nifedipine 20 mg.
• Excipients: lactose monohydrate - 31.6 mg, potato starch - 31.4 mg, microcrystalline cellulose - 31 mg, povidone K25 - 5.4 mg, magnesium stearate - 0.6 mg.
• Film shell composition: hypromellose - 5.188 mg, macrogol 6000 - 0.861 mg, macrogol 35000 - 0.393 mg, quinoline yellow dye (E104) - 0.143 mg, titanium dioxide (E171) - 1.377 mg, talc - 1.038 mg.

30 pcs. - brown glass bottles (1) - cardboard packs.

Description of the dosage form

Extended-release tablets, yellow, round, biconvex, film-coated; at the fracture there is a homogeneous yellow mass.

Characteristic

Selective blocker of “slow” calcium channels, a 1,4-dihydropyridine derivative.

Directions for use and doses

Take orally after eating, without chewing and with a sufficient amount of liquid. The dose of the drug is selected by the doctor individually in accordance with the severity of the disease and the patient’s sensitivity to the drug. For patients with concomitant severe cerebrovascular diseases and in elderly patients, the dose of the drug should be reduced.

Simultaneous food intake delays, but does not reduce, the absorption of nifedipine from the gastrointestinal tract.

Chronic stable and vasospastic angina

The initial dose is 10 mg (1 tablet) 2-3 times a day. If the clinical effect is not sufficiently pronounced, the dose of the drug is gradually increased to 2 tablets. (20 mg) 1-2 times/day. The maximum daily dose is 40 mg (4 tablets/day).

Essential hypertension

The average daily dose is 10 mg (1 tablet) 2-3 times a day.

If the clinical effect is not sufficiently pronounced, it is possible to gradually increase the dose of the drug to 20 mg (2 tablets) 2 times a day. The maximum daily dose is 40 mg (4 tablets/day).

When prescribed twice, the minimum interval between doses of the drug should be at least 4 hours.

The duration of treatment is determined by the attending physician.

Pharmacodynamics

Strengthens coronary blood flow, improves blood supply to ischemic areas of the myocardium without developing the “steal” phenomenon, and activates the functioning of collaterals. By dilating peripheral arteries, it reduces peripheral vascular resistance, myocardial tone, afterload and oxygen demand. It has virtually no effect on the sinoatrial and AV nodes and has weak antiarrhythmic activity. Increases renal blood flow, causes moderate natriuresis. The negative chrono-, dromo- and inotropic effects are overlapped by reflex activation of the sympathoadrenal system and an increase in heart rate in response to peripheral vasodilation. Does not affect the tone of the veins. The onset of the clinical effect is 20 minutes, its duration is 4-6 hours.

Pharmacokinetics

Suction

Absorption is high (more than 90%). Bioavailability - 50-70%. Eating increases bioavailability. Has a “first pass” effect through the liver. The Cmax of nifedipine in blood plasma after a single oral dose of 2 tablets (corresponding to 20 mg of nifedipine) is achieved after 1-3 hours and its value averages 28.3 ng/ml.

Distribution

Binding to blood plasma proteins (albumin) - 95%.

Penetrates through the BBB and placental barrier, excreted in breast milk.

There is no cumulative effect.

Metabolism and excretion

Completely metabolized in the liver.

T1/2 is 2-5 hours. It is excreted by the kidneys in the form of an inactive metabolite (60-80% of the dose taken), 20% with bile.

Pharmacokinetics in special clinical situations

Chronic renal failure, hemodialysis and peritoneal dialysis do not affect pharmacokinetics.

In patients with liver failure, total clearance decreases and T1/2 increases.

Indications for use Corinfar retard 20 mg 30 pcs. extended-release film-coated tablets

• Chronic stable angina (angina pectoris);
• Prinzmetal's angina (variant angina);
• arterial hypertension.

Contraindications

• Arterial hypotension (systolic blood pressure below 90 mm Hg);
• cardiogenic shock, collapse;
• chronic heart failure in the stage of decompensation;
• severe aortic stenosis;
• unstable angina;
• acute myocardial infarction (first 4 weeks);
• combined use with rifampicin;
• I trimester of pregnancy;
• lactation period (breastfeeding);
• hypersensitivity to nifedipine and other 1,4-dihydropyridine derivatives or other components of the drug.

With caution: mitral valve stenosis, hypertrophic obstructive cardiomyopathy, severe bradycardia or tachycardia, SSSS, malignant arterial hypertension, hypovolemia, severe cerebrovascular accidents, myocardial infarction with left ventricular failure, gastrointestinal obstruction, renal and hepatic failure, hemodialysis (due to the risk of arterial hypotension), II and III trimesters of pregnancy, childhood and adolescence up to 18 years (efficacy and safety have not been established), simultaneous use of beta-blockers, digoxin.

Application of Corinfar retard 20 mg 30 pcs. extended-release film-coated tablets during pregnancy and lactation

The drug is contraindicated in the first trimester of pregnancy and lactation.

With caution: the drug should be prescribed in the second and third trimesters of pregnancy.

Use in children

With caution: under 18 years of age (efficacy and safety have not been established).

special instructions

During the treatment period it is necessary to refrain from taking ethanol. It is recommended to stop treatment with the drug gradually.

It should be borne in mind that angina pectoris may occur at the beginning of treatment, especially after recent abrupt withdrawal of beta-blockers (the latter should be withdrawn gradually).

The simultaneous administration of beta-blockers must be carried out under conditions of careful medical supervision, as this may cause an excessive decrease in blood pressure, and in some cases, aggravation of symptoms of heart failure.

In case of severe heart failure, the drug is dosed with great caution.

The diagnostic criteria for prescribing the drug for vasospastic angina are: the classic clinical picture, accompanied by an increase in the ST segment, the occurrence of ergonovine-induced angina or coronary artery spasm, the detection of coronary spasm during angiography or the identification of an angiospastic component without confirmation (for example, with a different voltage threshold or with unstable angina, when ECG data indicate transient vasospasm).

For patients with severe obstructive cardiomyopathy, there is a risk of increased frequency, severity and duration of angina attacks after taking nifedipine; in this case, discontinuation of the drug is necessary.

In patients with irreversible renal failure who are on hemodialysis, have high blood pressure and reduced blood volume, the drug should be used with caution, because a sharp drop in blood pressure is possible. Patients with impaired liver function are closely monitored; if necessary, reduce the dose of the drug and/or use other dosage forms of nifedipine.

If surgical intervention under anesthesia is necessary, it is necessary to inform the anesthesiologist about the patient's treatment with nifedipine.

During in vitro fertilization, in some cases, BMCC caused changes in the head part of the sperm, which can lead to dysfunction of the sperm. In cases in which repeated in vitro fertilization has not been carried out for an unclear reason, the use of BMCC, including nifedipine, can be considered a possible reason for failure.

During treatment, it is possible to obtain a false positive result from the direct Coombs test and laboratory tests for antinuclear antibodies.

In the spectophotometric determination of vanillyl-mandelic acid in urine, nifedipine may cause a falsely high result, however, nifedipine does not affect the results of tests carried out using HPLC.

Caution should be exercised during simultaneous treatment with nifedipine, disopyramide and flecainide due to a possible increase in inotropic effect.

Impact on the ability to drive vehicles and operate machinery

During the treatment period, patients must be careful when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Overdose

Symptoms: headache, facial flushing, prolonged pronounced decrease in blood pressure, depression of sinus node function, bradycardia/tachycardia, bradyarrhythmia. In case of severe poisoning - loss of consciousness, coma.

Treatment: symptomatic therapy. In case of severe poisoning (collapse, suppression of the sinus node), the stomach is washed (if necessary, the small intestine), and activated charcoal is prescribed. The antidote is calcium preparations; intravenous administration of 10% calcium chloride or calcium gluconate is indicated, followed by transfer to a long-term infusion. With a pronounced decrease in blood pressure, slow intravenous administration of dopamine, dobutamine, adrenaline or norepinephrine is indicated. It is recommended to monitor glucose levels (insulin release may decrease) and electrolytes in the blood (K+, Ca2+). With the development of heart failure - intravenous administration of strophanthin. For conduction disorders - atropine, isoprenaline or an artificial pacemaker. Hemodialysis is not effective; plasmapheresis is recommended.

Side effects Corinfar retard 20 mg 30 pcs. extended-release film-coated tablets

From the cardiovascular system: tachycardia, palpitations, arrhythmias, peripheral edema (ankles, feet, legs), manifestations of excessive vasodilation (asymptomatic decrease in blood pressure, development or worsening of heart failure, “flushes” of blood to the facial skin, hyperemia of the facial skin, feeling of heat), marked decrease in blood pressure (rare), syncope. In some patients, especially at the beginning of treatment or when the dose is increased, angina attacks and, in isolated cases, myocardial infarction may occur, which requires discontinuation of the drug.

From the nervous system: headache, dizziness, general weakness, increased fatigue, drowsiness. With long-term use of the drug in high doses - paresthesia of the limbs, tremor, extrapyramidal (parkinsonian) disorders (ataxia, “mask-like” face, shuffling gait, tremor of the hands and fingers, difficulty swallowing), depression.

From the digestive system: dyspepsia (nausea, diarrhea or constipation), dry mouth, flatulence, increased appetite; rarely - gum hyperplasia, which completely disappears after discontinuation of the drug; with long-term use - liver dysfunction (intrahepatic cholestasis, increased activity of liver transaminases).

From the musculoskeletal system: arthritis, myalgia, swelling of the joints, cramps of the upper and lower extremities.

Allergic reactions: rarely - skin itching, urticaria, exanthema, autoimmune hepatitis, exfoliative dermatitis, photodermatitis, anaphylactic reactions.

From the hematopoietic system: anemia, leukopenia, thrombocytopenia, thrombocytopenic purpura, agranulocytosis.

From the urinary system: increased daily diuresis, deterioration of renal function (in patients with renal failure).

Other: rarely - visual impairment (including transient blindness at the maximum concentration of nifedipine in the blood plasma), gynecomastia (in elderly patients, completely disappearing after discontinuation of the drug), galactorrhea, hyperglycemia, pulmonary edema, bronchospasm, weight gain.

Drug interactions

With the simultaneous use of other antihypertensive drugs, as well as tricyclic antidepressants, nitrates, cimetidine, inhalational anesthetics, diuretics, the hypotensive effect of nifedipine may be enhanced.

BMCCs may further enhance the negative inotropic effects of antiarrhythmic drugs such as amiodarone and quinidine.

When nifedipine is combined with nitrates, tachycardia increases.

Diltiazem inhibits the metabolism of nifedipine in the body, which may require a reduction in the dose of nifedipine when these drugs are prescribed simultaneously.

Reduces the concentration of quinidine in blood plasma.

Increases the concentration of digoxin and theophylline in the blood plasma.

Rifampicin accelerates the metabolism of nifedipine; co-administration is not recommended.

When administered concomitantly with cephalosporins (for example, cefixime), the concentration of cephalosporins in the blood may increase.

Sympathomimetics, NSAIDs (suppression of prostaglandin synthesis in the kidneys and retention of sodium ions and fluid in the body), estrogens (fluid retention in the body) reduce the hypotensive effect.

Nifedipine can displace drugs with a high degree of binding from protein binding (including indirect anticoagulants - coumarin and indanedione derivatives, anticonvulsants, NSAIDs, quinine, salicylates, sulfinpyrazone), as a result of which their concentrations in the blood plasma may increase.

Nifedipine inhibits the metabolism of prazosin and other alpha-blockers, which may lead to increased hypotensive effects.

If necessary, the dose of vincristine is reduced, because nifedipine inhibits its elimination from the body, which may cause increased side effects.

Lithium preparations may enhance toxic effects (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus).

When procainamide, quinidine and other drugs known to prolong the QT interval are co-administered, the risk of significant prolongation of the QT interval increases.

Grapefruit juice inhibits the metabolism of nifedipine in the body and is therefore contraindicated during treatment with nifedipine.

Nifedipine is metabolized by the CYP3A isoenzyme, and therefore the simultaneous use of drugs that inhibit this system can lead to interaction between this drug and nifedipine: for example, macrolides, antiviral drugs (for example, amprenavir, indinavir, nelfinavir, ritonavir or saquinavir), antifungal drugs of the group azoles (ketoconazole, itraconazole or fluconazole) cause an increase in the concentration of nifedipine in the blood plasma.

Taking into account the experience with the use of nimodipine BMCC, similar interactions with nifedipine cannot be excluded: carbamazepine, phenobarbital can cause a decrease in the concentration of nifedipine in the blood plasma, and valproic acid can cause an increase in the concentration of nifedipine in the blood plasma.

conclusions

The prescription of calcium channel blockers in cardiology is due to the complex effect on the rheological properties of blood, vascular tone, and the conduction system of the heart.

Corinfar is one of the most used medications, which is characterized by a wide range of effects and positive reviews from patients. Convenient dosage, individual dosage regimen and the presence of a prolonged form are the main advantages of the product. The instructions for use of Corinfar define specific indications and restrictions for taking the drug.

Corinfar

From the cardiovascular system: tachycardia, arrhythmias, peripheral edema (ankles, feet, legs), manifestations of excessive vasodilation (asymptomatic decrease in blood pressure, “flushes” of blood to the facial skin, flushing of the facial skin, feeling of heat), excessive decrease in blood pressure (rarely), fainting , development or worsening of heart failure (usually worsening of an existing one). In some patients (especially with severe obstructive lesions of the coronary arteries), at the beginning of treatment or when the dose is increased, attacks of angina pectoris may occur, including the development of myocardial infarction (requires discontinuation of the drug).

From the nervous system: headache, dizziness, increased fatigue, asthenia, drowsiness. With long-term ingestion in high doses - paresthesia of the limbs, tremor, extrapyramidal (parkinsonian) disorders (ataxia, mask-like face, shuffling gait, stiffness of the arms or legs, tremor of the hands and fingers, difficulty swallowing), depression.

From the digestive system: dry mouth, increased appetite, dyspepsia (nausea, diarrhea or constipation); rarely - gum hyperplasia (bleeding, pain, swelling), with long-term use - liver dysfunction (intrahepatic cholestasis, increased activity of liver transaminases).

From the musculoskeletal system: rarely - arthralgia, swelling of the joints, myalgia.

From the hematopoietic organs: anemia, leukopenia, thrombocytopenia, thrombocytopenic purpura, asymptomatic agranulocytosis.

From the urinary system: increased daily diuresis, deterioration of renal function (in patients with renal failure).

Allergic reactions to the components of the drug: rarely - itching, urticaria, exanthema, autoimmune hepatitis.

Local reactions: burning at the site of intravenous administration.

Other: rarely - visual impairment (including transient loss of vision against the background of Cmax in plasma), gynecomastia (in elderly patients, completely disappearing after withdrawal), galactorrhea, hyperglycemia, pulmonary edema (difficulty breathing, cough, wheezing), weight gain. Overdose. Symptoms: headache, flushing of the facial skin, prolonged pronounced decrease in blood pressure, suppression of sinus node function, bradycardia, bradyarrhythmia.

Treatment: in case of severe poisoning (collapse, depression of the sinus node), gastric lavage is performed and activated charcoal is prescribed. The antidote is Ca2+ preparations: slow intravenous administration of 10% CaCl2 or calcium gluconate is indicated, followed by switching to a long-term infusion.

With a pronounced decrease in blood pressure, dopamine or dobutamine is administered intravenously. For conduction disorders - atropine, isoprenaline or an artificial pacemaker. With the development of heart failure - intravenous administration of strophanthin. Catecholamines should be used only when there is a threat to life (due to their reduced effectiveness, a high dosage is required, which increases the risk of developing arrhythmia). It is recommended to monitor blood concentrations of glucose (insulin release may decrease) and electrolytes (K+, Ca2+).

Hemodialysis is ineffective.