Review of the best according to the editors. About the selection criteria. The the material is subjective, is not advertising and is not serves as a guide to the purchase. Before purchase is needed consultation with a specialist.
For the first time in drug stories, you have to remove quality the definition of “best.” If it’s about rhythm disturbance, then the choice there is little medicine, and it’s not the patient who chooses the medicine, but only doctor. The patient is deprived of the right to choose antiarrhythmics: too expensive ignorance can turn out at the cost. An ordinary person without medical education, I probably never heard of the names of these medicines. And it’s very good and great because serious medications to stop heart rhythm disorders can if used incorrectly, serious complications can result.
Judge for yourself: those drugs that are sold at the pharmacy without prescription (over-the-counter) rarely can cause serious complications, such as cardiac arrest. But the drugs for treatment arrhythmias, (fortunately, not all) can cause it. So if you buy a medicine for constipation at your own choice, if you overdose, you run the risk of getting the opposite effect, and sit all day in a small room.
But if you yourself try to buy any medicine from arrhythmia that you want, then, firstly, you don’t sell, and secondly, the mistake can be fatal. You will be asked prescription, and sometimes to clarify the diagnosis. And here we come across the definition of arrhythmia, or heart rhythm disturbance. how as a rule, those sensations that a person may experience in the form of interruptions in the work of the heart, a feeling of failure in the chest, which accompanied by an unpleasant feeling similar to a quick lowering elevators are not related to serious arrhythmias. More often than not we are talking about ordinary sinus extrasystoles, when just the heart misses one full blow, and then it appears much more noticeable and stronger, but a little out of time, and therefore too noticeably. This is unpleasant, but not fatal. Real violations heart rhythm may not be felt at all, or may be manifested by others symptoms. For example, a change in blood pressure, shortness of breath, fear of death, and other serious symptoms.
Therefore, this material is written exclusively in fact-finding The goal is for people without a medical education to have a sense of group of antiarrhythmic drugs, and did not confuse them with those fast-moving medicines. After all, most often in case of heart failure and malaise, Corvalol is usually used, soothing herbal teas, motherwort tincture. In some cases, especially in old age, helps Validol, which annoys, chills and distracts, soothes, but does not affect a heart. Indeed, it is believed that interruptions in the heart, discomfort and feeling of pain is most likely associated with nerves and stress, especially at a young age, and in part, this is correct.
These drugs for rhythm disturbance are prescribed only doctor, moreover, only a cardiologist. Normal precinct the therapist may prescribe some of the drugs in this series, but according to other considerations. Most often, in this case we are talking about beta-blockers. This is a large, solid group of drugs, which is very widely used to treat hypertension disease, and therefore prescribed by a therapist. But if it’s about other groups, or classes of antiarrhythmic drugs, then their should be prescribed either by a cardiologist or even narrower Specialists: This is a cardiologist-arrhythmologist. Here are those patients who have there is an established diagnosis, and which are observed by doctors arrhythmologists – and are advanced readers of this material, and consumers of drugs for arrhythmia.
The list of drugs given in the article is not designed to show any advantages and disadvantages drug product. After all, in the case when it comes to treating serious disorders, such as disorders heart rate, the patient should not independently decide on those or other advantages or disadvantages. Here exists the concept of strict indications and contraindications, and independently nothing can be done.
Independent actions are understood not only self-medication, and the appointment of even the same drug, which the patient has taken before. These are questions of dosage change, the time of admission, and even changing the drug to “the same”, only manufactured by another company. The last question is very important because many imported quality drugs become less and less affordable, and the transfer of the patient to domestic analogues leads to unwanted effects.
This article describes some modern medicinal drugs that are used to treat heart rhythm disorders. A review of existing groups, or classes of antiarrhythmic funds indicating commercial names of drugs and range prices relevant in the Russian Federation for the fall of 2019.
- What drugs normalize heart rhythm?
- How to choose a cure for arrhythmia?
- Overview of Arrhythmia Medications
- Class I – membrane stabilizing agents (quinidine-like) from arrhythmia
- Subgroup IA: procainamide (Novocainamide, Pronestil, Cardioritmin)
- subgroup IB – Lidocaine (Xylocaine, Xicaine)
- Subgroup IC – Propafenone (Rhythmorm)
- Separate class 1 drug from arrhythmia – Etatsizin
- II class – beta-blockers
- Grade III – drugs for arrhythmias that slow repolarization (sotalol, Amiodarone)
- IV class – slow calcium channel blockers from arrhythmias
- Some other remedies for arrhythmia
What drugs normalize heart rhythm?
It has long been known many different substances that affect heartbeat. It has been said above that if the patient does not have organic damage to the conduction system of the heart, but there is an effect stress and emotional stress, then with arrhythmia they can cope tranquilizers and sedatives, herbal teas and tinctures, and even mild antidepressants.
Means that affect metabolism have more serious activity. mediators. These are cholinomimetics and anticholinergics, adrenergic blockers and adrenomimetics. These are local anesthetics, ranging from everything the well-known lidocaine if administered directly into blood flow. Even some drugs to treat epilepsy, or anticonvulsants, it turns out, can normalize the heart rhythm. IN In some cases, very simple preparations, such as potassium chloride or sodium bicarbonate can also restore disturbed heart rhythm with a change in the acid-base state.
The goal of the intense search for cardiologists and pharmacologists was finding drugs that have an effect on heart rate it would not be a side effect, but the main one, which can be well to predict and calculate. Here is an example. Beta blockers perfectly cope with tachycardia. If the patient is very high heart rate, for example with thyrotoxicosis, or pheochromocytoma – adrenal tumors, then they lead to a frequency heart contractions back to normal. But at the same time they significantly lower arterial pressure. On the one hand, it’s good when it comes to About a patient with hypertension. But if a person has an episode or paroxysm of tachycardia amid low pressure, then it is simply impossible to use adrenergic blockers. They, though cause a decrease in rhythm to comfortable values, but be sure blood pressure will “fill up” before collapse or even fainting. Therefore, we need those drugs that act only on the rhythm. TO Unfortunately, ideally this is not possible. After all, a change in rhythm changes and the power of contractions, and so on. To do this, I had to look for funds, which act on cell membranes, ion transport, and change in the electrical properties of myocardial cell membranes. At the end of the end, now there are several classes antiarrhythmic drugs. But how to choose a medicine? it simple or not? What are the tasks of the doctor?
How to choose a cure for arrhythmia?
Choosing a medicine to stop heart rhythm disturbances is a serious task. An arrhythmologist should, in addition to the main effects medications and indications consider the following factors:
- gender and age of the patient;
- the presence or absence of organic lesions and diseases heart
- what form of arrhythmia exists before the appointment of the drug;
- whether diagnosed arrhythmia is a single disorder, or there are several sources and types of arrhythmias at once;
- whether the patient has an enlarged heart or cardiomegaly;
- are there signs of heart failure with phenomena stagnation and edema;
- whether the patient has bad habits, additional factors risk (excess body weight, high blood pressure);
- what medicinal substances are taken by the patient, and especially diuretics and glycosides;
- does he have angina and what form is stress or rest;
- whether the patient had a heart attack, and what localization;
- Does he have ventricular aneurysms
- what is the ejection fraction of the heart, and how much is it reduced (from the risk of complications depends on this, as will be shown later);
- how the patient transfers samples with physical activity during bicycle ergometry, does he have a ST segment depression on this an electrocardiogram, which may indicate myocardial ischemia;
- whether the patient has coronary vessels affected by thrombosis, and how many branches of these vessels are affected;
- Did he undergo heart surgery – bypass, ablation, attempts to install a pacemaker.
Finally, you need to know the initial basic data parameters ECG, and imagine how they will change with the planned appointment medicinal product.
The patient begins to be given a drug for the first time to treat arrhythmia after “clean” is carried out within two days Holter monitoring without any antiarrhythmic drugs. After he first took a single dose of the drug, prolonged monitoring of the ECG, and bicycle ergometry load every hour. ECG recording against this background allows evaluate antiarrhythmic effect, dosage effectiveness. After prescribing the drug requires repeated Holter monitoring within 3-4 days, and in case if it was possible to achieve the desired effect, the patient begins a scheduled dose the drug.
Thus, the appointment of an antiarrhythmic drug is very a serious process, and roughly it can be compared with a process constant monitoring start of the automobile motor during its settings. So, when repairing a carburetor, the master can start engine several times until it achieves steady operation on idle by correcting quantity and quality screws mixtures. Arrhythmologist conducts approximately the same with Holter monitoring while taking the drug and increasing physical activity.
Therefore, in the event that a patient having serious cardiac diagnoses, comes to the doctor who sees him for the first time, and simply “from lantern “prescribes a medicine, then he needs to look for the real specialist.
The situation is aggravated by the fact that drugs for stopping arrhythmias may have the so-called proarrhythmic effect. it means that the medicine can treat arrhythmia, but at the same time cause another type of rhythm disturbance. Otherwise, it may make it heavier. clinical picture, although in other patients with exactly the same a diagnosis of the medicine will help. Development opportunity proarrhythmic effect and requires frequent and prolonged exercise samples and 24-hour ECG monitoring to make sure that the medicine is not harmful.
How can this harmful pro-arrhythmic effect manifest itself? At ventricular may appear on the background of the appointment of the drug extrasystoles, paroxysm of ventricular tachycardia may occur, may some new arrhythmia appears, which is very difficult to stop, for example, a polymorphic type of ventricular tachycardia. Can the heart rate slows down and the so-called bradyarrhythmia appears, or stopping sinus rhythm when the main source of contractions the underlying sections of the conduction system of the heart will be. Finally, in a patient against the background, the appointment of the drug may appear atrioventricular block.
All this will require urgent drug withdrawal, or its slow cancellation, if it is impossible to abruptly cancel. All this, of course, adds great complexity to the right treatment regimens. Such as “appointed and forgot, we’ll look at the result in a month”, You can’t allow it in any way. Of course, if a doctor prescribes medication, lowering cholesterol production, this option is quite applicable, because the effect develops gradually. And here’s the cure for arrhythmia, improperly selected can kill a person in a few minutes after the first dose.
But stop scaring the reader. It’s time to get to know the classes modern drugs for stopping arrhythmias. Drugs for treatment arrhythmias are divided into 4 classes. Some of them have their own subgroups, For simplicity, one representative will be described for each class, this will be quite enough.
Overview of Arrhythmia Medications
|Nomination||Name of product||price|
|Class I – membrane stabilizing agents (quinidine-like) from arrhythmia||Subgroup IA: procainamide (Novocainamide, Pronestil, Cardioritmin)||110 rub|
|subgroup IB – Lidocaine (Xylocaine, Xicaine)||43 rub|
|Subgroup IC – Propafenone (Rhythmorm)||302 rub|
|Separate Class 1 drug for arrhythmia||ETATSIZIN||1 455 rub.|
|II CLASS – Beta-blockers for arrhythmias||Anaprilin, Obzidan, Tenormin, Betacard, Betalok, Egilok||24 rub|
|II class – drugs for arrhythmias that slow repolarization||sotalol, Amiodaron||98 rub|
|IV class – blockers of “slow” calcium channels from arrhythmia||Verapamil, Isoptin, Finoptin||43 rub|
|Some others arrhythmias||digoxin||30 rub|
Class I – membrane stabilizing agents (quinidine-like) from arrhythmia
The first rhythm recovery drugs belonging to the first class, oppress the automatism of the main heart node – sinus. If the dose is too exceeded to toxic, then the activity of all pacemakers will disappear and the heart will stop. There are three subclass: 1a, 1c and 1c. Their effect on the myocardial action potential differently. So, drugs of the 1st subclass increase it, 2nd reduce, and group 1C – does not change.
Subgroup IA: procainamide (Novocainamide, Pronestil, Cardioritmin)
The medicine is produced in capsules, and in tablets, and in tablets with slow release, and in ampoules for intravenous administration. Procainamide reduces conductivity in almost all parts of the heart. it ventricles, atria, structures just below the atrioventricular node. An important property of this medicine is that it increases the threshold. fibrillation, but this is with intravenous administration, but tablets have a short fibrillation threshold increase effect ventricles.
Novocainamide suppresses the fourth phase of depolarization, and helps with those arrhythmias, when the automatism of the sinus node is increased. Effect of this medicine is dose-dependent, but exhibits antiarrhythmic action is an active metabolite that is formed in the liver. However there is a danger of a sharp drop in pressure as they expand peripheral vessels.
After taking the pills, the effect begins somewhere after 10 minutes, and with intravenous administration, immediately. Maximum action – through an hour and a half, and the duration of the entire action is from 5 to 10 hours. Arrhythmologists note that short courses of treatment are tolerated better than long lasting. But if you assign it for a very long time, then the risk of developing systemic lupus erythematosus is increased, even if it helps very well.
A very important point in the appointment of this drug is an early postoperative period in patients after coronary artery bypass surgery for coronary heart disease. If his prescribed to patients within 4 days after surgery, then reliably the risk of rhythm disturbances such as atrial fibrillation and ventricular tachycardia. Other indications for selection will be prolonged episodes of ventricular arrhythmia, extrasystoles, supraventricular tachyarrhythmia, such as atrial flutter, Wolf-Parkinson-White syndrome, which may occur atrial fibrillation.
Novocainamide is strictly contraindicated in case of deep heart block, the presence of systemic lupus erythematosus and in patients receiving cardiac glycosides. A side effect may be a sharp drop. blood pressure, headache agranulocytosis and others condition.
In the treatment with novocainamide, special measures must be observed precautions. This is serum creatinine control, regular blood tests, study of antinuclear antibody titers on systemic lupus erythematosus. Produces Russian procainamide Association “Organics”, one pack of tablets costs 120 rubles.
subgroup IB – Lidocaine (Xylocaine, Xicaine)
Of course, lidocaine is much more widely known as local anesthetic, for example, for small operations in dentistry. Also it is an effective antiarrhythmic that blocks, unlike from procainamide not only open channels for sodium, but also those which are inactivated. Preparations of this class practically do not affect the conductivity inside the heart and therefore do not affect QRS ventricular complex broadening (contraction time is not increases). Lidocaine selectively acts on damaged myocardial tissue, for example with ischemia, and forms foci of local blockade of the impulse. It is important that lidocaine has almost no effect on the tone of the autonomic nervous system, unlike procainamide, is not lowers blood pressure and does not reduce the fraction of the heart ejection.
Lidocaine is shown, like other drugs of this class, with development of ventricular arrhythmias on the background of acute heart attack myocardium, ventricular arrhythmias on the background of an overdose cardiac glycosides, with the so-called digitalis intoxication. Indications – and other ventricular arrhythmias, such as extrasystoles, tachycardia.
Reanimatologists are very fond of using lidocaine if rhythm disturbance during surgery, or for example, catheterization hearts. Lidocaine is always an intravenous administration, a drug patients do not receive pills at home. Enter it for 3-4 minutes, you can’t enter quickly, because you can quickly get into toxic dose range. Sometimes it is administered intramuscularly, but after all, metering syringes for adults are used abroad, which can inject intramuscularly 2 ml of lidocaine with the aim stopping arrhythmias. They refused the pills, because very quickly you can exceed the therapeutic dose and get into a toxic range.
Lidocaine is prohibited for patients with atrioventricular blockade, with Wolf-Parkinson-White syndrome. If you recall, then the previous drug, procainamide, was shown in this disease, despite the fact that the drugs belong to one class, but different subgroups. Lidocaine should not be prescribed to people with serious liver disease, and especially local anesthetics with adrenaline added since there is pronounced risk of vasoconstriction and the development of ischemia.
Side effects of lidocaine are dose related, and development is possible bradycardia and stopping the sinus node. There is drowsiness and headache, numbness of the limbs, paresthesia, double vision and muscle twitching. Because lidocaine may interact with other antiarrhythmic drugs with the same procainamide, it is strictly forbidden on its own attach to it any second drug without consultation arrhythmologist.
Lidocaine is one of the most inexpensive drugs, and buy it You can in almost any pharmacy, of course, not like antiarrhythmic drug, but as a means for local anesthesia. It is not intended for home use in Russia. 10 ampoules of 2 ml of 2% lidocaine produced by the domestic company “Biosynthesis” can be purchased even for 20 rubles.
Subgroup IC – Propafenone (Rhythmorm)
Medications for restoring rhythm from this subgroup prevent the work of fast sodium channels in the myocardium, in no way affect the speed of the action potential, but they slow down conducting an impulse along some beams. This is clearly visible on the ECG. The appointment of propafenone leads to an extension of the contraction of the ventricles, which is manifested by the expansion of the ventricular complex. These drugs have a pronounced antiarrhythmic effect, since they quite strongly inhibit the conductivity. But alas, propafenone alone so “white and fluffy.” Therefore, at present, perhaps, from drugs of this class applies only he.
Back in the nineties, a serious double blind a randomized, placebo-controlled study, under CAST name. It showed amazing things. All sick who suffered a myocardial infarction, and at the same time had a ventricular extrasystole, which proceeded without any symptoms, was shown increased overall mortality due to long-term drug treatment of this class, namely Encainid and Flecainide. Judge for yourself: in the placebo group, i.e. the dummy, mortality reached 3%, and against the background of taking antiarrhythmics – as much as 10%. It is a fact came like a bolt from the blue, and after it the sunset began this popular and even prestigious subclass.
Out of suspicion, only propafenone remained, which is used under the name Rhythmol, Propanorm, Normaritm. He influences comprehensively. Propafenone has local anesthetic properties, weak beta-blocking properties and the effect of calcium antagonist “in one bottle. “In doing so, it is safe when it comes to careful relief of various ventricular and supraventricular arrhythmias. But on against the background of propafenone, not very good things can develop increased pressure in the right heart and pulmonary artery, a decrease in heart index, and therefore it should not be assigned patients whose ejection fraction is less than 50%.
Currently, propafenone is used only if available ventricular arrhythmias that are at high risk for of life. Previously, they treated patients with a variety of ventricular and supraventricular arrhythmias, but he began to show the same bad proarrhythmic effect, which was found in almost 20% of all patients.
Propafenone is strictly contraindicated in cardiogenic shock, poorly controlled heart failure, with rare heart contractions (bradyarrhythmias) and sinus node weakness, with atrioventricular blockade of severe degrees, bronchial asthma, or in severe obstructive pulmonary disease. On the propafenone may cause side effects such as atrial flutter, and even cardiac arrest, but with inept administration in large doses. After this side effect, you can already nothing to continue, but you can still add. These are hallucinations confusion, liver damage, anemia, and baldness impotence, the development of systemic lupus erythematosus, and even depression. The list is quite and quite worthy. Despite this, propafenone short courses in severe conditions apply and help. One pack of 50 Rhythmorm tablets will cost, on average, 540 rubles. Produces her company Abbot.
Separate class 1 drug from arrhythmia – Etatsizin
Ethacisine (diethylaminopropionylethoxycarbonylaminophenothiazine) released in tablets and in solution, it also reduces the incoming current sodium ions, and exhibits a significant antiarrhythmic effect when ventricular and supraventricular arrhythmias when other antiarrhythmics turned out to be powerless. At the same time, its effect on heart during ECG during therapy. PQ interval significantly lengthens by 17%, and the ventricular complex QRS expands by 25%. Thus, a pulse takes a quarter more time to contraction of the ventricles occurred.
The most important adverse effect of the administration of etatsizin arterial hypotension is considered, which in combination with inhibition intraventricular and atrioventricular conduction may still exacerbate the situation. Therefore, against the background of low pressure have to abandon this drug, despite its advantages. It is administered intravenously, rather slowly at a rate of 10 mg per a minute. In tablets of 50 mg – 3 times a day, but not more than 200 mg per day. It may also have a dangerous pro-arrhythmic effect, causes shortness of breath and palpitations, can lead to pulmonary embolism arteries and even myocardial infarction, if applied in high dosages. Patients in 15% of cases had dizziness, in 10% cases – nausea and even urinary retention. Despite this, Etatsizin quite expensive. Pack of 50 tablets for 3 weeks of use, costs an average of 1,500 rubles. Produced Etatsizin by the Latvian company Olainfarm.
In general, it should be said that after studies conducted in the last decades of the XX century, it became known that Class 1 antiarrhythmic drugs may increase mortality patients with arrhythmias, if used continuously and for a long time. IN Currently, class 1 drugs are rarely used, and only with to eliminate the symptoms of arrhythmia, or to maintain normal, sinus rhythm in patients with atrial fibrillation in the background healthy heart (without organic changes – dilatation of chambers, hypertrophy, valvular abnormalities). They are not used to increase life expectancy of patients, and are not prescribed to those people who have a high risk of sudden death.
What replaced these funds, which were widely used in eighties? The revolution was made by the development of medical technicians: the appearance of defibrillators, cardioverter, the appearance new, minimally invasive surgical procedures heart system, and the introduction into clinical practice of new medicines.
II class – beta-blockers
These drugs are significantly safer than first class, used to relieve high blood pressure, quite often taken for a long time, but at the same time they have effect on conduction and automatism of the heart pulse. All drugs from this group specifically suppress adrenergic stimulation of sources of rhythm, and if they are prescribed in large doses, then they begin to exhibit a membrane-stabilizing effect. IN as a result, the rise in action potential decreases, electric excitation threshold for myocardial cells (myocardiocytes) increases, and the speed of the pulse decreases.
We will not consider various groups here. beta-blockers, let’s just say that the existing common indications for their appointment are very, very broad. Is it tall, or supraventricular arrhythmias starting from sinus tachycardia and ending with atrial fibrillation, of course, flickering tachyform atria in the first place. These are ventricular arrhythmias in the form of extrasystole. Hypertrophic blockers are indicated. cardiomyopathies, with stress (because the heart contracts more often under adrenaline), with factorial paroxysmal supraventricular tachycardia. They are used to prevent relapse of paroxysms. ventricular arrhythmias, including with the goal of preventing sudden death in patients after a heart attack. The use of beta-blockers significantly increases survival, for example, in patients with ventricular fibrillation.
Of the drugs, propranolol, nadolol, atenolol, metoprolol. But much more commonly used are the following commercial Names: Anaprilin, Obzidan, Tenormin, Betacard, Betalok, Egilok. The most expensive currently widely used is Betalok, which is produced by a Swedish company Astrazeneca. One bottle containing 100 tablets of 100 mg is worth an average of 490 rubles, which is also inexpensive.
Despite its broad purpose, beta-blocker therapy arrhythmias also have many pitfalls. Need to consider side effects – hypotension, possible hidden sympathomimetic activity, the likelihood of developing bronchospasm, and many other effects, the assessment of which we leave to professionals.
Grade III – drugs for arrhythmias that slow repolarization (sotalol, Amiodarone)
In the third class of antiarrhythmic drugs, practically Amiodaron reigns supreme, in the second place – sotalol and bretilium tosylate. Consider Amiodarone, which generally extremely widely used in hospitals and stations ambulance, being one of the main antiarrhythmics.
Amiodarone (Cordaron), it is available in tablets and in solution. The effect of Amiodarone on the rhythm of the heart is extremely complex, and you can say, similar to the influence of all antiarrhythmic classes, “by a little bit from everyone. We won’t describe his action here, as the result may be a whole book. Only worth say that this is the strongest antiarrhythmic drug, and that most importantly, it can eliminate ventricular fibrillation, and return a person from clinical death.
Long-term administration of Amiodarone reduces the development by almost 2 times ventricular fibrillation and ventricular tachycardia, but here is a “game in one gate “: if you stop taking, then the prognosis of life for the patient with severe rhythm disorders worsen. Amiodarone tablets effective not only after emergency defibrillation, but also can translate atrial fibrillation into a normal sinus rhythm, up to 86% of all cases. Even if a patient with rhythm pathology before Amiodarone tried a lot of drugs, and constantly he needed a cardioversion, that is, an electrical recovery rhythm, then Amiodarone in 20% of such complex cases was effective.
Amiodarone intravenously helps quickly – in the elderly with tachyform atrial fibrillation, which does not stop with anything, but a condition progressive worsens. Amiodarone administration in an hour reduces heart rate by an average of 40 beats per minute and a significant increase in low arterial pressure. Cardiac output increases and is restored sinus rhythm. Amiodaron feels pretty good and in combinations with drugs such as digoxin, quinidine, propafenone. A list of other indications for the use of Amiodarone includes prevention of arrhythmias in open heart surgery, relief dangerous arrhythmias, and so on.
So, in the USA, national recommendations on intravenous administration of Amiodarone in life-threatening arrhythmias. The total daily dose for the first day of admission should be approximately 1000 mg, or 1 g. This significantly reduces the risk of total mortality in severe arrhythmias.
However, each barrel of honey has its own fly in the ointment. Amiodarone cannot be prescribed to patients with weak sinus node and bradycardia, with a low ejection fraction of less than 40% (that’s why it need to know initially), with atrioventricular block 3 degrees, with a low concentration of potassium in the blood plasma and especially against the background powerful diuretic therapy, with a high risk of potassium loss. All this Amiodarone may increase the risk of sudden of death.
Of the side effects, Amiodarone has one serious potential condition that can be fatal – it is pneumonitis, i.e. interstitial or alveolar inflammation lung tissue, with diffuse lesion and pulmonary fibrosis. At the patient in this case there is severe shortness of breath and wheezing in the lungs, hypoxia in the blood, pleurisy, increased ESR and a rise in temperature. Because the patient is usually elderly and has severe arrhythmia, organic damage to the heart, then mortality in these pneumonitis can reach 10%, and this is a very high figure. The drug has a pro-arrhythmic effect, but is not pronounced in up to 5% of cases, it can cause atrioventricular blockade and affect the liver.
One of the interesting features of Amiodarone is photosensitization. If the patient takes the pill for a long time, and in the summer is in the sun, then open areas of the body are painted in violet, bluish red blue and gray. In some In patients with Amiodarone, dysfunction developed thyroid gland, both in large (hyperthyroidism), and in smaller side (hypothyroidism), half of the patients experience nausea, especially if there is heart failure, and the dose of Amiodarone high.
Against the background of taking Amiodarone during surgery in as prevention of arrhythmias, pressure may suddenly drop, and other unpleasant conditions occur. But you need to be especially careful administer amiodarone intravenously. May be phlebitis when administered solution into the peripheral vein, so not to “burn” it Amiodarone, its concentration should be low. Dropper for intravenous administration should be from a special material since polyvinyl chloride, from which ordinary droppers are made, can absorb Amiodarone, and lower its concentration, in the body. Summing up, we can say that Amiodarone is beautiful the drug, but in order to avoid a dirty trick, the doctor needs to have experience of treatment Amiodarone.
IV class – slow calcium channel blockers from arrhythmias
Finally, the last, fourth class of antiarrhythmic drugs represented by various calcium antagonists. They are no longer acting on sodium, and on slow calcium channels, blocking them, and stopping the slow flow of calcium into the cells of the heart muscle – myocardiocytes. Of the most diverse means of this class clinically only two drugs produce a significant effect: Diltiazem and Verapamil, and the remaining representatives are practically not used for stopping arrhythmias.
Verapamil, aka Isoptin or Finoptin, is cheap and affordable drug. So, domestic verapamil production Irbit Chemical Pharmaceutical Plant will cost an average of 50 rubles per packing of tablets, and the most expensive imported prolonged Isoptin will cost 440 rubles per pack of 30 tablets.
Verapamil and its analogues are indicated in the case of supraventricular tachycardia, with paroxysm of atrial fibrillation and flutter atria. In this case, the drug is administered intravenously, slowly, and certainly against the background of ECG recording during the introduction and blood pressure measurements. In this case, you must comply necessarily an initial dose. Tablets are usually taken. for prophylaxis, or paroxysms of supraventricular tachycardia, or other arrhythmias as indicated by the doctor. Usually a daily dose of 240 mg, which should be divided into 3 doses. Verapamil may interact with other antiarrhythmic drugs and this can be dangerous. So, if you take the drug Quinidine from the first groups, as a result, severe hypotension may develop (decrease blood pressure).
Some other remedies for arrhythmia
In addition to the officially approved antiarrhythmic drugs, there are drugs from other groups that are used to relief of certain attacks of arrhythmia. First of all, this cardiac glycosides. They are very good with beta-blockers or verapamil, and especially with atrial fibrillation and flutter. Of glycosides most commonly used is digoxin. But hearty glycosides can also throw a surprise. For example, they are in patients with paroxysm of atrial fibrillation can translate it into a constant form. On the other hand, a persistent form of atrial fibrillation may be even more favorable than temporary paroxysms. A business in that thromboembolic complications for example thromboembolic stroke is much more likely to occur when there are separate episodes of “flicker” than with constant form.
In addition to cardiac glycosides, potassium preparations are prescribed, for example potassium chloride. As a rule, if the patient has a low potassium plasma, then, first of all, it is necessary to compensate hypokalemia, and against the background of the introduction of potassium preparations, heart rhythm can normalize by itself. Antiarrhythmics include magnesium preparations, which are used in case of deficiency, but contraindicated in complete heart block. First of all, it’s magnesium. sulfate or magnesia, which can be applied orally.
In conclusion, it should be recalled that so many drugs which was described in this material has a low cost, because they are on the list of vital medicines (Vital and Essential Drugs) from year to year, and this is completely rightly so.
Attention! This rating is subjective, not advertising and does not serve as a guide to the purchase. Before the purchase consultation with a specialist is necessary.