Indications for use
in the complex therapy of chronic heart failure II (in the presence of clinical manifestations) and functional class III -IV;
tachysystolic form of flicker and flutter and paroxysmal chronic course (especially when combined testosterone enanthate with chronic heart failure).
Hypersensitivity to the drug, glycoside intoxication, Wolf-Parkinson-White syndrome, atriventrikulyarnaya blockade II degree, intermittent complete blockade.
Precautions (comparing the benefit / risk ratio): AV blockade degree I, sick sinus syndrome without pacemaker, the probability of unstable AV node, specifying a history of attacks of Morgagni-Adams-Stokes, hypertrophic subaortic stenosis, isolated mitral stenosis with a rare heart rate, cardiac asthma in patients with mitral stenosis (in the absence of tahisistolicheskoy atrial fibrillation), acute myocardial infarction, unstable angina, arteriovenous shunt, hypoxia, heart failure with diastolic dysfunction (restrictive cardiomyopathy, cardiac amyloidosis, constrictive pericarditis, cardiac tamponade), arrythmia, marked dilatation of the heart cavities, “pulmonary” heart.
Electrolyte disorders: hypokalemia, hypomagnesemia, hypercalcemia, hypernatremia. Hypothyroidism, alkalosis, myocarditis, advanced age, renal hepatic insufficiency, obesity.
Pregnancy and lactation
digitalis drugs cross the placenta. During labor, the concentration of in the blood serum of the newborn and the mother is the same. Safety applying it during pregnancy classification Administration Food and Drug US assets is classified as “C”: the application of the risk is not excluded. Studies in pregnant women are not sufficient, however, foreseen therapeutic effect of the drug can justify the risk of its application.
released into the mother’s milk. But the data on the called drug effects on infants are not given.
Dosing and Administration Dosing -. Inside Like all cardiac glycosides, the dose should be chosen with care for testosterone enanthate each individual patient. If the patient before prescribing taking cardiac glycosides, in this case, the drug dose should be reduced.
The dose of depends on the need for rapid therapeutic effect.
Moderately fast digitalization (24-36 hours) is used in emergency cases
daily dose of 0.75-1.25 mg, divided into 2 doses, under the control of an electrocardiogram before each subsequent dose.
After moving to achieve saturation supportive treatment.
Slow digitalization (5-7 days).
The daily dose of 0.125 – 0.5 mg appointed 1 time per day for 5-7 days (until saturation is achieved), then move on to maintenance treatment.
Chronic heart failure (CHF)
in patients with chronic heart failure, should be used in small doses: 0.25 mg per day (for patients weighing more than 85 kg to 0.375 mg daily) In elderly patients, the daily dose of should be reduced to 0 , 0625-0,125 mg (1/4; 1/2 tablet)
daily dose for maintenance therapy is determined individually and is 0,125-0,75 mg. Supportive therapy is usually carried out for a long time.
Observed side effects are often the initial signs of overdose.
Digitaliskaya intoxication: the part of the cardiovascular system – ventricular paroxysmal tachycardia, ventricular premature beats (often bigemini, politopnye ventricular arrythmia), junctional tachycardia, sinus bradycardia, sinuauricular (SA) block, flicker and atrial flutter, AV block; the ECG – ST depression to form a biphasic T-wave part of the digestive tract: anorexia, nausea, vomiting, diarrhea, abdominal pain, bowel necrosis. On the part of the central nervous system: sleep disturbances, headache, dizziness, neuritis, sciatica, manic -depressivny syndrome, paresthesias, and syncope in rare cases (mostly in elderly patients suffering from atherosclerosis), disorientation, confusion, visual hallucinations monochrome. from the senses: coloring visible objects in the yellow-green color, flashing “flies” before the eyes , decreased visual acuity, macro- and micropsia. allergic reactions: skin rash, urticaria rare. From the side of hematopoiesis and hemostasis system: thrombocytopenic purpura, epistaxis, petechiae.Other: hypokalemia, gynecomastia.
Overdose symptoms: loss of appetite, nausea, vomiting, diarrhea, abdominal pain, bowel necrosis; ventricular paroxysmal tachycardia, ventricular premature beats (often politopnye or bigemini), junctional tachycardia, SA blockade, flicker and flutter, AV block, drowsiness, confusion, delirium psychosis, decreased visual acuity, staining the visible objects in the yellow-green color, flashing ” flies “before their eyes, the perception of objects in a reduced or enlarged; neuritis, sciatica, manic-depressive syndrome, paresthesia.
. Cancel , the appointment of activated charcoal (to reduce absorption), the introduction of antidotes (unitiol, EDTA, anti-), symptomatic therapy
. Conduct continuous ECG monitoring in cases of hypokalemia potassium salts are widely used: 0.5-1 g of potassium chloride dissolved in water and taken several times a day to a total dose of 3-6 g (40-80 mEq K + ) for adults with adequate renal function. In urgent cases shown in / in drip of 2% or 4% potassium chloride solution. The daily dose is 40-80 mEq K + (diluted to a concentration of 40 mEq K +500 ml). The recommended rate of administration should not exceed 20 mEq / hr (under ECG control). When hypomagnesemia recommended the appointment of magnesium salts. In cases of ventricular tachyarrhythmias shown slow in / in the introduction of lidocaine. In patients with normal heart function and kidney usually effective in slow / intravenous (within 2-4 min) in an initial dose of lidocaine 2.1 mg / kg body weight, followed by transfer to a drip at a rate of 1-2 mg / min. In patients with renal impairment and / or heart dose should be reduced. In the presence of AV block II-III degree should not be administered lidocaine and potassium salts as long as the artificial pacemaker is installed. During the treatment it is necessary to monitor the content of calcium and phosphorus in the blood and daily urine.There is experience with these drugs with possible positive effect: beta-blockers, procainamide, bretylium, testosterone enanthate and phenytoin. Cardioversion can trigger ventricular fibrillation. For the treatment ofbradyarrhythmias and AV block shows the use of atropine. When AV blockade II – III degree, asystole, and the suppression of sinus node activity shows an installation of the pacemaker. azab 100