Verapamil Latin name. Analogues of "Verapamil": list of drugs, reviews

Selective blocker class I calcium channels, diphenylalkylamine derivative
Drug: VERAPAMIL

Active substance of the drug: verapamil
ATX coding: C08DA01
KFG: Calcium channel blocker
Registration number: P No. 013974/01
Registration date: 08/14/08
Owner reg. credential: SHREYA LIFE SCIENCES Pvt.Ltd. (India)

Verapamil release form, drug packaging and composition.

Tablets, coated film-coated 1 tab. verapamil hydrochloride 40 mg - "- 80 mg
Excipients: disubstituted calcium phosphate, starch, butylated hydroxyanisole, purified talc, magnesium stearate, gelatin, methylparaben, hydroxypropyl methylcellulose, titanium dioxide, indigo carmine.
10 pieces. - blisters (1) - cardboard packs.
10 pieces. - blisters (5) - cardboard packs.

DESCRIPTION OF THE ACTIVE SUBSTANCE.
All information provided is provided for information only about the drug; you should consult your doctor about the possibility of use.

Pharmacological action Verapamil

Selective class I calcium channel blocker, diphenylalkylamine derivative. It has antianginal, antiarrhythmic and antihypertensive effects.
The antianginal effect is associated both with a direct effect on the myocardium and with an effect on peripheral hemodynamics (reduces the tone of peripheral arteries, peripheral arterial resistance). Blockade of calcium entry into the cell leads to a decrease in the transformation of energy contained in macroergic bonds of ATP into mechanical work, decreased myocardial contractility. Reduces myocardial oxygen demand, has a vasodilating, negative ino- and chronotropic effect.
Verapamil significantly reduces AV conduction, prolongs the refractory period and suppresses the automaticity of the sinus node. Increases the period of diastolic relaxation of the left ventricle, reduces the tone of the myocardial wall (is auxiliary for the treatment of hypertrophic obstructive cardiomyopathy). Has an antiarrhythmic effect in supraventricular arrhythmias.

Pharmacokinetics of the drug.

When taken orally, more than 90% of the dose is absorbed. Protein binding - 90%. It is metabolized during the “first pass” through the liver. The main metabolite is norverapamil, which has a less pronounced hypotensive activity than unchanged verapamil.
T1/2 when taking a single dose is 2.8-7.4 hours, when taking repeated doses - 4.5-12 hours (due to the saturation of liver enzyme systems and an increase in the concentration of verapamil in the blood plasma). After IV administration, the initial T1/2 is about 4 minutes, the final T1/2 is 2-5 hours.
It is excreted mainly by the kidneys and 9-16% through the intestines.

Indications for use:

Angina pectoris (tension, stable without vasospasm, stable vasospastic), supraventricular tachycardia (including paroxysmal, with WPW syndrome, Lown-Ganong-Levine syndrome), sinus tachycardia, atrial fibrillation, atrial flutter, atrial extrasystole, arterial hypertension, hypertensive crisis (iv administration), hypertrophic obstructive cardiomyopathy, primary hypertension in the pulmonary circulation.

Dosage and method of administration of the drug.

Individual. Orally for adults - at an initial dose of 40-80 mg 3 times a day. For dosage forms prolonged action, the single dose should be increased and the frequency of administration reduced. Children aged 6-14 years - 80-360 mg/day, up to 6 years - 40-60 mg/day; frequency of administration - 3-4 times/day.
If necessary, verapamil can be administered intravenously (slowly, under the control of blood pressure, heart rate and ECG). A single dose for adults is 5-10 mg, if there is no effect after 20 minutes, it is possible reintroduction at the same dose. A single dose for children aged 6-14 years is 2.5-3.5 mg, 1-5 years - 2-3 mg, up to 1 year - 0.75-2 mg. For patients with pronounced violations liver function, the daily dose of verapamil should not exceed 120 mg.
Maximum dose: adults when taken orally - 480 mg/day.

Side effects of Verapamil:

From the outside of cardio-vascular system: bradycardia (less than 50 beats/min), marked decrease in blood pressure, development or worsening of heart failure, tachycardia; rarely - angina pectoris, up to the development of myocardial infarction (especially in patients with severe obstructive lesions coronary arteries), arrhythmia (including ventricular fibrillation and flutter); with rapid intravenous administration - AV blockade III degree, asystole, collapse.
From the central nervous system and peripheral nervous system: dizziness, headache, fainting, anxiety, lethargy, increased fatigue, asthenia, drowsiness, depression, extrapyramidal disorders (ataxia, mask-like face, shuffling gait, stiffness of the arms or legs, trembling of the hands and fingers, difficulty swallowing).
From the outside digestive system: nausea, constipation (rarely - diarrhea), gum hyperplasia (bleeding, soreness, swelling), increased appetite, increased activity of liver transaminases and alkaline phosphatase.
Allergic reactions: itchy skin, skin rash, facial skin hyperemia, multiform exudative erythema(including Stevens-Johnson syndrome).
Other: weight gain, very rarely - agranulocytosis, gynecomastia, hyperprolactinemia, galactorrhea, arthritis, transient loss of vision against the background of Cmax, pulmonary edema, asymptomatic thrombocytopenia, peripheral edema.

Contraindications to the drug:

Severe arterial hypotension, AV block II and III degrees, sinoatrial block and SSSU (except for patients with a pacemaker), WPW syndrome or Lown-Ganong-Levine syndrome in combination with atrial flutter or fibrillation (except for patients with a pacemaker), pregnancy, period lactation, increased sensitivity to verapamil.

Use during pregnancy and lactation.

Verapamil is contraindicated during pregnancy and lactation.

Special instructions for the use of Verapamil.

Caution should be used in case of AV blockade of the first degree, bradycardia, severe stenosis of the aortic mouth, chronic heart failure, mild or moderate arterial hypotension, myocardial infarction with left ventricular failure, hepatic and/or renal failure, in elderly patients, children and adolescents under 18 years of age (the effectiveness and safety of use have not been studied).
Possible if necessary combination therapy angina and arterial hypertension verapamil and beta-blockers. However, intravenous administration of beta-blockers should be avoided while using verapamil.
Impact on the ability to drive vehicles and operate machinery
After taking verapamil, individual reactions are possible (drowsiness, dizziness), affecting the patient’s ability to perform work that requires high concentration and speed of psychomotor reactions.

Interaction of Verapamil with other drugs.

When used simultaneously with antihypertensive drugs (vasodilators, thiazide diuretics, ACE inhibitors) there is a mutual strengthening of the antihypertensive effect.
When used simultaneously with beta-blockers, antiarrhythmic drugs, funds for inhalation anesthesia the risk of developing bradycardia, AV blockade, severe arterial hypotension, and heart failure increases due to the mutual strengthening of the inhibitory effect on the automatism of the sinoatrial node and AV conduction, contractility and conductivity of the myocardium.
When verapamil is administered parenterally to patients who have recently received beta-blockers, there is a risk of developing arterial hypotension and asystole.
When used simultaneously with nitrates, the antianginal effect of verapamil is enhanced.
When used simultaneously with amiodarone, the negative inotropic effect, bradycardia, conduction disturbances, and AV block are enhanced.
Since verapamil inhibits the CYP3A4 isoenzyme, which is involved in the metabolism of atorvastatin, lovastatin and simvastatin, manifestations are theoretically possible drug interactions caused by increased concentrations of statins in blood plasma. Cases of rhabdomyolysis have been described.
When used simultaneously with acetylsalicylic acid Cases of increased bleeding time due to additive antiplatelet effects have been described.
When used simultaneously with buspirone, the concentration of buspirone in the blood plasma increases, its therapeutic and side effects.
With simultaneous use, cases of increased concentrations of digitoxin in the blood plasma have been described.
When used simultaneously with digoxin, the concentration of digoxin in the blood plasma increases.
When used concomitantly with disopyramide, severe hypotension and collapse are possible, especially in patients with cardiomyopathy or decompensated heart failure. The risk of developing severe manifestations of drug interactions is apparently associated with increased negative inotropic effects.
When used simultaneously with diclofenac, the concentration of verapamil in the blood plasma decreases; with doxorubicin - the concentration of doxorubicin in the blood plasma increases and its effectiveness increases.
When used simultaneously with imipramine, the concentration of imipramine in the blood plasma increases and there is a risk of developing undesirable changes on the ECG. Verapamil increases the bioavailability of imipramine by reducing its clearance. Changes in the ECG are due to an increase in the concentration of imipramine in the blood plasma and the additive inhibitory effect of verapamil and imipramine on AV conduction.
When used simultaneously with carbamazepine, the effect of carbamazepine is enhanced and the risk of side effects from the central nervous system increases due to inhibition of the metabolism of carbamazepine in the liver under the influence of verapamil.
When used simultaneously with clonidine, cases of cardiac arrest in patients with arterial hypertension have been described.
When used simultaneously with lithium carbonate, the manifestations of drug interactions are ambiguous and unpredictable. Cases of increased effects of lithium and the development of neurotoxicity, a decrease in the concentration of lithium in the blood plasma, and severe bradycardia have been described.
The vasodilating effects of alpha blockers and calcium channel blockers may be additive or synergistic. With the simultaneous use of terazosin or prazosin and verapamil, the development of severe arterial hypotension is partly due to pharmacokinetic interaction: an increase in the Cmax and AUC of terazosin and prazosin.
With simultaneous use, rifampicin induces the activity of liver enzymes, accelerating the metabolism of verapamil, which leads to a decrease in its clinical effectiveness.
With simultaneous use, the concentration of theophylline in the blood plasma increases.
When used simultaneously with tubocurarine chloride and vecuronium chloride, the muscle relaxant effect may be enhanced.
When used simultaneously with phenytoin and phenobarbital, a significant decrease in the concentration of verapamil in the blood plasma is possible.
When used simultaneously with fluoxetine, the side effects of verapamil increase due to a slowdown in its metabolism under the influence of fluoxetine.
With simultaneous use, the clearance of quinidine decreases, its concentration in the blood plasma increases and the risk of side effects increases. Cases of arterial hypotension have been observed.
With simultaneous use, verapamil inhibits the metabolism of cyclosporine in the liver, which leads to a decrease in its excretion and an increase in plasma concentrations. This is accompanied by an increased immunosuppressive effect, and a decrease in the manifestations of nephrotoxicity is noted.
When used simultaneously with cimetidine, the effects of verapamil are enhanced.
When used simultaneously with enflurane, prolongation of anesthesia is possible.
When used simultaneously with etomidate, the duration of anesthesia increases.

Verapamil is a drug that has antihypertensive ( reduces pressure in blood vessels), antiarrhythmic ( prevents the occurrence of various disorders heart rate ) and antianginal effect ( reduces symptoms of coronary heart disease). This medication belongs to the group of slow calcium channel blockers, which affect the functioning of the cardiovascular system. It is worth noting that verapamil is to a greater extent affects the heart muscle myocardium) than on vessels.


Verapamil is a white crystalline powder that is highly soluble in water. This drug dissolves quite quickly and almost completely in digestive tract. Verapamil has its maximum effect on the body during the first 2 to 4 hours after oral administration (inside).

Types of medication, commercial names of analogues, release forms

Due to the fact that verapamil is well absorbed when taken orally, it is most often prescribed in tablet form. Verapamil is also available as a solution for intravenous administration.

It is worth mentioning that verapamil is also produced under other names - Veratard, Verogalid, Isoptin, Kaveril, Lekoptin, Finoptin, etc.

Manufacturers of verapamil

Company manufacturer	Commercial name of the drug	A country	Release form	Dosage
Avexima	Verapamil	Russia	Film-coated tablets.	Selected individually. The medication should be taken 30–40 minutes before meals. Adults and adolescents over 15 years of age are prescribed 0.04–0.08 grams ( 40 – 80 milligrams) three times a day. If necessary, the doctor can increase the dose to 0.12 - 0.16 grams ( 120 – 160 milligrams). The daily dosage should not exceed 240 – 480 milligrams. For children from six to fourteen years of age, the daily dose is 80–360 milligrams, and children up to six years old inclusive are prescribed 40–60 milligrams. Frequency of tablet intake ( children from six to fourteen years old) is 3 – 4 times a day.
North Star	Verapamil	Russia
Chemical and pharmaceutical plant AKRIKHIN	Verapamil	Russia
Alkaloid	Verapamil	Macedonia
Obolenskoe	Verapamil	Russia
Unipharm	Verapamil-Sopharma	Bulgaria	Film-coated tablets ( film coating is less than 10% of the weight of the entire tablet).
Valenta Pharmaceuticals	Verapamil	Russia
Serena Pharma	Verapamil	India
Alkaloid	Verapamil	Macedonia	Tablets, long-term ( prolonged) actions.	Should be taken before or after meals with a small amount of water ( 50 – 100 milliliters). As a rule, a daily dose of 240 to 360 milligrams is used. This dosage may be increased to 480 milligrams ( treatment must be carried out in a hospital). The frequency of administration is 2 – 3 times a day. It should be noted that the initial dose for patients with impaired renal and liver function should not exceed 120 milligrams.
Eskom	Verapamil-Eskom	Russia	Solution for intravenous administration.	Inject slowly, over at least 2–3 minutes. Heart rate and blood pressure should be monitored continuously during administration. Adults are administered 5–10 milligrams ( single dosage). If there is no desired effect, the administration should be repeated at the same dosage. The maximum daily dosage for adults should not exceed 480 milligrams. The starting dose for people with impaired renal and liver function should not exceed 120 milligrams. A single dose for children under one year old is 0.75 - 2 milligrams, from one to five years old 2 - 3 milligrams, from six to fourteen years old - 2.5 - 3.5 milligrams.
Biosynthesis	Verapamil	Russia

The mechanism of therapeutic action of the drug

Verapamil is a slow L-type calcium channel blocker ( is a calcium antagonist), which are located in the heart muscle, as well as in the blood vessels. In the heart, calcium channels are located in the sinoatrial and atrioventricular nodes, as well as in the Purkinje fibers ( these structures are part of the conduction system of the heart and support its normal contractile function). The increased rate of penetration of calcium ions from the intercellular space into the cells of the conduction system of the heart leads to rhythm disturbances. These changes inevitably lead to an excessive increase in oxygen consumption by the heart muscle, which is subsequently manifested by a decrease in blood supply to the heart tissues ( ischemia) and oxygen starvation ( hypoxia). Verapamil reduces myocardial demand ( heart muscle) in oxygen, which consumes more than 10% of all inspired oxygen, and is also able to correct the imbalance between oxygen supply and oxygen consumption in cardiomyocytes ( myocardial cells). Along with the above mechanisms, in cardiomyocytes there is an increase in the concentration of potassium ions, which is necessary for normal heart rhythm.

Inhibition of the penetration of calcium ions into the cells of the vascular wall leads to a reflex expansion of the coronary arteries of the heart ( vessels supplying the heart), and also dilates peripheral arterial vessels ( arteries and arterioles). There is also a decrease in total peripheral vascular resistance ( hypotensive effect).

It should be noted that verapamil is well absorbed in the body, but due to significant individual differences, this medication may exert its effect after a different period of time ( from 1 to 4 hours). When verapamil enters liver cells, it is actively metabolized ( exposed enzymatic digestion ). Subsequently, once in the blood, it binds to plasma proteins ( 90% ). The required constant concentration of the drug in the blood is achieved, as a rule, on the fourth day after reuse drug. Verapamil is excreted through bile ( 25% ), with urine ( 70% ), as well as unchanged ( 4 – 5 % ). The elimination period of verapamil is significantly increased in people with various liver dysfunctions.

When administered intravenously, the antiarrhythmic effect is achieved within the first 5 minutes and lasts about two hours ( verapamil is antiarrhythmic drug Group IV). Hypotensive effect (demotion blood pressure ) is observed after 3 – 6 minutes and lasts no more than 25 minutes. In most cases, verapamil is well tolerated.

Indications for use

Verapamil is prescribed for prevention as well as treatment various violations heart rate, with coronary disease hearts ( impaired blood supply to the myocardium due to damage coronary vessels ), as well as for some other heart diseases.

Use of verapamil

Indications for use	Mechanism of action	Dosage
Prevention and treatment of coronary heart disease ( IHD)
Chronic stable angina (emergence pain behind the sternal, caused by the same type of physical activity)	Reduces the release of calcium ions in the coronary vessels and thereby relieves spasm. Increases the concentration of potassium ions in myocardial cells, which also helps to reduce the contractility of the heart muscle and reduce pain. Reduces total peripheral vascular resistance, which leads to a decrease in pressure in the arteries.	The dosage should be selected individually. When used internally ( parenterally) the drug should be taken half an hour before meals. A single dosage for adolescents under 15 years of age and for adults is 40–80 milligrams. The medication should be taken up to three times a day. Sometimes a single dosage can be increased to 120 - 160 milligrams. Children under six years old are prescribed 40–60 milligrams, and from six to fourteen years old, 80–360 milligrams per day. Children and adolescents under 14 years of age take the drug up to four times a day.
Unstable angina (pain behind the sternum can occur both during any physical activity and against the background of complete rest)
Vasospastic angina (spasm of the vessels supplying the heart, which occurs at rest)
Prevention and treatment of certain heart rhythm disorders
Paroxysmal over ventricular tachycardia (sudden and paroxysmal increase in heart rate)	Reduces the excitability of ectopic foci ( These foci have their own excitability and can disrupt normal rhythm hearts). Normalizes and significantly reduces heart rate.	Most often used intravenously. During jet injection, it is necessary to monitor electrocardiogram readings, blood pressure, and also count the pulse for 2–3 minutes. A single dosage for adults is 5 – 10 milligrams. If the desired effect is not observed within the first 5 to 10 minutes, it is necessary to re-administer the medication in the same dosage. The frequency of administration should be selected by the attending physician. Children under one year of age are prescribed 0.75–2 milligrams. Children from one to five years old: 2 - 3 milligrams. Children from six to fourteen years old: 2.5 - 3.5 mg.
Supraventricular extrasystole (the appearance of extraordinary incomplete contractions of the heart against the background of increased excitability of ectopic foci)
Chronic form of atrial fibrillation and flutter (frequent and orderly contraction of the atria of the heart)		Used both intravenously and orally.
Prevention and treatment hypertensive conditions
Hypertension (increase in blood pressure over 140/90 mm Hg. Art.)	Directly affects arterial vessels of medium and small caliber and blocks the release of calcium in them, which leads to their reflex expansion. Also dilates coronary arteries.	Most often used intravenously ( to achieve faster results).
Hypertensive crisis (excessive increase in pressure, which can lead to damage various organs and systems)
Other heart diseases
Hypertrophic cardiomyopathy (thickening of the muscle layer of the left and sometimes right ventricle of the heart)	Helps reduce the contractility of the heart muscle by reducing excitability in the conduction system of the heart. Reduces the rate of calcium release in the vessels of the heart, as well as in peripheral arteries.	Can be used orally or as intravenous injections.

How to use the medicine?

Depending on the pathology, verapamil may be prescribed in tablet form, as well as as intravenous injections.

Verapamil tablets are most often prescribed for the prevention or treatment of coronary heart disease. The tablets should be taken before meals ( in 30 – 40 minutes), while washing them down with a small amount of liquid ( 50 – 100 milliliters). The dosage must be selected individually, taking into account the type and severity of the pathology. A single dosage for adults and adolescents over 15 years of age is, on average, 40–80 milligrams. The tablets are taken twice or thrice daily. In rare cases, a single dose can be increased to 120 – 160 milligrams ( only after consulting a doctor). Verapamil tablets can also be prescribed to children. For children under six years of age, a single dose is 15–20 milligrams, and for children from six to fourteen years of age – 20–80 milligrams ( 3 – 4 times a day).

In some cases, your doctor may prescribe long-acting or extended-release verapamil. Most often it is prescribed to lower blood pressure ( for hypertension), as well as for the prevention of attacks of angina and supraventricular tachycardia. Daily dose verapamil prolonged action is 240 - 360 milligrams. The medication should be taken in the morning during or immediately after meals. The tablet should also be taken with a small amount of liquid ( 50 – 100 milligrams). It should be noted that in persons with disorders liver function, as well as for older people, the single dose should be reduced.

For the treatment and prevention of various heart rhythm disorders ( supraventricular extrasystole, paroxysmal supraventricular tachycardia, chronic form atrial fibrillation and flutter), as well as in hypertensive crisis, verapamil is used intravenously. Verapamil is administered over at least 2 to 3 minutes under constant monitoring of heart rate and blood pressure. Adults are given a one-time dose of 5 or 10 milligrams of the drug, and if there is no effect, the same dose is repeated. Children under one year old are given a one-time dose of 0.75–2 milligrams, from one to five years old 2–3 milligrams, from six to fourteen years old 2.5–3.5 milligrams of verapamil. For elderly people, as well as patients with impaired liver and kidney function, the single and daily dose should be reduced ( less than 120 milligrams per day).

Possible side effects

The effects of verapamil on the cardiovascular system can in some cases lead to serious consequences. That is why intravenous administration of this medication should only be carried out in a hospital ( under the direct supervision of a physician). Verapamil can also lead to drug allergies.

Verapamil can cause the following side effects:

• disorders of the cardiovascular system;
• allergic manifestations;
• disorders of the central and peripheral nervous system;
• disorders of the digestive tract;

Cardiovascular disorders

Taking verapamil can sometimes lead to significant disturbances in heart rhythm. It is worth noting that these disorders most often occur when intravenous use medicine.

The following side effects from the cardiovascular system are distinguished:

• hypotension;
• angina pectoris;
• atrioventricular heart block;
• asystole.

Bradycardia represents a pronounced decrease in heart rate ( less than 50 beats per minute). Bradycardia occurs due to decreased conductivity of the sinoatrial node, which normally generates 60–90 heartbeats. Subjectively, bradycardia may not cause any sensations, but most often this state manifested by symptoms such as dizziness, severe weakness, cold sweat, as well as presyncope and fainting, which is caused by a decrease in oxygen supply to brain tissue ( brain hypoxia).

Hypotension characterized by a decrease in blood pressure ( below 90/60 mm Hg. Art.). A decrease in the excitability of the entire conduction system of the heart inevitably leads to a decrease in the pumping function performed by the heart muscle. Due to a decrease in blood pressure, tissues and organs experience oxygen starvation, which can significantly disrupt their activity.

Heart failure is a condition in which the contractile function of the heart is significantly impaired. Subsequently, blood stagnation occurs at the level of the entire body. If failure of the left ventricle of the heart occurs, this leads to shortness of breath, hemoptysis and cyanosis ( the skin and mucous membranes acquire a bluish tint). With failure of the right ventricle of the heart, shortness of breath and hepatomegaly are observed ( increase in liver size), swelling of the extremities. Fast growing ( acute) heart failure can lead to complications such as cardiac asthma ( attack of suffocation due to impaired contractility of the heart), cardiogenic shock ( state of shock caused by a significant decrease in the contractile function of the left ventricle) or pulmonary edema. It is worth noting that acute heart failure can directly threaten a person’s life and even lead to death.

Angina pectoris(angina pectoris) represents pain syndrome, which usually occurs after intense physical activity. Also, angina pectoris can appear against the background of psycho-emotional stress or after eating. Angina pectoris can manifest itself not only as pain in chest, but also a feeling of discomfort in the chest. The pain can usually spread ( radiate) V left hand, between the shoulder blades, in the neck or in lower jaw. The duration of pain during angina pectoris does not exceed 15 minutes. It is worth noting that angina pectoris can lead to myocardial infarction due to damage to the coronary arteries of the heart.

Atrioventricular heart block is one of the types of heart block, in which there is a disruption in the conduction of impulses from the atria of the heart to the ventricles. Atrioventricular block most often leads to heart rhythm disturbances. It is worth noting that there are three degrees of atrioventricular node blockade. Improper intravenous administration of verapamil can cause third degree atrioventricular block, which is characterized by a decrease in heart rate to 20 or lower. Complete atrioventricular block ( lack of conduction of electrical impulses to the ventricles) leads to complete cardiac arrest and death.

Asystole represents a complete cessation of cardiac activity. Ventricular asystole causes cardiac arrest in approximately 3–5% of cases.

Allergic manifestations

Drug allergies can occur to almost any drug. Usually, drug allergy manifested by the appearance of skin rash and itching.

When taking verapamil, the following allergic manifestations may occur:

• Stevens-Johnson syndrome.

Hives characterized by the appearance on skin itchy blisters ( skin rash). This form an allergic reaction occurs due to the release large quantities histamine ( allergic reaction mediator), which is involved in increasing the permeability of the vascular wall of capillaries ( small vessels), which leads to swelling of the surrounding tissues. The skin rash is most often symmetrical in nature and resembles blisters from a nettle burn. After stopping the medication, the skin rash completely disappears.

Stevens–Johnson syndrome, or erythema malignant exudative, is a fairly serious allergic reaction. This syndrome manifests itself on the skin and mucous membranes of the eyes, oral cavity, pharynx, genitals pinkish-red bubbles ( papules), which can have different sizes ( from a few millimeters to several centimeters). The skin most often affected is the forearms, hands, feet, legs and face. After opening these papules, severely painful bleeding areas remain on the mucous membranes and skin. It should be noted that this type skin rash accompanied by severe itching. Also, Stevens-Johnson syndrome is often accompanied by fever, headache, and joint pain.

Disorders of the central and peripheral nervous system

A decrease in heart rate inevitably leads to oxygen starvation brain. Nerve cells (neurons) are very sensitive to the lack of oxygen, which is necessary for their normal functioning. When the pumping function of the heart decreases arterial blood doesn't nourish enough nerve tissue brain, which can lead to various violations and pathological conditions.
bleeding, pain, and swelling of the gums. Hyperplasia occurs due to disruption of the release of calcium from the gum tissue, which subsequently leads to poor circulation. Ultimately, functional gum tissue is replaced by connective tissue (collagen).

Constipation occurs most often when long-term use verapamil. As a rule, constipation is atonic in nature, which is characterized by a decrease in intestinal muscle tone. Stopping taking verapamil in the vast majority of cases normalizes intestinal function.

Increased liver tests occurs due to the fact that verapamil is metabolized in the liver. Decomposition products this drug can disrupt the normal functioning of liver cells ( hepatocytes). As a result, various enzymes enter the blood from hepatocytes ( alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase), which normally should practically not penetrate into the bloodstream.

Approximate cost of the medicine

Verapamil and its analogues can be found in almost any city Russian Federation. Depending on the form of release, the price of this medication may vary slightly.

Average cost of verapamil

City	Average cost of medicine
	Pills	Long-acting tablets	Solution for intravenous administration
Moscow	21 ruble	142 rubles	23 rubles
Kazan	20 rubles	140 rubles	21 ruble
Krasnoyarsk	20 rubles	138 rubles	20 rubles
Samara	19 rubles	137 rubles	20 rubles
Tyumen	22 rubles	142 rubles	24 rubles
Chelyabinsk	24 rubles	145 rubles	26 rubles

Formula: C27H38N2O4, chemical name: alpha-methylamino]propyl]-3,4-dimethoxy-alpha-(1-methylethyl)benzeneacetonitrile (and as hydrochloride).
Pharmacological group: organotropic drugs/cardiovascular drugs/selective class 1 calcium channel blockers/diphenylalkylamine derivative.
Pharmachologic effect: antiarrhythmic, hypotensive, antianginal.

Pharmacological properties

Verapamil has a blocking effect on calcium channels (acts with inside cell membranes) and reduces transmembrane calcium current. The degree of interaction with the channel is determined by the level of membrane depolarization: verapamil most effectively blocks open channels of a depolarized membrane. Has less effect on closed channels with a polarized membrane, preventing their activation. It has a slight effect on alpha-adrenergic receptors and sodium channels. Verapamil reduces contractility, conduction velocity in the AV node, pacemaker frequency in the sinus node, AV and sinoatrial conduction, total peripheral vascular resistance, afterload, causes peripheral vasodilation, relaxes smooth muscles (mainly in arterioles, less in veins). Increases myocardial perfusion, reduces the difference between the supply and the heart's need for oxygen, promotes the reverse development of left ventricular hypertrophy, and reduces blood pressure. Removes spasms of the coronary arteries during angina and prevents their development. In patients with uncomplicated hypertrophic cardiomyopathy improves blood flow from the ventricles. Reduces the severity and frequency of headaches vascular origin. Verapamil inhibits neuromuscular transmission in pseudohypertrophic Duchenne myopathy and prolongs the recovery period after using vecuronium. Blocks the P170 enzyme in vitro and partially eliminates immunity cancer cells to chemotherapy drugs. After oral administration of verapamil, more than 90% of the drug dose is absorbed, but bioavailability is only 20–35% due to first-pass metabolism in the liver; bioavailability increases with prolonged use in large doses. The maximum concentration is achieved after 1 - 2 hours for tablets, after 5 - 7 hours for extended-release tablets, after 7 - 9 hours for extended-release capsules. 90% bound to plasma proteins. In the liver, verapamil is metabolized to form norverapamil, which has 20% of the antihypertensive activity of verapamil, and other metabolites (which are determined in small quantities). The half-life when using a single dose orally is 2.8-7.4 hours, with repeated doses - 4.5-12 hours (due to saturation of the liver enzyme systems). When administered intravenously, the half-life has two phases: early - approximately 4 minutes, late - 2-5 hours. When taken orally, the onset of effects is noted after 1–2 hours. When administered intravenously, the antiarrhythmic effect develops within 1–5 minutes (usually less than 2 minutes), hemodynamic effects within 3–5 minutes. The duration of effects is 8–10 hours for tablets or 24 hours for extended-release tablets and capsules. When administered intravenously, the antiarrhythmic effect lasts about 2 hours, the hemodynamic effect lasts 10–20 minutes. Excreted mainly by the kidneys, about 16% in feces.
Verapamil passes into breast milk and through the placenta, and is determined during childbirth in the blood of the umbilical vein. Rapid intravenous administration causes maternal hypotension, which leads to fetal distress.
With prolonged use, clearance decreases and bioavailability increases. In severe liver dysfunction, plasma clearance is reduced by 70% and the half-life increases to 14–16 hours. According to the results obtained in 2-year experiments on rats using doses that are 12 times higher than the MRDC, and in Ames bacterial tests, verapamil does not have mutagenic or carcinogenic activity. In experiments on rats in doses that are 6 times higher than those recommended for humans, verapamil inhibits fetal growth and increases the incidence of intrauterine fetal death.

Indications

Supraventricular paroxysmal tachycardia (with the exception of WPW syndrome), atrial extrasystole, sinus tachycardia, atrial flutter and fibrillation, angina pectoris (including exertional angina, Prinzmetal, post-infarction), arterial hypertension, hypertrophic idiopathic subaortic stenosis, hypertensive crisis, hypertrophic cardiomyopathy.

Method of administration of verapamil and dose

Use of verapamil orally. The duration of treatment and dosage regimen are set individually and depend on the patient’s condition, the particular course and severity of the disease, and the effectiveness of treatment. For the prevention of arrhythmia, angina pectoris and for the treatment of arterial hypertension, adults are prescribed an initial dose of 40–80 mg 3–4 times a day (for prolonged forms, the frequency of administration is reduced), with a small amount of water before meals. If necessary, the single dose can be increased to 120–160 mg. The maximum daily dose is 480 mg. In patients with severe liver dysfunction, the elimination of verapamil is slow, so it is better to start therapy with minimal doses; the daily dose should be no more than 120 mg. Use of verapamil intravenously. Administer slowly: the initial dose for adults is 5–10 mg (administer for at least 2 minutes) under the control of ECG, pulse rate, blood pressure; if the effectiveness is insufficient, it is possible to repeat the administration after half an hour at a dose of 10 mg. Children under 1 year of age for at least 2 minutes 0.1–0.2 mcg/kg (usually a single dose of 0.75–2 mg), children 1–15 years of age for at least 2 minutes 0.1–0.3 mg/kg (usually a single dose is not more than 2–5 mg). In case of hypertensive crisis, 5-10 mg is administered slowly intravenously.
If you miss the next dose of verapamil, do it when you remember. next appointment produce through set time from last use.
Use cautiously in patients with hypertrophic cardiomyopathy that is complicated high pressure jamming in the pulmonary capillaries, left ventricular obstruction, orthopnea or paroxysmal nocturnal dyspnea, disruption of the sinoatrial node. When used in patients with severe impairment of neuromuscular transmission (Duchenne myopathy) and liver function, constant monitoring by a physician and, possibly, a reduction in the dose of the drug are required. Use with caution by drivers during work and people whose professions involve high concentration of attention (as verapamil reduces reaction speed). During therapy with verapamil, it is recommended to avoid alcohol intake. Injection form verapamil may precipitate in solution with a pH greater than 6.0.

Contraindications for use

Hypersensitivity, cardiogenic shock, severe hypotension (systolic blood pressure less than 90 mm Hg), AV block 3 and 2 degrees, severe bradycardia (pulse rate less than 50 beats/min), myocardial infarction (recent or acute and complicated by bradycardia , hypotension, left ventricular failure), chronic heart failure stage 3, atrial fibrillation and flutter and Lown-Ganong-Levine syndrome (except for patients with a pacemaker) or WPW syndrome, sick sinus syndrome (if there is no pacemaker), Morgagni-Adams syndrome - Stokes, sinoatrial block, digitalis intoxication, pregnancy, severe aortic stenosis, breastfeeding.

Restrictions on the use of verapamil

1st degree AV block, mild or moderate hypotension, chronic heart failure stages 2 and 1, severe myopathy (Duchenne syndrome), hepatic and/or renal failure, for intravenous administration, ventricular tachycardia with a wide QRS complex.

Use during pregnancy and breastfeeding

The use of verapamil is contraindicated during pregnancy and breastfeeding.

Side effects of verapamil

Digestive system: nausea, dyspepsia, constipation, rarely - increased activity of alkaline phosphatase and liver transaminases, gum hyperplasia;
nervous system: headache, nervousness, dizziness, lethargy, weakness, drowsiness, paresthesia, fatigue; allergic reactions: skin rash and itching, urticaria, rarely - Stevens-Johnson syndrome, angioedema;
circulatory system: sinus bradycardia, arterial hypotension, AV block, at high doses – the appearance of symptoms of heart failure;
others: bronchospasm (when administered intravenously), peripheral edema, facial skin flushing, very rarely - gynecomastia, increased secretion of prolactin (in some cases).

Interaction of verapamil with other substances

Increases plasma concentrations of digoxin, theophylline, cyclosporine, carbamazepine, and reduces lithium preparations. Reduces the antibacterial activity of rifampicin, the depressant effects of phenobarbital, reduces the clearance of propranolol and metoprolol, and increases the effects of muscle relaxants. Rifampicin, phenobarbital, sulfinpyrazone, vitamin D, calcium salts - reduce the effect of verapamil. The hypotensive property is increased by antihypertensive drugs (vasodilators, diuretics), tetracyclic and tricyclic antidepressants, antipsychotics; the antianginal effect is increased by nitrates. Beta-blockers, cardiac glycosides, class IA antiarrhythmics, radiopaque agents, and inhalational anesthetics mutually potentiate the inhibitory effect on AV conduction, automatism of the sinoatrial node and myocardial contractility. When verapamil is used together with acetylsalicylic acid, existing bleeding increases. Cimetidine increases plasma levels of verapamil.

Overdose

An overdose of verapamil causes arterial hypotension, AV block, bradycardia, coma, cardiogenic shock, and asystole. Administration of calcium gluconate (10–20 ml of 10% solution intravenously) is required as a specific antidote; for AV block and bradycardia, atropine, orciprenaline or isoprenaline are administered; for hypotension - dopamine, plasma-substituting solutions, norepinephrine; when signs of heart failure appear - dobutamine.

In this article you can find instructions for use medicinal product Verapamil. Feedback from site visitors - consumers - is presented of this medicine, as well as the opinions of specialist doctors on the use of Verapamil in their practice. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Verapamil, if available structural analogues. Use for the treatment of heart rhythm disorders in adults, children, as well as during pregnancy and lactation.

Verapamil- belongs to the group of blockers of “slow” calcium channels. It has antiarrhythmic, antianginal and antihypertensive activity.

Reduces myocardial oxygen demand by reducing myocardial contractility and reducing heart rate. Causes expansion of the coronary vessels of the heart and increases coronary blood flow; reduces the tone of smooth muscles of peripheral arteries and total peripheral vascular resistance.

Verapamil significantly slows down atrioventricular conduction and inhibits the automatism of the sinus node, which allows the drug to be used for the treatment of supraventricular arrhythmias.

It has an effect in angina pectoris, as well as in the treatment of angina pectoris with supraventricular rhythm disturbances. Suppresses metabolism involving cytochrome P450.

Compound

Verapamil hydrochloride + excipients.

Pharmacokinetics

Binds to plasma proteins by 90%. Penetrates through the blood-brain and placental barrier and into breast milk (in small quantities). Rapidly metabolized in the liver by N-dealkylation and O-demethylation to form several metabolites. The accumulation of the drug and its metabolites in the body explains the increased effect during a course of treatment. Excreted by the kidneys 70% (unchanged 3-5%), with bile 25%.

Indications

Treatment and prevention of heart rhythm disorders:

• paroxysmal supraventricular tachycardia;
• atrial flutter and fibrillation (tachyarrhythmic variant);
• supraventricular extrasystole.

Treatment and prevention:

• chronic stable angina (angina pectoris);
• unstable angina;
• vasospastic angina (Prinzmetal's angina);

Treatment of arterial hypertension.

Release forms

Film-coated tablets and dragees 40 mg and 80 mg.

Film-coated tablets, prolonged release 240 mg.

Solution for intravenous administration (injections in injection ampoules).

Instructions for use and dosage

Pills

Verapamil is taken orally during or after meals with a small amount of water.

The dosage regimen and duration of treatment are established individually depending on the patient’s condition, severity, characteristics of the course of the disease and the effectiveness of therapy.

To prevent attacks of angina pectoris, arrhythmia and in the treatment of arterial hypertension, the drug is prescribed to adults at an initial dose of 40-80 mg 3-4 times a day. If necessary, increase the single dose to 120-160 mg. The maximum daily dose of the drug is 480 mg.

In patients with severe liver dysfunction, the elimination of verapamil from the body is slow, so it is advisable to start treatment with minimal doses. The daily dose of the drug should not exceed 120 mg.

Ampoules

Administer intravenously (as a drip) slowly over at least 2 minutes, with continuous monitoring of the electrocardiogram, heart rate and blood pressure. In elderly patients, administration is carried out over at least 3 minutes to reduce the risk of unwanted effects.

For cupping paroxysmal disorders heart rhythm is administered intravenously, in a stream (under ECG and blood pressure control) 2-4 ml of a 0.25% solution (5-10 mg). If there is no effect, repeated administration after 30 minutes at the same dose is possible. A verapamil solution is prepared by diluting 2 ml of a 0.25% solution of the drug in 100-150 ml of a 0.9% sodium chloride solution.

Side effect

• severe bradycardia (at least 50 beats/min);
• pronounced decrease in blood pressure;
• development or worsening of heart failure;
• tachycardia;
• possible development of angina, up to myocardial infarction (especially in patients with severe obstructive lesions of the coronary arteries);
• arrhythmias (including ventricular fibrillation and flutter);
• 3rd degree atrioventricular block;
• asystole;
• collapse;
• dizziness;
• headache;
• fainting;
• anxiety;
• lethargy;
• increased fatigue;
• asthenia;
• drowsiness;
• depression;
• extrapyramidal disorders;
• nausea;
• skin itching;
• rash;
• facial skin hyperemia;
• exudative erythema multiforme (including Stevens-Johnson syndrome);
• transient loss of vision against the background of maximum concentration;
• pulmonary edema;
• thrombocytopenia asymptomatic;
• peripheral edema (swelling of the ankles, feet and legs).

Contraindications

• chronic heart failure grade 2B-3;
• arterial hypotension;
• acute myocardial infarction;
• sinoatrial block;
• sick sinus syndrome;
• aortic stenosis;
• Morgagni-Adams-Stokes syndrome;
• digitalis intoxication;
• atrioventricular block 2 and 3 degrees;
• ventricular tachycardia;
• cardiogenic shock;
• Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome in combination with atrial flutter or fibrillation (except for patients with a pacemaker);
• porphyria;
• pregnancy;
• lactation period;
• parenteral administration of any beta-blocker within the previous 2 hours,
• age under 18 years (efficacy and safety have not been established);
• hypersensitivity to the components of the drug.

Use during pregnancy and breastfeeding

Contraindicated during pregnancy and lactation.

special instructions

During treatment, monitoring of cardiovascular and respiratory systems, the content of glucose and electrolytes in the blood, the volume of circulating blood and the amount of urine excreted. May prolong the PQ interval at plasma concentrations above 30 ng/ml. It is not recommended to stop treatment suddenly.

Impact on the ability to drive vehicles and operate machinery

Use with caution when working for drivers Vehicle and people whose profession is associated with increased concentration (reaction speed decreases).

Drug interactions

Increases the blood concentration of digoxin, theophylline, prazosin, cyclosporine, carbamazepine, muscle relaxants, quinidine, valproic acid due to suppression of metabolism involving cytochrome P450.

Cimetidine increases the bioavailability of verapamil by almost 40% (by reducing metabolism in the liver), and therefore, it may be necessary to reduce the dose of the latter.

Calcium supplements reduce the effectiveness of verapamil. Rifampicin, barbiturates, nicotine, accelerating metabolism in the liver, lead to a decrease in the concentration of verapamil in the blood, reducing the severity of antianginal, hypotensive and antiarrhythmic effects.

When used simultaneously with inhalational anesthetics the risk of developing bradycardia, atrioventricular block, and heart failure increases. Procainamide, quinidine, and other drugs that prolong the QT interval increase the risk of significant prolongation of the QT interval.

Combination with beta-blockers can lead to increased negative inotropic effect, increasing the risk of developing atrioventricular conduction disorders, bradycardia (administration of verapamil and beta-blockers must be carried out at intervals of several hours).

Prazosin and other alpha-blockers enhance the hypotensive effect. Nonsteroidal anti-inflammatory drugs reduce the hypotensive effect due to suppression of prostaglandin synthesis, retention of sodium ions and fluid in the body.

Increases the concentration of cardiac glycosides (requires careful monitoring and reduction in the dose of cardiac glycosides).

Sympathomimetics reduce the hypotensive effect of verapamil.

Disopyramide and flecainide should not be administered within 48 hours before and 24 hours after the use of verapamil (summation of negative inotropic effects, including death).

Estrogens reduce the hypotensive effect due to fluid retention in the body. Possible increase in plasma concentrations medicines, characterized high degree protein binding (including coumarin and indanedione derivatives, non-steroidal anti-inflammatory drugs, quinine, salicylates, sulfinpyrazone).

Medicines that lower blood pressure enhance the hypotensive effect of verapamil.

Increases the risk of the neurotoxic effect of lithium preparations. Enhances the activity of peripheral muscle relaxants (may require a change in dosage regimen).

Analogues of the drug Verapamil

Structural analogues of the active substance:

• Veracard;
• Verapamil Mival;
• Verapamil Sopharma;
• Verapamil Lect;
• Verapamil ratiopharm;
• Verapamil Eskom;
• Verapamil hydrochloride solution for injection 0.25%;
• Vero Verapamil;
• Verogalide EP 240 mg;
• Isoptin;
• Isoptin SR 240;
• Kaveril;
• Lekoptin;
• Finoptin.

Composition and release form

in blister packs 10, 15 or 25 pcs.; in a cardboard pack 1, 2, 3, 4, 5 and 10 pcs.; or in PE cans of 30, 50 or 100 pcs.; in a cardboard pack 1 jar.

Characteristic

Verapamil is one of the main drugs in the BCC group.

pharmachologic effect

pharmachologic effect- antihypertensive, antianginal, antiarrhythmic.

Pharmacodynamics

The drug reduces myocardial oxygen demand by reducing myocardial contractility and reducing heart rate. Causes expansion of the coronary vessels of the heart and increases coronary blood flow; reduces the tone of smooth muscles of peripheral arteries and peripheral vascular resistance.

Verapamil significantly slows down AV conduction and inhibits the automatism of the sinus node, which allows the drug to be used for the treatment of supraventricular arrhythmias.

Verapamil is the drug of choice for the treatment of angina of vasospastic origin (Prinzmetal's angina). It has an effect in angina pectoris, as well as in the treatment of angina pectoris with supraventricular rhythm disturbances.

Pharmacokinetics

When taken orally, more than 90% of the dose taken is absorbed. It is metabolized during the “first pass” through the liver. Protein binding 90%. T1/2 when taking a single dose - 2.8-7.4 hours; when taking repeated doses - 4.5-12 hours. Excreted mainly by the kidneys and 9-16% through the intestines. The main metabolite is norverapamil, which has less pronounced hypotensive activity than unchanged verapamil.

Indications for the drug Verapamil

treatment and prevention of heart rhythm disorders: paroxysmal supraventricular tachycardia, atrial flutter and fibrillation (tachyarrhythmic variant), supraventricular extrasystole;

treatment and prevention of angina: chronic stable angina (angina pectoris), unstable angina(angina at rest), vasospastic angina (Prinzmetal's angina, variant angina);

treatment of arterial hypertension.

Contraindications

hypersensitivity to the components of the drug;

severe bradycardia;

chronic heart failure stage IIB-III;

cardiogenic shock (except caused by arrhythmia);

sinoatrial block;

AV block II and III degrees (excluding patients with an artificial pacemaker);

sick sinus syndrome;

Wolff-Parkinson-White syndrome;

Morgagni-Adams-Stokes syndrome;

acute heart failure;

simultaneous use of beta-blockers intravenously;

children under 18 years of age.

Use during pregnancy and breastfeeding

The use of verapamil during pregnancy is possible only if the expected benefit to the mother exceeds potential risk for the fetus.

If it is necessary to use the drug during breastfeeding, it should be taken into account that verapamil is released from breast milk, That's why breast-feeding needs to stop.

Side effects

When using Verapamil the following are possible:

From the cardiovascular system: facial flushing, severe bradycardia, AV block, arterial hypotension, the appearance of symptoms of heart failure when using the drug in high doses, especially in predisposed patients.

From the gastrointestinal tract: nausea, vomiting, constipation; in some cases - a transient increase in the activity of liver transaminases in the blood plasma;

From the side of the central nervous system: dizziness, headache, in rare cases - increased nervous excitability, lethargy, increased fatigue.

Allergic reactions: skin rash, itching.

Others: development of peripheral edema.

Interaction

With simultaneous use of Verapamil:

with antiarrhythmic drugs, beta-blockers and inhalational anesthetics, an increased cardiodepressive effect is observed (increased risk of AV blockade, sharp decline Heart rate, development of heart failure, sharp drop in blood pressure);

with antihypertensive drugs and diuretics - the hypotensive effect of verapamil may be enhanced;

with digoxin - it is possible to increase the concentration of digoxin in the blood plasma due to a deterioration in its excretion by the kidneys (therefore, it is necessary to monitor the level of digoxin in the blood plasma in order to identify its optimal dosage and prevent intoxication);

with cimetidine and ranitidine - the concentration of verapamil in the blood plasma increases;

with rifampicin, phenobarbital - a decrease in plasma concentrations and a weakening of the effect of verapamil are possible;

with theophylline, prazosin, cyclosporine - it is possible to increase the concentration of these substances in the blood plasma;

with muscle relaxants - the muscle relaxant effect may be enhanced;

with acetylsalicylic acid - the likelihood of bleeding increases;

with quinidine - the concentration of quinidine in the blood plasma increases, the threat of a decrease in blood pressure increases, and in patients with hypertrophic cardiomyopathy, severe arterial hypotension may occur;

with carbamazepine and lithium - the risk of neurotoxic effects increases.

Directions for use and doses

Inside, during or after meals, with a small amount of water.

The dosage regimen and duration of treatment are established individually depending on the patient’s condition, severity, characteristics of the course of the disease and the effectiveness of therapy.

To prevent attacks of angina pectoris, arrhythmia and in the treatment of arterial hypertension, the drug is prescribed to adults at an initial dose of 40-80 mg 3-4 times a day. If necessary, increase the single dose to 120-160 mg.

The maximum daily dose is 480 mg.

In patients with severe liver dysfunction, the elimination of Verapamil from the body is slow, so it is advisable to start treatment with minimal doses. The daily dose of the drug should not exceed 120 mg.

Overdose

Symptoms: large doses (taking up to 6 g of the drug) can cause deep depression of consciousness, arterial hypotension, sinus bradycardia, turning into AV block, sometimes asystole.

Treatment: if arterial hypotension and/or complete AV block occurs, intravenous administration of fluid, dopamine (dopamine), calcium gluconate, isoproterenol or norepinephrine. Treatment is symptomatic and depends on clinical picture overdose. Hemodialysis is not effective.

special instructions

It is necessary to prescribe the drug with caution to patients with AV blockade of the first degree, chronic heart failure of the first and second degrees, arterial hypotension(garden<100 мм рт. ст. ), брадикардией, выраженными нарушениями функции печени.

During treatment, it is necessary to monitor the function of the cardiovascular and respiratory systems, the level of sugar and electrolytes in the blood, the volume of blood volume and the amount of urine excreted.

Storage conditions for the drug Verapamil

In a dry place, at a temperature not exceeding 25 °C.

Keep out of the reach of children.

Shelf life of the drug Verapamil

3 years.

Do not use after the expiration date stated on the package.

Instructions for medical use

Synonyms of nosological groups

Category ICD-10	Synonyms of diseases according to ICD-10
I10 Essential (primary) hypertension	Arterial hypertension
	Arterial hypertension
	Arterial hypertension
	Sudden increase in blood pressure
	Hypertensive state
	Hypertensive crises
	Hypertension
	Arterial hypertension
	Hypertension is malignant
	Essential hypertension
	Hypertonic disease
	Hypertensive crises
	Hypertensive crisis
	Hypertension
	Malignant hypertension
	Malignant hypertension
	Isolated systolic hypertension
	Hypertensive crisis
	Primary arterial hypertension
	Essential arterial hypertension
	Essential arterial hypertension
	Essential hypertension
	Essential hypertension
I15 Secondary hypertension	Arterial hypertension
	Arterial hypertension
	Arterial hypertension of crisis course
	Arterial hypertension complicated by diabetes mellitus
	Arterial hypertension
	Vasorenal hypertension
	Sudden increase in blood pressure
	Hypertensive circulatory disorder
	Hypertensive state
	Hypertensive crises
	Hypertension
	Arterial hypertension
	Hypertension is malignant
	Hypertension, symptomatic
	Hypertensive crises
	Hypertensive crisis
	Hypertension
	Malignant hypertension
	Malignant hypertension
	Hypertensive crisis
	Exacerbation of hypertension
	Renal hypertension
	Renovascular arterial hypertension
	Renovascular hypertension
	Symptomatic arterial hypertension
	Transient arterial hypertension
I20 Angina pectoris [angina pectoris]	Heberden's disease
	Angina pectoris
	Angina attack
	Recurrent angina
	Spontaneous angina
	Stable angina
	Angina syndrome X
	Angina pectoris
	Angina (attack)
	Angina pectoris
	Angina at rest
	Angina pectoris progressive
	Mixed angina
	Angina pectoris spontaneous
	Angina pectoris stable
	Chronic stable angina
I20.0 Unstable angina	Heberden's disease
	Unstable angina
	Unstable angina
I20.1 Angina pectoris with documented spasm	Heberden's disease
	Vasospastic angina
	Prinzmetal's vasospastic angina
	Variant angina
	Cardiospasm
	Coronary spasm
	Coronarospastic angina of Prinzmetal
	Prinzmetal angina
	Spasm of the coronary arteries
	Spasm of coronary vessels
	Coronarospastic angina
	Prinzmetal's angina
I20.8 Other forms of angina	Spontaneous angina
	Stable exertional angina
	Stable angina at rest
	Angina syndrome X
	Angina pectoris progressive
	Angina pectoris spontaneous
I25 Chronic ischemic heart disease	Coronary heart disease due to hypercholesterolemia
	Chronic ischemic heart disease
	Myocardial ischemia in arteriosclerosis
	Recurrent myocardial ischemia
	Coronary heart disease
	Stable ischemic heart disease
	Percutaneous transluminal angioplasty
I25.2 Previous myocardial infarction	Cardiac syndrome
	Previous myocardial infarction
	Post-infarction cardiosclerosis
	Post-infarction period
	Rehabilitation after myocardial infarction
	Reocclusion of the operated vessel
	Condition after myocardial infarction
	Condition after myocardial infarction
	Angina pectoris post-infarction
I42.1 Obstructive hypertrophic cardiomyopathy	Asymmetric hypertrophy of the interventricular septum
	Hypertrophic cardiomyopathy
	Hypertrophic obstructive cardiomyopathy
	Myocardial hypertrophy with obstruction
	Hypertrophic obstructive cardiomyopathy
	Obliterative restrictive cardiomyopathy
I47.1 Supraventricular tachycardia	Supraventricular paroxysmal tachycardia
	Supraventricular tachyarrhythmia
	Supraventricular tachycardia
	Supraventricular arrhythmias
	Supraventricular paroxysmal tachycardia
	Supraventricular tachyarrhythmias
	Supraventricular tachycardia
	Neurogenic sinus tachycardia
	Orthodromic tachycardia
	Paroxysmal supraventricular tachycardia
	Paroxysm of supraventricular tachycardia
	Paroxysm of supraventricular tachycardia in WPW syndrome
	Paroxysm of atrial tachycardia
	Paroxysmal supraventricular tachyarrhythmia
	Paroxysmal supraventricular tachycardia
	Polytopic atrial tachycardia
	Atrial arrhythmia
	Atrial true tachycardia
	Atrial tachycardia
	Atrial tachycardia with AV block
	Reperfusion arrhythmia
	Berzold-Jarisch reflex
	Recurrent sustained supraventricular paroxysmal tachycardia
	Symptomatic ventricular tachycardias
	Wolff-Parkinson-White syndrome
	Sinus tachycardia
	Supraventricular paroxysmal tachycardia
	Supraventricular extrasystole
	Supraventricular arrhythmias
	Tachycardia from AV junction
	Supraventricular tachycardia
	Tachycardia orthodromic
	Sinus tachycardia
	Junctional tachycardia
	Chaotic polytopic atrial tachycardia
I47.2 Ventricular tachycardia	Ventricular arrhythmia
	Ventricular paroxysmal tachycardia
	Ventricular tachyarrhythmia
	Ventricular tachycardia
	Paroxysmal bidirectional fusiform ventricular tachycardia
	Paroxysmal ventricular tachycardia
	Torsade de pointes (torsade de pointes)
	Torsades de pointes in myocardial infarction
	Symptomatic ventricular tachycardia
	Ventricular tachycardia
	Life-threatening ventricular arrhythmia
	Sustained ventricular tachycardia
	Sustained monomorphic ventricular tachycardia
I48 Atrial fibrillation and flutter	Stopping rapid ventricular rhythm during atrial fibrillation or flutter
	Atrial fibrillation
	Supraventricular arrhythmia
	Paroxysm of atrial fibrillation and flutter
	Paroxysm of atrial fibrillation
	Paroxysmal form of atrial fibrillation and flutter
	Paroxysmal atrial fibrillation and flutter
	Paroxysmal atrial fibrillation
	Permanent form of atrial fibrillation
	Atrial extrasystole
	Atrial extrasystoles
	Tachyarrhythmic form of atrial fibrillation
	Tachysystolic form of atrial fibrillation
	Atrial flutter
	Life-threatening ventricular fibrillation
	Atrial fibrillation
	Chronic atrial fibrillation
I49.1 Premature atrial depolarization	Supraventricular arrhythmia
	Supraventricular arrhythmia
	Supraventricular extrasystole
	Supraventricular arrhythmias
	Supraventricular extrasystoles
	Extrasystole supraventricular
	Atrial extrasystole
I49.4 Other and unspecified premature depolarization	Extrasystolic arrhythmia
	Extrasystole
	Extrasystole, unspecified
I49.9 Heart rhythm disorder, unspecified	AV reentrant tachycardia
	AV nodal reentrant tachycardia
	Antidromic reentrant tachycardia
	Arrhythmias
	Arrhythmia
	Heart arythmy
	Arrhythmia due to hypokalemia
	Ventricular arrhythmia
	Ventricular tachyarrhythmia
	High frequency of ventricular contraction
	Atrial fibrillation tachysystolic arrhythmia
	Heart rhythm disturbance
	Heart rhythm disturbances
	Heart rhythm disturbances
	Paroxysmal supraventricular arrhythmia
	Paroxysmal supraventricular arrhythmia
	Paroxysmal supraventricular tachycardia
	Paroxysmal rhythm disorder
	Paroxysmal atrioventricular rhythm
	Precordial pathological pulsation
	Cardiac arrhythmias
	Supraventricular tachyarrhythmia
	Supraventricular tachycardia
	Supraventricular arrhythmias
	Tachyarrhythmia
	Extrasystolic arrhythmia
R07.2 Pain in the heart area	Pain syndrome during myocardial infarction
	Pain in cardiac patients
	Cardialgia
	Cardialgia against the background of dyshormonal myocardial dystrophy
	Cardiac syndrome
	Cardioneurosis
	Myocardial ischemic pain
	Neuroses of the heart
	Pericardial pain
	Pseudoangina
	Functional cardialgia