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At the stage of heart disease treatment, it is absolutely essential to choose the most effective drug in terms of matching the spectrum of its impact and the nature of the arrhythmia. At the same time the medication must be as safe as possible. At the conclusion of the European Society of Cardiology, the closest to the ideal antiarrhythmic drug is Cordarone.
Cordarone pharmacological action
Cordarone advantages over other antiarrhythmic agents are represented not only by a combination of high antiarrhythmic efficacy with minimal iatrogenic proaritmogennoe act. Thus, due to the wide range of pharmacokinetic and pharmacodynamic effects Cordarone affects not only the function of the cardiovascular system, but also has metabolic effects, which distinguishes the therapeutic effect of the drug. Cordarone has a modulating effect on the activity of sympathetic nervous and renin-angiotensin-aldosterone system. This is one of the main factors that predefines the choice of the drug (an increased survival rate in congestive heart failure cases). Cordarone has no cardiodepressive action in patients with impaired left ventricular function of the heart. At the same time, the drug acts as a peripheral vasodilator, reducing systemic vascular resistance (due to a partial blockade of calcium channels.)
Cordarone indications for use
Improving the functional status of the left ventricle cannot be explained only by hemodynamic effects. The medication has a definite value of such factors as a positive effect on myocardial metabolism by:
• reducing the oxygen demand, partially due to antithyroid action and antioxidant properties;
• energy-saving effect in respect of the stocks of high-energy factors in the myocardium during ischemia and malnutrition;
• direct increase in coronary blood flow.
The possibility of using the preparation with digoxin and ACE inhibitors to press for potentiation of their favorable hemodynamic effects should also be considered. Reducing dystrophic and ischemic changes in myocardiocytes associated with an increase in exercise tolerance. Thus, the effects of therapeutic action allows considering the remedy as an important component in emergency and routine care of cardiac patients.
At the moment there are large amounts of data available on the use of a number of sections in Cordarone cardiology. It is known that about 10% of patients surviving after acute myocardial infarction (MI) die within the first year. The main factors of high risk of sudden death after myocardial infarction are ventricular arrhythmias and heart failure. Arrhythmia suppression with antiarrhythmics drugs (procainamide group) leads to a decrease in overall mortality.
Cordarone is the only antiarrhythmic drug that significantly improves survival in patients with high risk after myocardial infarction and heart failure. According to the summary data of 13 randomized controlled trials, Cordarone compared with the control group by 30% reduces the risk of arrhythmic death, and 13% - total mortality. At the same time there was a tendency to increase the efficiency cordarone in more severe cases.
The initial dosage is divided in several intakes and ranges from 600-800 mg/day to a maximum of 1200 mg/day to and a total dose of 10g (usually within 5-8 days).
Maintenance dosage equals 3 mg per kilo of weight each 24 hours, and varies within the range of from 100 to 400 mg/day in single dose. It should use the minimum effective dose in accordance with the individual therapeutic result. Since Cordarone has a very long half-life, it can be taken every second day (200 mg may be given every second day, and 100 mg daily is recommended to take); the medication may also be taken with continuous breaks. Please, consult your treating doctor before taking the preparation.
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