Betapace
Betapace
Betapace (Sotalol)Pharmacological action
Not selective beta adrenoblocker, operates on b1 - and b2-adrenoretseptory. The expressed antiarrhytmic an effect which mechanism consists in augmentation of duration of an action potential and elongation of the absolute refractory period in all sites of spending system of heart has. Reduces the CARDIAC CONTRACTIONS RATE slows down AV conductivity. Raises a tonus of a smooth musculation of bronchuses.
Indications
- A ventricular tachycardia;
- A supraventricular tachycardia at syndrome WPW;
- A ciliary arrhythmia.
Dosage regimen
The initial dose makes 80-120 mg/24h (parted on 2-3 receptions). At insufficient efficiency the dose can be raised to 160-240 mg/sut (in 2-3 receptions) or 320 mg/24h (in 2 receptions).
At serious tachyarrhythmias menacing to a life probably augmentation of a dose to 480 mg/24h, parted on 2-3 receptions.
The augmentation of a dose of a preparation should be spent with an interval in 2-3 days.
Tablets should be accepted not chewing, washing down with liquid enough.
Patients with disturbance of function of kidneys have a risk of development of a cumulation, therefore it is necessary to supervise a clearance of a creatinine and the CARDIAC CONTRACTIONS RATE (not below 50 blows in a minute)
At serious renal insufficiency it is necessary to carry out the regular control of an electrocardiogram and level of concentration of a preparation in blood serum.
Side effect
From cardiovascular system: a bradycardia, AV blockade, intensifying of symptoms of a heart failure, an arterial hypotension; in rare instances - intensifying of attacks of a stenocardia.
From the alimentary system: a nausea, a diarrhoeia, a constipation, dryness in a mouth.
From party TSNS and peripheric nervous system: the headache, giddiness, undue fatigability, drowsiness, paresthesias, dream disturbance, depression are possible; extremely seldom - visual acuity disturbance, a cornea and conjunctiva inflammation (it is necessary to consider at wearing of contact lenses).
From respiratory system: a bronchospasm (especially at disturbance of pulmonary ventilation).
Dermatological reactions: a dermal eruption, reddening, an alopecia.
Allergic reactions: seldom - a dermal eruption, an itch.
The other: a hypoglycaemia (it is the most probable at patients with a diabetes, or at diet strict observance), potency depression, a cold snap of extremities, muscular delicacy, cramps.
Contraindications
- Chronic heart failure IIB-III of a stage;
- A cardiogenic shock;
- AV blockade II or III degrees;
- Sinuatrial blockade
- A sick sinus syndrome;
- A bradycardia;
- Presence of extended interval QT;
- An arterial hypotension;
- Obliterating diseases of vessels;
- Obstructive diseases of lungs (including a bronchial asthma);
- A metabolic acidosis;
- An acute myocardial infarction;
- A hypopotassemia;
- A larynx edema;
- A myasthenia;
- A serious allergic rhinitis;
Pregnancy and lactemia
Betapace reception at pregnancy, especially in I trimester, is possible only under strict medical indications.
In case of therapy carrying out at pregnancy, preparation reception should be cancelled for 48-72 h to prospective term of sorts because of possibility of risk of development of a bradycardia, an arterial hypotension, a hypopotassemia and a respiratory depression at newborns.
Betapace gets into thoracal milk and reaches there effective concentration. In this connection it is necessary to supervise a condition of children who are on thoracal feeding.
Special indicatings
With care it is necessary to prescribe Betapace to patients with a diabetes (having in the anamnesis the expressed fluctuations of level of a glucose in blood); to patients at diet strict observance; at a pheochromocytoma (simultaneous appointment of alpha adrenoblockers is necessary); at presence in the anamnesis or the family anamnesis of a psoriasis; at disturbance of function of kidneys; to patients of advanced age.
With extra care Betapace apply at indicatings in the anamnesis on allergic reactions, and also against carrying out of desensitizing therapy (since Betapace suppresses sensitivity to allergens).
Treatment by a preparation is spent under the CARDIAC CONTRACTIONS RATE control, by a BP, an electrocardiogram. At the expressed depression of a BP a daily dose should be reduced.
In case of cancellation of a preparation the dose should be reduced gradually.
At joint Betapace application and Clonidinum at first cancel Betapace, and in some days gradually start to reduce Clonidinum dose.
At simultaneous Betapace appointment with diuretics it is necessary to supervise periodically glucose level in blood.
Some days prior to narcosis carrying out it is necessary to stop Betapace reception Betapace or to pick up an anaesthetic drug with the minimum influence on ability of a myocardium.
In connection with presence at a preparation of antiarrhytmic effect, it is necessary to supervise possibility of elongation of interval QT, and if necessary, to spend individual selection of doses.
In Betapace treatment is necessary to avoid alcohol reception.
Influence on ability to driving of motor transport and to management of mechanisms
In treatment it is necessary to abstain from employment by potentially dangerous kinds of the activity demanding special attention and speed of psychomotor reactions.
Overdosage
Symptoms: an arterial hypotension, a bradycardia, a loss of consciousness, generalised convulsive attacks, ventricular tachycardias; in serious cases - a cardiogenic shock, an asystolia.
Treatment: a glucagon - at first in the form of short-term i.v. infusions in a dose of mass of a body of 0.2 mg/kg, then in a dose of mass of a body of 0.5 mg/kg (during 12).
Application of Dopaminum, Dobutaminum, adrenaline is possible.
Betapace is deduced by means of a hemodialysis.
Medicinal interaction
At simultaneous Betapace reception and blockers of calcium channels (verapamil) probably expressed depression of a BP as a result of deterioration of contractility of a myocardium.
Betapace application and Noradrenalinum or inhibitors MAO, and also fast cancellation of Clonidinum can cause an arterial hypertensia.
Tritsiklichesky antidepressants, barbiturates, narcotic and antihypertensive agents, diuretics can cause sharp depression of a BP.
Application of agents for an inhalation narcosis, and also a tubocurarine against Betapace reception raises risk of oppression of function of a myocardium and development of an arterial hypotension.
At simultaneous Betapace application with Reserpinum, Clonidinum, an alpha-metildopoj, warm glycosides probably development of the expressed bradycardia and retardation of carrying out of excitation in a myocardium.
Appointment of insulin or peroral antidiabetic agents, in particular, at an exercise stress, can lead to intensifying of a hypoglycaemia and implication of its symptoms (the raised sweating, the speeded up pulse, a tremor). At a diabetes correction of doses of insulin, and-or hypoglycemic preparations is necessary.
Diuretics (Furosemidum) can provoke occurrence of the arrhythmia caused by a hypopotassemia.
Conditions and periods of storage
The preparation should be stored at a room temperature. A period of validity - 5 years.
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