Monoket
Monoket
Monoket (Isosorbide-5-Mononitrate)Pharmacological action
Antianginal preparation, organic Sodium nitritum.
Stimulates formation nitrogen oxid in an endothelium of the pots, a consequence of that the cGMP augmentation is intracellular.
Reduces requirement of a myocardium for oxygen at the expense of preload and afterload depression (reduces final diastolic volume of a left ventricle and reduces a systolic strain of its sides). Possesses coronarodilator action.
Reduces blood inflow to the right auricle, promotes pressure decrease in a small circle of a circulation and regression of symptoms at a fluid lungs. Promotes redistribution of a coronary blood flow in range with the lowered circulation.
Raises tolerance to an exercise stress at ischemic heart disease patients, a stenocardia.
Dilates pots of a brain, a firm meninx that can be accompanied by a headache.
As well as to other Sodium nitritums, two-dimensional tolerance educes. After cancellation (a rest in treatment) sensitivity to it is quickly recovered.
Indications
- Preventive maintenance of attacks of a stenocardia at ischemic heart disease patients, including after the tolerated myocardial infarction;
- A chronic heart failure (as a part of the combined therapy).
Dosing regimen
Monoket prescribe in an initial dose of 20 mg 1-2 times/days Depending on expression of clinical effect about 3-5 days of therapy a dose it is possible to enlarge about 60 mg/days the Maximum daily dose - 80 mg.
Side effect
From cardiovascular system: a headache, giddiness, a transient dermahemia of the person, sensation of fever, a tachycardia, the expressed depression of a BP; seldom - intensifying of attacks of a stenocardia (paradoxical reaction), an orthostatic collapse.
From party TSNS: constraint, drowsiness, a sight illegibility, depression of ability to fast mental and to motor reactions (especially in the treatment beginning); in single instances - a brain ischemia, a syncope (a subitaneous loss of consciousness).
From the alimentary system: a nausea, vomiting, sensation of a burning sensation of tongue, dryness in a mouth.
The other: at constant continuous treatment with use Monosodium nitritum Isosorbidum in high doses tolerance development, and also tolerance appearance to other Sodium nitritums is described. For prevention of reduction or efficacyy loss it is necessary to avoid constant application of a preparation in high doses.
Contraindications
- An arterial hypotension and a hypovolemia (a systolic pressure below 100 mm hg, a diastolic pressure below 60 mm hg, the central venous pressure below 5 mm hg);
- Acute vascular insufficiency (a shock, a vascular collapse);
- A left ventricular failure with a low final diastolic pressure;
- An acute myocardial infarction with an arterial hypotension;
- A cardiac tamponade;
- A toxic fluid lungs;
- The diseases accompanied by rising of an intracranial pressure (including a hemorrhagic stroke, a craniocerebral trauma);
- An angle-closure glaucoma;
- An anaemia (the serious form);
- Deficiency gljukozo-6-fosfatdegidrogenazy;
- A hyperthyroidism;
- The lactemia season;
- Children's age till 18 years;
- Advanced age;
- Hypersensitivity to a preparation, organic Sodium nitritums.
With guard it is necessary to apply a preparation at an aortal and-or mitral stenosis, the tendency to orthostatic disturbances of vascular regulation, a chronic cardial compression, a hypertrophic cardiomyopathy (increase of attacks of a stenocardia is possible), the expressed renal insufficiency, hepatic insufficiency (risk of development of a methemoglobinemia).
Pregnancy and lactemia
Now there is no sufficient experience of application of a preparation at pregnancy and in a lactemia.
Preparation appointment at pregnancy is possible only in that case when the expected advantage of therapy for mother exceeds potential risk for a foetus.
Appointment of a preparation in a lactemia is contraindicative. In need of its appointment it is necessary to stop thoracal feeding.
The special indicatings
Monoket do not apply to cupping of attacks of a stenocardia.
In therapy the control of a BP and the CARDIAC CONTRACTIONS RATE is necessary.
At long Monoket application tolerance development in this connection recommend to do after 3-6 weeks of regular reception of a preparation a rest for 3-5 days is possible.
At Monoket reception the time anoxemia at the expense of relative redistribution of a blood flow to hypoventilated alveolar regions is possible. At patients from an ischemic heart disease it can lead to a time hypoxia of a myocardium.
In case of need applications of Monoket preparation against an arterial hypotension it is necessary to introduce simultaneously the preparations possessing a positive inotropic effect, or to apply artificial circulatory support agents.
At appearance of the phenomena of intolerance in no event it is impossible to accept a preparation once again.
It is impossible to stop treatment by Monoket preparation sharply. It is necessary to cancel a preparation gradually to avoid development of a phenomenon of "cancellation".
Use in pediatrics
Efficacyy and safety of application of Monoket preparation in pediatric practice is not established.
Influence on ability to driving of motor transport and to control of mechanisms
In treatment it is not recommended to control vehicles and to be engaged in other potentially dangerous kinds of activity demanding fast psychomotor reactions.
Overdosage
Symptoms: the expressed depression of a BP, a headache, giddiness, palpitation, a hyperthermia, a dermahemia, a sweating, a nausea, vomiting, a diarrhoeia, a methemoglobinemia (a cyanosis, an anoxia), a bradycardia, cramps, visual distresses, intracranial pressure rising, a collapse, a syncope, a paralysis, a coma.
Treatment: a gastric lavage; at a methemoglobinemia - inside or i.v.
Medicinal interaction
Intensifying of hypotensive Monoket effect with other vasodilators, antihypertensive preparations, beta adrenoblockers, blockers of calcium channels, neuroleptics, also with alcohol, ethanol is possible.
At simultaneous Monoket application with Amiodaronum, propranolol, blockers of "slow" calcium channels (verapamil, nifedipine) intensifying of antianginal effect is possible.
The adsorbents knitting and enveloping agents reduce an adsorption of Isosorbidum of Monosodium nitritum in GASTROINTESTINAL TRACT.
Conditions and periods of storage
B.Preparat's list should be stored in a dry place inaccessible to children at temperature not above 25 C. The Period of validity - 5 years.
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