Verapamil hydrochloride is not effective for the treatment of heart-bladder ailments. Verapamil hydrochloride is more effective in the treatment of heart-and-bladder ailments.

Diyucha rechovina

Verapamil hydrochloride (verapamil)

Form vipusku, warehouse and packaging

Additional words: double-substituted calcium phosphate, starch, butylhydroxyanisol, talcum powder, magnesium stearate, gelatin, methylparaben, hydroxypropylmethylcellulose, titanium dioxide, indigo carmin.

Additional words: double substitution calcium phosphate, starch, butylhydroxyanisol, talcum powder, magnesium stearate, gelatin, methylparaben, hydroxypropylmethylcellulose, titanium dioxide, indigocarmic

10 pieces. - blister (1) - packs of cardboard.
10 pieces. - blister (5) - packs of cardboard.

Pharmacological diya

Verapamil is one of the main drugs in the group of calcium channel blockers. Win low antiarrhythmic, antianginal and antihypertensive activity.

The drug reduces the need for myocardium in acidity for a decrease in the rate of myocardium and a decrease in the frequency of the heart. Wicked enlargement of coronary heart disease and increased coronary blood flow; lowering the tone of smooth muscles of the peripheral arteries і zagalny peripheral vascular opіr.

Verapamil is quite versatile AV-performance, driving automatism sinus node, Allowing the use of a drug for the treatment of supraventricular arrhythmias.

Verapamil is a Vibor preparation for treating angina pectoris of vasospastic genesis (Prinzmetal's angina pectoris). Nadaє effect in case of angina pectoris, as well as in case of elimination of angina pectoris with supraventricular rhythm disturbances.

Pharmacokinetics

When you take more than 90% of the dose taken, soak in the middle. To be metabolized during the "first pass" through the liver. Linking with bricks - 90%. T 1/2 when taking a single dose to become 2.8 -7.4 hours; in case of repeated doses - 4.5-12 hours. It is carried out over and over with nirkami і 9-16% through the intestines. The main metabolite is norverapamil, which has a pronounced hypotensive activity;

showing

- treatment and prevention of rhythm breakdown: paroxysmal overslunochkova tachycardia, tachyarrhythmic arrhythmias (tachyarrhythmic variant), suprashlunochkova extrasystole;

- treatment and prevention of chronic stable angina(Angina pectoris), unstable angina(Angina pectoris calm); vasospastic angina pectoris (Prinzmetal's angina pectoris, angina pectoris);

- treatment of arterial hypertension.

Prototype

- bradycardia is rotated;

- chronic heart failure IIB- III stage;

- cardiogenic shock (behind the blame of vicious arrhythmia);

- synnotic blockade;

- AV-blockade of the II і III stage (for a vignette of ailments with a piece of water rhythm);

- sinus node weakness syndrome;

- syndrome Wolf-Parkinson-White;

- Morganya-Adams-Stokes syndrome;

- Gostra sertseva lack of;

- overnight zasosuvannya (i / v);

— childish vik up to 18 rock_v;

- sensitivity to the components of the preparation has been adjusted.

With protection it is necessary to prescribe the drug for AV-blockade of the 1st stage, chronic heart failure of the 1st and 2nd stages, arterial hypertension (systolic vise lower than 100 mm Hg), bradycardia, swelling of liver function disorders.

sundown

Verapamil will take in all the middle of the hour, for when he is drinking, drinking a small amount of water.

The dosage regimen and the triviality of treatment are established individually in the fallowness from the camp of the sick, the degree of severity, the particularities of overcoming the incapacitation and effectiveness of therapy.

for prevention of attacks of angina pectoris, arrhythmia and treatment of arterial hypertension the drug is prescribed grow up in a cob dose of 40-80 mg 3-4 times / add. If necessary, add a single dose to 120-160 mg. The maximum dose of the drug is 480 mg.

Have patients with abnormal liver functions Vivennya verapamilu from the body by and large, to docilely fix it with the minimum doses. Dobova dose of the drug is not guilty of perevischuvati 120 mg.

Pobichna diya

Three sides heart-vascular system: pohervoninnya, bradycardia, AV-blockade, arterial hypotension, manifesting symptoms of heart failure with vikorystanna drug in high doses, especially in sickly ailments, is swelling.

On the side of the herbal system: nudota, bloating, constipation; in some cases, there is a transient increase in the activity of liver transaminases in the blood.

On the side of the central nervous system: dirty, head b_l, In some cases, there is an increase in nervousness, sleepiness, an increase in obesity.

Allergic reactions: shkirny hang, sverbіzh.

Інші: development of peripheral embryos.

Overdose

symptoms: a large dose (taking up to 6 g of the drug) can cause severe loss of svidomosty, arterial hypertension, sinus bradycardia, which turned into aAV-blockade, inodi asystole.

lykuvannya: in case of arterial hypertension and / or abnormal AV blockade - intravenous administration of ridin, dopamine, isoproterenol or noradrenal. Lіkuvannya symptomatic і stale classic paintings overdose. Hemodialis is not effective.

likarska vzaєmodiya

With a one-hour consumption of Verapamil c:

- antiarrhythmics, beta-adrenergic blockers and inhalation anesthetics help to prevent the improvement of cardiac toxicity razkogo fadinnya arterial vise);

- antihypertensive drugs and diuretics are more powerful than the hypotensive effect Verapamil;

- it is possible to adjust the level of digoxin concentration in blood plasma in conjunction with the loss of the digoxin level in blood plasma (it is necessary to control the level of digoxin in the blood plasma in order to determine the optimal dose of oxygenation);

- cimetidine and ranitidine increase the concentration of Verapamil in blood plasma;

- rifampicin, phenobarbital can lower the concentration in blood plasma and weakened Verapamil;

- theophilin, prazosin, cyclosporin can be adjusted to the concentration of cich rechovins in the blood plasma;

- muscle relaxants are more powerful than muscle relaxants;

- acetic acidic acid will allow the possibility of bleeding;

- hinidinom to increase the level of concentration of heinidin in blood plasma, to accommodate the risk of lowering the arterial pressure, and in patients with hypertrophic cardiomyopathy there is a possibility of circulating hypertension;

- carbamazepine and lithium improve the risk of neurotoxic effects.

special requests

In case of elimination, the necessary control of the function of the heart-vascular and mental systems, the level of glucose and electrolytes in the blood, the volume of circulating blood and a few images of the section.

Vigor and lactation

Stagnation of Verapamil in case of vaginosis can be as much as possible, if the cinnamon for the mother has been removed, and the potential for the fetus is changed.

The drug is available for a prescription.

Mind that term zberigannya

Take in dry food, at temperatures not at 25 ° С. Term of attachment - 3 rocks.

• Instructions on the intake of Verapamil hydrochloride
• Warehouse for Verapamil hydrochloride
• Indicated to the drug Verapamil hydrochloride
• Take care of the drug Verapamil hydrochloride
• Term of attachment to the drug Verapamil hydrochloride

ATX code: Heart-vascular system (C)> Blockers of calcium channels (C08)> Selective blockers of calcium channels with direct infusion on the heart (C08D)> Fenylalkylamines of old (C08DA)> Verapamil (C08DA01)

Form vipusku, warehouse and packaging

10 pieces. - packaging of middle contour.
50 pcs. - banks.

to describe lykarsky drug Verapamilugidrochloride launched in 2010 at the department of instructions, distribution on the official website of the Ministry of Health Protection of the Republic of Belarus. Update date: 12.05.2011 r

Pharmacological diya

Verapamil repair antianginal, hypotensive, antiarrhythmic effects. Block of caltsіevi canals (dіє z internal side membranes) і lowering the transmembrane calcium strum. The interaction with the channel begins with the stage of membrane depolarization:

• more efficiently blocking the calcium channels of the depolarized membrane. In the menshіy world, the channels of the polarized membrane are poured into the closed channels, overwhelming their activation. Slightly infused into sodium channels and alpha-adrenergic receptors. Change in the speed, frequency of the rhythm of the sinus unit and the rate of performance in the AV university, sinusology and AV performance, relaxation of smooth connections (in the greater world of arteriology, low veins), visualization of the post-mortem Increases myocardial perfusion, reduces the disproportion between needs and heartbeats, reduces the hypertrophy of the louse, reduces the arterial grip. Increased development and assimilation of spasm of coronary arteries in case of variable angina pectoris. In patients with inadvertent hypertrophic cardiomyopathy, I will shrink the blood from shlunochki. Reducing the frequency and severity of headache Sudden Genesis- pereshkojaє zvuzhennyu sudin, scho vinnikє in the prodromal period, blockade of Ca 2+ - canals can be relaxed or get reactively expanded sudin. The metabolism is attributed to the participation of cytochrome P450.

When the ear is taken in the middle of the ear, the drug is determined in 1-2 years, the maximum effect develops after 30-90 hilines (as a rule, it lasts 24-48 years), the triviality of the effect is 810 hours.

Pharmacokinetics

If the recipient is in the middle of getting more than 90% of the taken dose, the bioavailability of a one-time intake becomes 20-35% as a result of the metabolism during the first pass through the liver and grows 1.5-2 times when it is trivial. C max in blood plasma is reached in 1-2 years and becomes 80-400 ng / ml. Engage with plasmas by 90%. Metabolize in the oven in a way of N-dealkylation and O-demethylation, with the approval of 12 metabolites. The accumulation of the drug and its metabolism in the body will explain the improvement of the process during the course treatment. The main pharmacologically active metabolite is norverapamil (20% of the hypotensive activity of verapamil). The metabolism of the drug takes the part of the isoenzyme CYP3A4, CYP3A5 and CYP3A7. T 1/2 with oral intake - 3-7 hours with a one-time intake, 4-12 years - with trivial intake (in connection with the enzymatic systems of the liver and changes in plasma concentrations of T 1/2, increase in 2 times). In case of severe damage to the function of the liver, the plasma clearance decreases by 70%, T 1/2 arrives at 14-16 hours. In patients with disabilities, there are no pharmacokinetic changes. Bioavailability of verapamil in females, but not in choloviks. Penetrates through the hematoencephalic bar, placental bar (20-92% concentration in the mother's blood plasma) and in breast milk (in low concentrations). Vivoditsya rely on nirkami - 70%, (3-5% in the undisputed viglyadі). 16-25% - gum. Hemodialis, hemofiltration and peritoneal dialis are not infused into the elimination of verapamil.

dosage regimen

Verapamil will take everything in the middle, for an hour or even at once, drinking a good amount of ridini. The pochatkova dose for grown-ups should be 40-80 mg 3-4 times for doba. The maximum dobov dose is up to 720 mg.

• with angina pectoris: 80-120 mg 3 times for doba, for the porosity of the functions of the liver, for lettuce sickness - 40 mg each for doba;
• With a prophylactic method in case of rotary paroxysmal supra-mucous tachycardia of the cob, the dose for older adults and adults should be given 240-80 mg per dose in 3-4 priyomy. For the control of the frequency of the heart's very fast lingering in chronic disease and in the front of the heart, the dose for older adults should be set to 240-320 mg in 3-4 doses. The maximum antiarrhythmic action is to become more active in the 48-year intervals from the cob of therapy in the guided doses;
• with arterial hypertension: 40-80 mg 2 times per dose, if necessary, an additional dose can be increased up to 480 mg; to the patients of the kidnapped vik, for with a small mass of tila, they should be given 40 mg 2 times for doba.

Children under 6 years old should receive 40-60 mg of verapamil per dobu, for children 6-14 years old - 80-360 mg for dobu. The drug should be taken at 3-4 times.

Pobichna diya

on the side of the heart-vascular system: bradycardia (less than 50 / hv), rotation of a decrease in arterial vise, development or improvement of heart failure, tachycardia;

from sides nervous system: looseness, headache, uncomfortableness, anxiety, hardness, swelling, dullness, asthenia, drowsiness, depression, extravagant damage (ataxia, mask-like person, shuffling of the hand, stiffness of the hand)

on the side of the herbal system: nudity, constipation (rarely - diarrhea), hyperplasia is clear (bleeding, soreness, swelling), an increase in appetite, an increase in the activity of "liver" transaminases and puddle phosphatase;

allergic reactions: itchy skin, Shkіrny visip, hyperemia of shkіri denunciations, multiforme erithema (including Stevens-Johnson syndrome);

іnshі: malignant mass, even more rarely - agranulocytosis, gynecomastia, hyperprolactinemia, galactorrhea, arthritis, swelling of lesions, thrombocytopenia is asymptomatic, peripheral swellings.

Prototype

Hypersensitivity, dysfunction of the louse is swollen, arterial hypertension (systolic arterial vise less than 90 mm Hg) or cardiogenic shock, AV block II-III stage, Syndrome of weakness of the sinus vascular - syndrome abo Laun-Ganong-Levin syndrome (in case of ailments with a cardiac stimulator), vaginism, period of lactation.

special requests

Before taking the drug, it is necessary to compensate for the heart failure in advance. In case of elimination, it is necessary to control the functions of the heart-vascular and dichotomous systems, as well as, instead of glucose and electrolytes in the blood, the volume of circulating blood as a result of the slaughter. Newborns and infants had severe hemodynamic effects. can podovjuvati Interval P-Q at a concentration in plasma of 30 ng / ml (for retail). During the period of counter-indications taking alcohol. It is not recommended to drink a rape drink.

Zapobizhnі come in

To protect stagnation in case of SA blockade, AV blockade of the 1st stage, Bradycardia, IGSS, CHS, peptic and / abnormal deficiencies, allowing for nerve transmission (Duchenne myopathy), in recent years in the Danish hour of the day, adequate clinical data about efficiency and security of storage). In case of elimination, the necessary control of the functions of the heart-vascular and mental systems, as well as of the amount of glucose and electrolytes in the blood, the amount of circulating blood and some of the seen section. Newborns and infants had severe hemodynamic effects.

Influencing the building with a car and other mechanisms: during the period of uniqueness, it is possible to take up potentially not safe types of activity, so that it requires an increased speed of reaction and concentration of respect (decrease of speed of reaction).

Overdose

symptoms: bradycardia, AV blockade, swelling of arterial vise reduction, HF, shock, asystole, SA blockade.

lykuvannya: in case of early detection - slurry production, no vugilla;

likarska vzaєmodiya

Verapamil zbіlshu rіven in the plasma of heart glycosides (requires more caution and a decrease in the dose of glucosides), cyclosporine, theophilin, carbamazepin (rhizic development, head of diplopathy) Zbіlshu risik of the neurotoxic effect of drugs in lithia. Rifampicin can significantly reduce the bioavailability of verapamil. Phenobarbital produces cleansing verapamil. Ingіbіtory CYP3A4 (including erithromicin, ritonavіr) podovzhuyut period on the basis of verapamіlu. Grapefruit juice significantly increases the concentration of verapamil in plasma. Cimetidine increased the bioavailability of verapamil by 40-50% (for a decrease in liver metabolism), in connection with which it may be necessary to change the dose of the remaining one.

Beta-adrenergic blockers, class I antiarrhythmics, heart glucosides, intravenous anesthetics, X-ray contrast to increase the potency (in the same way) induce an infusion on the automatism of the sinus site, AV speed and speed. The introduction of verapamil and beta-blockers must be carried out at intervals of several years.

With a one-hour consumption of acetylsalicylic acid, it is more possible to improve the apparent bleeding.

Dizopiramid and flecainid did not go on to signify for 48 years until 24 years for the loss of verapamil (summation of a negative inotropic effect, even to a lethal result). Peripheral muscle relaxants (you can squeeze the dose to the dosage regimen).

Increased concentration of ethanol (more trivial effect) and chinidin (risik of a rotated lower arterial grip).

- one of the most popular ailments in the whole world. There is no symptomlessness, and yes, the nobility about itself is deprived of that, if the arterial grip has become too high.

You will always get sick, it is necessary to regularly vimiruvaty arterial vise and crumple to a lykar when any unseen symptoms appear. As soon as the diagnosis of "hypertension" is confirmed, the patient should be given special antihypertensive disorders.

One of these drugs is Verapamil hydrochloride, which allows you to fight hypertension and major cardiovascular pathologies.

Pharmacological diya

Verapamil hydrochloride is a representative of the group of calcium channel blockers. Improvement of coronary artery disease, improvement of coronary blood flow, reduction of myocardial consumption in acidity, normalization of peripheral hemodynamics.

As a result, there is a decrease in calcium reabsorption, which will prevent the development of natriyuretic and diuretic effects, as well as increase the hypotensive effect.

The establishment of a decrease in ionic calcium, Verapamil hydrochloride is positively associated with the conductive nervous systems, vasodilatation, pressure on the synatric and atrioventricular maintenance, and prolonged life.

The active component of the drug can be moistened from the intestinal tract more (by 95 weights). After 1 or 2 years, the concentration of the drug is maximized in plasma. When you see it, you see it through nirki (70%), zhovchu (25%), as well as in an unchanged view (from 3 to 4%). The period for which the visa is taken starts is trivial therapy: with a one-time consumption of wines, it will last for three to seven years, and with regular consumption, it will take up to twelve years.

Hydrochloride shown before consumption on Verapamila

Appropriate to practice with such illnesses:

• hypertensive ailment;
• angina pectoris: vasospastic, unstable, spasms;
• problems heart rhythm, Including tachycardia, extrasystole, tachycardia and meteral atrium.

Likewise, zasosuvannya likiv allows you to reach the affected prophylactic efect (to prevent the development of overwhelmed diseases of the heart-vascular system).

How to secure

Verapamil tablets should be taken at once. Wash down with an insignificant amount of ridini (bazhano - drive).

We will grow to patients for a decrease in the arterial vise, the drug is indicated in a single dose of 40 or 80 mg, which is taken three to one times a day. At the same time, it is important to follow the team, the amount of taken verapamil did not exceed 480 mg / dose.

As soon as the patient is diagnosed with "pechinka deficiency", the maximum dose is automatically reduced to 120 mg. For a similar scheme to Verapamil, hydrochloride is used for the prevention of angina pectoris, as well as arrhythmias.

To stop the hospitalization (paroxysmal breakdown of heart rhythms, hypertensive crises), inject Verapamil hydrochloride as needed internally, strumenevo (from 5 to 10 mg, range from 2 to 4 ml) Possibility of the effect can be done for help re-introduction Rivnoi dose after 30 minutes.

Be respectful: when internal storage the drug requires continuous monitoring of heart rate, EKG, AT.

In some cases, children are diagnosed with arrhythmic and hypertensive problems. The medication should be taken 2-3 times / add. in a dose, proponated by virobnik. Children from 5 years are given 60 mg of the drug, children from 6 to 14 - 80-360 mg. As soon as it is planned to take a child, the drug is more beautifully administered internally. For nemovlyat, a single dose of a warehouse is 0.75-2 mg, and for dittok from pivtora rokiv - 2-3 mg.

The scheme of dosage and triviality of the course of therapy is established by a doctor to assess the size of the people, the hardships and peculiarities of the sickness. The analysis of the effectiveness of the indicated drug can be the reason for the change in the scheme of the consumption of Verapamilugidrochloride.

Form vipusku, warehouse

In the capacity of the head active component of the preparation, hydrochloride is added to the verapamil.

In addition, it is necessary to take advantage of additional sources of calcium disubstituted phosphate, magnesium stearate, starch, gelatin, purified talc, butylhydroxyanisol, titanium dioxide, methylparaben.

The medication is on sale in different forms: At viglyadі capsules, ampoules for ін'єкцій, rosette for intravenous administration, tablets and prolonged tablets, dragees.

Interaction with other drugs

With the prescribed drug varto vrahovuvati, the change of power on aphids is parallel to the reception of the others.

Hypotensive effect Verapamilugidrochloride can take advantage of the implantation of diuretics and other medications to reduce the grip.

Acceptance of cimetidine і ranіtidine spri to increase the concentration of verapamil in the blood.

In case of parallel congestion of beta-blockers, inhalational anesthetics and antiarrhythmic disorders, cardiotoxicity is often observed.

A decrease in the concentration of verapamil in plasma and a weakening of the yogo process is promoted in the case of treatment with rifampicin and phenobarbital.

Likuvannya verapamil on tlі reception of acetylsalicylic acid and may provoke bleeding.

One-hour consumption of theophilin, hinidin, prazonin, muscle relaxants and cyclosporin with the help of given drugs and improvement of concentration

Likuvalny power of carbamazepin and lithium, change with verapamil, can lead to the development of neurotoxic reactions.

Pobichna diya

Overdose

Acceptance of liquor without a prescription of a liquor, non-primed dosage of Verapamilugidrochloride, - all the way to provoke an overdose. At the same time, the patient sticks to different symptoms: Bradycardia, hypotension, cardiogenic shock, coma, asystole.

Happily, it’s a specific antidote, and it’s a good thing to change symptoms. Tse calcium gluconate. For a change in the manifestation of an overdose of 10-20 ml of a 10% solution, inject internally. If symptoms of bradycardia and AV block are evident, inject preparations of isoprenal, orciprenal or atropin; help norepinephrine and dopamine from hypotension; Kupiruvati the lack of additional help dobutamin.

Prototype

Chi not priznachayut Liky at gіpotenzії virazhenoyu, gіperchutlivostі, іnfarktі mіokarda (GOSTR abo recent myocardial i uskladnenomu symptoms levozheludochkovoynedostatnostі, gіpotenzії, bradikardії) shotsі cardiogenic, bradikardії virazhenoyu, AV-blokadі stage 2 i 3, CHF tretoї stadії, sinoatrіalnoї blokadі, trіpotіnnya i atrial fibrillation, Morgany-Adams-Stokes syndrome, WPW-syndrome or Laun-Ganong-Levin syndrome (vinyatok - patients with cardiac pacemakers), sinus node weakness syndrome (due to cardiac arrest), the importance of cardiac stenosis ...

Covered until sucked є Lack of heart chronic character (1, 2 stages), AV-blockade of the first stage, hypotension is less or less mild, myopathy is swollen (Duchenne's syndrome), tachycardia of shlunochkov with a wide complex of QRS deficiency (intravenous injection), abnormal

with vaginosti

In the first 3 months of vaginosity, Verapamyl hydrochloride is not recognized as a substance. In the last trimesters, when you are energetic, it’s just that, because the risk of crossing over at the outside of the day is a burden for the fetus. When mothers are a goddess, then they accept Daniy zasib hardened. It will explain why the active component is seen in milk.

Mind that term zberigannya

Verapamil hydrochloride, right up to the end of the term, is guilty of being in the place, stolen from vology and straight sleepy exchanges. The recommended temperature for the selection of tablet forms for the preparation is 15-25 degrees, and the temperature for the selection of non-standard forms is 8-25 degrees.

The tablets can be taken from 2 rocky, in the case of the coated tablet - 3 rocky, and the difference for ін'єкцій - also 3 rocky.

Price

The great popularity of the brand is amazed not only by the efficient efficiency, but rather by the democratic party. Remaining with the virobnik to the drug, as well as the amount of addiction lykarsky zasobu.

The price of pills in Russia to repair at 35 rubles, the price of prolonged tablets is at 150 rubles, the price of ampoules is at 50 rubles.

Minimum number of tablets in Ukraine become 7 hryvnia, average - 20 hryvnia.

analogs

Suchasnі pharmaceutical companies propose a drug-free drug with a diyu, analogous Verapamylhydrochloride (prevention and treatment of hypertension, arrhythmias, angina attacks).

Before them, such medications as Veracard, Verogalidu, Lekoptin, Phinoptin, Danistol, Izoptin, cover, Verapabene, Atsupamil, Flamon, Falikard are delivered.

Registration number:

Termіn dії restoration:

03/06/2015 to 03/06/2020

Named English:

VERAPAMILHYDROCHLORIDE

warehouse

1 tablet to take 80 mg of verapamil hydrochloride in a pererakhunka 100% dry river;
additional speeches: corn starch, lactose monohydrate, copovidone, magnesium stearate.

Film-forming coating: hydroxypropylmethylcellulose, lactose monohydrate, titanium dioxide (E 171), polyethylene glycol, triacetin.

Lykarska form

Basic physical and chemical authorities: round tablets, including a plastic sheath, white color, With a double-convex surface. On the transverse view, two cool structures are visible.

Pharmacotherapeutic group

Pharmacological authorities

Pharmacodynamics.

Verapamil hydrochloride є selective blocker Calcium channels in L type I class, to repair antianginal and hypotensive effects. Blocking the potential of calcification canals and porousing the necessary calcium in the middle of the clitin, zokrem, cardiomyocytes and clitin of smooth ointments of sudin, the concentration of calcium in the blood does not change at all.

The antianginal action of the drug realizes the decrease in the tone of the coronary and peripheral arterial vessels, the blood circulation of the heart, including in the ischemic dylyankas; lowering the need for myocardium in acidity, reducing the rate of myocardium and increasing coronary blood flow. The antianginal effect of accumulation is also a vasodilating peripheral effect, which can lead to a decrease in the consumption of myocardium in acid.

Verapamil hydrochloride should be added to class IV antiarrhythmic drugs. Antiarrhythmic effect of blockade of calcium channels in the cells of the wired system of the heart (sinus and atrioventricular universities) As a result, an effective refractory period in the sinus and atrioventricular nodes increases, the sinus rhythm is relied on, and the heart rate is changing.

The antihypertensive effect of verapamil hydrochloride is accompanied by the weakening of the smooth mucous membranes of the vessels, the decrease in the peripheral vertebral support, the arterial vise, as a rule, without the development of postural hypotension and reflex tachycardia; bradycardia (heart rate is less than 50 per chilin) ​​grows rarely.

Pharmacokinetics.

For oral administration in small intestine to get wet more than 90% of the administered dose of verapamil hydrochloride. The drug metabolizes very importantly in the case of intensive metabolism when it is first passed through the gate system of the liver, the bioavailability of the drug becomes 20-35%. The maximum concentration of verapamil hydrochloride in the blood plasma is determined after 1-2 years or after taking the drug.

The step of lowering the blood pressure is not to accumulate due to the concentration of Verapamilhydrochloride in the blood plasma.

About 90% of the drug is associated with blood cells.

Verapamil hydrochloride passes through the placenta and in breast milk. The average period should become 2.8-7.4 years for the first time and 4.5-12 years for the first time. For the older children of the group, the period of the day can be improved.

Not long ago, the tribute was discarded, but there is no difference in pharmacokinetic verapamil in people with healthy nirkas and in patients with a terminal stage of nirk deficiency.

In patients with pechinka deficiency, the period of time until 14-16 years old, the volume of growth increases, plasma cleansing becomes approximately 30% of the norms. Therefore, the dose for such patients should be reduced to 1/3 of the dobovy dose.

The drug is vivodirovanno by nirkami (70%), partly - by the intestines.

Сlіnіchnі characteristics

showing

· Gostra phase of myocardial infarction with accelerated (bradycardia 90 mm Hg), lack of livogram).

Severe deterioration of performance: sinoatrial and atrioventricular (AV) block

ІІ-ІІІ steps (behind a vignette of patients with piece water rhythm).

· Syndrome of weakness of the sinus node (behind a vignette of patients with a piece of rhythm).

Sertseva lack of a decrease in the fraction of wikid less than 35% or a vice in legendary artery eyelid 20 mm Hg. Art. (It’s just as well that the tachycardia above the shlunochkova does not end up in the infusion of verapamil therapy).

· Merekhtinnya / tripotinnya at the front in the presence of additional provincial paths (for WPW and LGL syndromes). In such patients, in case of stagnation of verapamil hydrochloride є risik development of slurry tachyarrhythmia, including slum fibrillation.

· One-hour b-adrenoreceptor blockers for intravenous administration (with the blame of intensive therapy).

Vzaєmodіya with інshі lіkarsky zasob and іnshi vidі vzaєmodіy.
Z b-blockers: zbіlshuє vzaєmnu perevazhna dіyu on automaticity sinoatrіalnogo vuzla, AV-provіdnіst i skorotnіst mіokarda, vnaslіdok tsogo pіdvischuєtsya rizik rozvitku virazhenoї arterіalnoї gіpotenzії, AV- i SA-blockades bradikardії, sertsevoї nedostatnostі, Especially when zastosuvannі temple b-doses at abo adrenoblokatorіv їh vnutrіshnovennomu vvedennі ...

A special group of patients to become patients with signs of chronic heart failure, severe cardiomyopathy, for those who have recently had myocardial infarction. Combined therapy of Verapamilugidrochloride with b-adrenergic blockers should only be carried out after clear indications and with suvorim control of the drug.

Z antihypertensive drugs (For example, vasodilatori, іngіbіtori APF, Diuretics, O ± blockers, prazosin і terazosin): verapamil hydrochloride potency.

Z tricycle antidepressants, antipsychotics: potentiation of the hypotensive effect of verapamil hydrochloride.

Z heart glycosides (For example, with digoxin): slid vrahovuvati, scho on the cob smack

(1st day) the level of digoxin in the blood is increased by 50-70%, which requires a dose of digoxin, and the second level in the blood is periodically monitored, especially on the ear of the drug.

Z antiarrhythmic drugs I-III class (Including amiodarone): It is not recommended to drink it overnight.

Z dizopiramid (ritmilen): do not go to sleep overnight, if you take the disopramid need to fix it 48 years before the ear of the verapamil hydrochloride, and you can change it not earlier than after 24 years, if you take the verapamil hydrochloride.

Z Fleckinidom: Often, it is important to change myocardium, to develop atrioventricular performance and to increase the triviality of repolarization.

Z hinidin: decrease in clearing khinidin (at ‰ € 35%) with oral administration. Mossy development of hypotension, and in patients with hypertrophic obstructive cardiomyopathy, there is a lot of legends. This is not a sign of offense to the drug at once.

Z oral anti-inflammatory drugs, hydantoins, salicylates, sulfanilamides and abandoned sulfonylsecovines: in a high level of connection to verapamil with blood plasma blood cells, the next step for the protection of patients, who take these drugs, which may be given the power.

Z calcium saltsі Vitamin D: the pharmacological effect of verapamil hydrochloride is changing.

Z propranolol, metoprolol: verapamil hydrochloride can reduce its clearence.

Z rifampicin, phenobarbital: May reduce the effectiveness of the drug yak inductors of microsomal enzymes.

Z salts of lithium, theophilin: For a verapamil the concentration in the blood can change, so that the patients who take the drugs are guilty of being given a real glance.

Z cyclosporine, everolimus, sirolimus, tacrolimus, ingibitors of serotonin receptors (So ​​yak almotіptan), carbamazepineі theophilinom: verapamіl to produce until the admission of їkh ryvnya in syrovattsі blood with a one-hour stasis.

Z colchicine: verapamil can lead to the strength of the yogi. Combination of drug intake is not recommended.

Z antagonists of H 2 -receptors, cimetidine: Possibility of adjusting the concentration of verapamil in blood plasma.

Z antiretroviral drugs (such a yak ritonavir, indinavir): Possibility of adjusting the concentration of verapamil in blood plasma. To that vikoristovuvati Verapamil hydrochloride in the whole combination of steps with protection, or the dose is guilty but reduced.

Z Ingibitor HMG-CoA reductazi (simvastatin, atorvastatin, lovastatin): lіkuvannya statins next to fix from the lowest possible doses and actions їkh zbіlshuvati. As a patient, who has already taken verapamil, statins are required, then a decrease in the dose is necessary and the dose is adjusted according to the concentration of cholesterol in the blood plasma.

Z simvastatin (In high doses): Rizik myopathies, rhabdomyolizu are advancing. The addition of simvastatin is guilty, but it has been reportedly incriminated.

Z fluvastatin, pravastatinі rosuvastatin: they are not metabolized by the CYP3A4 system and in conjunction with cym is practically not interconnected with verapamil.

Z substrates cytochrome P 450 izoenzyme 3A4, for example іngіbіtors СSE (incl. lovastatin, simvastatin, atorvastatin): the possibility of advancing the ryvnya of cich likars in blood plasma, toxic lesion m'yaz_v.

Z inhalation anesthetics abo s blockers of neuromuscular transmission: Dose the drug in the next few days, so that you can unify your heart's worth of action.

Z muscle relaxants: potential

Z macrolides (For example, erithromicine or clarithromicine): through a reciprocal inflow, rivin of verapamila into the blood plasma.

Z antidiabetic drugs (gliburide): to move S max gliburid by 28%.

Z doxorubicin (oral): increased bioavailability and maximum level of doxorubicin in blood plasma of patients with secondary cancer lungs.

Z with preparations of the zealous gnome: Changes in the area before the curve of concentration-hour, increase in 3 mah.

Z with radiopaque techniques: the potential of the overwhelming verapamil in the flow to the automatism of the synatric university, AV-conductivity and speed of the myocardium is possible.

Z ethanol: verapamil will take over the drop and increase the level in blood plasma, and we will do it ourselves with ethanol.

Z grapefruit juice: the bioavailability of verapamil is increased by 30%.

Z sulfinpyrazone: adjustment of oral verapamil in 3 times, bioavailability - by 60%. You can lower the hypotensive effect.

Z acetylsalicylic acid: pidvischennya rhiziku bleeding.

Z digitoxin: Reduction of digitaloxin clearance (at ‰ € 27%) and extrarenal clearance (at ‰ € 29%).

Z bunspiron: increase AUC and C max by 3-4 times.

Z imipramine: increase in AUC (in ‰ € 15%) of imipramine without infusion on the active metabolite desipramine.

Z midazolam: increase in AUC 3 times and C max - 2 times.

Prior to the metabolism of verapamyl hydrochloride in vitro, it was shown that it can be metabolized by cytochrome P450 CYP3A4, CYP1A2, CYP2C8, CYP2C9 and CYP2C18. Verapamil is an inhibitor of CYP3A4 and P-glucoprotein (P-gp) enzymes. With regard to clinically important interactions with CYP3A4 Ingibitors, who were supervised to treat verapamil in blood plasma, such as CYP3A4 inductors did not suffer from a decrease in plasma fluids.

specialties

The drug was used to protect patients with myocardial infarction, accelerate bradycardia, circulated arterial hypotension, or dysfunction of the little one.

Verapamil hydrochloride is injected into the atrioventricular and sinoatrial universities and for a prolonged hour of atrioventricular conductivity. Stasis to protect patients with AV-blockade of stage I, through a possible development of atrioventricular blockade of II or III stage, or one-beam, two-beam, or three-beam blockade of the therapy

Verapamil hydrochloride is injected into atrioventricular and sinoatrial universities and sometimes it can provoke the diagnosis of atrioventricular block II or III stage, bradycardia, asystole. More importantly, such symptoms are more likely to develop in patients with sinus syndrome weakness (sinus ailment), which often occurs in patients with abducted disease.

Asystole in patients who do not have the syndrome of weakness of the sinus node, is short-lived (a few seconds or less), from spontaneous turns to atrioventricular or normal sinus rhythm... As soon as the phenomenon is not shvidkoplinna, it is inaccurate to start a kind of therapy (div. Rozdil " side reactions»).

Antiarrhythmic zasobi, b-adrenergic blockers. In addition, the improvement of the cardiovascular activity (an increase in the level of atrioventricular blockade of the high grade, a decrease in the frequency of heart rates, a manifestation of heart failure, a decrease in an arterial grip). Symptomatic bradycardia (36 beats / hv) with a bloody water rhythm in the anterior heart was diagnosed in patients who were taking suppression therapy full-blooded with timolol (b-adrenergic blocker) for the treatment of verapamil hydrochloride.

With a one-hour consumption of verapamil with digoxin, the dose of digoxin should be changed (div. Rozdil "Vzaєmodia with іnshi lіkarsky zasob and іnshi vidi vzaєmodіy").

Before the ear of drinking with verapamil, it is necessary to compensate for the heart deficiency in patients with fractional wikid greater than 35% and adequately control their body during the whole period of treatment.

Verapamil hydrochloride followed by stagnation with protection in case of manifestation of ailment with damaged nerve-myazovoy patients with: Myastenia gravis, Lambert-Iton syndrome, progressive myazovoy dystrophy Duchenne).

To preserve Verapamil hydrochloride in patients with damaged liver function (it is recommended to reduce the dose to 30% of the extra dose); s nirk deficiency(Really control over the triviality of PQ-T, as well as signs of a possible overdose of verapamil hydrochloride).

It was easy to control the triviality of the PQ-interval on the EKG, as well as signs of a possible overdose of Verapamil hydrochloride in patients (regular monitoring of AT, heart rate).

When Verapamilugidrochloride is recognized, it is followed by a person who has been abducted, the mother may be sensitive to the drug, and should be guided by an appropriate dose.

The drug is to take revenge on lactose, which is not used by patients with severe decongestant forms of galactose intolerance, lactase deficiency, or glucose-galactose malabsorption syndrome.

Stagnation in the period of vaginosis and breastfeeding.

Read and good news of the drug intake for vaginal women in the daytime. That is why the drug should be used for an hour of vaginosity only once it is consumed. Verapamil crosses the placenta and appears in the umbilical cord blood.

Verapamil and its metabolism penetrate breast milk. The dose of verapamil, which is consumed in the body of a newborn, is low (0.1-1% of the dose taken by the mother);

I will look at the risik if there are serious side reactions in newborns, as they are being treated for breastfeeding, verapamil during the period of the breastfeeding period can be used only in case of extreme need for a mother.

The state of affairs is injected into the speed of reaction in case of keruvannas by motor transport or other mechanisms.

Through the antihypertensive effect of verapamil hydrochloride, in the presence of an individual reaction, the building of keruvati by transport means, by other mechanisms, or even in some kind of minds, can be ruined. Particularly, the cob phase of the drug is especially prone to occur, with an increased dose, with a change in a hypotensive drug, and also with a one-hour drug intake with alcohol. Verapamil can increase the level of alcohol in the blood plasma and make it possible for alcohol to drink.

How to store that dosi

Dose pick up individually for the skin patient.

Tablets kovtati tsіlimi, not rosmoktuvati, not roszhoyuchi, not prybnuvati, do not divide into parts; drink a sufficient amount of ridini (for example, 1 bottle of water, not at all grapefruit juice), more beautifully for the entire hour, or all at once.

Dos and podlіtki with masoyu tila ponad 50 kg

Ischemic ailment of the heart, Paroxysmal suprashlunochkova tachycardia, tripotinnya /

A persistent antihypertensive effect develops over a stretch of time as a cob of therapy.

With angina pectoris and arrhythmias The dose of the drug should be 80 mg 3-4 times per dobu (240-320 mg).

The maximum effect is to develop, as a rule, stretching 48 years from the ear of a drink.

Damaged function of nirok

The available data is described in the section "Features of the provision". For patients with a nircum lack of verapamyl hydrochloride, it should be stored for protection and for a simple visualization.

Damaged function of the stove

Patients with damaged functions of the stove in fallowness from the degree of severity to verapamil hydrochloride will adapt to that podovzhuyutsya through trusting the fall of the Lykarsky zasobu. Therefore, in such drops, the dose should be set up with special protection and fix at small doses (for example, for patients with damaged liver functions, 2-3 times for dobu at 40 mg, apparently 80-120 mg for dobu), div. "Peculiarities of storing".

If necessary, the cob dose can be incrementally adjusted as a patient and clinically indicated, assessed when the drug is consumed.

* If necessary, the dosage of verapamil in a dose of 40 mg should be taken as soon as possible.

Do not take the drug while lying down.

Verapamil hydrochloride cannot be given to patients with myocardial infarction for 7 days.

For trivial therapy, the drug should be changed, step by step lowering the dose.

The triviality of lіkuvannya viznacha lіkar іndivіdually, won’t lie in the form of a patient who has gone overboard.

Children.
For children the drug in daniy lykarskiy form do not acknowledge.

Overdose.
Symptoms that are suspected in case of overdose of verapamil, lie down from the amount of the drug taken, an hour, if you take detoxification, come in, that is the patient.

symptoms: arterial hypotension, bradycardia before atrioventricular block of the high stage і sinus vascular lesions, hyperglycemia, stupor і metabolic acidosis... Fatal falls as a result of overdose were prevented.

lykuvannya: I am the head of the rank of individual and individual. OI-adrenergic stimulation and / or intravenous administration of calcium (calcium chloride) preparations is effective for the reduction of symptoms of overdose in case of oral intake of verapamil hydrochloride.

In case of different hypotension, or atrioventricular blockade of a high stage, it is necessary to fix it, to move an arterial vise (subozuvuvlny), or cardiostimulants are available. In case of asystole, one hour from the stasis of early visits, followed by the stasis of OI-adrenergic stimulation (for example, isoproterenol hydrochloride), the most important ones, directed to the development of arterial hypertension, and

Verapamil hydrochloride is not used for additional hemodialysis.

side reactions

Sertsevo-sudinna system: angina pectoris, arterial hypotension, sinoatrial and

AV-blockade of I, II or III stages, bradycardia, bradyarrhythmia with fibrillation of the atrium, sinus node zypinka, asystole; risik zagostrennya / development of heart failure, orthostatic reactions; tachycardia, bile behind the breastbone, myocardial infarction, heart disease, peripheral ankle ridges, syncope, flushing.

Grass tract: discomfort in the stomach / belly, shlunkovo-gut rozladi, Such yak nudota, blues, flatulence; intestinal atony, intestinal imperfection, Constipation; dryness in rot, hyperplasia is clear (gingivitis and bleeding).

Nervous system: impairment of cerebral blood circulation, confusion of symptoms, impaired impairment of fever, stomia, sleeplessness, nervousness, malignancy, psychosis, neuropathy, extremia syndrome, drowsiness, headache, confusion,.

Organis for hearing and vestibular apparatus: dzvin u wuhah, vertigo.

Dichny system, organ breast cancer and middle: bronchospasm, dyspnea.

Nirki and sectional system: nirkova lack.

Sechostatev system: erectile dysfunction, including empowerment, parts of this, ruinous menstrual cycle; In patients with kidney disease, during trivial therapy, gynecomastia developed, and galactorrhea was passed on again after being given a drug.

Support-rucho system: m'yazova weakness, more at the meat, more at the slopes.

Shkira and pedagogical klitkovina: visip on shkіri (including maculopapular visip, cropping), suspicion of suspicion, hyperhidrosis, impaired pigmentation, erythromelalgia, multiforme erythema, John's syndrome, syndrome

Loss of exchange of words, metabolism: hyperkalієmіya.

Hepatobiliary system: adjustment of the level of transaminases, pool phosphatase and bilirubin; you can fight your liver key manifestations (bastard self-respect, Adjustment of the temperature of the floor (or at the right side). In connection with the cymbals, periodically, control over the function of the liver in patients. For children, they learn independently during advanced therapy.

Immune system: hypersensitivity, allergic hepatitis, bronchospasm.

іnshі: unclear zoru, increased prolactin levels in blood plasma, decreased tolerance to glucose.

I have seen about parallichy (tetraparesis), associations with combinated stasis of verapamil and colchicine. This may be explained by the penetration of colchicine through the hematoencephalic bar in the case of being driven by verapamil CYP3A4 and P-qp, therefore, the combination of colchicine and verapamil is not recommended.

Gross formula

Pharmacological group of speech Verapamil

Nosological classification (ICD-10)

CAS code

Characteristics of the speech Verapamil

Looks like fenilalkilamin. Verapamil hydrochloride is a crystalline bilium powder. Razchinniy in water, chloroform, methanol.

pharmacology

Block of the calcium channel (from the inner side of the membrane) and lowering the transmembrane calcium strum. The interaction with the channel begins with a step of membrane depolarization: it is more efficient to block the visible channel of the depolarized membrane. In the menshіy world, the channels of the polarized membrane are poured into the closed channels, overwhelming their activation. Slightly infused into sodium channels and alpha-adrenergic receptors. Change in the speed, frequency of the rhythm of the sinus unit and the rate of performance in the AV university, sinusology and AV performance, relaxation of smooth connections (in the greater world of arteriology, low veins), visualization of the post-mortem Increases myocardial perfusion, reduces the disproportion between needs and heartbeats, reduces the hypertrophy of the louse, reduces the arterial grip. Increased development and assimilation of spasm of coronary arteries in case of variable angina pectoris. In patients with inadvertent hypertrophic cardiomyopathy, I will shrink the blood from shlunochki. Changes in the frequency and intensity of headache of convulsive genesis. It causes nerve transmission in case of pseudohypertrophic Duchenne myopathy and the period of renewal of the disease. In vitro block enzyme P170 and partial assimilation resistance cancer cells before chemotherapy.

When the intake is in the middle of getting more than 90% of the dose, the bioavailability becomes 20-35% as metabolism during the "first pass" through the liver (it is increased with trivial intake at high doses). Tmax become 1-2 years (tablets), 5-7 hours (extended-release tablets) and 7-9 hours (extended-release capsules). Engage with plasmas by 90%. Metabolize in the liver with the statements of norverapamil, which is 20% of the hypotensive activity of verapamil, and 11 other metabolites (which start in small quantities). T 1/2 with an internal single dose is 2.8-7.4 years, with repeated doses - 4.5-12 years (in conjunction with the enzyme systems of the liver). With i / v introduced T 1/2, two-phase: early - close to 4 minutes, kintseviy - 2-5 hours. (play less than 2 minutes), hemodynamic effects - 3-5 minutes. The triviality of the diy becomes 8-10 years (tablets) or 24 years (capsules and prolonged tablets). With the on / in the antiarrhythmic effect, it is close to 2 hours, hemodynamic - 10-20 minutes. Vivod in the main nirkami and feces (close to 16%). Milk penetrates into the breast, passes through the placenta and appears in the blood of the umbilical vein before the hour is low. Intravenous intravenous administration of hypotension in the mother, which can lead to fetal distress. With a trivial increase, the clearence decreases and the accessibility increases. In the case of severe damage to the function of the liver, the plasma clearance decreases by 70% and T 1/2 decreases until the age of 14-16.

According to the results, taken in 2 days on pike, when injected in doses, 12 times overtaking the MRDC, and in the Eims bacterial test (5 pre-juvenile strains, the dose is 3 mg per cup, with metabolic activation), not even without mutagenic activity. In the past on pike, in doses, 6 times overwhelming the dose, it is recommended for people who trust the maturation of the fetus and the increased frequency of the internal uterine bend of the fetus.

Stagnation of speech by Verapamil

Paroxysmal suprashlunochkova tachycardia (crim WPW-syndrome a), sinus tachycardia, atrial extrasystole, atrial contraction, angina pectoris (including Prinzmetal, naprugi), postinfarction arterial hypertension, Hypertensive crisis, idiopathic hypertrophic subaortic stenosis, hypertrophic cardiomyopathy.

Prototype

Hypersensitivity, hypertension (SAT less than 90 mm Hg), cardiac shock, AV block II and III stages, myocardial infarction ./min), chronic heart failure of the III stage, tripotension and fibrillation of the atrium and WPW-syndrome and Laun-Ganong-Levin syndrome (most ailments with a cardiac pacemaker), syndrome of weakness of the sinus neoplasm (yamplans) Adams - Stokes, digitalis intoxication, severe stenosis of the aortic ring, vaginitis, breast disease.

Crimped to sucking

Stage I AV block, chronic heart failure of stages I and II, mild or moderate hypotension, myopathy (Duchenne syndrome), nirkov and / or abnormalities, low tachycardia with a wide QRS complex (for

Stagnation during vaginosis and breastfeeding

Stagnation of verapamil in case of vaginosity can only be taken into account, if cinnamon for the mother has been removed, the potential for the fetus is changed.

For an hour lіkuvannya slіd pinch breast year bath(Verapamil is seen in breast milk).

Pobіchnі diї speeches Verapamіl

On the side of the cardiovascular system and blood (blood formation, hemostasis): arterial hypotension, bradycardia (sinus), AV blockade, manifestation of symptoms of heart failure (at high doses).

On the side of the nervous system that organs are sensitive: headache, malnutrition, nervousness, dullness, drowsiness, weakness, stomachache, paresthesia.

On the side of the organs in the shlunkovo-intestinal tract: nudity, dyspepsia, constipation; Ridko - hyperplasia is clear, an increase in the activity of pecin transaminases, ALP.

Allergic reactions: shkіrny visip, kropiv'yanka, sverbіzh shkіri; Ridko - angioedema, Stevens-Johnson syndrome.

Інші: hyperemia of shkiri disclosure, bronchospasm (with intravenous injection), peripheral embryos, even more rarely - hynecomastia, increased secretion of prolactin (okremia vipadki).

vzaєmodiya

Zbіlshu rіven in plasma digoxin, cyclosporine, theophilin, carbamazepin, change - lіtіyu. I will weaken the antibacterial activity of rifampicin, which deprives the effect of phenobarbital, changes the clearence of metoprolol and propranolol, and reduces the effect of muscle relaxants. Rifampicin, sulfinpyrazone, phenobarbital, calcium salts, Vitamin D - weaken the diet. Hypotensive effect on antihypertensive drugs (diuretics, vasodilators), tricyclic and tetracyclic antidepressants and neuroleptics: antianginal - nitrati. Beta-adrenergic blockers, class IA antiarrhythmics, heart glucosides, anesthetics, radiopaque speech potential (mutually) attributable inflow to the automatism of a sinusoidal institution, AV speed and speed. With a one-hour consumption of verapamil with acetylsalicylic acid - the improvement of obvious bleeding. Cimetidine in plasma instead of verapamil.

Overdose

symptoms: Arterial hypotension, bradycardia, AV blockade, cardiogenic shock, coma, asystole.

lykuvannya: Yak specific antidote vikoristovuyut calcium gluconate (10-20 ml 10% v / v); with bradycardia and AV blockade, administer atropin, isoprenal or orciprenal; with hypotension - plasma-substituting solutions, dopamine, norepinephrine; in case of a sign of heart failure - dobutamin.

Zapobіzhny come in speeches Verapamіl

To protect the patients with hypertrophic cardiomyopathy, accelerated obstruction of the louse, in a vise wedging in the legeny capillaries, paroxysmal nichny zadishkoyu orthopedic, impaired function of the sinus-atrial node. If the patients are recognized with impaired liver function and neuro-muscular transmission (Duchenne myopathy), the necessary continuous control and, perhaps, change the dose. To protect the storage for an hour, the work is carried out by transport workers and people, the profession of which is tied to an increased concentration of respect (decrease in the speed of reaction), it is recommended to avoid drinking alcohol.

special requests

In''kts_yna form is insane with albumin,'in''kts_ynymi forms of amphotericin B, hydralazine, sulfamethoxazole, trimethoprim, and possibly in siege at pH 6.0.

Vzamodії with інshih dіyuchy speeches

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