Cordaflex RD, 40 mg, modified-release film-coated tablets, 30 pcs.

Compound

Coated tablets contain 10 mg of nifedipine each as an active substance. Excipients: polyvinyl butyral in an amount of 0.7 mg; talc (1 mg); 0.3 mg magnesium stearate ; 4 mg hydroxypropylcellulose ; lactose monohydrate (15 mg); croscarmellose sodium (13 mg); microcellulose (46 mg). The shell consists of hypromellose - 2.63 mg; titanium dioxide CI 77891 - 0.82 mg; yellow iron oxide - 0.3 mg and magnesium stearate - 0.25 mg.
Long-acting film-coated tablets contain the same active substance, but in a dose of 20 mg. Each of them contains the following substances as auxiliary substances: microcellulose (99 mg); lactose monohydrate (30 mg); croscarmellose sodium (26 mg); copolymers of methyl methacrylate and ethyl methacrylate in a ratio of 1:2 (1.9 mg); talc (2 mg); magnesium stearate (0.6 mg); hyprolose (0.5 mg). The film shell is made of hypromellose - 5.26 mg; titanium dioxide - 1.64 mg; red iron oxide - 0.6 mg; magnesium stearate - 0.5 mg.

Cordaflex, 60 pcs., 20 mg, extended-release film-coated tablets

Inside.

Film-coated tablets, 10 mg

should be swallowed whole before meals, without chewing, with a small amount of water.

The dosage regimen is set individually, depending on the severity of the disease and the patient’s response to the therapy. The initial dose is 1 tablet. (10 mg) 3 times a day. If necessary, the dose can be increased to 2 tablets. (20 mg) - 1-2 times a day. At least 2 hours should pass between two doses of the drug. The maximum daily dose is 40 mg.

If it is necessary to increase the dose to 80–120 mg for the treatment of angina pectoris or arterial hypertension, it is recommended to transfer the patient to Cordaflex® extended-release film-coated tablets, 20 mg.

To speed up the action of the drug at the beginning of an attack of angina or hypertensive crisis, the tablet should be chewed, held in the mouth for some time, and then swallowed with a small amount of water.

In elderly patients, the pharmacokinetics of nifedipine changes, and therefore lower doses may be required to maintain sufficient therapeutic effect.

If renal or hepatic function decreases, it is recommended to use with caution the same doses as for normal renal or hepatic function (tolerance may develop). If there is a significant decrease in liver function, it is not recommended to take a dose of more than 40 mg per day.

Extended-release film-coated tablets, 20 mg

should be swallowed whole, without chewing, with a small amount of water.

The recommended starting dose is 1 tablet. 2 times a day (2 × 20 mg). If necessary, the daily dose can be increased up to 2 times 2 tablets. The maximum daily dose of nifedipine should not exceed 120 mg. It is recommended to divide the daily dose into 2 doses at 12-hour intervals.

In patients with impaired liver function, the drug is used with caution under the monitoring of liver function; in case of severe impairment of liver function, the dose must be reduced. In patients with impaired renal function, no dose adjustment is required.

In elderly patients, the metabolism of nifedipine during the initial passage through the liver is reduced, and there is also a higher likelihood of deterioration of cerebral blood flow due to possible sharp peripheral vasodilation, therefore, at the beginning of treatment, the dose of Cordaflex® is reduced by approximately 2 times.

The drug should be discontinued gradually, especially after taking high doses.

Release form

There are two options for the release form of the drug:

• Coated tablets, weighing 10 mg. Every 100 tablets are placed in a brown glass bottle. The bottles are individually packaged in cardboard boxes.
• Film-coated tablets with prolonged action. Each tablet weighs 20 mg. Place 30 or 60 tablets in brown glass bottles. Vials must be sealed with polyethylene caps that have a first-opening control. The bottle is packed in a cardboard box.

Pharmacodynamics and pharmacokinetics

Nifedipine is a selective blocker of slow calcium channels, one of the 1,4-dihydropyridine derivatives. Its effect is manifested in a decrease in the flow of extracellular calcium ions into cardiomyocytes and smooth muscle cells of the arteries. Nifedipine can also increase renal blood flow, causing moderate natriuresis .

After taking one tablet of Cordaflex, which has a prolonged action, the clinical effect usually develops after 20 minutes, the effect lasts from 12 to 24 hours.

After administration, it is quickly, almost completely (at least 90%) absorbed from the digestive tract. And the bioavailability of the drug is in the range of 40-70%.

The maximum concentration of the active substance in the blood is found 30-60 minutes after taking the drug.

After taking one tablet with a prolonged action, the therapeutic concentration in the blood plasma is achieved within an hour and remains at an equal level for up to 6 hours; over the next 30-36 hours, a gradual decrease in concentration is observed.

Nifedipine has the property of binding to blood plasma proteins, in particular albumins , penetrating the blood-brain barrier (in small quantities - no more than 5%), through the placenta , and can be excreted in breast milk.

The half-life is 2 hours for a 10 mg tablet; for a 20 mg extended-release tablet it is approximately 3.8-16.9 hours.

Instructions for use

The effect of the drug is manifested by blocking Ca channels. As a result, the flow of calcium ions into cardiomyocytes and smooth muscle cells of the arteries decreases. This leads to vasodilation and a decrease in total peripheral resistance. As a result, blood flow in the heart improves and afterload decreases, anginal pain disappears, blood pressure drops, and spasmodic smooth muscles relax. The effective concentration of nifedipine is maintained for 12-24 hours.

Indications: what does the medicine help with?

Cordaflex is used for the following diseases:

• arterial hypertension;
• hypertensive crises
• coronary heart disease (to prevent attacks, including unstable Prinzmetal angina);
• prevention of migraine attacks;
• colic of various origins and other conditions requiring antispasmodic action
• Raynaud's disease.

At what pressure can it be taken?

If blood pressure exceeds 139/90, the condition can be classified as hypertension. Pathology leads to numerous complications, including heart attack and stroke. Patients with high blood pressure should monitor it and keep it within normal limits, or within the limits established by the doctor.

Consequently, Cordaflex is taken for long-term maintenance of blood pressure within the normal range, as soon as a diagnosis of hypertension is made.

Composition and release forms

The active ingredient of Cordaflex is nifedipine, a derivative of 1,4 dihydropyridine.

The medication is available in two forms:

• coated tablets, 10 mg, yellow, 100 units in a glass jar;
• extended-release tablets (long-acting) - also film-coated, purple, contain 20 mg of active substance. Packed in 30 or 60 pcs. in a bottle

Available in pharmacies by prescription.

Contraindications and side effects

Nifedipine has a number of side effects on various organ systems. Most often they appear due to dosage violations or combined use with other medications. To avoid unpleasant consequences, be sure to consult your doctor before taking it.

The drug is not recommended for use in the following cases:

• unstable angina;
• myocardial infarction;
• cardiogenic shock;
• arterial hypotension;
• vegetative-vascular dystonia of the hypotonic type;
• lactose intolerance;
• individual hypersensitivity to nifedipine, other 1,4-dihydropyridine derivatives, auxiliary ingredients of tablets.

The medicine is prescribed with caution in the following situations:

• the first month after myocardial infarction;
• severe valve defects;
• hypertrophic myocardiopathy;
• chronic cardiovascular failure;
• acute cerebral circulatory disorders (stroke, transient ischemic attack);
• acute/chronic liver or kidney failure;
• diabetes.

The safety of using nifedipine in children under 18 years of age has not been established, so it is better to refrain from taking it at this age. The drug is also prescribed with caution to elderly people, especially with concomitant kidney pathologies.

During pregnancy, the medicine may be indicated in the absence of other, safer alternatives. However, it is better not to take it while breastfeeding.

The drug does not affect concentration and coordination of movements, therefore driving and working with complex mechanisms are allowed while taking it. However, in the first time after the appointment, attacks of dizziness are possible - during this period it is better to abandon the above types of activities. In the future, this issue should be discussed with your doctor.

Drinking alcohol is not recommended during treatment with nifedipine, as this may cause an uncontrolled drop in blood pressure.

How to take: method of application and dose

Instructions for use of Cordaflex contain the following recommendations:

1. The exact dosage is determined by the attending physician. This takes into account the severity of the disease, the patient’s response to treatment, age, the presence of concomitant pathologies and other factors.
2. The tablets must be taken before meals (the extended-release form can be taken at any convenient time).
3. If you miss a dose, you must take the medication as quickly as possible, but do not double the dosage.
4. The medicine should be washed down with plain boiled water and swallowed without chewing.
5. When symptoms of a hypertensive crisis appear, to accelerate the effect, the drug should be chewed, kept in the mouth for some time, and only then swallowed.

The average therapeutic dose is 10 mg three times a day, if necessary it is changed in the right direction. A maximum of 40 mg of nifedipine can be taken per day. The interval between single doses should be at least 2 hours.

Prolonged Cordaflex is consumed twice a day, with an interval of 12 hours; if necessary, the daily dosage is increased to 80-120 mg (4-6 tablets). In patients with renal dysfunction, it should not exceed 40 mg.

For elderly people, as well as for maintenance therapy, the initial dose is reduced by half, with subsequent adjustment depending on the response to treatment.

Overdose

If the dosage is exceeded, the following symptoms occur:

• drop in blood pressure (up to collapse);
• syncope (fainting)
• autonomic disorders (headache, nausea, vomiting, dizziness)
• angina pectoris pain in the chest.

There is no specific antidote to this drug. Treatment consists of discontinuing the medication, gastric lavage, and taking absorbent agents. Symptomatic therapy is also recommended: hypertensive drugs (Norepinephrine, Dopamine), cardiotonics, antiarrhythmics .

Interaction with other drugs

An increase in hypotonic effect is possible when combined with the following drugs:

• beta blockers;
• tricyclic antidepressants;
• histamine H2 receptor blockers;
• diuretics;
• ACE inhibitors.

The effect of Cordaflex is weakened by taking calcium supplements

It is not recommended to use Cordaflex together with grapefruit juice due to the effect of the product on the metabolism of nifedipine.

The drug enhances the toxicity of Digoxin and Theophylline and anti-inflammatory drugs, as well as indirect anticoagulants.

special instructions

After a MI, nifedipine is prescribed only if hemodynamics are normalized.

In patients with heart failure, it is first necessary to undergo a course of therapy with cardiac glycosides until the condition stabilizes.

In diabetics, the drug may cause hyperglycemia.

Before general anesthesia, you must warn your doctor about taking Cordaflex.

Contraindications

Contraindications are:

• intolerance to nifedipine , other 1,4-dihydropyridine , additional components included in the tablets;
• arterial hypotension;
• unstable angina;
• the current or recent presence of acute myocardial infarction or severe aortic stenosis ;
• idiopathic subaortic stenosis;
• chronic heart failure during the period of decompensation;
• childhood.

It is prescribed with special caution to elderly patients, those with impaired renal function, and patients with diabetes mellitus .

Cordaflex® RD

Pharmacokinetic interactions

Medicines that affect the metabolism of nifedipine

Nifedipine is metabolized by CYP3A4/5 isoenzymes, which are located in the intestinal mucosa and liver. Drugs that inhibit or induce this enzyme system may affect the first pass effect through the liver (after oral administration) or the clearance of nifedipine.

Inducers of the CYP3A4 isoenzyme

Rifampicin

Rifampin is a potent inducer of the CYP3A4 isoenzyme. When used simultaneously with rifampicin, the bioavailability of nifedipine is significantly reduced and, accordingly, its effectiveness is reduced. Therefore, the simultaneous use of nifedipine with rifampicin is contraindicated.

Antiepileptic drugs that induce CYP3A4 (eg, phenytoin, carbamazepine, phenobarbital)

Phenytoin induces the CYP3A4 isoenzyme. With the simultaneous use of nifedipine and phenytoin, the bioavailability of nifedipine is reduced and its effectiveness is reduced. When using this combination simultaneously, it is necessary to monitor the clinical response to nifedipine therapy and, if necessary, increase its dose. If the dose of nifedipine is increased with simultaneous use of both drugs, the dose of nifedipine should be reduced after discontinuation of phenytoin. Clinical studies examining the potential interaction between nifedipine and carbamazepine or phenobarbital have not been conducted. Since both drugs reduce the concentration of nimodipine in the blood plasma, which is structurally similar to BMCC, the possibility of a decrease in the concentration of nifedipine in the blood plasma and a decrease in its effectiveness cannot be excluded.

CYP3A4 isoenzyme inhibitors

Macrolide antibiotics (for example, erythromycin)

Clinical studies on the interaction of nifedipine and macrolide antibiotics have not been conducted. Some macrolides are known to inhibit the CYP3A4 isoenzyme. As a result, the possibility of an increase in the concentration of nifedipine in the blood plasma cannot be excluded with the simultaneous use of nifedipine and macrolide antibiotics.

Azithromycin, a macrolide antibiotic, does not inhibit the CYP3A4 isoenzyme.

HIV protease inhibitors (eg, ritonavir)

Clinical studies examining the interaction of nifedipine and HIV protease inhibitors have not been conducted. It is known that drugs of this class inhibit the CYP3A4 isoenzyme. In addition, drugs of this class have been shown to suppress the metabolism of nifedipine mediated by the CYP3A4 isoenzyme in vitro.

When used simultaneously with nifedipine, a significant increase in the concentration of nifedipine in the blood plasma cannot be ruled out due to a decrease in the effect of “first pass” through the liver and slower elimination.

Azole antifungals (eg, ketoconazole)

Clinical studies examining the interaction of nifedipine and azole antifungals have not been conducted. It is known that drugs of this class inhibit the CYP3A4 isoenzyme. When used simultaneously with nifedipine, a significant increase in the systemic bioavailability of nifedipine is possible by reducing the effect of “first pass” through the liver.

Cimetidine and ranitidine

It has been established that cimetidine and ranitidine inhibit the CYP3A4 isoenzyme and cause an increase in the concentration of nifedipine in the blood plasma (by 80% and 70%, respectively), thereby enhancing its antihypertensive effect.

Diltiazem

Diltiazem reduces the clearance of nifedipine. This combination should be used with caution. A dose reduction of nifedipine may be required.

Fluoxetia

Clinical studies examining the interaction of nifedipine and fluoxetine have not been conducted. It is known that fluoxetine in vitro

suppresses the metabolism of nifedipine mediated by the action of the CYP3A4 isoenzyme. Therefore, the possibility of an increase in the concentration of nifedipine in the blood plasma cannot be excluded with the simultaneous use of nifedipine and fluoxetine.

Nefazodone

Clinical studies examining the interaction between nifedipine and nefazodone have not been conducted. Nefazodone is known to inhibit the metabolism of other drugs mediated by the CYP3A4 isoenzyme. Therefore, the possibility of an increase in the concentration of nifedipine in the blood plasma cannot be excluded with the simultaneous use of nifedipine and nefazodone.

Quinidine

Increased plasma concentrations of nifedipine have been reported when administered concomitantly with quinidine. Therefore, when using quinidine and nifedipine simultaneously, careful monitoring of blood pressure is necessary. If necessary, the dose of nifedipine should be reduced.

Quinupristin/dalfopristin

Concomitant use of quinupristin/dalfopristin may lead to increased plasma concentrations of nifedipine.

Valproic acid

Clinical studies examining the interaction of nifedipine and valproic acid have not been conducted. Since valproic acid increases the concentration of nimodipine in the blood plasma, which is structurally similar to BMCC, the possibility of increasing the concentration of nifedipine in the blood plasma and enhancing its effectiveness cannot be excluded.

Grapefruit juice

Grapefruit juice inhibits the CYP3A4 isoenzyme and suppresses the metabolism of nifedipine. The simultaneous use of nifedipine with grapefruit juice leads to an increase in the concentration of nifedipine in the blood plasma and a prolongation of its action due to a decrease in the effect of “primary passage” through the liver and a decrease in clearance. This may enhance the antihypertensive effect of nifedipine. With regular consumption of grapefruit juice, this effect can last for 3 days after the last consumption of the juice. The consumption of grapefruit/grapefruit juice during treatment with nifedipine is contraindicated (see section Contraindications).

CYP3A4 isoenzyme substrates

Substrates of the CYP3A4 isoenzyme (for example, cisapride, tacrolimus, benzodiazepines, imipramine, propafenone, terfenadine, warfarin), when used simultaneously with nifedipine, may act as CYP3A4 inhibitors and increase the concentration of nifedipine in the blood plasma.

Cisapride

Concomitant use of cisapride and nifedipine may lead to increased plasma concentrations of nifedipine.

Effect of nifedipine on other drugs

Quinidine

Nifedipine causes a decrease in the concentration of quinidine in the blood plasma. After discontinuation of nifedipine, a sharp increase in the concentration of quinidine in the blood plasma may occur. Therefore, when using nifedipine as additional therapy or discontinuing nifedipine, the concentration of quinidine in the blood plasma should be monitored and, if necessary, its dose should be adjusted.

Digoxin

The simultaneous use of nifedipine and digoxin may lead to a decrease in the clearance of digoxin and, consequently, to an increase in the concentration of digoxin in the blood plasma. The patient should be carefully monitored for symptoms of glycoside overdose and, if necessary, reduce the dose of digoxin, taking into account its concentration in the blood plasma.

Theophylline

Nifedipine increases plasma concentrations of theophylline, and therefore the concentration of theophylline in blood plasma should be monitored. The clinical effect of both drugs when used together does not change.

Tacrolimus

Tacrolimus is metabolized with the participation of the CYP3A4 isoenzyme. Recently published data indicate the possibility of increased tacrolimus concentrations in selected cases when administered concomitantly with nifedipine. When using tacrolimus and nifedipine simultaneously, the concentration of tacrolimus in the blood plasma should be monitored and, if necessary, its dose should be reduced.

Vincristine

Nifedipine slows down the elimination of vincristine from the body and may cause increased side effects of vincristine. If simultaneous use is necessary, reduce the dose of vincristine.

Drugs that bind to blood proteins

Nifedipine can displace drugs characterized by a high degree of binding from protein binding (including indirect anticoagulants - coumarin and indanedione derivatives, anticonvulsants, non-steroidal anti-inflammatory drugs (NSAIDs), quinine, salicylates, sulfinpyrazone), as a result of which their concentration may increase in blood plasma.

Cephalosporins

With the simultaneous administration of cephalosporins (for example, cefixime) and nifedipine in probands, the bioavailability of the cephalosporin increased by 70%.

Pharmacodynamic interactions

Medicines that lower blood pressure

The antihypertensive effect of nifedipine may be enhanced when used simultaneously with antihypertensive drugs, such as diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARA II), other BMCCs, alpha-blockers, phosphodiesterase-5 inhibitors, methyldopa.

When using nifedipine and beta-blockers simultaneously, it is necessary to carefully monitor the patient's condition, since in some cases the course of CHF may worsen.

The severity of the decrease in blood pressure increases with the simultaneous use of inhalational anesthetics and tricyclic antidepressants.

Nitrates

When used simultaneously with nitrates, tachycardia increases.

Antiarrhythmic drugs

BMCCs can enhance the negative inotropic effect of antiarrhythmic drugs such as amiodarone and quinidine. Nifedipine should be co-administered with disopyramide and flecainide with caution due to a possible increase in negative inotropic effect.

Magnesium sulfate

It is necessary to carefully monitor blood pressure in pregnant women while using nifedipine with intravenous magnesium sulfate due to the possibility of an excessive decrease in blood pressure, which is dangerous for both the mother and the fetus.

Fentanyl

The simultaneous use of nifedipine and fentanyl can lead to severe arterial hypotension. If possible, it is recommended that nifedipine be discontinued at least 36 hours before fentanyl-based anesthesia.

Calcium preparations

Reduced effectiveness of nifedipine.

NSAIDs

NSAIDs reduce the antihypertensive effect of nifedipine due to suppression of prostaglandin synthesis, sodium and fluid retention in the body.

Sympathomimetics

Sympathomimetics reduce the antihypertensive effect of nifedipine.

Estrogens

Estrogens reduce the antihypertensive effect of nifedipine due to fluid retention in the body.

Lithium preparations

When BMCC is used together with lithium drugs, it is possible to increase the manifestation of the neurotoxicity of the latter (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus).

Side effects

Cordaflex is usually well tolerated. Side effects appear rarely, more often at the beginning of treatment (then they may become weaker or disappear).

There are such side effects:

• On the heart and blood vessels: decreased blood pressure, flushing of the face and torso, swelling in the extremities , accelerated heart rate, paradoxical attack of angina , development of acute heart failure .
• On the nervous system: increased fatigue , dizziness , weakness , emotional lability , sleep disturbances, headache, tremor , paresthesia .
• On the gastrointestinal tract: the occurrence of heartburn , nausea , vomiting , flatulence , stool disorders, dryness or inflammation of the oral mucosa, intrahepatic cholestasis , as well as increased activity of certain liver enzymes.
• On the circulatory system: thrombocytopenia , leukopenia , anemia .
• On the urinary system: increased daily diuresis, night urination , decreased renal function.

Allergic reactions may occur in the form of urticaria , exanthema , and skin itching .

conclusions

Cordaflex is a highly effective antianginal and antihypertensive agent from the group of calcium channel blockers. Due to this, as well as its low cost, it has become widespread in the treatment of acute attacks of cardiovascular diseases.

However, it has a number of contraindications and can also cause various adverse reactions. The most common is a sharp drop in blood pressure. To avoid them, you must strictly adhere to dosages and recommendations for use.

Instructions for use of Cordaflex (Method and dosage)

The drug is taken orally. 10 mg film-coated tablets are swallowed whole before meals with water.

The dosage is set individually, as it very much depends on the severity of the disease, the type of disease and the body’s response to the therapy. Start with 1 tablet (10 mg) 3 times a day. There should be at least 2 hours between doses of the drug. The maximum dose per day is 40 mg.

Long-acting film-coated tablets are swallowed whole and washed down with water. In this case, the initial dose is 1 tablet 2 times a day. In any case, the daily dose is divided into 2 doses, between which a 12-hour interval must be observed.

According to the instructions for use of Cordaflex, discontinuation of the drug should be carried out gradually.

Cordaflex, 100 pcs., 10 mg, film-coated tablets

Inside.

Film-coated tablets, 10 mg

should be swallowed whole before meals, without chewing, with a small amount of water.

The dosage regimen is set individually, depending on the severity of the disease and the patient’s response to the therapy. The initial dose is 1 tablet. (10 mg) 3 times a day. If necessary, the dose can be increased to 2 tablets. (20 mg) - 1-2 times a day. At least 2 hours should pass between two doses of the drug. The maximum daily dose is 40 mg.

If it is necessary to increase the dose to 80–120 mg for the treatment of angina pectoris or arterial hypertension, it is recommended to transfer the patient to Cordaflex® extended-release film-coated tablets, 20 mg.

To speed up the action of the drug at the beginning of an attack of angina or hypertensive crisis, the tablet should be chewed, held in the mouth for some time, and then swallowed with a small amount of water.

In elderly patients, the pharmacokinetics of nifedipine changes, and therefore lower doses may be required to maintain sufficient therapeutic effect.

If renal or hepatic function decreases, it is recommended to use with caution the same doses as for normal renal or hepatic function (tolerance may develop). If there is a significant decrease in liver function, it is not recommended to take a dose of more than 40 mg per day.

Extended-release film-coated tablets, 20 mg

should be swallowed whole, without chewing, with a small amount of water.

The recommended starting dose is 1 tablet. 2 times a day (2 × 20 mg). If necessary, the daily dose can be increased up to 2 times 2 tablets. The maximum daily dose of nifedipine should not exceed 120 mg. It is recommended to divide the daily dose into 2 doses at 12-hour intervals.

In patients with impaired liver function, the drug is used with caution under the monitoring of liver function; in case of severe impairment of liver function, the dose must be reduced. In patients with impaired renal function, no dose adjustment is required.

In elderly patients, the metabolism of nifedipine during the initial passage through the liver is reduced, and there is also a higher likelihood of deterioration of cerebral blood flow due to possible sharp peripheral vasodilation, therefore, at the beginning of treatment, the dose of Cordaflex® is reduced by approximately 2 times.

The drug should be discontinued gradually, especially after taking high doses.

Overdose

An overdose of nifedipine may cause the following consequences:

• arterial hypotension;
• chest pain (similar to an angina );
• tachycardia;
• loss of consciousness;
• collapse;
• ventricular or nodal extrasystole ;
• bradycardia.

In severe cases, the development of metabolic alkalosis , cardiogenic shock with pulmonary edema, hypoxia , hyperkalemia , as well as disturbances of consciousness, which can progress to coma .

Interaction

Cordaflex should not be administered with alcohol-containing medications.

Orthostatic hypotension may develop when used with methyldopa , clonidine , as well as prazosin and octadine .

Cimetidine , ranitidine and tricyclic antidepressants will potentiate the antihypertensive effect .

When Cordaflex is combined with theophylline and digoxin , it is necessary to monitor the plasma concentrations of these drugs, as they may increase.

Phenytoin , calcium supplements and rifampicin reduce the effect of nifedipine .

Cordaflex reduces the rate of elimination of vincristine , which increases the risk of side effects. Therefore, dose adjustment is necessary.

Erythromycin , diltiazem , grapefruit juice in large quantities, azole antimicrobial drugs when taken with nifedipine significantly slow down its metabolism.

Cordaflex®

From the point of view of enhancing the antihypertensive and antianginal effect, the combination of Cordaflex with beta-blockers, diuretics, ACE inhibitors, and nitrates is rational. All of the above combinations are safe and effective in most clinical situations, since they lead to summation or potentiation of effects, however, in some cases there is a risk of a pronounced decrease in blood pressure and increased symptoms of heart failure.

The combination of Cordaflex with clonidine, methyldopa, octadine, prazosin is possible according to indications, but can cause severe orthostatic hypotension.

An increase in the hypotensive effect is also observed with combination therapy with cimetidine, ranitidine and tricyclic antidepressants.

Nifedipine increases the concentration of digoxin and theophylline in the blood plasma, and therefore the clinical effect and/or the content of digoxin and theophylline in the blood plasma should be monitored.

Procaine, quinidine and other drugs that cause QT prolongation enhance the negative inotropic effect and increase the risk of QT prolongation. Under the influence of nifedipine, the concentration of quinidine in the blood serum is significantly reduced, which is apparently due to a decrease in its bioavailability, as well as the induction of enzymes that inactivate quinidine. When nifedipine is discontinued, a transient increase in quinidine concentration is observed (approximately 2 times), which reaches a maximum level on days 3-4. Caution should be exercised when using such combinations, especially in patients with impaired left ventricular function.

Nifedipine can displace drugs characterized by a high degree of binding from protein binding (including indirect anticoagulants - derivatives of coumarin and indanedione, NSAIDs), as a result of which their concentrations in the blood plasma may increase.

When administered simultaneously with rifampicin, phenytoin and calcium preparations, the effect of nifedipine is weakened.

Nifedipine inhibits the elimination of vincristine from the body and may cause increased side effects of vincristine; if necessary, the dose of vincristine is reduced.

Diltiazem inhibits the metabolism of nifedipine in the body; if necessary, reduce the dose of nifedipine.

Grapefruit juice, erythromycin and azole antifungals (fluconazole, intraconazole, ketoconazole) may inhibit the metabolism of nifedipine and therefore enhance its effects.

Similarly, the simultaneous use of Cordaflex and cimetidine increases the concentration of nifedipine in the blood plasma and enhances its effects; however, simultaneous use with ranitidine does not lead to a significant increase in the concentration of nifedipine in the blood plasma.

Since nifedipine is metabolized by the CYP3A4 isoenzyme, any inhibitor or inducer of this enzyme may affect the metabolism of nifedipine. Cyclosporine is also a CYP3A4 substrate; therefore, when cyclosporine and nifedipine are used together, each may increase the duration of the effect of the other.

Cordaflex analogues (drugs that have a similar effect)

Level 4 ATC code matches:
Lacipil

Cordafen

Azomex

Nimodipine

Felodipin

Nifedipine

Farmadipin

Amlotop

Nimotop

Tenox

Nifecard HL

Cordipin

Felodip

Normodipine

Phenigidine

Norvask

Lerkamen

Corinfar

Vero-Amlodipine

Amlodipine

Analogs are the following drugs: Adalat , Vero-Nifedipine , Calcigard Retard , Zanifed , Cordafen , Cordaflex Retard , Cordipin , Cordipin Retard , Cordipine XL Corinfar , Nifedicap , Nifedipine and some other drugs.

Cordaflex Retard has particularly similar pharmaceutical characteristics and therapeutic applications.

Cordaflex price, where to buy

The price for 10 mg tablets is 72-95 rubles for 10 pieces, for 20 mg tablets – 63-139 rubles for 30 pieces, 74-168 rubles for 60 pieces.

• Online pharmacies in RussiaRussia

ZdravCity

• Cordaflex tablets p.p.o.
  prolonged action 20 mg 60 pcs. Egis 125 rub. order
• Cordaflex tab. p.o 10 mg n100Egis

  95 rub. order

• Cordaflex RD tablets p.p.o. with control release 40 mg 30 pcs Arena Pharmaceuticals GmbH/Egis

  RUB 192 order

• Cordaflex tablets p.p.o. prolonged action 20 mg 30 pcs. Egis

  90 rub. order