Primary hyperaldosteronism. Secondary hyperaldosteronism in the course of severe, chronic liver diseases, with edema and ascites. Secondary hyperaldosteronism in chronic heart failure with edema.
Composition:
1 ampoule of 10 ml contains 200 mg of potassium canrenone.
Action:
Aldosterone antagonist with diuretic effect. It inhibits this part of the exchange of sodium ions to hydrogen and potassium, which is activated by aldosterone. Thanks to this, the excretion of sodium and urine increases, and the loss of potassium is reduced. Aldosterone blocking occurs at the cellular level and is associated with impaired synthesis of proteins involved in the transport of sodium and potassium ions. Such a mechanism requires time to develop full effect, hence usually 2-3 or even 4 days elapse to complete drug activity. Similarly, after discontinuation of the drug, the disappearance of its action extends over 3-4 days. It lowers blood pressure. Applied parenterally. It binds to plasma proteins. T0,5 is 10-18 h. Metabolizowany m.in. up to 3 compounds, two of which are quickly excreted, the third (glucuronide) - slower. It is excreted mostly with urine and faeces. It passes through the placenta barrier and into breast milk.
Contraindications:
Hypersensitivity to the drug, impaired renal function with serum creatinine above 1.8 - 2.0 mg / dl and creatinine clearance below 30 ml / min, acute renal failure, anuria, hyponatremia, hyperkalemia, pregnancy, breast-feeding.
Precautions:
Use with caution, especially in the elderly with impaired renal and hepatic function, regular monitoring of water and electrolyte balance. If hyperkalemia occurs, treatment should be discontinued and measures taken to reduce potassium to normal. Use cautiously in people with decompensated liver cirrhosis, even if kidney function is normal - cases of metabolic acidosis have been reported. In patients with impaired renal function, there was a reversible increase in blood urea. Caution should be exercised in patients who are at risk of acidosis and who are at risk of hyperkalemia (eg in diabetes). The medicine contains 1.6 mmol (37.1 mg) sodium per dose, which should be taken into account in patients with impaired renal function and in the control of sodium in the diet. The drug should be used as soon as possible - in animal studies carcinogenic was found with long-term administration.
Pregnancy and lactation:
The use of the drug is contraindicated during pregnancy and breastfeeding.
Side effects:
Uncommon: in women - tension of the mammary glands, menstrual disorders (menstrual arrest or menstrual bleeding), postmenopausal bleeding. In men - hypersensitivity sensory nipples and gynecomastia. Potentiation disorders and decreased libido may develop. Hyperkalemia. Rare: hyperchloraemic metabolic acidosis, pressure drops, bone demineralization, osteomalacia, hirsutism, voice disorders (hoarseness) or lowering of the voice (in some cases, both in men and women, voice disorders may persist despite discontinuation of treatment, for which the voice is of particular importance, eg actors or teachers, the therapeutic benefits should be carefully considered in relation to the risk of treatment), nausea, vomiting, diarrhea, spasmic pains, stomach or intestinal ulcers, bleeding, thrombocytopenia, eosinophilia in patients with cirrhosis liver, hyponatremia, headache and dizziness, excessive drowsiness, confusion syndrome (which disappears after dose reduction or temporary discontinuation of treatment), increase in uric acid in the blood, pain at the injection site. Isolated cases: redness at the injection site, urticaria, exfoliation, vasculitis, erythema erythematosus, pseudo-lupus and resembling lichen planus, alopecia, alopecia areata, agranulocytosis, liver damage, hepatitis.In addition, electrolyte disturbances may cause: arrhythmia, fatigue, muscle weakness, muscle cramps, dizziness.
Dosage:
Intravenously. Adults: usually 200-400 mg (1-2 ampoules) per day. In exceptional cases, the dose may be increased to 800 mg daily. Children about the month of up to 50 kg - initial dose up to 4 to 5 mg / kg / day, then a maximum of 2 to 3 mg / kg / day; infants - maximum starting dose of 2 to 3 mg / kg / day, then a maximum of 1.5 to 2 mg / kg daily. The drug administered at a rate of not more than 1 ampoule (10 ml) in 2-3 min. In patients receiving high doses of the product, or when it is necessary to improve the tolerance of the drug by the patient, the drug can be administered in divided doses or as an intravenous infusion, lasting about 30 minutes.
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