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Panangin® Forte, tablets, film coated.
Latin name: Panangin® Forte.
Active ingredient: Potassium and Magnesium aspartate (Potassium aspartate and magnesium aspartate).
Pharmacological groups: Macro - and micronutrients.
Antiarrhythmic drugs.

Release form, composition and packaging:
Tablets, film coated white or almost white, oval, biconvex, with a slightly glossy surface, engraved with "A83" on one side, almost odorless; on cross section of white or almost white color.
-1 tab.
potassium asparaginate hemihydrate -332.6 mg which corresponds to the content of potassium asparaginate -316 mg
magnesium asparaginate tetrahydrate -350 mg, which corresponds to the magnesium content of asparaginate -280 mg
Excipients: corn starch - 172.2 mg, talc - 20 mg, magnesium stearate - 8 mg, potato starch - 6.6 mg, povidone K30 - 6.6 mg, colloidal silicon dioxide - 4 mg.
Composition film coat: talc - 7.3 mg, butyl methacrylate copolymer - 6 mg, titanium dioxide (color index: C.I. 77891, E171) - 5.3 mg, macrogol 6000 - 1.4 mg.
Blisters - packs cardboard.

pharmachologic effect :
A drug that affects metabolic processes. Source of potassium and magnesium ions.
Potassium and magnesium are intracellular cations, which play a major role in the functioning of many enzymes, in the formation of bonds between macromolecules and intracellular structures, and in the mechanism of muscle contractility.The intra- and extracellular ratio of potassium, magnesium, Calcium and sodium ions affects the contractility of the myocardium. Endogenous aspartate acts as a conductor of ions: has a high affinity for cells, due to the insignificant dissociation of its salts, ions in the form of complex compounds penetrate into the cell. Potassium and magnesium aspartate improves myocardial metabolism. A lack of potassium and / or magnesium ions predisposes to the development of arterial hypertension, atherosclerosis of the coronary arteries and the occurrence of metabolic changes in the myocardium.
One of the most important physiological functions of potassium is to maintain the membrane potential of neurons, myocytes, and other excitable structures of myocardial tissue. The imbalance between intra- and extracellular potassium levels leads to a decrease in myocardial contractility, the occurrence of arrhythmias, tachycardia and an increase in the toxicity of cardiac glycosides.
Magnesium is an important cofactor for more than 300 enzymatic reactions, including energy metabolism and the synthesis of proteins and nucleic acids. In addition, magnesium plays an important role in the heart: it improves contractility and heart rate, leading to a decrease in myocardial oxygen demand. Decrease in contractility of myocytes of smooth muscles of arteriole walls, incl. coronary leads to vasodilation and increased coronary blood flow. Magnesium has an anti-ischemic effect on myocardial tissue.
The combination of potassium and magnesium ions in one preparation is justified by the fact that the deficiency of potassium in the body is often accompanied by a deficiency of magnesium and requires the simultaneous correction of the content in the body of both ions. With simultaneous correction of the levels of these electrolytes, an additive effect is observed (low levels of potassium and / or magnesium have a proarrhythmic effect), in addition, potassium and magnesium reduce the toxicity of cardiac glycosides, without affecting their positive inotropic effect.

When administered absorption of the drug is high.
Excreted in the urine.
Data on the pharmacokinetics of the drug in the form of a solution for iv administration are not provided.

Indications to the use of the drug Panangin :
- in the complex treatment of heart failure, acute myocardial infarction, cardiac arrhythmias (mainly ventricular arrhythmias, as well as arrhythmias caused by an overdose of cardiac glycosides);
- to improve the tolerability of cardiac glycosides;
- replenishment of potassium and magnesium deficiency while reducing their content in the diet (for tablets).

Side effect:
When taken orally:
From the side of the cardiovascular system: AV blockade, paradoxical reaction (increase in the number of extrasystoles) are possible.
On the part of the digestive system: possible nausea, vomiting, diarrhea, discomfort or burning sensation in the pancreas (in patients with anacid gastritis or cholecystitis).
From the side of water and electrolyte balance: hyperkalemia (nausea, vomiting, diarrhea, paresthesia), hypermagnemia (facial flushing, thirst, decreased blood pressure, hyporeflexia, respiratory depression, convulsions are possible).

Contraindications to the use of the drug PANANGIN:
For oral administration
- acute and chronic renal failure;
- hyperkalemia;
- hypermagnesium;
- Addison's disease;
- AV block I-III degree;
- cardiogenic shock (BP <90 mm Hg);
- severe myasthenia gravis;
- disruption of amino acid metabolism;
- hemolysis;
- acute metabolic acidosis;
- dehydration of the body.
* With care: during pregnancy (especially in the first trimester) and during lactation.

Use of the drug PANANGIN during pregnancy and lactation:
Data on the negative effects of the drug in the form of a solution for IV injection during pregnancy and lactation (breastfeeding) are not available.
* The drug should be used with caution during pregnancy (especially in the first trimester) and during lactation (breastfeeding).

Application for violations of renal function:
Acute and chronic renal failure, oliguria, anuria.

Special instructions:
It should be used with caution in patients with an increased risk of developing hyperkalemia. In this case, it is necessary to regularly monitor the level of potassium ions in the blood plasma.
Before taking the drug, the patient should consult a doctor.
With rapid on / in the introduction of the drug may develop skin hyperemia.
Influence on ability to drive motor transport and control mechanisms
The drug does not affect the ability to drive and engage in activities that require high concentration of attention and speed of psychomotor reactions.

To date, cases of overdose are not described. In case of overdose, the risk of hyperkalemia and hypermagnesis growth increases.
* Symptoms of hyperkalemia: fatigue, myasthenia gravis, paresthesia, confusion, heart rhythm disturbances (bradycardia, AV blockade, arrhythmias, cardiac arrest).
* Symptoms of hypermagnesemia: decreased neuromuscular excitability, retching, vomiting, lethargy, decreased blood pressure. With a sharp increase in the content of magnesium ions in the blood - depression of tendon reflexes, respiratory paralysis, coma.
When ingestion - a violation of the conductivity of the heart (especially in the previous pathology of the conduction system of the heart).
* Treatment: the abolition of the drug, the conduct of symptomatic therapy (in / in the introduction of 100 mg / min of calcium chloride solution), if necessary, hemodialysis and peritoneal dialysis.

Drug Interactions:
With simultaneous use with potassium-sparing diuretics (triamterene, spironolactone), beta-blockers, cyclosporine, Heparin, ACE inhibitors, NSAIDs, the risk of hyperkalemia increases until arrhythmia and asystolia occur.
The use of potassium preparations together with the corticosteroids eliminates the hypokalemia they cause.
Under the influence of potassium, a decrease in the undesirable effects of cardiac glycosides is observed.
The drug enhances the negative dromo-and bathmotropic action of antiarrhythmic drugs.
Due to the presence of potassium ions in the composition of the drug when using Panangin with ACE inhibitors, beta-blockers, cyclosporine, potassium-sparing diuretics, heparin, NSAIDs, hyperkalemia may develop until extrasystole develops.
Magnesium preparations reduce the effectiveness of neomycin, polymyxin B, Tetracycline and streptomycin.
Calcium preparations reduce the effect of magnesium preparations.
Anesthetics increase the inhibitory effect of magnesium on the central nervous system.
When used with atracurium, dexametonium, suxametonium, an increased neuromuscular blockade is possible; with calcitriol - an increase in the level of magnesium in the blood plasma.
Knitting and enveloping agents reduce the absorption of the drug in the gastrointestinal tract. It is necessary to observe the 3-hour interval between ingestion of the drug Panangin with the above remedies.
The solution for iv administration is compatible with cardiac glycoside solutions (improves their tolerability, reduces the undesirable effects of cardiac glycosides).

Pharmacy sales conditions:
Panangin in the form of pills approved for use as a means of non-prescription.

Storage conditions:
The drug should be stored at a temperature of 15 ° to 30 ° C, out of the reach of children.

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