Review of the drug Cardiomagnyl: indications, dosage, side effects, price

For the treatment and prevention of heart and vascular diseases, a modern drug, Cardiomagnyl, was created based on acetylsalicylic acid.

The main purpose is to prevent thrombus formation and blockage of blood vessels with blood clots, to prevent heart attacks and strokes.

What is Cardiomagnyl used for?

This medicine helps prevent the development of thrombosis and related complications in people with diseases of the cardiovascular system. Active substance of the drug: acetylsalicylic acid (aspirin). NSAIDs with a pronounced antiplatelet effect prevent platelet adhesion and the formation of blood clots, improve blood fluidity. Magnesium hydroxide in the composition blocks the toxic effects of acetylsalicylic acid on mucous membranes.

In industry, Cardiomagnyl is produced in two dosages:

• white heart-shaped tablets: each contains 75 mg of aspirin and 15.2 magnesium;
• Cardiomagnyl Forte: round-oval scored pills, 150 mg of acetylsalicylic acid and 30.39 mg of magnesium each.

Form-forming and auxiliary substances of the drug: talc, starch, MCC and others.

Regular use of the medicine prevents platelet aggregation and the deposition of blood clots in blood vessels.

Cardiomagnyl in the prevention and treatment of cardiovascular diseases

About the article

65639

0

Regular issues of "RMZh" No. 5 dated March 18, 2006 p. 400

Category: General articles

Author: Teplova N.V. 1 1 Federal State Autonomous Educational Institution of Russian National Research Medical University named after. N.I. Pirogov Ministry of Health of Russia, Moscow, Russia

For quotation:

Teplova N.V. Cardiomagnyl in the prevention and treatment of cardiovascular diseases. RMJ. 2006;5:400.

Today, acetylsalicylic acid is the “gold standard” in the prevention and treatment of diseases of the cardiovascular system. Acetylsalicylic acid is the most widely used and perhaps the most fully studied drug in the world. A quarter of a century ago, despite the absence at that time of clear evidence of the effectiveness of antiplatelet agents, it became the rule to prescribe acetylsalicylic acid to almost any patient suffering from coronary heart disease or who had suffered a myocardial infarction or ischemic cerebrovascular accident. Subsequently, antiplatelet therapy was convincingly confirmed in almost all multicenter studies performed according to the standards of “evidence-based medicine.” According to these studies, it was found that antiplatelet agents are effective in both men and women, in various age groups, and in persons suffering from arterial hypertension and diabetes mellitus.

However, despite more than a century that has passed since the discovery of acetylsalicylic acid, the horizons of its therapeutic potential and mechanism of action are still expanding. Acetylsalicylic acid, as the “gold standard”, was not chosen by chance: it is easy to dose, inexpensive, relatively safe, side effects as a result of long-term clinical use are well known and predictable. The main mechanism of action of acetylsalicylic acid is associated with irreversible blockade of cyclooxygenase-1. It is present both in platelets and in the vascular wall. Acetylsalicylic acid inhibits the synthesis of thromboxane A2, which is formed in platelets and ensures platelet aggregation with vasoconstriction. In addition, acetylsalicylic acid leads anucleated platelets to the ability to aggregate throughout their life, which is 7–10 days. Other antiplatelet drugs do not have such a long-lasting effect. Despite the fact that about 10% of the total platelet pool is renewed daily, after a single dose of acetylsalicylic acid, it takes 5–7 days for at least half of the platelets to restore their normal function. Currently, a huge number of studies have been conducted around the world on the use of antiplatelet agents in cardiovascular diseases. In 2002, the largest meta-analysis of randomized clinical trials on the benefits of antiplatelet agents in patients at high risk of developing vascular diseases (Antithrombotic Trialists Collaboration) was published. The meta-analysis included the results of 287 studies, which included 135,000 patients at high risk of developing vascular diseases. The results of this meta-analysis indicate that the administration of antiplatelet agents to these categories of patients can reduce the risk of developing non-fatal myocardial infarction + non-fatal stroke + other vascular diseases by at least one quarter. In recent years, from the standpoint of evidence-based medicine, the benefits of acetylsalicylic acid have been identified for a wide variety of categories of patients, although the range of indications for its use is still expanding. The main groups of patients in whom the administration of acetylsalicylic acid can reduce mortality and the incidence of serious, including fatal, cardiovascular complications (myocardial infarction, stroke, thromboembolism) are: – patients with acute myocardial infarction. The effectiveness of acetylsalicylic acid in the acute stage of myocardial infarction in combination with thrombolytics reaches 42%. Moreover, if combination therapy is started in the first 6 hours after the onset of a heart attack, mortality rates are reduced by more than 50%. In addition, acetylsalicylic acid is the drug of choice for pericarditis, one of the complications of myocardial infarction (ACC/AHA Guidelines, 1996); – patients with unstable angina. Acetylsalicylic acid is a first-line drug in the treatment of patients with unstable angina, as it reduces the incidence of cardiovascular death and myocardial infarction. The administration of acetylsalicylic acid to this category of patients is accompanied by a highly significant reduction in the risk of developing cardiovascular complications by 46% (antithrombotic Trialists Collaboration meta-analysis). – patients with a history of myocardial infarction. The results of the Antithrombotic Trialists Collaboration meta-analysis indicate a reduction in the risk of cardiovascular events (myocardial infarction + stroke + cardiovascular mortality) during treatment with acetylsalicylic acid; – patients with silent myocardial ischemia. Acetylsalicylic acid is also effective for silent myocardial ischemia, as well as for the symptomatic version of coronary heart disease; – patients after surgery on the coronary arteries. Surgical treatments are inevitably associated with endothelial damage and subsequent platelet activation. Acetylsalicylic acid suppresses platelet activation, preventing the development of early stent stenosis or restenosis of the coronary vessels (Antiplatelets Trialists Collaboration 11, 1994); – patients with a history of stroke and/or transient ischemic attacks. According to international multicenter controlled studies, acetylsalicylic acid is the most effective drug for the secondary prevention of ischemic cerebrovascular accidents (ESPS - 2); – patients with acute stroke. Currently, the results of two large studies have been obtained: one of them is open - International stroke trial, daily dose of acetylsalicylic acid 300 mg, the other placebo-controlled - Chinese acute stroke trial, daily dose of acetylsalicylic acid 160 mg. The results of a meta-analysis indicate that the use of acetylsalicylic acid prevents nine serious cardiovascular complications for every thousand patients treated; – patients with atrial fibrillation. The latest guidelines issued by the National Stroke Association in the USA recommend the use of acetylsalicylic acid as primary prevention of stroke in patients over 65 years of age with atrial fibrillation and the absence of other risk factors. For patients aged 65 to 75 years with atrial fibrillation, acetylsalicylic acid is considered as an alternative to warfarin in the absence of other risk factors; – patients after heart valve surgery. In a study by Turpie et al., 1993, acetylsalicylic acid reduced the risk of embolism or death from complications by 77% in patients undergoing mitral valve replacement; – patients with peripheral arterial diseases. Acetylsalicylic acid helps prevent venous thrombosis and pulmonary embolism. In 2000, the largest clinical study on the prevention of venous thrombosis was published: “Pulmonary Embolism Prevention” (PEP-study), which convincingly proved a decrease in the development of pulmonary embolisms and the incidence of symptomatic deep vein thrombosis; – patients with diabetes mellitus. The American Diabetes Association (ADA) recommends the administration of acetylsalicylic acid to all patients with type 2 diabetes mellitus for the purpose of secondary prevention of coronary artery disease in the absence of contraindications. The administration of acetylsalicylic acid for the purpose of primary prevention of coronary artery disease is indicated for patients with type 2 diabetes mellitus over the age of 30 years who have a high risk of its occurrence (a family history of coronary artery disease, smoking, arterial hypertension, obesity, dyslipidemia); – patients with arterial hypertension. Currently, indications for the use of acetylsalicylic acid in patients with arterial hypertension are being considered. According to the HOT study, additional use of acetylsalicylic acid reduced the incidence of cardiovascular events by 15%, and the incidence of myocardial infarction by 36%. One of the most important issues in the use of acetylsalicylic acid remains the question of the size of its dosages. Thus, according to a meta-analysis of the Antithrombotic Trialists Collaboration, the reduction in the risk of cardiovascular complications during the use of acetylsalicylic acid in high doses of 500–1500 mg was 19%, in medium doses of 160–325 mg – 26%, and in low doses 75– 150 mg – 32%. At the same time, low doses are more preferable for long-term therapy due to a lesser ulcerogenic effect. Therefore, the currently recommended daily dose of acetylsalicylic acid is from 75 to 150 mg per day. Despite the positive effects associated with the use of acetylsalicylic acid, its use in clinical practice is limited due to side effects. In addition to the risk of bleeding, as well as a history of peptic ulcer disease, the main clinical problem of prescribing acetylsalicylic acid remains frequent side effects from the gastrointestinal tract (dyspeptic symptoms and an increase in the frequency of erosive and ulcerative lesions of the stomach and duodenum). The occurrence of erosive and ulcerative lesions of the stomach while taking acetylsalicylic acid in doses used in cardiology is a well-known fact. The use of enteric-soluble forms of acetylsalicylic acid has long been considered the only solution to this problem. However, when analyzing the results of a number of studies, some authors noted the formation of erosions and gastric ulcers even when using enteric-coated acetylsalicylic acid tablets. To date, new dosage forms of acetylsalicylic acid have been created, offering new ways to protect the gastrointestinal tract. One of the most effective is the drug Cardiomagnyl (Nycomed, Denmark) - a combination of acetylsalicylic acid (in the most effective and safe doses - 75 and 150 mg) with a non-absorbable antacid - magnesium hydroxide. Non-absorbable antacids are the most commonly used drugs in the treatment of stomach diseases, including peptic ulcers. Their positive effect is associated with the adsorption of hydrochloric acid; in addition, they reduce the proteolytic activity of gastric juice (through the adsorption of pepsin), have enveloping properties, bind bile acids and lysolecithin, which have a negative effect on the gastric mucosa. However, the most important thing for the prevention of aspirin-induced complications is data on the cytoprotective effect of antacids. In experimental and clinical settings, antacids can prevent the occurrence of damage to the gastric mucosa. It has been established that the cytoprotective effect of antacids is associated with an increase in the level of prostaglandins in the stomach wall (since a decrease in prostaglandins in the stomach wall is the main mechanism of ulcer formation when using acetylsalicylic acid), increased secretion of bicarbonates and an increase in glycoproteins of gastric mucus. Magnesium hydroxide, which is part of Cardiomagnyl, is the fastest-acting antacid. This is the most important point, since acetylsalicylic acid is quickly absorbed from the stomach: significant concentrations in the blood plasma are achieved within 15–20 minutes. At the same time, the results of a number of studies have proven that magnesium hydroxide does not affect the absorption of acetylsalicylic acid. It is well known that the most common side effect of acetylsalicylic acid on the gastrointestinal tract is dyspepsia (according to some authors, in 50 percent or more of cases), and esophagogastroduodenoscopy does not reveal erosive, ulcerative and inflammatory changes. This symptom complex is the most common reason for patients refusing to take acetylsalicylic acid. The combination of acetylsalicylic acid with magnesium hydroxide (Cardiomagnyl) can dramatically reduce the incidence of dyspepsia and increase patient adherence to treatment. Consequently, the use of the drug Cardiomagnyl in clinical practice, which also has an excellent price/effectiveness ratio, can increase the tolerability of acetylsalicylic acid in many patients with diseases of the cardiovascular system. Thus, the prescription of Cardiomagnyl is especially indicated: - in the acute stage of myocardial infarction, - patients with post-infarction cardiosclerosis, - in the presence of atrial fibrillation, - with stable and unstable angina, - with coronary revascularization, - in the acute stage of stroke, - patients with strokes in history and transient ischemic attacks, - after transplantation of artificial valves, - in the presence of deep vein thrombosis, - in patients with occlusive diseases of the peripheral arteries. The results of the ongoing clinical studies will provide new food for thought, but in practice it is necessary to use the rules of “medicine of evidence” and not doubtful facts. Therefore, when choosing a drug for the treatment of patients with cardiovascular diseases, from the point of view of effectiveness and safety, preference should currently be given to new dosage forms of acetylsalicylic acid, and, first of all, to compounds of acetylsalicylic acid with magnesium hydroxide (Cardiomagnyl). Literature 1. Ostroumova O.D. Possibilities of using Cardiomagnyl in patients with diabetes mellitus. // Rus. Honey. Magazine. – 2004.– vol. 12, no. 5. – pp. 34–37. 2. Collaborative meta–analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients (Antiplatelet Trialists Collaboration).– BMJ 2002; 324:71–86. 3. European Stroke Initiative – Recommendation for stroke management, 2003. 4. Ischemic Cerebrovascular Disease. // H. Adams, V. Hachinski. J. Norris/ – Oxford University press, 2001. – 575 p. 5. Stroce prevention by the practitioner./ Ed. J. Bogousslavsky. – Cerebrovascular Diseases, 1999/ – 9. –S 4. – 70 p.

Content is licensed under a Creative Commons Attribution 4.0 International License.

Share the article on social networks

Recommend the article to your colleagues

How does Cardiomagnyl work?

ASA (aspirin) in the composition of the drug is quickly absorbed from the gastrointestinal tract and blocks the main mediators that regulate platelet aggregation. Being present in the bloodstream, acid prevents excessive thickening and the formation of blood clots. Magnesium salt acts as a protector, protecting mucous membranes from irritation.

The active substance Cardiomagnyl is metabolized in the liver and intestines. Acetylsalicylic acid does not accumulate in the body. In the absence of severe damage to internal organs, salicylates are eliminated without causing harm.

Composition of Cardiomagnyl and its pharmacological properties

Cardiomagnyl is a drug that has pronounced antiplatelet properties. It has an analgesic and anti-inflammatory effect on the source of pathology in the patient’s body. It also belongs to the category of non-steroidal drugs, which can suppress the further spread of the inflammatory process. It is recommended for people who have been diagnosed with damage to the walls of vascular tissue of various etiologies. Such drugs as ACC-thrombo and Aspirin cardio have similar properties.

The main therapeutic effect of Cardiomagnyl is the ability to slow down thromboxane synthesis . Blood cells - platelets do not increase in number and the risk of blood clots forming inside large blood vessels is reduced. These properties of Cardiomagnyl are achieved due to its biochemical composition. Cardiomagnyl contains acetylsalicylic acid (150 mg per tablet) and a small amount of excipients in the form of corn and potato starch.

In what cases should you take Cardiomagnyl?

The medicine is prescribed to prevent complications in the following pathologies:

• risk of developing myocardial infarction;
• condition after a heart attack;
• chronic cardiac ischemia;
• diabetes;
• hypertonic disease;
• atherosclerosis, high cholesterol;
• risk of thrombosis with varicose veins.

Cardiomagnyl is unable to replace drugs for lowering blood pressure, does not regulate heart rhythm and has no effect on the general course of the disease. Its function is to prevent the development of thrombosis. The drug is also not used as a source of magnesium.

When Cardiomagnyl is contraindicated

The prohibition on the use of the drug in therapy includes:

• childhood;
• individual intolerance to any of the components;
• exacerbation of peptic ulcer;
• severe renal failure;
• history of angioedema or other allergic reactions to aspirin;
• decompensation of heart failure;
• bronchial asthma;
• vitamin K deficiency, impaired hematopoietic function.

Contraindications and side effects

The use of Cardiomagnyl must be approved by a doctor, since the drug has serious contraindications:

• excessive sensitivity to aspirin or any other component;
• intolerance to non-steroidal anti-inflammatory drugs;
• acute period of erosive and ulcerative lesions of the gastrointestinal tract;
• hemorrhagic stroke;
• predisposition to bleeding;
• bronchial asthma provoked by the use of NSAIDs or salicylic acid derivatives;
• gastrointestinal bleeding;
• severe kidney dysfunction;
• deficiency of the enzyme glucose-6-phosphate dehydrogenase;
• taking with the antitumor drug Methotrexate (in an amount of more than 15 mg per week);
• I and III trimesters of pregnancy, breastfeeding.

Prescribed with caution for gout, in the second trimester of pregnancy, with an increase in the amount of urate in the blood, ulcers and bleeding of the gastrointestinal tract in the past, dysfunction of the liver and kidneys, allergic conditions, bronchial asthma.

The following side effects were identified:

• nettle rash;
• angioedema;
• discomfort in the stomach - heartburn, ulcerative lesions of the gastric epithelium, bleeding, nausea, abdominal pain;
• intestinal irritation, inflammation of the colon mucosa;
• inflammation of the mucous membrane of the esophagus or oral cavity;
• bronchospasms;
• headache, sleep disturbances or drowsiness, dizziness;
• the appearance of bleeding, a decrease in hemoglobin levels, a critical decrease in platelet levels, a decrease in the number of neutrophils in the blood.

What are the dangers of an overdose of Cardiomagnyl?

The maximum daily dose of the drug is 150 mg. Exceeding it will lead to serious intoxication of the body:

• impaired coordination of movements;
• sweating;
• hearing loss, dizziness;
• lowering blood pressure;
• nausea and vomiting.

Acute poisoning is fraught with vascular collapse, loss of consciousness, respiratory disorders, and liver failure. Assistance in case of an overdose of Cardiomagnyl after gastric lavage should be provided by medical specialists.