Is it useful to take Panangin for arrhythmia?

Good day, dear guests!
Today we will discuss the issue of cardiac arrhythmia and the role of Panangin in its treatment. We will also study the effect of this drug on atrial fibrillation, and also learn how to take it correctly. Let's briefly go over the topic of the influence of Panangin Forte on this disease and find out what would be better to take in this case. In general, we will analyze the topic of preventing heart disease with our drug, we will break everything down point by point to make it easier to perceive the information. We will also briefly discuss the topic of drug overdose. Full instructions are located under the appropriate links, click if necessary, they are right here and will be further down the article. Unfortunately, this time I was able to find only one source that fully describes this topic. In others, the information was duplicated or simply already published by me on my blog. But I believe that with this article I will completely close this issue, so I wish you good reading and good health!

How does Panangin help the body?

Panangin contains potassium and magnesium salts in the form of aspartates. These compounds increase the strength of heart contractions and regulate their rhythm. The speed of metabolic processes in the myocardium, its energy supply, and therefore the blood supply to the entire body as a whole depends on the concentration of salts of the main microelements contained inside the muscle cells of the heart.

With a lack of potassium and magnesium, the following pathological processes develop:

1. arterial hypertension;
2. atherosclerotic changes in coronary vessels;
3. disturbance of the rhythm of contractions and impulse conduction within the myocardium;
4. dystrophic and sclerotic changes in the muscular layer of the heart.

Various forms of tachycardia

A person's pulse depends on the heart rate, and normally it ranges from 60 to 80 beats at rest.
An increase or decrease in these values ​​can also occur in a healthy body in the form of sinus arrhythmia under certain loads, or indicate developing heart diseases. Contractions of the heart are realized through the work of the conduction pathway system, which is headed by the pacemaker (pacemaker). Normally, this function is performed by the sinoatrial node. Then the generated impulse wave enters the atrioventricular node and follows the paths to the ventricles. Depending on which anatomical structure plays the role of a first-order pacemaker, we divide tachyarrhythmias into:

• paroxysmal (waves are generated not by the sinoatrial node, but by the underlying sections) - begin and end suddenly, with a rhythm of 140 to 240 beats per minute;
• non-paroxysmal tachyarrhythmias arise gradually, the rhythm is up to 140 beats per minute.

Paroxysmal tachycardias are supraventricular and ventricular, depending on the location of the electrical impulse. Supraventricular arrhythmias can occur in healthy people (more precisely, without heart damage). Complexes on the cardiogram have the usual shape and duration. With ventricular tachycardia, the impulse propagates unevenly, therefore, on the cardiogram, the complexes of teeth are expanded and deformed. A separate variant of the supraventricular form is atrial fibrillation (atrial fibrillation), in the malignant form of which the heart rate can reach 350-700 beats per minute.

To clarify the diagnosis and determine the exact form of automaticity disorder, transesophageal electrocardiography is recommended.

Will the drug help with arrhythmia, including atrial fibrillation?

Panangin restores the disturbed balance of electrolytes in the tissues of the heart muscle, which leads to normalization of signals from the sinus node (the main source of rhythm) to the atria, and from them to the ventricles.

Myocardial cells become less susceptible to the influence of stress factors, the contraction rhythm slows down, and at the same time the volume of cardiac output increases.

This explains the effectiveness of Panangin in the prevention and treatment of arrhythmias that occur with an acceleration of the pulse rate:

• tachycardia;
• extrasystole;
• atrial and ventricular fibrillation.

Panangin is most effective for the treatment of atrial fibrillation of ventricular origin, including those associated with intoxication with cardiac glycosides. It is prescribed for the prevention of microelement imbalances in combination with the main antiarrhythmic drugs to strengthen the myocardium.

Can the drug be used to treat tachycardia and bradycardia?

"Panangin" is valuable due to the presence of such effects from its use:

• antihypertensive;
• antiatherosclerotic;
• antiarrhythmic;
• anti-inflammatory;
• anticoagulant.

Magnesium has strong antiarrhythmic effects and is used both to prevent tachycardia in patients with heart failure and to enhance the effectiveness of other antiarrhythmic drugs. It is thought to be particularly useful for ventricular tachycardia that responds poorly to other therapies when used as an adjunct to primary treatment.

Potassium is often used to stop rapid heartbeat in the postoperative period. It shows especially good results when used together with magnesium, which determines the effect of “Panangin” for tachycardia.

It is not recommended to use Panangin for bradycardia , however, the decision to prescribe or stop taking the drug should be made only by the attending physician, who determines the treatment regimen according to your feedback on your state of health and the results of additional examination methods.

How to take Panangin for arrhythmia

The dose of Panangin and the duration of treatment are determined by the doctor after studying the examination data. For a single dose, 1 to 3 tablets may be recommended, depending on the heart rate and detected abnormalities in the content of potassium and magnesium in the blood. The frequency is usually 3 times a day.

The peculiarity of taking tablets is that they lose activity in the stomach in the presence of a large amount of hydrochloric acid, so they must be taken immediately after meals.

Panangin in the treatment of cardiovascular diseases

Potassium and magnesium deficiency is observed in patients with heart disease, type 2 diabetes mellitus (DM), chronic alcoholism, genetic forms of kidney loss of potassium and magnesium (Gitelman and Bartter syndrome), severe diarrhea and vomiting, malnutrition, taking certain drugs [1,4,5]. Potassium and magnesium are intracellular cations that play a major role in the functioning of many enzymes, the interaction of macromolecules and intracellular structures, and in the mechanism of muscle contractility. The intra- and extracellular ratio of potassium, magnesium, calcium and sodium ions affects myocardial contractility. Low levels of potassium and/or magnesium ions in the internal environment can have a proarrhythmic effect [6–8], predispose to the development of arterial hypertension (AH) [9–11], atherosclerosis of the cerebral and coronary arteries [12,13], and the occurrence of endothelial dysfunction ( due to the production of nitric oxide and participation in platelet aggregation), type 2 diabetes and metabolic changes in the myocardium [1,14]. One of the most important physiological functions of potassium is maintaining the membrane potential of neurons, myocytes and other excitable structures of myocardial tissue. Potassium is the main intracellular cation in tissues of various organs. Under normal conditions, the cell contains 150–160 mmol/l, and the blood serum contains 3.5–5.5 mmol/l. Potassium ions (K+) are involved in the formation of cellular action potentials (depolarization and repolarization phases), transmission of nerve impulses, contraction of cardiomyocytes, skeletal and smooth muscle fibers, and regulate and maintain the functions of the urinary system. An imbalance between intra- and extracellular potassium content leads to a decrease in the contractility of smooth muscle fibers and myocardium, the occurrence of arrhythmia, tachycardia and increased toxicity of cardiac glycosides [10]. The daily potassium requirement of an adult is 40–100 mmol/l. The causes of hypokalemia are associated with insufficient intake of potassium from food (improper and “fast” nutrition), increased removal from the body (vomiting, diarrhea, uncontrolled use of diuretics), increased blood pressure (primary hyperaldosteronism, renovascular hypertension, long-term use of corticosteroids), increased potassium consumption by tissues (insulin administration, excess catecholamines) [13]. Magnesium is a cofactor in more than 300 enzymatic reactions of energy metabolism and the synthesis of proteins and nucleic acids, reduces contractile tension and heart rate, leading to a decrease in myocardial oxygen demand, and has an anti-ischemic effect on myocardial tissue [15]. A decrease in the contractility of smooth muscle myocytes in the walls of arterioles, including coronary ones, leads to vasodilation and increased coronary blood flow [16,17]. Magnesium deficiency is associated with increased levels of total cholesterol, low-density lipoproteins, triglycerides, decreased activity of lecithin-cholesterol-aminotransferase and lipoprotein lipase, and increased activity of HMC-CoA reductase [18–20]. Magnesium deficiency leads to a decrease in cell resistance to free radical processes in the body, which underlie oxidative stress and atherosclerosis - the main links in the development of CVD [2,12,20]. The prescription of magnesium-containing drugs is especially justified for long-term use of cardiac glycosides, which provoke hypokalemia and subsequent rhythm disturbances, including those associated with a deficiency of this ion in patients with chronic heart failure (CHF). Panangin contains potassium and magnesium ions and affects metabolic processes. The combination of potassium and magnesium ions in one preparation (Panangin) is justified by the fact that potassium deficiency in the body is often accompanied by magnesium deficiency and requires simultaneous correction of the content of both ions in the body. When correcting the levels of these cations, an additive effect is observed, in addition, potassium and magnesium reduce the toxicity of cardiac glycosides without affecting their positive inotropic effect. The concentration of magnesium (Mg++) in blood serum is 0.65–1.1 mmol/l, in erythrocytes – 1.65–2.55 mmol/l. The daily requirement of an adult for magnesium is 25–35 mmol/l [21]. Panangin (Gedeon Richter, Hungary) is available in film-coated tablets (or in dragee form), containing 0.158 g of potassium aspartate (36.2 mg of potassium) and 0.140 g of magnesium aspartate (11.8 mg of magnesium), and also in the form of an injection solution in 10 ml ampoules containing 0.452 g of potassium aspartate (103.3 mg of potassium ion) and 0.40 mg of magnesium aspartate (33.7 mg of magnesium). Indications for use of Panangin: arrhythmias caused by hypokalemia, hypokalemia due to taking saluretics. The drug is prescribed as part of complex therapy for heart failure, myocardial infarction, cardiac arrhythmias (mainly ventricular arrhythmias); to improve the tolerability of cardiac glycosides; for metabolic syndrome (obesity, hypertension, impaired glucose tolerance, type 2 diabetes), to compensate for the deficiency of potassium and magnesium when their content in the diet is reduced. Magnesium deficiency is associated with impaired glucose tolerance, and magnesium preparations can correct this condition. The drug is taken orally, 1-2 tablets. (dragée) 3 times/day. The maximum daily dose is 3 tablets. 3 times/day. Panangin should be taken after meals, because the acidic environment of the stomach contents reduces its effectiveness. The duration of therapy and the need for repeated courses are determined by the doctor individually. Panangin is also prescribed intravenously as a slow infusion to relieve an attack of arrhythmia in urgent situations [22,23]. Single dose - 1-2 ampoules (diluted in 50-100 ml of 5% glucose solution or isotonic sodium chloride solution), if necessary, repeated administration can be done after 4-6 hours. For slow intravenous administration, 1-2 ampoules of Panangin can be diluted (10 –20 ml) in 250–500 ml of the same solutions and injected dropwise. For example, a solution of potassium and magnesium aspartate (aspartate) was successfully used to prevent atrial fibrillation after coronary artery bypass surgery [24]. Aspartic acid transports magnesium ion across the cell membrane and promotes its absorption. Panangin does not have a cumulative effect and has a limited list of relative contraindications for use: hyperkalemia, acute or chronic renal failure (oliguria, anuria), heart rhythm disturbances in combination with degree II-III atrioventricular block, acute metabolic acidosis, hypovolemia (dehydration), Addison's disease, individual hypersensitivity to the components of the drug. A meta-analysis of 19 studies (including 586 people, 412 of them with hypertension) showed a relationship between the severity of the hypotensive effect and the duration of potassium supplementation. An average reduction in blood pressure of 5.9/3.4 mmHg was demonstrated. when using tableted potassium preparations [9]. During long-term observation (on average 6.7 years) of 7563 patients with hypertension, of which 1679 received diuretics, it was noted that the resulting hypokalemia (potassium concentration less than 3.5 mmol/l) was accompanied by an increase in the incidence of cardiovascular complications [10]. It is advisable to assess changes in the concentration of potassium in the blood in parallel with the quantitative assessment of magnesium indicators, because it is an important component for the absorption of potassium and ensuring its optimal intracellular level. Combined potassium and magnesium deficiency can lead to hypokalemia that is resistant to treatment if magnesium deficiency is not simultaneously corrected [12]. It is believed that magnesium ions inhibit the activity of the renin-angiotensin-aldosterone system and, with their deficiency, more favorable conditions are created for systemic vasoconstriction. When Panangin is used simultaneously with potassium-sparing diuretics and ACE inhibitors, the risk of developing hyperkalemia increases (the level of potassium in plasma should be monitored). When using this drug, discomfort or burning in the stomach is possible in patients with hypoacid gastritis and cholecystitis. It is necessary to observe a three-hour interval between taking Panangin orally. With hypokalemia, nausea, vomiting, diarrhea, and paresthesia are possible. With hypermagnesemia, the following symptoms are observed: facial flushing, thirst, decreased blood pressure, hyporeflexia, respiratory depression, and convulsions [18]. Calcium supplements reduce the effect of magnesium supplements. Astringents and enveloping agents reduce the absorption of the drug in the gastrointestinal tract and reduce adverse reactions. Plasma magnesium levels below 0.76 mmol/l are considered a significant risk factor for stroke and myocardial infarction. The European Epidemiological Study on Cardiovascular Diseases identified hypomagnesemia as an important risk factor for death from stroke and CVD [25]. A recently completed study found a significant reduction in the risk of sudden cardiac death with increasing serum magnesium levels, independent of other factors such as hypertension, diabetes, potassium levels, heart rate, and a history of coronary artery disease. It has been established that low serum magnesium levels are an important predictor of sudden cardiac death (234 cases of sudden death were recorded in a cohort of 14,232 people aged 45–64 years (average follow-up 12 years) [8]. In relation to hypertension and coronary heart disease, a relationship was also previously established with serum magnesium concentration, rather than with its intake [12]. Thus, it is extremely important to compensate for potassium and magnesium deficiency in patients at risk of stroke, especially those with concomitant heart disease [26, 27]. Panangin, containing potassium aspartate and magnesium aspartate, improves metabolism in the myocardium, increases the tolerance of cardiac glycosides in patients with CHF, has antiarrhythmic activity and can be used for prophylactic purposes and in supportive combination therapy of patients with cardiovascular pathology. Literature 1. Iezhitsa IN, Spasov AA Potassium magnesium homeostasis: physiology, pathophysiology, clinical consequences of deficiency and pharmacological correction // Usp Fiziol Nauk. 2008. Vol. 39(1). R. 23–41. 2. Shilov A.M., Melnik M.V., Osiya A.O., Knyazeva S.A. Treatment of cardiovascular diseases in the practice of a primary care physician: the place of potassium and magnesium preparations (Panangin) // Russian Med. magazine. 2012. No. 3. pp. 102–106. 3. Weglicki WB, Mak Iu.T., Chmielinska JJ et al. The role of magnesium deficiency in cardiovascular and intestinal inflammation // Magnes Res. 2010. Vol. 23(4). R. 199–206. 4. Lucker PW, Witzmann HK Influence of magnesium and potassium deficiency on renal elimination and cardiovascular function demonstrated by impedance cardiography // Magnesium. 1984. Vol. 3 (4–6). R. 265–273. 5. Kramer JH, Spurney C, Iantorno M et al. Neurogenic inflammation and cardiac dysfunction due to hypomagnesemia // Am J Med Sci. 2009. Vol. 338(1). R. 22–27. 6. Eisenberg MJ Magnesium deficiency and sudden death // Am Heart J. 1992. Vol. 124. R. 544–549. 7. Zehender M., Meinertz T., Just H. Magnesium deficiency and magnesium substitution. Effect on ventricular cardiac arrhythmias of various etiology // Herz. 1997. Vol. 22 (suppl 1). R. 56–62. 8. Peacock JM, Ohira T., Post W. Serum magnesium and risk of sudden death in the Atherosclerosis Risk in Communities (ARIC) Study // Am Heart J. 2010. Vol. 160(3). R. 464–470. 9. Cappucio F., McGregor G. Does potassium supplementation lower blood pressure? A meta-analysis of published trials // J Hypertens. 1991. Vol. 9. R. 456–473. 10. Cohen HW, Madhavan S., Alderman MH High and low serum potassium associated with cardiovascular events in diuretic–treated patients // J Hypertens. 2001. Vol. 19 (7). R. 1315–1323. 11. Peacock JM, Folsom AR, Arnett DK et al. Relationship of serum and dietary magnesium to incident hypertension: the Atherosclerosis Risk in Communities (ARIC) Study // Ann Epidemiol. 1999. Vol. 9(3). R. 159–165. 12. Amighi J., Sabeti S., Schlager O. et al. Low serum magnesium predicts neurological events in patients with advanced atherosclerosis // Stroke. 2004. Vol. 35(1). R. 22–27. 13. Kotova O.V. Prevention of strokes: unaccounted opportunities // Russian Med. magazine. 2012. No. 10. pp. 514–516. 14. Kao WH, Folsom AR, Niero FJ et al. Serum and dietary magnesium and the risk for type 2 diabetes mellitus: the Atherosclerosis Risk in Communities Study // Arch Intern Med. 1999. Vol. 159. R. 2151–2159. 15. Ueshima K. Magnesium and ischemic heart disease: a review of epidemiological, experimental, and clinical evidence // Magnes Res. 2005. Vol. 18 (4). R. 275–284. 16. Ukholkina G.B. The role of magnesium in diseases of the cardiovascular system // Russian Med. magazine. 2011. No. 7. pp. 476–479. 17. Sjogren A., Edvinsson L., Fallgren B. Magnesium deficiency in coronary artery disease and cardiac arrhythmias // J Intern Med. 1989. Vol. 226(4). R. 213–222. 18. Abbott LG, Rude RK Clinical manifestations of magnesium deficiency // Miner Electrolyte Metab. 1993. Vol. 19. R. 314–322. 19. Shechter M. Does magnesium have a role in the treatment of patients with coronary artery disease? // Am J Cardiovascular Drugs. 2003. Vol. 3 (4). R. 231–239. 20. Altura BM, Shah NC, Jiang XC et al. Magnesium deficiency upregulates serine palmitoyl transferase( SPN 1 and SPT 2) in cardiovascular tissues: relationship to serum ionized Mg and cytochrome C // Am J Physiol Heart Circ Physiol. 2010. Vol. 299(3). R. 932–939. 21. Chakraborti S., Chakraborti T., Mandal M. et al. Protective role of magnesium in cardiovascular disease: a review // Mol Cell Biochem. 2002. Vol. 238. R. 163–179. 22. Kuhn P., Oberthaler G., Oswald J. Anti-arrhythmia effectiveness of potassium-magnesium-aspartate infusion // Wien Med Wochenschr. 1991. Vol. 141(3). R. 64–65. 23. Manz M., Susilo R. Therapy of cardiac arrhythmias. Clinical significance of potassium–and magnesium aspartate in arrhythmias // Fortschr Med Orig. 2002. Vol. 120(1). R. 11–15. 24. Piper SN, Kiessling AH, Suttner SW et al. Prevention of atrial fibrillation after coronary artery bypass graft surgery using a potassium–magnesium–aspartate solution (Inzolen) // Thorac Cardiovasc Surg. 2007. Vol. 55 (7). R. 418–423. 25. Schimatschek HF, Rempis R. Prevalence of hypomagnesemia in an unselected German population of 16,000 individuals // Magnes. Res. 2001. Vol. 14 (4). R. 283–290. 26. Postnikova S.L., Kasatova T.B., Vereshchagina G.S., Malysheva N.V. Magnesium and cardiovascular diseases // Russian Medical Journal. 2007. No. 20. pp. 1498–1500. 27. Shivakumar K. Pro-fibrogenic effects of magnesium deficiency in the cardiovascular system // Magnes Res. 2002. Vol. 15 (3–4). R. 307–315.

Is it possible to drink to prevent heart problems?

In certain situations, there is an increased need for potassium and magnesium ions. Therefore, there are categories of people who are recommended to take preventive courses of taking Panangin after consultation with their doctor:

• After 45 years, as the risk of atherosclerosis increases.
• During intense sports activities due to increased load on the myocardium.
• If the work involves intense sweating (hot workshops, bakers), as well as those who like to frequent saunas and steam baths. Microelements are excreted through sweat.
• If you follow strict diets or take teas for weight loss.
• When using birth control pills.
• During treatment with hormones (under the control of blood electrolyte levels).
• Together with taking diuretics (except potassium-sparing) and cardiac glycosides, as well as some antihypertensive drugs (except ACE blockers).
• In case of intestinal dysfunction.
• During times of stress.
• To prevent weakening of the heart muscle after viral infections.
• For insomnia and convulsive syndrome due to deficiency, mania.
• In complex therapy of diabetes mellitus.

The mechanism of action of "Panangin" on the heart rhythm

"Panangin" is a medical product that contains potassium and magnesium ions, which are necessary for many biochemical reactions, and especially for the regular functioning of the heart.

It is known that arrhythmias are often associated with hypomagnesemia and hypokalemia. The simplest ways to eliminate rhythm pathology are to correct the level of electrolytes in the cell and membranes of the heart muscle, antagonize calcium, increase the energy level of cells, improve oxygen supply and reduce the release of neurotransmitters, for example, adrenaline or norepinephrine.

Even with a slight decrease in potassium levels, the risk of developing tachycardia increases significantly. In addition, a person may experience weakness, irritability, and the pulse becomes thread-like.

Magnesium is necessary for the synthesis of DNA and RNA. In addition, this microelement takes part in the work of muscles, their contraction and transmission of nerve impulses, which determines its effect on the functioning of the heart and blood vessels. Thanks to this, magnesium is useful for regulating blood pressure, automatic function, vasomotor tone and neuromuscular conduction.

Panangin and pregnancy: can or cannot be combined for arrhythmia

Despite the fact that there is no information about the toxic effect on the fetus when a pregnant woman uses Panangin, it is recommended in the first trimester with caution, giving preference to natural sources of potassium and mania in the body (dried apricots, raisins, bran).

During lactation, Panangin passes into breast milk. Its prescription is carried out only in the presence of serious indications; the dosage of forte is not used.

Contraindications to taking the medicine

The drug is not recommended in the following cases:

• renal failure;
• drop in blood (systolic) pressure below 90 mmHg. Art.;
• decreased secretion of adrenal hormones;
• muscle weakness syndrome (myasthenia gravis);
• burn disease (with hyperkalemia);
• 3rd degree impulse conduction block;
• acute period of peptic ulcer and pancreatitis;
• with individual intolerance.

There are no sufficient studies on side effects in children, so most often Panangin is not prescribed for children under 12 years of age.

What to do if you accidentally drink more than the required dose

If the dose is exceeded slightly, symptoms may include nausea and stomach pain. In these cases, no additional treatment is required; the drug is non-toxic. If kidney function is impaired, there may be the following clinical signs of excess potassium and magnesium in the body:

• vomit;
• diarrhea;
• skin redness;
• increased thirst;
• drop in blood pressure;
• breathing problems;
• muscle twitching;
• weakness;
• rare and weak pulse.

In this case, you should immediately consult a doctor. Stop taking the drug. Intravenous administration of calcium chloride is used as an antidote, and if necessary, the patient is connected to an artificial kidney apparatus.

Symptoms of tachycardia

The clinical picture depends on the heart rate, the presence of circulatory disorders, the duration of the attack and the psycho-emotional characteristics of the person.

Some patients with tachycardia do not notice any symptoms during the attack. However, most people feel a pulsation spreading throughout the body, complain of shortness of breath, general weakness, heart pain, increased sweating, heaviness in the head, and frequent urination. In such a case, a decrease in blood pressure is possible due to a decrease in cardiac output.

Combination of Panangin with other drugs

The risk of slowing down the rhythm, even stopping contractions due to increased potassium levels in the blood, increases when the following drugs are prescribed together:

1. potassium-sparing diuretics;
2. beta blockers, ACE inhibitors;
3. non-steroidal anti-inflammatory drugs;
4. Heparin.

If the patient takes antibiotics from the tetracycline group, iron or fluoride preparations, then there should be a gap of at least 2.5 hours between them and Panangin.

Alternative drugs

In terms of composition, similar drugs are: Asparkam, Potassium-magnesium asparaginate, Aspangin. Caldium, Potassium normin, Kalipoz are used as a source of potassium. Magnesium can be obtained by taking the following medications:

• Magne B6;
• Magnerot;
• Biolectra magnesium fortissimum;
• Cormagnesin.

Although all tablet forms of such medications are approved for over-the-counter use, before using them, you must undergo a mandatory examination - an ECG, an analysis of the electrolyte composition of the blood, and a consultation with a therapist.

Panangin is intended to replenish potassium and magnesium reserves in the blood. It is prescribed for rhythm disturbances, high blood pressure and cardiac failure for preventive and therapeutic purposes. For atrial fibrillation, a short course of Panangin Forte may be recommended, followed by long-term treatment with a standard dose.