Composition of Panangin
The tablets contain active substances: magnesium aspartate (280 mg) and potassium aspartate (316 mg).
Additional substances: silicon dioxide, corn and potato starch, talc, povidone, magnesium stearate. The shell consists of talc, macrogol 6000, titanium dioxide, methacrylic acid copolymer. The concentrate for Panangin IV solution includes magnesium aspartate (40 mg) and potassium aspartate (45.2 mg), as well as water for injection.
Overdose
It is not recommended to exceed the prescribed dose. An overdose of the drug is possible, manifested by the following symptoms:
- excessive levels of potassium and magnesium ions in the blood;
- muscle hypotonicity;
- problems with the functioning of the heart, even to the point of cardiac arrest;
- arrhythmia;
- changes on the electrodiogram.
If such signs appear, you should immediately inject a solution of dextrose and sodium chloride intravenously. Depending on the patient's condition, peritoneal dialysis may be required.
pharmachologic effect
What is the medicine for? It is a source of potassium and magnesium. The drug helps restore electrolyte balance, regulates metabolic reactions and processes, and has a pronounced antiarrhythmic effect.
Potassium takes an active part in synaptic transmission, in the conduction of nerve impulses along fibers, in muscle contractions, and supports the normal functioning of the heart. When potassium metabolism is disturbed, the excitability of muscle tissue and nerves changes. Active ion transport maintains a high potassium gradient across the plasma membrane. Small dosages of potassium contribute to the expansion of the coronary arteries, and in large dosages the microelement narrows their lumen. Potassium has a moderate diuretic effect, negative bathmotropic and chronotropic effects.
Magnesium is a cofactor in three hundred enzyme reactions. Magnesium is an essential element during processes and reactions that provide energy intake and expenditure. Magnesium is part of the pentose phosphate structure of DNA, takes part in the process of cell division and growth, the structure of heredity, and RNA synthesis; is a natural BMCA, prevents the release of free fatty acids and catecholamines during stress, and promotes the penetration of potassium ions into the cell. The drug has a stimulating effect on intercellular phosphate synthesis.
Panangin 50 pcs. film-coated tablets
pharmachologic effect
Panangin is a drug that affects metabolic processes in the human body.
The drug is a source of magnesium and potassium ions. Potassium and magnesium are intracellular cations that play a major role in the proper functioning of most enzymes. These cations interact with macromolecules and intracellular structures, and also take part in the processes of muscle contraction in the body.
The contractile property of the myocardium depends on the intracellular and extracellular ratio of ions of such substances. Like calcium, magnesium, potassium and sodium. A low content of potassium and magnesium ions in the body can provoke a proarrhythmogenic effect, which will lead to the development of an increase in blood pressure in the vessels, atherosclerosis and the appearance of metabolic changes in the myocardium.
The most important physiological property of potassium is considered to maintain the stability of the membrane potential of neurons and other structures in myocardial tissue. If there is a violation of the relationship between the intracellular and extracellular presence of potassium, this can lead to a decrease in the ability of the myocardium to contract, to the occurrence of disturbances in the heartbeat rhythm, tachycardia, as well as to an increase in the level of toxicity in cardiac glycosides.
Magnesium is a substance necessary for the body to carry out more than three hundred enzymatic interactions of energy metabolism and synthesis in proteins and nucleic acids. Magnesium can reduce the tension that occurs as a result of contraction and heart rate. This leads to a decrease in myocardial oxygen demand. In addition, magnesium can be used to prevent ischemic effects on myocardial tissue.
The simultaneous combination of magnesium and potassium ions in the drug Panangin is based on the fact that potassium deficiency in the body is almost always accompanied by magnesium deficiency and vice versa. In such cases, simultaneous correction of the presence of these ions in the body is necessary. During correction of the levels of these electrolytes, an additive effect can be observed. In addition, magnesium and potassium reduce the toxicity of cardiac glycosides without affecting their effect on the force of heart contractions.
When the medicine is taken orally, it is characterized by high absorption. The drug is excreted in the urine.
Composition and release form Panangin 50 pcs. film-coated tablets
Tablets - 1 tablet.
- Active ingredients: potassium aspartate hemihydrate - 166.3 mg, which corresponds to the content of potassium aspartate - 158 mg; magnesium aspartate tetrahydrate - 175 mg, which corresponds to the content of magnesium aspartate - 140 mg;
- Excipients: colloidal silicon dioxide - 2 mg, povidone K30 - 3.3 mg, magnesium stearate - 4 mg, talc - 10 mg, corn starch - 86.1 mg, potato starch - 3.3 mg;
- Shell composition: macrogol 6000 - 1.4 mg, titanium dioxide Color ind. 77891, E171 - 5.3 mg, butyl methacrylate, dimethylaminoethyl methacrylate and methacrylate copolymer [1:2:1] - 6 mg, talc - 7.3 mg.
Description of the dosage form
White or almost white film-coated tablets, round, biconvex, with a slightly shiny and uneven surface, almost odorless.
Directions for use and doses
Before use, the patient should consult a doctor.
Prescribe 1-2 tablets orally. 3 times/day. The maximum daily dose is 3 tablets. 3 times/day.
The drug should be used after meals, because the acidic environment of the stomach contents reduces its effectiveness.
The duration of taking the drug and the need for repeated courses is determined by the doctor.
Pharmacodynamics
The most important intracellular cations potassium and magnesium play a key 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 myocardial contractility. Endogenous aspartate acts as a conductor of ions: it has a high affinity for cells, due to the slight 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.
Pharmacokinetics
When taken orally, absorption of the drug is high. Excreted by the kidneys.
Indications for use Panangin 50 pcs. film-coated tablets
As an additional remedy:
- in the treatment of chronic heart diseases (heart failure, condition after myocardial infarction);
- for heart rhythm disturbances (primarily ventricular arrhythmias);
- during treatment with cardiac glycosides.
Replacement therapy for lack of magnesium/potassium in food.
Contraindications
- hypersensitivity to the components of the drug;
- acute and chronic renal failure;
- hyperkalemia;
- hypermagnesemia;
- Addison's disease;
- AV blockade I-III degree;
- cardiogenic shock (BP
- violation of amino acid metabolism;
- myasthenia gravis;
- hemolysis;
- acute metabolic acidosis;
- dehydration of the body.
With caution: pregnancy (especially in the first trimester) and during lactation.
Application Panangin 50 pcs. film-coated tablets during pregnancy and breastfeeding
The drug should be used with caution during pregnancy (especially in the first trimester) and during lactation (breastfeeding).
special instructions
Use for renal impairment
Acute and chronic renal failure, oliguria, anuria.
Particular attention is required for patients with diseases accompanied by hyperkalemia: regular monitoring of the potassium ionogram in the blood plasma is necessary.
Overdose
Symptoms: cardiac conduction disturbances (especially with previous pathology of the cardiac conduction system).
Treatment: intravenous administration of calcium chloride, if necessary, hemodialysis and peritoneal dialysis.
Side effects Panangin 50 pcs. film-coated tablets
From the cardiovascular system: AV blockade, paradoxical reaction (increased number of extrasystoles) are possible.
From 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: possible hyperkalemia (nausea, vomiting, diarrhea, paresthesia), hypermagnesemia (redness of the face, thirst, decreased blood pressure, hyporeflexia, respiratory depression, convulsions).
Drug interactions
When used simultaneously with potassium-sparing diuretics (triamterene, spironolactone), beta-blockers, cyclosporine, heparin, ACE inhibitors, NSAIDs, the risk of developing hyperkalemia up to the appearance of arrhythmia and asystole increases.
The use of potassium supplements together with corticosteroids eliminates the hypokalemia they cause.
Under the influence of potassium, a decrease in the undesirable effects of cardiac glycosides is observed.
Strengthens the negative dromo- and bathmotropic effect of antiarrhythmic drugs.
Magnesium preparations reduce the effectiveness of neomycin, polymyxin B, tetracycline and streptomycin.
Anesthetics enhance the inhibitory effect of magnesium on the central nervous system.
When used simultaneously with atracurium, dexamethonium, succinyl chloride and suxamethonium, neuromuscular blockade may be enhanced; with calcitriol - increasing the level of magnesium in the blood plasma.
Calcium supplements reduce the effect of magnesium supplements.
Pharmacokinetic interaction
Astringents and enveloping agents reduce the absorption of the drug in the gastrointestinal tract. It is necessary to observe a 3-hour interval between oral administration of the drug Panangin® with the listed means.
Indications for use of Panangin
Indications for the use of Panangin are as follows; the drug is prescribed:
- for hypomagnesemia , hypokalemia ;
- when taking laxatives and diuretics, glucocorticosteroids;
- for diarrhea, persistent vomiting, taking saluretics;
- for myocardial infarction, heart failure , digitalis intoxication, ventricular extrasystole , atrial extrasystole , supraventricular tachycardia , paroxysmal tachycardia .
Example of a recipe in Latin: Rp.: Dragee “Panangin” N. 20
Combination with other medications
The drug may enhance the negative effects of antiarrhythmic drugs. Panagin helps to cope with the lack of potassium ions in the blood, which is associated with prolonged use of diuretic medications. Non-steroidal anti-inflammatory drugs, heparin, cyclosporine, increase the likelihood of hyperkalemia. When using general anesthetics, the inhibitory effect of the drug on the central nervous system increases.
Increased neuromuscular blockade can occur under the influence of decamethonium, suxamethonium and atracuronium. The use of astringents and coating agents reduces the absorption of trace elements in the stomach.
The drug improves the tolerability of antiarrhythmic and cardiotonic drugs.
Contraindications for Panangin
The drug is not used for:
- intolerance to fructose, sorbitol ;
- impaired amino acid metabolism;
- chronic pathology of the renal system;
- hemolysis;
- exicosis;
- dehydration;
- arterial hypotension;
- myasthenia gravis;
- atrioventricular block;
- hypermagnesemia;
- hyperkalemia;
- metabolic acidosis;
- Addison's disease.
Panangin is used with caution during pregnancy.
Side effects
Side effects are the following:
- ulceration of the mucous wall of the digestive tract;
- epigastric pain;
- diarrhea;
- bleeding from the digestive system;
- drop in blood pressure;
- bradycardia;
- paradoxical reaction in the form of an increase in the number of extrasystoles;
- dry mouth, nausea, flatulence ;
- hyporeflexia;
- itchy skin;
- dyspnea;
- thrombosis;
- phlebitis;
- paresthesia;
- dizziness;
- increased sweating;
- asthenia;
- myasthenia gravis.
With rapid intravenous infusion, hypermagnesemia and hyperkalemia .
Instructions for use of Panangin (Method and dosage)
Panangin tablets, instructions for use
How to take the medicine? The drug is taken orally three times a day, 2 tablets. Maintenance and preventive therapy: 1 tablet three times a day, course for 3-4 weeks. In some situations, a repetition of the course of therapy is required.
Instructions for intravenous use
Panangin solution is injected intravenously, slowly. The drug is administered at a rate of 20-30 drops per minute, 1-2 times a day, 300 ml. Dosing of the drug Panangin during pregnancy is carried out according to the standard regimen of medication use.
Children can take the medicine from birth.
How to take Panangin for prevention?
If you ask the question of the benefits and harms of Panangin, you should realize that this is a drug that has its own side effects, so you should not use it for prevention. Firstly, in this way you accustom the body to a high content of magnesium and potassium, and secondly, you can provoke an overabundance of these substances, which in turn can cause a lot of negative reactions.
How to use
Pills
The medicine in tablet form is intended for oral administration. You can take 2 tablets three times a day. For maintenance purposes, you can take 1 tablet three times a day. The treatment course is 20-25 days.
In special cases, an additional therapeutic course may be required.
Intravenous administration
Panangin in the form of a solution should be administered intravenously slowly, drip-wise. The rate of administration of the drug should not be more than 25 drops per minute. This procedure can be carried out no more than 2 times a day. No more than 300 ml can be administered at a time. The dosage of the medicine for pregnant women does not require adjustment and is carried out according to the standard scheme.
For prevention purposes
Patients are often interested in questions regarding the benefits and harms of a drug. It is worth understanding that Panangin can cause many negative reactions, so you should not use it for preventive purposes. This is explained by the fact that taking medications will cause the body to become accustomed to a certain content of microelements or may lead to an excess of these microelements in the human body, which will entail many negative consequences.
Interaction
Panangin is able to enhance the negative bathmotropic, dromotropic effects of antiarrhythmic drugs.
The medication eliminates hypokalemia, which develops against the background of long-term use of diuretics, glucocorticosteroids, and MCS.
NSAIDs, ACE inhibitors, Heparin , potassium-sparing diuretics, Cyclosporine , beta-blockers - increase the risk of developing hyperkalemia.
When using general anesthetics, the inhibitory effect of Panangin on the nervous system increases.
Succinyl chloride, decamethonium, atracuronium, suxamethonium enhance neuromuscular blockade.
The use of enveloping and astringent medications reduces the absorption of potassium and magnesium in the digestive tract.
In combination with insulin , dextrose as part of a polarizing mixture, the heart rate is normalized in case of an overdose of cardiac glycosides, in case of ectopic arrhythmias, myocardial infarction .
Panangin improves the tolerability of cardiac glycosides and is pharmaceutically compatible with their solutions.
Instructions
INSTRUCTIONS FOR MEDICAL USE
PANANGIN®
Trade name of the drug : PANANGIN®
Dosage form : film-coated tablets
Compound:
Each film-coated tablet contains:
active ingredients: potassium aspartate 158 mg (in the form of 166.30 mg potassium aspartate hemihydrate) and magnesium aspartate 140 mg (in the form of 175.0 mg magnesium aspartate tetrahydrate);
Excipients:
core: colloidal anhydrous silicon dioxide, potato starch, povidone, magnesium stearate, talc, corn starch;
film shell: macrogol 6000, titanium dioxide (E 171), eudragit E 100, talc.
Description: White or almost white, film-coated tablets, disc-shaped, with a biconvex, slightly glossy and slightly uneven surface, almost odorless.
Pharmacotherapeutic group: Mineral supplements. Other mineral preparations.
ATX code: A12СХ
Pharmacological properties
Pharmacodynamics
The most important intracellular cations of potassium (K+) and magnesium (Mg++) play a key role in the functioning of numerous 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 (K+), calcium (Ca++), sodium (Na+) and magnesium (Mg++) ions affects myocardial contractility. Endogenous aspartate (asparaginate) acts as a conductor of ions: it has a high affinity for cells, due to the slight dissociation of its salts, ions in the form of complex compounds penetrate into the cell. Magnesium and potassium aspartates improve myocardial metabolism. Lack of magnesium/potassium predisposes to the development of arterial hypertension, atherosclerosis of the coronary arteries, arrhythmias and metabolic changes in the myocardium.
Pharmacokinetics
Magnesium:
The total supply of magnesium in the body of a person weighing 70 kg is on average 24 g (1000 mmol); more than 60% of magnesium comes from bone tissue and about 40% from skeletal muscle and other tissues. About 1% of the total magnesium reserve in the body is found in the extracellular fluid, mainly in the blood serum. In healthy adults, serum magnesium levels range from 0.7 to 1.10 mmol/l.
The recommended dietary intake of magnesium for men is 350 mg per day, for women - 280 mg per day. The need for magnesium increases during pregnancy and breastfeeding.
Magnesium is absorbed from the gastrointestinal tract by active transport. The main regulator of magnesium balance in the body is the kidneys. 3–5% of ionized magnesium is excreted by the kidneys.
An increase in urine volume (for example, during therapy with highly effective loop diuretics) leads to an increase in the excretion of ionized magnesium. If absorption of magnesium in the small intestine is reduced, subsequent hypomagnesemia leads to a decrease in its excretion (<0.5 mmol/day).
Potassium:
The total potassium reserve in the body of a person weighing 70 kg is on average 140 g (3570 mmol). The total potassium reserve is slightly less in women than in men and decreases slightly with age. 2% of the total potassium reserve in the body is located outside the cells, and the remaining 98% is inside the cells.
The optimal intake of potassium with food is 3–4 g (75–100 mmol) per day. The main route of potassium excretion is renal (about 90% of potassium is excreted by the kidneys daily). The remaining 10% is excreted through the gastrointestinal tract. Thus, the kidneys are responsible for long-term potassium homeostasis as well as serum potassium levels. In the short term, blood potassium levels are also regulated by the flow of potassium between the intracellular and extracellular spaces.
Indications for use
- As an additional source of magnesium and potassium.
- As part of combination therapy for chronic heart diseases (chronic heart failure, condition after myocardial infarction), cardiac arrhythmias (mainly ventricular arrhythmias) as prescribed by the attending physician.
- Addition to therapy with cardiac glycosides as prescribed by the attending physician.
Directions for use and doses
Doses
Adults
Usual daily dose: 1-2 tablets 3 times a day. The daily dose can be increased to 3 tablets 3 times a day.
Children and teenagers
There are no data on the safety and effectiveness of Panangin in children and adolescents.
Mode of application
For oral administration.
The drug should be taken after meals, as the acidic environment of the stomach may reduce its effectiveness.
Side effects
Gastrointestinal disorders:
When using high doses of the drug, increased bowel movements may occur.
Reports of suspected adverse reactions
After registration of a medicinal product, it is important to provide information about cases of suspected adverse reactions. This allows for continuous monitoring of the benefit-risk ratio of the drug. Health care professionals are asked to report any suspected adverse reactions using the national reporting system.
Contraindications
- Hypersensitivity to the active substances or to any of the excipients of the drug.
- Acute and chronic renal failure.
- Addison's disease.
- Third degree atrioventricular block.
- Cardiogenic shock (blood pressure less than 90 mm Hg).
Drug interactions
No drug interaction studies have been conducted with Panangin. According to scientific literature, potassium and magnesium may interact with certain medications. When used together with potassium-sparing diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, cyclosporine, heparin and non-steroidal anti-inflammatory drugs, the risk of developing hyperkalemia increases.
Tetracyclines used orally, iron salts and sodium fluoride reduce the absorption of the drug from the gastrointestinal tract. The break between taking the above drugs and Panangin should be at least 3 hours.
special instructions
Special warnings and precautions
Patients with diseases accompanied by hyperkalemia require special attention: regular monitoring of electrolyte levels in the blood serum is necessary.
Each film-coated tablet of Panangin contains 36.2 mg of potassium. This should be taken into account in patients with impaired renal function or in patients receiving potassium supplements or potassium-containing dietary supplements.
Use during pregnancy and breastfeeding
To date, no harmful effects have been reported when using the drug in this category of patients.
Impact on the ability to drive vehicles and operate machinery
The drug does not affect the ability to drive vehicles and other machinery.
Overdose
To date, there have been no reports of cases of overdose with Panangin, even when taking high doses. Given the ability of the kidneys to excrete large amounts of potassium, increasing the dose of the drug can lead to hyperkalemia only against the background of acute and obvious disturbances in potassium excretion.
Magnesium has a wide therapeutic window, and in the absence of renal failure, serious side effects are extremely rare.
According to the literature, oral magnesium supplementation may cause mild side effects such as diarrhea. High doses of Panangin may cause increased stool frequency due to its magnesium content.
When administered intravenously, symptoms of hyperkalemia/hypermagnesemia may develop if administered rapidly.
Symptoms of hyperkalemia: general weakness, paresthesia, bradycardia, paralysis, arrhythmia.
Symptoms of hypermagnesemia: nausea, vomiting, lethargy, decreased blood pressure, bradycardia, weakness, hyporeflexia.
In case of overdose, you should stop taking the drug and carry out symptomatic therapy (intravenous administration of calcium chloride, if necessary, hemodialysis).
Release form
50 film-coated tablets in polypropylene bottles with a sealable cap equipped with a harmonic-shaped polyethylene gasket. The bottle is placed in a cardboard box with attached instructions for medical use.
Storage conditions
Store at a temperature not exceeding 25°C.
Keep out of the reach of children.
Best before date
5 years.
Do not use after the expiration date stated on the package.
Conditions for dispensing from pharmacies
Over the counter.
Manufacturer's name and address
JSC "Gedeon Richter"
1103 Budapest, st. Dymroyi 19-21, Hungary
Name and address of the organization accepting claims (proposals ) regarding the quality of medicines in the territory of the Republic of Uzbekistan
Representative office of JSC Gedeon Richter
100015, Tashkent, st. Nukus, 71, 5th floor
Tel.: (99878) 1479042
Panangina price, where to buy
The price of Panangin in tablets is about 150 rubles per package No. 50, the price in ampoules is about 160 rubles.
The price of Panangin in Ukraine is 110 and 140 UAH. for tablets and solution, respectively.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- Panangin tablets p.p.o.
50 pcs. Gedeon Richter/Gedeon Richter-RUS JSC RUB 152 order - Panangin tab. p/o captivity. 158 mg + 140 mg No. 100 JSC "Gedeon Richter-RUS" RU
RUB 265 order
- Panangin Forte tablets p.p.o. 316mg+280mg 60 pcs. JSC Gedeon Richter
RUB 316 order
- Panangin tab. p/o captivity. No. 50 JSC "Gedeon Richter-RUS" RU
RUB 149 order
- Panangin conc. ready solution d/inf 45.2 mg mg/ml + 0.04 g/ml 10 ml 5 pcs CJSC PharmFirma Sotex
RUB 156 order
Pharmacy Dialogue
- Panangin (tab.p.pl.vol. 158 mg + 140 mg No. 100) Gedeon-Richter/Gedeon Richter-RUS JSC
RUB 306 order
- Panangin forte (tab.pl/vol. 316mg+280mg No. 60)Gedeon-Richter
RUB 323 order
- Panangin (tab.p.pl/rev. No. 50)Gedeon-Richter/Gedeon-Richter-RUS ZAO
147 RUR order
- Panangin (amp. 10ml No. 5) Gedeon-Richter
RUB 161 order
- Panangin (concentrated solution 10ml No. 5) Gedeon-Richter
162 RUR order
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Pharmacy24
- Panangin N50 tablets VAT "Gedeon Richter", Ugorshchina
110 UAH. order - Panangin 10 ml No. 5 concentrate for the preparation of solution for infusion VAT "Gedeon Richter", Ugorshchina
142 UAH order
PaniPharmacy
- Panangin solution d/in. 10ml No. 5 Hungary, Gedeon Richter
142 UAH order
- Panangin tablet p/captivity about. No. 50 Hungary, Gedeon Richter
115 UAH order
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