What is Nisten 5mg?

Nisten 5mg is a film-coated tablet that contains ivabradine as the active ingredient. The drug is used in the treatment of cardiovascular diseases: Angina pectoris, coronary heart disease,... The following article will provide more information on the effects and use of Nisten 5mg effectively.

Nisten 5mg tablet contains ivabradine as the main ingredient. The pharmacodynamic property of ivabradine is to reduce heart rate. At usual doses, ivabradine reduces heart rate by about 10 beats/min at rest and exercise. This helps to reduce the load on the heart, which consumes myocardial oxygen. In particular, ivabradine did not affect intracardiac conduction, myocardial contractility, or ventricular repolarization.
Nisten 5mg is indicated for use in the following cases:
Treatment of coronary heart disease; Symptomatic treatment of chronic stable angina in coronary patients with normal sinus node rhythm. The drug is used for: Patients with intolerance, contraindications to beta-blockers; In combination with beta-blockers in patients not controlled with maximum beta-blockers, patients with a heart rate above 60 beats/min.

Usage: Nisten is used orally.
Treatment of coronary heart disease Usual starting dose: 5mg x 2 times/day; After 3-4 weeks of treatment, it may be increased to 7.5mg twice daily depending on the patient's response. If during treatment, the resting heart rate is usually below 50 beats/min or the patient has symptoms related to bradycardia such as dizziness, decreased blood pressure, fatigue, etc., the dose should be adjusted. about 2.5mg 2 times/day; If the heart rate remains below 50 beats/min or the bradycardia persists, treatment should be discontinued. Treatment of chronic heart failure Nisten should only be used in patients with stable heart failure; Usual starting dose: 5mg twice daily. After 2 weeks, it can be increased to 7.5mg twice daily if resting heart rate is normally above 60 beats/min. After 2 weeks of treatment, the dose may be reduced to 2.5 mg twice daily if the resting heart rate is usually less than 50 beats/min or the patient has symptoms related to bradycardia such as decreased blood pressure, dizziness, and fatigue. fatigue; If the patient's heart rate is about 50-60 beats/min, the dose should be maintained at 5mg x 2 times/day. Elderly: Patients 75 years of age and older should be started on a low dose of Nisten (2.5 mg twice daily) before increasing the dose if necessary. Patients with renal impairment: No dose adjustment is required if the patient has a creatinine clearance above 15ml/min. There are no data on the use of the drug in patients with creatinine clearance less than 15 ml/min, so caution should be exercised. Patients with hepatic impairment: No dose adjustment of Nisten is required in patients with mild hepatic impairment. Nisten should be used with caution in patients with moderate hepatic impairment. Contraindicated in patients with severe hepatic impairment.

Overdose: When using Nisten overdose, the patient may experience severe and prolonged bradycardia. In cases of bradycardia and poor hemodynamic tolerance, patients can be symptomatically treated with intravenous beta-stimulators. In addition, a temporary pacemaker can be placed if needed.
Missed dose: If a dose of Nisten is missed, the patient should take it as soon as he remembers. However, if it is almost time for your next dose, skip the missed dose and take your next dose as scheduled.

When using Nisten, patients may experience some unwanted side effects:
Very common: Fireflies eyes; Common: Headache (usually during the first month of treatment), dizziness, blurred vision, bradycardia, extrasystoles, 1st degree atrioventricular block; Uncommon: Uremia, eosinophilia, syncope, hypotension, tachycardia, nausea, dyspnea, constipation, diarrhea, rash, angioedema, cramps, fatigue, asthenia, increase creatinine,...; Rare: Erythema, pruritus, urticaria, malaise; Very rare: Atrial fibrillation, sinus node insufficiency syndrome, 2nd degree atrioventricular block, 3rd degree atrioventricular block,... When experiencing side effects of Nisten, patients should stop taking the drug and notify the doctor immediately. doctor for treatment instructions.

The drug Nisten 5mg is contraindicated for the following cases:
People with hypersensitivity to the ivabradine component or the excipients in the drug; Patients with resting heart rate less than 60 beats/min before treatment; People with cardiogenic shock ; Patients with acute myocardial infarction; People with severe liver failure; Patients with severe hypotension (less than 90/5 mmHg); People with sinus node failure syndrome; Patients with sinoatrial block; The patient is using a pacemaker; Patients with acute or unstable heart failure; People with unstable angina; People with 3rd degree atrioventricular block; Combination with strong cytochrome P450 3A4 inhibitors such as azole antifungals, macrolide antibiotics, HIV protease inhibitors, nefazodone; Women who are pregnant and during lactation.

Note when using Nisten 5mg:
Arrhythmia: Nisten is not effective in the treatment or prevention of arrhythmia, losing its effect when arrhythmia occurs. Therefore, the drug should not be used in patients with atrial fibrillation or other cardiac arrhythmias that affect sinus node function. Patients treated with the drug should be regularly monitored clinically to detect atrial fibrillation, electrocardiogram should be monitored if clinical signs are present. Simultaneously, closely monitor patients with chronic heart failure with ventricular conduction disturbances and ventricular dyssynchrony; Nisten is not recommended in patients with 2nd degree atrioventricular block; Do not use Nisten in patients with resting heart rate less than 60 beats/minute prior to treatment. During treatment, the dose should be reduced if the resting heart rate is usually below 50 beats/min or the patient has symptoms related to bradycardia such as dizziness, decreased blood pressure, and fatigue. Treatment should be discontinued if the heart rate remains below 50 beats/min or the bradycardia persists; Do not combine Nisten with calcium channel blockers that reduce heart rate such as diltiazem or verapamil. There are no safety data when combining Nisten with nitrates and dihydropyridine calcium channel blockers such as amlodipine;

People with chronic heart failure need to stabilize their heart failure before treatment with Nisten. Should be used with caution in patients with grade IV heart failure due to lack of safety data in this patient population; Do not use Nisten immediately after shock occurs; Nisten may affect retinal function. The drug should be discontinued if any possible visual damage occurs. The drug should be used with caution in patients with retinitis pigmentosa; There are insufficient data on the use of Nisten in patients with mild to moderate hypotension, so caution should be exercised in its use in this population. Contraindicated in patients with severe hypotension (less than 90/50 mmHg); Nisten should not be used in patients with congenital QT syndrome or being treated with drugs with the potential for QT prolongation. If necessary, close cardiovascular monitoring is required; Nisten does not affect the ability to drive or use machines, but it can cause transient eye irritation when there is a sudden change in light intensity, especially when driving at night. Therefore, users of Nisten should be cautious.

Do not combine ivabradine (an ingredient of Nisten) with drugs capable of inhibiting CYP3A4 such as: azole antifungals, macrolide antibiotics, HIV protease inhibitors and nefazodone. Ketoconazole and josamycin may increase mean plasma concentrations of ivabradine by 7 to 8 times.
Do not combine Ivabradine with drugs with the potential to prolong QT.
Caution when co-administering Nisten with:
Moderate CYP3A4 Inhibitors: When ivabradine and moderate CYP3A4 inhibitors are co-administered, a dose of 2.5 mg twice daily should be initiated if resting heart rate is present. over 60 beats/min, the patient should be closely monitored; Grapefruit juice: Ivabradine concentrations will increase about 2 times if taken with grapefruit juice. Therefore, do not use grapefruit juice during treatment with Nisten; CYP3A4 Inducers: This class of drugs may decrease the concentration and effects of ivabradine. The dose of Ivabradine may need to be adjusted as directed by your doctor. Patients should take Nisten exactly according to the doctor's instructions on the dose and duration of the drug. If you are having health problems, are taking some other medications, you should notify your doctor for appropriate adjustment.