On the part of the cardiovascular system: bradycardia, AV-dissociation, ventricular tachyarrhythmia, angina pectoris, worsening of heart failure (in patients with reduced left ventricular function), SA block, AV block, violations of intraventricular conduction, supraventricular tachyarrhythmia, while taking into high doses – orthostatic hypotension. From tren hexahydrobenzylcarbonate the digestive system: taste change, dry mouth, bitter taste in the mouth, nausea, decreased appetite, feeling of heaviness in the epigastric pain, constipation or diarrhea, rarely – liver function abnormalities, cholestatic jaundice, cholestasis. From the central nervous system: headache, dizziness, rarely – blurred vision, double vision, seizures. Laboratory findings: leukopenia, agranulocytosis, increased bleeding time, thrombocytopenia, appearance of antinuclear antibodies. With the genitourinary system: oligospermia, reduced potency. Allergic reactions: skin rash, itching, rash, redness, hives, lupus-like syndrome. Other: weakness, bronchospasm, hemorrhagic rash.
Intoxication may occur when the one-stage receiving a dose of 2 times the daily dose; intoxication symptoms appear after 1 hour, maximum – a few hours.
Symptoms: The sustained reduction in blood pressure, nausea, dry mouth, vomiting, mydriasis, somnolence, extrapyramidal disorder, confusion, bradycardia, prolongation of the interval QT, violations intraatrial and intraventricular conduction, ventricular tachyarrhythmias, paroxysms of polymorphic ventricular tachycardia, SA and AV block, asystole, coma, convulsions, delirium, pulmonary edema.
Treatment: gastric lavage, defibrillation, administration of dobutamine, diazepam; if necessary – artificial ventilation and chest compressions. Hemodialysis is not effective.
Interactions with other drugs
can not be combined with lidocaine (cardiodepressivny amplified effect).
Increases in plasma concentration of propranolol, metoprolol, digoxin (increases the risk of glycoside intoxication), indirect anticoagulants, cyclosporine. It enhances the effect of warfarin (blocks the metabolism).
In an application with beta-blockers, tricyclic antidepressantamii may increase antiarrhythmic action, with local anesthetics -. Increased risk of damage to the central nervous system
cimetidine and quinidine, tren hexahydrobenzylcarbonate slowing down the metabolism, increase the concentration of propafenone in plasma by 20% rifampicin – reduces.
Amiodarone increases the risk of tachycardia type “pirouette”.
Drugs that suppress the SA and AV nodes and has a negative inotropic effect, increase the risk of side effects.
Drugs that suppress bone marrow blood, increases the risk of myelosuppression.
During the course of treatment, especially at the beginning of therapy requires ECG monitoring.
Treatment is recommended to start at the hospital as an increased risk of arrhythmogenic action associated with the use of propafenone. Application propanorm should be under the control of blood electrolyte balance (especially potassium concentration) and ECG; Periodically determine the activity of “liver” transaminases.
In the treatment of ventricular arrhythmias propafenone effective antiarrhythmic drugs IA and IB classes.
In patients with liver function failure bioavailability of propafenone increased by 70% in these patients is recommended to reduce the dose and carry out regular monitoring of laboratory parameters.
Indications and a dose of extreme caution should be determined for patients with insertion of a pacemaker.
for patients undergoing long-term treatment with anticoagulants and hypoglycemic agents, it is necessary to conduct a thorough both clinical and laboratory monitoring.
if in the course of tren hexahydrobenzylcarbonate therapy manifest SA block or AV block of III degree, or often repetitive beats, then treatment should be interrupted.
Given the possibility of pro-arrhythmogenic effects, the drug is recommended for use only by prescription and under medical supervision.
In the period of treatment should refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and psychomotor speed reactions.