Concor side effects on the stomach and intestines. Concor side effects for women. Concor tablets are an effective heart remedy. International non-proprietary name
Trade name of the drug: Concor ®
International non-proprietary name:
bisoprololDosage form:
film-coated tabletsCompound:
1 film-coated tablet, 5 mg contains:
Nucleus
Active substance: bisoprolol fumarate 2:1 (bisoprolol hemifumarate) - 5 mg
Excipients:
shell
Iron dye yellow oxide (E 172), dimethicone 100, macrogol 400, titanium dioxide (E 171), hypromellose 2910/15.
1 film-coated tablet, 10 mg contains:
Nucleus
Active substance: bisoprolol fumarate 2:1 (bisoprolol hemifumarate) - 10 mg
Excipients: anhydrous colloidal silicon dioxide, magnesium stearate, crospovidone, microcrystalline cellulose, corn starch, anhydrous calcium hydrogen phosphate.
shell
Iron dye red oxide (E 172), iron dye yellow oxide (E 172), dimethicone 100, macrogol 400, titanium dioxide (E 171), hypromellose 2910/15.
Description
Film-coated tablets, 5 mg:
Pale yellow, heart-shaped, biconvex, film-coated tablets scored on both sides.
Film-coated tablets, 10 mg:
Light orange, heart-shaped, biconvex film-coated tablets, scored on both sides.
Pharmacotherapeutic group:
beta 1 - selective blockerATX code: C07AB07
Pharmacotherapeutic properties
Pharmacodynamics
Selective beta 1 - blocker, without its own sympathomimetic activity, does not have a membrane stabilizing effect. Reduces plasma renin activity, reduces myocardial oxygen demand, reduces heart rate (HR) (at rest and during exercise). It has antihypertensive, antiarrhythmic and antianginal effects. By blocking in low doses beta 1 - adrenoreceptors of the heart, it reduces the formation of cAMP from ATP stimulated by catecholamines, reduces the intracellular current of calcium ions, has a negative chrono-, dromo-, batmo- and inotropic effect (inhibits conduction and excitability, slows down atrioventricular conduction).
With an increase in the dose above the therapeutic one, it has a beta 2 -adrenergic blocking effect.
The total peripheral vascular resistance at the beginning of the use of the drug, in the first 24 hours, slightly increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors), which after 1-3 days returns to the original, and decreases with long-term administration.
The hypotensive effect is associated with a decrease in the minute volume of blood, sympathetic stimulation of peripheral vessels, a decrease in the activity of the renin-angiotensin system (it is of great importance for patients with initial renin hypersecretion), restoration of sensitivity in response to a decrease in blood pressure (BP) and an effect on the central nervous system ( CNS). With arterial hypertension, the effect occurs after 2-5 days, stable action - after 1-2 months.
The antianginal effect is due to a decrease in myocardial oxygen demand as a result of a decrease in heart rate, a slight decrease in contractility, lengthening of diastole, and improvement in myocardial perfusion. The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and a slowdown in atrioventricular (AV) conduction (mainly in antegrade and, to a lesser extent, in retrograde directions through the atrioventricular node) and along additional pathways.
When used in medium therapeutic doses, unlike non-selective beta-blockers, it has a less pronounced effect on organs containing beta 2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism, does not cause retention of sodium ions (Na+) in the body.
Pharmacokinetics
Suction. Bisoprolol is almost completely (>90%) absorbed from the gastrointestinal tract. Its bioavailability due to negligible "first pass" metabolism through the liver (at the level of about 10%-15%) is about 85-90% after oral administration. Eating does not affect bioavailability. Bisoprolol exhibits linear kinetics, with plasma concentrations being proportional to the administered dose over the dose range of 5 to 20 mg. The maximum plasma concentration is reached after 2-3 hours.
Distribution. Bisoprolol is distributed quite widely. The volume of distribution is 3.5 l/kg. Communication with proteins of a blood plasma reaches about 35%; capture by blood cells is not observed.
Metabolism. Metabolized by the oxidative pathway without subsequent conjugation. All metabolites are highly polar and are excreted by the kidneys. The main metabolites found in blood plasma and urine do not show pharmacological activity. Data obtained from experiments with human liver microsomes in vitro show that bisoprolol is metabolized primarily by CYP3A4 (about 95%), and CYP2D6 plays only a small role.
Withdrawal. The clearance of bisoprolol is determined by the balance between its excretion through the kidneys in the form of an unchanged substance (about 50%) and oxidation in the liver (about 50%) to metabolites, which are then also excreted by the kidneys. The total clearance is 15.6 ± 3.2 l / h, and the renal clearance is 9.6 ± 1.6 l / h. The half-life is 10-12 hours.
Indications for use
The drug Concor ® should not be used to treat patients with the following conditions:
With caution: liver failure, chronic renal failure, Prinzmetal's angina; myasthenia gravis, thyrotoxicosis, diabetes mellitus, atrioventricular block I degree, depression (including history), psoriasis, old age. Use during pregnancy and lactation
During pregnancy, Concor should only be recommended if the benefit to the mother outweighs the risk of side effects in the fetus.
As a rule, beta-blockers reduce blood flow in the placenta and may affect the development of the fetus. Blood flow in the placenta and uterus should be carefully monitored, as well as the growth and development of the unborn child, and in case of dangerous manifestations in relation to pregnancy or the fetus, alternative therapeutic measures should be taken. The newborn should be carefully examined after delivery. In the first three days of life, symptoms of low blood glucose and heart rate may occur. There are no data on the excretion of bisoprolol into breast milk or the safety of exposure to bisoprolol in infants. Therefore, taking Concor is not recommended for women during breastfeeding. Dosage and administration
The tablets should be taken with a small amount of liquid in the morning before, during or after breakfast. Tablets should not be chewed or crushed into powder. Treatment of arterial hypertension and angina pectoris
In all cases, the regimen and dosage is selected by the doctor for each patient individually, in particular, taking into account the heart rate and the patient's condition.
The usual starting dose is 5 mg (1 tablet Concor ® 5 mg) once a day. If necessary, the dosage can be increased to 10 mg once a day.
In the treatment of arterial hypertension and angina pectoris, the maximum recommended dose is 20 mg Concor ® once a day. Treatment of chronic heart failure
The beginning of the treatment of chronic heart failure with Concor ® requires a special titration phase and regular medical supervision.
The preconditions for treatment with Concor ® are as follows:
Treatment of chronic heart failure with Concor ® begins in accordance with the following titration scheme. This may require individual adaptation depending on how well the patient tolerates the prescribed dose, i.e. the dose can be increased only if the previous dose was well tolerated.
* To ensure the above dosing regimen at subsequent stages of treatment, it is recommended to use the drug Concor ® .
The maximum recommended dose in the treatment of chronic heart failure is 10 mg of Concor ® 1 time per day. Patients are advised to take the dose of the drug selected by the doctor if no adverse reactions occur.
After starting treatment with the drug at a dose of 1.25 mg (1/2 tablet of Concor KOR), the patient should be observed for about 4 hours (control of heart rate, blood pressure, conduction disturbances, signs of worsening heart failure).
During the titration phase or after it, a temporary worsening of the course of heart failure, fluid retention in the body, arterial hypotension or bradycardia may occur. In this case, it is recommended, first of all, to pay attention to the selection of the dosage of concomitant basic therapy (optimize the dose of diuretic and / or ACE inhibitor) before reducing the dosage of Concor ® . Treatment with Concor ® should be interrupted only if absolutely necessary.
After stabilization of the patient's condition, re-titration should be carried out, or treatment should be continued. Duration of treatment for all indications
Treatment with Concor ® is usually a long-term therapy. If necessary, treatment can be interrupted and resumed subject to certain rules.
Treatment should not be interrupted suddenly, especially in patients with ischemic heart disease. If it is necessary to stop treatment, then the dosage of the drug should be reduced gradually. Special patient groups
Impaired kidney or liver function:
Treatment of arterial hypertension or angina pectoris:
Elderly patients:
Dose adjustment is not required. Side effect
The frequency of the adverse reactions listed below was determined according to the following:
-very often: ≥1/10;
- often: >1/100.<1/10;
- infrequently:> 1/1000.<1/100:
-rarely: >1/10 OOO.<1/1000:
-very rarely:<1/10 ООО. включая отдельные сообщения. The cardiovascular system
Very often: decrease in heart rate (bradycardia, especially in patients with chronic heart failure); often: arterial hypotension (especially in patients with chronic heart failure), manifestation of angiospasm (increased peripheral circulatory disorders, feeling of coldness in the extremities (paresthesia); infrequently: impaired atrioventricular conduction, orthostatic hypotension, decompensation of heart failure with the development of peripheral edema. Nervous system
At the beginning of the course of treatment, disorders of the central nervous system may temporarily appear, infrequently: dizziness, headache, asthenia, increased fatigue, sleep disturbances. as well as mental disorders (infrequently - depression, rarely hallucinations, nightmares, convulsions). Usually these phenomena are mild and disappear, as a rule, within 1-2 weeks after the start of treatment. organs of vision
Rare: blurred vision, decreased tearing (should be taken into account when wearing contact lenses): very rarely: conjunctivitis. Respiratory system
Rare: allergic rhinitis. Uncommon: bronchospasm in patients with bronchial asthma or obstructive airways disease. Gastrointestinal tract
Often: nausea, vomiting, diarrhea, constipation, dryness of the oral mucosa; rarely: hepatitis. Musculoskeletal system
Infrequently: muscle weakness, cramps in the calf muscles, arthralgia. allergic reactions
Rare: hypersensitivity reactions such as pruritus. skin redness, sweating, rash. Very rare: alopecia. Beta-blockers can exacerbate psoriasis. genitourinary system
Very rare: erectile dysfunction. Laboratory indicators
Rarely: increased levels of liver enzymes in the blood (ACT, ALT), increased levels of triglycerides in the blood. In some cases: thrombocytopenia, agranulocytosis. Overdose
Symptoms: arrhythmia, ventricular extrasystole, severe bradycardia, atrioventricular block. pronounced decrease in blood pressure, acute heart failure, hypoglycemia, acrocyanosis, difficulty breathing, bronchospasm, dizziness, fainting, convulsions.
Treatment: gastric lavage and the appointment of adsorbing drugs; symptomatic therapy: with developed atrioventricular blockade - intravenous administration of 1-2 mg of atropine, epinephrine or setting up a temporary pacemaker; with ventricular extrasystole - lidocaine (class IA drugs are not used); with a pronounced decrease in blood pressure - the patient should be in the Trendelenburg position; if there are no signs of pulmonary edema - plasma-substituting solutions intravenously, if ineffective - the introduction of epinephrine, dopamine, dobutamine (to maintain the chronotropic and inotropic action and eliminate a pronounced decrease in blood pressure); in heart failure - cardiac glycosides, diuretics, glucagon; with convulsions - intravenous diazepam; with bronchospasm - beta 2 - adrenostimulants inhalation. Interaction with other drugs
The effectiveness and tolerability of drugs may be affected by the simultaneous use of other drugs. This interaction can also occur when two drugs are taken after a short period of time. The doctor must be informed that you are taking other medicines, even if you are taking them without a prescription.
Allergens used for immunotherapy or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving bisoprolol.
Iodine-containing radiopaque diagnostic agents for intravenous administration increase the risk of developing anaphylactic reactions.
Phenytoin when administered intravenously, drugs for inhalation general anesthesia (derivatives of hydrocarbons) increase the severity of the cardiodepressive effect and the likelihood of lowering blood pressure.
The effectiveness of insulin and oral hypoglycemic drugs may change during treatment with bisoprolol (masks the symptoms of developing hypoglycemia: tachycardia, increased blood pressure).
The clearance of lidocaine and xanthines (except for diphylline) may decrease due to a possible increase in their plasma concentration, especially in patients with initially increased clearance of theophylline under the influence of smoking. Non-steroidal anti-inflammatory drugs, glucocorticosteroids and estrogens weaken the hypotensive effect of bisoprolol (Na + retention, blockade of prostaglandin synthesis by the kidneys).
Cardiac glycosides, methyldopa, reserpine and guanfacine, calcium channel blockers (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, atrioventricular block, cardiac arrest and heart failure.
Nifedipine can lead to a significant decrease in blood pressure.
Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs can lead to an excessive decrease in blood pressure.
The action of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins during treatment with bisoprolol may be prolonged.
Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedatives and hypnotics increase CNS depression. Simultaneous use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. A break in treatment between taking MAO inhibitors and bisoprolol should be at least 14 days. Non-hydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders.
Ergotamine increases the risk of developing peripheral circulatory disorders; sulfasalazine increases the concentration of bisoprolol in the blood plasma; rifampicin shortens the half-life. special instructions
Do not stop treatment abruptly and do not change the recommended dosage without first consulting your doctor, as this can lead to a temporary deterioration in the activity of the heart. Treatment should not be interrupted suddenly, especially in patients with ischemic heart disease. If discontinuation of treatment is necessary, the dosage should be reduced gradually.
Monitoring the condition of patients taking Concor ® should include measuring heart rate and blood pressure (at the beginning of treatment - daily, then 1 time in 3-4 months), ECG, determination of blood glucose in patients with diabetes mellitus (1 time in 4-5 months ). In elderly patients, it is recommended to monitor kidney function (1 time in 4-5 months). The patient should be taught how to calculate heart rate and should be instructed to consult a doctor if the heart rate is less than 50 bpm.
Before starting treatment, it is recommended to conduct a study of the function of external respiration in patients with a burdened bronchopulmonary history.
Patients using contact lenses should take into account that during treatment, a decrease in the production of lacrimal fluid is possible.
When used in patients with pheochromocytoma, there is a risk of developing paradoxical arterial hypertension (if effective alpha-blockade has not been previously achieved). In thyrotoxicosis, Concor ® may mask certain clinical signs of thyrotoxicosis (eg, tachycardia). Abrupt discontinuation of the drug in patients with thyrotoxicosis is contraindicated, as it can exacerbate symptoms. In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentration to normal levels.
While taking clonidine, its reception can be stopped only a few days after Concor ® is canceled.
It is possible to increase the severity of the hypersensitivity reaction and the lack of effect from the usual doses of epinephrine against the background of an aggravated allergic history. If it is necessary to carry out planned surgical treatment, the drug should be discontinued 48 hours before general anesthesia. If the patient took the drug before surgery, he should choose a drug for general anesthesia with a minimally negative inotropic effect.
Reciprocal activation of the vagus nerve can be eliminated by intravenous atropine (1-2 mg).
Drugs that reduce catecholamine reserves (including reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect a pronounced decrease in blood pressure or bradycardia. Patients with bronchospastic diseases can be prescribed cardioselective blockers in case of intolerance and / or ineffectiveness of other antihypertensive drugs. If the dose of the drug is exceeded, there is a risk of developing bronchospasm.
If increasing bradycardia (heart rate less than 50 beats / min.), A pronounced decrease in blood pressure (systolic blood pressure below 100 mm Hg), atrioventricular blockade is detected in elderly patients, it is necessary to reduce the dose or stop treatment. It is recommended to stop therapy if depression develops.
You can not abruptly interrupt treatment because of the risk of developing severe arrhythmias and myocardial infarction. Cancellation of the drug is carried out gradually, reducing the dose for 2 weeks or more (reduce the dose by 25% in 3-4 days). It is necessary to cancel the drug before examining the content of catecholamines, normetanephrine and vanillinmandelic acid in the blood and urine; titers of antinuclear antibodies. Influence on the ability to drive a car and complex mechanisms
Bisoprolol does not affect the ability to drive a car in the study of patients suffering from diseases of the coronary vessels of the heart. However, due to individual reactions, the ability to drive a car or work with technically complex mechanisms may be impaired. Particular attention should be paid to this at the beginning of treatment, after changing the dose, and also with the simultaneous use of alcohol. Release form
Film-coated tablets, 5 and 10 mg.
10 tablets in a blister of aluminum foil and PVC, 3, 5 or 10 blisters, together with instructions for use, are placed in a cardboard box. Storage conditions
Store at a temperature not exceeding 30°C.
Keep out of the reach of children. Best before date
5 years. Do not use after the expiration date. Terms of dispensing from pharmacies
On prescription. Manufacturer
Merck KGaA, Germany Manufacturer's address:
Frankfurter Strasse 250 64293 Darmstadt, Germany
Frankfurterstrasse 250 64293 Darmstadt, Germany Presented in Russia and the CIS:
"Nycomed Austria GmbH", Austria: 119048 Moscow, st. Usacheva, d. 2, building 1
Cardiovascular diseases are widespread in the modern world. There are many reasons for this. With an increase in life expectancy, the number of vascular pathologies has increased. Stress, unfavorable environmental conditions, unbalanced nutrition exacerbate the situation. With consistently high pressure or jumps in blood pressure up, the attending physician may prescribe Concor tablets.
Before you start taking Concor, you should carefully study the instructions for use. Find out at what pressure you can drink pills without harming your health.
Hypertension has many faces. When prescribing a therapeutic course, many factors should be considered. A competent treatment program can only be created by a specialist on the basis of anamnesis and direct examination of the patient. Do not forget: self-treatment is dangerous!
How does the drug work?
Before you imagine the principle of the action of the drug on the body, you should understand the reasons for the increase in blood pressure.
This may be a spasm of the arteries or a decrease in their elasticity, tachycardia (high heart rate), renal pathologies, heredity, genetic predisposition and a number of other factors.
With an increase in pressure or an increase in heart rate, adrenaline is released into the blood. The vessels narrow, the volume of the bronchi expands, the flow of air into the lungs increases, the metabolic process accelerates. Adrenaline provides effective assistance to the body in critical situations, but not during illness.
Concor tablets help to stop unpleasant symptoms.
A selective beta-blocker (namely, Concor belongs to this group of drugs) limits the effect of adrenaline on cardiac activity and nerve endings susceptible to it.
As a result, the heartbeat slows down and the coronary arteries (the arteries that carry blood to the heart) dilate, resulting in a decrease in blood pressure. The mechanism that lowers blood pressure is based on a decrease in the volume of blood pushed by the heart into the circulatory system with each contraction.
Renin (a substance contained in the blood plasma responsible for regulating blood pressure) under the influence of the drug reduces its intensity, lowering the pressure.
The effect of the drug is well felt 4 hours after oral administration of the tablet. Concor is a long-acting drug (the active substance accumulates and has a beneficial effect on the cardiovascular system for a long time). A single daily dose guarantees a 24-hour therapeutic effect. Gently relieves pressure.
The use of the drug on an ongoing basis gives a stable positive result 15 days after the start of therapy.
Bisoprolol (the main active ingredient) is almost completely absorbed by the body, being absorbed by 90% from the gastrointestinal tract. The remaining 10% are metabolized. 3 hours after taking the drug in the blood plasma, the maximum concentration is formed.
All the ingredients that make up the drug are processed without entering into chemical reactions with other substances and without combining with them. Waste elements are excreted from the body with urine. The concentration of the substance is halved later - 10-12 hours after taking the medicine.
Composition and form of release
Concor is produced in the form of biconvex film-coated tablets of light yellow or orange color. The shape is heart-shaped. The presence of risks makes it easy to adjust the dosage and administration of the drug. Tablets of 5 mg or 10 mg are packed in blisters of 10 pieces. They go on sale packed in a cardboard box, 3-5 standards in each pack. Complete with official instructions.
Main active ingredient: bisoprolol. It has a directed extended drug effect. The maximum possible positive effect is achieved 3 hours after taking the Concor tablet.
The excipients that make up the drug contribute to the gradual release of the drug, optimally regulating the mechanism of pharmacodynamics.
The film shell consists of:
- titanium dioxide;
- hypromellose;
- dimethicone;
- macrogol and dyes.
The shell, gradually dissolving in the stomach, gradually releases the medicinal substance, contributing to a gradual long-term decrease in pressure.
Indications
Contraindications
The pharmaceutical industry produces drugs aimed at reducing blood pressure. Studies show that the higher the therapeutic efficacy of blood pressure lowering drugs, the more contraindications and side effects they have. Before taking the medicine, you should carefully study the list of prohibitions. Acceptance may be:
- heart failure in chronic and acute form;
- cardiogenic shock;
- violations of the sinus node;
- AV blockade 2 and 3 degrees, without a pacemaker;
- low blood pressure (below 100mmHg);
- slow heartbeat;
- bronchial pathology;
- circulatory disorders, accompanied by cooling of the limbs;
- tumors of the adrenal glands of a hormonal nature;
- violations of metabolic processes in the body;
- lactation period;
- hypersensitivity to individual ingredients of the drug.
Use with caution in patients suffering from:
- severe functional disorders of the liver;
- angina;
- some types of diabetes;
- thyroid disease with high levels of hormones in the blood;
- atrioventricular block I degree;
- scaly deprive (psoriasis);
- severe renal failure;
- congenital malformations of the heart or heart valve;
- restrictive cardiomyopathy;
- chronic heart failure in combination with myocardial infarction for 3 months;
- patients who are forced to follow a strict diet.
It happens that people with severe hypotension suffer from tachycardia. Can Concor be taken with low blood pressure? With a strong heartbeat against the background of pressure 90/60, Concor's intake is not excluded. Theoretically, taking the medicine in small doses is possible, but only a doctor can decide such issues.
Dosage
It is important to follow the rules for taking the drug. Tablets are taken once a day orally. They are not chewed, washed down with the necessary amount of water. Reception time - morning (can be on an empty stomach).
The dosage is determined by the attending physician, in accordance with clinical indications. In some cases, a gradual increase in dosage is practiced. The allowable amount is 20 mg per day.
The rate of adaptation of the patient to the drug depends on the individual tolerance of bisprolol. The doctor should monitor the following indicators:
- heart rate;
- arterial pressure.
With an exacerbation in the process of adaptation, the dosage should be reduced.
Cases of excessive lowering of pressure and slowing of the heart rate have been recorded. This is a reason to adjust the dose or completely cancel the drug until the patient's condition stabilizes.
Concor is a long-term drug that reduces blood pressure.
Patients with systemic lesions of the kidneys and liver, as well as the elderly, the daily dose is not more than 10 mg.
Overdose
An overdose can be fatal. The drug should be taken only on the recommendation and under the supervision of a physician.
In the case of excessive medication, the heartbeat may drop to a critical level. Perhaps a decrease in blood sugar below normal, a sharp decrease in blood pressure, bronchospasm, acute heart failure.
The therapeutic course is selected by the therapist on an individual basis.
Side effects
During the period of taking Concor tablets, unwanted side effects may occur.
The following negative manifestations are possible:
- dizziness and weakness;
- high fatigue;
- feeling of anxiety;
- confusion;
- short-term memory loss;
- insomnia;
- depression;
- arrhythmia;
- bradycardia;
- increased symptoms of cardiovascular insufficiency;
- deterioration of blood circulation;
- visual impairment;
- conjunctivitis;
- dry eyes;
- nausea and vomiting;
- abdominal pain and stool destabilization;
- distortion of taste sensations;
- liver dysfunction;
- bronchospasm;
- hives, etc.
Most of the discomfort goes away within a few days. In some cases, adaptation can take up to two weeks.
The use of Concor during pregnancy and lactation
The use of the drug during the period of bearing a child is possible in exceptional cases, when, according to the doctor, the expected therapeutic effect for the expectant mother outweighs the possible risk to the fetus (bisoprol is able to reduce the intensity of blood flow through the placenta).
During breastfeeding, the drug is contraindicated.
The nuances of the use of the drug
When starting a course of treatment for hypertension, it should be borne in mind that abrupt discontinuation of the drug is unacceptable. Dosage reduction should be implemented gradually under medical supervision.
When taking the drug, patients with bronchial pathology must simultaneously use drugs from the bronchodilator line. Concor provokes the development of sensitivity to allergens up to anaphylactic reactions.
If surgical treatment is planned using general anesthesia, the dosage of the drug should be gradually reduced in advance. Complete withdrawal of the drug should occur 2 days before surgery. The medical staff must be informed about the reception of Concor.
Concor is not always combined with other drugs. The patient is obliged to inform the attending physician about the intake of all drugs. The specialist will evaluate their possible interaction and give recommendations on the order of admission. A number of drugs can reduce or increase the therapeutic effect. Some drug combinations are undesirable.
All possible consequences of the interaction can only be assessed by a professional.
Precautions when storing the drug and expiration dates
Store at room conditions. The maximum allowable temperature is 30 °C. Keep away from children! Shelf life - 5 years from the date of manufacture. After the expiration date, do not use.
Sales through pharmacies
The drug is dispensed from pharmacies by prescription.
Price
The cost of the drug may vary, depending on the region and method of implementation. The recommended price in pharmacies is 173 rubles. (2.5 mg 30 pieces).
Analogues
The pharmaceutical industry produces a number of Concor analogues:
- Bisoprolol - from 47 rubles;
- Concor Kor - from 162 rubles;
- Coronal - from 114 rubles;
- Cordinorm - from 117 rubles.
At high pressure
Arterial hypertension is a chronic disease. It cannot be cured, but it can and should be controlled.
If you let the situation take its course, there is a high probability of developing coronary heart disease, strokes, kidney dysfunction, and a number of other pathologies. The sooner treatment for hypertension is started, the greater the chance of success.
Concor is an effective drug. With increased pressure, it has a positive effect on the body. A sharp drop in blood pressure can adversely affect human health. Concor gradually lowers and stabilizes blood pressure, relieves hypertensive crisis.
Concor has positive reviews:
Alla Vitaleva, 55 years old
I have been taking Concor blood pressure pills for several years now. The medicine calms the heartbeat well (I have tachycardia) and stabilizes the pressure (I suffer from high blood pressure, often rises to 160-180/100). I can not say that the adaptation was difficult for me. Concor suits me, the main thing is to listen to the doctor's advice.
Anastasia Gavrilenko, 45 years old
I have inherited high blood pressure. When the indicators rise to 200, everything is swimming before your eyes. Concor is "my" drug. The price is affordable. Heart pills evoke positive emotions. The effect of the drug is persistent.
Alexander Gaveryukin, 42 years old
I have hypertension. He took various drugs, but it did not work to reduce the pressure. Concor helped. The constant use of tablets had an impact on the decrease in performance. The pressure gradually began to decrease.
Cardiac treatment is based on various drugs, without which it is impossible to support the patient. One of the important medications is Concor.
High blood pressure affects people of both the elderly and middle age. The choice of the right medicine that alleviates the patient's condition depends on the therapeutic effect of the drug, its harmful and undesirable effects.
Composition and therapeutic effect
Concor is aimed at lowering blood pressure, lowering the increased heart rate and normalizing the heart rhythm. The main component of the drug is bisoprolol hemifumarate. The agent is supplemented with other elements, such as calcium hydrogen phosphate, starch, crospovidone, microcrystalline cellulose, magnesium stearate.
Concor reduces the necessary need for the myocardium of the heart to supply oxygen. Long-term use of the drug prevents angina pectoris and becomes a prophylactic against developing myocardial infarction.
Tablets begin their therapeutic effect 1-3 hours after they are taken. The digestive system perceives Concor well, which dissolves quickly and is absorbed into the bloodstream, while there is no dependence on the time of eating.
The drug is excreted from the body through the kidneys and liver. After taking the medicine, after 3 hours, the highest concentration of Concor is noted. The medical result is saved during the day.
The main medicinal properties of Concor include:
Of all the beta blockers, Concor is the most powerful and effective therapeutic agent, providing a long lasting effect. The greatest therapeutic effect, it turns out, when taking small and medium doses of the drug.
Release form and price
The drug is available in tablet form of 2.5 mg, 5 mg and 10 mg, covered with a thin film. The package contains 30 or 50 tablets.
The price of the drug depends on the dosage of the tablets. In Moscow pharmacies you can buy medicine from 210 rubles. for a package of 30 tablets or up to 550 rubles. for a pack of 50 tablets.
It contains 8 useful medicinal plants that are extremely effective in the treatment and prevention of arrhythmia, heart failure, atherosclerosis, coronary artery disease, myocardial infarction, and many other diseases. In this case, only natural ingredients are used, no chemicals and hormones!
Concor is prescribed when:
Methods of reception
Concor is prescribed for use no more than a single dose during the day in the morning before breakfast, washed down with a small amount of water, without chewing the tablets.
Overdose leads to bradycardia, arterial hypotension, bronchospasm, heart failure.
Contraindications for admission
The drug is not prescribed if the patient has:
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Concor is a drug designed to lower blood pressure. In addition, it is used in the treatment of various disorders of the heart. Let's talk on www.site about what Concor is, application, instructions for use, action, side effects of the drug.
Action Concor
The active substance in the composition of the drug is bisoprolol. It contributes to a mild decrease in blood pressure. When using the drug, its effect begins to appear immediately.
The medicine is used for a long time. At the same time, the condition gradually normalizes, stabilizes and remains so for another month after the end of the intake. In the treatment of functional disorders of cardiac activity, the Concor drug helps to normalize the heartbeat, reduces the need for oxygen in the heart muscle, and calms. When the drug is recommended for therapeutic purposes, it does not have a negative, detrimental effect on other organs and body systems.
Concor is prescribed by a doctor for hypertension, chronic cardiac functional disorders, ischemia, angina pectoris.
After taking the medicine, it begins to act within 1-3 hours. Its action lasts 24 hours.
The drug has a hypotensive effect. Due to the decrease in diastolic pressure, the supply of oxygen to the myocardium increases. For patients with chronic heart disease, Concor significantly improves well-being.
Application of Concor
The drug Concor is intended for oral administration. Take the drug in the morning, on an empty stomach, without chewing the medicine. A single dose is usually 2.5-5 mg. If indicated, it may be increased to 10 mg once a day. The maximum daily dose of the drug is 20 mg.
In the case of functional disorders of the kidneys, liver, the allowable doses of the product do not change significantly.
Contraindications
Instructions for use Concor indicates that the drug is prohibited for people with hypersensitivity to the components of the drug. It should not be used in acute heart failure. Concor is contraindicated in people suffering from cardiogenic shock, sick sinus node syndrome. It cannot be used for sino-arterial blockade, a pronounced heart muscle contraction rate, which is less than 50 beats per minute.
The drug is not taken in cases of very low blood pressure, lung diseases, bronchial asthma. Reception of Concor is contraindicated during pregnancy, as well as during lactation.
Currently, there is no information about the effect of the drug on children. Therefore, it is not recommended to take it to persons under 18 years of age.
With caution, this drug should be used by those suffering from liver failure, myasthenia gravis, diabetes mellitus, psoriasis, as well as the elderly.
The effectiveness of the use of the drug Concor depends on the use of other drugs. Therefore, before you start taking the drug, be sure to tell your doctor about all the drugs you use.
The drug should not be used when drinking alcohol, as well as people driving a motor vehicle.
The dosage of the medication is prescribed by the doctor, based on the severity of the disease, age, general condition of the patient. Self-use of the drug can lead to negative consequences.
Side effects when applied
The drug Concor has side effects:
From the nervous system - headache, insomnia, sleep disturbance. Perhaps the appearance of dizziness, depressive states, hallucinations, general weakness, fatigue may appear.
From the side of the cardiovascular system - possible violations of the peripheral blood supply to organs, systems, the appearance of edema.
On the part of the visual system - a decrease in visual acuity, the appearance of conjunctivitis.
On the part of the respiratory system - allergic rhinitis, the appearance of bronchospasm.
On the part of the gastrointestinal tract - a feeling of nausea may occur, vomiting, intestinal upset (diarrhea or constipation) may occur. Often there is dry mouth, rarely manifestations of hepatitis.
From the musculoskeletal system - muscle weakness, convulsions are possible. Allergy manifestations: skin rash, itching, excessive sweating.
Ingoda, after prolonged use of the drug, a violation of sexual function may occur.
Release form of the medicinal product
Concor is produced in packs of 30, 50 and 100 tablets. Each package of the drug contains instructions for use, which should be read in detail before taking the medicine.
The drug is released only on prescription. It should be stored out of the reach of children, at normal room temperature.
Tablets Concor is the trade name for another drug: Bisoprolol. Both are complete analogues, interchangeable, although there are some differences.
Both drugs belong to the class of selective beta1-blockers that reduce the sensitivity of specific receptors.
The use of Concor is advisable in the treatment and prevention of arterial hypertension, coronary heart disease, heart attack, stroke, angina pectoris.
Beta-blockers are difficult to prescribe, because an accurate account of the compatibility of different medications is required.
Meanwhile, for isolated exclusive reception, Concor, like many other beta-blockers, is practically not suitable. Efficiency will be insufficient.
Therefore, it is impossible to deal with the admission scheme and, in general, the expediency of the appointment on your own. The help of a cardiologist is required.
The active substance of the drug is bisoprolol fumarate. This, as was said, is a selective beta-blocking component that has pharmacological activity only in relation to the heart.
The drug is extremely selective, because it affects beta-2 receptors localized in the vessels and bronchi to a lesser extent.
This makes it possible to use the drug in a wider number of cases without the danger of side effects (bronchospasm, sharp jumps in blood pressure and other points).
Unlike its analogue, Bisoprolol, Concor contains twice as much active ingredient per tablet: 5 mg versus 2.5. This allows you to reduce the number of doses of the drug, at the same time, the exact dosing is somewhat more difficult.
In addition to the main active ingredient, the composition also includes additional substances. They do not affect either the heart, or the vessels, or the contractility of the myocardium.
The goal is different: to give the tablets a complete physical form, improve the bioavailability of the drug, increase absorption in the gastrointestinal tract.
What helps Concor and how it works
Concor is prescribed as a beta-blocker to combat arterial hypertension, tachycardia, ischemia of cardiac structures and some other diseases.
The beneficial effect is due to a group of mechanisms of influence on the human body:
Antianginal action
Simply put, Concor is able to reduce myocardial oxygen demand.
Ischemic disease, angina pectoris, heart attack - all these are the results of inadequate nutrition.
Beta-blockers have the ability to optimize metabolic processes, speed them up.
Speaking conditionally, the efficiency of the work of cardiac structures increases dramatically, which makes it possible to increase the resistance of tissues to negative influences.
There is one important nuance: despite the beneficial effect, it is only a symptomatic help. The main pathological process that provokes poor nutrition of the heart does not disappear.
The disease will continue to progress if no help is provided. Although slower.
Decreased heart rate
Concor is ideal for correcting tachycardia. Mostly sinus. requires the use of other medications.
It is possible to prescribe medication to correct acute palpitations. Although the tool does not quite cope with this task. Much more effective in such situations (Propranolol).
Concor with tachycardia beam should be used as part of regular, systematic therapy, in combination with other drugs.
The basis of the beneficial effect is the ability to reduce the sensitivity of the heart receptors to adrenaline, which often becomes the culprit in the increase in heart rate.
Restoring a normal rhythm
Concor is not specific in this regard. It can provide additional help in the treatment of various forms of arrhythmias, but is unable to cope with fibrillation, extrasystoles, and ventricular types of arrhythmias.
Requires the use of specific drugs: Amiodarone, Quinidine, similar.
Lowering blood pressure
Concor lowers blood pressure relatively gently. At the same time, the severity of the effect depends on the dosage. This is convenient because it allows you to vary the useful result.
Attention:
Overuse is not allowed. Even if high concentrations do not help, it makes sense to reconsider the therapeutic course.
The drug is used to maintain the normal state of the heart, blood vessels by providing tissue nutrition, correcting the frequency of contractions of the muscular organ.
It is also important that the drug practically does not affect the pumping function of the myocardium, the nutrition of tissues: the brain, kidneys and others, does not suffer.
When the dosage is exceeded, Concor acquires the properties to influence beta-2 receptors located in the vessels and bronchi. However, the advisability of exceeding the concentration of the drug for the sake of such an effect is more than controversial. For this purpose, other drugs will do better.
Indications
Reasons for use are described in the instructions. It is worth clarifying some points and considering them in more detail.
Arterial hypertension
Regardless of stage and origin. As an independent diagnosis or symptom of other disorders. In the early stages, the use of the name may well be isolated.
The exclusive use of Concor is not practiced from and especially later.
The medicine will not be enough to correct the condition, since irreversible organic changes in the heart and blood vessels begin. It will require parallel use, central action means, perhaps.
It is necessary to clearly select combinations of drugs, because beta-blockers with an illiterate choice of concomitant drugs can provoke heart, kidney failure, death from a critical drop in myocardial contractility and stop the organ.
Cardiac ischemia
Accompanied by a gradual disruption of the normal nutrition of cardiac structures.
May be independent. For example, as a result of aging of the body. Or caused by other pathologies: arterial hypertension, suffered a heart attack.
Sinus tachycardia
It can be used to relieve acute palpitations, although here it loses to its peers in the group.
Indications are not an axiom. Although the drug is generally well tolerated, exceptions are possible. In this case, it makes sense to give preference to others similar in effect, based on other active ingredients, and not bisoprolol fumarate.
Dosing regimen
Calculated individually. Start with a minimum dosage - 5 mg (one tablet) 1 time per day.
If there is no effect, the dose is increased by 2 times to - 10 mg (two tablets) 1 time per day.
In the treatment of arterial hypertension and stable angina pectoris, the maximum dose is 20 mg 1 time per day (4 tablets).
The drug Concor is taken once a day with a small amount of water, in the morning, regardless of the meal (before breakfast, during or after it).
Contraindications
There are quite a few reasons for refusing to use Concor, if we compare the medication with others:
- Individual intolerance to the drug. Unfortunately, it is possible to determine the presence of a reaction only after taking the drug, therefore it is recommended to start with a minimum dosage so as not to provoke an intense response.
- Pregnancy and lactation. During feeding, the main active ingredient is transmitted to the child through milk, therefore the application is impossible. When carrying, according to the manufacturer, it is allowed to prescribe the drug if the benefit exceeds the expected harm.
- Children's years, up to 18 years.
- . Until the condition is corrected.
- Severe forms of bronchial asthma. Especially in high dosages, because the drug at excessive concentrations (from 200 mg and more) tends to provoke narrowing of the airways, severe shortness of breath. Requires the use of medications.
- COPD Until the disease is brought under control.
- Also violations of the liver, kidneys. This is where the evaluation category comes into play. The possibility of application is determined by the specialist himself after a thorough diagnosis.
- with heart rate less than 50 beats per minute. Also, the tendency to such conditions for unknown reasons.
- Drop in blood pressure to critical levels. Less than mm Hg. Also, until the pathological process causing such sharp jumps is eliminated.
- . A kind of emergency with a drop in myocardial contractility. The disorder itself is almost always fatal and has a poor prognosis. But there are chances of survival. The use of beta-blockers against the background of such a disorder reduces them to zero.
- . Pathology of the peripheral circulation. With a proven course of deviation, the use of Concor is not allowed.
- . And others. To avoid critical violations of myocardial contractility. It is quite possible and even likely to stop the heart from minimal doses of the drug.
- Polyvalent allergic reaction to pharmaceuticals. Simply put - multiple intolerance to a whole group of drugs. It is rare, but if there is a response to other beta-blockers, you need to carefully monitor your own condition after taking it.
A proven reaction is the basis for excluding the drug, replacing it with a well-tolerated analogue.
- Pheochromocytoma. A type of adrenal tumor. Usually benign. Produces norepinephrine, which provokes jumps in blood pressure.
Concor can also be taken with this volumetric formation, but only in a system with alpha-blockers, otherwise the consequences are unpredictable.
drug interaction
As mentioned, you need to carefully select concomitant drugs so as not to provoke a mutual enhancement of the effect.
For example, with the simultaneous use of calcium antagonists (Diltiazem, Verapamil), there is a high probability of a critical drop in heart rate. Concor reduces blood pressure, like calcium antagonists, this is a dangerous combination.
When used with some diuretics, the rapid development of irreversible changes in the kidneys is possible.
Therefore, the choice of therapy falls on the shoulders of a specialist in cardiology. Unauthorized use of Concor is unacceptable.
Side effects
There are heterogeneous violations from several systems:
- Headache, weakness, drowsiness, inability to navigate in space.
- Shortness of breath, problems with lung function. Bronchial spasm, asthma attack. Especially when the dosage is exceeded.
- Skin itching, urticaria. General allergic reactions up to angioedema or even anaphylactic shock. Fortunately, really severe and potentially fatal processes develop very rarely (no more than 0.2-0.5% of cases, although there are exceptions).
- Joint pains. Arthralgia. Especially in the first few days from the start of the drug. Also cramps, muscle discomfort.
- Although doctors prescribe Concor for pressure, excessive activity of the drug in a particular patient is possible. BP values vary widely. It also depends on the amount of medication taken.
- Dry eyes. Inflammation of the outer shell - conjunctivitis.
- Decreased libido, temporary impotence.
- Bradycardia, decreased heart rate.
With proper use, side effects are quite rare, the drug is well tolerated.
Many negative effects disappear on their own after a few days from the start of use.
All discomfort should be reported to the doctor for prompt correction of the course of treatment.
Concor is a powerful but relatively safe beta-blocker. Suitable for long-term use in a wide variety of patient groups. The method of admission, the specific scheme is selected by the cardiologist, based on the indication.
Concor: instructions for use and reviews
Concor is a selective beta 1-blocker.
Release form and composition
Dosage form of Concor - film-coated tablets: light yellow or light orange in color, have a biconvex heart-shaped shape and a separating risk on both sides (5 mg or 10 mg in blisters: 10 pcs., in cardboard packs 3 or 5 blisters; 25 pcs., in cardboard packs 2 blisters; 30 pcs., 1 blister in a carton box; 5 mg, 30 pcs. in a blister, 3 blisters in a carton box).
Active ingredient - bisoprolol hemifumarate (bisoprolol fumarate (2:1)):
- 1 light yellow tablet - 5 mg;
- 1 light orange tablet - 10 mg.
Auxiliary components: corn starch, anhydrous calcium hydrogen phosphate, anhydrous colloidal silicon dioxide, crospovidone, microcrystalline cellulose, magnesium stearate.
The composition of the film shell: titanium dioxide (E171), hypromellose 2910/15, dimethicone 100, macrogol 400, iron dye yellow oxide (E172).
Additionally, in the composition of the film shell of light orange color - iron dye red oxide (E172).
Pharmacological properties
Pharmacodynamics
Concor is a selective beta 1-blocker that does not have its own sympathomimetic activity and membrane stabilizing effect. It has a slight affinity for beta 2 -adrenergic receptors of the smooth muscles of blood vessels, bronchi and for beta 2 -adrenergic receptors, which are involved in the regulation of metabolism. The drug does not affect the resistance of the respiratory tract, as well as metabolic processes that occur with the participation of beta 2-adrenergic receptors.
The selective effect of bisoprolol on beta 2 -adrenergic receptors is also observed outside the therapeutic range.
Bisoprolol does not have a pronounced negative inotropic effect. After oral administration, the maximum effect is achieved after 3-4 hours. The half-life is 10-12 hours. When using the drug once a day, the therapeutic effect persists for 24 hours. Most often, the maximum decrease in blood pressure is achieved 2 weeks after the start of therapy.
Bisoprolol blocks beta 2-adrenergic receptors of the heart and reduces the activity of the sympathoadrenal system.
In coronary heart disease and in the absence of chronic heart failure, a single oral dose of bisoprolol reduces heart rate and stroke volume, which leads to a decrease in ejection fraction and a decrease in myocardial oxygen demand.
With long-term treatment, there is a decrease in the initially increased total peripheral vascular resistance, and the activity of renin in the blood plasma also decreases (this effect is considered one of the components of the hypotensive effect of beta-blockers).
Pharmacokinetics
- absorption: bisoprolol is absorbed from the gastrointestinal tract almost completely (over 90%). Oral bioavailability is about 90%, there is a slight effect of "first pass" through the liver, in which about 10% is metabolized. Food intake does not affect bioavailability. The drug demonstrates linear kinetics, its concentration in blood plasma is proportional to the accepted dose of bisoprolol in the range of 5-20 mg. The time to reach maximum plasma concentration is about 2-3 hours;
- distribution: bisoprolol is distributed quite widely. The volume of distribution is 3.5 l / kg, the connection with plasma proteins is about 30%;
- metabolism: bisoprolol is metabolized by the oxidative pathway without conjugation. Metabolites of bisoprolol are polar (water-soluble), excreted by the kidneys. The main metabolites found in urine and blood plasma lack pharmacological activity. The results of studies of human liver microsomes showed that in vitro bisoprolol is primarily metabolized using the CYP3A4 isoenzyme (approximately 95%), and the role of the CYP2D6 isoenzyme is insignificant;
- excretion: the clearance of bisoprolol is due to the balance between excretion unchanged by the kidneys (about half the dose) and its metabolism in the liver (about half the dose) to metabolites excreted by the kidneys. The total clearance is 15 l / h, the half-life is 10-12 hours.
There are no data on the pharmacokinetics of Concor in patients with impaired renal or hepatic function and simultaneous coronary heart disease.
Indications for use
- Chronic heart failure;
- Arterial hypertension;
- Stable angina in ischemic heart disease.
Contraindications
- Acute form of heart failure;
- Decompensated chronic heart failure;
- Cardiogenic shock;
- Atrioventricular (AV) block II and III degree (in the absence of a pacemaker);
- Sick sinus syndrome;
- Severe bradycardia (heart rate (HR) less than 60 beats per minute);
- A pronounced decrease in blood pressure (BP) (systolic blood pressure below 100 mm Hg);
- Sinoatrial blockade;
- Severe form of bronchial asthma and chronic obstructive pulmonary disease (COPD), indicated in the anamnesis;
- Raynaud's disease, severe disorders of the peripheral arterial circulation;
- metabolic acidosis;
- Pheochromocytoma (without combination with alpha-blockers);
- Age up to 18 years;
- The period of breastfeeding;
- Hypersensitivity to the components of the drug.
With caution, Concor should be prescribed to patients with severe liver dysfunction, Prinzmetal's angina, type 1 diabetes mellitus and diabetes mellitus with significant fluctuations in blood glucose, hyperthyroidism, AV block I degree, psoriasis, severe renal failure (creatinine clearance less than 20 ml / min), congenital heart disease or valvular heart disease with severe hemodynamic disorders, restrictive cardiomyopathy, chronic heart failure due to myocardial infarction within the next 3 months, during the period of desensitizing therapy, as well as patients on a strict diet.
The use of Concor during pregnancy is possible if, according to the doctor's determination, the intended therapeutic effect for the mother outweighs the potential risk to the fetus (bisoprolol hemifumarate reduces blood flow in the placenta).
Instructions for use Concor: method and dosage
Concor tablets are taken orally, without chewing, with a sufficient amount of liquid. The drug should be taken once a day, in the morning, regardless of the meal.
The doctor prescribes dosing individually, taking into account the patient's condition and clinical indications.
In the treatment of angina pectoris and arterial hypertension, the dose is selected, taking into account the patient's heart rate. You should start with 5 mg per day. If necessary, the dose can be increased to 10 mg, it is not recommended to exceed 20 mg.
Treatment of chronic heart failure is carried out according to the standard scheme, including combination therapy, which includes angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists (with intolerance to ACE inhibitors), diuretics, beta-blockers, cardiac glycosides.
Concor is indicated only for stable chronic heart failure without exacerbation symptoms. Special titration phases must be carried out according to a specific scheme.
The recommended initial dosage in the treatment of chronic heart failure is 1.25 mg. Further dose adjustment depends on the individual tolerance of bisoprolol and is carried out after a certain adaptation to the previous one.
The dose is increased gradually, 1 time in 2 weeks by 1.25 mg, the maximum dose is 10 mg. The selection of the dose of Concor is carried out under the supervision of a physician and the control of heart rate, blood pressure, in case of an exacerbation of the condition against the background of the last titration, the dose should be reduced to the previous one.
A temporary exacerbation of the symptoms of the course of the disease, the appearance of arterial hypotension or bradycardia is possible from the first days of using the drug, during titration and treatment. In this case, it is necessary to simultaneously adjust the doses of concomitant therapy and bisoprolol, and in critical situations, cancel it until the patient's condition stabilizes. Then you can continue treatment or start re-titration of the dose.
The use of Concor for all indications is long-term.
Patients with mild or moderate hepatic or renal dysfunction and elderly patients do not usually need a dosage adjustment.
In case of severe impairment of kidney and liver function, the recommended daily dose should not exceed 10 mg, and increasing the dose in this category of patients is carried out with extreme caution.
Side effects
Against the background of the use of Concor, the following side effects may occur:
- From the side of the cardiovascular system: very often - bradycardia (with chronic heart failure); often - exacerbation of symptoms of chronic heart failure (with chronic heart failure), a feeling of numbness or coldness in the extremities, a strong decrease in blood pressure (more often in patients with chronic heart failure); infrequently - bradycardia (with angina pectoris or arterial hypertension), impaired AV conduction, orthostatic hypotension, increased signs of chronic heart failure (with angina pectoris or arterial hypertension);
- From the digestive system: often - vomiting, nausea, diarrhea or constipation; rarely - hepatitis;
- From the nervous system: often - dizziness and headache (more often at the beginning of treatment of arterial hypertension or angina pectoris, is mild and disappears after 1-2 weeks of therapy); rarely - loss of consciousness;
- From the senses: rarely - hearing impairment, decreased tearing; very rarely - conjunctivitis;
- On the part of the psyche: infrequently - insomnia, depression; rarely - terrible dreams, hallucinations;
- From the reproductive system: rarely - potency disorders;
- On the part of the respiratory system: infrequently - bronchospasm against the background of bronchial asthma or obstructive respiratory diseases in history;
- From the musculoskeletal system: infrequently - muscle cramps, muscle weakness;
- On the part of the skin: very rarely - alopecia; in patients with psoriasis - exacerbation of the disease or the appearance of a psoriasis-like rash;
- Allergic reactions: rarely - itching, skin rash, hyperemia, allergic rhinitis;
- On the part of laboratory parameters: rarely - an increase in the blood level of the concentration of liver enzymes (alanine aminotransferase and aspartate aminotransferase);
- Others: often - asthenia (with chronic heart failure), increased fatigue (more often at the beginning of treatment of arterial hypertension or angina pectoris, is mild and disappears after 1-2 weeks of therapy); infrequently - asthenia (with arterial hypertension or angina pectoris).
Overdose
The most common symptoms: AV blockade, marked decrease in blood pressure, severe bradycardia, acute heart failure, hypoglycemia, bronchospasm.
With a single high dose of bisoprolol, sensitivity in individual patients varies greatly. Probably, for patients with chronic heart failure, the sensitivity is increased.
In case of overdose, stop taking Concora and resort to supportive symptomatic therapy.
With severe bradycardia, intravenous atropine is recommended. If these measures are not enough, you can carefully enter the drug with a positive chronotropic effect. In some cases, temporary setting of an artificial pacemaker is carried out.
In the case of a pronounced decrease in blood pressure, intravenous administration of vasopressor drugs and plasma-substituting solutions is recommended.
With AV blockade, the patient should be constantly monitored and therapy with beta-adrenergic agonists (for example, epinephrine) should be prescribed. In some cases, temporary setting of an artificial pacemaker is appropriate.
In case of exacerbation of the course of chronic heart failure, intravenous administration of diuretics, vasodilators and agents with a positive inotropic effect is recommended.
For bronchospasm, bronchodilators are prescribed, including beta 2-agonists and / or aminophylline.
special instructions
You can not abruptly stop therapy, especially in patients with coronary heart disease, the abolition of Concor should take place by gradually reducing the dose. Dosing adjustments are made under the supervision and on the recommendation of a physician.
Patients with bronchial asthma or COPD are prescribed the drug only while taking bronchodilators. With an increase in airway resistance, it is recommended to increase the dose of beta 2-adrenergic agonists in patients with bronchial asthma.
Against the background of Concor, it is possible to increase sensitivity to allergens and the severity of anaphylactic reactions, while treatment with adrenaline (epinephrine) may not have a sufficient therapeutic effect.
Before a planned surgical operation using general anesthesia, it is necessary to gradually reduce the dose of the drug and stop taking it 48 hours before the start of the operation. The anesthesiologist should be informed about the intake of bisoprolol.
With pheochromocytoma, the use of the drug is possible only against the background of alpha-blockers.
The drug may mask the symptoms of hyperthyroidism.
Although Concor does not affect the patient's ability to drive vehicles and mechanisms, but given the different individual tolerability of the drug and the possible violation of the condition when changing the dose, caution is recommended, especially at the beginning of treatment and in case of simultaneous alcohol consumption.
Use during pregnancy and lactation
According to the instructions, Concor is allowed to be used during pregnancy only in cases where the potential risk to the fetus is lower than the expected benefit to the mother.
Under the action of beta-blockers, the blood flow in the placenta is reduced, which can affect the development of the fetus. Shows the control of blood flow in the uterus and placenta, as well as monitoring the development of the fetus. In case of diagnosis of adverse events, it is recommended to turn to alternative methods of treatment. The newborn after childbirth should be carefully examined. In the first three days of life, symptoms of hypoglycemia and bradycardia may appear.
There are no data on the excretion of bisoprolol into breast milk, so taking Concor during breastfeeding is not recommended. If the use of the drug is necessary, then breastfeeding should be discontinued.
Application in childhood
It is contraindicated to use Concor for the treatment of patients under the age of 18 years.
For impaired renal function
With severe renal failure (CC up to 20 ml / min), Concor should be used with caution. For mild to moderate renal impairment, there is no need to adjust the dose.
For impaired liver function
With severe violations of liver function, Concor should be used with caution. The maximum dose in such patients should not exceed 10 mg. For mild to moderate hepatic impairment, there is no need to adjust the dose.
Use in the elderly
In the treatment of elderly patients, dose adjustment is not required.
drug interaction
When prescribing Concor, the patient must inform the doctor about all the medicines that he is taking. This information will allow the doctor to take into account the possible interaction of drugs and give the patient the necessary recommendations about the rules and sequence of their use.
In the treatment of chronic heart failure, the simultaneous administration of quinidine, lidocaine, disopyramide, phenytoin, propafenone, flecainide and other class I antiarrhythmic drugs is not recommended.
Undesirable combinations for the simultaneous use of Concor:
- Diltiazem, verapamil and other slow calcium channel blockers can cause a decrease in myocardial contractility and impaired AV conduction;
- Clonidine, moxonidine, methyldopa, rilmenidine and other centrally acting antihypertensive drugs can cause a decrease in cardiac output and heart rate and lead to vasodilation against a background of a decrease in central sympathetic tone. The likelihood of rebound hypertension increases with abrupt discontinuation of the drug before the abolition of beta-blockers.
Special care should be taken in the treatment of angina pectoris and arterial hypertension in combination with lidocaine, quinidine, disopyramide, flecainide, phenytoin, propafenone (class I antiarrhythmic drugs), this combination with bisoprolol can reduce myocardial contractility and AV conduction.
Drugs in combination with which the appointment of Concor requires special care:
- Felodipine, nifedipine, amlodipine and other dihydropyridine derivatives - increase the risk of arterial hypotension, with chronic heart failure, a subsequent deterioration in the contractile function of the heart is possible;
- Non-steroidal anti-inflammatory drugs - reduce the hypotensive effect of bisoprolol;
- Amiodarone and other class III antiarrhythmic drugs - may exacerbate AV conduction disturbance;
- Beta-blockers for topical use, including eye drops for the treatment of glaucoma - increase the systemic effect of bisoprolol;
- Parasympathomimetics - may increase the risk of developing bradycardia and impaired AV conduction;
- Oral hypoglycemic agents and insulin - increase their clinical effect, symptoms of hypoglycemia (tachycardia) may be suppressed or masked;
- Preparations for general anesthesia - increase the likelihood of a cardiodepressive effect, which can lead to arterial hypotension;
- Cardiac glycosides - can increase the time of impulse conduction and lead to the development of bradycardia;
- Tricyclic antidepressants, phenothiazines, barbiturates and other drugs with an antihypertensive effect - may increase the hypotensive effect of Concor;
- Mefloquine - increases the likelihood of developing bradycardia;
- Monoamine oxidase (MAO) inhibitors (except for MAO B inhibitors) - potentiate the hypotensive effect of the drug and can cause the development of a hypertensive crisis.
The combination of Concor with isoprenaline, dobutamine and other beta-agonists leads to a decrease in the clinical effect of both drugs.
Simultaneous administration with bisoprolol of adrenomimetics that affect alpha and beta adrenoreceptors (norepinephrine, epinephrine) leads to an increase in blood pressure.
Analogues
The analogues of Concor are: Bisoprolol, Bisoprolol Sandoz, Bisoprolol-Richter, Bisoprolol-Maxpharma, Biprol, Bicard, Bisocard, Bisostad, Bisoprofar, Coronal, Cordinorm, Concor Cor, Coronal.
Terms and conditions of storage
Store at temperatures up to 30 °C. Keep away from children.
Shelf life - 5 years.