Concor side effects Concor side effects. How to take Concor heart pills correctly: one, two or three times a day

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Compound

The active ingredient of the tablets Concor is a beta1-blocker bisoprolol (more precisely bisoprolol hemifumarate mixed with bisoprolol fumarate in a ratio of 2:1).

In addition, the composition of the tablets includes excipients that provide this dosage form with the necessary volume and contribute to the long-term preservation of the active substance in the active state (anhydrous calcium hydrogen phosphate, corn starch, etc.).

International nonproprietary name (INN)

The international non-proprietary name of the drug Concor corresponds to the common name of the active substance ( bisoprolol).

Pharmacological group

The drug Concor refers to drugs intended for the treatment of diseases of the cardiovascular system. This is a very large group of heterogeneous medicines, which, according to the mechanism of pharmacological action, belong to different classes.

At the same time, Concor belongs to the so-called beta1-blockers (cardioselective blockers) - drugs that block the effect of stimulating nerve impulses of the central nervous system on the heart muscle.

In addition, beta1-blockers block the effect on myocardial cells of stress hormones coming from the bloodstream (such as adrenaline, norepinephrine, etc.).

Concor as a drug from the group of adrenergic blockers: the effect of the drug on the cardiovascular system

As a drug from the group of beta1-blockers, Concor has a sparing effect on the cardiovascular system, showing the following effects:

• reduces the heart rate;
• reduces the speed of impulses through the heart muscle, normalizing the heart rhythm;
• reduces the force of heart contractions, and thus reduces the need for oxygen in the heart muscle.

Indications for use

Indications for the use of the drug Concor are the following pathologies:

• high blood pressure;
• malnutrition of the heart muscle (ischemic heart disease);
• chronic heart failure in the stage of compensation.

Contraindications

As a fairly strong drug, Concor medicine has a fairly long list of contraindications. Like other medicines, Concor tablets are contraindicated in case of increased individual sensitivity to any of the components of the drug.

It should be noted that all adrenergic blockers have a similar structure, so if the patient had intolerance to one of them (for example, anaprilin), then it is not recommended to prescribe Concor tablets.

The mechanism of action of the drug involves a significant decrease in cardiac output, therefore, Concor tablets are not prescribed for shock conditions accompanied by a sharp decrease in heart function (cardiogenic shock, collapse), with chronic cardiovascular insufficiency in the stage of decompensation, as well as with a pronounced decrease in blood pressure (90/ 60 mm Hg and below).

Since Concor reduces the heart rate, inhibits cardiac automatism and negatively affects the conduction of impulses through the myocardium, tablets are not used at low heart rates (below 50 beats per minute), with sick sinus syndrome, sinus and atrioventricular blockade of the second or third degree ( if there is no pacemaker).

As a beta1-adrenergic blocker, Concor mainly affects the corresponding receptors of the heart, however, the development of such a side effect as a blocking effect on the beta2 receptors of the bronchi and peripheral vessels with an increase in the contraction of their muscle elements cannot be ruled out.

Therefore, this drug is not prescribed for pulmonary diseases that occur with bronchospasm (bronchial asthma, obstructive bronchitis, etc.), as well as for peripheral vascular lesions, the development of which is based on spasm of arterioles (Raynaud's disease, etc.).

Are Concor tablets prescribed during pregnancy and lactation

Pregnancy and lactation are contraindications to the appointment of the drug Concor.

The fact is that adrenergic blockers can cause contraction of the muscles of the uterus, and can provoke miscarriage or premature birth. In addition, the possibility of a negative effect on the fetus cannot be completely excluded, since Concor reduces blood flow in the placenta.

Large clinical studies on the use of this drug in pregnant women have not been conducted for obvious reasons. Concor tablets were used to treat pregnant women only in cases where the benefits of prescribing the drug many times exceeded the risk of developing pathology in the fetus.

But even with this kind of use, the drug should be stopped two to three days before the expected birth, and the newborn should be under constant medical supervision for at least three days.

Release form Concor (description of the appearance of the drug and photos of tablets containing 5 and 10 mg of the active substance)

The dosage form of the drug Concor is represented by biconvex pills having a characteristic heart shape. In the middle of each tablet there is a strip-recess for facilitating the division into two equal parts.

You should be careful, because there are two dosage forms: tablets containing 5 and 10 mg of the active substance. They differ in color: tablets containing 5 mg of the active substance have a lemon tint, and those containing 10 mg are beige.

Both types of tablets are produced in blisters of 10 pieces, blisters are enclosed in cardboard packages of 30-50 tablets (3 or 5 blisters per pack).

Country and manufacturing company

The country of origin of the drug Concor is Germany. Tablets are produced by Merck KGaA, which has representative offices in the Russian Federation and many CIS countries.

Where could I buy?

Concor tablets are widely represented in the pharmacy network. You can buy a medicine according to a doctor's prescription (according to a prescription issued by a doctor).

Recipe in Latin

A prescription for Concor medicine issued by a doctor will look like this:
Rep.: Tab. Concor 0.01 №50
D.S. One tablet once a day.

Translated from the generally accepted Latin abbreviations, this inscription contains an instruction for a pharmacy worker: "Take Concor tablets, which contain 10 mg of the active substance, in the amount of 50 pieces. Give out and indicate that the medicine should be taken one tablet once a day."

The price of the drug Concor 5 mg and 10 mg (packages containing 30 and 50 tablets)

The average cost of Concor tablets containing 5 mg of the active substance in Moscow pharmacies is about 200 rubles for a package of 30 tablets, and about 300 rubles for a package of 50 tablets.

Tablets containing 10 mg of the active substance are more expensive (about 300 rubles for a pack of 30 tablets and about 500 rubles for a pack of 50 tablets).

Medical preparation tablets Concor 5 and 10 mg: instructions for use

How long does it take to work?

Bisoprolol, the active substance of the drug Concor, begins to be absorbed immediately after entering the digestive tract, and then, together with other substances from the intestinal lumen, passes through the liver filter, where it is partially deactivated.

In general, the bioavailability of the drug is high (about 87%), so that the maximum concentration of the active substance in the blood is reached within 2-3 hours after ingestion, and three to four hours after taking the tablet, you can observe a detailed picture of the therapeutic effect of Concor (lowering blood pressure , slowing the pulse, reducing the need for oxygen in the heart muscle).

Time of action of Concor tablets

The medical preparation Concor belongs to the long-acting adrenergic blockers. The half-life of the active substance from the body is 10-12 hours.

At the same time, approximately 50% of the incoming bisoprolol is excreted by the kidneys in its pure form, and another 50% is preliminarily decomposed in the liver.

Since the liver and kidneys play an important role in the metabolism of bisoprolol, severe diseases of these organs can cause a delay in the body of the active substance of Concor tablets.

However, even with the normal functioning of the liver and kidneys, the decrease in blood pressure caused by Concor tablets remains at a therapeutically significant level for more than 24 hours. For a complete recovery of adrenoreceptors, it will take two weeks.

How to take Concor heart pills correctly: once, twice or three times a day?

Since the active substance of Concor tablets is a long-acting adrenergic blocker, the drug is taken once a day.

When should I take the Concor medication: in the morning or at night?

Concor tablets should be taken in the morning so that the maximum concentration of the active substance in the blood falls at the time when the body most needs blockade of adrenergic receptors (in accordance with biological rhythms, the greatest activity of the adrenergic system is observed during daylight hours).

How to take pills: before meals or after?

Eating does not affect the absorption of the active substance of Concor tablets by the body. Therefore, the drug can be taken both before and after meals.

However, if you prefer to swallow tablets before you sit down at the table, or during meals, do what is more convenient for you.

Doses of Concor

The dosage of the drug Concor depends on the type of pathology, the severity of the course of the disease and the general condition of the patient, and can range from 5 to 20 mg / day.

In this case, they usually start with small doses, gradually increasing the daily dose to the maximum maintenance dose.

How long can the drug be taken?

The drug Concor is designed for long-term use. This medicinal product is used for maintenance therapy, i.e. for permanent correction of blood pressure and heart rate.

If you want to stop taking the drug or find an adequate analogue, you should contact a specialist doctor (physician or cardiologist).

The use of the drug Concor tablets 5 and 10 mg for high blood pressure and as a prophylaxis for angina attacks (patient reviews and recommendations from cardiologists)

The dose of the drug Concor, in cases where it is used to treat arterial hypertension, is selected individually and depends primarily on the level of initial pressure.

So, for example, with mild arterial hypertension for maintenance therapy, as a rule, a dose of 2.5 mg is sufficient. The degree of arterial hypertension is judged by the value of the so-called diastolic pressure (it is written as the second indicator immediately after the fraction).

A mild degree of arterial hypertension is called a chronic increase in blood pressure, in which the diastolic pressure does not exceed 105 mm Hg. (for example, 160/100 mm Hg).

To correct higher blood pressure, maintenance doses of 5-10 mg are used.

In cases where high blood pressure is combined with such a manifestation of coronary heart disease as angina pectoris, the maximum tolerated doses of Concor (up to 20 mg) are allowed.

With arterial hypertension, if there are no additional indications, the initial dose is half the maintenance dose, but not more than 5 mg (1.25, 2.5 or 5 mg, depending on the initial level of pressure and the general condition of the body).

Reviews of patients using Concor tablets to normalize blood pressure indicate that the drug is quite effective, easy to use and well tolerated.

However, there are cases when the corrective effect of Concor tablets was insufficient. Cardiologists advise such patients to consult a specialist in order to select an antihypertensive drug from another pharmacological group.

Medicine Concor for the heart: use and dosage for chronic heart failure

Concor tablets are one of the basic remedies for the treatment of chronic heart failure in the compensation stage, since they significantly reduce the load on the heart muscle.

However, it should be borne in mind that, by reducing cardiac output, Concor can contribute to the onset of symptoms of heart failure.

Therefore, treatment in such cases is carried out gradually, starting with small doses, and the maintenance dose is selected individually, focusing on the tolerability of the drug.

As a rule, taking Concor tablets begins with a minimum dose of 1.25 mg (a quarter of a tablet containing 5 mg of the active substance). With good tolerance, the dose is gradually increased. In doing so, the following rules are observed:
1. The appointment of the drug is possible only with compensated heart failure. In case of exacerbation, stabilization of the process should first be achieved.
2. During the selection of a maintenance dose, regular monitoring of blood pressure, heart rate and the absence of symptoms of heart failure is carried out.
3. Increasing the dose is possible only after two weeks of taking a smaller dose with good tolerance.
4. Each time the dose is increased by no more than 1.25 mg.
5. In case of poor tolerance, a return to a lower dose may be necessary.
6. The maximum recommended dose of Concor in heart failure is 10 mg.

Side effects of the drug Concor (patient reviews and recommendations of cardiologists)

Most common side effects (according to clinical studies)

According to clinical studies, the most common side effects of Concor include the following unpleasant symptoms:

• headache (more than 10% of cases);
• infectious lesions of the respiratory tract (5%);
• inflammation of the nasal mucosa (4%);
• dizziness (3.5%);
• limb edema (3%);
• sleep disorders (2.5%);
• cough (2.5%);
• inflammation of the airways (sinusitis, frontal sinusitis and other sinusitis) (2.2%);
• increased fatigue, irritability, decreased mental and physical performance (1.5%);

In addition, even when using small doses of Concor, there is sometimes a decrease in heart rate below 60 beats per minute (0.5%), depression (0.2%), pain in the muscles, abdomen and chest (about 0.9%).

Common side effects (analyzed reviews of patients and a forum of doctors)

An analysis of reviews posted on the Internet about Concor tablets showed that the vast majority of patients tolerate this drug perfectly.

However, there are complaints about unpleasant symptoms associated with taking Concor. Among the most common side effects are lability of pressure and pulse, general weakness, muscle pain, headache and dizziness, cough.

In addition, there are references to cases when patients were forced to refuse to take Concor tablets due to extremely poor tolerance. Doctors advise to reduce the likelihood of side effects, start with a minimum dose and increase it gradually.

It should be noted that among the patients who need Concor, there are many people with a labile nervous system (hypertension, vegetovascular dystonia, etc.).

Some of the side effects described in the reviews (such as, for example, palpitations) are most likely not associated with taking Concor tablets, but with increased suspiciousness.

In this article, we have listed the most common side effects. Meanwhile, the list of possible side effects attached to the instructions for use of the drug is very long.

The fact is that all the unpleasant symptoms that appeared in patients when taking Concor tablets were registered there, including those that are extremely rare (once in 10,000 doses or less).

What side effects can be considered as contraindications to taking Concor?

If you experience any unpleasant symptoms while taking Concor tablets, you should contact your doctor.

The fact is that the side effects of Concor are non-specific and may be signs of a disease. So in some cases, you will need to undergo additional examination.

As for hypersensitivity to the drug, an individual approach is needed here. In some cases, it is enough to correctly adjust the dose, and in others, it is necessary to cancel the drug.

Often, the unpleasant symptoms that appeared at the beginning of taking Concor tablets decrease and completely disappear as the body gets used to the drug.

Correctly determine the treatment tactics: waiting, reducing the dose or replacing the drug can only be a specialist doctor. This takes into account the nature and severity of side effects, the dynamics of their appearance and the general condition of the body.

Overdose

An overdose of Concor medication is manifested by the following main symptoms:

• a decrease in heart rate (below 60 beats per minute) due to a strong suppression of cardiac automatism (the ability of specialized myocardial cells to independently generate an impulse that induces the heart muscle to contract);
• the appearance of arrhythmias (due to a decrease in the conduction of impulses from the nodes of automatism to myocardial cells);
• drop in blood pressure (below 100/60 mm Hg);
• a decrease in cardiac output, which leads to the appearance of such signs of heart failure as edema, acrocyanosis (cyanosis of the most distant skin areas from the heart), shortness of breath;
• decrease in blood glucose levels (manifested by a feeling of hunger, weakness, confusion).

In severe cases, a sudden drop in blood pressure (collapse), coma, and even death can occur.

If signs of an overdose appear, you should immediately consult a doctor. Gastric lavage and the appointment of adsorbing agents are shown (so that the active substance of Concor tablets that has entered the gastric tract is no longer absorbed).

As antidotes (antidotes), drugs of the opposite effect are used - atropine and beta-adrenergic agonists (isoprenaline).

In addition, as a rule, prescribe sedative (soothing) drugs, such as diazepam, lorazepam. To stop the symptoms of heart failure, cardiac glycosides, cardiotonic drugs (dopamine, epinephrine) and diuretics (diuretics) are used, and glucagon is used to increase blood glucose levels.

If necessary, carry out resuscitation measures.

Active ingredient of Concor tablets: compatibility and interaction with other drugs

Bisoprolol, the active ingredient in Concor tablets, is incompatible with many other drugs. Therefore, the doctor prescribing this drug must be aware of all the drugs that the patient is taking.

In particular, Concor tablets are incompatible with many antiarrhythmic drugs, which are often prescribed to heart patients.

Thus, the combination of bisoprolol with drugs from the group of sodium channel blockers (quinidine, lidocaine, propafenone, novocainamide, difenin, etc.) can lead to a sharp decrease in heart rate and a drop in blood pressure due to a decrease in cardiac output.

Medicines from the group of calcium channel blockers (verapamil, diltiazem, nifedipine, etc.) also cannot be combined with taking Concor tablets, since the unidirectional actions of these drugs are mutually potentiated. Such a combination can lead to a decrease in myocardial contractility and a decrease in heart rate.

Antiarrhythmic drugs from the group of potassium channel blockers (amiodarone) in combination with Concor tablets can cause severe conduction disturbances up to atrioventricular blockade.

A similar complication can develop if Concor is taken while using cardiac glycosides, which are often prescribed to patients suffering from chronic heart failure.

For the treatment of arterial hypertension, it is not recommended to use Concor tablets in combination with centrally acting antihypertensive drugs (methyldopa, moxonidine, reserpine, guanfacine, etc.), since this combination can provoke a sharp drop in blood pressure and heart rhythm disturbance. In addition, the abrupt withdrawal of one of the drugs after prolonged joint use can cause an extremely high "rebound" jump in blood pressure.

It should be borne in mind that the local use of beta-blockers (for example, in the form of eye drops for glaucoma) can significantly enhance the systemic effect of bisoprolol.

The appointment of bisoprolol together with drugs from the opposite group (for example, beta-agonists dobutamine or isoprenaline) will lead to a mutual weakening of the effects of both drugs.

At the same time, the appointment of the drug Concor together with adrenomimetics that stimulate alpha and beta receptors can lead to an increase in peripheral pressure due to stimulation of alpha-adrenergic receptors.

Great care is needed when prescribing Concor tablets with antidiabetic agents (insulin and tableted hypoglycemic drugs), since bisoprolol potentiates the action of these drugs. In addition, Concor tablets will suppress tachycardia characteristic of lowering blood sugar levels, which is fraught with the unexpected development of hypoglycemic coma.

It must also be remembered that any drugs that directly or indirectly reduce blood pressure (barbiturates, antispasmodics, diuretics, etc.) will increase the hypotensive effect of Concor tablets.

Many medicines from different groups affect the metabolism of bisoprolol in the body, thus enhancing or weakening its effect. Thus, the antibiotic rifampicin shortens the half-life of bisoprolol, and sulfasalazine increases the concentration of the active substance of Concor tablets in the blood.

The course of treatment with Concor and nutrition

By itself, Concor does not impose any requirements on the diet, since the bioavailability of the drug and all its transformations in the body up to elimination are not related to the regimen and quality of nutrition.

However, the diseases for which Concor is being treated (hypertension, chronic heart failure, atherosclerosis leading to coronary heart disease and angina pectoris) require not only drug therapy.

The generally accepted diet for cores is called table number 10 according to Pevsner, and involves the maximum restriction of table salt, animal fats and easily digestible carbohydrates. It is also necessary to reduce the intake of free liquid (including in the form of "liquid" dishes, such as soups, jelly, etc.).

All types of products that can have a tonic effect on the central nervous system, heart and blood vessels are excluded, including tea, coffee, cocoa, chocolate, spicy and hot dishes, smoked meats, meat, fish and vegetable broths.

In addition, foods rich in cholesterol and foods that cause a tendency to flatulence are banned.

Fish and seafood, dishes rich in lipotropic substances (oatmeal), ascorbic acid, B vitamins, nicotinic acid, potassium and magnesium salts are shown.

Alcohol compatibility

Like the vast majority of blood pressure lowering drugs, Concor tablets are poorly compatible with alcoholic beverages, since alcohol enhances the inhibitory effect of the drug on the central nervous system.

In addition, it should be noted that alcohol is categorically contraindicated in pathologies that are an indication for the appointment of the Concor drug (hypertension, chronic heart failure, coronary heart disease).

Sports and pills Concor

The drug Concor reduces the strength and frequency of heart contractions, so heavy physical exertion while taking Concor tablets can lead to signs of heart failure (shortness of breath, swelling, etc.).

At the same time, physiotherapy exercises are included in the complex of medical and recreational measures for all diseases of the cardiovascular system. In this case, the type and degree of physical activity is determined by a specialist doctor.

The effect of the drug on potency

Concor is a selective beta-blocker. Medicines of this group do not have a negative effect on potency.

Many patients are concerned about the fact that the decrease in potency is indicated in the instructions for the drug as one of the possible side effects.

The fact is that, according to international laws, the manufacturer must warn about each registered side effect of the drug.

Decreased potency is a "very rare" side effect. This means that the chance of developing such a complication is a maximum of 1 chance in 10,000.

This is incomparably lower than the likelihood of developing impotence due to the further development of diseases such as hypertension, heart failure or coronary heart disease.

Is the drug Concor addictive?

The drug Concor, as well as other drugs from the group of selective beta-blockers, is not addictive even with very long-term use.

It should be noted that addiction in pharmacology does not mean the emergence of drug dependence, but the need to increase the dose to achieve a therapeutic effect with prolonged use.

Concor tablets can be used for years, while the effectiveness of the minimum maintenance dose depends not on the duration of the course of treatment, but on the state of the body.

So the need to increase the dose may arise only in connection with the progression of the disease that caused the need to take the drug.

Concor drug withdrawal syndrome: symptoms and consequences

In "heavy" cores, with a sharp cessation of taking Concor tablets, the so-called withdrawal syndrome may develop, which is manifested by the following symptoms:

• tachycardia over 90 beats per minute in the absence of physical activity;
• a variety of cardiac arrhythmias associated with the formation of abnormal pathological sources of rhythm in the conduction system of the heart (extrasystoles, attacks of paroxysmal tachycardia);
• a sharp increase in blood pressure up to the development of a hypertensive crisis;
• aggravation of the course of angina pectoris;
• the appearance of signs of heart failure.

It should be noted that the likelihood of developing a withdrawal syndrome with a sharp cessation of taking Concor tablets, as well as the severity of its symptoms, does not depend on the duration of the period of taking the drug, but on the severity of the course of the disease that necessitated its appointment.

Especially dangerous is a sharp interruption of the course in such pathologies as:

• cardiac ischemia;
• high degree of arterial hypertension;
• a tendency to develop life-threatening tachyarrhythmias (heart rhythm disturbances accompanied by an increase in heart rate).

How to properly stop taking a drug such as the beta-blocker Concor

To avoid the development of a withdrawal syndrome, the dose of Concor is reduced gradually. At the same time, blood pressure and heart rate should be constantly monitored.

There is no single scheme for the withdrawal of Concor tablets, since the likelihood of developing a withdrawal syndrome depends on the size of the maintenance dose and the severity of the disease, which served as an indication for the drug.

As a rule, doctors advise reducing the maintenance dose of 1.25 mg of the active substance (that is, a quarter of a tablet containing 5 mg of bisoprolol) per week, focusing on the severity of pathological symptoms.

Before use, you should consult with a specialist.

Trade name of the drug: Concor ®

International non-proprietary name:

bisoprolol

Dosage form:

film-coated tablets

Compound:

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 blocker

ATX 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. Blocking in low doses beta 1-adrenergic receptors 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 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 approximately 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

arterial hypertension

ischemic heart disease: prevention of angina attacks.

chronic heart failure Contraindications
The drug Concor ® should not be used to treat patients with the following conditions:

hypersensitivity to bisoprolol or to any of the components of the drug (see section "Composition") and to other beta-blockers;

acute heart failure, chronic heart failure in the stage of decompensation;

shock caused by impaired cardiac function (cardiogenic shock), collapse;

atrioventricular block II and III degree, without a pacemaker;

sick sinus syndrome;

sinoatrial blockade;

severe bradycardia (heart rate less than 50 bpm);

a pronounced decrease in blood pressure (systolic blood pressure less than 90 mm Hg. Art.);

severe forms of bronchial asthma and chronic obstructive pulmonary disease in history;

late stages of peripheral circulatory disorders, Raynaud's disease;

pheochromocytoma (without the simultaneous use of alpha-blockers);

metabolic acidosis;

simultaneous administration of monoamine oxidase (MAO) inhibitors, with the exception of MAO-B;

age up to 18 years (efficacy and safety have not been established).
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:

chronic heart failure without signs of exacerbation in the previous six weeks,

practically unchanged basic therapy in the previous two weeks,

treatment with optimal doses of ACE inhibitors (or other vasodilators in case of intolerance to ACE inhibitors), diuretics and, optionally, cardiac glycosides.
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:

In case of impaired liver or kidney function, mild or moderate, usually does not require dose adjustment.

With severe renal dysfunction (creatinine clearance less than 20 ml / min.) And in patients with severe liver disease, the maximum daily dose is 10 mg.
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 stores (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

Concor is a drug that is quite widely used to lower blood pressure and for some heart pathologies.

To achieve the maximum therapeutic effect of the drug, you should carefully study the mechanism of action of Concor in the instructions below.

• 1 Action Concor
• 2 Composition
• 3 Contraindications and side effects
• 4 Treatment of patients with other diseases
• 5 Related videos

Action Concor

Concor has the following effect on the body:

• expands the walls of blood vessels;
• depresses cardiac conduction;
• reduces the frequency of contractions of the heart muscle at rest and during exercise;
• weakens the force of the heartbeat.

Speaking about Concor, the mechanism of action of the drug is to block beta-1-adrenergic receptors - receptors through which hormones mediate their action: adrenaline and norepinephrine.

In a patient who takes the drug, the heartbeat becomes calmer. As a result: angina attacks become less frequent, palpitations are reduced, and the likelihood of sudden death is significantly reduced.

As a rule, the drug is prescribed for:

• ischemic heart disease;
• arterial hypertension and chronic angina pectoris. As a rule, therapy for hypertension and chronic angina pectoris begins with 5 mg of the drug. Sometimes it is 10 mg. If arterial hypertension is complicated by chronic angina pectoris, the daily dose of the drug is 20 mg. But you need to start taking the drug with the initial 5 mg, gradually increasing the dosage;
• chronic heart failure. The use of Concor is allowed in the absence of an exacerbation of the disease. Before determining the optimal dosage, the attending physician prescribes 1.25 mg each to monitor the patient's condition after taking the drug. If the cardiovascular system tolerates the drug well, the dose is doubled. Sometimes it is necessary to increase the dosage every two weeks. It looks like this: 3.75 - 5 mg - 7.5 mg - 10 mg. If the patient's condition worsens, the doctor reduces the dose or completely cancels the drug.

How long does it take for Concor to start working? The active ingredients of the drug begin to be absorbed immediately after use.

Compound

Each tablet has a dividing line, which makes it possible, if necessary, to divide it in two.

• ground substance: bisopropol fumarate;
• Excipients: corn starch, silicon dioxide, magnesium stearate, microcellulose, calcium hydrogen phosphate anhydrous;
• substances that are intended for film coating: iron dye yellow oxide, titanium dioxide, macrogol and others.

The composition of the tablets contains only dyes, preservatives and other excipients that are safe for humans. How long should I take Concor? Since the drug has a long duration of action, one dose per day is enough. You should not prescribe this drug yourself, because. it is not intended for self-treatment.

Tablets Concor

The tablet should be washed down with enough water to swallow it. No need to chew or grind the product into a powder. This reduces the therapeutic properties of the drug and its safety.

The medicine is taken in the morning at the same time. For each patient, the doctor draws up an individual treatment regimen, based on the patient's condition, the presence of chronic pathological processes, age and the course of the disease.

The drug can be used in such cases as:

• frequent migraine attacks;
• glaucoma;
• non-severe obstructive pulmonary pathologies;
• during surgery: before or after;
• elderly people;
• after myocardial infarction, as a preventive measure for its repetition.

The use of the drug should be carried out under the constant supervision of a physician. While taking Concor, the doctor monitors the state of the patient's blood pressure and heartbeat, analyzing the symptoms of the course of the disease. This measure will avoid possible complications of the patient's condition, which may occur after the first dose of the drug.

Contraindications and side effects

Most often in the process of taking Concor, the following side effects occur:

• feeling of cold hands and feet;
• attacks of headache (migraine);
• dizziness;
• failure of the digestive tract, which is accompanied by nausea, vomiting, diarrhea.

If these deteriorations occur, the doctor should be notified immediately so that he can take measures appropriate to the patient's condition.

Even with a large number of useful properties of Concor, it has some contraindications for use.

Contraindications to the use of the drug include:

• heart failure in any form that requires the use of drugs with a positive inotropic effect;
• shock caused by a malfunction of the heart;
• bronchial asthma;
• chronic obstructive pulmonary disease;
• advanced stages of circulatory disorders of capillaries;
• metabolic acidosis;
• sick sinus syndrome;
• atrioventricular blockade of the first and third degree;
• severe sinoatrial blockade;
• intolerance to the components of the drug;
• obvious bradycardia (heart rate more than 50 beats per minute);
• a clear decrease in blood pressure (below 90 mm Hg).

Cannot be used for persons under 18 years of age, tk. its effect on children has not been fully studied.

Use with caution in such pathologies and features:

• severe liver pathology;
• Prinzmetal's angina;
• myasthenia gravis;
• diabetes;
• depressive state;
• psoriasis;
• people over 50;
• chronic renal failure.

During the bearing of a child and during lactation, Concor can be used only in extreme cases.

Treatment of patients with other diseases

People suffering from liver or kidney failure do not need to adjust the dosage of the drug. The daily dose of Concor for this category of patients should not exceed 10 mg. If necessary, only the attending physician can increase the dosage.

The drug is well tolerated by elderly patients, which eliminates the need to adjust the daily dose of Concor for them.

Very carefully you need to take this remedy for patients with chronic heart pathologies. The following pathologies can also be attributed to the risk group:

• diabetes mellitus (with insulin dependence);
• restructive cardiomyopathy;
• bronchospasm;
• congenital heart disease;
• pathology of peripheral arteries;
• heart valve disease with severe hemodynamic disturbances.

If Concor is taken in parallel with other drugs, this can reduce its medicinal properties and provoke complications in the patient's condition.

Concor should not be combined with the following medicines:

1. class 1 antiarrhythmic drugs: Quinine, Phenytoin, Propafenone, etc. When taken together, these drugs can cause heart block. Doctors do not allow such a combination because of its danger to the patient's life;
2. slow calcium channel blockers: Diltiazem, Verapil, etc. This combination can reduce myocardial contractility and cause heart block. If such drugs are administered to people who take Concor intravenously, atrioventricular blockade or overt hypertension may occur;
3. centrally acting antihypertensive drugs: Clonidine, Medildopa, etc. Such a combination can provoke a critical decrease in heart rate.

Concor should be used with caution in combination with such medications:

1. antihypertensive drugs, beta-blockers, etc.. in combination with Concor can lead to arterial hypotension and heart block;
2. Amlodipine or Nifediline, taken together with Concor, may lead to inhibition of the contractile functions of the heart;
3. class 3 antiarrhythmic drugs: Amiodarone etc. together with Conkorm, they can lead to an increase in AV conduction disturbance and provoke heart block;
4. cardiac glycosides: Digoxin, Korglikon, etc. in combination with Concor cause bradycardia.
5. nonsteroidal anti-inflammatory drugs: Ketorol, Nise, Ibuprofen neutralize the therapeutic effect.

Related videos

Indications for use and instructions for the drug Concor:

Treatment with Concor should be carried out with caution so as not to worsen your condition. To do this, you should follow all the instructions of the attending physician as accurately as possible. For the implementation of effective and safe treatment, it should be carried out under the constant supervision of specialists. Therefore, treatment with this drug should be carried out in a hospital.

The information on the site is for reference and generalizing, collected from publicly available sources and cannot serve as a basis for making a decision on the use of medicines in the course of treatment.

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Concor, the instruction for the use of which characterizes it in detail, refers to highly effective means. It belongs to the group of beta-1-blockers of the second generation and is used as mono- and as part of complex therapy.

Concor tablets have a wide range of indications and are recommended for the prevention of certain diseases.

The medicine Concor consists of active and additional components. The active substance, according to the instructions for use, is bisoprolol fumarate. Stability, structure and speed of assimilation of tablets provide additional components.

Table 1. The composition and effect of the drug Concor

Main component
bisoprolol fumarate	Contribute to a mild decrease in blood pressure, normalizes the heart rhythm, stops and prevents the manifestations of coronary artery disease
Excipients
Disubstituted calcium phosphate	Oxidizing agent, allows you to get the desired consistency
Corn starch	Provides texture and density
Silica	Hygroscopic, promotes the absorption of bisoprolol
Crospovidone	Accelerates the absorption of the drug, provides a quick onset of the effect
Magnesium stearate	preservative

The Concor annotation contains data about the components used to obtain the shell. It is possible to purchase 10, 25 or 30 tablets in plastic blisters and a cardboard box. Instructions for use are attached.

Manufacturer

Concor - tablets for pressure, packaged in the Russian Federation by the company "Nanolek". Production is carried out in Germany by the Merck KGaA enterprise. This is one of the most famous and oldest pharmaceutical companies, dating back to the 1670s. Now it is an extensive network covering many countries.

Concor, the manufacturer of which has established itself in the market exclusively on the positive side, is included in the list of the most popular Merck KGaA drugs. The exact address of the company and its representative office in Russia is indicated in the instructions for use.

What is Concor from?

From the instructions for use, we can conclude that Concor has a wide range of indications. Recommended:

1. To reduce blood pressure. Concor, the use of which contributes to the mild normalization of blood pressure, is prescribed with a regular increase in systolic and diastolic rates (140/90 mm Hg and above).
2. As monotherapy or as part of the complex treatment of certain cardiovascular diseases.
3. In order to carry out prevention to reduce the risk of death.

What Concor tablets look like, what they help with, in what doses they should be taken - described in the instructions for use. However, it is strictly forbidden to drink the drug without the consent of a specialist, even if there is evidence.

Mechanism of action

Concor, the active substance of which determines the effect of the drug, begins to produce an effect within 15-40 minutes after use. The highest concentration of bisoprolol in the blood is observed after 3-4 hours. The instructions for use indicate that the therapeutic effect persists for 24 hours. Beta 1-blocker bisoprolol is selective, i.e. does not affect the functioning of beta 2-adrenergic receptors. This reduces the number of possible side effects.

Table 2. The mechanism of action of the drug Concor

Direction	Action Concor
Beta 1-adrenergic receptors are receptors located at the junction of neurons. Sensitive to adrenaline and norepinephrine. Stimulation of the receptors leads to an increase in the heart rate.	are blocked
Number and strength of heart contractions	Decreases
Conductivity	Oppressed
Renin - increases blood pressure and reduces the lumen of blood vessels	Concentration is reduced, synthesis is reduced
Sympathetic vascular tone	Decreases
CNS	Oppressed
HELL	going down
angina attacks	are shrinking

At what pressure should I take it?

Concor is a drug that does not apply to emergency or one-time assistance. Tablets are recommended for exchange use over a long period of time.

The effectiveness of the drug can be assessed no earlier than 2 weeks after the start of therapy, and a stable effect is observed after 1.5–2 months.

If you take a pill only when you feel worse, then the prescribed pharmacological treatment will not give the proper result. Concor (the instructions for use at what pressure it is worth drinking a pill does not describe) must be taken regularly, based on the scheme recommended by the specialist.

Instructions for use

Concor (international name Concor) has a number of characteristics prescribed in the instructions for use. Before using the tablet, you must read the information.

Indications

The basis for prescribing the drug is an accurate diagnosis. Concor, the indications for which are few, is recommended for:

1. Hypertension. It is used in the primary and secondary form of the disease. The decrease in blood pressure is due to a decrease in heart rate. However, the drug is not recommended for the treatment of hypertension, not accompanied by heart pain and other manifestations. On the question of whether Concor reduces pressure, it is quite possible to give a positive answer, but with a caveat. The full effect is observed after 14 or more days.
2. Chronic HF. Description Concor reports that the remedy is ineffective in heart failure at the stage of decompensation.
3. . Regular intake of tablets can reduce the frequency and severity of ischemic attacks.

In addition, the drug is used at a high risk of developing coronary artery disease and / or death.

With tachycardia

A fast heartbeat that causes pain is called tachycardia. This is not a separate disease, but a symptomatic manifestation of some pathological conditions. It mainly occurs against the background of vegetovascular dystonia, with incorrect functioning of the endocrine system, arrhythmias, etc.

Concor with tachycardia helps to normalize the pulse and heartbeat. However, it should be used carefully in the absence of increased pressure, this can lead to:

• excessive pressure drop;
• decrease in heart rate (bradycardia).

With arrhythmia

According to the World Health Organization, it is a heart rhythm that differs from normal sinus. The difference can be expressed in:

• frequency
• strength;
• contraction/excitation sequences.

Concor with arrhythmia of the heart is very effective. It helps to reduce the automatism of the heart and reduce the contractility of its tissues. Course reception allows you to weaken the peripheral vascular resistance. Concor with arrhythmias reduces the likelihood of death due to fatal forms of cardiac arrhythmias.

Dosage

Table 3. Variable dosage of Concor, based on the disease being treated

The dose of Concor 2.5 mg is extremely small for therapy in coronary artery disease and hypertension. A similar amount is recommended for HF. It should be noted that the treatment of this disease should be accompanied by regular monitoring of the patient's health status.

For best results, the instructions for use recommend following some rules. In particular:

1. Take in the morning, at the same time.
2. Do not break the integrity of the tablet. Crushing or rubbing is not recommended.
3. You can take the drug regardless of food intake.
4. It is necessary to drink a small amount of water.

During the bearing of a child, the drug is prescribed extremely rarely. A specialist can make such a decision only if the benefits to the health of the mother are commensurate with the risks to the embryo. In this case, you should carefully take Concor - side effects for women in position can cause:

• circulatory disorders of the placenta;
• decrease in heart rate in a child;
• low fetal blood glucose;
• disturbances in the development and growth of the embryo.

Instructions for use indicate that therapy during lactation is unsafe. There are no studies confirming the penetration / non-penetration of bisoprolol into mother's milk.

Prevention of arterial hypertension

Contraindications

Selective beta 1-blockers of the second generation do not have such a significant list of restrictions as their predecessors. Concor, contraindications to which are prescribed in the instructions for use, is prohibited if there are:

• individual intolerance to the components of the drug;
• violations of the conduction of the heart muscle;
• cardiogenic shock;
• violation of the acid-base balance in the body;
• acute heart failure;
• chronic type HF at the stage of decompensation;
• decreased heart rate (bradycardia);
• disturbances of peripheral blood supply;
• bronchial asthma in severe forms;
• atrioventricular blockade of the 3rd degree;
• hormonally active tumors;
• bronchial pathology with obstruction;
• Raynaud's syndrome, etc.

Instructions for use prohibit drinking the drug to children and adolescents under 18 years of age. Studies on the safety of tablets for them have not been conducted.

Side effects

Negative consequences occur at the initial stages of treatment. They are especially pronounced in patients with angina pectoris or low blood pressure.

Table 4. Side effects of Concor tablets and systems affected by them

Heart/vessels	Lowering blood pressure, reducing the pulse (bradycardia); aggravation of heart failure, tachycardia (the doctor decides how to replace Concor with tachycardia and other phenomena) and so on
gastrointestinal tract	Heartburn, nausea, diarrhea, constipation, drug jaundice
CNS	Headache, weakness, decreased performance, etc.
sense organs	Hearing and vision disorders
Leather	Burning, urticaria, eczema, angioedema
reproductive system	Potency disorders
Respiratory system	Bronchospasm, asthma attack

In some cases, after a few weeks after the start of drug consumption, side effects disappear. If this does not happen, then it is worth replacing the drug.

Effect on potency

The list of side effects of the drug includes disorders affecting the reproductive system. The negative effect of Concor on potency is expressed in a decrease in androgen synthesis. Taking the drug can lead to a reduction in erectile function and sexual desire.

Concor (side effects for men may lead to a desire to stop treatment) can be replaced with Nebivolol (Nebilet). This tool is highly selective and does not have such an effect on male power.

Overdose

It is worth taking the tablets according to the instructions for use and the doctor's recommendations. Concor, an overdose of which is quite dangerous, in excess entails:

• bradycardia;
• lowering blood pressure;
• heart rhythm disturbances;
• excessive decrease in blood glucose levels;
• exacerbation of heart failure.

If you suspect an overdose of the drug, you need to call an ambulance.

The drug is prescribed mainly for a long period. As a rule, patients do not always manage to refrain from consuming alcoholic beverages for such a long time. It is possible to combine alcohol with a drug subject to the measure of intoxicating, however:

1. It is not recommended to drink alcohol at the beginning of treatment. At this stage, even a small amount of alcohol can cause negative consequences.
2. It must be remembered that combining Concor with alcohol can cause bradycardia, lowering blood pressure, or exacerbating heart disease.

If possible, the use of the drug and alcohol together should be avoided. Alcohol and Concor, the harm of which, when taken together, is very pronounced, can even lead to death.

This medicine has a similar brand name but is different:

1. Composition. It has 2 active substances - bisoprolol and amlodipine (slow calcium channel blocker). The excipients are also excellent.
2. Manufacturer. AM is a medicine produced by a Hungarian company.
3. At the cost. AM costs twice as much.

To evaluate other differences will allow the study of instructions for use. Concor AM refers to combination therapy and has a more pronounced effect.

Concor Cor is an analogue, but has some differences in the amount of active substance and scope. The drug is produced by the same company. Take in the morning with a small amount of water.

Concor is a drug used to lower blood pressure, treat coronary artery disease, and treat chronic heart failure. It includes 5 or 10 mg of the active substance. Concor Cor contains 2.5 mg of bisoprolol. For the treatment of arterial hypertension or coronary artery disease, such a low dosage is not suitable.

It is used exclusively as part of combination therapy for HF.

Can pills be harmful?

According to the instructions for use, the drug can have a negative effect in a number of cases:

• with unauthorized uncontrolled use;
• in case of incorrect appointment (for example, if the patient has contraindications);
• with an incorrectly calculated dosage;
• when used together with a number of drugs (for example, antihypertensive drugs);
• upon abrupt cessation of treatment.