Concor medicine contraindications. Concor instructions for use, contraindications, side effects, reviews. Concor - side effects and interactions with other drugs
Modern world suffers greatly from cardiovascular diseases. Problems hypertension or hypotensive conditions are quite common today, because technogenic humanity neglects its own health for the sake of its career. The problems of treating diseases of the circulatory system are relevant today, effective means Therapy specialists consider concor blood pressure tablets. Patients are interested in whether the drug increases or decreases blood pressure, what its effect is, how the medicine should be taken and for what diseases it should not be used.
Modern man leads a fairly active lifestyle, both physically and intellectually. Not always human body withstands the loads placed on it, this is especially felt by people who have crossed the age mark of 45–50 years - they are more often susceptible to cardiovascular diseases and influence external factors. Older patients are affected by the condition environment, which causes dizziness with pressure, nausea, rapid pulse, vomiting, headaches.
For the treatment of blood pressure, drugs that include bisoprolol are effective - prescribing Concor 5 mg to patients with hypertension can reduce blood pressure and restore normal pulse. The drug can be taken in the following situations:
- heart rhythm disturbances;
- with increased heart rate;
- with elevated blood pressure.
Taking Concor when your blood pressure is low is strictly prohibited, since the action of bisoprolol hemifumarate is aimed at lowering blood pressure. In hypotensive patients, these tablets cause severe disturbances in the functioning of the heart muscle and vascular system.
General information
Concor lowers blood pressure and normalizes pulse thanks to its composition:
- bisoprolol hemifumarate;
- bisoprolol fumarate;
- calcium hydrogen phosphate;
- corn starch;
- silicon dioxide;
- microcrystalline cellulose;
- crospovidone;
- magnesium stearate.
The compounds listed in the first two lines of the list are blood pressure lowering compounds - bisoprolol fumarate and hemifumarate. Treatment with the drug will be effective if the medicine is prescribed by the doctor observing the patient, and the patient takes it systematically in an appropriate dose.
The drug prevents angina attacks and normalizes the supply of oxygen to the cells of the heart muscle.
Concor - effective prophylactic, the intake of which prevents the development of myocardial infarction. The drug is well absorbed from the gastrointestinal tract, the maximum concentration of bisoprolol is achieved within 1–3 hours after administration. You can take the medicine regardless of food.
Concor is quickly absorbed and broken down, so its effect on other organs and systems is minimal. Excretion from the body occurs through the liver and kidneys. The effect of Concor lasts for 24 hours after administration.
Therapeutic effect
The effect of the tablets is quite mild, but they are effective. The medication affects not only blood pressure, but also pulse. Concor is included in the group of beta blockers; it is a potent drug with a long-term therapeutic effect. Medicinal properties The drug can be divided into three main groups:
- antiarrhythmic - concor affects the pulse, prevents rhythm and heart rate disturbances;
- antianginal - bisoprolol prevents attacks of angina pectoris and rest, normalizes the supply of O2 to myocardial cells (increases periods of relaxation of cardiomyocytes);
- hypotensive - the drug normalizes vascular tone, thereby reducing blood pressure.
In addition, Concor reduces the activity of the hormonal system and regulates the volume of blood circulating in the vascular bed.
Indications for use
The drug is prescribed to patients suffering from high blood pressure after a medical examination and additional research to help determine the cause of hypertension. Concor is recommended for use if the patient has the following conditions:
- chronic form of heart failure;
- hyperthyroidism - increased concentration of thyroid hormones;
- pathology mitral valve(insufficiency or stenosis);
- overexcitement sinus node;
- extrasystoles (extraordinary contractions of the atria and ventricles);
- angina pectoris;
- cardiac ischemia;
- increased blood pressure.
There are no clear symptoms for which it is necessary to take medicinal product, however, treatment with Concor at low blood pressure can be fatal to the body - bisaprolol can cause severe circulatory disorders.
For more effective results, you should know how to take Concor. There is no universal dosage, and to normalize blood pressure levels and stabilize hemodynamic parameters, the therapist individually prescribes the required dose, taking into account the medical history, Current state patient, test results and instrumental studies. In most cases, a daily dose of one tablet is suitable for an adult. It is swallowed without chewing and washed down with clean water.
According to experts, bisaprolol should be taken in the morning, before or immediately after meals - this dosage regimen is effective and safe.
For hypertension, Concor is prescribed, gradually increasing the daily dose. On the recommendation of the doctor, the dose can be increased during the third or fourth week of the course of treatment. There is no need to reduce the dose of Concor for patients in the older age group.
It is important to strictly follow all the doctor’s prescriptions and not stop taking the drug abruptly, because such an irresponsible approach can worsen the condition and cause an exacerbation of the disease. Accordingly, any changes to the drug dosage regimen must be carried out under the strict supervision of a physician.
It is important to avoid overdose; drug abuse has a detrimental effect on the cardiovascular system and heart rate. If the dose is exceeded, fainting develops, collapse (critical drop in blood pressure), convulsions, spasms are possible respiratory tract- these symptoms require reducing the dosage until the drug is completely discontinued.
Contraindications
Like any medicine, Concor has its contraindications due to its composition. Before starting treatment, additional diagnostic studies aimed at identifying diseases other than high blood pressure- this prevents the patient’s condition from deteriorating. Experts do not recommend the use of bisoprolol if the following diseases are detected:
- metabolic disorders, the cause of which is not precisely established;
- hypothyroidism (decreased function thyroid gland);
- Congenital heart defect;
- diabetes mellitus (therapy is possible only under medical supervision);
- functional disorders of the liver;
- breast-feeding;
- pregnancy;
- allergy;
- hypotension;
- critical disruption of blood flow in small arteries;
- acidosis (metabolic);
- bronchial asthma;
- obstructive pathological changes in the lungs;
- sinus node dysfunction (weakness, blockade);
- heavy organic diseases circulatory organs;
- Raynaud's disease;
- individual intolerance;
- acute heart failure and its terminal stage.
Concor is incompatible with alcohol (in any doses) - the combined effect provokes the development of severe angina, acute coronary syndrome, and myocardial infarction. The use of the drug should be avoided for people driving vehicles and working with dangerous machinery. With high blood pressure and diabetes mellitus During treatment, both a sharp increase and decrease in glucose in the blood serum is possible - Concor is a beta blocker, it affects the production of insulin and changes the sensitivity of body tissues to this hormone. If taking the drug is vital, then therapy is carried out under medical supervision.
During pregnancy and high blood pressure treatment with Concor is justified only when there is a risk negative influence the fetus is much weaker therapeutic effect- the drug is prescribed only if the benefit to the mother exceeds potential harm for the fetus. Bisoprolol penetrates into mother's milk, therefore, during treatment it is necessary to stop feeding the child (the drug causes severe disorders of the cardiovascular system and respiratory disorders in the baby).
Side effects
While taking Concor, you may develop side effects drugs that worsen the patient’s quality of life:
- sleep disturbance;
- muscle tremors;
- weakness;
- hearing loss (which goes away after treatment);
- dysfunction of lacrimation;
- numbness of the upper and lower limbs, their coldness, cyanotic skin;
- loose stools;
- constipation;
- nausea;
- vomit;
- headache;
- dyspnea;
- breathing disorders;
- various swelling;
- bradycardia (decreased heart rate);
- dizziness;
- fast fatiguability;
- allergic reactions;
- sexual dysfunction;
- depression.
During treatment, it is necessary to monitor the patient’s condition; if any unusual symptoms appear (if the pressure drops sharply, vomiting, nausea appears), you need to consult a doctor - timely consultation can prevent the worsening of side effects of therapy and severe dysfunction of vital functions. important organs and systems.
Concor effectively reduces blood pressure, but this drug should not be taken without a doctor’s prescription - self-medication leads to a worsening of the patient’s condition and the emergence of new side disorders. Timely diagnosis And correct use medicines are guaranteed positive result therapy (help lower blood pressure) and reduce the risk of unwanted effects from drug treatment.
"Concor" from pressure
More and more people are being diagnosed with pathologies of the cardiovascular system. For hypertension or regular sharp increase blood pressure (BP), the patient may be prescribed a medicine called Concor. This is a drug that quickly lowers blood pressure.
Therapeutic effect on the body
If your blood pressure rises or your heart rate increases, adrenaline is released into the blood. Under his influence blood vessels narrow, and the bronchi, on the contrary, expand, stimulating an increase in the volume of air entering the lungs. With hypertension, the effect of adrenaline on the body only aggravates the symptoms of the disease. Concor Cor is a medicine for high blood pressure that has the following therapeutic effect on the body:
- limits the effect of adrenaline on the heart and nerve endings;
- normalizes heart rhythm;
- dilates blood vessels, normalizing the blood circulation process;
- reduces the intensity of renin (a substance contained in blood serum and responsible for normalizing blood pressure).
These blood pressure pills are gentle. The tonometer readings return to normal 4 hours after taking the capsule. The medicine has a prolonged effect - Concor reduces blood pressure for 24 hours with a single dose. For hypertension, the drug can reduce and maintain normal tonometer readings after a 15-day course.
Release form and composition of the drug
Concor Cor is available in the form of heart-shaped tablets coated with a thin film coating. Basics active substance medication - bisoprolol. These blood pressure tablets are available in two dosages - 5 and 10 mg of the active ingredient. The color of the pill shell differs depending on the concentration of bisoprolol. Hearts of 5 mg each in a delicate lemon-colored shell. Tablets of 10 mg of the substance are beige in color. Additional components:
- titanium dioxide;
- macrogol;
- food colorings;
- Dimethicone
After oral administration, the tablet shell dissolves in the stomach, gradually releasing the active substance. Thanks to this, Concor lowers blood pressure gently and gradually.
Indications for use
Cardiologists prescribe Concor tablets to patients with pathologies of the cardiovascular system, namely:
- hypertension;
- ischemia;
- angina pectoris;
- heart failure.
It is enough to take Concor for blood pressure, one tablet per day. Therapeutic effect lasts 24 hours. The drug gradually lowers blood pressure without causing discomfort (weakness, headache) in hypertensive patients.
Main contraindications
Concor instructions for use prohibit taking it in the presence of the following concomitant pathologies:
- the body's sensitivity to the components of the drug;
- chronic heart failure or its aggravated form;
- Do not take Concor if you have low blood pressure;
- lactation period;
- bronchial diseases (asthma);
- cardiogenic shock;
- disturbance of the circulatory process, if it manifests itself in cold upper or lower extremities);
- metabolic disease;
- hormonal disbalance.
Concor is prescribed for high blood pressure in patients with the following concomitant diseases (under constant medical supervision):
- liver dysfunction;
- diabetes;
- congenital heart disease (or heart valve);
- severe renal failure;
- psoriasis;
- pathologies of the thyroid gland, due to which there is a hormonal imbalance.
People forced to follow a strict diet can take Concor tablets under the constant supervision of a cardiologist. Sometimes patients are interested in whether it is possible to take the drug with low blood pressure. blood pressure. The use of Concor for hypotension is justified only if decreased performance tonometer are accompanied by rapid heartbeat.
Symptoms of drug overdose
- reduction of heart rate to critically low levels (less than 60 beats per minute);
- unstable heartbeat;
- critically low performance HELL;
- swelling, difficulty breathing;
- change in color of nails and skin of extremities;
- weakness, feeling of dry mouth;
- hypoglycemia.
At the first symptoms of an overdose, you must take the sorbent and contact your doctor. ambulance for subsequent gastric lavage. The drug has antidotes - medications with the opposite principle of action - “Isoprenaline”, “Atropine”. IN complex treatment include sedatives, diuretics.
Side effects on the body
Long-term use of Concor may result in unwanted side effects. In most cases, the drug is well tolerated. However, sometimes uncomfortable symptoms may appear:
- general weakness;
- insomnia;
- short-term memory loss;
- depression;
- hearing and vision impairment;
- exacerbation of symptoms of poor circulation or heart failure;
- disturbance of taste sensations;
- indigestion;
- stomach cramps;
- dermatological reactions (including exacerbation of psoriasis).
Most of these side effects appear when you start taking Concor for blood pressure. The patient’s well-being stabilizes within 2 weeks of using the medication.
special instructions
Concor for blood pressure is taken in long courses. The patient should not abruptly stop treatment or voluntarily refuse to take the drug. The dosage of the medication is reduced gradually, under the supervision of a cardiologist. During therapy, the following points are taken into account:
- the tablets do not affect the ability to drive or complex mechanisms. However, in the first days of use, this medicine for hypertension causes side effects, so you should refrain from driving during this period;
- Patients with bronchial pathology need to take drugs from the group of bronchodilators in parallel with blood pressure medications.
The active substance of the tablets increases the body's sensitivity to allergens. Therefore, during the course of taking the medication, you should follow a diet, and you can additionally take anti-allergy medications.
Features of use during pregnancy
During pregnancy, doctors rarely prescribe this drug. One of the decisive factors is determining the balance of benefit to the mother and harm to the embryo. After all, it can cause complications in the baby’s development:
- the medicine reduces the blood flow of the placenta, causing disruption of the nutrition and development of the embryo. Therefore, taking pills is prescribed if it is not possible to use another type of therapy;
- After the baby is born, he is carefully examined and monitored for 3-5 days. After all, taking the drug may cause hypoglycemia or a slow heart rate in a newborn.
There is no data on the concentration in which the active substance penetrates into breast milk. Therefore, during lactation you should avoid this medication.
Interaction with other drugs
Before starting to take the drug, you should consult a cardiologist. After all, bisoprolol interacts with the active ingredients of other drugs, enhancing or weakening their effect on the body:
- when taking the medication simultaneously with symptomatic drugs, the therapeutic effect of bisoprolol decreases;
- when taking tablets with Alpha-methyldop and Reserpine, a sharp reduction in the number of heart beats per minute is observed;
- at elevated level glucose in the blood, bisoprolol enhances the effect of insulin, increasing the possibility of developing hypoglycemia. But at the same time, the active ingredient of the drug alleviates the symptoms reduced level Sahara;
- Nifedipine enhances the effect of bisoprolol.
The cardiologist takes into account the patient’s concomitant pathologies and develops an individual medication regimen.
Terms of sale and analogues
The drug is presented in the pharmacy chain. But you can only buy it with a doctor's prescription. Analogs of the drug are available for sale, identical in composition and principle of action.
The instructions for these medications indicate at what pressure they should be taken, contraindications and side effects. The most popular analogues of the product are:
- "Biprol";
- "Bisoprolol";
- "Bisomor";
- "Coronal"
- "Tirez."
Before replacing the drug with an analogue, you should consult a cardiologist. After all, such a replacement is not always justified.
Bisoprolol (INN - bisoprololum) is a selective β1-adrenergic receptor blocker. When used in therapeutic doses, it does not have BSA and clinically significant membrane-stabilizing properties. Reduces plasma renin activity, reduces myocardial oxygen demand, and reduces heart rate (at rest and during exercise). By blocking β1-adrenergic receptors of the heart in low doses, it reduces the catecholamine-stimulated formation of cAMP from ACE, reduces the intracellular current of calcium ions, and has a negative chrono-, dromo- and inotropic effect (inhibits conduction excitability, slows down AV conduction). 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, prolongation of diastole, and improved myocardial perfusion.
When increasing the dose above the therapeutic one, it has a β2-adrenergic blocking effect.
Concor Cor has a hypotensive effect due to a decrease in cardiac output, inhibition of renin secretion by the kidneys, as well as an effect on the baroreceptors of the aortic arch and carotid sinus. In case of hypertension (arterial hypertension), the effect occurs after 2-5 days, stable effect occurs after 1-2 months. With prolonged use, bisoprolol reduces increased peripheral vascular resistance.
When used in average therapeutic doses, in contrast to non-selective β-blockers, it has a less pronounced effect on organs containing β2-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. The severity of the atherogenic effect does not differ from the effect of propranolol.
After taking the drug orally, bisoprolol is well absorbed from the gastrointestinal tract. Bioavailability is about 90% and is independent of food intake. The maximum concentration is reached after 1-3 hours. Binding to blood plasma proteins is about 30%.
The effect of primary passage through the liver is insignificant (about 10%). About 50% of bisoprolol is biotransformed in the liver with the formation of inactive metabolites. The main metabolites found in blood plasma and urine do not exhibit pharmacological activity. The pharmacokinetics of bisoprolol is linear. Its concentration in blood plasma is proportional to the administered dose in the dose range from 5 to 20 mg. The maximum concentration in blood plasma is achieved after 2-3 hours.
Bisoprolol is distributed quite widely. The volume of distribution is 3.5 l/kg. Communication with blood plasma proteins is about 35%.
The total clearance is 15.6 ± 3.2 l/h, with renal clearance being 9.6 ± 1.6 l/h. The half-life is 10-12 hours. Approximately 98% is excreted from the body in the urine, 50% unchanged, the rest in the form of metabolites, approximately 2% of the dose is excreted in the feces.
Dose adjustments for patients with mild or mild hepatic or renal impairment medium degree no gravity required.
Indications for use of the drug Concor cor
Chronic heart failure.
Use of the drug Concor cor
The tablets should be taken with a small amount liquids in the morning before, during or after breakfast. The tablets should not be chewed or crushed into powder.
Initiation of treatment for chronic heart failure with Concor Cor requires a special titration phase and regular medical supervision.
Treatment of chronic heart failure with Concor Cor begins in accordance with the following titration scheme. Individual adaptation may be required depending on how well the patient tolerates the prescribed dose, i.e. the dose can only be increased if previous dose was well tolerated.
* To ensure the above dosage regimen, it is recommended to use the drug Concor in subsequent stages of treatment.
The maximum recommended dose for the treatment of chronic heart failure is 10 mg of bisoprolol once a day. Patients are advised to take the dose of the drug selected by the doctor, unless adverse reactions occur.
After starting treatment with the drug at a dose of 1.25 mg (1/2 t of Concor Cor tablet), the patient should be observed for about 4 hours (monitoring heart rate, blood pressure, conduction disturbances, signs of worsening heart failure).
During or after the titration phase, a temporary worsening of heart failure symptoms, fluid retention, hypotension, or bradycardia may occur. In this case, it is recommended, first of all, to pay attention to the selection of the dosage of the accompanying basic therapy(optimize the dose of diuretic and/or ACE inhibitor) before reducing the dosage of the drug Concor Cor. Treatment with Concor Cor should only be interrupted if absolutely necessary. After stabilization of the patient's condition, re-titration should be carried out, or treatment should be continued.
No dose adjustment is usually required for patients with mild to moderate hepatic or renal impairment. For patients with a marked decrease in renal function (creatinine clearance less than 20 ml/min) and with severe liver dysfunction daily dose should not exceed 10 mg. In any case, the dose is selected individually.
Treatment with Concor Cor is usually long-term. If necessary, treatment can be interrupted and resumed subject to certain rules.
Treatment should not be interrupted suddenly, especially in patients with coronary artery disease. If discontinuation of treatment is necessary, the dosage of the drug should be reduced gradually.
Contraindications to the use of Concor Cor
Hypersensitivity to bisoprolol or any of the components of the drug and other beta-adrenergic receptor blockers; shock (cardiogenic shock), collapse; AV block II-III degree, sick sinus syndrome, severe sinoatrial block, bradycardia (heart rate ≤50 beats/min), Prinzmetal angina; arterial hypotension (systolic blood pressure ≤90 mm Hg), history of severe forms of asthma and COPD; late stages violations peripheral circulation, Raynaud's disease; simultaneous administration MAO inhibitors (except for MAO type B inhibitors), psoriasis (including family history), pheochromocytoma, pregnancy and breastfeeding.
Side effects of the drug Concor cor
From the outside nervous system:
increased fatigue, dizziness, headache, sleep disturbances, depression may be observed (especially at the beginning of therapy), rarely - hallucinations (usually mild and disappear within 1-2 weeks), sometimes - paresthesia.
From the side of the organ of vision: visual impairment, decreased tear production (must be taken into account when wearing contact lenses), conjunctivitis.
From the cardiovascular system: in some cases - orthostatic hypotension, bradycardia, AV conduction disturbances, decompensation of heart failure with the development of peripheral edema, at the beginning of treatment - deterioration of the condition of patients with intermittent claudication or Raynaud's syndrome.
From the respiratory system: in isolated cases - shortness of breath (in patients prone to bronchospasm).
From the gastrointestinal tract: in some cases - diarrhea, constipation, nausea, abdominal pain, increased activity of liver enzymes in the blood serum (AST, ALT), hepatitis.
From the musculoskeletal system: in some cases - muscle weakness, cramps, arthropathy affecting one or more joints (mono- or polyarthritis).
From the outside endocrine system:
decreased glucose tolerance (with latent diabetes mellitus) and masking of signs of hypoglycemia, in some cases - increased TG levels in the blood, potency disorders.
From the skin: sometimes - itching, skin hyperemia, increased sweating, rash. When treated with β-adrenergic receptor blockers, hair loss, hearing impairment or tinnitus, weight gain, mood changes, short-term memory loss, allergic rhinitis, and priapism are observed in some cases.
Special instructions for the use of the drug Concor cor
Concor Cor should not be used during pregnancy and breastfeeding due to the lack of reliable clinical data confirming the safety of the drug. During pregnancy, Concor Cor should only be recommended if the benefit to the mother outweighs the risk of side effects to the fetus. IN exceptional cases When using bisoprolol during pregnancy, treatment should be discontinued 72 hours before the expected due date due to the possibility of bradycardia, hypoglycemia and respiratory depression in the newborn. If discontinuation of the drug is not possible, then after birth the newborn should be under medical supervision. Symptoms of hypoglycemia may occur during the first 3 days.
In some cases, beta-adrenergic receptor blockers may cause the development or exacerbation of psoriasis. In patients taking β-adrenergic blockers, due to weakened adrenergic feedback regulation anaphylactic reactions may have a more severe course.
Due to the individual nature of reactions to the drug, the ability to drive vehicles or operate machinery may be reduced. To a greater extent this concerns initial stage treatment and changes in the dose of the drug, as well as with simultaneous use of alcohol.
There are no clinical data on the effectiveness and safety of Concor Cor in children.
Interactions of the drug Concor cor
At simultaneous use Concor Cor may enhance the effect of antihypertensive drugs. With the simultaneous use of bisoprolol and reserpine, methyldopa, clonidine or guanfacine, it is possible a sharp decline Heart rate. At joint use Concor Cor and clonidine, digitalis preparations, as well as guanfacine may develop cardiac conduction disorders.
When using Concor and verapamil or diltiazem and others together antiarrhythmic drugs a decrease in blood pressure is possible, the risk of developing or worsening bradycardia, AV block, cardiac arrest and heart failure increases (IV administration of blockers should be avoided calcium channels and antiarrhythmic drugs during therapy with Concor Cor). Nifedipine can lead to a significant decrease in blood pressure.
Phenytoin for intravenous administration, drugs for inhalation general anesthesia(hydrocarbon derivatives) increase the severity of the cardiodepressive effect and the likelihood of lowering blood pressure when used while taking bisoprolol.
Effectiveness of insulin and oral hypoglycemic agents medicines may change during treatment with Concor Cor (masks the symptoms of developing hypoglycemia: tachycardia, increased blood pressure).
The clearance of lidocaine and xanthines may decrease due to a possible increase in their concentration in the blood plasma, especially in patients with an initially increased clearance of theophylline under the influence of smoking.
NSAIDs, corticosteroids and estrogens weaken the hypotensive effect of bisoprolol (Na+ retention, blockade of prostaglandin synthesis by the kidneys).
With the simultaneous use of Concor Cor and sympathomimetics (including cough suppressants, eye drops and nasal drops) the effect of bisoprolol may be weakened.
Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs can lead to an excessive decrease in blood pressure.
The effect of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins may be prolonged during treatment with bisoprolol.
Tri- and tetracyclic antidepressants, antipsychotics(neuroleptics), ethanol, sedative and hypnotic drugs increase CNS depression. Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. The treatment break 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; Rifampin shortens the half-life. With the simultaneous use of ergotamine derivatives (including ergotamine-containing migraine drugs) and Concor Cor, the severity of peripheral circulatory disorders may increase.
With the simultaneous use of Concor Cor and rifampicin, the half-life of bisoprolol may slightly decrease (increasing the dose of Concor is usually not required).
Overdose of Concor Cor, symptoms and treatment
Symptoms: arrhythmia, ventricular extrasystole, severe bradycardia, AV block, marked decrease in blood pressure, acute heart failure, hypoglycemia, acrocyanosis, difficulty breathing, bronchospasm, dizziness, fainting states, convulsions.
Treatment: gastric lavage and administration of adsorbent drugs; symptomatic therapy: in case of developed AV block, intravenous administration of 1-2 mg of atropine, epinephrine or placement of a temporary pacemaker; at ventricular extrasystole— lidocaine (class IA drugs are not used); with a pronounced decrease in blood pressure, the patient should be in a position with the foot end of the bed raised; if there are no signs of pulmonary edema - intravenous plasma replacement solutions; if ineffective - administration of epinephrine, dopamine, dobutamine (to maintain chronotropic and inotropic effects and eliminate the pronounced decrease in blood pressure); for heart failure - cardiac glycosides, diuretics, glucagon; for convulsions - intravenous diazepam; for bronchospasm - β2-adrenergic stimulants by inhalation.
Storage conditions for the drug Concor cor
At room temperature no higher than 25 °C. Shelf life: 3 years.
List of pharmacies where you can buy Concor Cor:
- Saint Petersburg
The drug Concor (Concor) is intended for patients with observed arterial hypertension (AH), angina pectoris (CHD) or chronic heart failure.
Pharmacological properties and effect of the drug
The product takes effect 1-3 hours after administration and has healing effect during the day. When cardiac output is reduced, it has a hypotensive effect, acting on the baroreceptors of the carotid sinus and aortic arch, inhibiting the secretion of renin by the kidneys. It has a side effect with an antianginal effect, increasing the supply of oxygen to the myocardium due to decreasing diastolic pressure. Significantly improves well-being in chronic heart failure.
Application and dosage*
You can take Concor only as prescribed by your doctor. Take the drug orally, in the morning and on an empty stomach, swallowing and without chewing. Completely absorbed into gastrointestinal tract and 90% is excreted by the kidneys. The norm for one dose for adults is 2.5-5 mg. If necessary, the dose can be increased to 10 mg (also once a day). The maximum norm per day is 20 mg.
For patients with diseases and disorders of the liver or kidneys, the norms for taking Concor are the same.
Contraindications Concor
The drug is contraindicated in states of shock, bradycardia, arterial hypotension, bronchial asthma, severe forms of peripheral circulation disorder, psoriasis and pheochromocytosis.
Side effects of Concor: wide range side effects the drug taking into account individual tolerance.
How does Concor affect the human body?
Effect on the central nervous system: increased fatigue, dizziness, headaches, sleep disturbances, less often hallucinations.
Effect on the organs of vision: blurred vision, conjunctivitis, decreased tear production;
Influence at cardiovascular system: in individual cases - bradycardia, orthostatic hypotension, conduction disturbances - AV, heart failure and the development of peripheral edema; at the beginning of the course of treatment, the condition may worsen with intermittent claudication or Raynaud's syndrome.
Influence at respiratory system: with a tendency to bronchospasm, shortness of breath may occur.
Influence at digestive system: side effects such as constipation, diarrhea, nausea, abdominal pain.
Influence at musculoskeletal system: in rare cases - convulsions, muscle weakness, arthropathy with joint damage (poly- or monoarthritis).
Effect on the skin in the form of dermatological reactions: in rare cases, itching, increased sweating, skin flushing, skin rash.
During pregnancy and breastfeeding
Overdose
Leads to bradycardia, arterial hypotension, heart failure, bronchospasm. Treatment is by gastric lavage or taking activated charcoal.
Combination with other drugs
Concor enhances the effect of antihypertensive drugs. With simultaneous use of Concor with nifedipine or other calcium channel blockers, an increase in the hypotensive effect is observed.
Release form: packs of 100, 50 and 30 tablets.
Concor storage conditions: at room temperature.
*There are contraindications to the use of the drug; before use, you must read the instructions for medical use and consult your doctor.
Tablets 50 mg
Indications for use of the drug Concor
arterial hypertension;
Coronary heart disease (prevention of angina attacks);
Chronic heart failure.
Release form of the drug Concor
film-coated tablets 5 mg; blister 10 cardboard pack 3;
film-coated tablets 5 mg; blister 10 cardboard pack 5;
film-coated tablets 5 mg; blister 10 cardboard pack 10;
film-coated tablets 5 mg; blister 25 cardboard pack 2;
film-coated tablets 5 mg; blister 30 cardboard pack 1;
film-coated tablets 10 mg; blister 10 cardboard pack 3;
film-coated tablets 10 mg; blister 10 cardboard pack 5;
film-coated tablets 10 mg; blister 10 cardboard pack 10;
film-coated tablets 10 mg; blister 30 cardboard pack 1;
film-coated tablets 10 mg; blister 25 cardboard pack 2;
Pharmacodynamics of the drug Concor
A selective beta1-blocker, without its own sympathomimetic activity, does not have a membrane-stabilizing effect. Reduces plasma renin activity, reduces myocardial oxygen demand, and reduces heart rate (at rest and during exercise).
It has hypotensive, antiarrhythmic and antianginal effects. By blocking beta1-adrenergic receptors of the heart in low doses, it reduces the formation of cAMP from ATP stimulated by catecholamines, reduces the intracellular current of calcium ions, has a negative chrono-, dromo-, bathmo- and inotropic effect, inhibits the conductivity and excitability of the myocardium, and reduces AV conductivity.
When increasing the dose above the therapeutic one, it has a beta2-adrenergic blocking effect.
OPSS at the beginning of drug use, in the first 24 hours, increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors and the elimination of stimulation of beta2-adrenergic receptors), which after 1-3 days returns to the original level, and with long-term administration decreases.
The hypotensive effect is associated with a decrease in minute blood volume, sympathetic stimulation of peripheral vessels, a decrease in the activity of the renin-angiotensin system (of great importance for patients with initial hypersecretion of renin), restoration of sensitivity in response to a decrease in blood pressure and an effect on the central nervous system. At arterial hypertension the effect occurs after 2-5 days, stable effect - 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 and decreased contractility, prolongation of diastole, and improved myocardial perfusion. By increasing end-diastolic pressure in the left ventricle and increasing the stretch of ventricular muscle fibers, it can increase oxygen demand, especially in patients with chronic heart failure.
The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity 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 AV conduction (mainly in the antegrade and, to a lesser extent, in the retrograde directions through the AV node) and along additional pathways.
When used in average therapeutic doses, in contrast to non-selective beta-blockers, it has a less pronounced effect on organs containing beta2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism, does not cause delay sodium ions (Na+) in the body; the severity of the atherogenic effect does not differ from the effect of propranolol.
Pharmacokinetics of the drug Concor
Suction. Bisoprolol is almost completely (>90%) absorbed from the gastrointestinal tract. Its bioavailability due to insignificant metabolization during the “first pass” through the liver (at a level of approximately 10–15%) is about 85–90% after oral administration. Food intake does not affect bioavailability. Bisoprolol exhibits linear kinetics, with plasma concentrations being proportional to the administered dose over a dose range of 5 to 20 mg. Cmax in blood plasma is reached after 2–3 hours.
Distribution. Bisoprolol is distributed quite widely. Volume of distribution - 3.5 l/kg. Plasma protein binding reaches approximately 35%; no uptake by blood cells is observed.
Metabolism. Metabolized via the oxidative pathway without subsequent conjugation. All metabolites have strong polarity and are excreted by the kidneys. The main metabolites found in blood plasma and urine do not exhibit pharmacological activity. Data obtained from in vitro experiments with human liver microsomes indicate that bisoprolol is metabolized primarily by CYP3A4 (about 95%), with CYP2D6 playing only a minor role.
Excretion. The clearance of bisoprolol is determined by the balance between its excretion through the kidneys as unchanged substance (about 50%) and oxidation in the liver (about 50%) to metabolites, which are then also excreted by the kidneys. Total Cl - (15.6±3.2) l/h, and renal Cl - (9.6±1.6) l/h. T1/2 - 10–12 hours.
Use of the drug Concor during pregnancy
In general, beta blockers reduce blood flow to the placenta and may affect fetal development. Blood flow in the placenta and uterus should be closely monitored, as well as the growth and development of the unborn child, and if dangerous manifestations regarding pregnancy or the fetus, take alternative therapeutic measures.
The newborn should be carefully examined after birth. In the first 3 days of life, symptoms of decreased blood glucose and heart rate may occur.
There are no data on the excretion of bisoprolol into breast milk or the safety of bisoprolol exposure in infants. Therefore, taking Concor® is not recommended for women during breastfeeding.
Contraindications to the use of the drug Concor
Hypersensitivity to bisoprolol or to any of the components of the drug (see “Composition and release form”) 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;
AV block II and III degrees, without pacemaker;
sick sinus syndrome;
sinoatrial block;
severe bradycardia (HR<50 уд./мин.);
pronounced decrease in blood pressure (sBP<90 мм рт. ст.);
history of severe forms of bronchial asthma and COPD;
late stages of peripheral circulatory disorders, Raynaud's disease;
pheochromocytoma (without simultaneous use of alpha-blockers);
metabolic acidosis;
simultaneous use of MAO inhibitors, with the exception of MAO-B;
age under 18 years (efficacy and safety have not been established).
Carefully:
liver failure;
chronic renal failure;
Prinzmetal's angina;
myasthenia gravis;
thyrotoxicosis;
diabetes;
AV block of the first degree;
depression (including history);
psoriasis;
elderly age.
Side effects of the drug Concor
The frequency of the adverse reactions listed below was determined according to the following: very often (≥1/10); often (>1/100,<1/10); нечасто (>1/1000, <1/100); редко (>1/10000, <1/1000); очень редко (<1/10000, включая отдельные сообщения).
Cardiovascular system: very often - decreased heart rate (bradycardia, especially in patients with chronic heart failure); often - arterial hypotension (especially in patients with chronic heart failure), manifestation of vasospasm (increased peripheral circulatory disorders, feeling of cold in the extremities - paresthesia); infrequently - impaired AV conduction, orthostatic hypotension, decompensation of heart failure with the development of peripheral edema.
Nervous system: at the beginning of the course of treatment, central nervous system disorders may temporarily appear; infrequently - dizziness, headache, asthenia, increased fatigue, sleep disturbances, as well as mental disorders (infrequently - depression; rarely - hallucinations, nightmares, convulsions). Typically, these phenomena are mild and disappear, as a rule, within 1–2 weeks after the start of treatment.
Visual organs: rarely - blurred vision, decreased tear production (should be taken into account when wearing contact lenses); very rarely - conjunctivitis.
Respiratory system: rarely - allergic rhinitis; uncommon - bronchospasm in patients with bronchial asthma or obstructive airway diseases.
Gastrointestinal tract: often - nausea, vomiting, diarrhea, constipation, dry oral mucosa; rarely - hepatitis.
Musculoskeletal system: uncommon - muscle weakness, cramps in the calf muscles, arthralgia.
Allergic reactions: rarely - hypersensitivity reactions, such as itching, redness of the skin, sweating, rash; very rarely - alopecia. Beta blockers can aggravate psoriasis.
Genitourinary system: very rarely - potency disorders.
Laboratory indicators: rarely - increased levels of liver enzymes in the blood (AST, ALT), increased levels of triglycerides in the blood. In some cases - thrombocytopenia, agranulocytosis.
Method of administration and dosage of the drug Concor
Orally, the tablets should be taken without chewing, with a small amount of liquid in the morning before, during or after breakfast, 1 time per day.
Treatment of arterial hypertension and angina pectoris
In all cases, the doctor selects the regimen and dosage for each patient individually, in particular taking into account the heart rate and condition of the patient.
Usually the initial dose is 5 mg (1 tablet Concor® 5 mg) 1 time per day. If necessary, the dosage can be increased to 10 mg 1 time per day.
For the treatment of arterial hypertension and angina pectoris, the maximum recommended dose is 20 mg Concor® 1 time per day.
Treatment of chronic heart failure
Initiation of treatment for chronic heart failure with Concor® requires a special titration phase and regular medical monitoring.
Prerequisites for treatment with Concor® are as follows:
Chronic heart failure without signs of exacerbation in the previous 6 weeks,
Almost unchanged basic therapy in the previous 2 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 one was well tolerated.
The maximum recommended dose for the treatment of chronic heart failure is 10 mg of Concor® 1 time per day.
After starting treatment with the drug at a dose of 1.25 mg (1/2 tablet of the drug Concor® Cor), the patient should be observed for about 4 hours (monitoring heart rate, blood pressure, conduction disturbances, signs of worsening heart failure).
During or after the titration phase, temporary worsening of heart failure, fluid retention, 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 a diuretic and/or ACE inhibitor) before reducing the dosage of Concor®. Treatment with Concor® should only be interrupted 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 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 coronary artery disease. If discontinuation of treatment is necessary, the dosage of the drug should be reduced gradually.
Special patient groups
Impaired kidney or liver function
Treatment of hypertension or angina:
Mild or moderate hepatic or renal impairment usually does not require dose adjustment;
In case of severe renal impairment (Cl creatinine<20 мл/мин) и у пациентов с тяжелыми заболеваниями печени максимальная суточная доза - 10 мг.
Elderly patients: no dose adjustment is required.
Overdose of Concor
Symptoms: arrhythmia, ventricular extrasystole, severe bradycardia, AV block, marked decrease in blood pressure, acute heart failure, hypoglycemia, acrocyanosis, difficulty breathing, bronchospasm, dizziness, fainting, convulsions.
Treatment: gastric lavage and administration of adsorbent drugs; symptomatic therapy: for developed AV block - intravenous administration of 1–2 mg of atropine, epinephrine or placement of a temporary pacemaker; for 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 - intravenous plasma-substituting solutions, if ineffective - administration of epinephrine, dopamine, dobutamine (to maintain chronotropic and inotropic effects and eliminate a pronounced decrease in blood pressure); for heart failure - cardiac glycosides, diuretics, glucagon; for convulsions - intravenous diazepam; for bronchospasm - beta2-adrenergic stimulants by inhalation.
Interactions of the drug Concor with other drugs
The effectiveness and tolerability of drugs may be affected by the simultaneous use of other drugs. Such interaction can also occur in cases where 2 drugs are taken after a short period of time. You must inform your doctor that you are taking other drugs, even if you are taking them without a prescription.
Allergens used for immunotherapy or allergen extracts for skin testing increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving bisoprolol.
Phenytoin with intravenous administration, drugs for inhalation general anesthesia (hydrocarbon derivatives) 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 diphylline) may decrease due to a possible increase in their concentration in the blood plasma, especially in patients with an initially increased clearance of theophylline under the influence of smoking.
NSAIDs, corticosteroids and estrogens weaken the hypotensive effect of bisoprolol (Na+ retention, blockade of PG synthesis by the kidneys).
Cardiac glycosides, methyldopa, reserpine and guanfacine, CCBs (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV 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 effect of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins may be prolonged during treatment with bisoprolol.
Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedatives and hypnotics increase CNS depression.
Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. The treatment break 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; Rifampin shortens the half-life.
Special instructions when taking the drug Concor
It is not recommended to interrupt treatment abruptly and change the recommended dosage without first consulting your doctor, because this may lead to a temporary deterioration in heart function. Treatment should not be interrupted suddenly, especially in patients with coronary artery 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 once every 3-4 months), conducting an ECG, determining blood glucose in patients with diabetes (once every 4-5 months ). In elderly patients, it is recommended to monitor renal function (once every 4–5 months).
The patient should be trained in the method of calculating heart rate and instructed about the need for medical consultation in case of heart rate<50 уд./мин.
Patients using contact lenses should take into account that during treatment the production of tear fluid may decrease.
When used in patients with pheochromocytoma, there is a risk of developing paradoxical arterial hypertension (if effective alpha blockade is not previously achieved).
In case of thyrotoxicosis, Concor® can mask certain clinical signs of thyrotoxicosis (for example, tachycardia). Abrupt withdrawal of the drug in patients with thyrotoxicosis is contraindicated, as it can increase symptoms.
In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentrations to normal levels.
When taking clonidine simultaneously, it can be discontinued only a few days after discontinuation of Concor®.
It is possible that the severity of the hypersensitivity reaction may increase and there will be no effect from usual doses of epinephrine against the background of a burdened allergic history.
If planned surgical treatment is necessary, the drug should be discontinued 48 hours before general anesthesia. If the patient took the drug before surgery, he should select a drug for general anesthesia with minimal 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 adrenergic 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 (HR) is detected in elderly patients<50 уд./мин), выраженного снижения АД (сАД <100 мм рт. ст.), AV блокады необходимо уменьшить дозу или прекратить лечение.
Treatment should not be abruptly interrupted due to the risk of developing severe arrhythmias and myocardial infarction. The drug is discontinued gradually, reducing the dose over 2 weeks or more (reduce the dose by 25% in 3-4 days). The drug should be discontinued before testing the content of catecholamines, normetanephrine and vanillylmandelic acid in the blood and urine; antinuclear antibody titers.
Impact on the ability to drive a car and operate complex machinery
Bisoprolol does not affect the ability to drive a car in a study of patients suffering from coronary heart disease. 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 when consuming alcohol at the same time.
Storage conditions for the drug Concor
List B.: At a temperature not exceeding 30 °C.
Shelf life of the drug Concor
The drug Concor belongs to the ATX classification:
C Cardiovascular system
C07 Beta blockers
C07A Beta blockers
C07AB Selective beta1-blockers
Concor is a drug intended to lower blood pressure. In addition, it is used in the treatment of various heart disorders. Let's talk on the www.site about what Concor is, application, instructions for use, action, side effects of the medicine.
Action Concor
The active substance in the drug is bisoprolol. It helps to gently lower blood pressure. When using the drug, its effect begins to appear immediately.
The medicine is used for a long time. In this case, the condition gradually normalizes, stabilizes and remains so for another month after the end of treatment. In the treatment of functional disorders of the heart, the drug Concor helps normalize the heartbeat, reduces the need for oxygen in the heart muscle, and calms. When the drug is taken for therapeutic purposes as recommended, it does not have a negative, detrimental effect on other organs and systems of the body.
Concor is prescribed by a doctor for hypertension, chronic cardiac functional disorders, ischemia, and angina.
After taking the medicine, it begins to act within 1-3 hours. Its effect 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 diseases, Concor significantly improves their 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 and liver, the permissible doses of the product do not change significantly.
Contraindications
Instructions for use of Concor indicate that the drug is prohibited for use by people with hypersensitivity to the components of the drug. It should not be used in acute heart failure. Concor is contraindicated for people suffering from cardiogenic shock or sick sinus node syndrome. It cannot be used with sinoarterial blockade, a pronounced heart muscle contraction frequency that is less than 50 beats per minute.
The drug should not be taken in cases of very low blood pressure, lung diseases, or bronchial asthma. Taking Concor is contraindicated during pregnancy, as well as during breastfeeding.
There is currently no information about the effect of the drug on children. Therefore, it is not recommended for use by persons under 18 years of age.
This drug should be used with caution by those suffering from liver failure, myasthenia gravis, diabetes mellitus, psoriasis, and the elderly.
The effectiveness of using the drug Concor depends on the use of other medications. Therefore, before you start taking the drug, be sure to tell your doctor about all the medications you are using.
The drug should not be used when drinking alcohol, or when driving a vehicle.
The dosage of the medication is prescribed by the doctor, based on the severity of the disease, age, and general condition of the patient. Self-use of the drug can lead to negative consequences.
Side effects during use
The drug Concor has side effects:
From the nervous system - headache, insomnia, sleep disturbance. Dizziness, depression, hallucinations, general weakness, and fatigue may occur.
From the cardiovascular system - possible disturbances in the peripheral blood supply to organs and systems, the appearance of edema.
On the part of the visual system - decreased visual acuity, the appearance of conjunctivitis.
On the part of the respiratory system - allergic runny nose, the appearance of bronchospasm.
From the gastrointestinal tract - a feeling of nausea may occur, vomiting, intestinal upset (diarrhea or constipation) may occur. Dry mouth often appears, manifestations of hepatitis are rare.
From the musculoskeletal system – possible muscle weakness, cramps. Manifestations of allergies: skin rash, itching, increased sweating.
Ingoda, after long-term use of the drug, sexual dysfunction may appear.
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 you should read in detail before taking the medicine.
The drug is available only with a doctor's prescription. It should be stored out of the reach of children, at normal room temperature.