CONCOR PILL 10 MG

Mechanism of action

Concor is a selective beta1-adrenergic blocker. When used in therapeutic doses, it has no intrinsic sympathomimetic activity and clinically significant membrane stabilizing properties.

After ingestion, the action develops in 1-3 hours and lasts for 24 hours.

It has a hypotensive effect due to a decrease in cardiac output, inhibition of renin secretion by the kidneys, an effect on the baroreceptors of the aortic arch and carotid sinus. With long-term intake, Concor reduces the initially elevated OPSS.

It has antianginal effect. Decreases myocardial oxygen demand by reducing heart rate, reducing cardiac output and reducing blood pressure. Increases the supply of oxygen to the myocardium by reducing the final diastolic pressure and lengthening diastole.

In chronic heart failure, Concor suppresses the activated sympatho-adrenal and renin-angiotensin-aldosterone system, which leads to an improvement in the course of the disease.

Indications and usage

• arterial hypertension;
• CHD (angina pectoris);
• chronic heart failure.

Composition

1 pill contains:

Active substance: bisoprolol fumarate 10 mg;

Excipients: colloidal silicon dioxide, Magnesium stearate, crospovidone, microcrystalline cellulose, corn starch, Calcium phosphate, dimethicone 100, macrogol 400, ferric oxide, titanium oxide, methyl hydroxypropylcellulose.

Dosage and administration

The drug is taken orally 1 time per day. pills should be taken with a small amount of liquid in the morning before breakfast, during or after it. pills should not be chewed or powdered.

Hypertension and Angina

The dose is selected individually, primarily taking into account the heart rate and the patient's condition.

As a rule, the initial dose is 5 mg 1 time per day. If necessary, the dose can be increased to 10 mg 1 time / day. In the treatment of hypertension and angina, the maximum recommended dose is 20 mg 1 time per day.

Chronic heart failure

The standard treatment regimen for chronic heart failure includes the use of ACE inhibitors or angiotensin II receptor antagonists (in the case of intolerance to ACE inhibitors), beta-blockers, diuretics, and, optionally, cardiac glycosides.At the beginning of the treatment of chronic heart failure with Concor®, it is necessary to conduct a special titration phase under regular medical supervision.

A precondition for treatment with Concor® is stable chronic heart failure with no signs of exacerbation.

Treatment 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, that is, the dose can be increased only if the previous dose was well tolerated.

To ensure an appropriate titration process at the initial stages of treatment, Bisoprolol is recommended in the dosage form of a 2.5 mg tablet.

The recommended initial dose is 1.25 mg 1 time / day. Depending on individual tolerance, the dose should be gradually increased to 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg 1 time / day. Each subsequent increase in dose should be carried out no less than 2 weeks. If an increase in the dose of the drug is poorly tolerated by the patient, then a dose reduction is possible.

The maximum recommended dose in the treatment of chronic heart failure is 10 mg 1 time / day.

During titration, regular monitoring of blood pressure, heart rate and the severity of symptoms of chronic heart failure is recommended. The aggravation of the symptoms of chronic heart failure is possible from the very first day of using the drug.

If the patient does not tolerate the maximum recommended dose of the drug, then the possibility of gradually reducing the dose should be considered.

During the titration phase or after it, a temporary deterioration in the course of chronic heart failure, hypotension or bradycardia is possible. In this case, it is recommended, first of all, to adjust the doses of drugs associated therapy. It may also require a temporary reduction in the dose of Concor® or its withdrawal. After the patient's condition has stabilized, a dose titration should be repeated, or the treatment should be continued.

The duration of treatment for all indications

Treatment with Concor® is usually long lasting.

Special patient groups

Patients with impaired hepatic or renal function of mild or moderate severity, as well as elderly patients, as a rule, do not need to adjust the dosage regimen.

With pronounced impaired renal function (CC less than 20 ml / min) and in patients with severe liver diseases, the maximum daily dose is 10 mg. Increasing the dose in these patients should be carried out with extreme caution.

Elderly patients dose adjustment is not required.

Since There is not enough data on the use of Concor® in children, it is not recommended to prescribe the drug to children under 18 years of age.

To date, there is insufficient data regarding the use of Conkor® in patients with chronic heart failure in combination with type 1 diabetes mellitus, severe impaired renal and / or liver function, restrictive cardiomyopathy,congenital heart disease or valvular heart disease with severe hemodynamic disorders. Also, so far not enough data have been obtained regarding patients with chronic heart failure with myocardial infarction in the last 3 months.

From the side of the central nervous system and peripheral nervous system: possible (especially at the beginning of the course of treatment) feeling of fatigue, dizziness, headache, sleep disturbance, depression; rarely - hallucinations. Usually these phenomena are mild and usually disappear within 1-2 weeks.

On the part of the organ of vision: rarely - impaired vision, reduced tearing (should be considered when wearing contact lenses), conjunctivitis.

Since the cardiovascular system: in some cases - orthostatic hypotension, bradycardia, impaired AV conduction, decompensation of heart failure with the development of peripheral edema; paresthesias and feeling of coldness in the limbs are possible. At the beginning of treatment, the condition may worsen in patients with intermittent claudication or Raynaud's syndrome.

On the part of the respiratory system: rarely - shortness of breath (in patients with a tendency to bronchospasm, including with bronchitis with broncho-obstructive syndrome).

From the digestive system: in some cases - diarrhea, constipation, nausea, abdominal pain, increased activity of liver enzymes in the blood plasma (AST, ALT), hepatitis.

From the musculoskeletal system: in some cases, muscle weakness, muscle cramps, arthropathy with damage to one or more joints (mono- or polyarthritis).

On the part of the endocrine system: reduced glucose tolerance (with latent diabetes) and masked signs of hypoglycemia; in some cases - an increase in the level of triglycerides in the blood.

From the reproductive system: in some cases - a violation of potency.

Dermatologic: itching is possible; rarely - redness of the skin, increased sweating, rash.

Drug interactions

With simultaneous use Concor may enhance the effect of antihypertensive drugs.
With simultaneous use of Concor and reserpine, alpha-methyldopa, clonidine, digitalis or guanfacine, a sharp decrease in heart rate is possible.
With simultaneous use of Concor and clonidine, digitalis preparations, as well as guanfacine, conduction disturbances are also possible.
With the simultaneous use of Concor and sympathomimetics (including those contained in cough drops, nose drops and eye drops), the effect of bisoprolol may be reduced.
With the simultaneous use of Nifedipine and other calcium channel blockers - dihydropyridine derivatives can enhance the antihypertensive effect of Concor.
With simultaneous use of Concor and Verapamil or diltiazem and other antiarrhythmic drugs, a sharp decrease in blood pressure, a decrease in heart rate, and the development of arrhythmia and / or heart failure (careful medical supervision is required) is possible.It is not necessary to inject IV calcium channel blockers and antiarrhythmic drugs during therapy with Concor.
With simultaneous use of Concor and clonidine, the latter can be canceled only if Concor was taken a few days before, due to the risk of an excessive increase in blood pressure.
At the same time taking ergotamine derivatives (including ergotamine-containing agents for the treatment of migraine) and Concor may increase the violations of the peripheral circulation.
When taking Concor and rifampicin at the same time, a slight decrease in T1 / 2 of bisoprolol is possible (an increase in the dose of Concor is usually not required).
With simultaneous use of Concor and insulin or oral hypoglycemic agents may increase the hypoglycemic action. Symptoms of hypoglycemia are masked or alleviated (regular monitoring of plasma glucose levels is necessary).

Overdose

Symptoms: most often, AV blockade, severe bradycardia, marked reduction in blood pressure, bronchospasm, acute heart failure and hypoglycemia. The sensitivity to a single dose of a high dose of bisoprolol varies greatly among individual patients and, probably, in patients with chronic heart failure, sensitivity is high.

Treatment: in the event of an overdose, first of all, you must stop taking the drug and begin supportive symptomatic therapy.

With severe bradycardia - in / in the introduction of atropine.If the effect is insufficient, then with caution you can enter a tool that has a positive chronotropic effect. Sometimes you may need a temporary setting of an artificial pacemaker.

With a pronounced decrease in blood pressure - in / in the introduction of plasma-substituting solutions and vasopressor drugs.

With AV blockade - constant clinical control, the appointment of beta-adrenomimetics, such as epinephrine. If necessary - staging an artificial pacemaker.

With exacerbation of chronic heart failure - in / in the introduction of diuretics, drugs with a positive inotropic effect, as well as vasodilators.

In case of bronchospasm - the appointment of bronchodilators, incl. β2-adrenomimetics and / or aminophylline.

When hypoglycemia - in / in the introduction of dextrose (glucose).

The drug should be kept out of the reach of children.