CONCOR 5MG PILLS
CONCOR 5MG PILLS - 50 TABS
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Indications and usage
- arterial hypertension;
- CHD (stenocardia);
- chronic heart failure.
Dosage and administration
At hypertension and ischemic heart disease the drug is prescribed on 1 tab. (5 mg of Bisoprolol fumarate) 1 time / day. At the beginning of treatment, 1/2 pill can be administered (2.5 mg of bisoprolol fumarate). If necessary, appoint 10 mg 1 time / day. A further increase in dose is justified only in exceptional cases. In all patients, the dose is selected individually, primarily taking into account the effectiveness of treatment and pulse rate.
Patients with impaired hepatic or renal function of mild or moderate severity, and elderly people correction dosing regimen is usually not required.
For patients with severe impaired renal function (with CC less than 20 ml / min) and patients with severe impaired liver function the maximum daily dose is 10 mg.
Concor is prescribed to patients with moderately severe and severe chronic heart failure (with an ejection fraction <= 35%, according to EchoCG), being in a stable state without aggravation in the last 6 weeks. You should not change the previous therapy for at least 2 weeks before taking Concor.Concor is prescribed in combination with an ACE inhibitor (or other vasodilator), a diuretic, and, if necessary, a cardiac glycoside.
The following dosing regimen is recommended: the initial dose of Concor Cor is 1.25 mg 1 time / day during the first week. During the second week of administration, 2.5 mg / day is prescribed. In the third week of treatment, the dose is 3.75 mg / day. From the fourth to the eighth week of administration, 5 mg are prescribed (2 pills of Concor Cor or 1 pill of Concor preparation containing 5 mg of bisoprolol fumarate or 1/4 pill of Concor containing 10 mg of bisoprolol fumarate). Then the dose is increased to 7.5 mg (from the eighth to the twelfth week). After the twelfth week of treatment, a maximum dose of 10 mg is prescribed (4 pills of Concor Cor or 2 pills of Concor containing 5 mg of bisoprolol fumarate or 1 pill of Concor containing 10 mg of bisoprolol of fumarate). The doctor may adjust the dosage regimen depending on the individual tolerance. After the start of treatment with Konkor Cor at a dose of 1.25 mg, a patient with chronic heart failure should be examined within 4 hours (BP, HR, conduction disturbances, worsening symptoms of heart failure). The occurrence of side effects may prevent patients from prescribing the maximum recommended dose. If necessary, the achieved dose can be gradually reduced. Treatment can be discontinued, if necessary, and then resumed in the same way.
In case of intolerance or worseningsymptoms of heart failure during the process of increasing the dose is recommended first to reduce the dose of Concor Cor or stop taking the drug (in case of severe hypotension, worsening symptoms of heart failure, accompanied by acute pulmonary edema, cardiogenic shock, bradycardia or AV blockade).
pills should be taken without chewing, with a small amount of liquid.
It is recommended to take Concor Cor in the morning on an empty stomach or during breakfast.
In the process of treatment requires regular monitoring by a physician. The course of treatment with Concor Cor is usually long.
The patient should not change the dose or interrupt treatment without the indication of the attending physician. Do not allow sudden discontinuation of treatment with Concor Cor. The course of treatment should be completed by gradually reducing the dose. This is especially important in the treatment of patients with coronary artery disease, as well as with chronic heart failure (in such cases, the dose should be reduced by 2 times weekly).
In all cases, the duration of drug treatment is determined by the doctor.
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.
Special senses: rarely - impaired vision, reduced tearing (should be considered when wearing contact lenses), conjunctivitis.
Cardiovascular: 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.
Respiratory: rarely - shortness of breath (in patients with a tendency to bronchospasm, including with bronchitis with broncho-obstructive syndrome).
Gastrointestinal: in some cases - diarrhea, constipation, nausea, abdominal pain, increased activity of liver enzymes in the blood plasma (AST, ALT), hepatitis.
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 - reddening of the skin, increased sweating, rash.
- AV blockade II and III degree;
- severe sinoatrial blockade;
- tendency to bronchospasm (bronchial asthma, obstructive respiratory diseases);
- late stages of impaired peripheral circulation;
- simultaneous administration of MAO inhibitors (with the exception of MAO inhibitors of type B);
- if you specify in the history of the presence of psoriasis in the patient or his relatives (the use of beta-blockers, including Concor Cor, should be made only after a thorough assessment of the balance between benefits and risks;
- pheochromocytoma (the appointment of Concor Cor to patients with pheochromocytoma is permitted only after taking alpha-blockers);
- in patients with chronic heart failure, Concor Cor should not be used during exacerbation of heart failure or during episodes of decompensation of heart failure, in which IV administration of drugs that affect myocardial contractility is required; in addition, for patients with chronic heart failure, Concor Cor is contraindicated in bradycardia, if the pulse is less than 50-60 / min and in arterial hypotension, if systolic BP is less than 90-100 mm Hg. st.
Pregnancy and breastfeeding
Concor should not be prescribed during pregnancy and lactation (breastfeeding) due to the lack of clinical experience with the drug in this category of patients.
In exceptional cases of use of Concor during pregnancy, treatment should be discontinued 72 hours before the expected due date of childbirth because of the possibility of bradycardia, hypoglycemia and respiratory depression in the newborn.If drug withdrawal is not possible, then after delivery the newborn must be under close supervision. Symptoms of hypoglycemia can be expected within the first 3 days.
Caution should be exercised in the treatment of patients with diabetes mellitus with significant fluctuations in blood glucose, because symptoms of hypoglycemia can be masked; in the treatment of patients on a strict diet; in the treatment of patients with metabolic acidosis; patients with a severe hypersensitivity reaction in the anamnesis; during desensitization therapy; with AV block I degree; with angiospastic angina (Prinzmetal stenocardia).
In some cases, the use of beta-blockers (including Concor) can cause the development or worsening of the course of psoriasis or lead to the appearance of psoriatic lesions on the skin.
While taking beta-blockers, more severe forms of hypersensitivity reactions may occur.
In the treatment of beta-blockers in some cases, there is hair loss, hearing loss or tinnitus, weight gain, mood changes, short-term memory loss, allergic rhinitis.
Before performing a surgical procedure, the anesthesiologist should be informed about the use of Concor.
Use in pediatrics
Do not prescribe Concor children because of the lack of clinical experience of the drug in this category of patients.
Influence on ability to drive motor transport and control mechanisms
The question of the possibility of practicing potentially hazardous activities requiring increased attention and quickness of psychomotor reactions should be resolved only after evaluating the patient's individual response to the drug (especially at the beginning of treatment or while drinking alcohol or ethanol-containing drugs).
Symptoms: bradycardia, arterial hypotension, heart failure, bronchospasm.
Treatment: gastric lavage, taking activated charcoal. With bradycardia or hypotension, intravenous atropine may be given in a dose of 1.5 to 2 mg, glucagon administration in a dose of 1-5 mg (up to 10 mg). In case of bronchospasm, beta2-adrenomimetics (for example, Salbutamol or fenoterol) are used.
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 may 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).
The drug should be kept out of the reach of children.