Nebilong Am pills 5mg + 5mg N30
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Active ingredients
Nebivolol + Amlodipine
Release form
Pills
Composition
Amlodipine (in the form of besylate) 5.0 mg; Nebivolol (in the form of hydrochloride) 5.0 mg
Pharmacological effect
Nebilong AM is a III generation cardioselective beta-blocker with vasodilating properties. The active substance is a racemate consisting of two enantiomers: D-nebivolol and L-nebivolol. Nebivolol is a competitive and selective blocker of β1-adrenoreceptors (affinity for β1-adrenoreceptors is 288 times higher than for β2-adrenoreceptors), in addition, it has a mild vasodilating effect by modulating the release of relaxing factor (NO) from the vascular endothelium. Nebivolol reduces heart rate and blood pressure at rest and under load, reduces the end diastolic pressure of the left ventricle, lowers the round neck, improves the diastolic function of the heart (decreases filling pressure), increases the ejection fraction; causes an antianginal effect in patients with IHD. Optimal hypotensive effect occurs after 1-2 weeks of treatment. In some cases, the maximum effect is achieved after 4 weeks.
Indications
Essential (primary) arterial hypertension, ischemic heart disease.
Contraindications
Bronchial asthma, chronic heart failure in the stage of decompensation, untreated pheochromocytoma, severe liver dysfunction, depression, angiospastic stenocardia (Prinzmetal's angina), peripheral vascular obliterating diseases (intermittent claudication), arterial hypotension, cardiogenic syndrome, arthritic hypotension, cardiogenic syndrome, arthritic hypotension, cardiogenic syndrome, arthritic hypotension, cardiogenic syndrome, heart failure, chrompathy, cardiogenic syndrome / min), SSSU, AV blockade II and III degrees, myasthenia gravis, muscular weakness, children and adolescents under 18 years of age, hypersensitivity to nebivolol.
Use during pregnancy and lactation
Use during pregnancy is possible only under strict indications (due to the possible development of newborn bradycardia, arterial hypotension, hypoglycemia and respiratory paralysis). Reception of nebivolol should be stopped 48-72 hours before delivery. In cases where this is not possible, strict monitoring of newborns should be ensured within 48-72 hours after delivery.
Dosage and administration
Inside, at the same time of day, without chewing, squeezed with a sufficient amount of water, during or after a meal - 5 mg 1 time per day. Patients with renal insufficiency or patients over 65 years old - 2.5 mg / day. The maximum daily dose is 10 mg.
Side effects
On the part of the central nervous system and peripheral nervous system: headache, dizziness, fatigue, paresthesia, depression, decreased concentration, drowsiness, insomnia, nightmares, hallucinations. ; On the part of the digestive system: nausea, constipation, diarrhea, dry mouth. ; Since the cardiovascular system: bradycardia, orthostatic hypotension, shortness of breath, edema, heart failure, AV-blockade, cardiac arrhythmias, Raynaud's syndrome, cardialgia. ; Allergic reactions: skin rash. ; Other: bronchospasm (including in the absence of obstructive pulmonary disease in history), photodermatosis, hyperhidrosis, rhinitis.
Overdose
Symptoms: bradycardia, arterial hypotension, bronchospasm, acute heart failure .; Treatment: gastric lavage, taking activated carbon, the appointment of laxatives; possible IVL and the introduction of atropine (with bradycardia and increased vagotonia), plasma or plasma substitutes, if necessary - catecholamines. For edema beta-adrenergic blocking action - isoprenaline hydrochloride (slowly, in / in, in the initial dose of 5 mcg / min to achieve the desired effect), dobutamine (in the initial dose - 2.5 mcg / min), in the absence of the effect - glucagon (in (50–100 mcg / kg, again after 1 h - 70 mcg / kg / h by infusion). When AV blockade - transvenous stimulation.
Interaction with other drugs
Calcium channel blockers increase the blockade of AV conduction, class I antiarrhythmics and amiodarone lengthen the time of excitation in the atria. Anesthetic agents (cyclopropane, diethyl ether, trichloroethylene), tricyclic antidepressants, barbiturates, phenothiazine derivatives potentiate hypotension, cimetidine and nicardipine increase plasma concentrations, and sympathomimetics level activity.
special instructions
It is necessary to stop therapy gradually (within 1-2 weeks). Decrease in heart rate to 55 beats / min requires dose reduction. Against the background of diabetes, it is possible to mask signs of hypoglycemia, with hyperfunction of the thyroid gland - tachycardia. May exacerbate reactions to pollen and other allergens. It should be canceled 24 hours before surgery using general anesthesia (including surgical dentistry) or choose an anesthetic with the least negative inotropic effect.If necessary, the simultaneous appointment of antacids nebivolol taken during meals, and antacids - between meals. Use with caution while working drivers of vehicles and people whose profession is associated with increased concentration of attention. At the time of treatment is recommended to exclude alcohol intake.