Niperten pills coated 5mg N30
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Active ingredients
Bisoprolol
Release form
Pills
Composition
Bisoprolol fumarate (2: 1) 5 mg adjuvants: microcrystalline cellulose, sodium carboxymethyl starch, povidone, anhydrous colloidal silicon dioxide, magnesium stearate film composition: hypromellose, macrogol, titanium dioxide, talc.
Indications
- arterial hypertension; - ischemic heart disease: prevention of strokes of stress; - chronic heart failure.
Contraindications
- shock (including cardiogenic); - collapse; - pulmonary edema; - acute heart failure; - chronic heart failure in the decompensation stage; - AV block II and III degree; - sinoatrial blockade; - SSSU; - severe bradycardia - Prinzmetal's angina; - Cardiomegaly (without signs of heart failure); - Hypotension (systolic blood pressure less than 100 mm Hg, especially with myocardial infarction); - Severe forms of bronchial asthma and COPD in history; - Simultaneous administration of MAO inhibitors ( with the exception of MAO type B); - late stages of violation peripheral blood circulation; Raynaud’s disease; pheochromocytoma (without simultaneous use of alpha-blockers); metabolic acidosis; age up to 18 years (efficacy and safety not established); hypersensitivity to the components of the drug; hypersensitivity to other beta adrenergic blockers. The drug should be used with caution in case of liver failure, chronic renal failure, myasthenia, thyrotoxicosis, diabetes mellitus, AV degree I blockade, depression (incl. in history), psoriasis, allergic reactions (in history) in elderly patients.
Precautionary measures
During treatment, psoriasis may worsen. During pheochromocytoma, propranolol can only be used after taking an alpha blocker. After a long course of treatment, propranolol should be discontinued gradually, under the supervision of a physician. during anesthesia, you must stop taking propranolol or find a remedy for anesthesia with minimal negative inotropic effects.The impact on the ability to drive vehicles and control mechanisms of patients whose activities require increased attention, the question of the use of propranolol on an outpatient basis should be addressed only after evaluating the individual response of the patient.
Use during pregnancy and lactation
Application during pregnancy and lactation is possible in the case when the expected benefit of therapy for the mother exceeds the risk of side effects in the fetus or infant. It should be borne in mind that the drug can cause intrauterine delay of the fetus, hypoglycemia, bradycardia. with breast milk is not. Therefore, if necessary, use of the drug during lactation breastfeeding should be stopped.
Dosage and administration
The drug is taken orally, in the morning on an empty stomach, without chewing, once. Arterial hypertension and coronary heart disease: prevention of strokes of angina; the recommended dose is 5 mg 1 time / day. If necessary, increase the dose to 10 mg 1 time / day. The maximum daily dose is 20 mg. In patients with impaired renal function with a CC of less than 20 ml / min, or with severely impaired liver function, the maximum daily dose is 10 mg. Dose correction in elderly patients is not required. Chronic heart failure Started treatment of chronic heart failure drug Niperten requires mandatory special period of selection of doses. The prerequisites for starting therapy are as follows: - chronic heart failure without signs of exacerbation in the preceding 6 weeks; - practically unchanged basic therapy in the previous 2 weeks; if necessary, cardiac glycosides. The maximum recommended dose of the drug Niperten is 10 mg 1 time / day. After starting treatment with the drug in a dose of 1.25 mg (1/2 tab. 2.5 mg), the patient should be monitored for about 4 hours (monitoring heart rate, blood pressure, ECG abnormalities, symptoms of worsening chronic heart failure). During the dose selection period or after it may experience a temporary deterioration in the course of chronic heart failure, fluid retention, arterial hypotension, or bradycardia.In this case, it is recommended, first of all, to pay attention to the selection of the dose of concomitant basic therapy (to optimize the dose of diuretic and / or ACE inhibitor), before lowering the dose of the drug Hypertension. Treatment with the drug should be interrupted only if absolutely necessary. After the patient's condition has stabilized, the patient should be re-titrated or continue treatment.
Side effects
CNS and peripheral nervous system: fatigue, weakness, dizziness, headache, sleep disorders, depression, anxiety, confusion or short-term memory loss, hallucinations, asthenia, myasthenia gravis, paresthesia in the extremities (in patients with intermittent claudication and Raynaud’s syndrome) ), tremor, convulsions. On the part of the organ of vision: blurred vision, reduction of secretion of the tear fluid, dryness and soreness of the eyes, conjunctivitis. On the side of the cardiovascular system: sinus bradycardia, heart ebienia, myocardial conduction disturbance, AV blockade (up to the development of complete transverse blockade and cardiac arrest), arrhythmias, weakening of myocardial contractility, development (aggravation) of chronic heart failure (swelling of ankles, feet, shortness of breath), reduction of blood pressure, orthostatic hypotension angiospasm (increased disturbance of peripheral circulation, cooling of the lower extremities, Raynaud's syndrome), chest pain, withdrawal syndrome (increased angina attacks, increased blood pressure). On the part of the digestive system: dryness oral mucosa, nausea, vomiting, abdominal pain, constipation or diarrhea, abnormal liver function (dark urine, sclera or skin jaundice, cholestasis), increased activity of ALT and ACT, increased bilirubin, changes in taste. From the respiratory system: nasal congestion, difficulty breathing when administered in high doses (loss of selectivity) and / or in susceptible patients - laryngitis and bronchospasm. From the endocrine system: hyperglycemia (in patients with insulin-dependent diabetes mellitus), hypoglycemia (in patients with sex) insulin), hypothyroid state. Allergic reactions: pruritus, rash, urticaria. Dermatological reactions: increased sweating, skin flushes, exanthema, psoriasis-like skin reactions, exacerbation of psoriasis symptoms, alopecia. hcalf muscles), back pain, arthralgia. On the part of the reproductive system: decreased libido, decreased potency. On the hematopoietic system: thrombocytopenia (unusual hemorrhages and hemorrhages), agranulocytosis, leukopenia. On the side of metabolism: an increase in triglycerides.
Overdose
Symptoms: arrhythmia, ventricular premature beats, severe bradycardia, AV-blockade, marked reduction in blood pressure, chronic heart failure, finger or palm nail cyanosis, difficulty breathing, bronchospasm, dizziness, fainting, cramps. Treatment: gastric lavage and prescription of adsorbing agents. Symptomatic therapy: with developed AV blockade - in / in the introduction of 1-2 mg of atropine, epinephrine or temporary staging of a pacemaker; for ventricular premature beats, lidocaine (class I A drugs are not used); with a decrease in blood pressure - the patient should be in the position of Trendelenburg; if there are no signs of pulmonary edema - in / in the introduction of plasma-substituting solutions, with ineffectiveness - administration of epinephrine, dopamine, dobutamine (to maintain chronotropic and inotropic action and eliminate pronounced decrease in blood pressure); in heart failure - cardiac glycosides, diuretics, glucagon; with convulsions - in / in diazepam; with bronchospasm - beta2-adrenostimulators inhalation.
Interaction with other drugs
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 radiopaque agents for IV administration increase the risk of anaphylactic reactions. inhalation anesthesia (derivatives of hydrocarbons) increase the severity of the cardiodepressive action of bisoprolol and the likelihood of a decrease in blood pressure. Nipertenis changes the effectiveness of insulin and hypoglycemic agents for oral administration, masks the symptoms of developing hypoglycemia (tachycardia, increased blood pressure). Bisoprolol reduces the clearance of lidocaine and xanthines (except theophylline) and increases their concentration in the blood plasma, especially in patients with initially increased clearance of theophylline under the influence of smoking. Hypotensive effect weaken NSAIDs (sodium ion retention and blockade of prostaglandin synthesis by the kidneys), GCS and estrogens (sodium ion retention). Cardiac glycosides, methyldopa, reserpine and guanfacine, slow calcium blockers x channel (verapamil, diltiazem),amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV blockade, cardiac arrest and heart failure. Nyphedipine 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. non-depolarizing muscle relaxants and increases the anticoagulant effect of coumarins. Tri-and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedatives and soporosis It is not recommended to use simultaneously with MAO inhibitors, due to a significant increase in the hypotensive effect, the treatment gap between taking MAO inhibitors and bisoprolol should be at least 14 days. Unhydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders. Ergotamine increases the risk development of peripheral circulatory disorders; sulfasalazine increases the concentration of bisoprolol in the blood plasma; rifampicin reduces.
special instructions
The condition of patients receiving Niperten should be monitored: measurement of heart rate and blood pressure (at the beginning of treatment - daily, then - once every 3-4 months), ECG, determination of blood glucose level in patients with diabetes mellitus (1 time in 4-5 months ). In elderly patients, it is recommended to monitor renal function (1 time in 4-5 months). The patient should be trained in the method of counting heart rate and instructed on the need for medical consultation with a heart rate less than 50 beats / min. Before starting treatment, it is recommended to conduct a study of the function of external respiration in patients with burdened bronchopulmonary history. Approximately in 20% of patients with angina, beta-blockers are ineffective. The main reasons are pronounced coronary atherosclerosis with a low ischemic threshold (HR less than 100 beats / min) and an increased end-diastolic volume of the left ventricle that disrupts subendocardial blood flow. In smokers, beta-adrenergic blockers are lower in efficacy. Patients using contact lenses should take into account that against the background of treatment, there may be a decrease in the production of tears. When using the drug in patients with pheochromocytoma, there is a risk of developing paradoxical hypertension (if not previously achieved effective alpha-adrenoblokada). When thyrotoxicosis, bisoprolol can mask certain clinical signs of thyrotoxicosis (for example, tachycardia).Abrupt cancellation in patients with thyrotoxicosis is contraindicated, as symptoms may increase. In diabetes mellitus, it may mask tachycardia caused by hypoglycemia. In contrast to non-selective beta-adrenergic blockers, insulin-induced hypoglycemia practically does not increase and does not delay the restoration of glucose concentration in the blood to normal levels. With simultaneous use of clonidine, its administration can be stopped only a few days after discontinuation of the drug Niperten. lack of effect from the usual doses of epinephrine on the background of burdened allergological anamnesis. If necessary, a planned surgeon cal treatment abolition of the drug is carried out for 48 hours prior to 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 introducing atropine (1-2 mg). Drugs that reduce catecholamine stores (in t. h. reserpine), can enhance the action of beta-blockers, so patients receiving such combinations of drugs, requires constant monitoring by a doctor to identify pronounced lowering of blood pressure or bradycardia. Cardioselective beta-blockers can be prescribed to patients with bronchospastic diseases in case of intolerance and / or failure of other antihypertensive drugs. Overdose is dangerous for the development of bronchospasm. In case of increasing bradycardia (less than 50 beats / min) in elderly patients, pronounced decrease in blood pressure (systolic blood pressure below 100 mm Hg), AV blockade, it is necessary to reduce the dose or discontinue treatment. discontinue therapy in the development of depression. You can not abruptly interrupt treatment because of the risk of developing withdrawal syndrome (severe arrhythmia and myocardial infarction). Cancellation is carried out gradually, reducing the dose for 2 weeks or more (reduce the dose by 25% in 3-4 days). Niperten should be canceled before the examination of the content in the blood and urine of catecholamines, normetanephrine and vanillin almond acid,antinuclear antibodies dizziness).