Betaloc Zok 25mg Astrazeneca treatment for hypertension (1 blister x 14 tablets)

Dosage form Box of 1 blister x 14 tablets
Specifications Metoprolol Succinat
Ingredient Astra

Ingredient

Composition information	Content
Metoprolol Succinat	23.75mg

Uses

Indications

Betaloc ZOK 25mg Treatment of hypertension: Reducing blood pressure and reducing the risk of cardiovascular death and coronary artery disease (including sudden death) and organ damage rate.

Long -term treatment of angina: Reducing attack frequency and improving exertion tolerance.

Treatment of chronic heart failure, stability from medium to severe with reduced left ventricular systolic function (blood emulsion fraction ≤ 40%): Combining enzyme inhibitors, diuretic and cardiological digitals.

Preventive treatment after myocardial infarction.

Treatment of some tachycardia: such as ventricular tachycardia (tachycardia, atrial fibrillation and atrial, tachycardia) or ventricular tachycard (ventricular tachycardia, dramatic tachycardia).

Pharmacokology

metoprolol is a beta-1 selective beta inhibitor, meaning it only inhibits the beta-1 receptor at a much lower doses than the dose needed to inhibit the beta-2 receptors.

Metoprolol has negligible membrane stability and has no partial interactive sympathetic activity.

Metoprolol reduces or inhibits the sympathetic impact on the hearts of catecholamine (these substances are released when there is a psychological stress). This means that the increase in heart rate, cardiac supply, myocardial and blood pressure contracts due to increased concentration of catecholamine will be reduced by metoprolol. When the endogenous adrenaline concentration, Metoprolol less affects blood pressure control than unsatisfactory beta inhibitors.

When required, Betaloc Zok can be used in combination with a beta-2 transport owner for patients with symptoms of obstructive pulmonary disease. When used with Beta-2 Betaloc Zok in the treatment, the dosage is less acting on the bronchodilator due to the beta-2 transport owner than the unsatisfactory beta inhibitors.

Betaloc ZOK gives stable plasma concentrations over time and creates an effect (Beta-1 breast) of more than 24 hours compared to the conventional forms of cells of selective inhibitors Beta-1.

Due to stable plasma concentrations, the clinical beta-1 receptor selection is improved in Betaloc Zok's formula when compared to the conventional forms of cellular tablets of Beta-1 selective inhibitors. Moreover, adverse effects related to peak plasma concentrations such as heartbeat and feet are also reduced.

Betaloc ZOK has little influence on insulin release and sugar metabolism compared to unsatisfactory beta inhibitors.

Betaloc ZOK also has little effect on the response of the heart for hypoglycemia compared to unsatisfactory beta inhibitors.

Short -term studies show that Betaloc Zok may slightly increase triglycerides and reduce free fatty acids in the blood. In some cases, the high density lipoprotein ratio (HDL) may decrease slightly, but at a lesser level when using unsatisfactory beta inhibitors. However, in a study performed over the years, after treatment with Metoprolol, the total cholesterol level in serum decreased significantly.

During the Betaloc Zok treatment period, the quality of life is maintained and improved.

The improvement of the amount of life is recorded after treatment with Metoprolol for patients after myocardial infarction.

pharmacokinetic

absorption

Betaloc ZOK 25mg is completely absorbed when taken. Birth after using the only dose is about 50%. Born reduced by about 20-30% for long -lasting release drugs compared to conventional cell tablets but does not important effects on clinical efficiency.

Distribution

Metoprolol combined with low plasma proteins, about 5-10%.

Metabolism

metoprolol metabolizes the liver with oxidation, mainly through CYP2D6 enzyme. The three main metabolites have no active beta inhibition activity.

Elimination

Over 95% of the dose is found in urine in about 5% in constant form. Metoprolol's excretion half -life is 3.5 hours. Total clearance about 1 liter/minute.

Before taking Betaloc Zok 25mg Astrazeneca treatment for hypertension (1 blister x 14 tablets)

How to use

Use Betaloc ZOK 25mg 1 time/day and best in the morning.

Take the whole tablet or ½ capsule (break the division) with water, do not chew or grind. Food does not affect the bioavailability of the drug.

Dosage

Dosage for adults.

Treatment of hypertension

Light - medium level: 2 tablets (50 mg)/day.

If the patient does not respond, it may increase to 4-8 tablets (100 - 200 mg)/day and/or in combination with other hypertension medications.

Long -term treatment of angina

4 - 8 tablets (100 - 200 mg)/day, can be combined with other angina medications.

Treatment of chronic heart failure, stability from medium to severe with reduced left ventricular systolic function (blood emulsion fraction ≤ 40%) in combination with enzyme inhibitors, diuretic and in most cases with heart support digitalis.

Patients must have a stable chronic heart failure, no acute manifestation in the last 6 weeks and are taking a basic therapy needed unchanged in the last 2 weeks. Treatment of heart failure with beta inhibitors can sometimes temporarily increase symptoms. In some cases, treatment may continue to treat or reduce the dose, and in other cases, it is necessary to stop treatment. The starting dose for patients with severe heart failure (Grade IV according to NYHA) must be indicated by intensive heart failure treatment.

Heart failure II

In the first 2 weeks: 1 tablet (25 mg)/day.

after 2 weeks, an increase of 2 tablets (50 mg)/day and then double the dose every 2 weeks.

The target dose for long -term treatment is 8 tablets (200 mg)/day.

should adjust the dose for each patient and monitor patients closely during the dose increasing because the symptoms of heart failure may become serious in some patients.

after 1-2 weeks can increase to 1 tablet (25 mg)/day.

If the patient is tolerated, double the dose every 2 weeks to a maximum dose of 8 tablets (200 mg)/day.

Hypotension at the beginning of the miserable treatment means that Betaloc Zok cannot tolerate chronic heart failure, but do not increase the dose until the patient has stabilized and need to enhance the control of renal function.

Treat some tachycardia

4 - 8 tablets (100-200 mg)/day.

Preventive treatment after myocardial infarction

Long -term treatment at a dose of 8 tablets (200 mg)/day reduces the risk of death (including sudden death) and reduces the risk of cardiomyopathy (common in diabetics).

Nephrotic function: No dose adjustment.

Liver function: usually does not need to adjust the dose. However, when there are signs of serious liver failure (for example, a patient with a shunt) should be reduced.

Elderly: No dose needed.

Children: There is no recommendation to specify Betaloc Zok.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose?

Symptoms:

Symptoms on the heart are the most important, but in some cases, especially in children and adolescents, nervous and respiratory symptoms can dominate.

Slow heart rate, atrial atrial block I - III, extend the period of QT (in several exceptions), heart -hearted, reduced blood pressure, poor peripheral perfusion, heart failure, heart shock.

Respiratory failure, apnea.

Other symptoms: fatigue, confusion, coma, tremor, cramps, sweating, paresthesia, bronchospasm, nausea, vomiting, can be spasms of esophageal, hypoglycemia (especially in children) or hyperglycemia, hyperkalemia.

affects the kidneys.

Simultaneously used with alcohol, medication to treat hypertension, quinidin or barbiturat can worsen the patient condition.

Early expression of overdose from 20 minutes to 2 hours after taking the drug.

Treatment:

It is necessary to take care of patients in medical facilities with all appropriate support equipment, monitoring and monitoring. If appropriate, gastric and/or activated carbon can be washed. Atropine, an irritant nervous system or pacemaker used to treat slow heart rate symptoms and conduction disorders. The intubation and mechanical ventilation should be made with very wide indications. The pacemaker is an optional therapy. If the circulation is stopped due to overdose, can be cured by resuscitation measures for a few hours.

Hypotension, acute heart failure and shock are treated by increasing the appropriate body fluid volume, Glucagon injection (if necessary, then glucagon intravenous infusion), intravenously stimulating sympathetic nervous systems such as Dobutamin, and supplementation of α1 receptor -mastering drugs when vascular dilatation occurs, may consider using Ca2+ ionic ionic solution. Treatment of bronchodial spasms with bronchodilators.

What to do when you forget 1 dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

Common, ADR> 1/100

Body: weakness. 1/1000

Digestive: Vomiting

Cardiovascular: heart failure, hypotension, chest pain, heart shock in patients with myocardial infarction. Sweat.

Neurological: Perception. Raynaud, which worsens the pain of the recovery, necrosis in patients with severe peripheral circulatory disorders, stroke. Morning. Drugs.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Contraindicated

betaloc zok 25mg contraindicated in the following cases:

Acute heart failure, loss of heart failure must be treated with myocardial contraction drug. (systolic blood pressure Be cautious when using

Before starting to use Metoprolol Succinate: It is necessary to treat chronic heart failure symptoms with optimal dose (Move inhibitors, diuretics and conventional digitals).

Must ensure the status of stabilizer for at least 4 weeks before the first treatment with Metoprolol Succinate. Metoprolol Succinate medical monitoring should be considered, because it is similar to any other beta inhibitors, which can lead to a more severe heart failure due to the effect of reducing heart contractions, especially during the dose adjustment period.

Do not suddenly stop treatment, especially in patients with chim (risk of serious arrhythmia, myocardial infarction and sudden death unless really necessary (slow heart rate, serious hypotension, heart shock or atrial block).

After the first medication: monitoring heart rate, electrocardiogram, blood pressure when lying and standing, signs of intolerance, dizziness, shortness of breath for at least 3 hours after taking the drug.

Whenever the dose increases: Check the heart rate, blood pressure when lying and standing, clinical and electrocardiogram. Periodically monitor heart failure, hemodynamic, kidney function when effective, if necessary.

Chronic obstructive pulmonary and obstructive pulmonary disease (COPD): only use Betaloc ZOK in a mild case with a low starting dose. Before starting to use, check the respiratory function. If the malignant asthma occurs and COPD exacerbations during treatment can use bronchodilators Beta.

Slow heart rate (

Atrial atrial block 1: Precautions when indicated because Betaloc ZOK reduces the atrial -ventilated transmission speed.

Prinzmetal angina: Betaloc Zok 25mg can cause an increase in the number of times and the time of the prinzmetal angina. In the form of coordination and small scale, simultaneously selected beta 1 inhibitors with a vasodilator.

Peripheral artery disorders: The drug may aggravate the peripheral artery disorders (Raynaud's syndrome/artery disease, chronic underground arteritis). In this case, you should be carefully used for selective beta inhibitors on the heart with partial activity.

Chrome -preferred cell tumor of the adrenal marrow: Only Metoprolol Succinate after the patient has this tumor treated with Alpha receptor inhibitors.

Diabetes: Symptoms of hypoglycemia such as abnormal tachycardia, suspense and sweat may be covered. Patients should control blood sugar by themselves to prevent and maintain at the early stages of the treatment process.

Psoriasis: Only beta inhibitors (including Metoprolol) after evaluation of benefits and risks.

Allergic reactions: Metoprolol may aggravate anaphylactic reaction and cause resistance when treated with adrenalin with normal doses, especially when using Floctafenin or during the treatment of sensitivity.

Anesthesia: Metoprolol and anesthetics have the effect of reducing cardiac contraction. For patients with severe coronary artery failure, such as prolonged heart failure treated with Metoprolol Succinat, it is advisable to continue treating until surgery because there may be risks when suddenly stopping beta inhibitors. Do not start using Metoprolol for patients who are about to have non-cardiac surgery.

Systemic poisoning: Betaloc ZOK can cover the signs of the cardiovascular system.

Sports: The drug contains active ingredient Metoprolol can cause a positive reaction to doping tests.

The ability to drive and operate machinery

Betaloc Zok 25mg medicine may be stunned and tired, so be careful when driving or operating machinery.

Pregnancy

Betaloc ZOK 25mg causes reducing placental perfusion, related to developmental retardation, fetal loss, miscarriage and early labor. Therefore, it is necessary to carefully monitor the mother and fetus while being treated with Betaloc Zok.

Infants whose mothers used to use beta inhibitors, the activity of the drug still exists a few days after birth and can lead to slow heart rate, respiratory failure, hypoglycemia but these accumulation do not cause clinical consequences.

However, there are cards that avoid heart failure cases need to be actively treated by reducing the compensation reactions of the cardiovascular system when suffering from heart failure and at the same time avoiding excessive infusion (the risk of acute pulmonary edema). Therefore, under normal medication conditions, the drug can be taken during the fetal life if necessary. In case the mother needs to be treated until birth, it is necessary to closely monitor babies (heart rate and blood sugar for the first 3-5 days from birth).

breastfeeding period

betaloc zok 25mg is excreted through breast milk. Hypoglycemia and slow heart rate appear when using beta inhibitors that are less related to plasma proteins. Women who are breastfeeding should not use pesticides when essential.

Medicinal interaction

metoprolol is a metabolic substrate of Cytochrome P450 Isoenzyme CYP2D6. These induction or inhibition drugs may affect the plasma concentrations of Metoprolol. Metoprolol levels in plasma may increase when used simultaneously with active ingredients metabolized through CYP2D6, such as anti-arrhythmia, antihistamine drugs, Histamine 2, antidepressants, antidepressants, psychotic drugs and COX-2 inhibitors. Metoprolol concentration in plasma decreases by ritampicin and can be increased by alcohol and hydralazine.

Need to monitor when used simultaneously with sympathetic inhibitors, other beta receptor inhibitors (for example, eye drops) or enzyme inhibitors.

When discontinued in combination with clonidine, beta inhibitors should be discontinued a few days before stopping clonidine.

Should monitor the effect of inhibiting heart contraction and slow heart rate when using Metoprolol combination with calcium channel blockers of the Verapamil and Diltiazem and/or anti -arrhythmic drugs. When patients are taking beta receptor inhibitors, calcium channel blockers should not be injured in the Verapamil group.

Beta inhibitors can increase the inhibition of myocardial and delayed congestion of anti -arrhythmia (Quinidine and Amiodarone groups).

Beta inhibitors combined with digitalis glycoside can increase the time of atrial transmission and slow heart rate.

In patients treated with beta inhibitors, airway anesthesia increases heart inhibition effect.

Treatment in combination with indomethacin or prostaglandin synthetic inhibitors can reduce the effectiveness of the beta inhibitors.

In some cases when using Adrenaline for patients treated with beta inhibitors, the selected beta inhibitors on the heart less affect blood pressure than unsatisfied beta inhibitors.

may have to adjust the dose of oral diabetes treatment in patients with beta inhibitors.

Storage

No storage at temperatures above 30 ° C.

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