Bihasal 2.5 Hasan treatments for hypertension, angina, and chronic heart failure (5 blisters x 10 tablets)

Dosage form Box of 5 blisters x 10 tablets
Specifications Bisoprolol
Ingredient Heart failure, high blood pressure, angina

Ingredient

Composition information	Content
Bisoprolol	2.5mg

Uses

indications

Bihasal 2.5 mg Hasan 5x10 drugs are indicated in the following cases:

Treatment of hypertension.

Treatment of angina. Strong inhibition select Beta 1 receptor, no stimulating effect of intrinsic sympathetic nerves and no stable effect when used within the scope of treatment.

Bisoprolol has a low affinity with beta 2 receptor on bronchial smooth muscles and blood vessels as well as beta 2 receptors related to the regulation of metabolic processes.

Therefore, Bisoprolol does not affect the resistance in the respiratory tract and metabolic reactions through the beta 2 receptor. Bisoprolol is also used to treat hypertension and angina.

In acute treatment in patients with coronary heart disease without chronic heart failure, bisoprolol reduces heart rate and systolic volume leads to reduced cardiac supply and oxygen consumption. In chronic treatment, Bisoprolol initially reduces peripheral resistance.

pharmacokinetics

absorption:

Bisoprolol is almost completely absorbed through the gastrointestinal tract and bioavailability reaches about 90% after drinking. Food does not affect the absorption of drugs.

Distribution:

bisoprolol binds to plasma proteins about 30%. The distribution volume is 3.5 liters/kg.

Metabolism:

Bisoprolol is metabolized in two roads: 50% will be metabolized in the liver into an inactive form, the remaining 50% is not metabolized and eliminated through the kidney.

Era:

total clearance of approximately 15 liters/hour. The process of elimination in the liver and kidneys occurs with equal levels, so there is no need to adjust the dose in patients with liver or kidney failure.

Sell waste time in plasma for 10 - 12 hours and give efficiency up to 24 hours after drinking 1 time/day.

linear:

The dynamic of linear bisoprolol and regardless of age. In patients with chronic heart failure (degree III according to NYHA classification), the concentration of bisoprolol in plasma is higher and the half -life is longer than a healthy volunteer.

Before taking Bihasal 2.5 Hasan treatments for hypertension, angina, and chronic heart failure (5 blisters x 10 tablets)

How to use

Bihasal 2.5 drug used by oral, in the morning, can be used with food.

Dosage

Treatment of hypertension and angina:

Dosage should be adjusted to each patient, the response of the disease and the tolerance of the patient. The starting dose is 2.5-5 mg/day/day. Do not stop treatment suddenly. The dose should be slowly reduced (reduced half a week).

Treatment of chronic heart failure stability:

Standard congestive heart failure treatments include: A ACE transferred enzyme inhibitor (or an angiotensin receptor inhibitor in case of intolerance with ACE transferred enzyme inhibitors), a beta blocker, diuretics and/ or an appropriate cardiac glycoside. Patients should be stable treatment (no acute heart failure) before starting treatment with bisoprolol.

Need to comply with the starting principle with low doses and increase the dose slowly. The treatment should be indicated by a specialist.

Treatment of chronic heart failure with bisoprolol must start with a dose adjustment period by the following steps:

1.25 mg/time/day (1/2 tablets) for 1 week, if tolerated well.

Increase: 2.5 mg/time/day (1 tablet) in the next 1 week.

If tolerated well, continue to increase: 3.75 mg/time/day (1.5 capsules) in the next 1 week.

If tolerated well, continue to increase: 5 mg/time/day (2 capsules) in the next 4 weeks.

If tolerated well, continue to increase: 7.5 mg/time/day (3 tablets) for the next 4 weeks.

If tolerated well, continue to increase: 10 mg/time/day (4 tablets) and maintenance treatment at this dose.

Maximum dose recommended is 10 mg/time/day.

Advice to closely monitor important signs (heart rate, blood pressure) and symptoms of heart failure more severe during the dose increasing stage. Symptoms may occur on the first day after the beginning of treatment.

The adjustment dose does not have to follow the clinical response but according to the level of tolerance to the target dose. If the maximum dose is not tolerated well, it may be necessary to consider reducing the dose gradually.

In case of more severe heart failure, hypotension or a slow heart rate, it is necessary to reconsider the dosage of combined drugs, which can also be temporarily considered to reduce the dose of bisoprolol or stop treatment.

Then consider increasing the dose of bisoprolol or treating again when the patient has stabilized again. In case of stopping the drug, it is necessary to reduce the dose slowly because the sudden stopping of the drug can make the disease worse.

Dosage in special clinical objects:

kidney failure, liver failure:

Treatment of hypertension and angina: No dose adjustment in patients with liver or kidney dysfunction from mild to medium. Patients with severe renal impairment (creatinine clearance

Treatment of stable chronic heart failure: There is no information on pharmacokinetics in patients with chronic heart failure accompanied by kidney failure or liver failure. So be cautious when increasing the dose in these patients.

Elderly: No need to adjust the dose. Should start with the lowest dose possible.

Children: No experience in Bisoprolol treatment in children, so Bisoprolol is not recommended for children.

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? It should be noted that symptoms of slow heart rate and/ or hypotension. All patients are recovered. There is a difference between individuals in terms of sensitivity to a single high doses of Bisoprolol, in which patients with heart failure are very sensitive.

How to handle: If an overdose occurs, drug use and symptomatic treatment should be combined with supportive treatment. Based on the general pharmacological effects of beta blockers, it is necessary to consider the following general management measures:

Slow heart rate: Atropine intravenous injection. If the response is inappropriate, it is possible to use isoprenalin or another substance that regulates heart rate but must be cautious. In some cases, using a pacemaker if necessary.

Hypotension: intravenously and use hypertension. Glucagon intravenous injection may be helpful. Atrial block - ventricular (degree 2 or degree 3): Patients should be carefully monitored and treated with isoprenalin transmission or temporary rhythms.

Heart severe heart failure: diuretic intravenous infusion, myocardial stimulant, vasodilators.

Bronchospasm: Using bronchodilators such as isoprenalin, beta 2 and/or aminophyllin stimulants.

Hypoglycemia: intravenous glucose.

There are a few data that shows that Bisoprolol is difficult to be removed by a cup.

What to do when you forget a 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

When using Bihasal 2.5mg Hasan 5x10, you may experience unwanted effects (ADR).

Common, ADR> 1/100

Body: weakness, fatigue.

Neurology: headache.

Digestive: Nausea, vomiting, diarrhea, constipation.

Cardiovascular: Slow heart rate, worse heart failure.

Bone muscles and connective tissue: Cipher, muscle spasm.

Blood vessels: Cold or numbness in limbs, hypotension.

rarely, 1/1000

Respiratory: Bronchospasm in bronchial patients with bronchial or a history of respiratory diseases.

Cardiovascular: Atrial -vented disorders.

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

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Bihasal 2.5mg Hasan 5x10 drugs in the following cases:

Hypersensitivity to bisoprolol fumarat or any ingredients of the drug.

acute heart failure or during loss of loss of heart failure requires treatment with intravenous heart contractions.

Atrial atrial block 2 and 3 (no heart rate air conditioner).

Sinus syndrome.

Atrial sinus block.

Symptomatic heart rate.

Symptomic hypotension.

Severe bronchial asthma or serious chronic obstructive pulmonary disease.

Diseases that cause severe peripheral embolism or severe cases of Raynaud's syndrome.

Unexplained adrenal marrow.

Metabolic acidosis.

Be cautious when used

Treatment of chronic heart failure stability with bisoprolol must be started with a stage of increasing dose carefully. In particular, patients with ischemic heart disease should not stop treating with bisoprolol suddenly unless indicated and can make the heart failure worse. Starting the treatment of chronic heart failure stability with Bisoprolol should be carefully monitored.

There is no experience in treating heart failure with bisoprolol in the following cases:

Insulin dependents (type 1).

Severe kidney failure.

Severe liver failure.

Restricted myocardial disease.

congenital heart disease.

Cardiac disease affects hemodynamic.

Myocardial infarction within 3 months.

bisoprolol must be used carefully in the following cases:

Diabetes with large oscillating blood sugar, symptoms of hypoglycemia (tachycardia, chest drum or sweating) may be covered.

The person is in a strict diet.

People who are using sensitive solutions: Bisoprolol as well as other beta blockers can increase sensitivity to allergens or worsen anaphylactic reactions. Treatment with epinephrin is not always possible to bring the expected effect.

Atrial atrial block I.

Prinzmental angina.

Peripheral stenosis, symptoms may be more serious, especially when it is started to treat.

Patients with a history or psoriasis should only take beta blockers (such as bisoprolol) after considering the benefits and risks.

Symptoms of thyroid poisoning may be covered if treated with bisoprolol. For patients with adrenal tumors, only bisoprolol is used after using alpha blockers.

In patients with general anesthesia, beta blockers reduce the frequency of heart arrhythmia and myocardial ischemia during anesthesia, intubation and postoperative stage.

Anesthesia must know about beta blockers because of the risk of interacting with other drugs, leading to symptoms of slow heart rate, reducing reflective fast heart rate, reducing reflexes to compensate for the loss of blood. If it is necessary to stop the treatment regimen with beta blockers before surgery, proceed slowly and stop completely for 48 hours before anesthesia.

For patients with bronchial asthma or other chronic obstructive pulmonary disease, Bisoprolol may increase the symptoms of the disease, bronchodilators should be indicated. Sometimes the phenomenon of increasing airway resistance can occur in bronchial asthma patients, so it is necessary to increase the dosage of Beta 2.

Bihasal 2.5mg preparations contain lactose excipients. Patients with rare genetic problems in tolerance of galactose, Lapp Lactase deficiency or Glucose-Galactose should not be used.

The ability to drive and operate machinery

In a study in patients with coronary artery disease, Bisoprolol does not reduce the ability to drive. However, depending on the treatment of each patient may affect the ability to drive or use machines. This should be considered, especially when starting treatment, when changing the drug, or used with alcohol.

Pregnancy

bisoprolol has pharmacological effects that can be harmful to pregnant women and/or fetus or infants.

In general, the sympathetic beta receptor blockers reduce the os ornamental placenta, which is associated with the growth of the fetus in the uterus, miscarriage or early labor. Unwanted effects such as hypoglycemia, slow heart rate can occur in fetus and infant.

If you need to be treated with sympathetic beta receptors, the beta 1 receptor selection is more suitable for pregnant women.

Bisoprolol is not recommended for use during pregnancy unless really necessary and need to monitor blood flow to the placenta and fetal development. If there is any unwanted effect, should consider replacement treatment. Babies should be closely monitored, symptoms of hypotension and slow heart rate may occur in the first 3 days.

The period of breastfeeding

There is no information on the excretion of bisoprolol in breast milk or the safety of bisoprolol for babies. So do not breastfeed during medication.

Drug interaction

Uncountable coordination:

Anti-arrhythmia group 1 (quinidin, disopyramid, lidocaine, phenytoin, flecainid, propafenon: increase the time of atrial transmission, increase the inhibition of the contractions of the heart muscle.

Verapamil -type calcium blockers are lower than the diltiazem type: adversely affects the contraction and atrial -ventilation. Verapamil infusion in patients undergoing with Bisoprolol can cause hypotension and atrial block.

Central -acting blood pressure drugs (Clonidin, Methyldopa, Moxonidin, Rilmenidin): may reduce the central sympathetic tone, leading to a decrease in heart rate, reduced cardiac supply and vasodilation. The sudden stopping of the drug, especially before stopping the use of beta receptor blockers, may increase the risk of "hypertension in the back".

Cautions need to be cautious:

Calci channel blockers Dihydropyridin (Felodipine, Amlodipin): Use simultaneously may increase the risk of lowering blood pressure and cannot rule out the risk of decreased left ventricular valve function in patients with heart failure.

Anti -arrhythmia group III (Amiodaron): may increase the time of atrial - ventricular.

Sympathetic neuropathy: simultaneous use may increase the time of the atrial transmission - ventricular and the risk of slow heart rate.

Beta blockers on the spot (eye drops of glaucoma): When shared can increase the body effect of bisoprolol.

insulin and oral diabetes medications: Bisoprolol increases hypoglycemia. Beta blockers can cover the symptoms of hypoglycemia.

Anesthesia: Reduce reflection heart rate, increase the risk of hypotension.

Glycosides of cardiac support: Increasing atrial transmission time, reducing heart rate.

Non -steroid anti -inflammatory drugs (NSAIDs): NSAIDs can reduce the hypotension effect of bisoprolol.

sympathetic beta stimulants (isoprenalin, dobutamin): coordinating with bisoprolol can reduce the effect of both drugs.

Alpha and Beta adrenergic stimulants (norepinephrin, epinephrin): in combination with bisoprolol can increase the vasoconstrictor effect of Alpha receptor intermediaries leading to hypertension and worsen anhuman pain. These interactions are more common than unsatisfactory beta blockers.

Other anti -blood pressure or other drugs that have the effect of lowering blood pressure (three -round depression, barbiturat, phenothiazine): in combination with bisoprolol can increase the risk of hypotension.

The coordination should be considered:

mefloquin: Increased risk of heart rate.

Oxidase monoamine inhibitors (except Mao-B inhibitors): Increases the hypotension effect of beta blockers but also has the risk of hypertension.

Rifampicin: A slightly reducing the half -life of bisoprolol due to metabolic enzyme touch in the liver. Usually do not need to adjust the dose.

Ergotamine derivatives: aggravate peripheral circulatory disorders.

Storage

In a dry place, below 30 ° C. Avoid light.

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