Bisoprolol 2.5mg Tablets Stella medicine for hypertension, chronic angina (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Bisoprolol
Ingredient Heart failure, high blood pressure, angina

Ingredient

Composition information	Content
Bisoprolol	2.5mg

Uses

indications

Bisoprolol 2.5mg drug indicated in the following cases:

Treatment of hypertension.

Bisoprolol is a high selective beta-1-adrenergic receptor receptor, which has no effect of interior sympathetic nerve and does not stabilize cell membranes.

Bisoprolol shows that only very low affinity with the beta-2 receptor of bronchial muscle and vascular walls as well as beta-2 receptors related to metabolic regulation.

Therefore, bisoprolol generally does not affect the airway resistance and has no metabolic effects through the beta-2 receptor receptor. Selective characteristics on Beta-1 of the drug lasts far beyond the dose of treatment.

Hypertension or angina:

By inhibiting the beta receptor in the heart, bisoprolol inhibits responding to sympathetic activation. That leads to reduced heart rate and contraction thus reducing the oxygen needs of the heart muscle.

In acute treatment in patients with coronary artery disease without chronic heart failure, Bisoprolol reduces heart rate and volume of squeezing, thus reducing cardiac amount and reducing oxygen consumption.

In chronic treatment will reduce the initial increase in peripheral resistance.

Bisoprolol is used to treat hypertension and angina. Like other beta-1 inhibitors, the mechanism of impact in hypertension is not clear, however, Bisoprolol is known to reduce plasma renin activity.

Dynamic pharmacokinetics

absorption: Bisoprolol is absorbed almost completely through the gastrointestinal tract. Because only the initial metabolism in the liver is very little, it is highly available about 90%.

Distribution: about 30% bisoprolol binds to plasma proteins. The distribution volume is 3.5 l/kg. The total clearance is about 15 l/hour. The drug has a semi -discharged time in plasma about 10 - 12 hours for efficiency in 24 hours after 1 -day dosage/day.

Metabolic: 50% is metabolized in the liver into inactive metabolites that will then be eliminated through the kidneys.

Elimination: Bisoprolol is eliminated from the body in 2 directions. 50% is converted in the liver into non -active metabolites, which will then be eliminated through the kidneys. The remaining 50% will be eliminated through the kidney in the form of unchanged. Because the elimination occurs in the kidneys and liver at the same level, there is no need to adjust the dose for patients with liver or kidney failure.

Special subjects

Patients with stable chronic heart failure (NYHA phase III) have a higher plasma bisoprolol level and a longer selling time than healthy people. The maximum concentration of plasma in a stable state is 64 ± 21 ng/ml at a dose of 10 mg/day and the sale time is 17 ± 5 hours.

Before taking Bisoprolol 2.5mg Tablets Stella medicine for hypertension, chronic angina (3 blisters x 10 tablets)

How to use

Bisoprolol 2.5 mg tablets tablets are used orally, should be used in the morning and may be accompanied by food, should not chew tablets.

Dosage

Dosage in case of treatment of hypertension and chronic angina stability:

Adults: Bisoprolol dose must be adjusted to each patient. The starting dose is 5 mg/day, the usual dose is 10 mg x 1 time/day, the maximum dose is 20 mg/day.

Patients with kidney failure or liver failure:

The pharmacokinetics of the drug may be changed in patients with kidney damage (creatinine clearance

Patients with severe renal impairment (Creatinine clearance

Elderly: No dose adjustment. Should start with the lowest dose possible.

Children: Inexperienced in using bisoprolol for children, so it is not recommended to use bisoprolol for children.

Stop treatment: Do not stop the drug suddenly. Should reduce the dose gradually by reducing half the weekly dose.

Dosage in case of stable chronic heart failure:

Chronic heart failure treatment regimen consists of enzyme inhibitors (ACE) (or angiotensin receptor blockers in the event of no transferred enzyme inhibitors), beta blockers, diuretics and heart glycosides when appropriate.

Start treatment with bisoprolol when the patient's condition is stable (no acute heart failure).

Treatment doctor needs experience in the treatment of chronic heart failure.

Standard regimen: Treatment of chronic heart failure stability with bisoprolol with a standard regimen. The treatment with bisoprolol is started by increasing the dose slowly in the following steps:

1.25 mg Bisoprolol, 1 time/day, for 1 week, increase the dose if tolerated well.

2.5 mg Bisoprolol, 1 time/day, in the next 1 week, increase the dose if tolerated well.

3.75 mg Bisoprolol, 1 time/day, in the next 1 week, increase the dose if tolerated well.

5 mg Bisoprolol, 1 time/day, in the next 4 weeks, increase the dose if tolerated well.

7.5 mg Bisoprolol, 1 time/day, in the next 4 weeks, increase the dose if tolerated well.

Maintain treatment later: 10 mg Bisoprolol, 1 time/day.

The maximum dose is 10 mg of bisoprolol, 1 time/day.

Heavy heart failure, lower blood pressure or slow heart rate may occur during the dose adjustment stage and then.

Recommendations should closely monitor the signs of survival (heart rate, blood pressure) and symptoms of heart failure more severe throughout the regimen. Symptoms may occur on the first day after the beginning of treatment.

Dosage adjustment: Gradually reduce the dose if the patient cannot tolerate the maximum dose. In case of severe heart failure, hypotension or slow heart rate, should review the dosage of the drug being used simultaneously.

may reduce the dose of bisoprolol temporary or stop the drug if necessary. Review or increase the dose of bisoprolol when the patient stabilizes. If the medication is stopped, it is necessary to gradually reduce the dose, because the sudden stopping of the drug can lead to acute heart failure. Treatment of chronic heart failure with Bisoprolol is a long -term treatment.

Patients with kidney or liver failure: The pharmacokinetics of the drug may be changed in patients with kidney damage (creatinine clearance

Elderly: No dose adjustment.

Children: Inexperienced in using bisoprolol for children, so it is not recommended to use bisoprolol 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?

Symptoms:

When using an overdose (for example, daily dose is 15 mg instead of 7.5 mg), atrioventricular block III, slow heart rate, dizziness has been reported.

In general, the most common signs when overdose of a beta blocker are slow heart rate, hypotension, bronchospasm, acute heart failure and hypoglycemia.

Experience of overdose is limited, only a few cases of overdose Bisoprolol (maximum 2000 mg) have been reported in patients with hypertension and/ or coronary artery disease shows that the heart rate is slow and/ or lowering blood pressure and all patients recover.

Management:

Normally, if overdose occurs, Bisoprolol should be stopped, supportive treatment and symptoms. Based on the expected pharmacological effects and recommendations for other beta blockers, consider general methods when clinically allowed:

Slow heart rate: Atropine intravenous injection. If not fully responded, caution can be used with isoprenaline or another drug that increases heart rate. In some cases, it may be necessary to place a venous pacemaker.

Hypotension: intravenous fluid and use of hypertension drugs. Glucagon intravenous injection may also be helpful.

Atrial Block (Grade II or III): Monitoring patient kidneys and treatment by injecting isoprenaline or placing intravenous pacemaker.

Temperament more feature: Intravenous diuretics. Hypothalar contractions, vasodilators.

Bronchospasm: use bronchodilators such as isoprenaline, beta-2 and/or aminophylline sympathetic drugs.

Hypoglycemia: intravenous glucose.

Restricted data shows that Bisoprolol is not appraised.

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

Unwanted effects when using Bisoprolol 2.5 mg that you may encounter.

Common, ADR> 1/100

Heart: Slow heart rate (for patients with chronic heart failure), worse the previous heart failure (for patients with chronic heart failure).

nerve: dizziness, headache. digestive: digestive disorders such as nausea, vomiting, diarrhea, constipation. blood vessels: Cold or numbness in limbs, hypotension especially in patients with heart failure. Systemic: weakness (for patients with chronic heart failure), fatigue.

Uncommon, 1/1000

Heart: Atrial transmission disorders, worse the heart failure before (for patients with hypertension or angina), slow heartbeat (for patients with hypertension or angina).

Vascular blood pressure: Hypotenary pressure vertical.

Respiratory, chest and mediastinum: bronchospasm in bronchial patients with bronchial asthma or a history of airway obstruction.

musculoskeletal and connective tissue: muscle weakness, muscle cramps.

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

Bisoprolol 2.5mg contraindicated drug in the following cases:

sensitive to bisoprolol or any ingredients of the drug.

Acute heart failure or in the stages of loss of loss of heart failure need intravenous injection that increases myocardial contraction. Cardiococci.

Atrial AI Block II or III.

Sinus impairment syndrome.

Sinus block.

Symptomatic heart rate.

Symptomic hypotension.

Severe bronchial asthma or chronic obstructive pulmonary disease.

The severe form of peripheral artery obstruction or Raynaud's syndrome.

Chrome -preferred cells are not treated.

Metabolic acidosis.

Caution when using

Warning:

Only applies to chronic heart failure indications.

The treatment of chronic heart failure with Bisoprolol must be started with a special dose standard.

Applies to all indications.

Because the risk of cardiovascular condition is worse, it is not advisable to stop the drug, especially in patients with ischemic heart disease, unless clearly indicated.

Caution:

Only applies to hypertension and angina.

Be cautious when using bisoprolol for patients with hypertension or angina with heart failure.

Only applies to chronic heart failure indications.

Need to monitor regularly at the beginning and stop treatment with bisoprolol. There is no experience of therapeutic with bisoprolol in the treatment of heart failure in patients with the following diseases and conditions:

Insulin dependent diabetes (Type 1).

Severe renal function.

Severe liver function.

Restricted myocardial disease. congenital heart disease.

Valid valve is related to hemodynamic.

Myocardial infarction within 3 months.

Applies to all indications.

bisoproiol must be used carefully in:

Bronchospasm (bronchial asthma, respiratory obstruction diseases).

Diabetes with large fluctuating blood sugar, symptoms of hypoglycemia (such as fast heartbeat, chest drum, sweating) may be obscured.

Strict fasting.

is in sensitive solution. Like other beta blockers, Bisoprolol can increase both sensitivity to raw allergies and the severity of anaphylactic reactions. Epinephrine is usually not effective.

atrial block 1.

Prinzmetal angina.

Peripheral artery disease. Symptoms may be worse, especially at the beginning of treatment.

Systemic anesthesia.

Patients with psoriasis or a history of psoriasis should only use beta blockers (like bisoprolol) after careful consideration of benefits.

Symptoms of thyroid poisoning can be obscured when treated with bisoprolol. The sudden stop of beta blockers can worsen the symptoms of the thyroid function or may promote the storm. Chrome -preferred cell tumors should only use bisoprolol after alpha receptor blockers.

In patients with systemic anesthesia, beta blockers reduce the rate of arrhythmia and myocardial ischemia during the process of lingering, intubation and postoperative stage.

Currently, it is recommended to continue maintaining beta blockers before and after surgery.

Anesthesia specialists must be known for the use of beta blockers because they have the ability to interact with other drugs, leading to slow arrhythmia, reducing fast heart rate reflexes and reducing the ability to reflect blood loss. If it is necessary to discontinue beta blocked therapy before surgery, it should gradually perform and complete about 48 hours before anesthesia.

If you need to continue treating with bisoprolol near surgery, you must be especially cautious when used with anesthetic to impair myocardial function, such as Ether, Cyclopropane and Trichiorethylene.

Combining Bisoprolol with calcium -type or diltazem calcium blockers with anti -arrhythmia group 1 and with anti -hypertension drugs acting on the central nervous system is not recommended.

Although there is less impact on the combination of unsatisfactory beta blockers, selective beta blockers on the heart (beta-1) should be avoided for patients with respiratory clogged patients like all other beta blockers, unless clinically required to use.

In that case, bisoproloi should be used carefully. In patients with respiratory clogged patients, Bisoprolol should be used with the lowest possible doses and patients should be carefully monitored with new symptoms (such as shortness of breath, unable to withstand exertion, cough).

The coordination with bronchodilator therapy is recommended in the case of bronchial asthma or other chronic obstructive diseases that may cause symptoms.

There is occasional increase in airway resistance in asthma patients, so the Beta-2 Landing Owner needs to be increased.

Heart failure: Psychic stimulation is an essential effect that supports circulatory function in the beginning of congestive heart failure and beta blockers can lead to an additional decline in heart muscle contraction and promote worse heart failure. However, in some patients with congestion heart failure may also need to take this medication.

In this case, the medication must be used carefully. The drug is only added when it is available for heart failure with basic drugs (diuretics, digitalis, enzyme inhibitors) under the strict control of a specialist. The drug can increase the number of Prinzmetal angina.

Patients with no history of heart failure: The continuous inhibition of the heart muscle of beta blockers on some patients may promote heart failure. When the first signs and symptoms of heart failure, it is necessary to consider the stopping of bisoprolol. In some cases, Beta blockers can continue to continue treating heart failure with other drugs.

Sudden stop treatment: severe angina and in some cases, myocardial infarction or ventricular arrhythmia appears in people with coronary artery disease after a sudden stop of beta blockers.

Therefore, it is necessary to remind these patients to not stop taking the drug without a doctor's advice. Even for patients with unknown coronary artery disease, Bisoprolol should be advised to gradually reduce Bisoprolol for about a week under the careful monitoring of the doctor. If the symptoms of cessation occur, the drug should be used at least for a period of time.

Peripheral vascular disease: Beta blockers can cause or worsen symptoms of artery anemia in patients with peripheral vascular disease.

Diabetes and hypoglycemia: Beta blockers can cover the manifestations of hypoglycemia, especially tachycardia.

Unstolant beta blockers can increase the level of hypoglycemia caused by insulin and slow down the recovery of serum glucose levels.

Due to the selective nature of Beta-1, this is less likely to occur with Bisoprolol. However, it is necessary to warn the patient or hypoglycemia, or diabetes patients who are taking insulin or blood glucose oral medications for this ability and must be used carefully.

The ability to drive and operate machinery

studies in patients with coronary artery shows that Bisoprolol does not impair the patient's driving ability. However, depending on the response of each patient for treatment, the ability to drive or operate machinery may be impaired. This should be considered, especially when starting treatment, when changing the drug or in combination with alcohol.

Pregnancy

Pharmacological effects of bisoprolol can be dangerous to pregnancy and/or fetus/infant.

In general, beta blockers reduce the perfusion of the placenta and may be associated with the fetal retardation, the fetal death in the uterus, miscarriage or early labor. Unwanted effects (such as hypoglycemia and slow heart rate) can occur in fetus and infant.

If it is necessary to treat with the beta-adrenergic receptor blockers, it is best to choose the beta-1-adrenergic receptor blocker selected. It is not recommended to use bisoprolol during pregnancy if it is really unnecessary. If it is necessary to use bisoprolol, need to carefully monitor the blood flow of the placenta - uterus and the development of the fetus.

In case of harm to the mother or fetus, it is necessary to consider changing the treatment. Babies should be carefully monitored. Symptoms of hypoglycemia and slow heart rate often occur within the first 3 days.

The period of breastfeeding

There is no data on Bisoprolol's excretion ability in breast milk or the safety of bisoprolol for children. Therefore, do not indicate bisoprolol for nursing women.

Drug interaction

should not be used in combination

Only applies to chronic heart failure indications:

Anti -arrhythmic drugs Group 1 (such as Disopyramide, Quinidine, Lidocaine, Phenytoin; Fiecainide, Propafenone): can increase the time of atrial transmission and reduce myocardial contraction.

Applies to all indications:

Verapamil and diltiazem antagonistic drugs: reduce contraction and slow down the atrial transmission. Verapamil intravenous injection in patients treated with beta blockers can cause strong hypotension and atrial block.

Hydromolen liking on the central nervous system (such as Clonidine, Metbyldopa, Moxonidine, Rilimenidine): simultaneous use can reduce the central sympathetic tone (can lead to reduced heart rate and cardiac weight, and vasodilation). Stop using the drug suddenly, especially before stopping the use of beta blockers may increase the risk of "corresponding hypertension".

Precautions when combining

Only applies to hypertension or angina:

Anti -arrhythmic drugs Group 1 (such as Disopyramide, Quinidine, Lidocaine, Phenytoin; Fiecainide, Propafenone): can increase the time of atrial transmission and reduce myocardial contraction.

Applies to all indications:

Dihydropyridine calcium antagonists (such as nifedipine, amlodipine, felodipine): simultaneous use may increase the risk of lowering blood pressure and increase the risk of damage to the ventricular pump function in patients with heart failure.

Anti -arrhythmia group III (such as amiodarone): may increase the time of atrial transmission.

Beta blockers on the spot (such as glaucoma eye drops): may increase the body effect of bisoprolol.

Seed -like drugs: simultaneous use can increase the time of the atrial transmission and increase the risk of slow heart rate.

insulin and oral diabetes treatment: increase hypoglycemia. Beta receptor blockers can hide hypoglycemic symptoms.

Anesthesia: Reducing reflected tachycardia and increases the risk of hypotension.

Glycoside (digitalis): Reduce heart rate, increase the time of atrial transmission.

Non -steroid anti -inflammatory drugs (NSAID): Reduce bisoprolol's hemorrhage effect.

Beta sympathetic medication (such as isoprenaline, dobutamine): combined with bisoprolol can reduce the effect of both drugs.

Seed -like drugs that activate both Beta and Alpha receptors (such as Noradrenaline, Adrenaline): combined with bisoprolol can increase the indirect vasoconstriction of the alpha receptor of these drugs leading to hypertension and worsen the lame lame. These interactions often occur with unsatisfactory beta blockers.

Sympathetic medications: combined with bisoprolol can reduce the effect of both drugs. It is possible to take higher doses of epinephrine to treat allergic reactions.

Concentrated with antihypertensive drugs as well as other drugs that can lower blood pressure (such as 3 -round antidepressants, barbiturate, phenothiazine) can increase the risk of hypotension.

Consider when combining

Mefloquine: Increased risk of heart rate.

Monoamine oxidase inhibitors (except for Mao-B inhibitors): Increases the hypotension effect of beta blockers but also has a sudden risk of hypertension.

Storage

Store in closed packaging, dry in, avoid light and avoid moisture. The temperature does not exceed 30 ° C.

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