Carsantin 6.25mg Hasan Treatment of Definitely Hypertension (3 blisters x 10 tablets)
Dosage form Carvedilol
Specifications Myocardial ischemia, cirrhosis, esophageal varicose veins, heart failure, high blood pressure, angina
Ingredient Hepatic failure, low blood pressure, bronchial asthma, chronic obstructive pulmonary, atrial block, slow heartbeat
Ingredient
| Composition information | Content |
| Carvedilol | 6.25mg |
Uses
indications
Carsantin 6.25mg Hasan is indicated in the following cases:
Carvedilol does not have an intrinsic effect like a sympathetic but sustainable effect of weak cell membranes. In addition, Carvedilol also has antioxidant effects.
Clinical research has shown when using a combination of alpha and beta receptor blockers, the heart frequency decreases or does not change when resting, maintaining blood fraction and blood flow in the kidney and peripheral.
pharmacokinetics
absorption:
Carvedilol is not completely absorbed in the digestive tract and is strongly metabolized for the first time through the liver, so the bioavailability absolutely fluctuates 20-25%. The maximum concentration in plasma is achieved after drinking about 1-2 hours. The concentration in plasma increases linearly to the dose, within the recommended dose range. In the blood of the drug attached to protein about 98%.
Distribution:
The distribution volume is about 2 liters/kg. Normal plasma clearance is about 590 ml/min.
Metabolism:
The drug is strongly metabolized in the liver through CYP 2D6 and CYP 2C9.
Three metabolites have a beta receptor blocker, but due to the low concentration of these substances in the blood and weak vasodilation effect, it does not significantly contribute to the effect of the drug.
Era:
The metabolites excreted mainly through the liver and only about 15% of oral doses are eliminated through the kidneys. Therefore, there is no need to adjust the carvedilol dose in people with renal failure. Carvedilol's waste sale time is 6 - 10 hours after drinking.
Before taking Carsantin 6.25mg Hasan Treatment of Definitely Hypertension (3 blisters x 10 tablets)
How to use
use the drug with sufficient amount of water. In patients with heart failure, it is recommended to take medicine with food to slow down the absorption rate, reduce the risk of hypotension.
Dosage
Treatment of idiopathic hypertension:
Can use carvedilol monotherapy or combined with other hypertension medications, especially diuretics.
recommendations for use 1 time/day.
Maximum single dose as recommended as 25 mg, the maximum daily dose as recommended as 50 mg/day.
Adults:
The recommended starting dose is 12.5 mg/day/day for the first 2 days.
Then increase the dose to 25 mg/time/day. May be gradually increased by at least 2 weeks if needed.
Elderly:
Starting dose and recommended maintenance dose is 12.5 mg/time/day. However, if not fully achieved the effectiveness of this dose, it may gradually increase the dose at least every 2 weeks.
Treatment of chronic stable angina:
Adults:
The recommended starting dose is 12.5 mg/time x 2 times/day for the first 2 days.
Then, increase the dose up to 25 mg/time x 2 times/day. If necessary, it is possible to increase the dose gradually at least 2 weeks to the maximum recommended dose of 100 mg/day (divided into 2 times/day).
Elderly:
The recommended starting dose is 12.5 mg/time x 2 times/day. After that, the maximum dose recommends is 25 mg/time x 2 times/day.
Treatment of chronic heart failure to stabilize average to severe to severe:
Before starting treatment with Carvedilol, the patient must be treated with a standard regimen including diuretics, enzyme inhibitors that switch angiotensin, cardiac glycosides and/or vasodilators. The patient must be clinically stabilized (without changes in NYHA classification, not hospitalized due to heart failure) and standard treatment therapy must be stable for at least 4 weeks before treatment. In addition, patients need to have low left ventricular blood, heart rate> 50 beats/minute and systolic blood pressure> 85 mmHg.
The recommended starting dose is 3,125 mg/time x 2 times/day for 2 weeks. Then, if the patient tolerates this dose, it may increase gradually for at least 2 weeks to the dose of 6.25 mg/time x 2 times/day, followed by 12.5 mg/time x 2 times/day and finally 25 mg/time x 2 times/day. Should increase the dose to the maximum tolerance.
The maximum recommended dose is 25 mg/time x 2 times/day in patients 85 kg, provided that the heart failure is not serious. Increasing dose up to 50 mg/time x 2 times/day should be done carefully under the supervision of the doctor.
The worse condition of the symptoms of heart failure may occur in the early stages of the treatment process or the time of increasing dose, especially in patients with severe heart failure and/or using high dosage dosage. This usually does not require stopping the use of the drug, however, do not increase the dose. Patients should be carefully monitored by a specialist for 2 hours after the beginning of treatment or increasing dose.
Before each dose increasing, it is necessary to check the symptoms of signaling more severe heart failure or excessive vasodilation symptoms (such as kidney failure, body mass, blood pressure, heart rate). If heart failure is worse or water retention occurs, it is necessary to treat by increasing diuretics and should not increase the dose of carvedilol until the patient is stable.
If the heart rate is slow or prolonged the atrial transmission, first should monitor the concentration of digoxin. Occasionally, the dose may be reduced or temporarily stop carvedilol. Even in these cases, the adjustment of the dose with Carvedilol can be successful.
Need to monitor regular kidney, platelet and blood sugar function during the dose adjustment process. After adjusting the dose, the frequency of monitoring may decrease.
If you stop using Carvedilol for more than 2 weeks, it should be started at a dose of 3,125 mg/time x 2 times/day and gradually increase the dose as recommended above.
Dosage in some special clinical subjects:
kidney failure:
Should identify specific doses by individuals, however, according to pharmacokinetic parameters, the adjustment of unnecessary dose in patients with renal impairment.
Average liver failure:
Need to adjust the dose.
Children under 18 years old:
It is not recommended to use Carvedilol in children under 18 years of age due to lack of data on the safety and effectiveness of the drug.
Elderly:
Elderly people are often more sensitive to the effects of the drug, need to monitor carefully. Like other beta receptor blockers, especially in people with coronary artery disease, the process of stopping the drug should take place gradually before stopping.
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
In case of overdose, it may cause serious hypotension, heart rate, heart failure, shock, cardiac arrest. It may also occur in respiratory problems, bronchospasm, vomiting, cognitive disorders, all epilepsy.
How to handle
General support treatment, monitoring and treatment of living brands. If necessary, need special care. Use atropine when the heart is too slow, supporting the ventricular function with intravenous glucagon or using sympathetic stimulants (dobutamin, isoprenalin). If you need to use positive transmission agents, consider using phosphodiesterase inhibitors.
In case of toxic peripheral vasodilation, Noradrenalin should be used and continues to monitor the circulation. In case the heart is slow resistance, should place the airborne air conditioner on the spot. If bronchospasm occurs, use the beta sympathetic drug (aerosol or intravenous), or injected intravenous infusion aminophyllin.
Use diazepam or clonazepam when epilepsy occurs. Carvedilol is strongly linked to plasma proteins. Therefore, it cannot be excluded by the method of appraisal.
In case of severe overdose with shock symptoms, it is necessary to maintain long -term support treatment until the patient's condition is stable because it can extend the time of selling or re -distributing carvedilol into the deeper compartments of the body.
What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.
Side Effects
When using Carsantin 6.25mg 3x10 Hasan, you may experience unwanted effects (ADR).
Very common, ADR> 1/10
Common, ADR> 1/100
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
Carsantin 6.25mg 3x10 Hasan is contraindicated in the following cases:
Hypersensitivity to Carvedilol or any ingredients of the drug.
Heart failure IV by NYHA classification is enclosed with significant water retention or intravenous infusion of the agents affecting myocardial spasm.
Chronic obstructive pulmonary or bronchial obstruction.
Clinical significant liver failure.
Bronchial asthma.
Atrial AI Block II or III (except for permanent pacemaker placement).
Slapped heart rate (
Sinus node syndrome (including atrial sinus block).
Cardioma.
Severe hypotension (systolic blood pressure below 85 mmHg).
Prinzmetal angina.
Untreated adrenal marrow.
Metabolic acidosis.
Serious peripheral circulation disorders.
Concentrated with Verapamil or Diltiazem intravenously.
Caution when using
Special caution in patients with heart failure.
In patients with chronic heart failure, Carvedilol is mainly used with diuretics, enzyme inhibitors Angiotensin, heart glycosides and/or vasodilators. The beginning of treatment should be supervised by a specialist. The drug should only be used when the patient has stabilized with standard treatment for at least 4 weeks.
Patients with severe heart failure, salt loss and water, the elderly, or low blood pressure patients should be monitored for about the first 2 hours after the first dose or after the dose increasing period because of the hypotension may occur. Hypotension due to excessive vasodilation should be treated by reducing diuretics. If still not, should reduce the dose of enzyme inhibitors Angiotensin.
At the beginning of treatment or increased dose, water retention may occur or worsen heart failure, in this case, so increasing diuretic dose. However, in some cases, it may be necessary to reduce the dose or stop using Carvedilol. Carvedilol dose should not be increased before controlling the symptoms caused by more severe heart failure or hypotension due to vasodilation.
Reduced renal function has been observed during treatment with carvedilol in patients with low blood pressure (systolic blood pressure
Use caution carvedilol in patients with chronic heart failure treatment with cardiac glycosides because carvedilol and cardiac glycosides can extend the atrial transmission time.
The common cautions for Carvedilol and the beta receptor blocker group.
Unstolant beta receptor blockers can cause angina in patients with Prinzmetal angina. Due to no clinical experience, caution should be used when using Carvedilol in these patients.
Do not use carvedilol in patients with chronic obstructive pulmonary disease tend to spend bronchospasm without treating oral or aerosol. Only use when benefits beyond the risk, should monitor patients when starting to take the drug or increase the dose. If bronchospasm occurs, Carvedilol should be reduced.
Carvedilol can hide symptoms and signs of acute hypoglycemia. There have been reports on defeat in blood sugar control in diabetes patients and heart failure when using Carvedilol. Therefore, closely monitor blood sugar in patients with diabetes, especially during the dose adjustment stage. Should monitor the concentration of blood sugar carefully after long -term fasting.
Carvedilol can hide the signs and symptoms of thyroid disease.
Carvedilol can cause a slow heart rate, if the heart rate is below 55 beats/minute and the clinical symptoms occur due to the heart rate, the carvedilol dose is needed.
When using Carvedilol simultaneously with calcium channel blockers such as Verapamil, Diltiazem or other treatments for arrhythmia, especially amiodaron, should monitor blood pressure and electrocardiogram. Avoid using the above drugs.
Be cautious when used simultaneously with cimetidine because it can increase the effects of carvedilol.
Patients who are using contact lenses should be warned of the possibility of reducing the secretion.
Be cautious when using Carvedilol in patients with a history of serious allergic reactions and are using anesthetic because the beta receptor blockers can increase antigen sensitivity and the severity of anaphylactic reaction. Caution should be careful when indicating Carvedilol in psoriasis patients because it can seriously cause skin reactions.
Be cautious when using carvedilol in people with peripheral vascular disease or Raynaud's syndrome, because beta blockers can worsen the symptoms of the disease.
Careful monitoring patients with poor metabolism Debrisoquin at the beginning of treatment.
Due to the lack of clinical experience, Carvedilol should not be used in secondary hypertension patients, unstable hypertension, vertical hypertension, acute heart disease, heart valve hemodynamic obstruction or output flow of the heart, end-stage peripheral artery disease, simultaneous use with alpha-1 receptor antagonist or Alpha-2 receptor owner.
In patients with adrenal marrow tumors, it is recommended to treat Alpha receptor blockers before starting treatment with beta receptor blockers. Although Carvedilol shows the impact of both Alpha and Beta receptors, because of lack of experience, should not be used in these patients. Due to negative transmission effects, do not use Carvedilol in heart block patient 1.
Beta receptor blockers reduce the risk of arrhythmia due to anesthesia, but the risk of hypotension may increase. Caution should be used in patients using anesthesia or anesthesia. However, recent studies have shown the superior benefits of beta receptor blockers in preventing more severe heart disease around surgical and cardiovascular complications.
Like other beta receptors, it is not advisable to stop using Carvedilol suddenly, especially in people with ischemic heart disease. Should stop the drug gradually within 2 weeks (for example, reducing daily dose every 3 days). If necessary, it is possible to start other alternative treatments to prevent worse angina.
The ability to drive and operate machinery
The drug has a low level to drive and operate machinery. Some patients may be alert in the early stages of drug use and the dose adjustment stage.
During pregnancy
There was no complete study of the use of carvedilol during pregnancy, and animal research showed that the drug causes reproductive toxicity. Research on rats and rabbits shows 25 times the dose (on rabbits) and 50 times the maximum dose in humans (on rats) affects the ability to conceive and fetal weight. In the mouse, 10 times the dose and the rabbit is 5 times the dose of no observations of the influence. There is no adequate research and well controlled. The drug is only used on pregnant women when the benefits are out of risk.
Lactation period
Carvedilol has high lipid solubility and based on animal research results, carvedilol and metabolites that can be distributed into breast milk. Therefore, nursing mothers should not use Carvedilol. Stop medication or stop breastfeeding depending on the need for the drug for the mother.
Drug interaction
Anti -arrhythmic drugs: separate shift reports on transmission disorders (rarely hemodynamic impairment) have been reported when using Carvedilol and Diltiazem, Verapamil and/or Amiodaron. Like other beta receptor blockers, carefully monitor the electrocardiogram and blood pressure when used simultaneously with calcium blockers such as Verapamil and Diltiazem due to the risk of atrial and heart failure disorders.
Need to monitor carefully when using Carvedilol, Amiodaron or anti -arrhythmic drugs Group I. Slow heart, cardiac arrest, ventricular arrhythmia have been reported immediately after using beta receptor blockers in patients using amiodaron. The risk of heart failure increases when used simultaneously with anti -arrhythmic drugs IA, intravenous IC.
reserpin, guanethidin, methyldopa, guafacin and Monoamin oxidase inhibitors (except Mao - B inhibitors): can cause heart rate reduction.
dihydropydin: There is a serious report on heart failure and hypotension when using simultaneously dihydropyridine and carvedilol.
Nitrate: Increases hypotension.
cardiac glycosides: Increases the concentration of Digoxin's stability about 16% and of Digitoxin about 13% in hypertension patients with simultaneously carvedilol and these drugs. Monitor plasma digoxin at the beginning, adjust the dose or stop using carvedilol.
Other medications for hypertension: Carvedilol increases the effectiveness of other hypertension medications (such as alpha -1 receptor resistant drugs) and drugs that can cause hypotension such as barbiturat, phenothiazine, three -ring antidepressants, vasodilators, alcohol.
cyclosporin: slightly increase cyclosporin levels when used simultaneously with carvedilol. Due to the different experience in adjusting the doses of cyclosporin, carefully monitoring cyclosporin levels after the beginning of treatment with carvedilol.
Oral diabetes treatment, including insulin: may increase the hypoglycemic effect of these drugs. Carvedilol conceals signs of hypoglycemia. Need to regularly monitor blood sugar in patients with diabetes.
Clonidin: When stopping using carvedilol and clonidin, carvedilol should be stopped for a few days before stopping clonidin.
Aerodynamic anesthetic: Has an impact of force, increasing the effect of negative heart muscle spasms and hypotension.
Non -steroid anti -inflammatory, estrogen and corticosteroids: reduces the treatment of hypertension of carvedilol due to salt and water holding effects.
Cytochrom P450 inhibitors or induction drugs: Patients use simultaneous induction (rifampicin, barbiturat) or inhibitor (cimetidin, ketoconazol, fluoxetin, haloperidol, verapamil, erythromycin) enzyme cytochrom P450 need to be carefully monitored during carved treatment with carved treatment Serum carvedilol levels may be changed by the above drugs. Rifampicin decreased by about 70% of plasma carvedilol levels, cimetidine increased AUC value by about 30% but did not change CMAX.
Parolic stimulants have the same effects similar to alpha and beta: The risk of hypertension and heart is too slow.
ergotamine: increased vasoconstriction.
Neuromusy: Increased risk of neuromuscular blockers.
Storage
Where dry, less than 30 ° C. Avoid light.
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