Corneil 5 Dat Phu Phu treats hypertension, chest pain (3 blisters x 10 tablets)

Bisoprolol is used to treat hypertension. Bisoprolol's effectiveness is equivalent to other beta blockers. The mechanism of lowering the hypotension of Bisoprolol may include the following factors: reducing heart flow, renal inhibition releases renin and reducing the impact of sympathetic nerve from vasomotor centers in the brain. But the most prominent effect of Bisoprolol is to reduce the heart frequency, both resting and at exertion. Bisoprolol reduces the flow of the heart at a break and when exertion, accompanied by a few changes in the volume of blood expanding in every heart squeeze and only increases less right atrial pressure or pulmonary capillary pressure at rest and at exertion. Unless there is contraindications or the patient is not tolerated, beta blockers have been used in combination with enzyme inhibitors, diuretic and heart glycosides to treat heart failure due to left ventricular dysplasia, to reduce progressive heart failure. The good effect of beta blockers in the treatment of congestive heart failure is mainly due to inhibition of the effects of sympathetic nervous system. Long -term beta blockers, as well as conversion inhibitors, can reduce heart failure symptoms and improve clinical status of people with chronic heart failure. These good effects have been shown in people who are taking a transferred inhibitor, showing the inhibition of the coordination of the renin-angiotensin system and the sympathetic nervous system are plus effects.

Pharmacokinetics

absorption

Bisoprolol is almost completely absorbed through the gastrointestinal tract. Food does not affect the absorption of the drug.

Because only the initial metabolism is very little, orally via oral about 90%. After drinking, the peak concentration in plasma is reached from 2 - 4 hours.

Distribution

About 30% of the drug attaches to plasma proteins. Bisoprolol is moderately dissolved in lipid.

Metabolism and elimination

Semi -selling time in plasma from 10 to 12 hours. Metabolic drugs in the liver and excretion in urine, about 50% in constant form and 50% in the form of metabolites.

pharmacokinetics on special statues

In the elderly, the sale time in plasma is slightly longer than young people, although the average plasma concentration in a stable state increases, but there is no significant difference in the accumulation of bisoprolol between young people and the elderly.

In people with creatinine clearance ratio below 40 ml/ minute, the semi -disposal time in plasma increases about 3 times higher than normal people.

In people with cirrhosis, the rate of excretion of Bisoprolol changes more and lower is significant than normal people (8.3 - 21.7 hours).

Maximum doses recommended: 10 mg x 1 time/ day.

The adjustment dose does not have to follow the clinical response but according to the level of tolerance to the target dose. In some patients, there may be unwanted effects, so it is impossible to achieve the maximum recommended dose. If necessary, the dose must gradually reduce. In case of necessity, it is necessary to stop treatment, then continue treatment again. During the dose adjustment period, when the heart failure worsens or is not tolerated, it is necessary to reduce the dose, even stop treating immediately if needed (severe blood pressure, severe heart failure accompanied by acute pulmonary edema, cardiac shock, bradycardia or atrial - ventricular block).

Treatment of stable chronic heart failure with bisoprolol is a long -term treatment, not suddenly stopped, which can worsen the heart failure. If it is necessary to stop, gradually reduce the dose, divide the dose half a week.

kidney failure or liver failure in people with chronic heart failure: There is no pharmacokinetic data. Must be very careful to increase the dose in this patient.

People with liver or kidney failure: In patients with severe liver or kidney failure (creatinine clearance Elderly: No need to adjust the dose.

Children: There is no data. Unsired 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?

Observed a slow and/ or hypotension. In some cases, the drugs have been used as sympathetic nerve and all the patients have recovered.

Signs of overdose due to beta blockers include slow heartbeat, hypotension and sleeping and if severe, delirium, coma, convulsions and respiratory arrest. Sound blood failure, bronchospasm and hypoglycemia may occur, especially in people who have diseases in these organs. If an overdose occurs, bisoprolol stops and support treatment and symptoms. There are a few data that suggest bisoprolol fumarat cannot be separated.

Slow heart rate: Atropine intravenous injection. If the response is incomplete, caution can be used with isoproterenol or another drug that increases the heart rate. In some cases, temporary pacemaker places to stimulate the rhythm.

Hypotension: Intravenous fluid and use of hypertension drugs. Can use intravenous glucagon.

Heart Block (two or three): careful monitoring of patients and isoproterenol infusion or pacemaker, if appropriate.

SECRETING HEART: Take common measures (use digitalis, diuretics, medications that increase muscle contraction, vasodilators).

Bronchospasm: Use a bronchodilator like isoproterenol and/ or aminophyllin.

Hypoglycemic blood glucose: glucose intravenous injection.

What to do when you forget 1 dose? If you forget to take 1 dose, you have to take the medication as soon as possible. After that, take the next dose as usual. Do not take a few doses to compensate.

When ADR occurs with the above manifestations, it can be treated as cases of overdose symptoms.

The drug can cause other unwanted effects, need to monitor closely and recommend the patient to notify the doctor with unwanted effects when using the drug.

Be cautious when using

heart failure: Sympathetic stimulation is an essential component that supports circulatory function in the beginning of congestive heart failure and beta blockers can lead to further decrease in heart muscle contraction and promote more severe heart failure. However, in some patients with congested heart failure, compensation may need 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, inhibitors) under the strict control of specialized physicians.

For patients without heart failure: The continuous inhibition of the heart muscle of beta blockers can cause heart failure. When there are signs or first symptoms of heart failure, it is necessary to consider stopping 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 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 the advice of a physician. Even for patients with unknown coronary artery disease, it is advisable to gradually reduce Bisoprolol for about a week under the careful monitoring of a physician. If the symptoms of cessation occur, the drug should be used at least for a period of time.

Peripheral vascular disease: Beta blockers can worsen the symptoms of artery failure in people with peripheral artery inflammation, which should be cautious for these patients.

Bronchospasm: In general, patients with bronchial spasms must not use beta blockers. However, due to the relatively selective nature of Beta1, bisoprolol can be used in patients with bronchospasms that do not respond to or unable to tolerate other anti -hypertension treatment. Because the beta1 selection is not absolutely absolutely, the lowest bisoprolol dose must be used and start at a dose of 2.5 mg. There must be a Beta2 motorbike owner (bronchodilator).

Anesthesia and surgery: If it is necessary to continue treating with bisoprolol near surgery, it is necessary to be especially cautious when using anesthesia to impair myocardial function such as ether, cyclopropan and tricloroethylen.

Diabetes and hypoglycemia: Beta blockers can cover the manifestations of hypoglycemia, especially tachycardia. Unstolant beta blockers may increase the level of hypoglycemia caused by insulin and slow down the recovery of serum glucose concentrations. Due to the selective nature of Beta1, this is less likely to occur with Bisoprolol. However, it is necessary to warn the patient or hypoglycemia, or diabetic patients who are taking insulin or blood glucose oral medications for these possibilities and must be used carefully.

End poisoning: Beta - adrenergic blockers can cover clinical signs of hyperthyroidism such as tachycardia. The sudden stop of beta blockers can worsen the symptoms of the thyroid function or may promote the storm.

impaired renal and liver function: Need to adjust Bisoprolol dose carefully for patients with renal impairment or liver failure.

Warning and caution related to excipients:

The drug contains lactose, patients with rare genetic diseases with galactose tolerance, lactase deficiency or glucose-galactose absorption disorders should not be used.

To be out of reach of children.

The ability to drive and operate machinery

The drug can affect the ability to drive and operate machinery. So be careful, especially in the early stages of treatment, after changing the drug or drinking alcohol.

Pregnancy

bisoprolol can be harmful to pregnant women and or fetus/ infant. In general, beta blockers reduce perfusion through the placenta, which may be related to underdeveloped pregnancy, pregnancy, miscarriage or early labor. Unwanted effects (such as lowering blood glucose and slow heart rate) can occur in fetus and infants. If it is necessary to treat with beta blockers, it is better to use beta1 selective blockers.

Only use bisoprolol for women during pregnancy when really necessary. The blood flow should be monitored and the development of the fetus. In case of harmful effects on pregnant women or fetus, recommendations to consider replacement treatment. Closely monitor babies. Symptoms of hypoglycemia of blood glucose and slow heart rate often occur within the first 3 days.

The period of breastfeeding

No Bisoprolol report is excreted in human milk or not, need to be cautious when using Bisoprolol for women who are breastfeeding.

Drug interaction

Do not combine bisoprolol with other beta blockers.

Need to closely monitor patients using drugs that consume catecholamine such as reserpin or guanethidin, because the increase in the effect of beta - adrenergic blocker can cause excessive reduction in sympathetic activity.

The drugs enhancing the hypotension effect of bisoprolol, for example: enzyme inhibitors, calcium and clonidin channel blockers may be beneficial in controlling hypertension. The drug that causes hypotension such as Aldesleukin and anesthesia also enhances the hypotension effect of the drug while other drugs, such as NSAID, antagonistic anti -blood pressure.

Be careful to use bisoprolol when used simultaneously with cardiomyopathy inhibitors or atrial - ventricular inhibitors, like some calcium antagonistic drugs, especially in the groups of phenylalkylamin (verapamil) and benzothiazepine (diltiazem), or anti -arrhyths, such as disopyramid.

bisoprolol can increase the ability to slow down the heart rate due to digoxin.

Beta blockers in diabetics can reduce response to insulin and hypoglycemic drugs through their effects on the beta receptors.

Beta peripheral receptor blockers affect the impact of sympathetic drugs; Patients using beta blockers, especially unsatisfactory beta blockers, may have hypertension if they use Adrenalin and the bronchodilator effect of Adrenalin is also inhibited. Responding to adrenalin so that anaphylactic shock can be reduced in patients using prolonged beta blockers.

Absorbing drugs include aluminum and plastic acid -mounted salts such as Colestyramin.

Medications for malaria, like halofantrin, mefloquin and quinin can cause heart transmission defects, cautious if used with beta blockers.