Corneil medicine Dat Vi Phu treats hypertension, angina (6 blisters x 10 tablets)

Dosage form Box of 6 blisters x 10 tablets
Specifications Bisoprolol
Ingredient Heart failure, high blood pressure, angina

Ingredient

Composition information	Content
Bisoprolol	2.5mg

Uses

Indications

Corneil 2.5 drugs are indicated in the following cases:

Hypertension, angina. Filter (Selective receptor of sympathetic Beta1), anti -hypertension, angina, congestive heart failure.

Bisoprolol is a selective beta1 blocker but has no membrane stability and has no effect of interrelated sympathetic nerve when used within the treatment dose range.

With low doses, Bisoprolol inhibits selectively responding to adrenalin stimulation by competing the Beta1 adrenalin receptor of the heart, but has little effect on the beta 2 receptor receptor of bronchial muscles and vascular walls. With high doses (for example, 20mg or more), the selective properties of bisoprolol on the beta1 receptor usually decrease and the drug will compete inhibiting both beta1 and beta2 receptors.

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 cardiac flow, renal inhibitors releasing renin and reducing the impact of sympathetic nerves from vascular 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 the time of rest and when exertion, accompanied by few changes in the volume of blood expedites in every heart squeeze and only increases less right atrial pressure or pulmonary capillary pressure at break and at exertion. Unless there is a contraindication or an intolerant, beta blockers have been used in combination with transferred 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. Using long -term beta blockers, as well as conversion inhibitors, can reduce symptoms of heart failure and improve clinical condition of people with chronic heart failure.

These good effects have been proven in people who are taking a transferred inhibitor, showing inhibitors in combination of the Renin Angiotensin system and sympathetic nervous system are plus effects.

pharmacokinetic

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 subjects

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 40ml/min, the sale time in plasma is about 3 times more 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).

Before taking Corneil medicine Dat Vi Phu treats hypertension, angina (6 blisters x 10 tablets)

How to use

oral, oral or non -meal.

Swallow whole tablet with water, do not chew or break the pill.

Dosage

The dose of bisoprolol fumarat must be determined for each patient and adjusted depending on the response of the disease and the tolerance of the patient, usually at least 2 weeks apart.

Treatment of hypertension and angina:

In adults the dose of Bisoprolol Fumarat is used from 5 - 10mg, taken 1 time/day.

The maximum dose is 20mg/day.

Dosage reduction in liver failure or kidney failure.

Treatment of stable chronic heart failure:

Patients with chronic heart failure must be stable, there is no exacerbation within 6 weeks and must be treated with an enzyme inhibitor in the appropriate dose (or with another vasodilator in case of non -tolerance of enzyme inhibitors) and a diuretics and/or sometimes with a digital, before bisoprolol treatment.

Treatment has not changed much in the last 2 weeks before taking Bisoprolol.

The treatment must be monitored by a cardiologist. Treatment of stable chronic heart failure with bisoprolol must start with a dose adjustment period, the dose is gradually increasing according to the following diagram:

Use 1.25mg/1 time/day (taken in the morning) for 1 week; If tolerated, increased the dose.

Use 2.5mg/1 time/day for 1 week; If tolerated well, increase.

Use 5mg/1 time/day for 4 weeks later; If tolerated well, increase.

Use 7.5mg/1 time/day for 4 weeks later; If tolerated well, increase.

Use 10mg/1 time/day for maintenance treatment.

After starting the first dose of 1.25mg, the patient must be monitored within 4 hours (especially monitoring blood pressure, heart frequency, conduction disorders, signs of severe heart failure).

Maximum doses recommended: 10mg/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.

Renal failure or liver failure in people with chronic heart failure: There is no dynamic 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: 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 the slow heart rate 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, 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 forgetting a 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 double the dose to compensate.

Side Effects

When using Corneil 2.5, you may experience unwanted effects (ADR).

Bisoprolol is well tolerated in most patients. Most of the ADR is mild and temporary. The proportion of patients who need to stop treatment due to ADR is 3.3% for patients using bisoprolol and 6.8% for patients using Placebo.

Very common, ADR ≥ 1/10

Heart: Slow heart rate.

Common, 1/100 ADR

Heart: severe heart failure.

nerve: dizziness, headache. digestive: digestive disorders such as nausea, vomiting, diarrhea, constipation. blood vessels: Feeling cold or numbness in the head, lowering blood pressure.

General: weakness, fatigue.

Uncommon, 1/1,000 ADR

heart: Atrial - ventricular disorders.

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

muscle and connective tissue: muscle weakness, muscle spasm, joint pain.

Mental: Sleep disorders, depression. general: chest pain, peripheral edema.

Rare, 1/10,000 ADR

Testing: Increasing triglycerides, increasing liver enzymes (ALT, AST).

nerve: coma. Eye: Reduce tear secretion (should be noted if the patient uses contact lenses). ears: hearing disorders.

Respiratory, chest and mediastinum: allergic rhinitis.

Skin and subcutaneous tissue: Hypersensitivity reactions such as itching, redness, rash. liver - bile: hepatitis.

Reproduction and mammary gland: erectile dysfunction.

Mental: Nightmares, hallucinations.

Very rare, ADR

Eye: conjunctivitis.

Skin and subcutaneous tissue: Beta blockers can cause onset or worsen psoriasis or cause psoriasis rashes, hair loss.

ADR management

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 closely monitor and recommend the patient to notify the doctor unwanted effects when using the drug.

Warnings

Contraindicated

Corneil 2.5 contraindications in the following cases:

sensitive to bisoprolol or any ingredient of the drug.

bisoprolol contraindicated in patients with cardiac shock, acute heart failure, untreated heart failure by treating background, heart failure III or IV, atrial block - second or third degree and sinus slow heartbeat (under 60/minute before treatment), sinus node disease.

Severe or lung disease - Chronic bronchial obstruction.

Severe Raynaud syndrome.

adrenal marrow tumor (chrome cell tumor) before being treated.

Low blood pressure (

Metabolic acidosis.

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 myocardial 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 a history of 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.

Stop sudden 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 stop taking the drug without a doctor's advice. 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. Be cautious for these patients.

Bronchospasm: In general, patients with bronchospasm 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 selection of beta1 is not absolutely, the lowest bisoprolol dose must be used and started at a dose of 2.5mg. There must be a Beta 2 -maneuverbate (bronchodilator).

Anesthesia and surgery: If it is necessary to continue treating with bisoprolol near surgery, it must be particularly cautious when using anesthesia to impair myocardial function such as ether, cyclopropane and tricroethylen. 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.

Thyroid poisoning: Beta - adrenergic blockers can cover clinical signs of thyroid hyperplasia 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 kidney or liver failure.

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 and lactation

Pregnancy

Bisoprolol can be harmful to pregnant women and 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.

Breastfeeding period

Do not know if bisoprolol 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 hypertension control.

Hematopsy such as Aldesleukin and anesthesia also enhance 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 to treat anaphylaxis can be reduced in patients using prolonged beta blockers.

Absorbing drugs include aluminum and plastic salts mounted bile like cholestyramin.

Bisoprolol metabolism can be increased by drugs such as barbiturat and rifampicin and decreased with drugs such as cimetidin, erythromycin, fluvoxamine and hydralazin.

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

Storage

In a dry place, avoid light, the temperature does not exceed 30 degrees C.

To be out of reach of children.

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