Egilok 100mg Egis Pharma medicine for hypertension, angina (60 tablets)

Dosage form Box of 60 capsules
Specifications Egis

Uses

Indications

Egilok 100mg Egis 60V indicated in the following cases:

Hypertension, simple use or if needed, coordinated with other antihypertensive drugs: reducing cardiovascular death and coronary artery (including sudden death) in patients with hypertension. (Table sinus rhythm, tachycardia, external ventricular ventricular).

In hypertension drugs lower the patient's blood pressure both when standing and lying. The long -term hypotension effect of the drug is related to the gradual decrease in the total peripheral resistance.

In patients with hypertension, long -term drug use will lead to a decrease in statistical significance of left ventricular volume and improving the activity of left ventricle during the diastolic period.

In male patients with severe to severe hypertension, Metoprolol reduces cardiovascular death (especially the rate of sudden death, infarction that causes death and non -fatal and stroke).

Like other beta blockers, Metoprolol reduces oxygen needs in the heart due to reducing systemic artery blood pressure, heart rate and heart muscle contraction force. By slowing down the heart rate and thereby prolonging diastolic time, Metoprolol improves perfusion and oxygen supply for blood myocardial areas reduced blood supply.

Therefore, in angina, the drug reduces the number of times, time and severity of the pain as well as the ischemic anemia silently, and improves the patient's movement.

In myocardial infarction, Metoprolol reduces death by reducing the risk of sudden death.

This effect is mainly due to the prevention of ventricular tremors. The effect of reducing death is also seen the same when the Metoprolol is given in the early or later stages and is also evident in patients at high risk and patients with diabetes. Use after myocardial infarction, the drug reduces the relapse of non -dead infarction.

In the tachycardia on ventricular, atrial fibrillation and ventricular external ventricular, Metoprolol reduces the frequency of ventricular and the number of heartbeat beats out.

With the treatment doses, the effect of peripheral vessels and bronchospasm of Metoprolol is not as strong as the beta blockers that have an unstable effect.

Comparison with beta blockers has an unstable effect, Metoprolol has less impact on insulin production and carbohydrate metabolism. The drug does not significantly change the reaction of the heart for low blood sugar or prolong the time of hypoglycemia.

In short -term clinical trials, metoprolol gently increases the concentration of triglycerides in the serum and reduces the concentration of free fatty acids in the serum.

In some cases, there is also a slight reduction in HDL cholesterol levels, but this reduction is less than using beta blockers that have an unstable effect. However, long -term clinical trial results show a significant decrease in the whole serum cholesterol after many years of using Metoprolol.

Dynamic pharmacokinetics

metoprolol is absorbed quickly and completely from the digestive system.

The pharmacokinetics of the drug have linear signs according to the dose of treatment.

Peak concentration in plasma appears 1.5-2 hours after treatment. Although the plasma concentration changes a lot among individuals, but in a kernel, it changes small.

After being absorbed, Metoprolol is strongly metabolized. The bioavailability of Metoprolol is about 50% after the single dose and about 70% after repeated dose.

Take medicine with food can increase the bioavailability of Metoprolol to 30-40%. Metoprolol is less attached to plasma proteins, about 5-10%.

Metoprolol is widely distributed in tissue, and has a large indicator volume (5.6 l/kg).

metoprolol is metabolized in the liver by cytochrome P450. The metabolites are not clinically important.

The half-life (t1/2) is 3.5 hours (change in about 1-9 hours). The total clearance of the body is about 1 liter/minute.

More than 95% of the treatment dose found in urine, 5% are discharged in the form of Metoprolol unchanged. Later rate can increase to 30% in some cases.

Metoprolol's

pharmacokinetics are not much different in elderly patients.

Kidney failure does not change the bioavailability in the body and the elimination of metoprolol. However, reducing the elimination of metabolites in these cases.

There is a significant accumulation of metabolites in patients with severe disease in the kidney (Filter of 5 ml/minute glomerular filtration). However, the accumulation of metabolites does not increase the level of beta.

Liver failure only small impact on pharmacokinetics of Metoprolol.

However, when severe cirrhosis and after the surgery, the cavalry is a portable venous coccus, the bioavailability may increase, the total clearance from the body can decrease.

In patients with the Northern-circulating venous surgery, the total clearance of the body decreases to about 0.3 liters/minute and the area under the concentration-shape curve increases by 6 times compared to healthy people.

Before taking Egilok 100mg Egis Pharma medicine for hypertension, angina (60 tablets)

How to use

can take external medicine or during meals.

When needed, you can break the tablet in half.

Dosage

The dosage must be calculated for each case to avoid the heart rate too slow. The usual dose is as follows:

Hypertension:

In case of mild and moderate hypertension, the starting dose is 25-50 mg twice a day (morning and evening).

The starting dose is 25-50 mg two to three times a day, depending on the response of the patient that can gradually increase to 200 mg of the day, or in combination with other anti-angina drugs.

The usual dose of 50 - 100 mg twice a day (morning and evening).

The starting dose is 25-50 mg two days or three times.

The daily dose of the recommended day is 150 - 200 mg divided into 3 to 4 times.

The usual dose is 50 mg twice a day (morning and evening). May be increased to 100mg 2 times if needed.

Special patient groups:

There is no need to change the dose in patients with renal disease. Age.

The aforementioned symptoms may be worse after use with alcohol, antihypertensive drugs, quinidine and barbiturates.

The first symptom of an overdose appears within 20 minutes- 2 hours after taking the drug.

In overdose treatment measures, need to take care of and monitor patients closely (parameters of circulation, respiratory, kidney function, blood sugar, electrolytes in serum).

If the drug has just been taken, it may reduce the absorption of the drug by gastrointestinal (or causing vomiting by the medical staff who has been trained if it is not possible to wash the stomach and if the patient is awake) and the use of activated carbon.

In case of severe hypotension, slow heart rate and threatening heart failure, it is necessary to use β1 stimulants by intravenous line with a distance of 2-5 minutes, or infusion until the desired effect.

If there is no selective β1 stimulant drug, an atropine can be used in intravenously or intravenous dopamine. If the results are not satisfactory, it is necessary to consider the use of other drugs that have the same sympathetic neurological effect (dobutamine or norepinephrine). Glucagon with doses of 1-10 mg can also be effective in reversing the effect of strong beta closing.

In case of heavy slow heart rate that does not respond to the drug, may need a heart rate machine. Bronchospasm can be treated with β2 stimulants by intravenous lines (such as terbutaline). Detoxes can be used in higher dose than treatment.

Cannot remove Metoprolol effectively by hemolysis.

What to do when forgetting the 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

Often patients with Metoprolol well -tolerated patients, side effects occur are usually mild and recover. The following side effects have been recorded in clinical trials and in regular treatment with side effects.

One of the cases cannot be checked between the use of drugs and the side effects. The terms below, used to refer to the frequency of side effects, are defined as follows: Very common:> 10%, common: 1-9.9%, uncommon: 0.1-0.9%, rare: 0.01-0.09%, very rare:

Nervous system:

Very common: fatigue

Common: Dizziness, headache

less common: abnormalities, muscle spasms, depression, attention disorders, drowsiness, insomnia, nightmares

rare: agitation, stress, sexual disorders

Very rare: Memory loss, illusion Circuit:

Common: Slow heart rate, posture hypotension (very rarely fainting), cold limbs, nervous

Uncommon: Symptoms of heart failure become severe, atrial block, edema, chest pain in the heart area

Rare: Pacilty, transmission disorders

Very rare: Messiac email to external diseases. Chemistry:

Common: Nausea, abdominal pain, diarrhea, constipation

less common: vomiting

Rare: dry mouth, Liver function test changes.

Uncommon: skin rash (urticaria, psoriasis and skin damage due to nourishment), sweating a lot

rare: Hair loss

is very rare: light sensitivity; Psoriasis worse.

Respiratory system:

Common: Difficulty breathing in exertion

Uncommon: Bronchospasm (although not suffering from obstructive pulmonary disease)

Rare: Rhinitis.

Rare: visual disorders, dry eyes and/or irritated eyes, conjunctivitis

very rare: tinnitus, taste disorders.

Intermediate metabolism:

Uncommon: weight gain.

Hematology:

Very rare: platelet reduction.

Very rare: joint pain.

Testing values:

It rarely increases the serum triglyceride level.

Notify the doctor with unwanted effects when using the drug.

Warnings

Contraindicated

Egilok 100mg Contraindicated in the following cases:

Hypersensitivity to Metoprolol or other ingredients of the drug, or with other beta blockers.

Unsatisfied heart failure.

Because clinical data is small, so contraindicated use Metoprolol when the myocardial infarction is acute if:

Heart rate below 45/minute

PQ time is longer than 240 ms

systolic blood pressure lower than 100 mmHg.

Patients need to be treated continuously or stages with the drug on muscle contraction force (Beta stimulation).

Be cautious when using

Anaphylaxis may occur more worse in patients using Metoprolol.

Very rarely moderate disorders that lead atrial-proprietary transmission become severe, and may occur atrial block.

If a slow heart rate occurs, it must be treated at a lower dosage or to stop the drug.

Metoprolol can make peripheral disorders more severe.

Must stop Egilok by reducing the dose step by step in about 14 days. Suddenly stopping the drug can make symptoms of angina worse, and increases the risk of coronary artery disease. Patients with coronary artery disease must be specially monitored when they have to stop the drug.

Although beta blockers with selective effects in the heart have a weaker effect on respiratory function compared to beta blockers that have an unstable effect, but they should still avoid using them as much as possible if the patient has respiratory obstruction.

If Metoprolol must be used for patients with asthma, it may be necessary to coordinate with β2 stimulants (tablets and/or gas or adjustments β2 stimulating drugs.

While the β blockers with a selective effect affects carbohydrate metabolism, or covering some symptoms of high blood sugar, if you have to use Egilok for diabetics, you must check the metabolism of carbohydrates more often, and if necessary, you must adjust insulin dose and oral diabetes medications. When treating patients with chromium cell tumors, Metoprolol must be combined with alpha blockers.

Must notify the anesthetist before having surgical intervention if there is Metoprolol, but should not stop Egilok.

The effect of drug drivers and operating machinery

metoprolol affects the ability to drive and do jobs at risk of accidents, especially when starting treatment and if they can drink alcohol at the same time (sometimes they can be dizzy and tired), so the dose of driving and making dangerous jobs must be identified for each case.

pregnancy and lactation

Pregnancy

Pre -clinical data: Pre -clinical data does not show harmful effects.

Data on humans:

When treatment must consider gain/harm. If the medication is required, the fetus and the newborn must be monitored very carefully for several days (48-72 hours) after birth, because the reduction of the circulation in the uterus-fetal fetus can affect the development of the fetus, and the medication in the circulation of the fetus can cause the heartbeat, respiratory failure, hypotension, and hypoglycemia.

Breastfeeding period

Although used at the treatment dose, Metoprolol is less excreted into breast milk, so it is not possible to cause beta blockers for children, but it still needs to monitor more carefully (which can occur slowly).

Drug interaction

The hypotension effect of Egilok and of other other antihypertensive drugs often plus each other, so to avoid low blood pressure must be cautious when coordinating with each other. However, the nature of the effect of antihypertensive drugs can help control blood pressure more effectively when needed.

Use Metoprolol at the same time with Verapamil and/or other diltiazem calcium blockers that will increase the negative and rhythmic effects. Veous venous veins should not be used by Verapamil type when patients are treated with beta blockers.

Precautions when coordinating with:

Oral anti -arrhythmia (quinidine and amiodarone) and drugs that are similar to sympathetic nerve (risk of hypotension, slow heart rate, atrial block).

Digitalis glycoside (risk of bradycardia, conduction disorders, Metoprolol does not affect the positive effect of digitals).

Other antihypertensive drugs/ mainly Guanethidine, Reserpine, Alpha-Methyl-Dopa-Clonidine and Guanfacine/ (risk of hypotension and/ or bradycardia).

If coordinated with clonidine, when stopping the drug, it is always necessary to stop metoprolol before and a few days later, stop clonidine after stopping metoprolol. Hypertension can occur if stopped clonidine first.

Some drugs act on the central nervous system such as: Sleeping drugs, nerves, anti -depression in groups of 3 rounds and 4 rounds, sedation, alcohol (risk of hypotension).

Addictive sleeping pills (risk of heart inhibition).

Medications that are similar to the sympathetic neuropathy Alpha and Beta (the risk of hypertension, higher heart rate, cardiac arrest).

ergotamine (increasing vasoconstriction).

Medicines have a sympathetic nerve effect β2 (functional resistance).

Non -steroid anti -inflammatory drugs (such as: indomethacin, can reduce the effect of hypotension).

Estrogen (can reduce the hypotension effect of metoprolol).

Oral and insulin diabetes (metoprolol increases hypoglycemia, and can hide low blood sugar signs).

Curare muscle relaxation drugs (as a more mechanical nervous closing effect).

Yeast inhibitors (such as cimetidine, alcohol, hydralazine, SSRIs such as paroxetine, fluoxetine, sertraline) (the effect of metoprolol due to higher plasma concentrations).

Menur sensor (such as rifampicin, barbiturate) (the effect of metoprolol may be reduced due to metabolic increased in the liver).

When used with sympathetic nerve inhibitors or other beta blockers (such as eye drops), or imao, it is necessary to closely monitor patients.

Storage

Store at temperatures below 30 ͦ c.

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