Egilok 50mg Egis Pharma medicine for hypertension, angina (60 tablets)

Dosage form Box of 60 capsules
Specifications Metoprolol tartrate

Ingredient

Composition information	Content
Metoprolol tartrate	50mg

Uses

Indications

Egilok 50 mg is indicated in the following cases:

Hypertension, simple use or if needed, coordinated with other antihypertensive drugs; Reduce cardiovascular and coronary artery (including sudden death) in patients with hypertension. It is possible to use medication alone or in combination with other anti -angina drugs. Arrhythmia (sinus tachycardia, ventricular ventricular upper, ventricular external ventricular). pressure.

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 to the heart muscle 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 mobility.

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 serum. In some cases, there is also a slight reduction in HDL cholesterol levels, but this reduction is less than using beta blockers that are not selective. However, long -term clinical trial results show a significant decrease in the whole serum cholesterol after many years of using Metoprolol.

pharmacokinetic pharmacokinetics

Metoprolol is quickly and completely absorbed 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 concentration in plasma changes a lot between individuals, but in an individual, it changes little.

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 appointment volume (5.6 liters/kg).

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

Semi -cancellation time (T1/2) is 3.5 hours on average (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, there is a reduction in metabolites in these cases.

There is a significant accumulation of metabolites in patients with severe disease in the kidneys (Filter of 5 ml/minute glomerulon). 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 has severe cirrhosis and after the surgery of the across the portal vein - the owner can increase, the total clearance of the body from the body can decrease. In patients with the Northern Variaced Surgery - the owner, the total clearance of the body decreases to about 0.3 liters/minute and the area under the concentration curve - the time increases by 6 times compared to healthy people.

Before taking Egilok 50mg Egis Pharma medicine for hypertension, angina (60 tablets)

How to use

Egilok 50 mg can take the medicine outside or during meals.

When needed, you can break the tablet in half.

Dosage

The dose 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 medium hypertension, the starting dose is 25 - 50 mg twice a day (morning and evening). When needed, the dose can be increased by up to 100 mg twice a day, or can be combined with other lower blood pressure drugs.

Angina

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

Maintain treatment after myocardial infarction

Normal dose 50 - 100 mg twice a day (morning and evening).

arrhythmia

The starting dose is 25 - 50 mg two or three times. If necessary, the daily dose is up to 200 mg, or can be combined with other anti -arrhythmic drugs.

hyperthyroidism

Dosage on the recommended day is 150 - 200 mg divided into 3 to 4 times.

Prevention of migraine

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

Special patient groups

No need to change the dosage in patients with kidney disease.

generally no need to change the dose when cirrhosis, because Metoprolol is less attached and plasma protein (5 - 10%). If you have severe liver failure (as after the bridge surgery), you may need to reduce the dose of metoprolol.

No need to change the dosage in elderly patients. There is little clinical experience in using Metoprolol 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?

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, β1 stimulants must be used by intravenous line with a distance of 2-5 minutes, or infusion until the desired effect. If there is no selective β1 stimulant drug, intravenous trang trophy or dopamine can be used. If the results are not satisfactory, it is necessary to consider the use of other drugs that have the same sympathetic nerve effect (dobutamine or norepinephrine).

Glucagon with doses of 1 - 10 mg may 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 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 Egilok 50 mg, you may experience unwanted effects (ADR).

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, refer to the frequency of side effects, are defined as follows: Very common> 10%. Usually 1 - 9.9%. Less common 0.1 - 0.9%. Rarely 0.01 - 0.09%. Very rare

Nervous system

Very common: fatigue.

Common: Dizziness, headache.

cardiovascular system

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

Common: Nausea, abdominal pain, diarrhea, constipation.

Uncommon: skin rash (urticaria, psoriasis and skin damage due to dysplasia), a lot of sweating. Psoriasis worse.

Respiratory system

Common: Difficulty breathing during exertion.

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

Less: weight gain.

Hematology

Very rare: platelet reduction.

Very rare: joint pain.

Testing values

Very rarely increased the concentration of triglycerides in serum.

Must stop Egilok if the aforementioned effects occur in severity and the cause cannot be clearly defined.

Notify the doctor with unwanted effects when using the drug.

Instructions on how to handle ADR

In the treatment of hypertension and angina with beta blockers: When there are signs or the first symptoms threaten heart failure, it is necessary to treat patients with digitalis and/or diuretics. Must closely monitor the response. If the heart failure continues, despite treating digitalis and diuretics, Metoprolol must be stopped.

When the Metoprolol stops have been used for a long time before, gradually reducing the dose for 1-2 weeks and careful monitoring of the patient. It should be noted that patients with hypertension are accompanied by coronary artery lesions and in many cases as asymptomatic, so if forced to stop using Metoprolol on these objects, it is necessary to reduce the dose slowly, avoid sudden stopping of the drug.

Be careful when treating patients suspected of having thyroid poisoning to avoid sudden stopping of beta blockers, because it can promote toxicity.

In the treatment of myocardial infarction with beta blockers: carefully monitor the patient's hemodynamic condition. If heart failure occurs or still exists despite being fully treated, Metoprolol must be stopped.

If the sinus frequency drops below 40 beats/minute, especially if combined with signs of heart flow reduction, an atropine intravenous (0.25 - 0.5 mg) can be injured. If therapeutic with atropine is not effective, methoLol must be stopped and carefully used isoproterenol or considering the pacemaker.

If the heart block occurs, Metoprolol must be stopped and consider treating with atropin, isoproterenol or a pacemaker.

If hypotension (systolic blood pressure

Metoprolol must be used carefully in patients with impaired liver function.

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

Egilok 50 mg contraindicated in the following cases:

Hypersensitivity to Metoprolol or other ingredients of the drug or other beta blockers. The heart is out of compensation.

Be cautious when using

Anaphylaxis can occur more worse in patients using Metoprolol.

Very rarely moderate atrial -ventilated disorders are severe and may occur atrial - ventricular 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 still avoid them as much as possible if the patient has respiratory obstruction. If Metoprolol must be used for patients with asthma, they may need to be coordinated with β2 stimulants (tablets and/or gases) or adjust the stimulant dose of β2 previously used.

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 the 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 ability to drive and operate machinery

Metoprolol affects the ability to drive and do jobs at risk of accidents, especially when starting treatment and if at the same time drinking alcohol (sometimes it can be dizzy and tired), so the dosage allowed to drive and do dangerous jobs must be identified for each case.

Pregnancy

Prelise clinical data does not show harmful effects.

Data on humans: When treated, it is necessary to consider and take advantage. If the medication is required, the fetus and the newborn must be monitored very carefully for many days (48 - 72 hours) after birth, because the reduction of circulation in the uterus - the placenta can affect the development of the fetus and the drug in the circulation of the fetus can cause the heart rate, respiratory failure, hypotension and hypoglycemia.

Breastfeeding period

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

Medicinal interaction

The hypotension effect of Egilok and other other antihypertensive drugs often plus each other, so to avoid low blood pressure must be cautious when coordinating the drugs together. 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 arrhythmia (Quinidine and amiodarone) and drugs that are similar to sympathetic neurological effects (risk of hypotension, slow heart rate, atrial block). Other blood pressure are mainly guanethidine, reserpine, alpha-methyl-dopa-clonidine and guanfacine (risk of lowering blood pressure and/or bradycardia). Hypertension may occur if clonidine is discontinued first. The heart is slow, cardiac arrest). Metoprolol). Paroxetine, Fluoxetine, Sertraline) (Metoprolol's effect due to higher plasma concentrations). Eye), or imao, it is necessary to closely monitor patients.

Storage

Store at temperatures below 25 ° C.

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