Nebicard 2.5 torrent tablets for hypertension (5 blisters x 10 tablets)

Dosage form Box of 5 blisters x 10 tablets
Specifications Nebivolol

Ingredient

Composition information	Content
Nebivolol	2.5mg

Uses

Indications

Nebicard 2.5mg is indicated for treatment of hypertension .

Pharmacokological

Nebivolol is a β1 blocker of water body, clinically used in the form of a racemic mixture of two optical copper D and L in equal ratio. It is a competitive substance, highly selected antagonistic with β1 receptor and has some slight effects on blood vessels, possibly due to interaction by L - Arginine/Nitric Oxid mechanism.

Nebivolol has the effect of protecting the functioning of the left ventricular heart. The drug tends to reduce the burden and maintain or reduce the burden. The heart rate and pressure at the end of the centrifugal ventricular ventricular are decreasing while the volume of the squeeze increases and the heart amount is maintained.

pharmacokinetic

absorption

After taking Nebivolol tablets, the drug reaches the blood concentration in the blood within 0.5 to 2 hours and this time is not affected by food. Oral bioavailability is about 12% on average people in those who metabolize good drugs and reach 96% in poor metabolic people.

With a stable condition and the same dose level, the peak concentration of Nebivolol's plasma is constant in those who metabolize drugs about 23 times less than those who are capable of good drug metabolism.

Distribution

In plasma, both of Nebivolol's optical isomers are associated with albumin. The associated ratio of plasma proteins of SRRR - Nebivolol is 98.1 % and of RSSS - Nebivolol is 97.9 %.

Metabolism

Nebivolol is strongly metabolized, partly into hydroxyl metabolites. Nebivolol is metabolized through the process of hydroxylation of saturated and aromatic ring, n - n - dealkylation and glucuronid, then hydroxyl metabolites are also associated with gluconid compounds. Nebivolol's aromatic hydroxylation depends on the polymorphism in the gene expression of the enzyme CYP2D6.

The difference between the peak concentration of the drug in the form of unchanged and its active metabolites is 1.3 to 1.4 times.

Due to the difference in the metabolic speed, the dose of Nebivolol should always be adjusted depending on the patient: those who metabolize drugs are poor, so it is necessary to be used lower doses.

Stable plasma concentrations in most patients (fast metabolic people) are achieved after 24 hours for Nebivolol and within a few days for its hydroxyl metabolites. Plasma concentrations are proportional to the dose of about 1 - 30mg. Age does not affect the pharmacokinetics of Nebivolol.

Elimination

In those who metabolize drugs fast, the sale time of optical isomers of Nebivolol is 10 hours on average.

For those who metabolize drugs slowly, the semi -waste time lasts 3-5 times. In those who metabolize drugs fast, the plasma concentration of the SRRR isomer is slightly higher than the RSSS concentration.

For those who metabolize slowly, this difference is greater. In those who metabolize drugs quickly, the sale time of hydroxyl metabolites of both types of isomers averages is 24 hours and for slow metabolic people, this period of time is twice.

Before taking Nebicard 2.5 torrent tablets for hypertension (5 blisters x 10 tablets)

How to use

Drugs used by oral.

Drugs can be taken at meals.

Dosage

Dosage: 5 mg/time/day, drink at a certain time of the day.

Patients with renal failure:

The plasma concentration of optical isomers and hydroxylation metabolites significantly increased in patients with kidney failure . Therefore, the reduction of the dose is recommended for these patients.

In patients with renal failure, the starting dose is recommended for 2.5mg per day.

If necessary, daily dose can be increased to 5mg.

Patients with liver failure:

Data on drug use for patients with liver failure or liver function impairment is limited. Therefore, the use of Nebivolol for these patients is contraindicated.

Elderly:

Due to the limited medication experience for patients over 75 years old, when using the drug should be cautious and need to closely monitor these patients.

Children:

There is no data on the safety and efficiency of Nebivolol for children. Therefore, the use of drugs for children is not recommended.

Bring the tablet along with the packaging so that the doctor knows what medicine he takes and has timely measures.

Symptoms:

Symptoms of overdose of beta blockers are slow heart rate, hypotension, bronchospasm and acute heart failure.

Treatment:

When overdose, patients need to be closely monitored and active treatment. Need to check blood glucose levels. It is possible to prevent the absorption of the remaining drugs in the gastrointestinal tract by gastrointestinal lavage or for patients to take activated carbon and a bleach.

Artificial respiration may also be necessary. Bradycardia or widespread vagus reactions can be treated with atropine and methyl atropin.

hypotension and shock should be treated with plasma/plasma substances and if necessary, with catecholamine.

Beta blockers can be neutralized by slow venous infusion isoprenalin hydrochloride starting at a dose of about 5μg/min, or dobutamin with the starting dose of 2.5μg/minute, until the desired effect is obtained. With non -response cases, isoprenalin can be combined with dopamine.

If this measure still does not produce the desired response, it can be considered to use the Glucagon intravenous injection method of 50 - 100μg/kg.

If needed, can be reminded within an hour and even needed, can infect glucagon intravenously at a dose of 70μg/kg/hour.

With the most severe cases when the slow heart rate phenomenon does not respond to treatment, the pacemaker can be placed for patients.

What to do when you forget the dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Do not drink twice as prescribed.

Side Effects

Hypertension.

Unwanted effects are reported mainly from light to medium levels listed in the table below, classified by organs and frequency order:

Agency system

popular

(≥ 1/100 -

Rare

(≥ 1/1,000- ≤ 1/100)

Very rare

(≤ 1/10,000)

Unknown

immune system disorders

Mental disorders

Headache, dizziness, paresthesia

Difficulty breathing

Bronchospasm

constipation, nausea, diarrhea

Indigenous, flatulence, vomiting

Psoriasis worse

tired, suitable

Practolol.

‘‘ Inform your doctor about unwanted effects when using the drug. ”

Warnings

Contraindicated

Nebicard 2.5 is contraindicated in the following cases:

Patients who are sensitive to nebivolol. and 3. Drugs.

Precautions when taking drugs

Anesthesia

Continue to use beta blockers reduces the risk of arrhythmia at the beginning and intubation. If you stop the beta blockers to prepare for surgery, it is necessary to stop the drug at least 24 hours before surgery.

Be careful to monitor anesthesia due to inhibiting myocardial inhibition. Patients need to be cared for to avoid reactions on the nerves due to the use of intravenous Atropin.

Cardiovascular

Do not use beta - adrenergic blockers in patients who have not been treated for congestive heart failure, unless the patient's condition is stable.

Should stop taking Beta - adrenergic blockers slowly above patients with anemia, about 1-2 weeks after 1-2 weeks. If needed, replacement therapy should be started at the same time to prevent the seriousness of angina

Beta - adrenergic blockers can increase the heart rate slowly: If the heart rate is about 50 - 55BPM at leave and/or during activity, this symptom evokes a slow heart rate, which is needed to reduce the dose.

Should kidneys in using beta - adrenergic blockers on:

Patients with peripheral circulatory disorders (disease or raynaud or cramps), because these disorders may be more serious;

In patients with atrial atria, because beta blockers have a negative effect on the transmission time;

In patients with prinzmetal angina due to the antagonistic alpha intermediate coronary artery: Beta - adrenergic blockers can cause increased quantity and time of angina.

It is not recommended to use Nebivolol with calcium channel blockers such as Verapamil and Diltiazem, anti -arrhythmic drug group 1, anti -hypertension.

Metabolism/endocrine

Nebivolol does not affect glucose levels in diabetics. However, be cautious when used in these patients because Nebivolol can hide the symptoms of hypoglycemia (tachycardia, chest drumming).

Beta - adrnergic blockers can hide symptoms of tachycardia in hyperthyroidism. Sudden stopping drugs can cause these symptoms.

Respiratory

In patients with chronic obstructive pulmonary disorders, caution should be used with beta-adrenergic blockers due to respiratory spasms may be worse.

Other

Be careful to consider using beta - adrenergic blockers in patients with a history of psoriasis.

Beta - adrenergic blockers can cause allergies and serious anaphylactic reactions.

Need to check regularly when starting treatment in chronic heart failure with Nebivolol. No sudden treatment unless indicated.

Due to lactose -containing drugs, do not use this drug in rare genetic patients with galactose intolerance, lapp - lactase lack of glucose - Galactose.

The ability to drive and operate machinery

because the drug can cause headaches, dizziness, fatigue, and paresthes during use. Should be cautious when driving or operating machinery.

Pregnancy and lactation

Pregnancy

The data on the use of Nebivolol for pregnant women is incomplete to identify the harmful effects of the drug with this object. Animal studies have not seen signs of any adverse effects other than the effect of the pharmacological properties of the drug.

Beta blockers that reduce the flow of fetal vegetables can lead to fetal death, miscarriage or premature birth.

Moreover, adverse effects (hypoglycemia and slow heart rate) may appear in the fetus and babies.

Babies in the early stages after birth are still at high risk of heart and lung complications. Therefore, Nebivolol should not be used for women during pregnancy.

Breastfeeding period

Most beta blockers, especially water -body compounds like Nebivolol and its metabolites, can be breastfed to different degrees.

Because in humans, whether Nebivolol is excreted in breast milk or not, it is still unknown, so the use of nebivolol for women during breastfeeding is contraindicated. Animal studies show that Nebivolol is excreted in milk.

Other special subjects (elderly, children, allergies)

Elderly: Due to the experience of using drugs for patients over 75 years old is also limited, so when using the drug should be cautious and need to closely monitor these patients.

Children: There is no data on the safety and effectiveness of Nebivolol for children. Therefore, the use of drugs for children is not recommended.

Drug interaction

Calcium channel blockers:

Be careful when using Beta - Adrenergic antagonists simultaneously with calcium channel blockers such as Verapamil or diltiazem because of their adverse effects on heart contraction and atrial transmission.

Verapamil intravenous injection is contraindicated for patients taking Nebivolol.

anti -arrhyths:

It should be noted when using beta -adrenergic antagonists in combination with anti -arrhythmic drugs group I and amiodaron because of their impact on the transmission time in the atria and the ability to reduce myocardial contraction.

Clonidine:

Adrenergic antagonists - adrenergic drugs increase the risk of feedback on feedback after suddenly stop using clonidine.

Digitalis:

Digitalis cardiac glycosides combined with beta - adrenergic antagonistic drugs can cause atrial -ventricular increasing time. Clinical trials with Nebivolol does not give any clinical evidence of an interaction.

nebivolol does not affect the dynamics of digoxin .

insulin and oral anti -diabetic drugs:

Although Nebivolol does not affect blood sugar levels, some symptoms of hypoglycemia (chest drum, tachycardia) can be hidden when taking the drug.

Anesthesia:

Concomitance of Beta - Adrenergic antagonism with anesthesia with anesthetic can reduce tachycardia reflexes and increase the risk of hypotension. Anesthesia doctors must be notified if the patient is taking Nebivolol.

Other drugs:

Concomitance nonsteroidal anti -inflammatory drugs (NSAID) does not affect the effectiveness of nebivolol's hypotension.

Concentrated use with cimetidine increases the plasma concentrations of nebivolol but does not change the clinical effect.

Simultaneous use with rantidin does not change the pharmacokinetics of nebivolol. Can be prescribed Nebivolol to drink when eating and an antacids (antacid) used between meals.

Combining nebivolol with nicardipine increases the plasma concentration of both drugs but does not change the clinical effect.

Simultaneously used with alcohol, Furosemid or hydroclothiazid does not affect the pharmacokinetics of Nebivolol.

Nebivolol does not affect Warfarin's pharmacokinetics and pharmacokinetics. Sympathetic drugs may lose the effect of beta - adrenergic antagonists. Beta - adrenergic antagonists can increase the effects of Adrenergic Adrenergic enhancement of sympathetic drugs that act on both alpha and beta adrenergic systems (leading to the risk of hypertension, bradycardia and cardiac block).

Concomitance of 3 -round antidepressants, barbiturat and phenothiazine sleeping pills may increase the effectiveness of nebivolol's hypotension.

Due to the process of metabolism of Nebivolol related to CYP2D6 enzyme, simultaneous use of Serotonin reabsorption inhibitors or other compounds are metabolized mainly by this enzyme that will reduce Nebivolol's metabolism.

Storage

You should store at room temperature not exceeding 30 ° C, avoid moisture and avoid light.

Expiry date: 36 months from the date of manufacture.

Other drugs

Disclaimer

Every effort has been made to ensure that the information provided by Drugslib.com is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Drugslib.com information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Drugslib.com does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Drugslib.com's drug information does not endorse drugs, diagnose patients or recommend therapy. Drugslib.com's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugslib.com does not assume any responsibility for any aspect of healthcare administered with the aid of information Drugslib.com provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.