Nebivolol Stella 5mg tablets treat hypertension (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Nebivolol

Ingredient

Composition information	Content
Nebivolol	5mg

Uses

indications

Nebivolol Stella 5 mg is indicated in the following case:

Treatment hypertension .

Pharmacokic

Nebivolol is a racemic mixture of two forms of SRRR-nebivolol (or D-nebivolol) and RSSS-Nebivolol (or L-Nebivolol). The drug combines both pharmacological effects: Nebivolol is a selective and competitive beta receptor blocker: This effect is due to SRRR-Enantiomer (D-Enantiomer).

The drug has light vasodilators due to interaction with the L-arginin/Nitric Road.

pharmacokinetics

absorption:

nebivolol is quickly absorbed when taken. Nebivolol's absorption is not affected by food. Therefore, Nebivolol can be used regardless of the meal.

Metabolism:

Nebivolol is metabolized, partly forming a active hydroxyl metabolic substance. Nebivolol is metabolized through saturated and aromatic hydroxylation, reducing alkyl in N-and glucuronide, in addition to forming glucuronides of hydroxyl metabolites.

The metabolism of nebivolol by hydroxylation of aromatic rings depending on the polymorphic oxidant properties of genetic properties dependent CYP2D6.

The average Nebivolol's oral bioavailability is 12% in fast metabolic and almost entirely in slow metabolic people.

Because there are many different levels of metabolism, Nebivolol's dose is always adjusted to respond to each patient: poor metabolic people need lower doses. In fast metabolic people, the sale time of the average nebivolol isomers is 10 hours. In people who metabolize slowly, longer than 3 to 5 times. In fast metabolic people, the sale time of hydroxyl metabolites of both types of isomers is 24 hours, and double the time in slow metabolic people.

Distribution:

Stable plasma levels in most subjects (fast metabolic) achieved within 24 hours for nebivolol and within a few days for hydroxyl metabolites. In plasma, both nebivolol isomers are largely combined with albumin. Countered with plasma proteins is 98.1% for SRRR-Nebivolol and 97.9% for RSSS-Nebivolol.

Era:

A week after taking the drug, 38% of the dose is excreted in the urine and 48% in feces. The excretion in urine in the form of unchanged Nebivolol is less than 0.5% of the dose.

Before taking Nebivolol Stella 5mg tablets treat hypertension (3 blisters x 10 tablets)

How to use

Nebivolol Stella 5 mg is used by oral.

Dosage

Dosage (5 mg)/day, it is best to take the same time of the day.

The effect of hypotension is evident after 1-2 weeks of treatment. Sometimes, the optimal effect is only achieved after 4 weeks.

Patients with impaired renal function.

The recommended starting dose is 2.5 mg/day. If necessary, the dose may be increased to 5 mg/day.

In patients over 65 years old, the recommended starting dose is 2.5 mg/day. If necessary, the dose can be increased to 5 mg/day.

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 do

do when using overdose?

Symptoms

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

Handling

In case of overdose or hypersensitivity to the drug, the patient needs to be closely monitored and treated under special care. Blood glucose concentration should be checked.

Can prevent the absorption of the rest of the drug still present in the gastrointestinal tract by gastric lavage, use activated carbon and a laxative, need for artificial respiration. Slow heart rate or excessive sympathetic response should be treated by using atropine or methylatropin.

Hypotension and shock should be treated with plasma/substances instead of blood and if necessary, using catecholamine. The effect of beta blockers can be reduced by slow intravenous injection isoprenalin hydrochloride, starting at a dose of about 5 mcg/minute or Dobutamin starts at a dose of 2.5 mcg/minute until the desired effect.

In persistent cases, isoprenalin can be combined with dopamine. If still not achieved the desired effect, maybe intravenously glucagon 50 -100 mcg/kg. If necessary, it should be repeated by intravenous glucagon 70 mcg/kg intravenously within an hour, monitoring. In cases where the heart rate is too slow to resist the treatment, an additional heart rate air conditioner can be used.

What to do when you forget 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 Nebivolol Stella 5 mg, you may experience unwanted effects (ADR).

Common, ADR> 1/100

Nervous system: headache , dizziness.

Respiratory system: Difficulty.

Digestive system: constipation , nausea, diarrhea.

Systemic: Perception, fatigue and edema.

Uncommon, 1/1000

There is no information

Instructions on how to handle ADR

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.

Contraindications:

Nebivolol Stella 5 mg contraindicated in the following cases:

Sensitive to the active ingredient or any excipients of the drug.

Lack of liver function or liver function impairment.

Acute heart failure, cardiac shock or loss of heart failure need to be intravenous medication. Sinus button impairment syndrome includes sinus block.

Block of the second or three -degree heart (not yet pacent air conditioner).

History of bronchospasm or bronchial asthma.

Untreated adrenal marrow.

Metabolic acid infection.

Slow heart rate (heart rate

Hypotension (systolic blood pressure

Severe peripheral peripheral disorders.

Caution when using

Anesthesia

Continuing to treat with beta blockers reduces the risk of arrhythmia in anesthesia and intubation. If you have to stop the beta blocker to prepare for surgery, it is necessary to stop at least 24 hours before. Caution should be monitored for some anesthetic because it can cause myocardial failure. Atropin intravenous injection can help patients against sympathetic neurological reactions.

Cardiovascular

Normally, beta-adrenergic blockers should not be used for patients with congestive heart failure, unless untreated, unless the status of the person has stabilized.

In patients with local heart anemia, treatment with beta blockers should stop the drug slowly (1-2 weeks). If necessary, replacement treatment should start the same time to prevent serious angina.

Beta -adrenergic blockers can cause slow heart rate: If the circuit frequency drops below 50 - 55 beats/minute at rest and/or patients with signs related to slow heart rate, need to reduce the dose.

Should take Beta-commenergic blockers carefully

In patients with peripheral circulatory disorders (Raynaud's disease or syndrome, limp) because they can worsen these disorders.

In patients with cardiac block 1, due to the negative effects of beta blockers during transmission.

In patients with Prinzmetal angina due to the apron-intermediary artery spasm of the alpha receptor is antagonistic: beta-adrenergic blockers may increase the frequency and time of angina.

Metabolism/endocrine

Nebivolol does not affect glucose concentration in diabetes patients. However, caution should be used because Nebivolol can cover a few symptoms of hypoglycemia (tachycardia, broken chest drum).

Respiratory

In patients with chronic pulmonary obstruction, beta-adrenergic blockers are used carefully because it can increase respiratory spasms.

Nebivolol Stella 5 mg contains lactose. This drug should not be used for patients with rare genetic problems galactose intolerance, total lactase enzyme deficiency or glucose - galactose.

The ability to drive and operate machinery

There has been no research on the effect of the drug on the ability to drive and operate machinery. Pharmacological studies show that Nebivolol does not affect mental function. Using drugs when driving or operating machinery can sometimes be stunned and tired.

Pregnancy

Nebivolol has pharmacological effects that may be harmful to pregnant women and/or fetus/infant. Nebivolol should not be used during pregnancy unless the use is necessary. If required to be treated with nebivolol, blood amounts must be controlled through the placenta and the development of the fetus.

The period of breastfeeding

Animal studies show that Nebivolol is secreted in milk. It is unknown whether this drug is secreted through breast milk or not. Therefore, Nebivolol should not be used when breastfeeding.

Drug interaction

Group I anti -arrhyths (quinidin, hydroquinidin, cibenzolin, flecainid , disopyramld, lidocaine, mexiletin , Propafenon): impact on the time of transmission - ventricular and increase in mechanical direction.

Calcium channel blockers belong to the Verapamil/Diltiazem group: negative effects on the contraction and atrial - ventricular transmission. Verapamil intravenous injection in patients being treated with beta blockers can lead to excessive hypotension and atrial - ventricular block.

Hematurosis is acting on the central ( clonidin , guanfacin, moxonidin. Methyldopa, Rilmenidin): Concentrated with antihypertensive drugs acting on the central can worsen heart failure due to reducing central sympathetic nerves (reducing heart rate and cardiac supply, vasodilation). Sudden stopping the drug, especially if previously stopped using beta blockers, it increases the risk of "hypertension bound backwards".

body weight when coordinated:

Anti -arrhythmic drugs Group III (Amlodaron): Increases the impact on the atrial -ventilation time.

Halogen derivative anesthesia: simultaneous use of beta and anesthetic blockers can reduce heart reflexes quickly and increase the risk of hypotension. The general principle of avoiding sudden stopping of beta blockers. Notify anesthetic specialist when patients are taking Nebivolol.

Note when coordinating:

Glycosides Digitalis: Use simultaneously can increase the time of atrial - ventricular.

Calcium blockers dihydropyridine group (amlodipin, telodipin, lacidipin, nifedipine, nicardipine, nimodipine, nitrendipine): SHOULD LEARNING may increase the risk of lowering blood pressure and not excluding the risk of reducing blood pump function in the heart of heart failure.

Sedative, antidepressants (3 rounds, barbiturates and phenothiazin): Singapore use can increase the hypotension effect of Beta blockers (impact of force).

Parity: Simultaneous use can neutralize the effect of beta-adrenergic blockers. The beta-adrenergic blockers lead to alpha-adrenergic activity of the sympathetic antagonistic drug with both alpha and beta-adrenergic systems (risk of hypertension, severe slow heart rate and heart block).

Pharmacokinetic interaction:

Due to the metabolic mechanism of Nebivolol related to isenzyme CYP2D6, simultaneous use with these enzyme inhibitors, especially paroxetin, fluoxetin, thioridazine and quinidine can lead to increased plasma concentration of nebivolol, increasing the risk of slow heart rate and other desirable effects.

Used in combination with cimetidine increases the concentration in plasma Nebivolol but does not change the clinical effect.
Concomitance Nebivolol and Nicardipine increases the plasma concentration of both drugs but does not change the clinical effect.

Storage

Store in secret, dry places. The temperature does not exceed 30 ° C.

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