Saviprolol Plus HCT 2.5/6.25 Savi treatment for hypertension (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Bisoprolol, hydrochlorothiazide

Ingredient

Composition information	Content
Bisoprolol	2.5mg
Hydrochlorothiazide	6.25mg

Uses

indications

Saviprolol Plus HCT 2.5/6.25 combined Bisoprolol Fumarate (2.5mg) and hydrochlorothiazide (6.25 mg) are indicated for hypertension treatment. Is a combination of two hypotension agents with one daily oral dose per day: Selective congerators Beta1 (competing for beta receptors, heart, bisoprolol fumarate) and a diuretics of benzothiadiazine diuretics (hydrochlorothiazide).

The effect of lowering the blood pressure of these active ingredients is Hiep Luc. Hydrochlorothiazide dose of 6.25 mg increases the hypotension diploma of bisoprolol fumarate.

Pharmacokology

bisoprolol fumarate (B) combines hydrochlorothiazide (HCT)

Bisoprolol Fumarate (B) and Hydrochlorothiazide (HCT) have been used individually or combined to treat hypertension. The hypotension effect of these active ingredients is Hiep force; HCT 6.25mg significantly increases the hypotension effect of Bisoprolol Fumarate. The rate of hypotension of bisoprolol fumarate and HCT 6.25mg (b/h) is significantly lower than HCT 25mg. In the clinical trials of Bisoprolol Fumarate and Hydrochlorothiazide, the average change of serum potassium content in patients is treated with a combination of bisoprolol fumarate and 6.25mg hydrochlorothiazide 2.5mg/6.25mg - 5mg/6,25mg or fake less than ± 0.1 MEQ/L. The average change of the serum potassium content of patients treated with any Bisoprolol dose combined with HCT 25mg changes from -0.1 to -0.3 Meq/l.

Bisoprolol Fumarate is a selective blockbean, (cardioselec-tive) that has no significant membrane stability or no effect of intrinsic sympathetic nerve within the scope of treatment. At high doses (20mg), Bisoprolol Fumarate also inhibits the beta receptor, located in the bronchial system and blood vessels. To keep the relative selection, it is important to use the lowest dose effectively.

Hydrochlorothiazide is a diuretics of benzothiadiazine.

Thiazide affects the renal tubular mechanism of electrolyte reabsorption and increases the excretion of sodium and chloride in almost equal amounts. Sodium - urinary (sodium) will cause secondary potassium loss.

bisoprolol

Bisoprolol is a selective blockbuster beta, (β1) but has no membrane stability and has no effect of interrelated sympathetic nerve when used within the scope of treatment.

In low doses, Bisoprolol inhibits selectively responding to adrenalin stimulation by competing with the receptor blocker B. Adrenalin of the heart, but has little effect on the beta receptor, (β2) Adrenalin of bronchial muscles and vascular walls. With high doses (for example, 20 mg or more), the selective properties of bisoprolol on receptors β1 usually decrease and the drug will compete inhibiting both receptors β1 and β2.

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 heart flow, renal inhibition releases renin and reducing the impact of sympathetic nerve from vasomotor centers in the brain. But the most prominent effect of Bisoprolol is to reduce the heart frequency, both at suspicion and effort.

Bisoprolol reduces the flow of the heart at a break and when exertion, accompanied by few changes in the volume of blood emul for each heart, and only increases less right atrial pressure or pulmonary capillary pressure at rest and at exertion. Unless there is contraindications or the patient is not tolerated, beta blockers have been used in combination with enzyme 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 shown in people who are taking a transferred inhibitor, showing the inhibition of the coordination of the Renin-Anotensin system and the sympathetic nervous system are plus effects.

In control clinical trial, Bisoprolol Fumarate is used as a single dose every day proving to be an effective active ingredient that is effective when used alone or simultaneously with thiazide diuretic.

The mechanism of hypotension of Bisoprolol Fumarate has not been completely set. The elements can be involved include:

Reduce cardiac output. There is no effect on the dosage on the beta2-adrenergic receptor is observed. Lung function research has been performed in healthy volunteers, asthma patients and patients with chronic obstructive pulmonary disease (COPD). The dose of Bisoprolol Fumarate ranges from 5mg to 60mg, ATE-NOLOL 50mg -200mg, Metoprolol from 100mg to 200 mg and Proprano-Lol 40mg-80 mg when comparing them together.
Electrical research in humans has shown that Bisoprolol Fumarate significantly reduces the heart rate, increases the recovery time of the sinus button, extends the resting time of AV AI button (Atriovovicular) and with fast stimulation, extending the atrial transmission time.
hydrochlorothiazide
hydrochlorothiazide and thiazide diuretics increase the excretion of sodium chloride and water attached to the mechanism of inhibiting the reabsorbing sodium and chloride ions in the distance. The excretion of other electrolytes also increases, especially potassium and magnesi, and calcium decreases.
Hydrochlorothiazide also reduces the activity of carbon dioxide enzyme, so it increases the secretion of bicarbonate but this effect is usually small compared to the excretion effect C1 and does not significantly change the urine pH. Thiazide has a moderate diuretic effect, because about 90% of sodium ions have been reabsorbed before arriving in the distance is the main position of the drug.
hydrochlorothiazide has the effect of lowering blood pressure, which is probably due to a decrease in plasma volume and extracellular fluid related to sodium urine. Then, during the use of the drug, the effect of lowering blood pressure depends on the decrease in peripheral resistance, through the gradual adaptation of blood vessels from the reduction of Na+concentration. Therefore, the hypotension effect of hydrochlorothiazide is shown slowly after 1-2 weeks, while diuretic effects occur quickly and can be seen right after a few hours.
hydrochlorothiazid increases the effects of other antihypertensive drugs.
Sodium-sodium (sodium) will cause secondary potassium loss. The acute effects of thiazide are thought to be a result of reducing blood mass and cardiac weight, causing a sodium excretion effect, although the direct vasodilation mechanism has been proposed. With long -term (chronic) treatment, the volume of plasma volume returns to normal but reduces peripheral resistance.
Thiazides does not affect normal blood pressure. The drug begins to impact within 2 hours after use, maximum observation effect is about 4 hours and the impact lasts up to 24 hours.
Dynamic pharmacokinetics

bisoprolol fumarate (b) Combining hydrochlorothiazide (HCT)
In healthy volunteers, both Bisoprolol Fumarate and Hydrochlorothiazide are well absorbed after drinking. There is no vendor for each substance when drinking together in the same pill.
The absorption of Bisoprolol Fumarate and Hydrochlorothiazide is not affected whether used with food. The average peak concentration in the plasma of bisoprolol fumarate is about 9 nanogam/ml, 19 nanogam/ml and 36ng/ml occurring about 3 hours after taking the dose of 2.5mg/6.25mg, 5mg/6.25mg and 10mg/6.25mg of combined, corresponding tablets. The average peak concentration of plasma of hydrochlorothiazide 30nanogam/ml occurs about 2.5 hours after taking a combination of pills. Increasing the dose increases the plasma concentration ratio of Bisoprolol Fumarate has been observed between the dose of 2.5 mg and 5mg, as well as between the dose of 5mg and 10mg.
Half of life eliminates T1/2 of Bisoprolol Fumarate within 7 to 15 hours and hydrogen-chlorothiazide from 4 hours to 10 hours. The percentage of dosage in urine is about 55% for bisoprolol fuma-value and about 60% with hydrochlorothiazide.
bisoprolol fumarate
Bisoprolol Fumarate is almost completely absorbed through the digestive tract. And only through the initial fire, the oral bioavailability is about 90%. After drinking, the peak concentration in plasma is reached from 2 - 4 hours.
About 30% of the drug attaches to plasma proteins. Food does not affect the absorption of the drug. Half life eliminated in plasma from 10 to 12 hours. Bisoprolol dissolves moderate in lipid. Metabolic drugs in the liver and excretion in urine, about 50% in constant form and 50% in the form of metabolites.
In the elderly, half a lifetime eliminated in plasma is slightly longer than young people, although the average plasma concentration in a stable state increases, there is no significant difference in the accumulation of Bisoprolol among young people and the elderly.
In people with creatinine clearance ratio below 40 ml/min, half -life plasma increases about 3 times higher than normal people. In people with cirrhosis, Bisoprolol elimination speed changes more and lower is significant than normal people (8.3 - 21.7 hours).
Absolute bioavailability after oral dose 10mg Bisoprolol Fumarate is about 80%. The first metabolism of Bisoprolol Fumarate is about 20%. The pharmacokinetic records of Bisoprolol Fumarate have been tested after a single dose and in a stable state. Linking with serum protein is about 30%. Plasma peak concentration occurs within 2-4 hours after taking the drug in doses from 2.5mg to 20mg and the average peak value is from 9nanogam/ml at 2.5mg to 70nogam/ml at 20 mg. When taking Bisoprolol Fumarate with a one -time standard daily, the result is a less than twice -changing plasma peak concentration. The concentration is proportional to oral dose ranges from 2.5mg to 20mg.
Half of the lifetime of plasma is about 9 - 12 hours and a bit longer in elderly patients, partly due to the reduced renal function. Stable state is achieved within 5 days with a dose once a day. In both groups of young people and the elderly, the accumulation of plasma is low, the citadel is about 1.1 to 1.3 and is what has been expected from half a life and the standard for a daily use of the drug.
Bisoprolol Fumarate is excreted equally by kidney and non -kidney, with about 50% of the dosage that appears in the urine in the form of constant and 50% in the form of inactive metabolites. In humans, metabolites are known to be unstable or have no pharmacological activity. There are less than 2% of the dose is excreted in the feces. The pharmacokinetic characteristics of the two equiles are similar. Bisoprolol is not transferred Cytochrome P450 II D6 chemical by yeast (Debrisoquin hydroxylase).
For objects with creatinine clearance below 40ml/min, half -life plasma increases by three times higher than healthy people. In patients with cirrhosis, Bisoprolol elimination rate is often significantly changed and significantly slower than healthy objects, accompanied by a different half -life of plasma, from 8 hours to 22 hours.
In the elderly people, the average plasma concentration in a stable state has been increased, partly due to decreasing creatinine clearance. However, there is no significant difference in the accumulation level of Bisoprolol found between the young group and the elderly.
hydrochlorothiazide (HCT)
Hydrochlorothiazide is well absorbed (65% -75%) after taken.
The absorption of hydrochlorothiazide in patients with congestive heart failure.
The concentration of the maximum of the correlation is within 1-5 hours after taking the drug and is within 70 nanogam 490 nanogam/ml after the oral dose from 12.5mg to 100mg. The plasma concentration is linearly related to the dose. The concentration of hydrochlorothia -zide in the whole blood is 1.6 - 1.8 times higher than in plasma. Linking with serum protein has been reported about 40% to 68%. Half lifetime of plasma excretion is reported about 6-15 hours. Hydrochlorothiazide is eliminated mainly by kidney.
After the oral dose of 12.5mg to 100mg, about 55% - 77% of the dose appears in the urine and more than 95% of the absorption dose is excreted in urine in the form of constant. HCT's plasma concentration increases and half -life eliminates for patients with kidney disease.

Before taking Saviprolol Plus HCT 2.5/6.25 Savi treatment for hypertension (3 blisters x 10 tablets)

How to use

Saviprolol Plus HCT 2.5/6.25 oral.

Dosage

Bisoprolol therapy is an effective treatment for hypertension in the dose of 2.5mg to 40 mg once daily, while hydrogen -chlorothiazide is effective in the 12.5mg - 50mg doses.

In clinical trials combining bisoprolol/hydrochlorothiazide when using bisoprolol combinations from 2.5mg to 20mg and hydrochlorothiazide doses from 6.25mg to 25mg, lowering blood pressure increases with the proportion to the dose of each component.

The side effects of Bisoprolol are a mixture of phenomena depending on the dose (mainly slow heart rate, diarrhea, weakness and fatigue) and independent phenomena (for example, sometimes rash) and of hydrochlorothiazide are a mixture of events depending on the dose (mainly hypotension) and independent phenomena (for example, pancreatitis) much more than the phenomena independent of the dose.

Clinically treated treatment regimen

A patient with uncontrolled blood pressure with doses from 2.5mg - 20mg Bisoprolol can be replaced daily with a combination of bisoprolol fumarate+hydrochlorothiazide. Patients with blood pressure are fully controlled at a dose of 50mg of hydrochlorothiazide daily, but showing significant loss of blood potassium with this regimen, can achieve similar control of blood pressure without electrolyte disorders if switched to bisoprolol fumarate+hydrochloro-thiazide.

Initial therapy

Hematoaive treatment can be started with the lowest dose of Bisoprolol Fumarate-Hydrochlorothiazide 2.5 mg/ 6.25 mg (B/ HCT) once a day once a day. After the titration (about 14 days away), it is possible to increase the dose with a combination of bisoprolol fumarate +hydrochlorothiazide up to a maximum recommended dose of 20mg/12.5mg (ie twice the dose of 10mg/6.25mg) orally once daily when appropriate.

Alternative therapy

This combination can be replaced for individual ingredients when needed to increase the dose.

Stop treatment

If you want to stop treating with Bisoprolol Fumarate and Hydrochloro-Thiazide, you need to plan to achieve gradually for about 2 weeks. Patients must be carefully monitored.

Patients with kidney or liver failure

Be careful to use and adjust the dose according to the titration of patients with liver failure or renal dysfunction. Because there is no sign that hydrochlorothiazide may be separated and there is little data showing that Bisoprolol can be separated, unnecessary to replace drugs in dialysis patients.

Elderly patients

Adjustable dose on the basis of age is usually unnecessary, unless there is significant kidney or liver dysfunction.

In clinical trials, at least 270 patients are treated with bisoprolol fumarate combined with hydrochlorothiazide (HCT) aged 60 or more. HCT significantly adds bisoprolol's hypotension in hypertension patients. There is no overall difference in effectiveness or safety observed between elderly patients and young patients. Clinical experience reports have determined the difference in drug response between elderly and younger patients, but the sensitivity of some older individuals cannot be excluded.

Patients with children: There is no data for bisoprolol fumarate and hydrochlorothiazide.

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? However, some cases of overdose with Bisoprolol Fumarate have been reported (maximum: 2000mg). Slow heart rate and/or hypotension have been recorded. Sympathetic drugs have been used in some cases and all patients recovered.

Signs are expected to observe with beta blockers overdose are slow heart rate and hypotension. Sleeping is also common and with serious overdose will be delirious, comatose, convulsions and respiratory stops that have been reported. Solid heart failure, bronchospasm and hypoglycemia may occur, especially in patients who are available to diseases in these organs. With thiazide diuretics, acute poisoning is very rare. The most outstanding feature of overdose is to cause liquid loss and acute electrolytes. Signs and symptoms include Cardiovascular (fast heartbeat, hypotension, shock), nervous (weak, confused, dizziness, muscle cramps, abnormalities, fatigue, consciousness impairment), digestive (nausea, vomiting, thirst), kidneys (urine, urinary or irony [caused by hemoconcentration]) Blood chloride (hypochlor-emia), alkaline infection, hyperkemop of blood urea (bun, blood urea nitrogen) [especially in patients with renal failure]) and dehydration due to excessive diuretic. The dose of LD, of hydrochlorothiazide is greater than 10g/kg for both rats and rats.

If there is an overdose of Bisoprolol Fumarate and Hydrochlorothiazide, treatment should be stopped and patients should be closely monitored.

Symptomatic treatment and support because there is no special antidote. Some limited data that suggest bisoprolol fumarate cannot be separated, similarly there is no sign that hydrochlorothiazide may be separated.

General proposal measures include vomiting and/or gastric lavage, activated carbon, respiratory support, adjusting liquid and electrolyte imbalance and treating seizures. Based on the expected and recommended pharmacological effects for other beta blockers and hydrochlorothiazide, the following measures should be considered for clinical implementation:

Slow heart rate

Atropine intravenous injection. If the response has not been achieved, caution can be used with isoproterenol or another drug that increases the pace (chronotropic) positive. In some cases, temporary pacemaker places to stimulate the rhythm.

Hypotension, shock

Patients who lie in a pins should be raised. Intravenous infusion to adjust the liquid and electrolyte balance (potassium, sodium). Glucagon intravenous injection may be needed or an alpha-adrenergic agonorice. Heart block (second or third level) Patients should be carefully monitored and treated with isoproterenol transmission or pacemaker, if appropriate.

SECRETING HEART

Start taking common treatment measures (i.e. using digitalis, diuretics, vasodilators, increased myocardial contraction force).

Bronchospasm

Use a bronchodilator like isoproterenol and/or amino-phyllline.

Hypoglycemia

Intravenous glucose.

Health supervision

Balancing liquid and electrolyte (especially potassium serum) and renal function must be monitored until normalization.

In an emergency, call the 115 emergency center immediately or go to the nearest local health station.

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 the drug, there are common unwanted effects (ADR) such as:

bisoprolol fumarate (B) combines hydrochlorothiazide (HCT)

The combination dose of bisoprolol fumarate/hydrochlorothiazide (HCT) 6.25mg is well tolerated in most patients.

Most side effects (AES) are light and transient. Of the more than 65,000 patients treated worldwide with Bisoprolol Fumarate, rarely appears bronchospasm. The percentage due to AES is similar to the combination dose of Bisoprolol Fumarate/HCT 6.25 mg and patients with placebo.

In the United States, 252 patients were given doses of Bisoprolol Fumarate (2.5mg, 5mg, 10mg or 40mg) in combination with HCT 6.25mg and 144 patients used placebo in two control tests. In research 1, the combination dose of Bisoprolol Fumarate 5mg/HCT 6.25mg is used for 4 weeks. In study 2, the doses combined with Bisoprolol Fumarate 2.5 mg, 10 mg or 40 mg/HCT 6.25 mg are used for 12 weeks.

All the adverse effects occur, related to the drug or not and the adverse side effects occur in patients treated with Bisoprolol Fumarate doses of 2.5mg - 10mg/HCT 6.25mg compared to 4 -week treatment time with a frequency of

Cardiovascular: Slow heart rate/peripheral/chest ischemia/chest pain Nursing: Dizziness/headache.

bisoprolol fumarate

Bisoprolol is well tolerated in most patients. Most unwanted effects are mild and temporary. The proportion of patients who have to stop treatment due to unwanted effects is 3.3% for patients using bisoprolol and 6.8% for patients using Placebo.

In clinical trials worldwide or experience after bringing the drug to the market, a series of other side effects (AES), in addition to the side effects listed above, have been reported. While in many cases, whether it is a causal relationship between Bisoprolol and AES, but still listed the warning to the doctor about the possible relationship.

The central nervous system: unsteady, dizzy, dizziness, headache, fainting, paresthesia, hypoeshesia, sensory increase (hyperesthesia), sleep disorders, insomnia, drowsiness, depression, anxiety / restlessness. Systemic blood pressure, chest pain, congestive heart failure, difficulty breathing during exertion. Ban, acne, eczema (eczema), psoriasis, skin irritation, itching, hemorrhage, blushing, sweating, hair loss, dermatitis, dermatitis (very rare), skin vasculitis. Gout. Chest, fatigue, edema, weight gain, angioior.

hydrochlorothiazide

The disadvantageous effects, in addition to the effects listed above, have been reported to hydrochlorothiazide (usually at a dose of 25mg or higher).

General: weakening. Saliva (sialadenitis), dry mouth. Gold chemistry, xanthopia).

metabolism: Gout.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Saviprolol Plus HCT 2.5/6.25 contraindications in the following cases:

bisoprolol

Bisoprolol is contraindicated in patients with heart shock, acute heart failure, untreated heart failure by treating background, severe heart failure or IV level, atrial bloc - two or three ventricle, and sinus slow heartbeat (less than 60 /minute before treatment), Sinus, severe or chronic lung disease.

severe Reynaud syndrome. Hypersensitivity to bisoprolol, adrenal medulla (chrome cell tumor) before being treated.

hydrochlorothiazide

Hypersensitivity to thiazide and sulfonamide derivatives, gout, hyperuricemia, dysentic, Addison disease, hypercalcemia, liver and kidney failure.

Be cautious when using

bisoprolol

heart failure

Parasma stimulation is an essential component that supports circulatory function in the beginning of congestive heart failure, and the-ball blocker can lead to further decline in heart muscle contraction and promote more 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 has been treated for heart failure with basic drugs (diuretics, digitalis, inhibiting enzymes) under the strict control of a specialist.

Patients without heart failure

In some patients with beta blockers can continue to cause heart muscle (pinch) and promote heart failure. Based on the first signs or symptoms of heart failure, it is necessary to consider stopping bisoprolol fumarate and hydrochlorothiazide. In some cases, the treatment with bisoprolol fumarate and hydrochlorothiazide can be continued while heart failure is treated with other drugs.

Sudden stop treatment

Exacections of angina and in some cases, myocardial infarction or ventricular arrhythmia have been observed in patients with coronary artery disease determined after suddenly stopping treatment with beta blockers. Therefore, these patients need to be warned that they are not interrupted or stopped without the doctor's advice. Even in patients without coronary artery disease can be recommended for treatment with Bisoprolol Fumarate and Hydrochlorothiazide for more than a week provided that patients must be carefully monitored. If the symptoms occur, it is necessary to re -establish treatment with beta blockers, at least temporarily. If the symptoms of cessation occur, the drug should be used at least for a period of time.

Peripheral vascular disease

Beta blockers can promote or aggravate the symptoms of artery failure in patients with peripheral vascular disease. Caution should be used for these patients.

Bronchospasm

In general, patients with bronchospasm should not use beta blockers. Because it is related to the selection of Beta, of Bisopro-Lol Fumarate, Bisoprolol Fumarate + Hydrochlorothiazide can be used in patients with bronchoid spasms who do not respond to drugs or those who cannot tolerate other antihypertensive drugs. Due to the selection of beta, not absolutely (selection decreases when increasing the dose), the lowest possible dose of Bisoprolol Fuma-Rate and Hydrochlorothiazide. Beta's ownership effect, (bronchodilators) can also be effective.

Anesthesia and surgery

If Bisoprolol Fumarate and Hydrochlorothiazide are still continued treatment during the pre -surgical period, it is necessary to perform special care because anesthetics impaired myocardial function, such as using Ether, Cyclopropane and Trichlorethylene.

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 beta, this is less likely to occur with Bisoprolol Fumarate. However, it is necessary to warn patients or hypoglycemia, or diabetic patients who are taking insulin or blood glucose oral medications for these possibilities, and must be used with bisoprolol carefully.

In addition, potential diabetes can become a manifestation and diabetes because Thiazide may require adjusting their insulin dose. Due to the low dosage of hydrochlorothiazide, this may be less likely to happen with a combination of bisoprolol fumarate and hydrochlorothiazide.

thyroid poisoning

beta-adrenergic blockers can cover the clinical signs of hyperthyroidism (hyperthyroidism), such as tachycardia.

Sudden stopping of beta blockers can worsen the symptoms of hyperthyroidism or may promote the storm.Kidney disease

Need to adjust the dose of bisoprolol carefully for patients with renal failure or liver failure.

The accumulation of thiazide can develop in patients with impaired renal function. In these patients, Thiazide can cause blood nitrogen. Subjects with creatinine clearance below 40ml/minute, half-life plasma of bisoprolol fuma-value increased to triple than healthy people. If the renal failure progresses, it is necessary to stop the bisoprolol fumarate and hydrochlorothiazide.

Liver disease

Bisoprolol Fumarate and Hydrochlorothiazide should be used carefully in patients with impaired liver function or progressive liver disease. Thiazide can change the balance of fluid and electrolytes, which can cause liver coma. In addition, the elimination of Bisoprolol Fumarate is significantly slower in patients with cirrhosis than healthy people.

hydrochorothiazide

The provincial nearsightedness and secondary angle -closed angle (Glaucoma)

Hydrochlorothiazide, a sulfonamide that can cause its own specific reaction, leading to transient myopia and increased acute glaucoma. Symptoms include an acute impulsive or visual reduction of pain and often occur within hours to a few weeks when starting to take the drug. The angle hypertrophy of the angle if left untreated can lead to permanent vision loss. The main treatment is to stop hydrochlorothiazide as quickly as possible. Suggestions for treatment or surgery may need to be considered if the intraocular pressure is still uncontrolled. Risk factors for developing an angle of glaucoma may include a history of sulfonamide or penicillin allergy.

Cautions

The condition of the fluid and electrolyte balance

Although the probability of developing hypoglycemia is limited to bisopro-lol fumarate and hydrochlorothiazide (HCT) because the very low doses of HCT, should periodically determine the electrolyte in the serum and the patient must be monitored the signs of fluid or electrolyte disorders, that is, hypoglycic hematoma, hypoglore-mical hypotension) (hypomagnesemia).

Thiazides shows that there is a giving magnesi excretion through the urine, which can result in reducing blood magnesium (hypomagnesemia). However, any chloride ionic deficiency occurs is usually mild and does not need specific treatment, except for unusual cases (such as in liver disease or kidney disease) Chloride replacement may be required in the treatment of metabolic alkaline infections.

Warning signs or symptoms of fluid imbalance and electrolytes include dry mouth, thirst, weakness, indifference, drowsiness, restlessness, muscle pain or cramps, muscle fatigue, hypotension, ureter, tachycardia and digestive disorders such as nausea and vomiting.

Hypotension can develop, especially with rapid diuretic during severe cirrhosis, during use simultaneously with Corti-Costeroid or Hormonal Hormonal (ACTH) or after prolonged treatment. Interventions with adequate oral electrolytic will also contribute to hypokalemia. Hypotension and decreased blood magnesium can cause ventricular arrhythmia or increase sensitivity or increase the heart response of the heart with the toxic effects of digitalis. Hypotension can be avoided or treated with potassium or increased consumption of potassium -rich foods.

Reducing blood hyponemia may occur in patients with edema in hot weather, appropriate treatment is to limit water rather than drinking salt water, except for a rare case of hypoglycemia that threatens life. In reality of salt decline, the appropriate choice is to replace therapy.

Hyper uric acid hyperkemosis

Hypergaric hyper uric acid or acute gout can occur in some patients using thiazide bisoprolol fumarate diuretics, used alone or in combination with HCT, are associated with uric acid hypertrophy, but in clinical trials in the United States, the incidence of high uric acid hypertension related to treatment in hydrochlorothiazide dose (HCT) 25%) With b/HCT 6.25 mg (10%). Because of the very low dosage of HCT, hyperuricemiaemiasis can be less likely to occur with a combination of bisoprolol fumarate +hydrochlorothiazide.

Hyperglycemia

Hyperglycemia can occur with thiazide diuretics.

Hence potential diabetes can be expressed when treated with thiazide.

Other effects

The hypotension effects of the drug can increase in patients with surgery to remove sympathetic nerve.

Armor disease

Thiazide reduces calcium secretion and changes the pathology of parathyroid glands, hypercalcemia and hypoglycemia has been observed in some prolonged thiazide patients. Thiazide can cause continuous and mild hypertopic growth in the absence of calcium metabolic disorders. Marking for hypercalcemia may be evidence of hidden hyperthyroidism. Thiazide should be stopped before performing the adjacent function test. The increase in cholesterol and neutral fat levels may be related to thiazide diuretics.

kidney failure

If the renal failure progresses, it is clear, it is necessary to consider reducing the dose or not to continue treating with diuretics.

Thiazide has been shown to increase the secretion of urine magnesium, which can lead to hypotengnesemia.

Thiazide should be used cautiously in severe kidney disease. In patients with renal disease, Thiazide can cause urea-cumulative cumulative cumulative movements that can be developed in patients with impaired renal function.

Using drugs for women during pregnancy and lactation

The case of pregnancy

Thiazide passes through the placenta and appears in the umbilical cord blood. The use of thiazide in pregnant women requires predicting benefits compared to the risks for the fetus. These dangers include jaundice for fetuses or babies, pancreatitis, thrombocytopenia and may have other adverse reactions that have occurred in adults.

Cases of breastfeeding

Bisoprolol Fumarate used mono or combined with HCT has not been studied in mothers who are breastfeeding. Thiazide is excreted through breast milk. A small amount of bisoprololfumarate ( The effect of drugs on driving and operating machinery

Experience shows that the treatment does not affect the ability to drive or use the patient's machines. However, some adverse reactions such as dizziness, headache, and drowsiness are still rare but can still occur, so it can affect the ability to drive or operate machinery.

Drug interaction

bisoprolol fumarate (B) combines hydrochlorothiazide (HCT)

Bisoprolol Fumarate + Hydrochlorothiazide can increase the effect of other hypotension drugs when used simultaneously.

Bisoprolol Fuma-Rate and Hydrochlorothiazide should not be used in combination with other beta blockers. Patients who receive drugs decrease/consume catechol-amine, such as reserpine or guanethidine, should be closely monitored because of the increase in beta-adrener-gic blocking effect that can cause excessive decline in sympathetic activity. In patients treated simultaneously with clonidine, if needed to stop treatment, bisoprolol fumarate and hydrochlorothiazide should be discontinued a few days before stopping clonidine.

Bisoprolol Fumarate+Hydrochlorothiazide should be cautious when used with myocardial inhibitors or inhibitors of atrial conduction or depression, such as identified calcium antagonistic drugs (especially phenylalkylamine [Verapamill and Benzothiazepine [DiltIAZEM]) or anti-aging drugs, such as rhythmic dispensing disopyramide.

Both digitalis glycosides and beta blockers slow down the atrial transmission and heart rate decreases. Simultaneous use may increase the risk of slow heart rate.

bisoprolol

Simultaneously used with rifampin increases the clearance of bisoprolol fumarate, shortening half -life of elimination. However, it is not necessary to change the starting dose.

Pharmacokinetic research documents do not show clinical interactions related to other simultaneous use, including thiazide and cimeti-dine diuretics.

bisoprolol fumarate has no effect on prothrombin time in patients with stable warfarin doses.

Risk of anaphylactic reaction

While taking beta blockers, patients with a serious history of allergies with different allergens may have a stronger reaction to the use of repeated drugs or by accident or due to treatment. These patients may not respond to the dose of epinephrine often used to treat allergic reactions.

hydrochlorothiazide

When simultaneously with the following drugs, there may be interaction with thiazide diuretics including alcohol, sedative or addictive sleeping pills: There may be an increase in vertical potential.

Diabetes (oral and insulin drugs): Need to adjust the dosage of diabetes drugs due to hypoglycemic glucose.

Other antihypertensive drugs: can occur in a synergistic effect or increase the potential of hypotension.

Cholestyramine and Colestipol plastic: The absorption of hydrochlorothia-zide is impaired when there is the presence of the anion exchange resin mentioned above. The only dose of cholestyramine and colestipol plastic associated with hydrochlorothiazide and reduces the absorption in the digestive tract to 85% and 43%, respectively.

corticosteroid, ACTH: increase and exhausted electrolytes, especially hypokalemia.

Amine (eg norepinephrine): may reduce response to hypertension amines but not enough to prevent them from using them.

Muscle relaxants, non -reducing groups (for example, tubocurarine): may increase in response to muscle relaxants.

lithium: should not be used with diuretics. Diuretics reduce lithium's kidney clearance and cause high risk of lithium poisoning. Refer to the user manual of lithium preparations before using bisoprolol fumarate and hydrochlorothiazide.

Non -steroid anti -inflammatory drugs: In some patients, when taking nonsteroidal anti -inflammatory drugs can reduce diuretics, reduce sodium secretion and reduce the effect of lowering blood pressure of thiazide diuretics. Therefore, when Bisoprolol Fumarate+Hydrochlorothiazide is simultaneously used with nonsteroidal anti -inflammatory drugs, patients need to be closely monitored to determine the desired effect of diuretics.

When using Thiazide, sensitive reactions may occur with patients with or without a history of allergies or bronchial asthma. Light -sensitive reactions and may aggravate or activate the whole body lupus that has been reported in patients using Thiazide. The hypotension effect of Thiazide can increase in patients after removal of sympathetic nerve.

Storage

Leave a cool place, avoid light, temperature below 30⁰C.

Other drugs

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