The drug was developed for use in arterial hypertension and heart attack, it also provides important assistance for coronary heart disease, chronic heart failure (CHF), angina pectoris, heart complications after a sore throat. As a rule, it is prescribed if cardiac arrhythmias are observed with extrasystole, arrhythmias, thyrotoxicosis.
Bisoprolol analogues are on sale in a rather wide variety. Preparations with the same name, but from different manufacturers are quite different in price. The designation of the manufacturer may be added to the name: “Teva”, “Vertex”, “North Star”. Depending on the number of tablets in the package, the characteristics of the composition, the manufacturer, one package costs from 20 to 200 rubles.
According to the instructions, “Bisoprolol” is recommended to be taken starting from a dose of 1,25 mg per day (for the treatment of heart failure). It is maintained throughout the first week of treatment. In the second week, the concentration is increased to 2,5 mg, after another week they increase again, and the daily dose reaches 3,75 mg. Then, for several weeks (from the fourth to the eighth), 5 mg are taken every day in the morning, and from the ninth to the twelfth, 7,5 mg.
If during treatment with Bisoprolol (according to the instructions) the patient has noticed an improvement, the course should not be interrupted without coordination with the attending physician. You can check with your doctor whether it is realistic to stop treatment, but without the consent of a specialist, it is strictly prohibited to stop taking it. The condition can not only return to that which was before the start of therapy, but also become noticeably more difficult.
When choosing “Bisoprolol” it is necessary to regularly monitor the patient’s condition. It is important to track heart rate, pressure. At the beginning of the use of “Bisoprolol” indicators are checked every day, with good tolerance, you can monitor the patient’s condition every 3-4 months. It is recommended to regularly undergo an ECG, with diagnosed diabetes, donate blood for glucose at least once every 4 months.
When using Bisoprolol therapy in old age, it is recommended to monitor renal function, the corresponding analysis is given three times a year. If the drug is used to treat heart failure with an initial dosage of 1,25 mg, the body needs to be taken for the first four hours. The manufacturer recommends monitoring pressure, heart rate, and taking ECG readings.
For the most effective control of his condition, the patient being treated with Bisoprolol should be able to calculate heart rate by himself. If the value is less than 50 beats per minute, you should immediately consult your doctor.
What are bisoprolol tablets from? Indications for the use of Bisoprolol are arterial hypertension (persistently high blood pressure), stable angina pectoris (IHD), chronic heart failure (CHF).
The drug Bisoprolol is produced by a sufficiently large number of pharmaceutical companies, however, regardless of where and by whom they are issued, the tablets have the same indications for use: that is, the indications for use of Bisoprolol-Pran are identical to the indications for the use of a drug manufactured, for example, by Lugansk HFZ or Israeli company Teva.
The dosage of the drug is selected individually. Tablets are taken in the morning, before meals, without chewing. The course of treatment begins with the appointment of a patient 0,005 grams, which are taken once. For patients whose blood pressure is slightly increased, the starting dose is – 0.0025 grams per day.
In cases where it is necessary, the dose is doubled. The regimen remains the same.
The highest daily dose is 0,02 grams; for patients with renal dysfunction, which is characterized by a decrease in creatinine clearance (CC) below 20 ml per minute, the highest dose should be half as much (0,01 grams per day).
Exceeding the prescribed average daily dose is allowed in extreme cases. The drug is usually used for a long time.
Elderly patients do not need dose adjustment.
The instructions for use of Bisoprolol-Ratiopharm are identical to the instructions for use of Bisoprolol-Lugal and instructions for use of Bisoprolol-Teva. According to the same scheme, Bisoprolol-Prana and other bisoprolol preparations are taken.
- Is it possible to replace the drug with an analogue?
- Side effects
- How to use?
- Pharmacodynamics and pharmacokinetics
- Feature of application
- How does it work?
- What else to pay attention to?
- special instructions
- Reviews on Bisoprolol
- In pregnancy
- Bisoprolol Price
- Pharmacy Dialog
- Eurofarm * 4% discount on medside11 promotional code
- Pani Pharmacy
Is it possible to replace the drug with an analogue?
The structural analogues of Bisoprolol (synonyms) are Biprol, Bisogamma, Niperten, Bisoprolol-Prana, Bisoprolol-Lugal, Bisoprolol-Ratiopharm, Bisoprolol-Teva, Concor, Concor Cor, Bisomor, Bioskard, Corbis, Bidopor, Bidop, A, Bidop.
Analogs of the drug according to the mechanism of action are Atenolol, Betacard, Betalok, Binelol, Cordanum, Lidalok, Lokren, Metozok, Metoprolol, Metokor, Nebivator, Nebilong, Nebilet, OD-Neb, Egilok, Estecor.
Which is better – Bisoprolol or Concor?
Concor is a trademark under which the original bisoprolol is produced. The manufacturer of the drug is the German pharmaceutical company Merck KGaA. However, the patent for this medicine has long expired, so a large number of more affordable bisoprolol generics are currently on the market.
It is believed that all of them are not inferior in quality to the original drug, however, official data that would confirm this is not enough today.
Some of them are available at an affordable cost, like the medication in question, others are more expensive. If the doctor advised using Bisoprolol, the effect of this drug will be greater than that of analogues. Replace the drug with such drugs (generics) is possible only with the agreement of the attending physician.
It is known that the compatibility of Bisoprolol and agents containing clonidine allows the use of these drugs at the same time, but it is unacceptable to cancel both drugs at the same time. First stop taking one drug, and after a few days – the second. With the use of drugs, under the influence of which the volume of catecholamines is reduced, the effectiveness of beta-blockers can increase.
The tool can be used for diabetes. The drug does not affect hypoglycemia in most cases, but with the development of tachycardia provoked by this factor, regular use of Bisoprolol may mask the symptoms. The medication in question does not interfere with the restoration of glucose in the blood to normal levels.
Side effects are rare (in one out of a hundred patients). As follows from the reviews of the drug, patients face similar troubles infrequently, on average, the tolerance of the drug is good. At the same time, you need to be prepared for side effects and, at the first manifestations of a worsening condition, you should immediately consult your doctor.
In some patients, when using Bisoprolol, fatigue increases, sleep, vision, and eye pain appear. Perhaps the development of sinus bradycardia, lowering the pressure. Relatively often, you can hear complaints about the dryness of the oral mucosa and problems with stool. If the drug is used in a very large dose, there is a risk of developing breathing difficulties.
With diabetes, the likelihood of hyperglycemia, hypoglycemia (depending on the type of disease) increases. Very rarely, allergic reactions are observed, manifested by urticaria or skin itching, a rash is possible. When using the product during pregnancy, there is a chance of delayed fetal development. In some cases, the so-called withdrawal syndrome was diagnosed when, at the end of the course of treatment, angina pectoris worsened. Also in rare cases, a decrease in potency was noted.
Bisoprolol (INN – Bisoprolol) belongs to the clinical and pharmacological group “β1-blockers.” Its action is aimed at relieving symptoms of myocardial ischemia (antianginal effect), normalizing the disturbed rhythm of contractions of the heart muscle (antiarrhythmic effect), as well as at lowering blood pressure (antihypertensive effect).
Bisoprolol may be accompanied by:
- dizziness and headaches;
- feeling of tiredness;
- sensation of a rush of blood to the face;
- sleep disorders
- mental disorders (usually depression, less often – hallucinations);
- paresthesia of the limbs and a feeling of cold in them;
- decreased secretion of tear fluid;
- the development of conjunctivitis;
- abdominal pain, nausea, vomiting;
- diarrhea or vice versa constipation;
- muscle weakness;
- increase in convulsive activity of muscles;
- symptoms of bronchial obstruction (in patients who are predisposed to this);
- excessive sweating;
- impaired potency;
- orthostatic hypotension;
- violations of AV conduction.
In some cases, it is possible to aggravate the course of heart failure with the development of peripheral edema.
In patients with impaired blood supply to the lower extremities, which is accompanied by intermittent claudication, as well as in patients who are diagnosed with Raynaud’s syndrome, an increase in the main symptoms of these diseases is possible.
Also, the possibility of a decrease in glucose tolerance, mainly in patients with concomitant diabetes mellitus (including including latent (latent) diabetes, which is characterized by the complete absence of any manifestations of this disease), is not ruled out.
Not recommended combinations:
- with calcium antagonists;
- with antihypertensive drugs, which are characterized by a central mechanism of action;
- with MAO inhibitors (with the exception of MAO-B inhibitors).
With caution, the drug is prescribed with:
- antiarrhythmic drugs of class I and III;
- calcium antagonists, which belong to the group of dihydropyridine derivatives;
- anticholinesterase drugs;
- β-blockers of local action;
- insulin preparations and oral antidiabetic agents;
- cardiac glycosides (digitalis preparations);
- non-steroidal anti-inflammatory drugs;
- ergotamine derivatives;
- sympathomimetics, which are characterized by the ability to activate α- and β-adrenergic receptors;
- antihypertensive drugs that increase the risk of hypotension (for example, tricyclic antidepressants, phenothiazines or barbiturates);
- corticosteroid drugs.
How to use?
Bisoprolol belongs to the group of selective beta1-blockers. The product is available in the form of tablets, each of which has a shell – a thin film that facilitates administration.
How to take Bisoprolol is described in detail in the instructions that accompany the drug. Usually they drink it in the morning before breakfast on an empty stomach. The entire daily dose is used at a time, swallowed immediately, without chewing. As a rule, from 5 to 10 mg are prescribed per day. The daily dose of Bisoprolol for an adult should not be more than 20 mg.
Pharmacodynamics and pharmacokinetics
Bisoprolol is a selective β1-blocker and does not have internal sympathomimetic and membrane-stabilizing activity.
Under the influence of low doses of the active substance of bisoprolol fumarate in a patient:
- decreased plasma renin activity (regulating blood pressure and water-salt homeostasis of the proteolytic enzyme);
- myocardial oxygen demand decreases;
- the excitability and conductivity of the myocardium is reduced;
- the frequency of contractions of the heart muscle decreases (both at rest, and with a load on it);
- stimulated catecholaminal and the formation of cyclic adenosine monophosphate from adenosine triphosphate are reduced;
- the flow of calcium ions into the intracellular space decreases;
- reduced cardiac output (despite the fact that a significant decrease in stroke volume is not observed);
- atrioventricular (AB) conductivity is inhibited;
- pressure decreases;
- the symptoms of myocardial ischemia are stopped.
According to the annotation, Bisoprolol in a dosage significantly exceeding the therapeutic (0,2 grams or more) is capable of causing blockade, including β2-adrenergic receptors, mainly in the bronchi and smooth muscles of the vascular walls.
The drug is absorbed by approximately 80-90%, while the level of absorption is independent of food intake. The concentration of the active substance in plasma reaches its maximum value in 60-180 minutes after taking the pill.
Bisoprolol fumarate binds to plasma proteins approximately 30%. The substance is not capable of:
- pass through the placental and blood-brain barriers;
- penetrate the milk of a nursing woman.
About half of the dose taken is metabolized in the liver, resulting in the formation of inactive metabolites. The elimination half-life varies from 10 to 12 hours. About 98% is eliminated from the body unchanged in the urine, up to 2% is excreted in the bile.
Feature of application
Confirm the effectiveness of hypertension “Bisoprolol” reviews, which are published in large numbers on the World Wide Web. As the manufacturer explains, the positive effect is due to a reduction in the minute volume of blood circulation. In addition, the active active ingredient of the drug stimulates peripheral vessels, the renin-angiotensin-aldosterone system is inhibited.
The effect that eliminates heart complications after angina is also confirmed by reviews of Bisoprolol. As the manufacturer explains, the effectiveness is guaranteed by the fact that under the influence of the active component the myocardium receives the necessary amount of oxygen, since heart rate decreases, diastole becomes longer, myocardial perfusion is better. Diastolic pressure increases, muscle fibers in the ventricles of the heart more effectively stretch.
Considering the testimony of “Bisoprolol”, one cannot lose sight of arrhythmia. The effectiveness of taking the medication in patients with this disorder is ensured by the inhibition of the factors that provoke the corresponding state of the body. Spontaneous arousal becomes almost impossible.
The drug stands out against the background of non-selective beta-adrenergic blockers, since the side effects of Bisoprolol on other organs are much less at the average therapeutic dose. First of all, this applies to those systems where there are beta2-adrenergic receptors. The negative effect on carbon and sodium metabolism is also reduced (the latter does not accumulate in the body).
The use of bisoprolol is contraindicated in:
- hypersensitivity to the components of the drug;
- hypersensitivity to other β-blockers;
- acute heart failure (AHF);
- CHF in the stage of decompensation (if the patient needs the appointment of inotropic therapy);
- shock (including including cardiogenic);
- syndrome of weakness (dysfunction) of the sinus node;
- pulmonary edema;
- sinoatrial blockade;
- bradycardia (extremely low heart rate, in which the heart rate does not exceed 60 beats per minute);
- AV block 2 and 3 degrees without pacemaker;
- severe form of arterial hypotension, in which the systolic blood pressure does not exceed 100 mm RT. Art.);
- severe bronchial asthma;
- a history of COPD;
- pheochromocytoma (in cases where the patient is not simultaneously prescribed α-blockers);
- poorly controlled diabetes;
- metabolic acidosis;
- late stage peripheral circulation disorders (for example, with Raynaud’s syndrome);
- refractory hypokalemia, hypercalcemia, or hyponatremia;
- lactase deficiency;
- glucose-galactose malabsorption syndrome.
Due to the fact that there is not enough data on the safety and effectiveness of the drug for patients under the age of 18, bisoprolol is not used in pediatrics.
In addition, the drug is not prescribed for patients undergoing treatment with MAO inhibitors (with the exception of cases where B-type monoamine oxidase inhibitors are prescribed).
How does it work?
As follows from the instructions of “Bisoprolol” (reviews confirm this), the drug has a strong hypotensive effect, helps fight arrhythmia. The drug acts selectively and belongs to the class of beta1-blockers. It affects beta1 receptors in the cardiac system, but at a relatively low dose, due to which the activity of catecholamines is suppressed, the generation of ATP, cAMP decreases, and calcium metabolism slows down. The tool slows down the heart rate due to inhibition of excitability and the ability of the myocardium to contract.
An overdose of the drug is accompanied by the following symptoms:
- severe bradycardia;
- ventricular extrasystole;
- AV blockade;
- marked decrease in blood pressure;
- cyanosis (cyanosis) of fingers or palms;
- difficulty breathing
- syncopal conditions;
Treatment involves a gastric lavage procedure, intake of absorbent drugs and the appointment of symptomatic therapy:
- the introduction into the vein of 1-2 grams of atropine or epinephrine with AV block (for some patients, a temporary pacemaker is installed to solve the problem);
- the introduction into the vein of lidocaine with ventricular extrasystole (in this case, class IA preparations should not be used);
- moving the patient to the Trendelenburg position with a decrease in blood pressure;
- intravenous administration of plasma-replacing solutions (if there are no signs of the onset of pulmonary edema; if this does not give the expected effect, epinephrine, dobutamine or dopamine should be administered to the patient to maintain a chrono- and inotropic effect and stop the marked decrease in blood pressure);
- the appointment of cardiac glycosides, diuretic drugs, as well as glucagon in heart failure;
- intravenous diazepam for seizures;
- inhaled administration of β-adrenostimulants with bronchospasm.
What else to pay attention to?
Despite the indications of “Bisoprolol”, in some cases with angina pectoris, the remedy does not have the proper effectiveness. This is due to the specifics of the disease: it is known that all drugs from the group of beta-blockers do not give a result in approximately every fifth patient. As a rule, this is due to coronary atherosclerosis, in which there is a low ischemic threshold. The effectiveness of the drug decreases if a person smokes for a long time, as well as with impaired subendocardial blood flow.
Before prescribing Bisoprolol, the doctor checks the function of external respiration in patients with a history of bronchopulmonary burden. If the patient uses contact lenses, it must be remembered that the use of “Bisoprolol” in some cases provokes a decrease in the secretion of tear fluid. With established pheochromocytoma, there is the likelihood of a specific form of hypertension, if it was not possible to achieve effective alpha-adrenoblock. When choosing Bisoprolol for the treatment of patients with diagnosed thyrotoxicosis, it must be remembered that the drug cannot be canceled abruptly.
The drug should be prescribed with caution:
- patients who are diagnosed with psoriasis, as well as patients whose family history has indications of this disease;
- with diabetes mellitus in the stage of decompensation;
- patients who are predisposed to allergic reactions;
- patients whose work requires a high speed of psychomotor reactions or potentially threatens health and / or life (as a rule, the reaction rate may decrease at the initial stages of treatment, when changing the drug, as well as when Bisoprolol interacts with alcohol).
For patients diagnosed with pheochromocytoma, the drug is prescribed only after treatment with α-blockers.
The sudden withdrawal of the drug is unacceptable, the course of its use is completed gradually, gradually reducing the prescribed dose (it is considered optimal to reduce it by halving the daily dose).
Reviews on Bisoprolol
More often than not, the topic of drug withdrawal is discussed at relevant forums. The reviews about Bisoprolol left by patients and doctors are mainly associated with withdrawal syndrome, which occurs against the background of a sharp cessation of treatment with this agent.
Particular manifestations of it are increased heart rate and attacks of arterial hypertension. Some patients note that against the background of drug treatment, their vision was significantly reduced.
However, since Bisoprolol is prescribed for a long period of time (for some patients, even for life), impaired visual function and medication may be unrelated phenomena.
Taking bisoprolol may be accompanied by side effects. Some of the patients almost do not notice them at home, and someone, according to reviews, they are expressed quite strongly.
In connection with all of the above, neither treatment nor withdrawal of the use of this drug should be an independent decision of the patient. In each case, the treatment regimen and dosage regimen are determined solely by the doctor who leads the patient.
On the Internet there are mostly positive responses about Bisoprolol. The medication is inexpensive and helps to stabilize the patient’s condition even with serious illnesses, if used as directed by the attending doctor and with regular monitoring of the condition. Mostly negative responses are caused either by self-administration of the drug without the help of a specialist, or by intolerance to the body associated with individual characteristics.
Also, some patients noted the difficulty of combining the active component of Bisoprolol with substances that are present in other drugs. This interaction makes it necessary to use the drug only if there is a recommendation from the attending physician who knows which drugs his patient is taking.
At the same time, there are reviews about Bisoprolol, which say that the remedy was ineffective in a particular case. As the manufacturing company notes, this is possible in every fifth case and is due to other health problems or individual characteristics. You need to be prepared for such a situation.
Bisoprolol is not recommended for the treatment of pregnant and lactating women. However, in situations where the benefit to the mother potentially exceeds the likely risks to the developing fetus, the drug can still be prescribed.
In exceptional cases, when the medicine is used during pregnancy, it should be discontinued no later than 72 hours before the expected date of birth. Otherwise, a newborn baby is more likely to develop hypoglycemia, arterial hypotension, bradycardia, and respiratory depression.
When withdrawal is not possible, constant monitoring of the infant’s condition is necessary during the first 72 hours after birth.
If it is necessary to appoint Bisoprolol to a nursing woman, it is necessary to decide on the termination of lactation.
The price of Bisoprolol depends on which pharmaceutical company produced the drug. So, for example, the average price of Bisoprolol-Ratiopharm is 0,005 grams – 55 UAH (in Russian pharmacies it can be bought for about 345 rubles), but the price of Bisoprolol-Astrapharm starts from 8 UAH.
The price of analogues of the drug on the Russian pharmaceutical market is from 32 rubles (the average cost for a buyer is Bisoprolol-Prana packaging of 0,005 grams).
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