Concor
The drug is taken orally 1 time/day. The tablets should be taken with a small amount of liquid in the morning before, during or after breakfast. The tablets should not be chewed or crushed into powder.
Arterial hypertension and stable angina
The dose is selected individually, primarily taking into account the heart rate and the patient’s condition.
As a rule, the initial dose is 5 mg 1 time / day. If necessary, the dose can be increased to 10 mg 1 time / day. For the treatment of arterial hypertension and angina pectoris, the maximum recommended dose is 20 mg 1 time / day.
Chronic heart failure
The standard treatment regimen for chronic heart failure includes the use of ACE inhibitors or angiotensin II receptor antagonists (in case of intolerance to ACE inhibitors), beta-blockers, diuretics and, optionally, cardiac glycosides. At the beginning of treatment of chronic heart failure with Concor®, a special titration phase is required under regular medical supervision.
The precondition for treatment with Concor® is stable chronic heart failure without signs of exacerbation.
Treatment with Concor® begins in accordance with the following titration scheme. Individual adaptation may be required depending on how well the patient tolerates the prescribed dose, i.e. the dose can only be increased if the previous dose was well tolerated.
To ensure an appropriate titration process, it is recommended to use bisoprolol in the dosage form of 2.5 mg tablets at the initial stages of treatment.
The recommended starting dose is 1.25 mg 1 time/day. Depending on individual tolerance, the dose should be gradually increased to 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg 1 time / day. Each subsequent dose increase should be carried out at least 2 weeks later. If increasing the dose of the drug is poorly tolerated by the patient, then a dose reduction is possible.
The maximum recommended dose for the treatment of chronic heart failure is 10 mg 1 time / day.
During titration, regular monitoring of blood pressure, heart rate and the severity of symptoms of chronic heart failure is recommended. Worsening of the symptoms of chronic heart failure is possible from the first day of using the drug.
If the patient does not tolerate the maximum recommended dose of the drug, then a gradual dose reduction should be considered.
During the titration phase or after it, a temporary worsening of chronic heart failure, arterial hypotension or bradycardia is possible. In this case, it is recommended, first of all, to adjust the doses of concomitant therapy drugs. It may also be necessary to temporarily reduce the dose of Concor® or discontinue it. After stabilization of the patient's condition, the dose should be re-titrated or treatment should be continued.
Duration of treatment for all indications
Treatment with Concor® is usually long-term.
Special patient groups
Patients with mild or moderate hepatic or renal dysfunction, as well as elderly patients, usually do not require dosage adjustment.
In case of severe renal impairment (creatinine clearance less than 20 ml/min) and in patients with severe liver disease, the maximum daily dose is 10 mg. Increasing the dose in such patients should be carried out with extreme caution.
Elderly patients do not require dose adjustment.
Because There is not enough data on the use of the drug Concor® in children; it is not recommended to prescribe the drug to children and adolescents under the age of 18 years.
To date, there is insufficient data regarding the use of Concor® in patients with chronic heart failure in combination with type 1 diabetes mellitus, severe renal and/or liver dysfunction, restrictive cardiomyopathy, congenital heart defects or heart valve disease with severe hemodynamic impairment. Also, sufficient data have not yet been obtained regarding patients with chronic heart failure with myocardial infarction within the last 3 months.
Overdose
Symptoms: most often - AV block, severe bradycardia, marked decrease in blood pressure, bronchospasm, acute heart failure and hypoglycemia. Sensitivity to a single high dose of bisoprolol varies widely among individual patients and sensitivity is likely to be high in patients with chronic heart failure.
Treatment: if an overdose occurs, first of all, it is necessary to stop taking the drug and begin supportive symptomatic therapy.
For severe bradycardia, intravenous administration of atropine. If the effect is insufficient, then a drug with a positive chronotropic effect can be administered with caution. Sometimes temporary placement of an artificial pacemaker may be necessary.
With a pronounced decrease in blood pressure, intravenous administration of plasma-substituting solutions and vasopressor drugs.
For AV blockade, constant clinical monitoring and prescription of beta-adrenergic agonists such as epinephrine. If necessary, install an artificial pacemaker.
In case of exacerbation of chronic heart failure - intravenous administration of diuretics, drugs with a positive inotropic effect, as well as vasodilators.
For bronchospasm - prescribing bronchodilators, incl. beta2-adrenergic agonists and/or aminophylline.
For hypoglycemia, intravenous administration of dextrose (glucose).
Pharmacological properties
Pharmacodynamics.
The active ingredient of the drug Concor Cor is bisoprolol, a selective β1-adrenergic receptor blocker. when used in therapeutic doses, it does not have internal sympathomimetic activity and clinically significant membrane-stabilizing properties. has antianginal and hypotensive effects. Concor Cor reduces myocardial oxygen demand by reducing heart rate, cardiac output and blood pressure, and increases myocardial oxygen supply by reducing end-diastolic blood pressure and prolonging diastole. the drug has very low affinity for β2 receptors of smooth muscles of the bronchi and blood vessels, as well as β2 receptors of the endocrine system. The drug can only in rare cases affect the smooth muscles of the bronchi and peripheral arteries, as well as glucose metabolism. Pharmacokinetics. Absorption and distribution. After oral administration, Concor Cor is well absorbed from the gastrointestinal tract. Bioavailability is about 90% and is independent of food intake. The volume of distribution is 3.5 l/kg body weight. The total clearance of bisoprolol is 15 l/h. Due to the long half-life (10–12 hours), the drug retains its therapeutic effect for 24 hours after a single use of the drug.
Metabolism and excretion. Bisoprolol is excreted from the body in two ways: 50% is biotransformed in the liver with the formation of inactive metabolites and excreted by the kidneys, 50% is excreted unchanged in the urine.
The pharmacokinetics of bisoprolol is linear, its indicators do not depend on age.
Side effects
Adverse effects according to the frequency of occurrence are classified into the following categories: very often (≥1/10), often (≥1/100 and 1/10), infrequently (≥1/1000 and 1/100), rarely (≥1/10,000 and 1/1000), very rarely (1/10,000).
From the cardiovascular system: very often - bradycardia; often - signs of worsening heart failure, a feeling of coldness or numbness of the extremities, arterial hypotension, especially in patients with heart failure; infrequently - impaired AV conduction, orthostatic hypotension.
From the nervous system: often - dizziness, headache; rarely - syncope.
On the part of the organ of vision: rarely - decreased tear production (should be taken into account when wearing contact lenses); very rarely - conjunctivitis.
On the part of the hearing organ: rarely - hearing loss.
From the respiratory system: infrequently - bronchospasm in patients with a history of asthma and chronic obstructive respiratory diseases; rarely - allergic rhinitis.
From the digestive tract: often - nausea, vomiting, diarrhea, constipation.
On the skin: rarely - hypersensitivity reactions (itching, redness, rash); very rarely - when treated with β-adrenergic receptor blockers, the condition of patients with psoriasis may worsen in the form of psoriatic rash, alopecia.
From the musculoskeletal system: infrequently - muscle weakness, cramps.
From the liver: rarely - hepatitis.
From the reproductive system: rarely - impaired potency.
Mental disorders: infrequently - depression, sleep disorders; rarely - nightmares, hallucinations.
Laboratory indicators: rarely - increased TG levels in the blood, increased activity of liver enzymes in the blood plasma (AST, ALT).
Body as a whole: often - asthenia, fatigue.
In case of side effects or undesirable reactions, you must immediately inform your doctor.
Interactions
Combinations that are not recommended for use
Treatment of chronic heart failure. Class I antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone): the effect on AV conduction and the severity of the negative inotropic effect may be potentiated.
All indications. Calcium antagonists such as verapamil, and to a lesser extent diltiazem: a negative effect on myocardial contractile function and AV conductivity. IV administration of verapamil can lead to severe arterial hypotension and AV block.
Antihypertensive drugs with a central mechanism of action (clonidine, methyldopa, moxonidine, rilmenidine): possible worsening of heart failure due to a decrease in central sympathetic tone (decreased heart rate and cardiac output, vasodilation). Sudden discontinuation of the drug, especially if preceded by discontinuation of beta-adrenergic blockers, may increase the risk of rebound hypertension.
Combinations to use with caution
Treatment of hypertension or coronary heart disease (angina). Class I antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone): the effect on AV conduction and the severity of the negative inotropic effect may be potentiated.
All indications. Calcium antagonists such as dihydropyridine (eg nifedipine, felodipine, amlodipine) may increase the risk of arterial hypotension. The possibility of increased negative effects on myocardial inotropic function in patients with heart failure cannot be ruled out.
Class III antiarrhythmic drugs (eg amiodarone) may increase the negative effect on AV conduction.
Local β-adrenergic receptor blockers (for example, contained in eye drops for the treatment of glaucoma): the severity of the systemic effects of bisoprolol may be increased.
Parasympathomimetics: May prolong AV conduction time and increase the risk of bradycardia.
Insulin and oral hypoglycemic agents: enhanced hypoglycemic effect. β-adrenergic receptor blockade may mask symptoms of hypoglycemia.
Anesthesia agents: the risk of myocardial function depression and arterial hypotension increases (see SPECIAL INSTRUCTIONS).
Cardiac glycosides: decreased heart rate, increased AV conduction time. NSAIDs may weaken the hypotensive effect of bisoprolol.
β-Sympathomimetics (for example, orciprenaline, isoprenaline, dobutamine): use in combination with Concor Cor may lead to a decrease in the therapeutic effect of both drugs. Higher doses of epinephrine may be required to treat allergic reactions.
Sympathomimetics that activate α- and β-adrenergic receptors (for example, epinephrine, norepinephrine): a vasoconstrictor effect mediated through α-adrenergic receptors is possible, which leads to increased blood pressure and increased intermittent claudication. Such an interaction is more likely when using non-selective beta-adrenergic blockers.
When combined with antihypertensive drugs and drugs that exhibit hypotensive effects (for example, tricyclic antidepressants, barbiturates, phenothiazines), the risk of arterial hypotension may increase.
Possible combinations. Mefloquine may increase the risk of bradycardia.
MAO inhibitors (with the exception of MAO type B inhibitors) increase the hypotensive effect of β-adrenergic receptor blockers, but there is a risk of developing a hypertensive crisis.
Note!
Description of the drug Concor Cor tablet. p/o 2.5 mg No. 30 on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.
Contraindications
Acute heart failure or decompensated heart failure that requires IV inotropic therapy; cardiogenic shock; AV blockade II and III degrees; sick sinus syndrome; pronounced sinoatrial block; symptomatic bradycardia; symptomatic arterial hypotension; severe form of ba; severe form of peripheral arterial occlusive disease or Raynaud's disease; untreated pheochromocytoma; metabolic acidosis; hypersensitivity to bisoprolol or other components of the drug.
