home Warm floor Concor can I split the pill. Can concor be taken in the evening

Concor can I split the pill. Can concor be taken in the evening

It blocks β1-adrenergic receptors with high selectivity, shows low selectivity for adrenergic β2 receptors and does not carry out internal sympathomimetic activity.

As a result, cardiac output and peripheral vascular resistance decrease, renin activity decreases, and a decrease in blood pressure is achieved. In order to successfully control arterial hypertension, it is important to figure out how to take Concor correctly: before meals or after and how many times, can you drink it at night and how long can you take Concor without a break. You also need to understand how to treat them with comorbidities and how to stop drinking Concor if necessary to cancel it.

How to take Concor with high blood pressure?

In hypertension, the dosage of the drug should be gradually increased under the control of the level of blood pressure, the starting dose is 5 mg. Patients with diastolic pressure less than 105 mm Hg. Art. treatment begins with 2.5 mg.

If the target blood pressure was not achieved, then the daily dosage of the drug is increased in steps of 1.25-2.5 mg and gradually increased to 10 mg. The dose may be increased, but Concor should not be taken more than 20 mg.

Patients often have questions related to the rational dosing of drugs and the correct regimen, especially if it is necessary to take Concor with several drugs at the same time.

The remedy is intended for long-term treatment, therefore, for proper treatment, you need to clearly understand how many times to drink the drug - 1 or 2 times a day, when to drink it: in the morning or in the evening, and whether Concor can be taken at night.

The patient needs to understand:

how to link treatment with food intake;
drink Concor before or after meals;
how long does it take for the medicine to work?
what is the duration of the therapeutic effect.

The instructions for use provide only one indication of how to take it according to the time of day: the drug is advised to be taken on an empty stomach in the morning or with meals, it does not indicate whether Concor can be drunk at night. There are no restrictions on the number of reception, as well as warnings about the evening reception.

1 or 2 times a day?

The answer to the questions of those who want to do things their own way, deviating from the recommendations, and wondering if it is possible to take Concor twice and at night, is simple: it is possible, but not necessary. There are several reasons why you need to follow the instructions:

duration of action;
change in the severity of the effect per day;
the relationship between the amount of medication taken and errors in the dosing regimen.

The number of doses of the drug is determined by the duration of action. The half-life of bisoprolol is 10.5 hours, and it lasts more than a day, while the residual effect 24 hours after taking the drug is reduced by less than a third compared to the maximum effect during the day. Therefore, there is no need to take Concor several times. In addition, the ability to take the drug once and its relationship with food intake simplify treatment and increase patient adherence to the chosen regimen.

Foreign studies have established that with an increase in the frequency of administration, the number of people who violate the regimen of drug use increases. So, when prescribing tablets 2 times a day, every third violates the regimen, with three times the use of errors allows almost half of the patients, forgetting to take the medicine on time.

Incorrect fulfillment of prescriptions leads to a decrease in the effectiveness of treatment and may lengthen the time for selecting the required dose. Simplifying the treatment regimen improves prescription fulfillment. The option is considered optimal in terms of convenience when you need to take one dosage unit of the drug once in the morning, which is associated with a meal in time.

Whether it is possible to take Concor twice a day is determined only by the doctor who prescribes and controls the treatment, he also determines how long Concor can be taken. Patients should not make independent decisions about changing their treatment regimen.

When: morning or evening?

When analyzing the question of how to drink Concor correctly: when to take it (in the morning or in the evening), how best to drink and why - you will have to pay attention to the points of its influence and the features of the functioning of the body.

The effects of bisoprolol are provided by its ability to reversibly block β1-adrenergic receptors related to the sympathetic division of the autonomic nervous system. Under its influence, the stimulating effect of adrenaline on the heart and blood vessels decreases. Therefore, it matters at what time to take Concor.

The vegetative part of the nervous system is characterized by a daily cycle of activation and inhibition processes, which are reflected in the heart and blood vessels. During the day you can see:

increased heart rate;
increased vascular tone;
increase in blood pressure.

At night, the opposite is true.

In the daytime, the sympathetic part of the autonomic system is activated and the activity of the parasympathetic is reduced, which is characterized by an increase in the frequency of heart contractions and an increase in blood pressure in awake people. In stressful situations and during physical exertion, under the influence of sympathoadrenal stimuli, the load on the heart increases, vasoconstriction occurs, and blood pressure rises even more and the heart rate increases.

During the period of nocturnal sleep, the energy reserves of the body are restored due to an increase in the influence of parasympathetic autonomics and a decrease in the activity of the sympathetic department of the nervous system. Wherein:

cardiac activity slows down;
the pulse slows down;
vascular tone decreases and blood pressure decreases.

On average, during the day, blood pressure indicators during sleep and wakefulness in one person differ by 15 mm Hg. Art.

Average blood pressure by age

Can I take it in the evening (at night)?

Taking Concor in the evening creates the highest concentration of the drug during the period of natural decrease in the effects of the sympathoadrenal system and will not have the desired effect during the period of its increase, which will lead to insufficient control of hypertension with the same drug load on the liver and kidneys as with morning medication.

The creation of a high level of an adrenergic blocker with the activation of the parasympathetic autonomic system can increase the risk of adverse manifestations of the heart and blood vessels, which will not be timely diagnosed and eliminated during sleep.

For evening reception:

the maximum effect of the drug occurs during the period of lowering blood pressure;
during the period of maximum blood pressure, the effect is reduced;
increases the risk of arrhythmias and other side effects at night.

Before meals or after?

You need to understand why the connection between the use of the drug and food is important and how to take Concor correctly - on an empty stomach or after a meal - in case of missing a dose of medication. The manufacturer recommends drinking the medicine before meals or with the first meal, advising to drink it with water.

But there are cases when the patient cannot eat after taking the medicine or forgets to take it before breakfast.

The ratio of medication to food is determined by:

the degree of absorption of the drug;
water and fat solubility;
effect on the stomach and intestines.

For Concor, the first two factors are taken into account.

Bisopolol is characterized by high bioavailability: 90% of the drug enters the bloodstream and the presence of food does not change the degree of its absorption. But at the same time, different products have different times for splitting and staying in the stomach. Therefore, when the drug is taken with food, its absorption rate will slow down due to the fact that the amount of gastric and intestinal contents increases. Slowing the rate of drug entry into the blood will increase the time to maximum effect. When taking the medicine after a meal, its slow absorption is observed, therefore it is more correct to drink Concor before meals.

How long does it take to work?

Concor should be taken constantly, it creates a lasting effect that develops over several hours.

To understand how long Concor works, you need to know:

concentration periods;
food influence;
the speed of development of the effect at the site of action.

The time to reach the highest concentration is 2.5-3.5 hours, the maximum hypotensive effect occurs 3-4 hours after taking Concor.

Can it be taken at low pressure?

Concor helps to normalize blood pressure in hypertension due to its hypotensive effect, and this is not the only advantage. In chronic heart failure, it is used not to lower blood pressure, but to reduce the load on the heart.

A decrease in vasospasm reduces peripheral resistance, while the same volume of blood is pumped with less heart energy and less pressure. The heart muscle itself does not receive blood during the contraction phase, since the heart vessels fill during diastole with a relaxed myocardium. With a decrease in the frequency of contractions, the duration of diastole increases and the heart itself receives more nutrients and oxygen while slowing down.

Heart failure (HF) can also occur with normal and low blood pressure. Since the drug has a clinically significant hypotensive effect, patients with heart failure need to clearly know whether Concor can be taken at low pressure.

The degree of decrease in blood pressure can be different, the lowest level is indicated as. Hypotension is defined as a condition in which the systolic blood pressure is less than or equal to 90 mm Hg. Art. Acute hypotension is a condition accompanied by a sharp decrease in blood pressure by 20% or more compared to baseline. In acute cases, the use of Concor and other pressure-reducing agents is contraindicated.

Concor is contraindicated in symptomatic arterial hypotension, that is, with a constant level of systolic blood pressure less than 90 mm Hg. Art. or a frequent decrease to such values in the presence of clinical manifestations: dizziness, weakness, collaptoid states.

In cases where there are no contraindications and there are conditions requiring the use of Concor, then it can and should be used when prescribed by the attending physician. Including - and in patients with low blood pressure.

With low pressure, you need to take Concor:

in reduced dosages;
with a slow increase in dose;
under close medical supervision.

Therefore, it is desirable to carry out such treatment with Concor in medical institutions.

How to take with low blood pressure?

There are several features in how to take Concor with low blood pressure. The drug is prescribed in reduced doses, they are gradually titrated. The starting dosage is 1.25 mg, every week the dose is increased by the same amount of medication.

Such a selection of treatment is carried out by an experienced physician who already has experience in choosing a bisoprolol therapy regimen.

Possible dosing regimen:

7 days - 1.25 mg;
8-14 days - 2.5 mg;
further - 3.75 mg.

When taking Concor by patients with low blood pressure, careful monitoring of blood pressure and pulse is mandatory.

Special instructions for treatment

Care must be taken in patients with:

bronchial asthma;
anaphylaxis;
diabetes;
obliterating or endarteritis;
atrioventricular blockade of the 1st degree.

Anesthesia may require discontinuation of the drug a few days before surgery, so it is imperative to inform the anesthetist about taking Concor.

During treatment, it is necessary to gradually increase the dose, up to the need for its titration. You can not abruptly stop taking the medicine, the abolition of Concor should be gradual.

Interaction with other drugs

Most antihypertensive drugs potentiate the hypotensive effect when used together, the strength of the combination can significantly exceed their effect alone and cause severe acute hypotension.

Concor should not be combined with clonidine, as well as with other drugs with a central action. The hypotension caused by them can cause acute heart failure.

The combined use of Concor with antiarrhythmic drugs enhances their negative effect on the conduction of excitation in the heart muscle and can cause bradycardia and reduce the strength of muscle contractions of the heart. Concor should not be taken if used:

Lidocaine;
Verapamil;

The interaction of Concor with other drugs requires increased attention when used with many drugs: and other antiarrhythmic drugs, anesthetics, adrenergic blockers for local use, cardiac glycosides.

Non-steroidal anti-inflammatory drugs can weaken the hypotensive effect of bisoprolol, so you should not take Concor with diclofenac, nimesulide or ibuprofen - this may be accompanied by an increase in blood pressure.

You can take Concor while using herbal sedatives and antihypertensives.

How long can the drug be treated?

The product is intended for long-term treatment. When determining how much Concor can be taken for hypertension, the following is taken into account:

effectiveness of hypertension control;
change in heart rate;
other actions of the drug.

With good tolerance and adequate pressure control, Concor can be taken for as long as required, sometimes for life. In heart failure, Concor is prescribed in the form of courses, in these cases, the duration of Concor's administration will be several weeks or months.

How to cancel correctly?

Bisoprolol has a cumulative effect and abrupt discontinuation of Concor can cause a withdrawal syndrome in the form of an exacerbation of the disease and an increase in pathological manifestations: increased pressure, aggravation of heart failure.

You need to know how to stop drinking Concor correctly, without causing a worsening of the course of the disease. Before canceling Concor, the specialist explains to the patient the importance of gradually giving up the medicine so that the cancellation does not coincide with the moment when it simply ended and the patient decides not to buy it anymore.

Concor stop taking gradually with a number of precautions:

its dose is gradually reduced - it can be halved in a week, you can completely stop taking Concor when it is reduced to 2.5 mg per day or a quarter of the main dose;
in the process of dose reduction and withdrawal, regular monitoring of blood pressure and pulse is necessary;
in diabetes, control glucose levels.

Is it possible to take with arrhythmia of the heart?

Some patients need to know if Concor can be taken for cardiac arrhythmias. Concor can only be taken for certain types. It slows down the passage of nerve impulses in the sympathetic nerves, slowing down the heart rate - it is not used in case of impaired conduction and automatism.

It is contraindicated in the following arrhythmias:

atrioventricular blockade II - III degree;
sick sinus syndrome;
sinoatrial block;
bradycardia with clinical symptoms.

It is used for other types, such as: tachyarrhythmias, extrasystoles, as well as in patients with an installed pacemaker.

Can Concor be treated with insulin resistance?

The drug can be used in people with concomitant diabetes of all types, therefore it is possible to take Concor with insulin resistance. It is necessary to take into account such points:

bisoprolol increases the hypoglycemic effect of hypoglycemic drugs and insulin;
it is possible to lubricate the manifestations of hypoglycemia by slowing down the work of the heart.

When treating patients with diabetes, carefully monitor blood glucose levels.

Useful video

For more information about Concor tablets, see this video:

Conclusion

Reliable pressure control, ease of dosing and a relatively small number of restrictions in use have ensured frequent recommendations to take Concor.
The high selectivity of the action of bisoprolol on adrenoreceptors allows it to be taken by patients who are contraindicated in others.
However, there are a number of warnings and features that need to be taken into account and taken Concor, adhering to the recommendations for its use.

- a fairly effective medicine belonging to the group of beta-blockers. It is available as a heart-shaped film-coated tablet with a pale yellow tint.

They are biconvex, have a double-sided notch for easy dosing. The active component of the product is bisoprolol fumarate.

Tablets are produced with a dosage of the active substance 5, 10 mg. The composition of the drug includes additional components: silicon dioxide, MCC (microcrystalline cellulose), calcium hydrogen phosphate, magnesium stearate, corn starch, crospovidone.

The shell consists of dimethicone, hypromellose, dye, titanium dioxide, macrogol. The drug goes on sale in packs of 10 - 30 pieces. How to take Concor correctly will be described in detail in the article.

Patients are often interested in when it is better to take Concor in the morning or in the evening, whether it is possible to drink it in the evening and at night. Doctors strongly advise to use the remedy in the morning.

Tablets Concor

To the question of how to take Concor before or after meals, any cardiologist or therapist will definitely answer: before or during a meal. The tablet is swallowed whole, washed down with water

Dosage of the drug

The amount and method of using this drug directly depends on the pathology that the patient has.

Arterial hypertension and angina pectoris

About how to drink Concor with, only a doctor can reliably tell during an examination, consultation.

Usually, the doctor prescribes the dose individually, guided by the severity of symptoms, the patient's condition.

Often start with 5 mg once a day.

Sometimes with a mild course, half a tablet is enough for patients. In more severe conditions, the dosage is doubled (10 mg once a day). A further increase in the daily use of the drug is permissible in exceptional cases at the discretion of the physician. The maximum dose is 20 mg.

Corrects the scheme of how to take Concor with high blood pressure, doctor, based on the resulting therapeutic effect, heart rate.

Chronic heart failure

Traditionally, the therapy for this diagnosis includes beta-blockers, diuretics,. At the beginning of treatment, under the close supervision of a specialist, a special stage of titration is carried out. A prerequisite for making a decision on inclusion in the Concor scheme is CHF without exacerbation.

To ensure that the patient passes the titration phase correctly, the initial dosage of the drug is 1.25 mg.

Every two weeks, subject to normal tolerance, the amount of the drug is increased according to the following principle: 2.5 mg, 3.75 mg, 5 mg, 7.5 mg, 10 mg. If during the next increase in the dose the patient feels a significant deterioration, the daily intake of the drug is reduced or the condition is corrected with the help of other means included in the therapy regimen.

Cases of weakly expressed negative dynamics during this phase are quite frequent. After the body adapts to the drug, unpleasant symptoms disappear, but during titration, monitoring of pressure, pulse, and well-being should be daily.

Duration of treatment

In some cases, doctors prescribe a life-long use of this medication to reduce the severity of the manifestations of diseases, stabilize the condition, and maintain a comfortable level of pressure.

special instructions

Therapy with the drug must not be abruptly interrupted, especially for people with coronary artery disease. If necessary, "leave" it should be slowly, gradually reducing the dosage used. It is also impossible to change the scheme prescribed by the doctor on your own, because this can worsen the functioning of the heart.

The first months of admission should be under medical supervision. Particularly carefully, this remedy is prescribed for the following comorbidities:

diabetes with a wide range of fluctuations in plasma sugar levels with the likelihood of masking the symptoms of hypoglycemia;
Prinzmetal's angina;
bronchospasm;
bronchial asthma;
the period of desensitizing treatment;
psoriasis;
AV blockade of the first degree;
strict diet;
weakly, moderately expressed pathological changes in the peripheral circulation;
anesthesia.

It should be noted that in patients with asthma, COPD, bronchodilators should be used in parallel with bisoprolol therapy. The drug reduces the risk of arrhythmias, myocardial ischemia during general anesthesia, so it cannot be canceled before surgery.

At the same time, it is imperative to inform the resuscitator several days in advance about taking the drug, so that the doctor correctly selects the drugs for anesthesia and excludes the possibility of unwanted interactions that provoke blockade of beta-adrenergic receptors, bradycardia, asystole.

All beta-blockers have the ability to increase sensitivity to substances that provoke allergic reactions, worsen anaphylaxis.

Concor can mask the clinic of hypothyroidism. With pheochromocytoma, it is used exclusively in a duet with alpha-blockers.

In most cases, the drug does not have any effect on the control of the machine, mechanisms. However, there have been isolated cases of violations of these tasks due to individual reactions of the body.

Overdose

a sharp decrease in pressure;
AV block;
spasm in the bronchi;
hypoglycemia;
bradycardia.

When registering the above symptoms, you should immediately stop the use of this remedy, consult a doctor on an emergency basis. With severe bradycardia, Atropine is administered parenterally.

With a sharp drop in pressure, vasopressors, plasma-substituting media are given. Exacerbation of CHF justifies the need for injections of diuretics, vasodilators. For hypoglycemia, glucose is given by vein. AV block is treated with epinephrine.

Side effects

Undesirable effects from taking the drug vary in occurrence. So, the most common side effects include the following:

nausea (with CHF);
high fatigue;
headache;
bradycardia (with CHF);
exacerbation of CHF symptoms;
diarrhea;
expressed;
asthenia;
vomit;
constipation;
paresthesia.

Infrequently occurring phenomena:

asthenia (with GB);
insomnia;
depression;
bradycardia (with hypertension);
hypotension;
conduction disorder;
bronchospasm in BA;
muscle weakness;
convulsions.

Rarely in the control groups, the following symptoms were recorded:

loss of consciousness;
nightmares;
hallucinations;
decrease in tear fluid;
hearing impairment;
hepatitis;
allergic rhinitis;
potency disorders;
skin reactions;
increase in ALT, AST.

The following phenomena are extremely rare:

conjunctivitis;
alopecia.

Pregnancy and breastfeeding

This remedy is prescribed to pregnant women only in case of a significant excess of benefits for the mother over the possible risks for the child.

Concor, like all beta-blockers, reduces fetoplacental blood flow, which can slow down, disrupt the development of the embryo in the uterus.

That is why a woman using this medicine should be under the supervision of doctors. In the first days, the baby is carefully examined. This is necessary to exclude malformations, disturbances in the functioning of systems. The child may experience hypoglycemia, low heart rate for the first day.

The excretion of bisoprolol with milk, its effect on the baby has not been reliably studied. It is not recommended to use the medicine while breastfeeding. If it is not possible to avoid taking the substance, the child must be transferred to the mixture without fail.

Interaction with other drugs

There are combinations that should not be used in CHF. Thus, first-class antiarrhythmic drugs (Lidocaine, Propafenone, Disopyramide and others) can increase the severity of the inotropic effect.

Verapamil, Diltiazem in combination with the agent under discussion have a bad effect on the ability of the heart muscle to contract, and can induce atrioventricular blockade.

Centrally acting anti-pressure drugs (Rilmenidine, Methyldopa) may worsen CHF symptoms. Possible decrease in heart rate, vasodilation, decreased ejection.

With IHD, AH, Lidocaine, Disopyramide, Phenytoin and other first-class antiarrhythmics should be used with extreme caution. Dihydropyridine can induce a sharp decrease in pressure. Amiodarone and other drugs in this group increase the negative effect on atrioventricular conduction.

Glaucoma drops, if they contain beta-adrenergic blockers, can lead to a doubling of the overall effect of the active ingredient of Concor.

Strengthen the hypoglycemic effect can tablets used in diabetes, insulin. Anesthetics increase the risk of cardiac muscle depression. All parasympathomimetics increase the risk of bradycardia.

When this drug is combined with barbiturates, tricyclic antidepressants, the risk of hypertension increases significantly. Dobutamine and other beta-sympathomimetics, when used simultaneously with Bisoprolol, mutually reduce their therapeutic effects. NSAIDs reduce the drug's ability to lower blood pressure.

It is known that MAO inhibitors increase the hypotensive effect of the drug, Mefloquine increases the risk of bradycardia, and the simultaneous use of beta-adrenergic blockers can be fraught with a hypertensive crisis.

Useful video

When should I take Concor? How long does the drug take to work? All about the correct reception of Concor in the video:

In conclusion, it should be said that Concor has established itself as a fairly reliable, effective antihypertensive drug. But he, like all products of the pharmaceutical industry, has a long list of side, undesirable effects, so only a specialist can decide on the appropriateness of its use.

Beta 1-adrenergic blocker selective

Active substance

Release form, composition and packaging

light yellow, heart-shaped, biconvex, with a risk on both sides.

Excipients: anhydrous calcium hydrogen phosphate - 132 mg, corn starch (fine powder) - 14.5 mg, anhydrous colloidal silicon dioxide - 1.5 mg, microcrystalline cellulose - 10 mg, crospovidone - 5.5 mg, magnesium stearate - 1.5 mg.

The composition of the film shell: hypromellose 2910/15 - 2.2 mg, macrogol 400 - 0.53 mg, dimethicone 100 - 0.11 mg, iron dye yellow oxide (E172) - 0.02 mg, titanium dioxide (E171) - 0.97 mg.

30 pcs. - blisters (3) - packs of cardboard.

Film-coated tablets light orange, heart-shaped, biconvex, with a risk on both sides.

Excipients: anhydrous calcium hydrogen phosphate - 127.5 mg, corn starch (fine powder) - 14 mg, anhydrous colloidal silicon dioxide - 1.5 mg, microcrystalline cellulose - 10 mg, crospovidone - 5.5 mg, magnesium stearate - 1.5 mg.

The composition of the film shell: hypromellose 2910/15 - 2.2 mg, macrogol 400 - 0.53 mg, dimethicone 100 - 0.22 mg, iron dye yellow oxide (E172) - 0.12 mg, iron dye red oxide (E172) - 0.002 mg, titanium dioxide (E171) - 0.85 mg .

10 pieces. - blisters (3) - packs of cardboard.
10 pieces. - blisters (5) - packs of cardboard.
25 pcs. - blisters (2) - packs of cardboard.
30 pcs. - blisters (1) - packs of cardboard.

pharmachologic effect

Selective beta 1 -blocker, without its own sympathomimetic activity, does not have a membrane stabilizing effect.

It has only a slight affinity for β 2 -adrenergic receptors of the smooth muscles of the bronchi and blood vessels, as well as for β 2 -adrenergic receptors involved in the regulation of metabolism. Therefore, bisoprolol generally does not affect airway resistance and metabolic processes that involve β 2 -adrenergic receptors.

The selective effect of the drug on β 1 -adrenergic receptors persists outside the therapeutic range.

Bisoprolol does not have a pronounced negative inotropic effect.

The maximum effect of the drug is achieved 3-4 hours after ingestion. Even with the appointment of bisoprolol 1 time / day, its therapeutic effect persists for 24 hours due to the 10-12 hour half-life from the blood. As a rule, the maximum reduction in blood pressure is achieved 2 weeks after the start of treatment.

Bisoprolol reduces the activity of the sympathoadrenal system by blocking the β 1 -adrenergic receptors of the heart.

With a single oral administration in patients with coronary artery disease without signs of chronic heart failure, bisoprolol reduces heart rate, reduces the stroke volume of the heart and, as a result, reduces the ejection fraction and myocardial oxygen demand. With long-term therapy, the initially elevated OPSS decreases. A decrease in plasma renin activity is considered as one of the components of the hypotensive effect.

Pharmacokinetics

Suction

Bisoprolol is almost completely (> 90%) absorbed from the gastrointestinal tract. Its bioavailability due to a small degree of metabolism during the "first pass" through the liver (at the level of about 10%) is about 90% after oral administration. Eating does not affect bioavailability. Bisoprolol exhibits linear kinetics, with plasma concentrations being proportional to the administered dose over the dose range of 5 to 20 mg. C max in blood plasma is reached in 2-3 hours.

Distribution

Bisoprolol is distributed quite widely. V d is 3.5 l / kg. Binding to plasma proteins reaches approximately 30%.

Metabolism

Metabolized by the oxidative pathway without subsequent conjugation. All metabolites are polar (water soluble) and excreted by the kidneys. The main metabolites found in blood plasma and urine do not show pharmacological activity. Data obtained from experiments with human liver microsomes in vitro show that bisoprolol is metabolized primarily by the CYP3A4 isoenzyme (about 95%), and the CYP2D6 isoenzyme plays only a minor role.

breeding

The clearance of bisoprolol is determined by the balance between excretion by the kidneys unchanged (about 50%) and metabolism in the liver (about 50%) to metabolites, which are also excreted by the kidneys. The total clearance is 15 l / h. T 1/2 is 10-12 hours.

There is no information on the pharmacokinetics of bisoprolol in patients with CHF and concurrent impairment of liver or kidney function.

Indications

Contraindications

hypersensitivity to bisoprolol or any of the excipients;
acute heart failure, chronic heart failure in the stage of decompensation, requiring inotropic therapy;
cardiogenic shock;
AV block II and III degree, without a pacemaker;
SSSU;
sinoatrial blockade;
severe bradycardia (HR< 60 уд./мин);
severe arterial hypotension (systolic blood pressure< 100 мм рт.ст.);
severe forms of bronchial asthma;
severe disorders of the peripheral arterial circulation, Raynaud's syndrome;
pheochromocytoma (without the simultaneous use of alpha-blockers);
metabolic acidosis;
age up to 18 years (not enough data on efficacy and safety).

With caution: desensitizing therapy, Prinzmetal's angina, hyperthyroidism, type I diabetes mellitus and diabetes mellitus with significant fluctuations in blood concentrations, AV blockade of the first degree, severe renal failure (CC less than 20 ml / min), severe liver dysfunction, psoriasis , restrictive cardiomyopathy, congenital heart disease or valvular heart disease with severe hemodynamic disorders, CHF with myocardial infarction within the last 3 months, severe forms of COPD, strict diet.

Dosage

Concor tablets should be taken once a day with a small amount of liquid, in the morning before, during or after breakfast. Tablets should not be chewed or crushed into powder.

Arterial hypertension and stable angina

In all cases, the doctor selects the regimen and dose for each patient individually, in particular, taking into account the heart rate and the patient's condition. Usually, the initial dose is 5 mg of Concor 1 time per day.

As a rule, the initial dose is 5 mg 1 time per day. If necessary, the dose can be increased to 10 mg 1 time per day. In the treatment of arterial hypertension and stable angina pectoris, the maximum recommended dose is 20 mg 1 time per 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. The beginning of CHF treatment with Concor requires a special titration phase and regular medical supervision. A prerequisite for treatment with Concor is stable CHF without signs of exacerbation.

Treatment with Concor begins in accordance with the following titration scheme. This may require individual adaptation depending on how well the patient tolerates the prescribed dose, i.e. the dose can be increased only if the previous dose was well tolerated.

To ensure an appropriate titration process at the initial stages of treatment, it is recommended to use bisoprolol in the dosage form of a 2.5 mg tablet.

The recommended starting dose is 1.25 mg once/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 increase in dose should be carried out at least 2 weeks later. If an increase in the dose of the drug is poorly tolerated by the patient, a dose reduction is possible.

During titration, regular monitoring of blood pressure, heart rate and the severity of symptoms of chronic heart failure is recommended. The aggravation of the symptoms of the course 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 deterioration in the course of CHF, arterial hypotension or bradycardia may occur. In this case, it is recommended, first of all, to adjust the doses of concomitant therapy drugs. You may also need to temporarily reduce the dose of the drug Concor or cancel 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

Impaired kidney or liver function

In case of mild or moderate hepatic or renal impairment, dose adjustment is usually not required.
With severe renal dysfunction (CC 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 done with extreme caution.

Elderly patients

Dose adjustment is not required.

Children

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 on the use of the drug Concor in patients with chronic heart failure in combination with type 1 diabetes mellitus, severe renal and / or liver dysfunction, restrictive cardiomyopathy, congenital heart disease or valvular heart disease with severe hemodynamic disorders. Also, until now, sufficient data have not been obtained regarding patients with chronic heart failure with myocardial infarction during the last 3 months.

Side effects

The frequency of the adverse reactions listed below was determined according to the following: very often (≥1/10); often (≥ 1/100,<1/10); нечасто (≥ 1/1000, <1/100); редко (≥ 1/10 000, <1/1000); очень редко (< 1/10 000).

From the side of the cardiovascular system: very often - bradycardia (in patients with chronic heart failure); often - aggravation of symptoms of chronic heart failure (in patients with chronic heart failure), a feeling of coldness or numbness in the extremities, a pronounced decrease in blood pressure (especially in patients with chronic heart failure); infrequently - a violation of AV conduction, bradycardia (in patients with arterial hypertension or angina pectoris), aggravation of symptoms of chronic heart failure (in patients with arterial hypertension or angina pectoris), orthostatic hypotension.

From the side of the central nervous system: often - dizziness*, headache*; rarely - loss of consciousness.

From the side of the psyche: infrequently - depression, insomnia; rarely - hallucinations, nightmares.

From the side of the organ of vision: rarely - a decrease in lacrimation (should be taken into account when wearing contact lenses); very rarely - conjunctivitis.

From the organ of hearing: rarely - hearing impairment.

From the respiratory system: infrequently - bronchospasm in patients with bronchial asthma or a history of airway obstruction; rarely - allergic rhinitis.

From the digestive system: often - nausea, vomiting, diarrhea, constipation; rarely - hepatitis.

From the side of laboratory indicators: rarely - an increase in the concentration of triglycerides and the activity of "liver" transaminases in the blood (aspartate aminotransferase (AST) and alanine aminotransferase (ALT).

From the musculoskeletal system: infrequently - muscle weakness, muscle cramps.

From the side of the skin: rarely - hypersensitivity reactions, such as pruritus, rash, flushing of the skin; very rarely - alopecia. Beta-blockers may exacerbate psoriasis or cause a psoriasis-like rash.

From the reproductive system: rarely - a violation of potency.

General violations: often - asthenia (in patients with chronic heart failure), increased fatigue *; infrequently - asthenia (in patients with arterial hypertension or angina pectoris).

* In patients with arterial hypertension or angina pectoris, these symptoms especially often appear at the beginning of the course of treatment. Usually these phenomena are mild and disappear, as a rule, within 1-2 weeks after the start of treatment.

Overdose

Symptoms: most often - AV blockade, severe bradycardia, marked decrease in blood pressure, bronchospasm, acute heart failure and hypoglycemia. Sensitivity to a single high dose of bisoprolol varies greatly among individual patients and it is likely that patients with CHF are highly sensitive.

Treatment: in the event of an overdose, first of all, it is necessary to stop taking the drug and start supportive symptomatic therapy.

With severe bradycardia - in / in the introduction of atropine. If the effect is insufficient, a remedy with a positive chronotropic effect can be administered with caution. Sometimes temporary placement of an artificial pacemaker may be required.

With a pronounced decrease in blood pressure - in / in the introduction and vasopressor drugs.

For AV block: Patients should be monitored closely and treated with beta-adrenergic agonists such as epinephrine. If necessary, the setting of an artificial pacemaker.

With an exacerbation of the course of chronic heart failure - in / in the introduction of diuretics, drugs with a positive inotropic effect, as well as vasodilators.

With bronchospasm - the appointment of bronchodilators, incl. beta 2-agonists and / or aminophylline.

With hypoglycemia - in / in the introduction of dextrose (glucose).

drug interaction

The effectiveness and tolerability of bisoprolol may be affected by the simultaneous use of other drugs. This interaction can also occur when two drugs are taken after a short period of time. The doctor must be informed about the use of other drugs, even if they are taken without a doctor's prescription (i.e. over-the-counter drugs).

Treatment of chronic heart failure

Class I antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and cardiac contractility.

Blockers of "slow" calcium channels such as verapamil and, to a lesser extent, diltiazem, when used simultaneously with bisoprolol, can lead to a decrease in myocardial contractility and impaired AV conduction. In particular, intravenous administration of verapamil to patients taking beta-blockers can lead to severe arterial hypotension and AV blockade. Centrally acting antihypertensives (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and a decrease in cardiac output, as well as to vasodilation due to a decrease in central sympathetic tone. Abrupt withdrawal, especially before the withdrawal of beta-blockers, may increase the risk of developing "rebound" arterial hypertension.

Combinations requiring special care

Treatment of arterial hypertension and angina pectoris

All indications for the use of the drug Concor

BMCC derivatives of dihydropyridine (for example, nifedipine, felodipine, amlodipine), when used simultaneously with bisoprolol, may increase the risk of arterial hypotension. In patients with chronic heart failure, the risk of a subsequent deterioration in the contractile function of the heart cannot be excluded.

Class III antiarrhythmic drugs (for example, amiodarone), when used simultaneously with bisoprolol, may increase the disturbance of AV conduction.

The action of topical beta-blockers (for example, eye drops for the treatment of glaucoma) may enhance the systemic effects of bisoprolol (lowering blood pressure, slowing heart rate).

Parasympathomimetics, when used simultaneously with bisoprolol, can increase the disturbance of AV conduction and increase the risk of developing bradycardia.

The hypoglycemic effect of insulin or oral hypoglycemic agents may be enhanced. Signs of hypoglycemia, in particular tachycardia, may be masked or suppressed. Such an interaction is more likely with the use of non-selective beta-blockers.

General anesthetics may increase the risk of cardiodepressive effects, leading to arterial hypotension.

Cardiac glycosides, when used simultaneously with bisoprolol, can lead to an increase in impulse conduction time, and thus to the development of bradycardia.

NSAIDs can reduce the hypotensive effect of bisoprolol.

Simultaneous use of the drug Concor with beta-agonists (for example, isoprenaline, dobutamine) may lead to a decrease in the effect of both drugs.

The combination of bisoprolol with adrenomimetics that affect α- and β-adrenergic receptors (for example, norepinephrine, epinephrine) can enhance the vasoconstrictor effects of these drugs that occur with the participation of α-adrenergic receptors, leading to an increase in blood pressure. Such an interaction is more likely with the use of non-selective beta-blockers.

Antihypertensive agents, as well as other agents with a possible antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines) can enhance the hypotensive effect of bisoprolol.

Mefloquine, when used simultaneously with bisoprolol, can increase the risk of developing bradycardia.

MAO inhibitors (with the exception of MAO B inhibitors) may enhance the hypotensive effect of beta-blockers. Simultaneous use can also lead to the development of a hypertensive crisis.

special instructions

Do not stop treatment with Concor abruptly and do not change the recommended dose without first consulting your doctor, because. this can lead to a temporary deterioration in the activity of the heart.

Treatment should not be interrupted suddenly, especially in patients with CAD. If discontinuation of treatment is necessary, the dose should be reduced gradually.

In the initial stages of treatment with Concor, patients need constant monitoring.

The drug should be used with caution in the following cases:

severe forms of COPD and non-severe forms of bronchial asthma;
diabetes mellitus with significant fluctuations in blood glucose concentration: symptoms of a pronounced decrease in glucose concentration (hypoglycemia), such as tachycardia, palpitations or excessive sweating, may be masked;
strict diet;
conducting desensitizing therapy;
AV block I degree;
Prinzmetal's angina;
violations of peripheral arterial circulation of mild to moderate degree (at the beginning of therapy, there may be an increase in symptoms);
psoriasis (including history).

Respiratory system: in bronchial asthma or COPD, the simultaneous use of bronchodilators is indicated. In patients with bronchial asthma, an increase in airway resistance is possible, which requires a higher dose of beta 2-adrenergic agonists. In patients with COPD, treatment with bisoprolol when it is prescribed in complex therapy for the treatment of heart failure should be started at the lowest possible dose, and patients should be carefully observed for the appearance of new symptoms (for example, shortness of breath, exercise intolerance, cough).

Allergic reactions: beta-blockers, including Concor, may increase sensitivity to allergens and the severity of anaphylactic reactions due to the weakening of adrenergic compensatory regulation under their action. Therapy with epinephrine (adrenaline) does not always give the expected therapeutic effect.

General anesthesia: when conducting general anesthesia, the risk of blockade of β-adrenergic receptors should be taken into account. If it is necessary to stop therapy with Concor before surgery, this should be done gradually and completed 48 hours before general anesthesia. You should warn the anesthetist that you are taking Concor.

Pheochromocytoma: in patients with a tumor of the adrenal glands (pheochromocytoma), Concor can be prescribed only against the background of the use of alpha-blockers.

Hyperthyroidism: during treatment with Concor, the symptoms of hyperthyroidism may be masked.

Influence on the ability to drive vehicles and mechanisms

The drug Concor does not affect the ability to drive vehicles according to the results of a study in patients with coronary artery disease. However, due to individual reactions, the ability to drive a car or work with technically complex mechanisms may be impaired. Particular attention should be paid to this at the beginning of treatment, after changing the dose, and also with the simultaneous use of alcohol.

Pregnancy and lactation

During pregnancy, the drug Concor should be recommended for use only if the benefit to the mother outweighs the risk of side effects in the fetus and / or child.

As a rule, beta-blockers reduce blood flow in the placenta and may affect the development of the fetus. Blood flow in the placenta and uterus should be monitored, as well as the growth and development of the unborn child, and in case of adverse events in relation to pregnancy and / or the fetus, alternative methods of therapy should be taken.

The newborn should be carefully examined after delivery. In the first 3 days of life, symptoms of bradycardia and hypoglycemia may occur.

There are no data on the excretion of bisoprolol into breast milk. Therefore, taking Concor is not recommended for women during breastfeeding. If taking the drug during lactation is necessary, breastfeeding should be discontinued.

For patients with severe hepatic impairment the maximum daily dose is 10 mg.

Use in the elderly

Elderly patients dose adjustment is not required.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

ENG-CIS/CONCO/0718/0049

Terms and conditions of storage

The drug should be stored out of the reach of children at a temperature not exceeding 30 ° C. Shelf life - 5 years.

Many suffer from problems with blood vessels and heart today. Pharmacists offer different means for the treatment of cardiovascular diseases.

But not all of them are effective in practice. Quite good results are shown by Concor therapy. What is Concor, how long can you take it, the article will tell.

The active substance of Concor is bisoprolol, which blocks the action of adrenaline on the heart muscle. Under the influence of adrenaline, the heart rate accelerates, blood vessels constrict, blood pressure rises, and metabolism is activated.

Tablets Concor

Concor is a selective beta1-blocker: it suppresses the action of adrenaline only on the heart. After taking this drug, the coronary arteries dilate, the heart begins to contract less often. Due to the fact that the volume of blood that the heart muscle pushes into the circulatory system during contraction decreases, blood pressure begins to drop.

The drug is used for coronary heart disease, hypertension, chronic heart failure and angina pectoris. It supplies the heart muscle with oxygen, reduces cardiac output, arterial and end-diastolic pressure. Sometimes the drug affects glucose metabolism, the smooth muscles of the bronchi and arteries.

Often you can hear from patients: Concor does not reduce pressure, what to do in this case? First you need to pay attention to the dosage.

Concor 2.5 mg is taken only in chronic insufficiency. For the treatment of high blood pressure, this dose is too small.

Pharmacies sell Concor AM, which contains, in addition to bisoprolol, amlodipine. With hypertension, this drug is more effective.

Concor can cause a number of unpleasant symptoms characteristic of an overdose:

weakness;
depressive state;
hallucinations;
dyspnea;
nausea and vomiting;
bradycardia;
itching, sweating and rash;
allergic rhinitis;
muscle weakness;
convulsions;
hepatitis;
weight gain;
hair loss.

If side effects occur, as a rule, you should not stop taking the drug. You just need to reduce the dose. The doctor should select the dosage and monitor the condition. Before treatment with Concor, you should carefully read the instructions for the drug.

Duration of treatment

Treatment of hypertension is quite long. And if the hypertension is the last stage, the pills will have to be taken for life.

Therefore, patients often have the question of how long Concor can be taken without a break in order to maintain pressure at an optimal level and not harm the body.

Concor is designed for long-term use. It is often used as maintenance therapy.

The instructions for the drug do not contain information regarding the duration of treatment. Therefore, the course should be determined by the doctor, taking into account the patient's condition.

How long it takes to be treated with Concor depends on the disease. For example, with coronary heart disease, one dose is enough to reduce the heartbeat. It is enough to take the drug once a week so that the manifestations of ischemia are not disturbed. If we are talking about mild hypertension, tablets are prescribed as a course, and after achieving a lasting effect, the drug is canceled.

In severe hypertension, it is likely that you will have to drink the pills for life.

Is there an addiction?

The question of whether Concor is addictive with long-term use arises in many hypertensive patients to whom the doctor prescribes this remedy.

Beta1-blockers are usually not addictive. Therefore, Concor is allowed to take indefinitely.

But here the opinions of doctors differ. Some argue that there is no addiction to the means. Others say that Concor, like other medicines, is addictive over time.

Some patients also complain that after taking the drug for a long time, it starts to help worse and you have to increase the dosage in order for the pressure to drop to the desired level. But here, rather, the reason is not the body's addiction to bisoprolol, but the progression of the disease. One Concor is not enough and you have to prescribe more additional drugs. For example, diuretics, ACE inhibitors, cardiac glycosides.

If you had to take several medications to lower blood pressure, this does not mean that you will have to drink all the drugs for the rest of your life. For example, you need to try to lose weight, use other methods to normalize pressure without pills. Then the dosage of Concor can be reduced to the minimum allowable.

How to stop taking?

To help Concor, the course of treatment must be long. The remedy slowly but well helps with arterial hypertension.

Like any drug, it can cause side effects. Most often it is a slow heartbeat, nausea, hypotension, weakness.

Some patients are interested in how long Concor can be taken if side effects appear, and how soon all unpleasant symptoms will pass.

As a rule, side effects pass quickly. But sometimes the state does not change. This indicates intolerance by the body of the individual components of the drug. Then it has to be cancelled.

Cancellation, replacement of the drug should be carried out according to the recommendations and under the strict supervision of the doctor. It must be canceled gradually, carefully. Abrupt discontinuation can cause a strong increase in blood pressure, arrhythmia. Too rapid withdrawal of the drug is fraught with stroke, heart attack, death.

First, you should reduce the daily dose by 1.25 mg. Observe how you feel for a few days.

If everything is in order, then it is allowed to reduce the dosage a little more. So until the complete cessation of taking the pills. There is no single cancellation scheme. Many doctors say that withdrawal should take at least a week.

Often, patients complain that they started drinking Concor tablets, and their health does not improve. The question arises, how long to take Concor, so that the result becomes noticeable?

Doctors say that it all depends on the condition of the patient. But, as a rule, after a few days, the pressure begins to slowly decrease to the standard value. And after one or two months, a lasting effect occurs.

Concor is not always allowed to drink indefinitely. How much you can take Concor depends on the presence of concomitant diseases.

So there is not enough data on the use of the drug in those who have diabetes mellitus, pathological changes in the liver and kidneys, chronic heart failure, heart defects.

In this case, Concor is prescribed with caution, and during therapy, the doctor monitors the patient's condition, determines the dosage and duration of treatment.

As a rule, treatment with Concor is long-term. But if there is a need to take a break for a while, the resumption of admission must be carried out in compliance with all the rules. Self-adjustment of the dosage is not recommended.