Expiration date: 04/2025

The composition and form of issue: 

tablets, film-coated. 1 tablet contains bisoprolol fumarate 5 or 10 mg

other ingredients: microcrystalline cellulose mannitol croscarmellose sodium magnesium stearate hypromellose titanium dioxide macrogol 6000 

Description pharmaceutical form:

Round convex, film-coated, white pill scored on one side, the risk side and engraved "B 5" (for 5 mg tablets) or "B 10" (tablets 10 mg) on the other side.

Pharmacokinetics:

Absorption is 80-90%, eating does not affect the absorption. Cmax in plasma is after 1-3 h, binding to plasma proteins is about 35%. The permeability of the BBB and placental barrier, the secretion of breast milk — low. 50% of the dose is metabolized in the liver to form active metabolites, T1/2 is 9-12 h. About 98% is excreted by kidneys, 50% unaltered, less 2% — with bile.

Description pharmacological action:

Selective beta1-blocker without own sympathomimetic activity. Blocking in low doses beta1-adrenergic receptors of the heart, reduces catecholamines stimulated camp formation from ATP, reduces intracellular current Ca2+, exerts a negative Chrono-, dromo-, batmo - and inotropic effect (slows heart rate, inhibits conduction and excitability, reduces myocardial contractility). With increasing doses having beta2-adrenoblokirtee action. The CSO at the beginning of the use of beta - blockers in the first 24 h, increases (as a result of reciprocal increase in activity of alpha - adrenergic receptors and eliminate stimulation of beta2-adrenergic receptors), which, through 1-3 day returns to the source, and prolonged assignment is reduced.

Hypotensive effect is associated with the reduction of the IOC, sympathetic stimulation of peripheral vessels, decreased activity of the renin-angiotensin system (has a greater significance for patients with initial hypersecretion of renin), restoring sensitivity of baroreceptors of the aortic arch (does not enhance their activity in response to decreased blood pressure) and the influence on the Central nervous system. In arterial hypertension effect occurs in 2-5 days, stable effect — in 1-2 months. Antianginal effect is due to reduction of requirement of a myocardium in oxygen as a result of deceleration in heart rate and decrease contractility, lengthening of diastole, improved myocardial perfusion. By increasing the end-DBP in the left ventricle and increase the tension of the muscle fibers of the ventricles can increase oxygen demand, especially in patients with chronic heart failure. Antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased camp content, arterial hypertension), decrease in speed spontaneous initiation sinusnogo and ectopiceski drivers rhythm and slowing AV conduction (mainly in the anterograde and to a lesser extent, in the retrograde directions through the AV node) and on additional ways. Unlike nonselective beta-blockers when administered in high therapeutic doses has a less pronounced effect on bodies containing beta2-adrenergic receptors (pancreas, skeletal muscle, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism, does not cause the delay of Na + in the body the severity of the atherogenic actions is not different from the action of propranolol. When used in high doses exerts a blocking effect on both subtypes of beta-adrenergic receptors.

Indications:

• hypertension
  
• Coronary artery disease (prevention of angina attacks).
  

Contraindications:

• hypersensitivity to bisoprolol or to any component of the drug, other beta-blockers
  
• shock (including cardiogenic)
  
• collapse
  
• pulmonary edema
  
• acute heart failure
  
• chronic heart failure decompensation
  
• AV blockade 2-3 degree (without pacemaker)
  
• sinoatrial block
  
• syndrome weakness sinusnogo hub
  
• bradycardia (heart rate <50 beats/min)
  
• Prinzmetal's angina
  
• cardiomegaly (with no signs of heart failure)
  
• hypotension (SBP <100 mm Hg. art., particularly when myocardial infarction)
  
• bronchial asthma and COPD in history
  
• simultaneous reception of MAO inhibitors (except MAO-B)
  
• late stages of peripheral circulatory disorders
  
• Raynaud's disease
  
• pheochromocytoma (without the simultaneous use of alpha-blockers)
  
• metabolic acidosis
  
• the age of 18 years (efficacy and safety not established).
  

With caution:

• liver failure
  
• chronic renal failure
  
• myasthenia gravis
  
• thyrotoxicosis
  
• AV blockade 1 degree
  
• depression (including in history)
  
• psoriasis
  
• old age.
  

Application of pregnancy and breast-feeding:

Application of pregnancy and breastfeeding perhaps if the benefits to the mother outweighs the risk of side effects in the fetus and child.

Side effects:

From the nervous system: fatigue, weakness, dizziness, headache, drowsiness or insomnia, "nightmarish" dream, depression, anxiety, confusion or short-term memory loss, hallucinations, asthenia, myasthenia, paresthesia in the extremities (in patients with "intermittent" claudication and Raynaud's syndrome), tremor.

From the sensory organs: impaired vision, reduced secretion of tear fluid, dryness and soreness of eyes, conjunctivitis.

From the side of cardiovascular system: sinus bradycardia, heartbeat, impaired conduction of the myocardium, AV blockade (until the development of a complete transverse blockade and heart failure), arrhythmia, weakening of myocardial contractility, the development (worsening) of chronic heart failure, reducing AD, orthostatic hypotension, manifestation of angiospasm (increased peripheral circulatory disorders, cold lower extremities, Raynaud's syndrome), chest pain.

Gastrointestinal: dryness of the mucous membrane of the mouth, nausea, vomiting, abdominal pain, constipation or diarrhea, the human liver (dark urine, yellowness of the sclera or skin, cholestasis), changing taste.

The respiratory system: nasal congestion, difficulty breathing in the appointment of high doses (loss of selectivity) and/or prone patients — laringo - and bronchospasm.

From the endocrine system: hyperglycemia (in patients with insulin-independent diabetes mellitus), hypoglycemia (in patients, receiving insulin), hypothyroid state.

Allergic reactions: itching, rash, hives.

With the skin: increased sweating, hyperemia of skin, exanthema, psoriasiform skin reactions, exacerbation of psoriasis, alopecia.

The laboratory parameters: thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia, change of enzyme activity, bilirubin and triglycerides.

Effect on fetus: intrauterine growth retardation, hypoglycemia, bradycardia.

From the side of musculoskeletal system: muscle weakness, cramps in calf muscles.

Other: back pain, arthralgia, weakening of libido rarely reduced potency syndrome "cancel" (increasing angina attacks, increased blood pressure).

Drug interactions:

Allergens, used for immunotherapy or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients, receiving bisoprolol. Radiocontrast iodine-containing drugs for at/in the introduction increases the risk of anaphylactic reactions. Phenytoin in the on/in the introduction, drugs for inhalation General anesthesia (derivatives of hydrocarbons) increase the intensity of cardiodepressive actions and reduce the likelihood of AD. Changes the effectiveness of insulin and oral hypoglycemic drugs, masks the symptoms of developing hypoglycemia (tachycardia, the AD). Reduces the clearance of lidocaine and xantinov (except difillina) and increases their concentration in plasma, especially in patients with initially increased clearance of theophylline under the influence of Smoking. Gipotenzivny effect NPVS weaken (delay of Na+ and blockade of Pg synthesis by the kidney), corticosteroids and estrogens (delays Na+). Cardiac glycosides, methyldopa, reserpine, and guanfacine, bmkk (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or exacerbating bradycardia, AV block, cardiac arrest and heart failure. Nifedipine can lead to significant reduction of HELL. Diuretics, clonidine, sympatholytic, hydralazine, and other antihypertensive drugs can lead to excessive reduction of HELL. Prolongs the action of non-depolarizing muscle relaxants and anticoagulant effect of coumarins. Three - and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedatives and hypnotics drugs increase oppression CNS. Not recommended simultaneous application with MAO inhibitors because of significant increase gipotenzivnogo actions, break in treatment between receiving MAO inhibitors and bisoprolol must be not less than 14 days. Non-hydrogenated ergot alkaloids increase the risk of peripheral circulatory disorders. Ergotamine increases risk of peripheral circulation sulfasalazine bisoprolol improves concentration in plasma rifampicin shortens T1/2.

Method of application and dose:

Inside, in the morning fasting, not liquid, 2.5–5 mg once. The usual starting dose is 5 mg 1 times per day. If necessary, increase the dose to 10 mg 1 time per day. The maximum dose for adults is 20 mg/day.

Treatment of hypertension and angina pectoris: treatment of patients with liver or kidney disease mild or moderate degree usually does not require dose adjustment.

In patients with the expressed impaired kidney (Cl creatinine <20 ml/min) or with acute human liver the maximum daily dose — 10 mg.

Dose adjustment in elderly patients is not required.

Overdose:

Symptoms: arrhythmia, ventricular arrythmia, expressed aetiology, AV blockade, decreased blood pressure, congestive heart failure, cyanosis of nails of fingers or palms, difficulty in breathing, bronchospasm, dizziness, fainting, seizures.

Treatment: gastric lavage and the appointment of adsorbing drugs symptomatic therapy: with advanced AV blockade — in/in the introduction 1-2 mg of atropine, epinephrine or staging a temporary pacemaker with ventricular arrhythmia — lidocaine (class Ia drugs do not apply) while reducing AD — the patient should be in Trendelenburg position if there are no signs of pulmonary edema — in/in plasma-substituting solutions in case of its ineffectiveness — introduction epinephrine, dopamine, dobutamine (for maintaining chronotropic and inotropic actions and resolve expressed lower AD) heart failure — cardiac glycosides, diuretics, glucagon in convulsions — in/diazepam with bronchospasm — beta2-agonists inhalation.

Special instructions:

Control for patients receiving bisoprolol should include the monitoring of HR and AD (at the beginning of treatment — daily, then 1 once in 3-4 months), ECG, glucose content of blood in patients with diabetes mellitus (1 once in 4-5 mo). In elderly patients it is recommended to monitor kidney function (1 once in 4-5 mo). Should teach the patient methods of calculating heart rate and instruct on the need of medical advice in the heart rate less than 50 BPM Before treatment is recommended study of respiratory function in patients with a history of bronchopulmonary history. About 20% patients with stroke beta-adrenoblokatora ineffective. The main reason — severe coronary atherosclerosis with the low threshold of ischemia (heart rate less than 100 beats/min) and increased end-diastolic volume of the left ventricle that violate the upper subendocardialnah blood flow. The "smokers" the effectiveness of beta-adrenoblokatorov below. Patients using contact lenses should take into account that the treatment may decrease the production of tear fluid. When used in patients with pheochromocytoma there is a risk of paradoxical hypertension (if not previously achieved effective alpha adrenoblokada). Thyrotoxicosis bisoprolol can mask certain clinical signs of hyperthyroidism (e.g. tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated, because it can reinforce the symptoms. At diabetes can mask the tachycardia, caused by hypoglycemia. Unlike nonselective beta-blockers virtually no increases caused by insulin hypoglycemia and not delay restoration of glucose in the blood to normal levels. At the same time taking clonidine its reception can be terminated only a few days after discontinuation of bisoprolol. Perhaps the increased severity of hypersensitivity reactions and lack of effect of conventional doses of epinephrine with aggravated allergic anamnesis. In case of the need for planned surgical treatment elimination of the drug is carried out for 48 h before General anesthesia. If the patient has taken the drug before surgery, he should pick up the drugs for General anesthesia with minimal negative inotropic effects. Reciprocal activation of n.vagus can eliminate I/atropine (1-2 mg). Drugs, reducing stocks of catecholamines (eg reserpine), may enhance the action of beta-adrenoblokatorov, therefore, patients, accepting such combination drugs, should be under constant supervision of a doctor to identify arterial hypotension or bradycardia. Patients with bronchospastic diseases you can assign a cardioselective blocker in case of intolerance and/or ineffectiveness of other antihypertensive medicines, but should strictly follow the dosage. Overdose is dangerous development of bronchospasm. In the case of elderly patients increasing bradycardia (less 50 beats/min), hypotension (garden below 100 mm Hg. Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe violations of the liver and kidneys, it is necessary to reduce the dose or stop the treatment. It is recommended to discontinue therapy in the development of depression caused by the reception beta-adrenoblokatorov. Do not abruptly discontinue the treatment because of the risk of severe arrhythmias and myocardial infarction. Lifting a gradually reducing the dose over 2 weeks or more (reduce the dose 25% in 3-4 day). Should be lifted before the examination of blood and urine catecholamines, normetanephrine and vanillylmandelic acid, titles of antinuclear antibodies. During the period of treatment must be careful when driving and occupation of other potentially hazardous activities, require high concentration and psychomotor speed reactions.