Aritel for the prevention of the problems of the cardiovascular system. Aritel - Instructions for applying Aritel 5 mg Instructions for use

You can lower blood pressure using beta-1-adrenobloclars. A good domestic medicine of this type is Arita. The active ingredient drug is bisoprolol.

The component has an antiagonal, hypotensive and antiarrhythmic effect. Arithele is produced in the form of pills for oral administration. There are tablets in a film shell of 5 and 10 mg.

The remedy for the recipe from the doctor is released. On Aritel 5 MG, the price of 100-120 rubles, and Aritel 10 mg costs about 130-160 rubles. The cost is posted for packaging of 30 tablets. Manufacturer of medicine - Cranvonfarm Sales, Russia.

Medication mechanism

High-selective beta-1-adrenobloclars are widely used in cardiological practice. Medicines are prescribed to patients suffering from symptomatic or essential arterial hypertension.

Arita is a good domestic beta-1-adrenoblor. The active substance of the drug - bisoprolol. Still in the tablets contain auxiliary components - povidone, lactose, hypimosellos, etc.

The active substance of the medication oppresses the renin angiotensin system. Bisoprolol causes a decrease in blood pressure and extension of vessels. Also, the component reduces the concentration of renin in the blood plasma, reduces the need of myocardium in oxygen, lengthens diastole.

An antiarrhythmic action of an arithea can be explained by the fact that the active component of the drug eliminates the factors that provoke arrhythmia. In particular, the substance slows down AV-conducting, reduces blood pressure and prevents tachycardia.

When observing the therapeutic doses of Aritel will not have a significant effect on the beta-2-adrenoreceptors of the smooth muscle structure of the pancreas, peripheral arteries and bronchi. By the way, Bisoprolol does not have any influence on carbohydrate exchange and does not lead to a delay in the withdrawal of sodium ions from the body.

When internal use is absorbed by the order of 90% of the drug. The maximum concentration of the active ingredients in the blood was observed after 1-3 hours, the binding of plasma proteins did not exceed 30%. The average half-life is about 10-12 hours, excretion is carried out mainly by the kidneys.

The hypotensive effect occurs approximately 1-1.5 hours after receiving the tablet. The action is preserved for 12-24 hours.

Instructions for use of the drug

The main indication for use is arterial hypertension. Moreover, the medication will be equally effective in both primary and in the secondary form of the disease.

Aritel can also be used in the treatment of stress angina, ventricular extrasystole, sinus tachycardia, chronic heart failure, ischemic heart disease. Tablets Some patients are prescribed as a preventive measure for the prevention of angina and myocardial infarction.

How to take a drug? Use the medicine is preferably before or during food. Multiplicity of use - 1 time per day. In the application guide, it is said that when treating arterial hypertension or IBS, the starting dosage is 5 mg. If necessary, it rises to 10-20 mg. Elderly patients should be used in the same doses - there is no need for correction.

In the treatment of HSN, the optimal dose is 1.25 mg. Patients with this diagnosis is best to carry out the use of Arithiza Cor, since this medication is produced in the form of 2.5 mg tablets. In the treatment of HSN, a dose increases to 2.5-10 mg. The increase is carried out gradually.

In the treatment of angina, ventricular extrasystole and sinus tachycardia, the dose is selected individually, taking into account the indicator of the blood pressure and heart rate. Usually the dosage is 2.5-10 mg. For infarction prevention, you can take 5-10 mg.

The duration of the therapeutic course in the instructions is not specified. The duration of treatment is individually selected.

Contraindications and side effects

You can not prescribe an arital in all cases. The drug has a number of contraindications to use. Such are increased sensitivity to the components of the tablets, decompensated / acute heart failure, hypotension, Reyno syndrome, AV blockade 2 and 3 severity, bradycardia (slow heartbeat), cardiogenic shock and bronchial asthma.

Also in the list of contraindications includes the reception of Mao inhibitors, breastfeeding period, lactose intolerance and / or galactose, children's age, pregnancy.

Caution should be observed to patients who have diseases such as type 1 diabetes, AV blockade 1 gravity, renal or hepatic insufficiency, printela chapard, hemodynamic disorders, congenital heart defects.

Possible side effects:

• Excessive decrease in blood pressure.
• Chair disorders - diarrhea / constipation.
• Allergic reactions.
• Thrombocytopenia.
• Violations in the liver work, including hepatitis.
• Reduced hearing acuity.
• Bronchospasm.
• Cramps.
• Weakness in the muscles.
• Conjunctivitis.
• Numbness / cooling in the limbs.
• Bradycardia.
• Dizziness.
• Vomiting / nausea.
• Erectile disfunction.
• Renal colic.
• Reduced libido.
• Headaches.

Overdose - hypoglycemia, AV blockade, bronchospasm, aggravation of heart failure, bradycardia, hypotonic shock.

• Arithite refers to a group of selective beta-adrenobloclars with anti-indant, hypotensive and antiarrhythmic properties.
• Active substance: Bisoprolol.
• Pharmacological group: beta1 adrenoblocator.
• ATH code: C07AB07.
• Manufacturer - Russia.
• Latin Drug Name: Aritel.

Composition

1 TB. Aritel contains 10 or 5 mg. Active substance - Bisoprolol (Fumarat). In addition to the composition and in the shell tablets there are such auxiliary components as:

• macrogol (polyethylene glycol - 400, 4000) - 0.33 mg;
• potato starch - 18 mg;
• cellulose microcrystalline - 20 mg;
• monohydrate (milk sugar) - 54 mg;
• colloidal silicon dioxide - 1.5 mg;
• halgonellose - 1.8 mg;
• magnesium stearate - 1 mg;
• titanium dioxide - 0.39 mg;
• iron oxide of red and yellow - 0.03 mg;
• povidone - 3 mg.

The drug is sold in cardboard packages, each tablet is placed in the contour cell. 80 - 90% of Aritel are absorbed from the tract. The maximum concentration of the active substance in the blood plasma is marked, after 2 hours from the start of the reception. The period of removal of the drug with urine is 12 hours.

Form release

The drug is produced in the form of light orange biconvecake tablets of a rounded shape and a film coated 5 mg and 10 mg.

Photo of drug

Therapeutic action

The member of the arithea has an impact on the respiratory system and on metabolism.

An antiarrhythmic effect is explained by the elimination of an arrhythmogenic factor (increasing the activity of the sympathetic nervous system, tachycardia, an increase in the level of cyclic adenosine monophosphate, hypertension, etc.).

The hypotensive effect is due to a decrease in cardiac output, the sympathetic stimulation of peripheral vessels, a decrease in renin-angiotensin activity, which is most important for patients with the initial increase in the level of renin. The effect occurs 5 days later, and stable indicators are installed in 1-2 months.

The antiagonal effect is due to a decrease in the needs of myocardial oxygen as a result of heart rate, improving myocardial perfusion and diastole lengthening, especially in patients with CHN (chronic heart failure).

In case of simultaneous oral medication, patients with coronary heart disease (against the absence of CXN), the frequency of heart abbreviations and blood volume decrease significantly. In most cases, the maximum decrease in blood pressure indicators is observed after 1.5-2 weeks from the start of accepting an arithea.

Indications

Prescribed with arterial hypertension, chronic heart failure (CHHN) and as preventing stable angina (IBS).

Instructions for use

The digestibility of the drug does not influence the time of the day in which the drug is accepted. However, the most optimal dosage is considered to receive 1 tablet in the morning (before or after eating) without chewing.

In the treatment in the initial phase of XSN (chronic heart failure), medical control and the titration phase is needed, after which the individual treatment scheme of the aritel is selected. In some cases, an individual adaptation is required, taking into account the tolerability of the drug by the patient, followed by the drug adjustment.

The drug is prescribed in accordance with the following scheme:

• at the initial stages of the disease, the minimum dose of an arithea - ½ TB is recommended. 2.5 mg (1.25 mg) 1 time during the day;
• with good tolerability and the absence of side manifestations, the dosage rises to 1 TB. (2.5 mg) per day;
• next, the dosage can increase to 3.75 mg (1.5 tab. 2.5 mg);
• 5 mg. (1 tons of 5 mg or 2 TB. 2.5 mg);
• 7.5 mg (1 TB. 2, 5 mg + 1 TB. 5 mg).

The maximum allowable dosage of the arithea is up to 20 mg within the day. In case of violation of the kidney or liver, the medium and light stage of correction is not required, with the exception of an individual reaction. In case of severe disorders of the functionality of the kidneys and the liver, the limiting daily dosage can be 10 mg. In this case, the increase in the dose is carried out extremely carefully.

Currently, there are too few confirmed data on the use of aritia patients with chronic heart failure against the background of the development of type 1 diabetes mellitus, as well as with congenital heart disease, restrictive cardiomyopathy and hemodynamic heart rate.

Application during pregnancy and lactation

The pills of Aritel and Aritel Cor are allowed to use pregnant women only when the risk of developing complications in the mother exceeds the risk of developing side manifestations in a child, since β-adrenoblockers reduce placental blood circulation.

If necessary, the application of an arythela during pregnancy requires monitoring of blood flow in the uterus and placenta, the growth and development of the fetus, and in case of suspected pathology regarding the mother or child, the drug is replaced by alternative methods of therapy. In the postpartum period, the newborn is carefully examined and observed, since bradycardia and hypoglycemia are possible in the first 3 days after birth.

There are no information about penetration into breast milk of bisoprolol, so Aritel is not recommended for women in the lactation period. If necessary, compulsory reception of the drug, breastfeeding is terminated.

Application of children

In this age group, the study of the drug was not carried out, which is an absolute contraindication to the appointment of Aritel to children and adolescents under the age of 18.

Application in old age

The use of arithea in therapy in elderly patients does not differ from all other cases. The correction of the dosage of the drug is not required.

Contraindications

Despite its effectiveness of Aritis, there has a number of serious contraindications to use, whose group includes:

• OSN (acute heart failure);
• individual sensitivity on the components of the drug;
• cardiogenic shock and pulmonary swelling;
• pronounced bradycardia and synoyatrial blockade;
• arterial hypertension and weakness of the sinus node;
• natina printela (spontaneous);
• a history of bronchial asthma;
• reino disease and pronounced circulatory disruption, including peripheral;
• metabolic acidosis and arterial hypotension.

Special caution is required at:

• psoriase, thyrotoxicosis and myasthenia;
• liver failure, including chronic type;
• in diabetes and atrioventricular blockade.

In addition, care is required when prescribing an arytel with patients suffering from depressions and disorders from the CNS.

Side effects

In some cases, including in the improper use and violation of medical recommendations, the drug is able to cause a number of serious side effects:

• from the cardiovascular system, an orthostatic hypotension is possible, a sinus type bradycardia, a violation of the work of myocardium, the pain in the chest, a sharp drop of blood pressure and angiospasm;
• from the CNS side - an approached headache may occur, increased fatigue and weakness, sleep disturbance, asthenia, confusion, depression, paresthesia in lower limbs and pronounced hallucinations;
• respiratory system - Against the background of accepting Aritel, bronchospasm, rhinitis and shortness of breath are possible;
• from the head of the GCT, the appearance of nausea, abdominal pains, dryness of the mucous membranes, violation of the chair, the change in taste, and the disruption of the liver, manifests itself with cholestasis and color change;
• the reaction from the skin is manifested by allergic rash, itching, redness, exchanging, strengthening sweating and exacerbation of psoriasis;
• endocrine disorders are accompanied by hypoglycemia (for insulin patients), hypoteriosis and hyperglycemia (with insulin-dependent diabetes).

Violation, conjunctivitis, dry mucous membranes, decrease in the production of tear fluid, is extremely rare. Lab diagnostics reveals thrombocytopenia, agranulocytosis, elevated bilirubin and leukopenia.

Overdose

When overdose, the prisoner of the arithele can provoke the following symptoms:

• bradycardia and arrhythmia;
• hypotension and heart failure, manifested by edema, difficulty breathing and acricyanosis;
• collapse is extremely rare.

When an aritel is overdose, a classic pattern of therapy is used, aimed at combating intoxication, which includes adsorbents, stomach wash, receiving atropine, epinephrine, isoprenaline, etc. Diuretics and cardiac glycosides (capsules, tableted and injection drugs) can be appointed additionally.

Medicinal interaction

With simultaneous reception of an arithea with other drugs, various reactions are possible, which are necessarily taken into account during treatment:

• the use of antihistamine and arithea increases the risk of systemic reactions;
• with the simultaneous use of iodine-containing radiocontrase drugs, the likelihood of an anaphylactic reaction increases as an infusion therapy.
• the joint taking of Phoenitin and Arithele increases the risk of cardiopresses and hypotension;
• Aritel is able to change insulin efficiency and can mask hypoglycemia;
• simultaneous reception with diuretics and sympatholithics leads to a sharp decrease in blood pressure;
• Aritel, together with Ergotamin, significantly increase the likelihood of peripheral circulatory disorders;
• joint admission of the drug with a group of heart glycosides enhances the likelihood of the appearance of bradycardia, up to a complete stop of the heart.

The simultaneous acceptance of the arithea with monoaminoxidase inhibitors is undesirable. This can lead to an uncontrolled increase in hypotensive action.

special instructions

Before starting the patient's therapy, it is necessary to prevent the correct use of the arithea and comply with the special guidelines.

It is impossible to independently increase or reduce the dosage of the drug, and also sharply interrupt the therapy without prior consultation of the doctor. Such actions are able to provoke temporary deterioration of cardiac activity, especially in patients with ischemic disease. If necessary, the dosage decreases gradually.

Patients hosting bisaprolol requires constant blood pressure control (at the initial stage 1 time during the day, and then 1 r. For 3-4 months), heart rate, blood glucose concentration (diabetics), ECG and kidney functions (1 p. at 3-4 months).

Before the start of treatment, an analysis of the function of external respiration is performed (in patients with a burdened anamnesis). In the development of hyperthyroidism, the appearance of tachycardia is possible, while the sharp abolition of the drug is excluded, since the cessation of its prime is able to strengthen the symptoms of the disease, from which the aritian tablets lose their effectiveness.

In nicotine dependence, the effectiveness of the effects of beta-adrenoblockers is reduced, and patients using contact lenses should be taken into account the possibility of reducing the products of the tear fluid.

In patients with diabetes, there is a possibility that the aritel can mask tachycardia, which is provoked by hypoglycemia. When a preparation with a clonidine, the Aritian is canceled gradually, only after the acceptance of the arithea is stopped.

Patients in which bronchospast diseases are diagnosed with the ineffectiveness of the hypotensive agent can be prescribed cardioslelective adrenoblasts in compliance with the dosing mode, since the dose can provoke bronchospasm.

If necessary, planned operational interference with the abolition of prescribed drugs is performed 2 days before the general anesthesia. In the case when the patient, despite the preliminary training, adopted Arita, the drug for anesthesia is selected with a minimum negative effect. The patient must be warned by a doctor about accepting Arithele.

If elderly patients have an increasing bradycardia (less than 50 shots per minute), arterial hypertension, ventricular arrhythmia, bronchospasm and violation of the liver and kidney work, requires cessation of treatment. Strongly interrupting therapy is strictly prohibited, since there is a danger of the development of myocardial infarction and severe arrhythmia. Cancellation is executed gradually, the dosage is reduced within 2 weeks.

In addition, it should be borne in mind that Aritel is able to cause a slowdown in psychomotor reactions, which is especially important to take into account when managing motor vehicles.

Analogs

If for some reason the aritis tablets are not suitable for the patient, they can be replaced by analogues in which Bisaprolol is present.

These include:

• Bidop;
• Biol;
• Biprol;
• Coronal;
• Aritel Cor;
• Bisoprolol-Prana is the cheapest replacement of arithea.

All substitutes are selected by an exclusively attending physician in accordance with the general state of the patient.

Beta 1 -adrenoblocator

Active substance

Release form, composition and packaging

Auxiliary substances: Potato starch - 24 mg, silicon colloidal dioxide (aerosil) - 1.8 mg, magnesium stearate - 0.6 mg, monohydrate lactose (milk sugar) - 63.1 mg, - 4.5 mg, microcrystalline cellulose - 21 mg.

Film shell composition: Seloate AQ-02140 - 6 mg (hypimloose (hydroxypropylmethyl cellulose) - 3.3 mg, macrogol 400 (polyethylene glycol 400) - 0.54 mg, macrogol 6000 (polyethylene glycol 6000) - 0.84 mg, titanium dioxide - 1.278 mg, dye solar sunset yellow - 0.042 mg) .

Tablets covered with film shell light orange color, round, biconvenets; Two layers are visible on the cross section: the inner layer is almost white.

Auxiliary substances: Potato starch - 36 mg, silicon colloidal dioxide (aerosil) - 2.7 mg, magnesium stearate - 0.9 mg, monohydrate lactose (milk sugar) - 91.7 mg, povidone - 6.7 mg, microcrystalline cellulose - 32 mg.

Film shell composition: Seloat AQ-02140 - 9 mg (hypimloose (hydroxypropylmethyl cellulose) - 4.95 mg, macrogol 400 (polyethylene glycol 400) - 0.81 mg, macrogol 6000 (polyethylene glycol 6000) - 1.26 mg, titanium dioxide - 1.917 mg, dye solar sunset yellow - 0.063 mg) .

7 pcs. - Packaging cell contour (2) - packs cardboard.
7 pcs. - Packaging cell contour (4) - packs cardboard.
10 pieces. - Packaging cell contour (3) - packs cardboard.
10 pieces. - Packaging cell contour (5) - packs cardboard.
10 pieces. - Packaging cell contour (10) - packs cardboard.
28 pcs. - Packaging cell contour (1) - packs cardboard.
28 pcs. - Packaging cell contour (2) - packs cardboard.
30 pcs. - Packaging cell contour (1) - packs cardboard.
30 pcs. - Packaging cell contour (2) - packs cardboard.
30 pcs. - Packaging cell contour (3) - packs cardboard.

pharmachologic effect

Selective beta 1 -adrenoblocator. Does not have its own sympathomimetic activity and membrane-stabilizing properties. It has only insignificant affinity for the β 2 -adrenoreceptors of the smooth muscles of the bronchi and vessels, as well as to β 2 -adrenoreceptors participating in the regulation of metabolism. Consequently, bisoprolol as a whole does not affect the resistance of the respiratory tract and metabolic processes in which β 2 -adrenoretteceptors are involved.

Bisoprolol reduces the activity of the sympathoyadrenal system, blocking β 1 -adrenoreceptors of the heart.

With a single reception inside in patients with IHS without signs of chronic heart failure (CHN), bisoprolol reaches the heart rate, reduces the impact volume of blood and, as a result, reduces the emission fraction and the need of myocardium in oxygen. With long therapy, an initially increased OPS decreases. Reducing the activity of renin in the blood is considered as one of the components of the antihypertensive effect of beta-adrenobloclars.

As a rule, the maximum reduction of blood pressure is achieved 2 weeks after the start of therapy.

Pharmacokinetics

Suction

Bisoprolol is almost completely (more than 90%) absorbed from the gastrointestinal tract. The effect of the "first passage" through the liver (approximately 10%) is subjected to a slight degree, as a result of which bioavailability after intake is approximately 90%. Meal does not affect bioavailability. C Max in the blood plasma is reached after 2-3 hours.

Distribution

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

Bisoprolol demonstrates linear kinetics, and its blood plasma concentrations are proportional to the adopted dose in the range from 5 to 20 mg.

Metabolism

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

Election

Clearance of bisoprolol is determined by the equilibrium between the removal of the kidneys unchanged (about 50%) and metabolism in the liver (about 50%) to metabolites, which are also derived by the kidneys. General clearance is 15 l / h. T 1/2 - 10-12 h.

Pharmacokinetics in special clinical cases

There is no information on the pharmacokinetics of bisoprolla in patients with CXN and simultaneous disruption of the liver or kidney function.

Indications

- chronic insufficiency;

- arterial hypertension;

- Prevention of attacks of stable angina with IHD.

Contraindications

- cardiogenic shock;

- collapse;

- acute heart failure;

- chronic heart failure in the decompensation stage, requiring intrinsic therapy;

- AV blockade II and III degree (without an electrostimulator);

- synoyatrial blockade;

- pronounced bradycardia (CSS less than 50 UD / min);

- arterial hypotension (systolic blood pressure<90 мм рт.ст.);

- pronounced disorders of peripheral blood circulation or Reino syndrome;

- bronchial asthma of severe;

- COPD of severe;

- the simultaneous use of Mao inhibitors (with the exception of Mao Type B);

- the simultaneous use of floccamentin and sutrudiform;

- Feochromocytoma (without the simultaneous use of alpha adrenoblockers);

- metabolic acidosis;

- lactation period;

- children's and adolescent age up to 18 years (efficiency and safety are not established);

- lactase deficiency, lactose intolerance, malabsorption syndrome / galactose;

- Increased sensitivity to the components of the drug and other beta adrenoblockers.

FROM caution The drug should be applied during desensitizing therapy; angina printela; hyperthyroidism; type 1 diabetes and diabetes mellitus with significant fluctuations in blood glucose concentration; AV Blocade I degree; pronounced renal failure (QC less than 20 ml / min); pronounced disorders of the liver function; psoriasis; restrictive cardiomyopathy; congenital heart defects or heart valve shock with severe hemodynamic disorders; chronic heart failure with myocardial infarction over the last 3 months; pheochromocyte (with the concomitant use of alpha-adrenobloclars); Compliance with a strict diet.

Dosage

The drug is taken inside 1 time / day, in the morning, regardless of meals. Tablets must be made with sufficient liquid; Do not chew pills or rub into powder.

Chronic Heart Failure (CHHN)

The beginning of the treatment of HSN by the preparation of Aritel requires a compulsory conduct of the special phase of titration and regular medical control.

A prerequisite for treatment with the preparation of Arita is a stable chronic heart failure without signs of exacerbation.

The treatment of HSN with the preparation of Aritian should be started in accordance with the following titration scheme. This may require individual adaptation depending on how well the patient carries the prescribed dose, i.e. The dose can be increased only if the previous dose was well tolerated.

To ensure the appropriate titration process at the initial stages of treatment, it is recommended to apply the drug in smaller doses.

The recommended initial dose is 1.25 mg (0.5 tab. 2.5 mg) 1 time / day. Depending on individual tolerability, the dose should be gradually increased to 2.5 mg, 3.75 mg (1.5 Table. 2.5 mg), 5 mg, 7.5 mg (1 tab. 5 mg and 1 tab. 2.5 mg), and 10 mg 1 time / day With an interval of at least 2 or more weeks.

If the increase in the dose of the drug is poorly tolerated by the patient, a dose is possible.

The maximum daily dose in the treatment of HSN is 10 mg 1 time / day.

During the titration phase or after it, a temporary deterioration of the flow of HSN, arterial hypotension or bradycardia may occur. In this case, it is recommended, first of all, a dose correction of concomitant therapy drugs. It may also require a temporary decrease in the dose of the preparation of Aritel or the abolition of treatment.

After stabilization of the patient's condition, the dose should be re-teding, or continue treatment.

Arterial hypertension and IBS (preventing stable angina attacks)

With arterial hypertension and IBS, the drug is prescribed 5 mg 1 time / day. If necessary, the dose increases to 10 mg 1 time / day. The maximum daily dose is 20 mg 1 time / day.

It is possible to use bisoprollaol in another dosage form (2.5 mg tablets with risk).

In all cases, the dosing regimen should be selected to each patient individually, given the individual characteristics and condition of the patient.

For violation of the liver or kidney function is easy or medium degree Usually no dose correction is required.

For violation of the function of the kidney of severe (QC less than 20 ml / min) and u patients with severe liver diseases The maximum daily dose is 10 mg. Increasing the dose in such patients should be carried out with extreme caution.

W. elderly patients Dose correction is not required.

To date, there is not enough data regarding the use of an aritel preparation in patients with HSN, conjugated with type diabetes mellitus, expressed by the impaired kidney function and / or liver, restrictive cardiomyopathy, congenital heart defects or hemodynamically determined heart defects. Also, there was also a sufficient amount of data regarding patients with HSN with myocardial infarction over the last 3 months.

Side effects

The frequency of adverse reactions below was determined as follows: 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, включая отдельные сообщения).

From the nervous system: Infrequently - dizziness *, headache *; Rarely - loss of consciousness.

Mental disorders: infrequently depression, insomnia; Rarely hallucinations, nightmarish dreams.

From the body of the vision: rarely - reduce tears (should be taken into account when wearing contact lenses); Very rarely - conjunctivitis.

From the side of the hearing organ: Rarely - hearing impairment.

From the hematopopitation system: In some cases, thrombocytopenia, agranulocytosis.

From the side of the cardiovascular system: Very often - bradycardia (in patients with HSN); Often - exacerbation of the symptoms of the CXN flow (in patients with HSN), a feeling of cooling and numbness in the limbs, a pronounced decline in blood pressure, especially in patients with CXN; Infrequently - violation of AV conduction, bradycardia (in patients with arterial hypertension or angina), exacerbating the symptoms of the flow of CXN (in patients with arterial hypertension or angina), orthostatic hypotension.

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

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

From the urinary system: Rarely - cystitis, renal colic, polyuria.

From the side of the sexual system: Rarely - potency violation, weakening of libido, Peyroni disease.

From the side of the skin: rarely - increased sensitivity reactions, such as skin itching, rash, skin hyperemia; Very rarely - alopecia. Beta-adrenoblays can contribute to the exacerbation of the symptoms of the flow of psoriasis or cause psoriazo-like rash.

On the side of the musculoskeletal system: Infrequently - muscle weakness, muscle cramps.

Influence on the fruit: Intrauterine growth delay, hypoglycemia, bradycardia.

From the laboratory indicators: Rarely - an increase in the concentration of triglycerides and the activity of hepatic transaminase in the blood (ACT, ALT).

Others: Often - asthenia (in patients with HSN), increased fatigue *; Infrequently - asthenia (in patients with arterial hypertension or angina).

* In patients with arterial hypertension or angina test, these symptoms usually appear at the beginning of the course of treatment, neuro are expressed and pass within 1-2 weeks after the start of treatment.

Overdose

Symptoms: AV blockade, bradycardia, decreased blood pressure, bronchospasm, acute heart failure and hypoglycemia.

Treatment:if an overdose occurs, first of all, it is necessary to stop taking the drug and begin supporting symptomatic therapy.

With pronounced bradycardia - in / in the introduction of atropine. If the effect is insufficient, with caution, you can enter a means with a positive chronotropic effect. Sometimes it may be necessary to temporaultly formulate an artificial rhythm driver.

With an excessive decrease in Hell-to / in the introduction and purpose of vasopressors.

With AV blockade, patients must be under constant supervision; The treatment of beta-adrenomimetics, such as epinephrine, is shown. If necessary, the formulation of an artificial rhythm driver.

With the exacerbation of the flow of the CHF - in / in the introduction of diuretics, preparations with a positive inotropic effect, as well as vasodilators.

In bronchospasm, the use of bronchodlatators is shown, incl. Beta 2 -Simpatomimetics and / or aminoophylline.

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

Medicinal interaction

In the treatment of chronic heart failure, antiarrhythmic agents of class I (for example, quinidine, dyspeciramide, lidocaine, phenytoin, cheapinide, conpaphenon) while using bisoprolol can reduce AV conductivity and reduction ability of the heart.

In the treatment of chronic heart failure, arterial hypertension, stable angina blockers of slow calcium channels (BMKK) type verapamil and to a lesser extent, diltiazem, while simultaneous use with bisoprolol can lead to a decrease in the contractile ability of myocardium and violation of AV conduction. In particular, the introduction of verapamil to patients receiving beta-adrenoblays can lead to a pronounced arterial hypotension and AV blockade.

Hypotensive means of central action (such as clonidine, methyldop, moxonidine, RylMidin) can lead to heart rate cut and reduce heart rate, as well as to vasodilation due to a decrease in the central sympathetic tone. Sharp abolition, especially before the cancellation of beta-adrenoblockers can increase the risk of "ricoce" arterial hypertension.

Combinations requiring compliance with special caution

In the treatment of arterial hypertension, stable angina, antiarrhythmic agents I class (for example, quinidine, dyspeciramide, lidocaine, phenytodein, freakinide, conpaphenon) while simultaneously use with bisoprolol can reduce AV conductivity and myocardial contractility.

In the treatment of chronic heart failure, arterial hypertension, a stable angina angina BMKK Dihydropyridine derivatives (for example, nifedipine, feelodipine, amlodipine), while simultaneous use with bisoprolol can increase the risk of arterial hypotension. In patients with chronic heart failure, it is impossible to exclude the risk of subsequent deterioration of the contractile function of the heart.

Antiarrhythmic agents of class III (for example, amiodaron) can enhance the violation of AV conduction.

The action of beta-adrenobloclars for local use (for example, eye drops for the treatment of glaucoma) can enhance the systemic effects of bisoprolla (decreased blood pressure, heart rate).

Parasympathomimetics while simultaneously use with bisoprolol can enhance the violation of AV conductivity and increase the risk of bradycardia.

The hypoglycemic effect of insulin or hypoglycemic agents for intake can intensify. Signs of hypoglycemia (in particular, tachycardia) can be masked or suppressed. Such interactions are more likely when applying non-selective beta-adrenobloclars.

Tools for carrying out general anesthesia can increase the risk of cardiodepressive action, leading to arterial hypotension.

Cardiac glycosides while using bisoprolol simultaneously can lead to an increase in the time of the pulse and, thus, to the development of bradycardia.

NSAIDs can reduce the antihypertensive effect of bisoprolol.

The simultaneous use of the drug with beta-adreminimetics (for example, isoprenaline, dobutamine) can lead to a decrease in the effect of both drugs.

The combination of bisoprolol with adrenomimetics, affecting α- and β-adrenoreceptors (for example, norepinephrine, epinephrine), can enhance the vasoconstrictor effects of these agents arising from the participation of α-adrenoreceptors, leading to an increase in blood pressure. Such interactions are more likely when applying non-selective beta-adrenobloclars.

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

MEFLOKHIN while simultaneously use with bisoprolol can increase the risk of bradycardia.

Mao inhibitors (with the exception of Mao T-type Mao inhibitors can enhance the hypotensive effect of beta adrenobloclars. Simultaneous use can also lead to the development of a hypertensive crisis.

Contraindicated combinations

Blockers β-adrenoreceptors may interfere with compensatory cardiovascular reactions in a hypotension caused by flocculation.

With simultaneous use with sulctoid cause, there is a risk of ventricular arrhythmia.

special instructions

The patient needs to be informed that it should not be dramatically interrupted by the drug and change the recommended dose without prior consultation with the doctor, because This can lead to a temporary deterioration of the heart. Treatment should not be interrupted suddenly, especially in patients with IBS. If the cessation of treatment is necessary, then the dose should be reduced gradually.

Monitoring the state of patients taking bisoprolol should include observation of CSS and Hells (at the beginning of treatment - daily, then 1 time in 3-4 months), ECG, blood glucose concentration in patients with diabetes mellitus (1 time in 4-5 months). In elderly patients, it is recommended to control the kidney function (1 time in 4-5 months). The patient should be trained by the procedure for calculating the heart rate and instruct the need for medical consultation at less than 50 ° C. / min.

Approximately 20% of patients with beta adrenoblasts are ineffective. The main reasons are heavy coronary atherosclerosis with a low threshold of ischemia (CSS less than 100 ° C. / min) and an increased finite diastolic volume of the left ventricle that disrupts subendocardial blood flow.

In smoking patients, the effectiveness of beta-adrenoblastors below.

Patients using contact lenses should be borne in mind that against the background of treatment it is possible to reduce the products of the tear fluid.

When using the drug in patients with a peochromocytoy, there is a risk of developing paradoxical arterial hypertension (if effective alpha adrenoblockade is not previously achieved).

In hyperthyroidism, the drug can mask certain clinical signs of thyroid hyperfunction (hyperthyroidism), for example, tachycardia. The sharp cancellation of the drug in patients with hyperthyroidism is contraindicated, as it can increase symptoms.

With diabetes mellitus, the use of the drug can mask tachycardia caused by hypoglycemia. In contrast to non-selective beta-adrenobloclockers, bisoprolol practically does not enhance the hypoglycemia caused by insulin and does not delay the restoration of blood glucose content to a normal level.

With simultaneous use with clonidine, the reception may be discontinued only a few days after the cancellation of the Aritian preparation.

It is possible to strengthen the severity of the reactions of increased sensitivity and the lack of effect from the usual doses of epinephrine (adrenaline) against the background of a burdened allergological history.

If it is necessary to carry out planned surgical treatment, the drug cancellation is carried out 48 hours before total anesthesia. If the patient adopted a drug in front of surgery, you should choose a drug for general anesthesia with a minimum negative inotropic effect. The patient should be warned by a anesthesiologist's doctor that he accepts the preparation of Arita.

Reciprocal activation of the wandering nerve can be eliminated in / in the administration of atropine (1-2 mg).

Drugs that reduce the stocks of catecholamines (including reserpine) can enhance the effect of beta-adrenobloclars, so patients taking such combinations of drugs should be under constant supervision of the doctor to identify arterial hypotension or bradycardia. Patients with bronchospast diseases can be prescribed cardioslelective adrenobloclars in the case of intolerance and / or inefficiency of other hypotensive drugs, but the dosing mode should be strictly observed. Overdose is dangerous by the development of bronchospasm.

In case of appearance in elderly patients, increasing bradycardia (less than 50 ° C. / min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe disorders of the liver and kidney function must be reduced by a dose Or stop treatment. It is recommended to stop therapy in the development of depression caused by the reception of beta-adrenobloclars.

It is impossible to drastically interrupt treatment due to the danger of the development of heavy arrhythmias and myocardial infarction. The abolition is carried out gradually, reducing the dose for 2 weeks or more (reduce the dose by 25% at 3-4 days).

It is necessary to cancel the drug before studying the blood content and the urine of catecholamines, normatenefrin and vanironyluminant acid; Antinuclear antibody titles.

Impact on the ability to driving vehicles and control mechanisms

During the period of treatment, care must be taken when driving vehicles and occupation by other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Pregnancy and lactation

The use of the drug during pregnancy is possible only when the estimated benefit for the mother exceeds the potential risk to the fetus. As a rule, beta-adrenoblockers reduce blood flow in the placenta and can affect the development of the fetus. Bloodflow should be controlled in the placenta and the uterus, as well as to observe the growth and development of the fetus. In the event of undesirable phenomena for pregnancy and / or fetal, alternative methods of therapy should be applied. It is necessary to carefully examine the newborn after childbirth. In the first 3 days of life, symptoms of hypoglycemia and bradycardia may occur.

There are no data on the release of bisoprolol with breast milk. Therefore, the use of the preparation of Aritel is not recommended for women during breastfeeding. If it is necessary to use the drug during lactation, breastfeeding should be discontinued.

Childcare

The use of the drug in children's and adolescent age up to 18 years (effectiveness and security is not established).

With violations of the kidney function

With caution, the drug should be applied with pronounced renal failure (QC less than 20 ml / min).

When violations of the liver function

With caution, the drug should be applied with pronounced liver function.

Application in old age

In the elderly patients, the dose correction is not required.

Conditions of vacation from pharmacies

The drug is released by the prescription.

Terms and Storage Terms

The drug should be stored in an inaccessible for children, dry, light-protected place at a temperature not higher than 25 ° C. Shelf life - 2 years.

The World Health Organization over the past 10 years will take place in the first place in the incidence and mortality on all continents the pathology of the cardiovascular system. Not only elderly and retirees suffer from these ailments, but also the persons of working age. In most cases, they have arterial hypertension, which is often accompanied by a stress angina.

In this regard, a huge number of pharmaceutical firms are engaged in the development and release of hypotensive drugs. One of the most efficient and available wide circle of consumers are beta-adrenoblays with cardioslelective action. Pretty popular in our country is Arita of the Russian Firm "Kanonfarma Production".

Arithele tablets have one active ingredient - bisoprolol in the form of fumaric acid salts. The medicine is a beta-adrenoblocator and has a high cardionective action, which causes its selective impact on the heart exclusively, avoiding interaction with the second type of receptor in bronchi, muscles, the uterus.

Composition and mechanism of action

Bisoprolol has an anti-overcommic and anti-naiginal effect even after one-time reception. The basis of this mechanism is the reduction of energy costs and oxygen needs.

As a result of binding with receptors in the heart, electrical excitation in the heart muscle slows down. This leads to a decrease in the frequency and strength of heart abbreviations. Thus, Arita lengthens the period of diastolic relaxation, significantly improves microcirculation in the heart. Also, this effect is achieved by oppressing the action of catecholamines (adrenaline, norepinephrine and dopamine), which allows the use of a drug during cardiac attacks during stressful situations.

A pronounced antihypertensive effect manifests itself within two weeks of regular reception of the drug. It is achieved by reducing the total peripheral resistance of the vessels. Also, the bisoprolol normalizes the level of renin in serum.

Bisoprolol affects the conductive heart system, slowing the occurrence of excitation in the sinus node and passing the electrical pulse through an atrioventricular compound. This is the basis of an antiarrhythmic action.

Properties

Based on the above mechanism of action, it should be noted the effects that Arithele on the heart should be noted:

1. Negative chronotropic effect (decrease in heart rate).
2. Negative Batmo and Dromotropic Effects (inhibition of excitability and conductivity of an electrical impulse).
3. Inotropic effect (reduction of muscle reduction).

The therapeutic effect of the drug is due to hypotensive, anti-indant, anti-hour and antiarrhythmic effects.

Forms of release and price for the drug

Given the high prevalence of hypertensive and ischemic diseases, the most popular in the market are drugs that have a profitable and affordable price, as well as convenient in use. One of these means is Arita.
There are two varieties of medication:

The composition of the tablets includes auxiliary agents that give shape, color and protecting from premature decay in the digestive channel. All of them are permitted by the profile committees for use in pharmaceuticals and have no negative effects on the body.

The price of arithic is available and profitably differs in comparison with imported counterparts. On average one plate tablets 10 pcs. It will cost 25-40 rubles depending on the required dosage.

Aritel Cor and Aritel Plus: Differences from Aritel

Given the need for an individual selection of treatment for each patient, many drugs are produced in various dosages and combinations. Aritel Cor - low dosage preparation, suitable for starting therapy. Most often it is used to prevent hypertensive crises in humans with a systolic pressure level not higher than 140 mm Hg. Art.

Aritel Plus contains in its composition, in addition to bisoprolol, diuretic hydrochlorothiazide, therefore it is preferred in the treatment of GB complicated by heart failure. This means helps to get rid of excessive circulating blood and eliminates swelling. It removes potassium and magnesium ions from the body, which requires the correction of the electrolyte balance by taking appropriate drugs (asparks).

Indications and contraindications

What does this medicine helps from? The main goal that is trying to achieve by appointing drugs with bisoprolol (Aritel) is to control the level of blood pressure and the prevention of hypertensive crises.

Also, one of the main indications is the stable angina stress and ischemic heart disease, for the prevention and relief of the bouts of pain in the heart. Use the drug in patients with chronic heart failure, tachycardia, flickering arrhythmia. However, there is a whole list of contraindications from the cardiovascular system. First of all, it is shock, collapse and acute heart failure.

Bisoprolol slows the heart rate, so it is prohibited for use in people, with a rhythm below 50. This agent exacerbates the course of various types of atrioventricular blockade, sinus node syndrome. From the side of respiration by contraindications are obstructive lung diseases, bronchial asthma.

Instructions for use

Tablets should be taken inside, swallowed whole, not chewing and not resaking. Be sure to drink sufficient clean water. It is not desirable to use tea, coffee, juice for these purposes, because they contribute to the dissolution of the film shell and accelerate the absorption of the drug.
Take tablets standing in the morning, regardless of meals.

In the application instructions, it is indicated that the dose of the drug should be selected strictly individually under the control of the cardiologist. You need to start with a minimal with a gradual increase before achieving the desired effect. Maximum daily dose - 20 mg of bisoprolol. Increasing the dose to elderly people, people with impaired liver and kidney work. Dosage correction is carried out with extreme caution.

Side effects and overdose

Usually Aritel is moved well. However, in the case of incorrectly selected dosage, bradycardia, hypotension, arrhythmia may occur. These symptoms are quickly fixed when the drug is canceled. In rare cases, an overdose is manifested by the development of acute heart failure, hypoglya and bronchospasm, which requires relevant drug correction.

Instructions for use:

Aritel is a drug with β-adrenoblocking, hypotensive, anti-naniginal effect.

Release form and composition

Arithele Dosage Form - Tablets Covered with film shell: Two-orange, round, light orange; The inner layer on the cross section is almost white (7 pcs. in contour cellular packs, in a cardboard pack of 2 or 4 packs; 10 pcs. in contour cellular packs, in a cardboard pack 3, 5 or 10 packages; by 28 PC. In contour cellular packages, in a cardboard pack of 1 or 2 packs; 30 pcs. in contour cellular packages, in a cardboard pack of 1-3 packs).

1 tablet composition:

• active substance: Bisoprolol - 5 or 10 mg (in the form of fumarate);
• auxiliary components (5/10 mg): Potato starch - 24/36 mg; colloidal silicon dioxide (aerosil) - 1.8 / 2.7 mg; magnesium stearate - 0.6 / 0.9 mg; Milk sugar (lactose monohydrate) - 63.1 / 91.7 mg; Povidone - 4.5 / 6.7 mg; microcrystalline cellulose - 21/32 mg;
• film shell: Selecoat AQ-02140 - 6/9 mg (hydroxypropylmethylcellulose (hydroxypropylmethyl cellulose) - 3.3 / 4.95 mg; polyethylene glycol 400 (macrogol 400) - 0.54 / 0.81 mg; polyethylene glycol 6000 (macrogol 6000) - 0.84/126 mg; titanium dioxide - 1.278/1.917 mg; Yellow dye Sunny sunset - 0.042 / 0.063 mg).

Indications for use

• arterial hypertension;
• chronic heart failure (CHF);
• attacks of stable angina with ischemic heart disease (prevention).

Contraindications

Absolute:

• cardiogenic shock;
• collapse;
• acute heart failure;
• atrioventricular blockade of II-III degree (without an electrostimulator);
• chronic heart failure in the decompensation stage requiring intrinsic therapy;
• sinus node weakness syndrome;
• synoyatrial blockade;
• arterial hypotension (systolic blood pressure (blood pressure)<90 мм рт.ст.);
• pronounced bradycardia (at the frequency of heart rate (heart rate) to 50 ice / min);
• metabolic acidosis;
• bronchial asthma in severe flow;
• feochromocytoma (without combined use of α-adrenoblockers);
• reino syndrome / pronounced peripheral circulation;
• chronic obstructive pulmonary disease in serious flow;
• combined use with monoaminoxidase inhibitors (MAO) (except Mao type B);
• combined use with floccamentin and sutrode;
• lactose intolerance, lactase deficiency, Mal Absorption Syndrome Galactose / Glucose;
• age up to 18 years (security profile for this category of patients has not been studied);
• lactation period (security profile for this category of patients has not been studied);
• hypersensitivity to the components of the drug, as well as to other β-adrenoblockers.

Relative (aritel is prescribed with caution with such diseases / conditions):

• angina printela;
• pheochromocytoma (with combined use with α-adrenoblockers);
• hyperthyroidism;
• type 1 diabetes and diabetes mellitus, leaking with significant fluctuations in blood glucose concentration;
• congenital heart defects / heart valve vanity with severe hemodynamic disorders;
• atrioventricular blockade of I degree;
• pronounced functional liver disorders;
• pronounced renal failure (creatinine clearance less than 20 ml / min);
• psoriasis;
• restrictive cardiomyopathy;
• chronic heart failure with myocardial infarction over the past 3 months;
• compliance with a strict diet;
• conducting desensitizing treatment.

Pregnant women of Aritian are prescribed only after estimating the ratio of benefit with risk (the effect of therapy for the development of the fetus is possible).

Method of application and dosage

Aritis take inside, in the morning. Meal to the effectiveness of the drug influence does not. Tablets need to be powered by liquid in sufficient quantities. It should not be trimmed into powder or chew.

Multiplicity of acceptance of arithea - 1 time per day.

Chronic heart failure

The prerequisite for the appointment of an arithea is a stable chronic heart failure, which flows without signs of exacerbation.

At the beginning of therapy shows the conduct of a special phase of titration and regular control by a specialist. It may be necessary to carry out individual adaptation depending on tolerance: an increase in the dose is possible only in case of good tolerability of a dose scheduled earlier.

To ensure the appropriate titration process, the initial stages of therapy recommended the use of an arithea in smaller doses.

The recommended dosing mode is the initial dose with the gradual (break - at least 14 days) by increasing, in the case of good tolerability: 1.25 / 2.5 / 3.75 / 5 / 7.5 / 10 mg. With poor portability of the increase in the dose, it is possible to reduce it.

Maximum dose per day - 10 mg.

The titration phase and the period after its end may be accompanied by a deterioration in the flow of HSN, arterial hypotension or bradycardia. In such cases, it is recommended, first of all, the correction of the dose of drugs of concomitant therapy, sometimes in combination with a decrease in the dose of an arithea or cancellation of treatment.

After stabilization of the state, the dose titration should be re-conducted or continue therapy.

Ischemic heart disease (prevention of seizures of stable angina) and arterial hypertension

The initial daily dose is 5 mg. If necessary, it is possible to increase it to 10 or 20 (maximum) mg.

Dosing mode in all cases is selected individually on the basis of the individual characteristics and condition of the patient.

Correction of the drug intake scheme with violation of the liver / kidney function of medium or easy degree is not usually required.

It is possible to use another dosoprolol dosoprolol (2.5 mg tablets).

The maximum daily dose with the functional disorders of the kidney of severe (with creatinine clearance less than 20 ml / min) and severe liver diseases - 10 mg. In such a patient, the dose increases, observing special care.

Data on the use of an arithea with a type of type with type 1 diabetes, restrictive cardiomyopathy, pronounced functional disorders of the liver / kidney, hemodynamically determined heart defects, congenital heart defects, as well as myocardial infarction for the past 3 months not enough.

Side effects

Probable side reactions (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, с учетом отдельных случаев):

• cardiovascular system: Very often - Bradycardia (CHP treatment); Often - exacerbating the symptoms of the flow of CXN (CHP treatment), a sense of numbness / cooling in the limbs, a pronounced decline in blood pressure (especially in the treatment of CHF); Infrequently - orthostatic hypotension, impaired atrioventricular conductivity, bradycardia (treatment of arterial hypertension / angina), aggravation of symptoms of CXT flow (treatment of arterial hypertension / angina);
• respiratory system: infrequently - bronchospasm in patients with respiratory tract or bronchial asthma (anamnestic data); rarely - allergic rhinitis;
• nervous system: infrequently - headache, dizziness; rarely - loss of consciousness;
• hOLDING SYSTEM: in some cases - agranulocytosis, thrombocytopenia;
• urinary system: rarely - renal colic, cystitis, polyuria;
• digestive system: often - diarrhea, nausea, vomiting, constipation; rarely - hepatitis;
• psyche: Infrequently - insomnia, depression; rarely hallucinations, nightmarish dreams;
• sex system: rarely - the weakening of the libido, disturbance of potency, Peyroni disease;
• skeletal-muscular system: infrequently - muscle cramps, muscle weakness;
• skin cover: rarely - hypersensitivity reactions (in the form of a skin, rash, hyperemia of the skin); very rarely - alopecia; It is possible to exacerbate the symptoms of the flow of psoriasis or the appearance of psoriazo-like rashes;
• organ of view and hearing: rarely - hearing impairment, reduction of tears; very rarely - conjunctivitis;
• laboratory indicators: rarely - increase the concentration of triglycerides and the activity of hepatic transaminases in the blood (alaninotransferase, aspartataminotransferase);
• influence on the fruit: hypoglycemia, intrauterine growth delay, bradycardia;
• others: often - asthenia (CHP treatment), increased fatigue; Etysthenia (treatment of arterial hypertension / angina).

special instructions

It should not be changed dramatically to therapy and independently, without medical advice, it should not change the prescribed dose, as this may lead to a short impairment of heart activities. A sudden cessation of accepting arithea, especially with ischemic heart disease, is not recommended. If necessary, stop treatment, the dose must be reduced gradually.

During the therapy, monitoring the state of patients, including observation of the heart rate and blood pressure (first - every day, then 1 time in 3-4 months), ECG, blood glucose concentration against the background of diabetes mellitus (1 time in 4-5 months), as well as kidney function (old patients; 1 time in 4-5 months). At heart rate less than 50 UD / min, you need to consult with a specialist.

With a burdensome anamnesis, a study of the external respiratory function is recommended before the start of therapy.

The effectiveness of the arithea in smoking patients below.

Approximately 20% of cases treatment of angina pectoris is inefficient. Possible causes: Heavy coronary atherosclerosis with a low threshold of ischemia (heart rate up to 100 ot / min) and an increased finite diastolic volume of the left ventricle that disrupts subendocardial blood flow.

During the treatment period, the products of the tear fluid may decrease, which must be considered when using contact lenses.

With a feuohromocytoma, there is a possibility of paradoxical arterial hypertension (in cases where the effective α-adrenoblocade was achieved in advance).

In patients with hyperthyroidism, the treatment with an aritel can mask certain clinical symptoms of the disease, for example, tachycardia. Sudden cancellation of treatment in such patients is contraindicated, since the likelihood of symptoms is high.

The use of drug during diabetes is capable of masking tachycardia associated with hypoglycemia. The aritel practically does not enhance hypoglycemia, which is caused by insulin, and does not delay the reduction of glucose content in the blood to normal values.

In case of combined use with clonidine, its reception can be stopped only a few days after the cancellation of the arithele.

With a burdened allergological history, there may be no effect on the use of conventional adrenaline doses (epinephrine) and an increase in the manifestations of hypersensitivity reactions is observed.

When a planned surgical surgery is needed, Aritel needs to be canceled 48 hours before total anesthesia. If the patient has taken the drug before surgery, for general anesthesia, it is necessary to choose a drug with the smallest negative inotropic effect. An anesthesiologist must be informed about the preparation accepted.

To eliminate the reciprocal activation of the wandering nerve can be administered by atropine (intravenously at a dose of 1-2 mg).

The increase in the action of the arytel is possible with combined use with drugs that reduce the reserves of catecholamines (including reserpine). In this regard, for the state of patients who take such a combination, it is necessary to establish control, in order to identify bradycardia or arterial hypotension. With bronchospast diseases, it is possible to assign cardioslelective adrenoblockers in cases of ineffectiveness / intolerance of other hypotensive tools, however, it is necessary to strictly observe the assigned dosing mode. In case of overdose, there is a possibility of bronchospasm.

Elderly patients in cases of growing bradycardia (less than 50 UD / min), arterial hypotension (systolic pressure below 100 mm Hg), AV blockades, ventricular arrhythmias, bronchospasm, severe renal / liver function disorders show a dose reduction or cancellation of therapy . Also abolishing an arytel is necessary in the event of an associated depression therapy.

Due to the likelihood of severe arrhythmias and myocardial infarction, it is impossible to abruptly. It is necessary to complete the treatment gradually, lowering the dose every 3-4 days by 25%.

Before conducting a study of the content in the urine and blood of Nordeutanephrin, catecholamines and vanillaminal acid, the drug must be canceled.

Medicinal interaction

With a combined application of an arithea with some drugs / substances, various effects may develop.

Contraindicated combinations:

• sulntahberry: the likelihood of ventricular arrhythmia;
• floctafenine: obstruction of compensatory cardiovascular reactions in hypotension associated with its reception.

Combinations in which special caution is required:

• antiarrhythmic preparations of class I (freakinide, diecopyramide, quinidine, lidocaine, phenytoin, conpaphenon): decrease in AV conduction and myocardial contractility in the treatment of stable angina, arterial hypertension;
• antiarrhythmic Class III preparations (amiodar): enhancing AV conduction disorders;
• blockers of slow calcium channels Dihydropyrididine derivatives (feelodipine, nifedipine, amlodipine): an increase in the likelihood of arterial hypotension in the treatment of chronic heart failure, stable angina, arterial hypertension; At CHF, it is impossible to exclude the likelihood of the subsequent deterioration of the contractile function of the heart;
• local β-adrenoblays (eye drops for glaucoma therapy): enhancing the systemic effect of bisoprolol (in the form of a decrease in blood pressure, demolition of heart rate);
• parasympathomimetics: enhancing AV conduction disorders and increasing the likelihood of bradycardia;
• insulin, oral hypoglycemic agents: Strengthening their action, and the suppression is noted or masking signs of hypoglycemia (in particular, tachycardia);
• preparations for general anesthesia: an increase in the likelihood of cardiodepressive action and, as a result, the development of arterial hypotension;
• heart glycosides: an increase in the time of the impulse and, as a result, the emergence of bradycardia;
• non-steroidal anti-inflammatory drugs: reduction of the hypotensive effect of bisoprolol;
• β-adreminimetics (isoprenaline, dobutamine): reducing the effectiveness of both drugs;
• adrenomimetics affecting α- and β-adrenoreceptors (norepinephrine, epinephrine): enhancing the vasoconstrictor action of these drugs, arising from the participation of α-adrenoreceptors, an increase in blood pressure;
• antihypertensive agents, other drugs with a possible hypotensive effect (barbiturates, tricyclic antidepressants, phenothiazines): enhancing the hypotensive effect of bisoprolol;
• mEFLOKHIN: Increase the likelihood of bradycardia;
• inhibitors of MAO (except B): enhancing the anti-characteristic antithe action, the occurrence of a hypertonic crisis.

• antiarrhythmic drugs I class (lidocaine, quinidine, dyspeciramide, freaking, phenytoin, conpaphenon): reduction of AV conduction and the contractile ability of the heart in the treatment of chronic heart failure;
• hypotensive drugs of central action (methyldop, clonidine, Rilmenidin, Moxonidine): Defendment of heart rate, reduced cardiac output, development of vasodilation due to lowering the central sympathetic tone; sharp abolition, especially before the abolition of β-adrenobloclars, can increase the risk of ricocertic hypertension;

Shelf life - 2 years.