Concor, indications, side effects, effect on male potency. The other side of the drug Concor: contraindications and side effects Concor use and contraindications

Diseases of the cardiovascular system, of course, need to be treated. The main medicinal purpose is antihypertensive beta-blockers, but like other medicines, they have contraindications and side effects.

If taken for long courses, they can cause a strong blow to the viability of the reproductive system, overwhelmingly affect the synthesis of testosterone, as the main male hormone. But how does concor behave, does it have side effects for men? Can they lead to a decrease in potency, because the annotation does not say how this drug negatively affects erectile function?

Concor, what kind of medicine?

Concor is a beta-blocker, it contains bisoprolol as an active ingredient. Indications for use:

Active drug

• ischemia of the heart;
• myocardial infarction (secondary);
• arrhythmia;
• tachycardia;
• hypertension;
• heart failure;
• angina.

This is a new generation cardio drug with a small number of side effects, unlike other old analogues. Concor has an antianginal effect, helps to reduce heart rate, supply oxygen to the heart muscle, normalize blood pressure, increase vascular elasticity, and compensate for heart failure. As a result, to the normalization of pressure indicators, the elimination of tachycardia attacks.

If you neglect the doses, then side effects can be taken by surprise:

• weakness;
• numbness of hands, feet;
• headache;
• nausea, vomiting;
• a sharp decrease in vision;
• increased sweating;
• slow heart rate;
• dysfunction of the gastrointestinal tract.

The main contraindications for use:

• heart failure;
• low pressure;
• bronchial asthma.

REFERENCE! Drowsiness and headache are the main side effects after taking Concor. It is undesirable to take the drug if you are concerned about depression, which can also be triggered during treatment. It is better to choose more gentle analogues, consult a specialist. For example, Nebivolol has a similar effect, but does not lead to similar adverse reactions, does not adversely affect erection, reproductive functions of men

Side effects

Concor belongs to the group of strong beta-blockers of the new generation. It is designed to reduce pressure, but at the same time it can lead to the development of erectile dysfunction, other complications, side effects and effects.

When using the drug, a direct effect is exerted on the nervous system, which in turn can provoke unpleasant symptoms:

• distortion of color perception;
• drowsiness;
• dizziness;
• fear for no reason;
• chronic fatigue;
• headache;
• excessive feeling of anxiety;
• nightmares;
• chronic fatigue.

The constant manifestations of such symptoms are not reflected in the best way on the psycho-emotional background of men, in particular the reproductive system, eventually leading to impotence, erectile dysfunction. So if at an early stage there is no ejaculation, and ejaculation comes 2-3 hours late at the time of intimacy after excitability, then over time the disease will begin to progress and erection problems may become apparent.

On a note? If there are constant depressions, suicidal tendencies while taking Concor, then it is better to refuse and look for gentle analogues with a different chemical composition. If there are signs of an overdose and a toxic effect, then you need to urgently rinse the stomach, drink an activated charcoal tablet, visit a therapist, a urologist

How does the drug affect potency

It can be assumed that this medication will not have a negative effect on potency, since it is recommended for use even by older men with diabetes. But, the opinion of doctors and patients is ambiguous. It's all about arterial hypertension, the impact of which falls on the organs of the genitourinary system - the kidneys, blood vessels, heart. If the vessels begin to suffer, then the reproductive system will experience a lack of nutrients, and the prostate will lack oxygen when supplied to the tissues. If heart problems appear, then the physical condition and endurance of men will be greatly undermined.

The kidneys, as the main urinary organ, in the event of a malfunction, will lead to a water-salt imbalance, and these are problems with urination:

• departure of a sluggish stream.
• urinary retention.
• pain, pain, burning.
• incontinence at first.

Erectile function begins to gradually decline. In addition, antihypertensive drugs have a depressing effect on testosterone synthesis. In the male body, the concentration of, on the contrary, the female hormone, estradiol, begins to increase. It is unlikely that with such an imbalance in the hormonal background, one can speak of a normal, timely erection.

Is it worth looking for a replacement for concor?

A cardiac beta-blocker does not have the best effect on the sexual sphere of men, but has proven its effectiveness in the treatment of vascular and heart diseases. It can become indispensable for patients with diabetes mellitus.
If we compare concor and side effects for men with other analogues, then the number of unpleasant manifestations is minimal.

Use as directed by a doctor in compliance with dosages will prevent the development of complications, severe defects:

• bronchospasm;
• heart failure;
• a sharp decrease in blood pressure;
• bradycardia;
• myocardial infarction.

According to doctors? It is not Concor itself that has a negative effect on potency, namely hypertension, which leads to dysfunction of the heart muscle, deterioration of blood flow. So it begins to have a negative impact on potency. Men develop sexual impotence. Needless to say that a healthy erection is possible only with a normal outflow of blood, tides to the cavernous bodies of the penis.

Hypertension, like high blood pressure, is the enemy of men's health. Fear and fear of getting sexual disorders provoke only additional psycho-emotional instability in the stronger sex. It is men after 50 years of age who often experience a complete list of problems in the genital area and many unpleasant manifestations.

In the course of clinical studies, it was found that there is no negative effect of concor on potency. The drug did not have the best effect on intimate life in only 5% of men in old age, and in those who experienced erectile dysfunction before using Concor. If we talk about the younger generation, then Bisoprolol as an active ingredient can adversely affect potency in isolated cases. This component is harmless, low-toxic.

If hypertension is not treated, then impotence will develop much faster than from taking Concor's medication. The instruction indicates that the drug reduces libido and potency, although the overwhelming effect on the reproductive system from high pressure can be much stronger.

How to increase potency and stabilize blood pressure

For young guys, of course, potency is more important than blood pressure jumps. But if you completely stop taking adreno-blockers prescribed by your doctor, then high blood pressure is fraught with complications - stroke, myocardial infarction. Diseases are clearly life threatening. However, it is still possible to minimize the negative impact on potency in men, the genitourinary system. After all, no one canceled simple preventive measures, lifestyle.

It:

1. Dieting, refusal of products that provoke an increase in pressure. Only proper nutrition will prevent an increase in pressure, reduce the dosage of medications taken.
2. Elimination of bad habits (alcohol, smoking), because you can reduce the dose of Concor if you refuse to drink alcohol in excess of the norm, while the pressure will not jump to high values.
3. Maintaining an active lifestyle, tk. it is congestion in the pelvic area that provokes a violation of urination, at the same time - a deterioration in erection.

REFERENCE! Alcohol and tobacco lead to poisoning of the body at the cellular level. Nicotine deposits in the body reduce the elasticity and permeability of the vascular walls, impair blood supply, provoke insufficient blood flow to the cavernous bodies. The heart, blood vessels, kidneys, potency begin to suffer. Alcohol contributes to a decrease in sperm motility, a deterioration in the quality of sperm. Endogenous testosterone gradually reduces its production, fertilization and conception for men becomes problematic

Negatively influencing bad habits lead to the development of prostatitis and this is also the enemy of male ability. If the disease is not treated in time, then it is possible to live up to oncology, when there can be no question of viability in sex. If tobacco can be attributed to a rather weak, harmless drug, then abuse, for example, marijuana, can lead to chromosome damage and genetic mutations in men. And this is despite the fact that this herb is of plant origin.

Doctors have a special attitude towards steroids. The effect of the application is the acceleration of protein synthesis and increased endurance, which is important for athletes. But a long, illiterate intake of these drugs is fraught with the development of erectile dysfunction, a sharp decrease in testosterone production.

If you still reconsider your lifestyle, start actively playing sports and walking more. Physical activity is conducive to increasing potency, activates blood flow, and normalizes metabolic processes. If there is a tendency to depression, then it will not be superfluous for men to undergo a course of psychotherapy, reconsider their behavior and outlook on life.

As for Concor, one of the side effects is excessive anxiety, an obsessive feeling of fear. Men tend to sleep, but the fear of seeing nightmares leads to depression, erectile disorders. The emotional sphere and potency in men are inextricably linked. If there is a tendency to suicidal acts, then of course, you should consult a doctor. It is better to stop taking Concor and choose another optimal drug. Although it is quite effective in the treatment of cardiac pathologies, the new drug, unlike other analogues of the old generation, has more side effects.

The main thing is to take Concor, according to the instructions, do not neglect the dosages and instructions of the doctors.

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 regimen for the treatment of 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

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

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, may 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 the 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.

Concor is a drug designed to lower blood pressure. In addition, it is used in the treatment of various disorders of the heart. Let's talk on www.site about what Concor is, application, instructions for use, action, side effects of the drug.

Action Concor

The active substance in the composition of the drug is bisoprolol. It contributes to a mild decrease in blood pressure. When using the drug, its effect begins to appear immediately.

The medicine is used for a long time. At the same time, the condition gradually normalizes, stabilizes and remains so for another month after the end of the intake. In the treatment of functional disorders of cardiac activity, the Concor drug helps to normalize the heartbeat, reduces the need for oxygen in the heart muscle, and calms. When the drug is recommended for therapeutic purposes, it does not have a negative, detrimental effect on other organs and body systems.

Concor is prescribed by a doctor for hypertension, chronic cardiac functional disorders, ischemia, angina pectoris.

After taking the medicine, it begins to act within 1-3 hours. Its action lasts 24 hours.

The drug has a hypotensive effect. Due to the decrease in diastolic pressure, the supply of oxygen to the myocardium increases. For patients with chronic heart disease, Concor significantly improves well-being.

Application of Concor

The drug Concor is intended for oral administration. Take the drug in the morning, on an empty stomach, without chewing the medicine. A single dose is usually 2.5-5 mg. If indicated, it may be increased to 10 mg once a day. The maximum daily dose of the drug is 20 mg.

In the case of functional disorders of the kidneys, liver, the allowable doses of the product do not change significantly.

Contraindications

Instructions for use Concor indicates that the drug is prohibited for people with hypersensitivity to the components of the drug. It should not be used in acute heart failure. Concor is contraindicated in people suffering from cardiogenic shock, sick sinus node syndrome. It cannot be used for sino-arterial blockade, a pronounced frequency of contractions of the heart muscle, which is less than 50 beats per minute.

The drug is not taken in cases of very low blood pressure, lung diseases, bronchial asthma. Reception of Concor is contraindicated during pregnancy, as well as during lactation.

Currently, there is no information about the effect of the drug on children. Therefore, it is not recommended to take it to persons under 18 years of age.

With caution, this drug should be used by those suffering from liver failure, myasthenia gravis, diabetes mellitus, psoriasis, as well as the elderly.

The effectiveness of the use of the drug Concor depends on the use of other drugs. Therefore, before you start taking the drug, be sure to tell your doctor about all the drugs you use.

The drug should not be used when drinking alcohol, as well as people driving a motor vehicle.

The dosage of the medication is prescribed by the doctor, based on the severity of the disease, age, general condition of the patient. Self-use of the drug can lead to negative consequences.

Side effects when applied

The drug Concor has side effects:

From the nervous system - headache, insomnia, sleep disturbance. Perhaps the appearance of dizziness, depressive states, hallucinations, general weakness, fatigue may appear.

From the side of the cardiovascular system - possible violations of the peripheral blood supply to organs, systems, the appearance of edema.

On the part of the visual system - a decrease in visual acuity, the appearance of conjunctivitis.

On the part of the respiratory system - allergic rhinitis, the appearance of bronchospasm.

On the part of the gastrointestinal tract - a feeling of nausea may occur, vomiting, intestinal upset (diarrhea or constipation) may occur. Often there is dry mouth, rarely manifestations of hepatitis.

From the musculoskeletal system - muscle weakness, convulsions are possible. Allergy manifestations: skin rash, itching, excessive sweating.
Ingoda, after prolonged use of the drug, a violation of sexual function may occur.

Release form of the medicinal product

Concor is produced in packs of 30, 50 and 100 tablets. Each package of the drug contains instructions for use, which should be read in detail before taking the medicine.

The drug is released only on prescription. It should be kept out of the reach of children, at normal room temperature.

Among the huge number of various diseases that many of us have to face, a special place is occupied by cardiovascular ailments, which mercilessly affect not only the elderly, but also representatives of the younger age category. Fortunately, an incredible number of drugs created by both domestic pharmaceutical companies and foreign manufacturers are offered to combat this problem.

Today, pharmacies present a lot of new medicines, the action of which is aimed at actively combating high and low blood pressure, but you should not buy them yourself without the advice of a doctor, since each of the drugs has its own characteristics of effects on the body, side effects and contraindications. Only a doctor, having made a full examination, as well as prescribing the necessary tests, will be able to accurately diagnose and prescribe competent treatment.

How to deal with high blood pressure, and what drug is the most effective today? Is there a medicine that can be used without harm to the body, and can such a remedy simultaneously fight the disease, and also act as a prophylactic? These and many other questions are asked by every person suffering from high or low blood pressure.

In this article, we will pay attention to hypertension, or rather, one of the most popular means that allows you to eliminate this disease, as well as relieve many associated ailments.

Concor is a pill that people with a diagnosis of hypertension have probably heard of, but few of them know what the features of this drug are, what effect it has on the body, and what side effects you may encounter during the implementation of the therapeutic course.

Let's take a closer look at this medicinal product to understand why it has gained popularity and whether it should be trusted. So, what are Concor tablets from? Let's start a detailed acquaintance with the drug.

What are the features of the drug?

Despite the fact that today many remedies are offered, most of them have a huge list of contraindications, as well as side effects. That is why some medicines should be used only under the supervision of a doctor. In addition, not all are suitable for people suffering from hypertension, as well as concomitant ailments, since drugs with their powerful effect can aggravate the symptoms of manifested diseases. That is why, only a specialist should choose the appropriate drug to combat high blood pressure.

Concor tablets belong to the safest group of drugs, therefore they are prescribed by doctors very often. This drug is a representative of the group "beta-blockers". This name was given to the drugs because they are able to quickly block the effect of adrenaline on the most important organ - the heart. The fact is that it is in the zone of this organ that there are beta-adrenergic receptors, or nerve endings, which are very sensitive to adrenaline.

Almost every person has a peculiar idea of ​​how adrenaline can affect the human body - it literally charges it and puts it on alert. As soon as this powerful hormone is exposed, there is a more frequent contraction of the heart muscle, constriction of blood vessels, and an increase in blood pressure. In addition, with such exposure, bronchial expansion is observed (the volume of air penetrating into the lung area increases), as well as activation of metabolic substances.

Concor tablets differ in that they actively suppress the effect of adrenaline exclusively on the heart, and this suggests that the drug is a selective (selective) agent of the "beta-blockers" group. Due to the fact that the drug blocks the action of adrenaline, there is not a frequent contraction of the heart, but the coronary arteries (those vessels that supply blood to the region of the main human organ) begin to expand. Under the influence of the drug, it also effectively supplies general blood pressure (arterial pressure) and this is due to the fact that the volume of blood pushed out by the heart directly into the circulatory system during each contraction is significantly reduced.

In what cases is the drug prescribed?

The peculiarity of the impact of Concor tablets on the body makes it possible to use this drug in the treatment of a large number of ailments.

In the modern world, this effective product is widely used when it is necessary to get rid of such disorders as:

1. Ischemic heart disease. This medicinal product has an effect throughout the day. It is able to perfectly maintain the coronary vessels in a relaxed state. Due to this, the symptoms of angina pectoris begin to disappear in the patient, or their duration and frequency are noticeably reduced;
2. Observation of consistently high elevated blood pressure (arterial hypertension). Concor tablets help to effectively influence high blood pressure, gradually bringing it back to normal, due to which the condition of the user of the drug improves significantly;
3. In the presence of chronic heart failure, these pills help the heart very well. But they give positive results only in those cases when the disease develops at the stage of compensation, namely, when the human heart is to a large extent capable of independently coping with its work. In cases where decompensation occurs (appearance of puffiness, shortness of breath, etc.), you should not use Concor tablets, since they can significantly aggravate the disease.

What side effects might you experience?

As mentioned earlier, Concor tablets produce a selective blocking of the action of adrenaline directly on the heart. But, despite this, the drug is not capable of completely getting rid of the blocking of the action of the mentioned hormone on all other organs. It is not always possible for the remedy to stop the effect of adrenaline on important body systems, which leads to various side effects. Thus, by blocking the hormone to the bronchi, the drug can cause such a violation in the patient as bronchospasm. Side effects can also appear from the functioning of other organs.

Many patients, while undergoing treatment with the Concor medication, observed the appearance of such disorders as:

• headache;
• constant dizziness;
• vomiting;
• bouts of nausea;
• diarrhea;
• hearing loss;
• poor liver function;
• the appearance of increased fatigue;
• all kinds of allergic reactions;
• observation of weakness in the muscles.

In addition, the effect of tablets directly on the heart may be accompanied by the occurrence of side effects, especially if the patient takes the drug without taking into account all the contraindications that prohibit its use.

During the use of Concor tablets, the patient may experience bradycardia (heart contractions are made too sharply).

In addition, there are also changes in the functioning of the body, such as:

• exacerbation of manifestations of heart failure;
• extremities constantly very cold;
• a sharp drop in blood pressure;
• observation of heart blockades (indicates the appearance of disturbances in the conduction of impulses in the region of the heart).

Features of the composition and therapeutic effects of the drug

Concor tablets are designed to lower blood pressure, as well as reduce increased heart rate. They are used in cases of need to normalize the heart rhythm.

The main active ingredient of this medicinal product is a component such as bisoprolol. In addition, the drug contains other components (starch, calcium hydrogen phosphate, magnesium stearate, cellulose).

The effect of the drug on the body is made after about 3 hours after use, so they are not used in cases where it is necessary to provide urgent assistance to the patient.

The human digestive system perfectly perceives these tablets. They dissolve very quickly and enter the bloodstream, and it does not matter at what point in the meal they were used, before or after meals.

The most important therapeutic characteristics of Concor include:

Compared to all other products that represent the group of "beta-blockers", Concor tablets are the most effective and very powerful. They provide an excellent therapeutic result, and the treatment effect is maintained for a long time. But it is very important to choose the right dosage of the drug, since when using minimal doses, it is impossible to achieve a therapeutic effect, as well as protect yourself from diseases that occur against the background of regular high blood pressure. On the other hand, when using excessively large doses, the patient may encounter not only side effects, but also significant disorders that will be very difficult, and sometimes impossible, to eliminate.

When should tablets not be used?

The drug Concor is contraindicated in the category of patients who have acute cardiac ailments, such as:

• heart failure;
• shock is cardiogenic.

Such disorders can occur for a variety of reasons, but most often they appear in the presence of serious cardiac arrhythmias, as well as myocardial infarction, etc. If the patient has chronic heart failure that develops at the stage of decompensation, then it is also better to refuse Concor tablets.

This is only a small list of contraindications, so you should not buy Concor without a doctor's prescription. He must conduct a number of preliminary studies before recommending the mentioned medication, or other drugs that can get rid of high blood pressure.

Tablets 50 mg

Indications for use of the drug Concor

arterial hypertension;

Ischemic heart disease (prevention of angina attacks);

Chronic heart failure.

Release form of the drug Concor

film-coated tablets 5 mg; blister 10 cardboard pack 3;
film-coated tablets 5 mg; blister 10 cardboard pack 5;
film-coated tablets 5 mg; blister 10 cardboard pack 10;
film-coated tablets 5 mg; blister 25 cardboard pack 2;
film-coated tablets 5 mg; blister 30 cardboard pack 1;
film-coated tablets 10 mg; blister 10 cardboard pack 3;
film-coated tablets 10 mg; blister 10 cardboard pack 5;
film-coated tablets 10 mg; blister 10 cardboard pack 10;
film-coated tablets 10 mg; blister 30 cardboard pack 1;
film-coated tablets 10 mg; blister 25 cardboard pack 2;

Pharmacodynamics of the drug Concor

Selective beta1-blocker, without its own sympathomimetic activity, does not have a membrane stabilizing effect. Reduces the activity of blood plasma renin, reduces myocardial oxygen demand, reduces heart rate (at rest and during exercise).

It has antihypertensive, antiarrhythmic and antianginal effects. By blocking beta1-adrenergic receptors of the heart in low doses, it reduces the formation of cAMP from ATP stimulated by catecholamines, reduces the intracellular current of calcium ions, has a negative chrono-, dromo-, batmo- and inotropic effect, inhibits myocardial conduction and excitability, reduces AV conduction.

With an increase in the dose above the therapeutic one, it has a beta2-adrenergic blocking effect.

OPSS at the beginning of the drug, in the first 24 hours, increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors and the elimination of stimulation of beta2-adrenergic receptors), which after 1-3 days returns to the original, and decreases with long-term administration.

The hypotensive effect is associated with a decrease in the minute volume of blood, sympathetic stimulation of peripheral vessels, a decrease in the activity of the renin-angiotensin system (it is of great importance for patients with initial renin hypersecretion), restoration of sensitivity in response to a decrease in blood pressure and an effect on the central nervous system. With arterial hypertension, the effect occurs after 2-5 days, stable action - after 1-2 months.

The antianginal effect is due to a decrease in myocardial oxygen demand as a result of a decrease in heart rate and a decrease in contractility, lengthening of diastole, and improvement in myocardial perfusion. By increasing the end diastolic pressure in the left ventricle and increasing the stretching of the muscle fibers of the ventricles, it can increase the need for oxygen, especially in patients with chronic heart failure.

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and a slowdown in AV conduction (mainly in the antegrade and, to a lesser extent, in the retrograde directions). through the AV node) and via additional pathways.

When used in medium therapeutic doses, unlike non-selective beta-blockers, it has a less pronounced effect on organs containing beta2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism, does not cause delay sodium ions (Na+) in the body; the severity of the atherogenic action does not differ from the action of propranolol.

Pharmacokinetics of the drug Concor

Suction. Bisoprolol is almost completely (> 90%) absorbed from the gastrointestinal tract. Its bioavailability due to insignificant metabolization during the "first pass" through the liver (at the level of approximately 10-15%) is about 85-90% 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. Cmax in plasma is reached after 2-3 hours.

Distribution. Bisoprolol is distributed quite widely. The volume of distribution is 3.5 l / kg. Plasma protein binding reaches approximately 35%; capture by blood cells is not observed.

Metabolism. Metabolized by the oxidative pathway without subsequent conjugation. All metabolites are highly polar and are 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 CYP3A4 (about 95%), and CYP2D6 plays only a small role.

Withdrawal. The clearance of bisoprolol is determined by the balance between its excretion through the kidneys in the form of an unchanged substance (about 50%) and oxidation in the liver (about 50%) to metabolites, which are then also excreted by the kidneys. Total Cl - (15.6 ± 3.2) l / h, and renal Cl - (9.6 ± 1.6) l / h. T1 / 2 - 10-12 hours

Use of the drug Concor during pregnancy

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 carefully monitored, as well as the growth and development of the unborn child, and in case of dangerous manifestations in relation to pregnancy or the fetus, alternative therapeutic measures should be taken.

The newborn should be carefully examined after delivery. In the first 3 days of life, symptoms of a decrease in blood glucose and heart rate may occur.

There are no data on the excretion of bisoprolol into breast milk or the safety of exposure to bisoprolol in infants. Therefore, taking Concor® is not recommended for women during breastfeeding.

Contraindications to the use of the drug Concor

Hypersensitivity to bisoprolol or to any of the components of the drug (see "Composition and form of release") and to other beta-blockers;
acute heart failure, chronic heart failure in the stage of decompensation;
shock caused by impaired cardiac function (cardiogenic shock), collapse;
AV block II and III degree, without a pacemaker;
sick sinus syndrome;
sinoatrial blockade;
severe bradycardia (HR<50 уд./мин.);
marked decrease in blood pressure<90 мм рт. ст.);
severe forms of bronchial asthma and COPD in history;
late stages of peripheral circulatory disorders, Raynaud's disease;
pheochromocytoma (without the simultaneous use of alpha-blockers);
metabolic acidosis;
simultaneous reception of MAO inhibitors, with the exception of MAO-B;
age up to 18 years (efficacy and safety have not been established).

Carefully:
liver failure;
chronic renal failure;
Prinzmetal's angina;
myasthenia gravis;
thyrotoxicosis;
diabetes;
AV block I degree;
depression (including history);
psoriasis;
elderly age.

Side effects of Concor

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 (>1/10000, <1/1000); очень редко (<1/10000, включая отдельные сообщения).

Cardiovascular system: very often - a decrease in heart rate (bradycardia, especially in patients with chronic heart failure); often - arterial hypotension (especially in patients with chronic heart failure), the manifestation of angiospasm (increased peripheral circulatory disorders, a feeling of cold in the extremities - paresthesia); infrequently - a violation of AV conduction, orthostatic hypotension, decompensation of heart failure with the development of peripheral edema.

Nervous system: at the beginning of the course of treatment, CNS disorders may temporarily appear; infrequently - dizziness, headache, asthenia, fatigue, sleep disturbances, as well as mental disorders (infrequently - depression; rarely - hallucinations, nightmares, convulsions). Usually these phenomena are mild and disappear, as a rule, within 1-2 weeks after the start of treatment.

Organs of vision: rarely - blurred vision, decreased tearing (should be taken into account when wearing contact lenses); very rarely - conjunctivitis.

Respiratory system: rarely - allergic rhinitis; infrequently - bronchospasm in patients with bronchial asthma or obstructive respiratory diseases.

Gastrointestinal tract: often - nausea, vomiting, diarrhea, constipation, dryness of the oral mucosa; rarely - hepatitis.

Musculoskeletal system: infrequently - muscle weakness, cramps in the calf muscles, arthralgia.

Allergic reactions: rarely - hypersensitivity reactions such as pruritus, skin redness, sweating, rash; very rarely - alopecia. Beta-blockers can exacerbate psoriasis.

Genitourinary system: very rarely - potency disorders.

Laboratory indicators: rarely - an increase in the level of liver enzymes in the blood (ACT, ALT), an increase in the level of triglycerides in the blood. In some cases - thrombocytopenia, agranulocytosis.

Method of application and dose of the drug Concor

Inside, tablets should be taken without chewing, with a small amount of liquid in the morning before breakfast, during or after it, 1 time per day.

Treatment of arterial hypertension and angina pectoris

In all cases, the regimen and dosage is selected by the doctor for each patient individually, in particular, taking into account the heart rate and the patient's condition.

Usually the initial dose is 5 mg (1 tablet. Concor® 5 mg) 1 time per day. If necessary, the dosage can be increased to 10 mg 1 time per day.

In the treatment of arterial hypertension and angina pectoris, the maximum recommended dose is 20 mg Concor® 1 time per day.

Treatment of chronic heart failure

The start of treatment of chronic heart failure with Concor® requires a special titration phase and regular medical supervision.

The preconditions for treatment with Concor® are as follows:

Chronic heart failure without signs of exacerbation in the previous 6 weeks,

Almost unchanged basic therapy in the previous 2 weeks,

Treatment with optimal doses of ACE inhibitors (or other vasodilators in case of intolerance to ACE inhibitors), diuretics and, optionally, cardiac glycosides.

Treatment of chronic heart failure 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 one was well tolerated.
The maximum recommended dose in the treatment of chronic heart failure is 10 mg of Concor® once a day.

After starting treatment with the drug at a dose of 1.25 mg (1/2 table of the drug Concor® Cor), the patient should be observed for about 4 hours (control of heart rate, blood pressure, conduction disturbances, signs of worsening heart failure).

During the titration phase or after it, a temporary worsening of the course of heart failure, fluid retention in the body, arterial hypotension or bradycardia may occur. In this case, it is recommended, first of all, to pay attention to the selection of the dosage of concomitant basic therapy (optimize the dose of diuretic and / or ACE inhibitor) before reducing the dosage of Concor®. Treatment with Concor® should be interrupted only if absolutely necessary.

After stabilization of the patient's condition, re-titration should be carried out, or treatment should be continued.

Duration of treatment for all indications

Treatment with Concor® is usually long-term therapy.

If necessary, treatment can be interrupted and resumed subject to certain rules.

Treatment should not be interrupted suddenly, especially in patients with CAD. If it is necessary to stop treatment, then the dosage of the drug should be reduced gradually.

Special patient groups

Impaired kidney or liver function

Treatment of arterial hypertension or angina pectoris:

In case of impaired liver or kidney function, mild or moderate, usually does not require dose adjustment;

With severe impairment of kidney function (Cl creatinine<20 мл/мин) и у пациентов с тяжелыми заболеваниями печени максимальная суточная доза - 10 мг.

Elderly patients: dose adjustment is not required.

Overdose of Concor

Symptoms: arrhythmia, ventricular extrasystole, severe bradycardia, AV blockade, marked decrease in blood pressure, acute heart failure, hypoglycemia, acrocyanosis, shortness of breath, bronchospasm, dizziness, fainting, convulsions.

Treatment: gastric lavage and the appointment of adsorbing drugs; symptomatic therapy: with developed AV blockade - in / in the introduction of 1-2 mg of atropine, epinephrine or setting up a temporary pacemaker; with ventricular extrasystole - lidocaine (class IA drugs are not used); with a pronounced decrease in blood pressure - the patient should be in the Trendelenburg position; if there are no signs of pulmonary edema - plasma-substituting intravenous solutions, if ineffective - the introduction of epinephrine, dopamine, dobutamine (to maintain chronotropic and inotropic action and eliminate a pronounced decrease in blood pressure); in heart failure - cardiac glycosides, diuretics, glucagon; with convulsions - in / in diazepam; with bronchospasm - beta2-adrenergic stimulants by inhalation.

Interactions of the drug Concor with other drugs

The effectiveness and tolerability of drugs may be affected by the simultaneous use of other drugs. Such an interaction can also occur in cases where 2 drugs are taken after a short period of time. The doctor must be informed that you are taking other drugs, even if you are taking them without a prescription.

Allergens used for immunotherapy or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving bisoprolol.

Phenytoin when administered intravenously, drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressive effect and the likelihood of lowering blood pressure.

The effectiveness of insulin and oral hypoglycemic drugs may change during treatment with bisoprolol (masks the symptoms of developing hypoglycemia: tachycardia, increased blood pressure).

The clearance of lidocaine and xanthines (except diphylline) may decrease due to a possible increase in their plasma concentration, especially in patients with initially increased clearance of theophylline under the influence of smoking.

NSAIDs, corticosteroids and estrogens weaken the hypotensive effect of bisoprolol (Na + retention, blockade of PG synthesis by the kidneys).

Cardiac glycosides, methyldopa, reserpine and guanfacine, CCBs (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV block, cardiac arrest and heart failure.

Nifedipine can lead to a significant decrease in blood pressure.

Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs can lead to an excessive decrease in blood pressure.

The action of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins during treatment with bisoprolol may be prolonged.

Tri - and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedative and hypnotic drugs increase CNS depression.

Simultaneous use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. A break in treatment between taking MAO inhibitors and bisoprolol should be at least 14 days.

Non-hydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders.

Ergotamine increases the risk of developing peripheral circulatory disorders; sulfasalazine increases the concentration of bisoprolol in the blood plasma; rifampicin shortens the half-life.

Special instructions when taking the drug Concor

It is not recommended to interrupt treatment abruptly and change the recommended dosage without first consulting a 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 dosage should be reduced gradually.

Monitoring the condition of patients taking Concor® should include measuring heart rate and blood pressure (at the beginning of treatment - daily, then 1 time in 3–4 months), ECG, determination of blood glucose in patients with diabetes mellitus (1 time in 4–5 months ). In elderly patients, it is recommended to monitor kidney function (1 time in 4-5 months).

The patient should be taught how to calculate heart rate and instruct about the need for medical consultation with heart rate<50 уд./мин.

Patients using contact lenses should take into account that during treatment, a decrease in the production of lacrimal fluid is possible.

When used in patients with pheochromocytoma, there is a risk of developing paradoxical arterial hypertension (if effective alpha-blockade has not been previously achieved).

In thyrotoxicosis, Concor may mask certain clinical signs of thyrotoxicosis (eg, tachycardia). Abrupt discontinuation of the drug in patients with thyrotoxicosis is contraindicated, as it can exacerbate symptoms.

In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentration to normal levels.

While taking clonidine, its reception can be stopped only a few days after the withdrawal of Concor®.

It is possible to increase the severity of the hypersensitivity reaction and the lack of effect from the usual doses of epinephrine against the background of an aggravated allergic history.

If it is necessary to carry out planned surgical treatment, the drug should be discontinued 48 hours before general anesthesia. If the patient took the drug before surgery, he should choose drugs for general anesthesia with a minimally negative inotropic effect.

Reciprocal activation of the vagus nerve can be eliminated by intravenous atropine (1–2 mg).

Drugs that reduce catecholamine reserves (including reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect a pronounced decrease in blood pressure or bradycardia.

Patients with bronchospastic diseases can be prescribed cardioselective blockers in case of intolerance and / or ineffectiveness of other antihypertensive drugs. If the dose of the drug is exceeded, there is a risk of developing bronchospasm.

In case of detection in elderly patients of increasing bradycardia (heart rate<50 уд./мин), выраженного снижения АД (сАД <100 мм рт. ст.), AV блокады необходимо уменьшить дозу или прекратить лечение.

You can not abruptly interrupt treatment because of the risk of developing severe arrhythmias and myocardial infarction. Cancellation of the drug is carried out gradually, reducing the dose for 2 weeks or more (reduce the dose by 25% in 3-4 days). It is necessary to cancel the drug before examining the content of catecholamines, normetanephrine and vanillylmandelic acid in the blood and urine; titers of antinuclear antibodies.

Influence on the ability to drive a car and complex mechanisms

Bisoprolol does not affect the ability to drive a car in the study of patients suffering from diseases of the coronary vessels of the heart. 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.

Storage conditions of the drug Concor

List B.: At a temperature not higher than 30 °C.

Shelf life of the drug Concor

Belonging of the drug Concor to the ATX-classification:

C Cardiovascular system

C07 Beta-blockers

C07A Beta-blockers

C07AB Selective beta1-blockers