"Nebilet": reviews of cardiologists and patients, indications, instructions, analogues. Nebilet: analogues and detailed instructions for use. Claim address

Description of the drug

Nebivolol is a racemate of two enantiomers: SRRR-nebivolol (D-nebivolol) and RSSS-nebivolol (L-nebivolol), combining two pharmacological actions:

- D-nebivolol is a competitive and highly selective blocker of β 1 -adrenergic receptors;

– L-nebivolol has a mild vasodilating action by modulating the release of vasodilatory factor (NO) from the vascular endothelium.

By reducing myocardial oxygen demand (decreased heart rate and reduced preload and afterload), reduces the number and severity of angina attacks and increases tolerability physical activity.

The antiarrhythmic effect is due to the suppression of the pathological automatism of the heart (including in the pathological focus) and the slowing of AV conduction.

List of analogues

Note! The list contains Nebilet synonyms that have a similar composition, so you can choose a replacement yourself, taking into account the form and dose of the medicine prescribed by your doctor. Give preference to manufacturers from the USA, Japan, Western Europe, as well as well-known companies from Eastern Europe: Krka, Gedeon Richter, Actavis, Egis, Lek, Geksal, Teva, Zentiva.

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Official instructions for use

Nebilet ®

International non-proprietary name:

Dosage form:

Compound:

Description:

Pharmacotherapeutic group:

Pharmacological properties:

pharmachologic effect

Cardioselective beta 1-blocker. It has antihypertensive, antianginal and antiarrhythmic effects. Reduces high blood pressure at rest, during physical exertion and stress. Competitively and selectively blocks postsynaptic β 1 -adrenergic receptors, making them inaccessible to catecholamines, modulates the release of endothelial vasodilating factor nitric oxide (NO).

Nebivolol is a racemate of two enantiomers: SRRR-nebivolol (D-nebivolol) and RSSS-nebivolol (L-nebivolol), combining two pharmacological actions:

- D-nebivolol is a competitive and highly selective blocker of β 1 -adrenergic receptors;

— L-nebivolol has a mild vasodilating effect by modulating the release of vasodilator factor (NO) from the vascular endothelium.

The hypotensive effect is also due to a decrease in the activity of the renin-angiotensin-aldosterone system (RAAS) (does not directly correlate with changes in plasma renin activity).

A stable hypotensive effect develops after 1-2 weeks of regular use of the drug, and in some cases - after 4 weeks, a stable effect is observed after 1-2 months.

By reducing myocardial oxygen demand (decrease in heart rate and decrease in preload and afterload), it reduces the number and severity of angina attacks and increases exercise tolerance.

The antiarrhythmic effect is due to the suppression of the pathological automatism of the heart (including in the pathological focus) and the slowing of AV conduction.

Pharmacokinetics

Suction

After oral administration, both enantiomers are rapidly absorbed. Food does not affect absorption, so nebivolol can be taken with or without food. The bioavailability of nebivolol after oral administration averages 12% in individuals with a "fast" metabolism (first pass effect through the liver) and is almost complete in individuals with a "slow" metabolism.

Distribution

In plasma, both enantiomers are predominantly bound to albumin. Plasma protein binding for D-nebivolol is 98.1%, and for L-nebivolol it is 97.9%.

Metabolism

Metabolized by acyclic and aromatic hydroxylation and partial N-dealkylation. The resulting hydroxy- and amino derivatives are conjugated with glucuronic acid and excreted as O- and N-glucuronides.

breeding

It is excreted by the kidneys (38%) and through the intestines (48%).

In individuals with a "fast" metabolism T 1/2 hydroxymetabolites - 24 hours, nebivolol enantiomers - 10 hours; in persons with a "slow" metabolism: hydroxymetabolites - 48 hours, enantiomers of nebivolol - 30-50 hours.

The excretion of unchanged nebivolol in the urine is less than 0.5% of the amount of the drug taken orally.

Indications

- arterial hypertension;

- ischemic heart disease: prevention of angina attacks;

- chronic heart failure (as part of combination therapy).

Dosing regimen

Tablets are taken orally, 1 time / day, preferably always at the same time of day, regardless of food intake, with a sufficient amount of liquid.

Average daily dose for treatment arterial hypertension and ischemic heart disease is 2.5-5 mg (1/2-1 tab.). Nebilet ® can be used as monotherapy or in combination with other blood pressure lowering agents.

At patients with renal insufficiency, as well as patients over the age of 65 the recommended initial dose is 2.5 mg (1/2 tab.) / day. If necessary, the daily dose can be increased to a maximum of 10 mg (2 tablets of 5 mg in 1 dose).

Treatment of chronic heart failure should begin with a slow increase in dose until the individual optimal maintenance dose is reached. Dose selection at the beginning of treatment should be carried out according to the following scheme, while maintaining intervals of 1 to 2 weeks and based on the tolerance of this dose by the patient: a dose of 1.25 mg of nebivolol (1/4 tab. 5 mg) 1 time / day can be increased first to 2.5-5 mg (1/2 tab. 5 mg or 1 tab. 5 mg), and then to 10 mg (2 tab. 5 mg) 1 time / day.

The maximum daily dose is 10 mg 1 time / day.

At the beginning of treatment and with each dose increase, the patient should be under the supervision of a physician for at least 2 hours to ensure that the clinical condition remains stable (especially blood pressure, heart rate, conduction disturbances, as well as symptoms of exacerbation of chronic heart failure).

Rules for dividing tablets

To divide, place the tablet on a hard, flat surface with the cross-shaped notch up, press down on the tablet with both index fingers. For 1/4 tablet, repeat the same steps for 1/2 tablet.

Side effect

Frequency of side effects: very often (>10%), often (>1% and<10%), нечасто (>0.1% and<1%), редко (>0.01% and<0.1%), очень редко (<0.01%, включая отдельные сообщения).

From the side of the central nervous system and peripheral nervous system: often - headache, dizziness, fatigue, weakness, paresthesia; infrequently - depression, nightmares, confusion; very rarely - fainting, hallucinations.

From the digestive system: often - nausea, constipation, diarrhea; infrequently - dyspepsia, flatulence, vomiting.

From the side of the cardiovascular system: infrequently - bradycardia, acute heart failure, AV blockade, orthostatic hypotension, Raynaud's syndrome.

From the skin and subcutaneous tissues: infrequently - skin rash of an erythematous nature, itching; very rarely - aggravation of the course of psoriasis; in some cases - angioedema.

Others: infrequently - bronchospasm; rarely - dry eyes.

Contraindications for use

- acute heart failure;

- chronic heart failure in the stage of decompensation (requiring intravenous administration of drugs with an inotropic effect);

- severe arterial hypotension (systolic blood pressure less than 90 mm Hg);

- SSSU, including sinoatrial blockade;

- AV block II and III degree (without artificial pacemaker);

- bradycardia (heart rate less than 60 bpm);

- cardiogenic shock;

- pheochromocytoma (without the simultaneous use of alpha-blockers);

- metabolic acidosis;

- severe violations of liver function;

- bronchospasm and bronchial asthma in history;

- severe obliterating diseases of peripheral vessels (intermittent claudication, Raynaud's syndrome);

- myasthenia gravis;

- depression;

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

- children and adolescents under 18 years of age (efficacy and safety have not been studied);

- hypersensitivity to nebivolol or one of the components of the drug.

FROM caution the drug should be used for renal failure, diabetes mellitus, hyperthyroidism, a history of allergic diseases, psoriasis, chronic obstructive pulmonary disease, AV block I degree, Prinzmetal's angina, as well as patients over the age of 75 years.

Use during pregnancy and lactation

During pregnancy, Nebilet ® is prescribed only for vital indications, when the benefit to the mother outweighs the possible risk to the fetus or newborn (due to the possible development of the fetus and newborn bradycardia, arterial hypotension, hypoglycemia). If treatment with Nebilet ® is necessary, then uteroplacental blood flow and fetal growth should be monitored. Treatment must be interrupted 48-72 hours before delivery. In cases where this is not possible, it is necessary to establish strict observation of newborns within 48-72 hours after delivery.

Nebivolol is excreted in breast milk. If you need to take the drug Nebilet ® during lactation, breastfeeding should be stopped.

Use in children

Contraindicated in children and adolescents under 18 years of age.

Overdose

Symptoms: pronounced decrease in blood pressure, nausea, vomiting, cyanosis, sinus bradycardia, AV blockade, bronchospasm, loss of consciousness, cardiogenic shock, coma, cardiac arrest.

Treatment: gastric lavage, activated charcoal. In the case of a pronounced decrease in blood pressure, it is necessary to give the patient a horizontal position with raised legs, if necessary, in / in the introduction of fluid and vasopressors. In case of bradycardia, 0.5-2 mg of atropine should be administered intravenously; in the absence of a positive effect, a transvenous or intracardiac pacemaker can be placed. With AV blockade (II-III stage), it is recommended to / in the introduction of beta-adrenergic stimulants, if they are ineffective, the issue of setting an artificial pacemaker should be considered. In heart failure, treatment begins with the introduction of cardiac glycosides and diuretics, in the absence of an effect, it is advisable to administer dopamine, dobutamine or vasodilators. With bronchospasm, intravenous β 2 -adrenergic stimulants are used. With ventricular estrasystole - lidocaine (antiarrhythmic drugs of class IA cannot be administered).

drug interaction

Pharmacodynamic interaction

With the simultaneous use of beta-blockers with blockers of slow calcium channels (verapamil and diltiazem), the negative effect on myocardial contractility and AV conduction is enhanced.

Contraindicated in / in the introduction of verapamil against the background of the use of nebivolol.

With the simultaneous use of nebivolol with antihypertensive drugs, nitroglycerin or slow calcium channel blockers, severe arterial hypotension may develop (special caution is necessary when combined with prazosin).

With the simultaneous use of nebivolol with class I antiarrhythmic drugs and samodarone, it is possible to increase the negative inotropic effect and lengthen the time of excitation through the atria.

With the simultaneous use of nebivolol with cardiac glycosides, there was no increase in the effect on slowing down AV conduction.

The simultaneous use of nebivolol and drugs for general anesthesia can cause suppression of reflex tachycardia and increase the risk of arterial hypotension.

No clinically significant interaction between nebivolol and NSAIDs has been established.

The simultaneous use of nebivolol with tricyclic antidepressants, barbiturates and phenothiazine derivatives may enhance the hypotensive effect of nebivolol.

Pharmacokinetic interaction

With the simultaneous use of nebivolol with drugs that inhibit serotonin reuptake, or other agents that biotransform with the participation of the CYP2D6 isoenzyme, the concentration of nebivolol in the blood plasma increases, the metabolism of nebivolol slows down, which may lead to a risk of bradycardia.

When used simultaneously with digoxin, nebivolol does not affect the pharmacokinetic parameters of digoxin.

With the simultaneous use of nebivolol with cimetidine, the concentration of nebivolol in the blood plasma increases.

The simultaneous use of nebivolol and ranitidine does not affect the pharmacokinetic parameters of nebivolol.

With the simultaneous use of nebivolol with nicardipine, the concentration of active substances in the blood plasma increases slightly, but this has no clinical significance.

Co-administration of nebivolol and ethanol, furosemide or hydrochlorothiazide does not affect the pharmacokinetics of nebivolol.

No clinically significant interaction between nebivolol and warfarin has been established.

With the combined use of nebivolol with insulin and oral hypoglycemic agents, symptoms of hypoglycemia (tachycardia) may be masked.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

The drug should be stored out of the reach of children at a temperature not exceeding 25°C. Shelf life - 3 years.

Application for violations of liver function

Contraindicated in severe liver dysfunction.

Application for violations of kidney function

In patients with renal insufficiency, the initial dose is 2.5 mg / day.

Use in elderly patients

FROM caution the drug should be used in patients over the age of 75 years.

special instructions

Cancellation of beta-blockers should be carried out gradually over 10 days (up to 2 weeks in patients with coronary artery disease).

Control of blood pressure and heart rate at the beginning of the drug should be daily.

In elderly patients, monitoring of kidney function is necessary (1 time in 4-5 months).

With exertional angina, the dose of the drug should provide heart rate at rest in the range of 55-60 beats / min, with exercise - no more than 110 beats / min.

Beta-blockers can cause bradycardia: the dose should be reduced if the heart rate is less than 50-55 bpm.

When deciding on the use of the drug Nebilet ® in patients with psoriasis, the expected benefits of using the drug and the possible risk of exacerbation of the course of psoriasis should be carefully correlated.

Patients using contact lenses should take into account that against the background of the use of beta-blockers, a decrease in the production of lacrimal fluid is possible.

When performing surgical interventions, the anesthesiologist should be warned that the patient is taking beta-blockers.

Nebivolol does not affect the concentration of glucose in blood plasma in patients with diabetes mellitus. However, caution should be exercised in the treatment of these patients, since Nebilet ® may mask certain symptoms of hypoglycemia (eg, tachycardia) caused by the use of oral hypoglycemic agents and insulin. Control of the concentration of glucose in the blood plasma should be carried out 1 time in 4-5 months (in patients with diabetes mellitus).

With hyperthyroidism, beta-blockers can mask tachycardia.

Beta-blockers should be used with caution in patients with chronic obstructive pulmonary disease, as bronchospasm may increase.

Beta-blockers may increase sensitivity to allergens and the severity of anaphylactic reactions.

Influence on the ability to drive vehicles and control mechanisms

The effect of the drug Nebilet ® on the ability to drive vehicles and control mechanisms has not been specifically studied. Studies of the pharmacodynamics of nebivolol have shown that Nebilet ® does not affect psychomotor function. During the period of treatment with Nebilet ® (if side effects occur), care should be taken when driving vehicles and when engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Returns pressure values ​​to the norm suitable for an individual person and eliminates malfunctions in the work of the heart.

If the patient is prescribed this medicine, then it is worth familiarizing yourself with its action, the active substance and the list of analogues with which it can be replaced if there are problems with the use of this substance.

Nebilet consists of 2 active substances, each of which acts in its own way, but in general has the desired positive effect.

The components of the drug are:

• D-nebivolol- inhibits the function of adrenaline in the blood, which helps to calm the work of the heart and valves;
• L-nebivolol- gently affects the walls.

This drug has an effect on the body, expressed in a decrease in the frequency of contraction of the heart muscle, both at complete rest and in the state. Due to this effect, the patient's blood pressure decreases.

It should be borne in mind that the medicinal property has a cumulative effect, therefore, in the first days of taking the medicine, its effect will occur later than if the patient is being treated with the drug on a regular basis for at least 2 weeks.

A faster result will come after the drug has accumulated in the blood, and this moment will reduce the risk of seizures in the future. Also, the use of funds on a long-term basis will allow the body to withstand physical activity and make them more intense.

Tablets Nebilet

In normal situations, a person is prescribed from 2.5 to 5 mg per day of this remedy, depending on the condition. However, in older patients over 65 years of age, as well as patients with kidney problems, this drug is always prescribed at a dose of no more than 2.5 mg. If necessary, the dose can be increased to 10 mg, but in such situations, monitoring of intake should occur constantly.

Drug analogues

Considering that in addition to the active ingredients, Nebilet contains additional components, allergic reactions may occur. In addition, sometimes the drug simply does not fit.

The need to change the medication may be due to the fact that the patient has a history of other diseases and possible side effects can provoke them.

Identical drugs include a whole range of drugs, for example,

• - almost complete analogue;
• Nebitens- this medication can be used together with other cardiac drugs;
• OD-Neb- contains nebivolol hydrochloride;
• Nebilan Lannacher- is also a complete analogue of the tool.

Other types are also referred to as identical means, but it should be understood that they contain the same active substance. Drugs that replace Nebivol include drugs that have other ingredients, and, accordingly, they have other active substances, but according to their effect on the body, they can be used to stabilize pressure in patients who need it.

Tablets Niperten 5 mg

Means that have a similar effect on the body include:

• Etekor- in the form of an active component contains esatenolol;
• Niperten- fumarate;
• Metozok- this medicinal product contains succinate;
• – betaxolol is presented as an active substance.

There are also other analogues of the main remedy under consideration for arterial problems.

In any case, about the selection of the drug, you need to consult with the doctors.

Nebilet or Concor: which is better?

The first medicine is quite popular with doctors due to the presence of a vasodilating effect, which in the case of problems with pressure gives a positive result. Therefore, when choosing a medicine for the absence of clearly expressed contraindications, Nebilet is prescribed most often.

The composition is represented by the following components:

• bisoprolol hemifumarate- reduces the dose of oxygen in the myocardium, thereby reducing the heart rate;
• bisoprolol fumarate- it gives a whole list of effects, inhibits ischemia, normalizes the rhythm of heart contractions, reduces blood pressure.

The composition of the first substance contains exactly 2 times more than the second, thus achieving the effect of lowering pressure and normalizing the heart rhythm.

Concor is prescribed to patients in a daily dose of not more than 20 mg, while the start of admission always starts with 5 mg, while monitoring the state of health.

It is worth considering that in case of heart failure, the daily dose should not exceed a value of 10 mg, while the initial intake pattern is maintained. It is also worth considering that the appointment of Concor to persons under 18 years of age is strictly.

Tablets Concor

One of the important points in which the appointment of Concor has a significant advantage is that it does not have any effect on patients with temporary or permanent problems with the respiratory tract, while Nebilet in these situations is used with possible risk.

Concor should be used with caution in patients who have problems with sugar and use hypoglycemic agents, in this case, bisoprolol has a reinforcing effect, which can play both a positive and a negative value.

Nebilet or Nebivolol?

Both of these drugs are from the same group and have identical effects, as well as similar side effects. However, their difference lies in who makes the medication.

The original drug Nebilet is manufactured by German enterprises and contains an active substance that undergoes a good degree of purification.

Nebivolol tablets

In turn, Nebivolol is a cheap analogue that is manufactured by different countries and, accordingly, the degree of purification of the active agent will be different.

In addition, this parameter affects the degree of effect of the drug on the body and therefore, in some cases, the therapeutic effect may occur later, or the expected effect will be less pronounced than that of the original remedy.

It is worth noting that if the patient is faced with the fact that the medication is not suitable for him for health reasons, then both drugs cannot be used because of the identical substance. In this case, you will have to use an analogue.

That is, in fact, both drugs have a good effect when used, but their work as a whole is affected by the manufacturing conditions and the quality of the ingredients used.

Dosage forms

tablets 5mg

Manufacturers

Berlin-Chemie AG/Menarini Group (Germany)

Pharmgroup

Beta1-blockers (cardioselective)

International non-proprietary name

Nebivolol

Vacation order

Released by prescription

Synonyms

Compound

Active ingredient: Nebivolol.

pharmachologic effect

Hypotensive, antianginal, antiarrhythmic. The decrease in blood pressure is due to a decrease in cardiac output, bcc, OPSS, inhibition of renin formation, partial loss of sensitivity of baroreceptors. The hypotensive effect usually develops after 1-2 weeks and stabilizes within 4 weeks. Lowers heart rate at rest and during exercise, left ventricular diastolic blood pressure, improves diastolic filling of the heart, reduces myocardial oxygen demand (antanginal activity), reduces myocardial mass and myocardial mass index. Does not adversely affect lipid metabolism. When taken orally, it is rapidly absorbed. Excreted by the kidneys and intestines. Penetrates through the BBB, secreted into breast milk.

Indications for use

Arterial hypertension (monotherapy or in combination with other antihypertensive drugs), ischemic heart disease, exertional angina.

Contraindications

Hypersensitivity, sinus bradycardia (less than 45-50 bpm), arterial hypotension, cardiogenic shock, sick sinus syndrome; AV block II-III degree, treatment-refractory severe heart failure; peripheral circulatory disorders, sinoatrial blockade, liver dysfunction, bronchial asthma, bronchospasm, pregnancy, breastfeeding, childhood. Restrictions on use: Tendency to bradycardia, diabetes mellitus, hyperthyroidism, psoriasis, aggravated allergic history, old age (over 75 years).

Side effect

From the nervous system and sensory organs: headache, dizziness, fatigue (weakness), paresthesia; depression, nightmares; transient visual impairment. From the digestive tract: nausea, vomiting, constipation; flatulence, diarrhea. From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): symptomatic bradycardia, AV blockade, hypotension, heart failure, exacerbation of intermittent claudication. Other: skin reactions, bronchospasm.

Interaction

Calcium channel blockers increase the blockade of AV conduction, class I antiarrhythmics and amiodarone prolong the time of excitation through the atria. Narcotic drugs (cyclopropane, ether, trichlorethylene), tricyclic antidepressants, barbiturates, phenothiazine derivatives potentiate hypotension, cimetidine and nicardipine increase plasma concentration, sympathomimetics level the activity.

Overdose

Symptoms: bradycardia, arterial hypotension, bronchospasm, acute heart failure. Treatment: gastric lavage, activated charcoal, the appointment of laxatives; possible mechanical ventilation and the introduction of atropine (with bradycardia and increased vagotonia), plasma or plasma substitutes, if necessary - catecholamines. To stop the beta-adrenergic blocking action - isoprenaline hydrochloride, dobutamine, in the absence of effect - glucagon. With AV blockade - transvenous stimulation.

Method of application and dosage

Inside, regardless of the meal, drinking plenty of liquid at the same time of day. The average daily dose is 2.5-5 mg. Patients with renal insufficiency or patients over 65 years of age are recommended at an initial dose of 2.5 mg / day; if necessary, the daily dose can be increased to 10 mg. Patients with stage I hypertension admitted to flight practice: the initial dose is 2.5 mg 1 time per day (in the morning, from 7-11 am). In the future (not earlier than after 2 weeks), with good tolerance, increase the dose to the recommended working dose - 5 mg / day.

special instructions

Stop therapy should be gradual (within 1-2 weeks). A decrease in heart rate to 55 bpm requires a dose reduction. Against the background of diabetes mellitus, masking of signs of hypoglycemia is possible, with hyperfunction of the thyroid gland - tachycardia. May increase reactions to pollen and other allergens. It should be canceled 24 hours before surgery using general anesthesia (including surgical dentistry) or choose an anesthetic with the least negative inotropic effect. If it is necessary to simultaneously prescribe antacids, nebivolol is taken with meals, and antacids between meals. Use with caution during work for drivers of vehicles and people whose profession is associated with increased concentration of attention. At the time of treatment, it is recommended to exclude alcohol.

Storage conditions

List B. At a temperature not higher than 25 gr. FROM.

The heart rate decreases after taking this medicine. So, let's take a closer look at the instructions for using Nebilet, reviews of cardiologists and patients about it, prices and analogues.

Features of the drug

In international medical practice, the drug has generic name Nebivolol. The term Nebival is also used as a synonym.

Compound

The drug Nebilet in 2 tablets contains 5.45 mg of micronized Nebivolol hydrochloride (this number corresponds to the content of 5 mg of nebivolol). To give taste and for other medical purposes, the following additional substances are also used in the composition of the drug:

• lactose;
• hypromellose;
• cellulose;
• cornstarch and some others.

Dosage forms

The drug is produced in the form of round white tablets, in the middle of which there is a cross-shaped notch for the possibility of separating the pill. The box contains 1-2 or 4 blisters, each of which consists of 7 or 14 tablets.

As for the cost, depending on the manufacturer, it can vary significantly. So, for example, Nebilet No. 28 in Moscow pharmacies costs an average of 1010 rubles, and the same drug with Sandoz No. 14 is 254 rubles.

Pharmacological action and pharmacodynamics

• It is a cardioselective β1-blocker that has hypotensive, antiarrhythmic, and antianginal effects.
• Helps to lower blood pressure both in a state of stress or strong physical activity, and at rest.
• Due to the selective form of action, the drug selectively blocks postsynaptic β1-adrenergic receptors. Due to this, such receptors become inaccessible to catecholamines.
• There is also a modulation of the release of endothelial nitric oxide. This action leads to the expansion of blood vessels.
• In addition, the activity of the renin-angiotensin-aldosterone system decreases, thereby causing a hypertensive effect. After 1-2 weeks of constant intake, the patient should feel a positive trend. The greatest effect on lowering blood pressure can usually be achieved after 1-2 months.
• The drug helps to reduce myocardial oxygen demand, reduces both the frequency and quality.
• As for the antiarrhythmic properties, in the process of taking this beta1-blocker, the pathological automatism of the “motor” is suppressed, and AV conduction slows down.

Pharmacokinetics

• Suction. Both enantiomers are rapidly absorbed after taking the tablet by mouth, regardless of the meal, as it does not affect absorption. Bioavailability is about 12% in those who can boast of an accelerated metabolism, in the same patients who got a "slow" metabolism, bioavailability is almost complete.
• Distribution. These enantiomers are mostly associated with albumin.
• Metabolism the active substance of the drug occurs through alicyclic and aromatic hydroxylation.
• breeding residues occurs through the kidneys and intestines.

It is excreted by the kidneys (38%) and through the intestines (48%).

Indications for the use of Nebilet

The drug is used in the treatment of patients with the following ailments of the cardiovascular system:

• arterial hypertension;
• , seizures ;
• , as part of a combination therapy together with ACE inhibitors and other drugs.

Women "in position" the drug can be shown only in the case when the benefits of taking the medicine outweigh the potential harm or risk of such harm to the health of the fetus, since he may also develop hypertension. If therapy is nevertheless prescribed, then the doctor must carefully monitor the uteroplacental blood flow and the growth of the unborn child. Before childbirth for 2-3 days, the drug is stopped taking.

During lactation, taking the drug is undesirable, or the child is not allowed to consume such milk.

Now consider the instructions for the drug Nebilet.

Instruction

As for the dosage, doctors usually prescribe Nebilet to the patient once a day (regardless of food intake). It is highly desirable to use the drug every day at the same time. Each tablet of Nebilet is taken orally with water.

Depending on the type of disease, the dosage may vary:

• For the treatment of arterial hypertension and coronary artery disease, 0.5-1 tablet per day is prescribed.
• With combined treatment of CHF, taking tablets begins with a minimum dose (1.25 mg), with a gradual increase once a week or two under the vigilant supervision of a doctor.
• If the patient has renal insufficiency, as well as those whose age is more than 65 years, 0.5 tablets are prescribed with a gradual increase to a maximum of 2 pieces per day.
• With IHD, the dosage of the drug is similar to the treatment of arterial hypertension and is 0.5-1 tablet per day.

The attending physician should monitor the patient within 2 hours after the first dose of the drug, as well as in the case of an increase in dosage.

The maximum allowable daily dose of the drug is 10 mg.

Contraindications

Like any drug, Nebilet has contraindications, namely:

• CHF at the stage of decompensation;
• systolic blood pressure is less than 90 mm Hg. column;
• and other SSSUs;
• AV blockade of the second and third degrees;
• severe ailments and impaired liver function;
• past bronchospasm/bronchial asthma;
• bradycardia;
• serious;
• impotence, myasthenia gravis;
• metabolic acidosis;
• pheochromocytoma;
• depressive state.

In addition, there are “non-painful” factors, such as:

• lactose intolerance;
• age less than 18 years;
• high sensitivity to the substances that make up the drug.

This drug should be used with extreme caution in people with:

• kidney failure;
• allergies and psoriasis;
• AV blockade of the first degree;
• diabetes mellitus;
• hyperthyroidism,
• chronic obstructive pulmonary disease.

Also, special attention should be paid when taking the medicine if the patient has already reached the age of 75.

Side effects

For a better understanding, the possible side effects have been presented in the form of a table:

special instructions

In the event that an overdose of a β-adrenergic blocker has occurred in a patient, it may manifest itself.