Bisogamma
Bisogamma: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Bisogamma
ATX code: C07AB07
Active ingredient: bisoprolol (bisoprolol)
Producer: Mauermann Arzneimittel KG (Germany), Artesan Pharma (Germany), SC Magistra C&C (Romania)
Description and photo update: 2019-26-08
Prices in pharmacies: from 100 rubles.
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Bisogamma is a drug from the group of selective beta-blockers used to treat hypertension.
Release form and composition
The drug is produced in the form of film-coated tablets (10 pcs. In blisters, 3 or 5 blisters in a cardboard box).
The main active ingredient of Bisogamma is bisoprolol hemifumarate, in 1 tablet - 5 or 10 mg.
Excipients: pregelatinized starch, crospovidone, microcrystalline cellulose, colloidal silicon dioxide, macrogol, magnesium stearate, titanium dioxide, talc, hypromellose, iron dye yellow oxide.
Pharmacological properties
Pharmacodynamics
Bisoprolol is a selective β 1 -adrenergic blocker without intrinsic sympathomimetic activity; it has no membrane stabilizing effect. Reduces myocardial oxygen demand, lowers blood plasma renin activity, and reduces heart rate both during exercise and at rest. It has antianginal, hypotensive and antiarrhythmic effects.
The effects of bisoprolol, which are provided by blocking β 1 -adrenergic receptors of the heart when used in low doses:
- reduction of catecholamine-stimulated formation of cAMP (cyclic adenosine monophosphate) from ATP (adenosine triphosphate);
- decrease in the intracellular current of calcium ions;
- negative dromo-, chrono-, ino- and batmotropic action.
With an increase in the dose to exceed the therapeutic dose, bisoprolol has a β 2 -adrenoceptor blocking effect.
In the first 24 hours of therapy, there is an increase in the total peripheral vascular resistance (due to a reciprocal increase in the activity of α-adrenergic receptors and the elimination of stimulation of β 2 -adrenergic receptors). After 1–3 days, the indicator returns to the initial value, and with prolonged therapy, it decreases.
The development of the hypotensive effect is associated with a decrease in the minute blood volume, a decrease in the activity of the renin-angiotensin system (especially important for patients with initial hypersecretion of renin), sympathetic stimulation of peripheral vessels, an effect on the central nervous system and restoration of sensitivity in response to a decrease in blood pressure.
The therapeutic effect in arterial hypertension is observed after 2–5 days of taking Bisogamma, the development of a stable effect - after 1–2 months.
The antianginal effect of bisoprolol is due to a decrease in myocardial oxygen demand (as a result of a decrease in heart rate and a decrease in contractility), an improvement in myocardial perfusion, and an increase in diastole. Due to an increase in the end-diastolic pressure in the left ventricle and an increase in the stretching of the muscle fibers of the ventricles, oxygen demand can increase, especially against the background of chronic heart failure.
Antiarrhythmic properties are associated with the elimination of arrhythmogenic factors (arterial hypertension, increased activity of the sympathetic nervous system, tachycardia, increased cAMP content), a decrease in the rate of spontaneous excitation of ectopic and sinus pacemakers, and a slowdown in AV conduction (mainly in the antegrade and, to a lesser extent, in the retrograde directions) through the atrioventricular node).
Unlike nonselective β-blockers, Bisogamma, when used in moderate therapeutic doses, has a less pronounced effect on organs that contain β 2 -adrenergic receptors (including the pancreas, skeletal muscles, smooth muscles of peripheral arteries, uterus and bronchi), and on carbohydrate metabolism … Bisoprolol does not cause retention of sodium ions in the body. Does not differ from propranolol in the severity of atherogenic action.
Pharmacokinetics
After oral administration, bisoprolol is absorbed at the level of 80–90%. Food intake does not affect this indicator. The time to reach C max (maximum concentration of the substance) in blood plasma ranges from 1 to 3 hours.
Plasma protein binding is approximately 30%. It penetrates slightly through the blood-brain and placental barriers. It is excreted in breast milk in small quantities.
Half of the dose taken is metabolized in the liver, with the formation of metabolites that do not have activity. The kidneys excrete 50% of the substance unchanged. T 1/2 (half-life) is 10-12 hours.
Indications for use
According to the instructions, Bisogamma has the following indications for use:
- Arterial hypertension;
- Ischemic heart disease (for the prevention of angina attacks).
Contraindications
The use of Bisogamma is contraindicated in pulmonary edema, collapse, acute and chronic heart failure (in the stage of decompensation), atrioventricular blockade 2-3 degrees, bradycardia, cardiomegaly, shock, severe forms of bronchial asthma, chronic obstructive pulmonary disease, pheochromocytoma, depression, Raynaud's disease.
In addition, Bisogamma should not be taken by persons under the age of 18 and patients with hypersensitivity to the components of the drug and to other beta-blockers.
The drug should be used with caution in chronic renal failure, liver failure, thyrotoxicosis, diabetes mellitus, psoriasis.
It is possible to take the drug during pregnancy if the potential benefit of the treatment is higher than the risk of side effects in the fetus.
Instructions for the use of Bisogamma: method and dosage
Bisogamma tablets are taken once in the morning on an empty stomach. They start with a dosage of 5 mg, which, if necessary, can be increased to 10 mg.
The maximum daily dose is 20 mg, for patients with impaired renal (or liver) function - 10 mg.
Side effects
The use of Bisogamma can cause the following side effects:
- From the nervous system: weakness, fatigue, dizziness, sleep disturbance, depression, tremor, convulsions;
- From the side of the cardiovascular system: bradycardia, AV blockade, aggravation of chronic heart failure, orthostatic hypotension, peripheral angiospasm (cold extremities, Raynaud's syndrome);
- From the gastrointestinal tract: dry mucous membranes, nausea, stool disturbance, change in taste;
- From the respiratory system: difficulty breathing (when using high doses of Bisogamma), bronchospasm (in patients predisposed to it), nasal congestion;
- From the senses: blurred vision, soreness and dryness of the eyes, conjunctivitis;
- On the part of laboratory parameters: it is possible - a decrease in the number of platelets in the peripheral blood, agranulocytosis, leukopenia (a decrease in the number of leukocytes in the blood), an increase in the activity of liver enzymes (ALT, AST).
In addition, allergic reactions are possible in the form of urticaria, rash, itching.
Overdose
The main symptoms: bronchospasm, severe bradycardia, ventricular premature beats, atrioventricular block, dizziness, convulsions, fainting, marked decrease in blood pressure, cyanosis of fingernails or palms, chronic heart failure, difficulty breathing.
Therapy: gastric lavage and the use of adsorbents.
Symptomatic treatment (carried out depending on the indications):
- atrioventricular blockade: epinephrine, atropine (intravenous administration in a dose of 1-2 mg), or setting a temporary pacemaker;
- lowering blood pressure: the patient must be in the Trendelenburg position (lying on his back at an angle of 45 ° with the pelvis raised in relation to the head); in the absence of signs of pulmonary edema, intravenous administration of plasma-substituting solutions is indicated, if they are ineffective, epinephrine, dopamine, dobutamine are administered (to maintain inotropic and chronotropic action and eliminate a pronounced decrease in blood pressure);
- ventricular premature beats: lidocaine (class IA drugs cannot be used);
- heart failure: diuretics, cardiac glycosides, glucagon;
- bronchospasm: β 2 -adrenostimulants (inhalation);
- convulsions: diazepam (intravenous administration).
special instructions
In the case of the appointment of Bisogamma, it is necessary to monitor blood pressure and heart rate (HR) (at the beginning of therapy - every day, then once every 3 months). If the heart rate is less than 50 beats per minute, you should immediately consult a doctor. ECG monitoring is also necessary, and patients with diabetes should be monitored for blood sugar levels.
In smokers, the effectiveness of Bisogamma is lower.
In case of lung diseases, a study of the function of external respiration is recommended before starting the drug.
Bisogamma alters the effectiveness of insulin therapy and oral hypoglycemic drugs and may mask the symptoms of hypoglycemia.
The antihypertensive effect of this drug is reduced by non-steroidal anti-inflammatory drugs, glucocorticoids and estrogens.
The use of Bisogamma in combination with cardiac glycosides, calcium channel blockers and antiarrhythmic drugs increases the risk of developing bradycardia, AV blockade.
Bisogamma should not be used in conjunction with MAO inhibitors.
Simultaneous administration of the drug with antidepressants and antipsychotic drugs can increase the depression of the central nervous system.
Influence on the ability to drive vehicles and complex mechanisms
During the period of taking Bisogamma while driving, patients should be careful.
Application during pregnancy and lactation
Bisogamma during pregnancy / lactation can be used only in cases where the benefits expected from therapy outweigh the potential risk.
Pediatric use
Bisogamma therapy is contraindicated in patients under 18 years of age.
With impaired renal function
Patients with chronic renal failure should take Bisogamma with caution.
The maximum daily dose in patients with impaired renal function (CC <20 ml / min) is 10 mg.
For violations of liver function
Patients with hepatic impairment should take Bisogamma with caution.
The maximum daily dose in patients with severe hepatic impairment is 10 mg.
Use in the elderly
Bisogamma therapy in elderly patients should be carried out under medical supervision.
Drug interactions
Possible interactions:
- monoamine oxidase inhibitors: the hypotensive effect of bisoprolol is significantly enhanced; combined use is not recommended, the interval between the use of these drugs should be at least 14 days;
- iodine-containing X-ray contrast agents for intravenous administration: the risk of anaphylactic reactions increases;
- allergens used for immunotherapy or allergen extracts for skin tests: the likelihood of severe systemic allergic reactions or anaphylaxis increases;
- phenytoin (intravenous administration), drugs for inhalation general anesthesia (hydrocarbon derivatives): increases the severity of the cardiodepressant effect and the likelihood of lowering blood pressure;
- insulin, oral hypoglycemic drugs: their effectiveness changes, and with combination therapy, symptoms of developing hypoglycemia are masked (in the form of tachycardia, increased blood pressure);
- lidocaine, xanthines (excluding diphylline): their clearance decreases, and plasma concentration increases, especially in patients with an initially increased clearance of theophylline associated with smoking;
- non-steroidal anti-inflammatory drugs, glucocorticosteroids and estrogens: the hypotensive effect of bisoprolol decreases;
- methyldopa, cardiac glycosides, reserpine and guanfacine, slow calcium channel blockers (diltiazem, verapamil), amiodarone and other antiarrhythmics: the likelihood of the appearance / aggravation of AV blockade, bradycardia, heart failure and cardiac arrest increases;
- nifedipine: there may be a significant decrease in blood pressure;
- non-depolarizing muscle relaxants: their effect is prolonged;
- coumarins: the duration of their anticoagulant effect increases;
- tetra- and tricyclic antidepressants, ethanol, antipsychotic drugs (antipsychotics), drugs with hypnotic and sedative effects: the inhibitory effect of bisoprolol on the central nervous system is enhanced;
- diuretics, sympatholytics, clonidine, hydralazine and other antihypertensive drugs: there may be an excessive decrease in blood pressure;
- non-hydrogenated ergot alkaloids (including ergotamine): the likelihood of peripheral circulatory disorders increases;
- rifampicin: T 1/2 of bisoprolol decreases;
- sulfasalazine: the plasma concentration of bisoprolol in the blood increases.
Analogs
Bisogamma analogs are: Concor, Bisokard, Coronal, Biprol, Aritel, Cordinorm, Bidop, Biol.
Storage conditions and periods
Store no more than 3 years at an air temperature not exceeding 25 ° C.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Bisogamma
According to reviews, Bisogamma is an effective drug. The main disadvantage is considered a large list of contraindications and side effects. The cost in most cases is assessed as affordable.
Price for Bisogamma in pharmacies
The approximate price for Bisogamma is 70-135 rubles. (30 tablets 5 mg each) or 112-222 rubles. (30 tablets, 10 mg each).
Bisogamma: prices in online pharmacies
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Drug name Price Pharmacy |
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Bisogamma 5 mg film-coated tablets 30 pcs. RUB 100 Buy |
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Bisogamma tablets p.o. 5mg 30 pcs. RUB 104 Buy |
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Bisogamma 5 mg film-coated tablets 30 pcs. RUB 105 Buy |
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Bisogamma 10 mg film-coated tablets 30 pcs. 156 r Buy |
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Bisogamma tablets p.o. 10mg 30 pcs. 172 r Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
