Bisoprolol-Prana
Bisoprolol-Prana: 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: Bisoprolol-Prana
ATX code: C07AB07
Active ingredient: bisoprolol (bisoprolol)
Producer: Pranafarm (Russia), Prana LLC (Russia)
Description and photo update: 2018-25-10
Prices in pharmacies: from 43 rubles.
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Bisoprolol-Prana is a selective beta1-blocker.
Release form and composition
Dosage form Bisoprolol-Prana - film-coated tablets: 5 mg - light yellow, with a line; 10 mg - light orange in color, scored. The cross section shows two layers: a film shell and an inner layer - almost white or white.
Packing of tablets: blisters - 10 pcs., In a cardboard box 1, 2, 3 or 4 packages; polymer cans - 50, 60, 70, 80, 90 or 100 pcs., 1 can in a cardboard box.
Composition for 1 tablet:
- active ingredient: bisoprolol hemifumarate (fumarate), in 1 tablet - 5 or 10 mg;
- additional substances: colloidal silicon dioxide, magnesium stearate, corn starch, crospovidone, microcrystalline cellulose, anhydrous calcium hydrogen phosphate;
- film shell: dimethicone 100, titanium dioxide, macrogol-400, tablets 5 mg - iron dye yellow oxide; tablets 10 mg - iron oxide red dye.
Pharmacological properties
Pharmacodynamics
Bisoprolol hemifumarate is a selective beta1-blocker that does not have its own sympathomimetic activity and does not have a membrane stabilizing effect.
The drug reduces the activity of blood plasma renin, slows down the heart rate (both at rest and during exercise), reduces myocardial oxygen demand. It has antiarrhythmic, antianginal and hypotensive effects. When used in low doses, it blocks beta1-adrenergic receptors of the heart, thereby reducing the formation of cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP) stimulated by catecholamines. It has a negative batmo-, dromo-, chrono- and inotropic effect. Reduces atrioventricular conductivity and excitability, as well as the intracellular current of calcium ions (Ca 2+).
When the recommended therapeutic doses are exceeded, it has a beta2-adrenergic blocking effect.
In the first 24 hours of using the drug, the total peripheral vascular resistance increases, after 1–3 days it returns to its initial value, with prolonged use it decreases.
The hypotensive effect of Bisoprolol-Prana is due to its ability to reduce the minute blood volume, stimulate peripheral vessels, and affect the central nervous system. It is also associated with the restoration of sensitivity in response to a decrease in blood pressure (blood pressure). With arterial hypertension, improvement is noted after 2–5 days, a stable effect - after 1–2 months.
The antianginal effect of the drug is due to its ability to lengthen diastoles and improve myocardial perfusion, as well as to slow down the heart rate and reduce myocardial contractility, as a result of which myocardial oxygen demand decreases.
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 may increase in some patients, especially with concomitant chronic heart failure.
Bisoprolol hemifumarate, used in medium therapeutic doses, in contrast to non-selective beta-blockers, has a less pronounced effect on carbohydrate metabolism and organs with beta2-adrenergic receptors (skeletal muscles, pancreas, smooth muscles of the bronchi, peripheral arteries and uterus).
The severity of the atherogenic effect of bisoprolol does not differ from that of propranolol.
Bisoprolol-Prana does not cause retention of sodium ions (Na +) in the body.
Pharmacokinetics
After oral administration, bisoprolol is absorbed by 80–90% from the gastrointestinal tract. Food does not affect absorption. The maximum concentration in the blood reaches within 1-3 hours. It is characterized by a low binding to plasma proteins (about 30%) and a low ability to penetrate the placental and blood-brain barriers.
About 50% of the dose taken is metabolized in the liver to form inactive metabolites. Approximately 98% is excreted by the kidneys (50% of them - unchanged), no more than 2% - with bile through the intestines.
Indications for use
According to the instructions, Bisoprolol-Prana is intended for the treatment of arterial hypertension.
Also, the drug is used to prevent attacks of angina pectoris in patients with ischemic heart disease.
Contraindications
Absolute:
- arterial hypotension (systolic blood pressure less than 100 mm Hg, especially in myocardial infarction);
- chronic heart failure in the stage of decompensation;
- severe bradycardia;
- acute heart failure;
- cardiomegaly (no signs of heart failure);
- sinoatrial blockade;
- atrioventricular (AV) block II-III degree;
- Prinzmetal's angina;
- sick sinus syndrome;
- severe forms of bronchial asthma and a history of chronic obstructive pulmonary disease;
- pulmonary edema;
- collapse;
- shock (including cardiogenic);
- metabolic acidosis;
- Raynaud's disease;
- late stages of peripheral circulatory disorders;
- pheochromocytoma (without the simultaneous use of alpha-blockers);
- age up to 18 years;
- concomitant use of monoamine oxidase inhibitors (except for type B);
- hypersensitivity to the components of Bisoprolol-Prana or other beta-blockers.
Relative:
- AV blockade I degree;
- chronic renal failure;
- liver failure;
- a history of allergic reactions;
- diabetes;
- thyrotoxicosis;
- myasthenia gravis;
- psoriasis;
- depression;
- elderly age.
Instructions for use of Bisoprolol-Prana: method and dosage
Bisoprolol-Prana should be taken orally 1 time a day, in the morning on an empty stomach, swallowing the tablets whole.
The doctor selects the optimal dose individually, taking into account the heart rate and therapeutic response.
At the beginning of therapy, adult patients are prescribed 5 mg. If the effect is insufficient, the dose is increased to 10 mg once.
The maximum daily dose of Bisoprolol-Pran should not exceed 20 mg, for patients with impaired renal function and severe hepatic impairment - 10 mg.
Side effects
- on the part of the cardiovascular system: chest pain, manifestation of angiospasm (cooling of the lower extremities, increased disturbance of peripheral circulation, Raynaud's syndrome), arrhythmias, decreased blood pressure, impaired myocardial conduction, sinus bradycardia, weakening of myocardial contractility, palpitations, orthostatic hypotension, development or worsening of chronic heart failure (shortness of breath, swelling of the ankles / feet), atrioventricular block (up to the development of complete transverse blockade and cardiac arrest);
- from the central and peripheral nervous system: myasthenia gravis, tremor, asthenia, anxiety, headache, fatigue, sleep disorders, dizziness, depression, weakness, paresthesia in the extremities (with concomitant intermittent claudication or Raynaud's syndrome), hallucinations, confusion or short-term memory loss, cramps (including the calf muscles);
- from the respiratory system: nasal congestion; when prescribed in high doses and / or in predisposed patients - difficulty breathing, laryngo- and bronchospasm;
- from the digestive system: changes in taste, abdominal pain, dryness of the oral mucosa, diarrhea / constipation, nausea, vomiting, liver dysfunction (yellowness of the sclera / skin, dark urine, cholestasis);
- from the endocrine system: hypothyroidism; in patients receiving insulin - hypoglycemia; in patients with non-insulin dependent diabetes - hyperglycemia;
- on the part of the organ of vision: a decrease in the secretion of lacrimal fluid, visual impairment, conjunctivitis, dryness and soreness of the eyes;
- on the part of the skin: psoriasis-like skin reactions, skin flushing, increased sweating, alopecia, exacerbation of psoriasis symptoms, exanthema;
- allergic reactions: skin rashes, itching, urticaria;
- laboratory parameters: agranulocytosis, thrombocytopenia (unusual hemorrhages and bleeding), leukopenia, changes in triglyceride and bilirubin levels, increased activity of liver enzymes (alanine aminotransferase, aspartate aminotransferase);
- others: withdrawal syndrome (increased blood pressure, increased angina attacks), arthralgia, back pain, decreased potency, weakened libido;
- effect on the fetus: hypoglycemia, intrauterine growth retardation, bradycardia.
Overdose
Symptoms: dizziness, fainting, cyanosis of fingernails or palms, marked decrease in blood pressure, severe bradycardia, ventricular AV block, extrasystole, arrhythmia, chronic heart failure, difficulty breathing, bronchospasm, convulsions.
After a recent intake of too high a dose, gastric lavage and absorption of adsorbents are recommended. Further treatment is symptomatic.
In the case of a decrease in blood pressure, the patient should take the Trendelenburg position (lying on his back at an angle of 45 ° with the pelvis raised in relation to the head). If there are no signs of pulmonary edema, plasma-substituting solutions are injected intravenously, if ineffective - dopamine, epinephrine, dobutamine (to eliminate a pronounced decrease in blood pressure, maintain ino- and chronotropic action).
In case of bronchospasm, beta2-adrenostimulants are prescribed by inhalation; with ventricular premature beats - lidocaine (the use of class IA drugs is contraindicated); with heart failure - glucagon, diuretics, cardiac glycosides; for convulsions - intravenous diazepam; with AV blockade - intravenous administration of atropine (1-2 mg), epinephrine, or a temporary setting of a pacemaker is recommended.
special instructions
During treatment, it is necessary to monitor blood pressure and heart rate (at the beginning of therapy - every day, then - every 3-4 months), an electrocardiogram. Patients with diabetes mellitus are shown to determine the concentration of glucose in the blood - every 4–5 months. In elderly patients, it is necessary to monitor renal function - every 4–5 months.
Patients who are prescribed Bisoprolol-Prana should be trained in the method of calculating the heart rate (HR) and instructed to consult a doctor if this indicator is less than 50 beats per minute.
In patients with a burdened bronchopulmonary history, it is recommended to conduct a study of the function of external respiration before prescribing the drug.
With thyrotoxicosis, bisoprolol can mask some of the clinical signs of this disease (for example, tachycardia). Abrupt withdrawal of therapy is contraindicated in such patients, since symptoms may increase.
In diabetes mellitus, Bisoprolol-Prana can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, bisoprolol practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose levels to normal levels.
If an effective alpha-blockade is not previously achieved in patients with pheochromocytoma, bisoprolol increases the risk of developing paradoxical arterial hypertension.
Against the background of a burdened allergic history, there is a likelihood of an increase in the severity of hypersensitivity reactions and the lack of effect from the use of conventional doses of epinephrine.
Beta-blockers are ineffective in about 20% of patients with angina pectoris. The most common causes are severe coronary atherosclerosis with a low ischemic threshold (heart rate less than 100 beats / minute) and an increased left ventricular end-diastolic volume, which disrupts subendocardial blood flow.
The effectiveness of beta-blockers is reduced by smoking.
It is necessary to cancel Bisoprolol-Prana in case of depression, as well as before conducting a study on the content of catecholamines, vanillyl mandelic acid and normetanephrine in urine and blood, as well as antinuclear antibody titers.
The drug can reduce the production of tear fluid, which should be considered in patients who use contact lenses.
When prescribing a planned surgical intervention, Bisoprolol-Prana should be canceled 48 hours before general anesthesia. If the drug was taken before the operation, the patient should be warned about this by the anesthesiologist so that he selects an anesthetic agent with the least negative inotropic effect.
Reciprocal activation of the vagus nerve is eliminated by intravenous administration of atropine at a dose of 1–2 mg.
Patients with bronchospastic diseases with intolerance and / or ineffectiveness of other antihypertensive drugs can be prescribed cardioselective beta-blockers. An overdose in them is fraught with the development of bronchospasm.
The effect of bisoprolol can be enhanced by drugs that reduce the reserves of catecholamines (including reserpine), therefore, patients receiving such combinations need careful medical supervision in order to detect a pronounced decrease in blood pressure or the development of bradycardia in time.
With increasing bradycardia in elderly patients (heart rate less than 50 beats per minute), a pronounced decrease in blood pressure (systolic below 100 mm Hg), the development of atrioventricular block, the dose of bisoprolol should be reduced or therapy should be discontinued.
Due to the risk of a withdrawal syndrome (may manifest as severe arrhythmias, myocardial infarction), Bisoprolol-Prana should be withdrawn gradually, with a dose reduction over two or more weeks (by 25% every 3-4 days).
Influence on the ability to drive vehicles and complex mechanisms
The degree of restrictions on the performance of potentially dangerous and complex types of work during drug therapy, especially at the beginning of treatment, is decided on an individual basis, after evaluating the effect of bisoprolol on the patient. The risk of dizziness must be considered.
Application during pregnancy and lactation
The use of Bisoprolol-Prana during pregnancy is not recommended, but it is possible in cases where the expected benefit to the woman outweighs the potential risks to the fetus. In exceptional cases of taking the drug during pregnancy, 72 hours before the intended delivery, bisoprolol should be canceled, since there is a risk of hypoglycemia, arterial hypotension and bradycardia in the newborn, as well as respiratory depression. If the cancellation of therapy is not possible, in the first three days the newborn should be under close medical supervision.
When drug treatment is required during lactation, breastfeeding must be discontinued.
Pediatric use
Under the age of 18, Bisoprolol-Prana is contraindicated.
With impaired renal function
Patients with chronic renal failure should be treated with caution. Do not exceed the daily dose of Bisoprolol-Pran 10 mg.
For violations of liver function
Patients with hepatic impairment should be treated with caution. Do not exceed a daily dose of 10 mg.
Use in the elderly
In old age, Bisoprolol-Prana should be used with caution. No dose adjustment is required.
Drug interactions
It should be borne in mind that bisoprolol:
- changes the effectiveness of oral hypoglycemic agents and insulin, masks the symptoms of developing hypoglycemia (tachycardia, increased blood pressure);
- decreases clearance and increases plasma concentrations of xanthines (with the exception of theophylline) and lidocaine;
- lengthens the action of non-depolarizing muscle relaxants;
- increases the anticoagulant effect of coumarins.
The antihypertensive effect of bisoprolol is weakened by estrogens, glucocorticosteroids, nonsteroidal anti-inflammatory drugs.
With the simultaneous use of nifedipine, sympatholytics, diuretics, clonidine, hydralazine or other antihypertensive drugs, an excessive decrease in blood pressure is possible.
Ethanol, antipsychotics (neuroleptics), tri- and tetracyclic antidepressants, hypnotics and sedatives increase the depression of the central nervous system.
Nonhydrogenated ergot alkaloids increase the likelihood of developing peripheral circulatory disorders, intravenous iodine-containing X-ray contrast agents - anaphylactic reactions.
With the combined use of blockers of slow calcium channels (for example, diltiazem or verapamil), cardiac glycosides, guanfacine, reserpine, methyldopa, amiodarone or other antiarrhythmic drugs, the risk of developing or aggravating existing bradycardia, AV blockade, developing heart failure, cardiac arrest increases.
Phenytoin (when used intravenously) and inhalation anesthetics, which are derivatives of hydrocarbons, increase the severity of the cardiodepressant effect, increase the likelihood of lowering blood pressure.
Rifampicin reduces the half-life of bisoprolol. Sulfasalazine increases its concentration in blood plasma.
When using ergotamine simultaneously with Bisoprolol-Prana, the risk of developing peripheral circulatory disorders increases.
For patients undergoing bisoprolol therapy, skin tests using allergen extracts and the appointment of allergens for immunotherapy are contraindicated, since it increases the risk of severe allergic reactions and anaphylaxis.
Bisoprolol-Prana is not recommended to be combined with monoamine oxidase inhibitors, since they significantly enhance its hypotensive effect. The break in the use of these funds must be at least 14 days.
Analogs
Analogs of Bisoprolol-Prana are: Bidop, Aritel, Bidop Cor, Aritel Cor, Biol, Biprol, Biprol plus, Bisoprolol, Bisomor, Bisogamma, Bisoprolol-OBL, Bisoprolol-Lugal, Bisoprolol-LEXVM, Bisoprololisopheva rati, Bisoprololis -SZ, Concor, Concor Cor, Cordinorm, Coronal, Corbis, Niperten, Cordinorm Cor, Tirez.
Terms and conditions of storage
The shelf life is 3 years.
Storage conditions: temperature up to 25 ° С, dry, dark place inaccessible to children.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Bisoprolol-Prana
According to reviews, Bisoprolol-Prana is an inexpensive but effective drug that quickly slows down the heart rate and lowers high blood pressure.
Some patients consider the disadvantages of Bisoprolol-Prana a large list of contraindications and side effects.
Price for Bisoprolol-Prana in pharmacies
The approximate price of Bisoprolol-Prana for 30 tablets per package, depending on the dosage: 5 mg - 30-60 rubles, 10 mg - 30-55 rubles.
Bisoprolol-Prana: prices in online pharmacies
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Drug name Price Pharmacy |
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Bisoprolol-Prana 5 mg film-coated tablets 30 pcs. 43 rbl. Buy |
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Bisoprolol-Prana 10 mg film-coated tablets 30 pcs. RUB 48 Buy |
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Bisoprolol-Prana 2.5 mg film-coated tablets 30 pcs. RUB 72 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!
