Carvedilol pills 12.5 mg №30

Indications

- arterial hypertension (in monotherapy and combination with diuretics);

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

- CHD: stable angina.

Dosage and administration

Inside, regardless of the meal.

To ensure the following dosing regimen, it is possible to use the drug Carvedilol in the dosage form of a 6.25 mg tablet.

Arterial hypertension

The initial dose is 6.25-12.5 mg 1 time per day in the first two days of treatment. Then - 25 mg 1 time / day. In case of insufficiency of the antihypertensive effect after 2 weeks of therapy, the dose can be increased by 2 times. The maximum recommended dose of the drug is 50 mg 1 time / day (possibly divided into 2 doses).

Coronary heart disease

The initial dose is 12.5 mg 2 times / day for the first two days of treatment. Then - 25 mg 2 times / day. In case of insufficiency of antianginal effect after 2 weeks of therapy, the dose can be increased by 2 times. The maximum recommended daily dose of the drug is 100 mg, divided into 2 doses.

Chronic heart failure

The dose is selected individually, under the close supervision of a doctor. The recommended initial dose is 3.125 mg 2 times / day for 2 weeks. With good tolerance, the dose is increased at intervals of at least 2 weeks to 6.25 mg 2 times / day, then to 12.5 mg 2 times / day, then to 25 mg 2 times / day. The dose should be increased to the maximum, which is well tolerated by patients.Have patients weighing less than 85 kg target dose is 50 mg / day; at patients weighing more than 85 kg target dose of 75-100 mg / day.

Adverse effects

From the side of the central nervous system: dizziness, headache (usually not severe, and at the beginning of treatment), loss of consciousness, myasthenia gravis (more often at the beginning of treatment), fatigue, depression, sleep disturbance, paresthesia.

Since the cardiovascular system: bradycardia, orthostatic hypotension, AV-blockade II - III stage, rarely - a violation of the peripheral circulation, the progression of heart failure (in the period of
doses), edema of the lower extremities, angina pectoris, marked reduction in blood pressure.

From the digestive system: dry mouth, nausea, diarrhea or constipation, vomiting, abdominal pain, loss of appetite, increased activity of liver transaminases.

From the hemopoietic system: rarely - thrombocytopenia, leukopenia.

Metabolism: weight gain, impaired carbohydrate metabolism.

Allergic reactions: allergic skin reactions, exacerbation of psoriasis, nasal congestion.

On the part of the respiratory system: shortness of breath and bronchospasm (in predisposed patients).

Other: blurred vision, reduced tearing, flu-like syndrome, sneezing, myalgia, arthralgia, pain in the limbs, intermittent claudication; rarely - urination disorders, renal dysfunction.

Contraindications

- acute and decompensated chronic heart failure, requiring IV injection of inotropic drugs;

- severe liver failure;

- AV blockade II-III century;

- severe bradycardia (less than 50 beats / min);

- sick sinus syndrome;

- arterial hypotension (systolic blood pressure less than 85 mm Hg. Art.);

- cardiogenic shock;

- bronchial asthma;

- Chronic obstructive pulmonary disease;

- age up to 18 years (efficiency and safety have not been established);

- Hypersensitivity to carvedilol or other components of the drug.

WITH caution: bronchospastic syndrome, chronic bronchitis, pulmonary emphysema, Prinzmetal's stenocardia, thyrotoxicosis, occlusive peripheral vascular diseases, pheochromocytoma, psoriasis, renal failure, AV-block I degree, extensive surgical intervention and general anesthesia, diabetes mellitus, hypoglymia, and hypoglymia.

Use during pregnancy and lactation

Controlled studies of the use of carvedilol in pregnant women have not been conducted, therefore, the appointment of the drug in this category of patients is possible only in cases where the benefit to the mother outweighs the potential risk to the fetus.

Breastfeeding during carvedilol treatment is not recommended.

Application for violations of the liver

Contraindicated in severe liver failure.

Application for violations of kidney function

With care - at a renal failure.

Use in children

Contraindicated in children under 18 years.

Use in elderly patients

Carefully.

Special notes

Therapy should be carried out for a long time and should not stop abruptly, especially in patients with coronary heart disease, as this can lead to a worsening of the course of the underlying disease. If necessary, dose reduction of the drug should be gradual, within 1-2 weeks.

At the beginning of carvedilol therapy or with an increase in the dose of the drug in patients, especially the elderly, there may be an excessive decrease in blood pressure, mainly when getting up. Correction of the dose of the drug. In patients with chronic heart failure in the selection of the dose may increase the symptoms of heart failure, the appearance of edema. You should not increase the dose of carvedilol, it is recommended the appointment of large doses of diuretics until the patient's condition stabilizes.

Constant monitoring of the electrocardiogram and blood pressure is recommended while simultaneously administering carvedilol and slow Calcium channel blockers, phenylalkylamine derivatives (verapamil) and benzodiazepine (diltiazem), as well as class I antiarrhythmic drugs.

It is recommended to monitor renal function in patients with chronic renal failure, arterial hypotension, and chronic heart failure.

In the case of surgery using general anesthesia, the anesthesiologist should be warned about prior carvedilol therapy.

Carvedilol does not affect the concentration of glucose in the blood and does not cause changes in the glucose tolerance test in patients with insulin-dependent diabetes mellitus.

During the period of treatment avoid the use of ethanol.

Patients with pheochromocytoma should be given alpha-blockers before therapy.

Patients wearing contact lenses should be aware that the drug may cause a decrease in tearing.

Influence on ability to drive motor transport and control mechanisms

It is not recommended to drive a car at the beginning of therapy and with increasing doses of carvedilol. It should refrain from other activities related to the need for high concentration of attention and quick psychomotor reactions.

Overdosage

Symptoms: decrease in blood pressure (accompanied by dizziness or fainting), bradycardia. Dyspnea due to bronchospasm and vomiting may occur. In severe cases, cardiogenic shock, respiratory failure, confusion, conduction disturbances are possible.

Treatment: it is necessary to monitor and correct vital indicators, if necessary, in the intensive care unit. Treatment is symptomatic. It is advisable intravenous administration of m-cholinoblockers (atropine), adrenomimetics (epinephrine, norepinephrine).

Drug interaction

Carvedilol can potentiate the action of other concurrently taking antihypertensive drugs or drugs that have a hypotensive effect (nitrates).

When combined with carvedilola and diltiazem cardiac conduction and hemodynamic disturbances may develop.

While taking carvedilola and digoxin the concentration of the latter increases and the time of atrioventricular conduction may increase.

Carvedilol may potentiate action insulin and oral hypoglycemic agents, however, the symptoms of hypoglycemia (especially tachycardia) can be masked, therefore, in patients with diabetes mellitus, regular monitoring of blood sugar levels is recommended.

Inhibitors of microsomal oxidation (cimetidine) enhance, and inductors (phenobarbital, rifampicin) weaken the hypotensive effect of carvedilol.

Catecholamine Reducing Agents (reserpine, monoamine oxidase inhibitors), increase the risk of arterial hypotension and severe bradycardia.

With simultaneous use cyclosporine the concentration of the latter increases (correction of the daily dose of cyclosporine is recommended).

Simultaneous appointment clonidine can potentiate the antihypertensive and cardiovascular effects of carvedilol.

General anesthetics enhance the negative inotropic and hypotensive effect of carvedilol.

Terms and conditions of storage

List B. Store in a dry, dark place at a temperature not higher than 25 ° C. Keep out of the reach of children.