Aritel pills coated 5mg №30

Indications and usage

Arterial hypertension; IHD, angina pectoris, myocardial infarction (secondary prophylaxis), CHF. Rhythm disorders - sinus tachycardia, supraventricular and ventricular premature beats; arrhythmias on the background of mitral valve prolapse, thyrotoxicosis.

Contraindications

Hypersensitivity, acute HF or decompensated CHF, cardiogenic shock, AV block II-III stage, SA blockade, SSS, bradycardia (HR less than 60 beats / min - in the treatment of CHF, less than 50 / min - according to other indications), cardiomegaly ( no signs of HF), arterial hypotension (systolic blood pressure less than 100 mm Hg - in the treatment of CHF and 90 mm Hg - according to other indications), COPD (including bronchial asthma), impaired peripheral blood circulation (late stages); lactation period, simultaneous administration of MAO inhibitors (with the exception of MAO-B inhibitors).

Pregnancy and Breastfeeding

The use of the drug during pregnancy and lactation is possible only in the case when the intended benefits to the mother outweigh the potential risk to the fetus. When using Aritel during pregnancy, the fetus may have intrauterine growth retardation, hypoglycemia, bradycardia.

Dosage and administration

Aritel is taken orally, in the morning on an empty stomach, without chewing, 5-10 mg once a day.The maximum dose for adults is 20 mg / day. In patients with impaired renal function with a CC of less than 20 ml / min or with severely impaired liver function, the daily dose is 10 mg. CHF: initial dose of 1.25 mg once a day for 1 week; during the 2nd week - 2.5 mg / day, during the 3rd week - 3.75 mg; from week 4 to week 8 - 5 mg, week 9-12 - 7.5 mg; further 10 mg.

Adverse reactions

From the side of the central nervous system and peripheral nervous system: fatigue, weakness, dizziness, headache, sleep disturbance, depression, anxiety, confusion or short-term memory loss, hallucinations, asthenia, myasthenia gravis, paresthesias in the extremities (in patients with intermittent claudication and Raynaud's syndrome), tremor.
Since the cardiovascular system: sinus bradycardia, palpitations, myocardial conduction disturbances, AV-blockade (up to the development of complete transverse blockade and cardiac arrest), arrhythmias, weakening of myocardial contractility, development (worsening) of chronic heart failure (swelling of the ankles and feet, shortness of breath), decrease in blood pressure, orthostatic hypotension, manifestation of angiospasm (increased disturbance of peripheral circulation, cooling of the lower extremities, Raynaud's syndrome), chest pain.
From the digestive system: dryness of the oral mucosa, nausea, vomiting, abdominal pain, constipation or diarrhea, abnormal liver function (dark urine, jaundice of sclera and skin, cholestasis), changes in taste; changes in liver enzymes (increased ALT, ACT), bilirubin levels, triglycerides.
On the part of the respiratory system: nasal congestion, difficulty breathing when administered in high doses (loss of selectivity) and / or in susceptible patients - laryngism, bronchospasm.
On the part of the endocrine system: hyperglycemia (in patients with non-insulin dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), a hypothyroid state.
From the senses: blurred vision, decreased secretion of tear fluid, dryness and pain in the eyes, conjunctivitis.
From the hemopoietic system: thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia.
Dermatological reactions: increased sweating, skin hyperemia, rash, psoriasis-like skin reactions, exacerbation of psoriasis symptoms.
Allergic reactions: skin itch, rash, urticaria.
Other: back pain, arthralgia, decreased libido, reduced potency, withdrawal syndrome (increased angina attacks, increased blood pressure).

Special notes

Monitoring patients receiving Aritel should include measuring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), conducting an ECG, determining blood glucose in patients with diabetes mellitus (1 time 4-5 month). In elderly patients, it is recommended to monitor renal function (1 time in 4-5 months). Patient should be trained in how to calculate heart rate and instruct on the need for medical consultation with heart rate.

Allergens used for immunotherapy or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving Bisoprolol.Iodine-containing radiopaque drugs for iv administration increase the risk of Anaphylactic reactions. Phenytoin with the on / in the introduction, drugs for inhalation general anesthesia (derivatives of hydrocarbons) increase the severity of the cardiodepressive action and the likelihood of a decrease in blood pressure. Changes the effectiveness of insulin and oral hypoglycemic drugs, masks the symptoms of developing hypoglycemia (tachycardia, increased blood pressure). The hypotensive effect is weakened by NSAIDs (delayed Na + and blockade of Pg synthesis by the kidneys), GCS and estrogens (delayed Na +). Cardiac glycosides, methyldopa, reserpine and guanfacine, BMCC (verapamil, diltiazem), Amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV blockade, 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. Lengthens the action of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins. Three - and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedatives and hypnotic drugs increase the depression of the central nervous system. It is not recommended simultaneous use with MAO inhibitors due to a significant increase in the hypotensive effect, the interval in treatment between taking MAO inhibitors and bisoprolol should be at least 14 days. Unhydrogenated ergot alkaloids increase the risk of developing disorders of the peripheral circulation.Ergotamine increases the risk of developing impaired peripheral circulation; rifampicin shortens T1 / 2.

Overdosage

Symptoms: arrhythmia, ventricular premature beats, severe bradycardia, AV blockade, marked reduction in blood pressure, chronic heart failure, cyanosis of the finger or palm nails, difficulty in breathing, bronchospasm, dizziness, fainting, convulsions.
Treatment: gastric lavage and prescription absorbent drugs. Symptomatic therapy: with developed AV-blockade in / in 1-2 mg of atropine, epinephrine or staging of a temporary pacemaker; for ventricular premature beats, Lidocaine (class 1a drugs are not used); with a decrease in blood pressure, the patient should be in the Trendelenburg position, in the absence of signs of pulmonary edema - in / in plasma-substituting solutions, with ineffectiveness - administration of epinephrine, dopamine, dobutamine (to maintain chronotropic and inotropic action and eliminate marked reduction in blood pressure); in heart failure - cardiac glycosides, diuretics, glucagon; with convulsions - in / in diazepam; with bronchospasm - inhalation beta₂-adrenostimulators.

Storage conditions

The drug should be stored out of the reach of children, dry, protected from light, at a temperature not exceeding 25 ° C.