What does bisoprolol help with, for what diseases is it prescribed?

From this article you will learn: the effect of bisoprolol on the body, why bisoprolol is used.

Author of the article: Yachnaya Alina, oncologist surgeon, higher medical education with a degree in General Medicine.

Article publication date: 05/14/2017

Article updated date: 05/29/2019

Bisoprolol is a drug from the group of beta blockers - drugs that block the effect of adenaline and norepinephrine on tissues and organs.

Bisoprolol lowers blood pressure, reduces heart rate (HR), prevents the development of tachyarrhythmias, reduces cardiac output, reducing the load on the heart.

Due to its wide range of effects on the structures and functions of the heart, the drug is prescribed for the treatment of many cardiac diseases: coronary heart disease (CHD), certain types of arrhythmias, chronic heart failure (CHF), arterial hypertension.

Structural formula of bisoprolol

Analogues in other dosage forms

In addition to the tablet form, Bisoprolol analogues are available in the form of solutions for intravenous administration. These medications are intended for emergency treatment of myocardial infarction and acute coronary syndrome. Often medications are prescribed to relieve a crisis of hypertension. All medications in this category are used only in a hospital setting (intensive care unit) and under the supervision of a doctor.

Anepro

The drug is produced in a solution with the main component – ​​metoprolol. The drug is used for heart pathologies in the acute stage. The β1-adrenergic receptor blocker reduces cardiac output, thereby lowering the blood pressure index. It is prohibited to take medicine for the following pathologies:

• hypotension and bradycardia;
• disturbance of cardiac impulse conduction;
• metabolic acidosis;
• disturbance in the blood flow of the cerebral and peripheral arteries.

Metabolic acidosis

The drug is not prescribed together with Verapamil and antidepressants. The medication is administered in the intensive care unit by medical specialists.

To stop tachycardia, 5 mg of the drug is administered over 1-2 minutes. Administration at this dosage can be carried out three times with an interval of 5-7 minutes. Identical administration regimen for heart attack and cardiac ischemia. The maximum dose per day is 20 ml.

Betalok

A drug based on metoprolol is produced in a colorless solution. Betaloc belongs to the group of beta1-blockers. Intravenous administration of the drug is used mainly during a heart attack to relieve pain and reduce the risk of death after an attack.

To stop a heart attack, 5 mg of the drug is administered over 1-2 minutes. Administration at this dosage can be carried out three times with an interval of 5-7 minutes until the therapeutic effect occurs. The total dosage for stopping a heart attack is from 10 to 15 ml. This drug is one of the most expensive analogues of Bisoprolol, as it is produced in the UK.

Metocore

Metocor is used for heart disease. The drug blocks adrenaline receptors, which reduces blood pressure and heart rate. Available in solution and tablets. The solution is intended for the relief of hypertensive crisis, attacks of angina pectoris and ventricular fibrillation, as well as ACS and myocardial infarction.

Hypertensive crisis

Contraindications for use are the same as for other beta blockers. During pregnancy, it is prescribed under the strict supervision of a gynecologist or obstetrician. During lactation, it is necessary to transfer the child to artificial nutrition, and then use medicine.

To stop a heart attack, you need to administer 15 ml of Metocor three times at intervals of 5 minutes. For cardiac ischemia and angina - 5 ml every 2 minutes. You need to carry out 3 procedures.

Who prescribes bisoprolol

Uncontrolled use of the product can lead to serious health problems. Only the doctor should decide why bisoprolol should be prescribed. The therapist or cardiologist will refer you for the necessary examination, determine the indications, exclude contraindications and select an individual dosage of the drug. In many cases, they start with a minimum dose of bisoprolol, slowly increasing it to a level that provides maximum therapeutic effect and is well tolerated by the patient.

Beta blockers are often used in the treatment of heart disease, but their use may be limited by existing contraindications, individual intolerance, and undesirability of combination with individual drugs.

Despite the selectivity of bisoprolol, large doses of the drug can lead to blockade of beta-2 adrenergic receptors with undesirable effects, in particular bronchospasm and peripheral circulatory disorders. Therefore, the prescribed drug should be taken under the supervision of a doctor, who, if necessary, will adjust the dose of bisoprolol or discontinue the drug. Discontinuation of the drug is carried out with caution, gradually reducing the dose due to the possibility of withdrawal syndrome.

Side effects

The use of Bisoprolol can cause various adverse reactions from organs and systems of the body.

• The appearance of various hypersensitivity reactions;
• Reproductive system: impaired potency;
• Metabolic processes: increased sweating;
• Musculoskeletal system: cramps, muscle weakness;
• Respiratory system: narrowing of the lumen of the bronchi;
• Digestive system: various stool disorders, abdominal pain;
• Sense organs: decreased secretion of tear fluid, inflammation of the conjunctiva of the eyes;
• Skin lesions: the appearance of psoriasis-like rashes, skin itching, increased symptoms of psoriasis;
• Central nervous system: increased fatigue, headaches, various mental disorders, involuntary contractions of the muscles of the extremities, increased weakness, dizziness, sleep disorders, feeling of coldness in the extremities;
• Cardiovascular system: decreased heart rate, the appearance of pronounced symptoms of functional heart failure, increased manifestations of Raynaud's syndrome, a sharp decrease in blood pressure when changing body position, cardiac muscle conduction disorders.

Is it possible and how to take Bisoprolol during pregnancy?

In general, the medicine is not prescribed during pregnancy. However, if a woman suffers from serious illnesses of the cardiovascular system, then to save her life, pills can be used in an interesting position.

Is it possible and how to take Bisoprolol during pregnancy:

• Doctors recommend stopping the drug three days before the onset of labor, that is, before the due date.
• This is because the medicine slows the heart rate and may also lower glucose levels, which may cause the child's breathing to become worse. Children were often born with pathologies of the respiratory system and pneumonia.
• If it is impossible to stop taking the medicine within three days, or labor begins spontaneously, then it is necessary to keep the child under special control for 5 days.
• Indeed, in the first 3 days, there is a high risk of a jump in glucose and breathing problems.

drug

Bisoprolol analogues and substitutes

Bisoprolol can be replaced with drugs from the group of selective beta1-blockers with the same or another active substance. They are used to treat hypertension and prevent complications of angina attacks. Well-known analogues are Bicard, Bisokard, Dorez, Concor Cor, Corbis, Niperten.

Cordinorm (Germany)

Analogue and replacement of the drug Bisoprolol. Recommended for arterial hypertension, unstable heart rhythm, tachycardia.

Eliminates shortness of breath and pain in the heart area.

Reduces the need for oxygen in the heart muscle.

At the initial stage of treatment, you may feel weak and dizzy. A noticeable therapeutic effect appears on days 3-5.

• In tablets of 5 mg 30 pcs. – 178 rub.
• Tablets (Cordinorm Cor) 2.5 mg 30 pieces – 126 rub.

Biol (Switzerland)

After administration, the therapeutic effect develops gradually. It works softly. Normalizes and stably maintains acceptable pressure levels throughout the day. Patients note a decrease in chest pain, and the feeling of “lack of oxygen” disappears. If you follow the dosage and doctor's recommendations, side effects are minimized.

Packaging 5 mg 30 pieces – 190 rubles.

Niperten

Selective beta-blocker analogue of the drug Bisoprolol. Prescribed for arterial hypertension, angina pectoris.

Reduces heart rate.

Eliminates pressing, squeezing pain behind the sternum.

Convenient to take - once a day. The affordable price makes the medicine a frequent choice of patients.

Five milligram tablets 30 pcs. – price 150 rub.

Bidop

Compared to its analogue, Bidop tablets are more expensive. They contain bisoprolol in the form of hemifumarate, which has hypotensive, antianginal and antiarrhythmic effects:

Concor

Concor is not much more expensive, but has a wider range of indications for use. It contains the same active substance, which has hypotensive and antianginal effects:

Bisogamma

A more expensive analogue of the drug in question, Bisogamma, has hypotensive, antiarrhythmic and antianginal effects. It contains bisoprolol hemifumarate. Characteristics of the product:

Features of use Advantages Disadvantages Orally on an empty stomach once a day, without chewing, 5-20 mg

begins to work stably 2-5 days after the start of treatment, reaches a maximum after a few months; may be taken with caution during pregnancy and lactation.

has many contraindications and side effects; A smooth completion of treatment is necessary, otherwise “withdrawal syndrome” will develop.

Metoprolol

Belongs to the same pharmacological group as bisoprolol, a cardiac adrenergic receptor blocker. It has a similar effect on the body. Additionally reduces rennin activity and restores baroreceptor function. This provides an antihypertensive effect that develops 15 minutes after consuming the drug. Used to prevent migraines.

Amlodipine

An analogue of Bisoprolol produced in Russia, the cost of which ranges from 110 to 180 rubles. The main component of the drug is amlodipine besylate. Contraindications for the hypertensive drug include hypotension, tachycardia, pulse and heart rhythm disturbances, as well as previous heart attacks.

Aritel

It is considered a complete replacement for Bisoprolol, its price ranges from 150 to 200 rubles. It has contraindications, including hypotension, various chronic heart diseases, including arrhythmias and atrial fibrillation, bronchial asthma, psoriasis and taking other medications that are not compatible with the active component.

Lokren

French potent drug, the price of which can reach 1300 rubles. Able to regulate blood pressure even under stress conditions with long-term use. And also contraindicated in case of heart rhythm disturbances.

Sandoz

A full Ukrainian synonym for the drug, costing from 80 to 350 rubles, depending on the amount of medicine and dosage. It has a large number of side effects and is also prohibited for heart failure.

Composition and mechanism of action

The medicine is based on bisoprolol hemifumarate in an amount of 5 mg per tablet. This active component determines a whole group of beneficial properties of the drug.

Lower blood pressure

The path that underlies this result is complex. The ability to relax the muscles of blood vessels is involved, thereby eliminating hypertonicity and spasm.

Bisoprolol also makes tissues less sensitive to the prehormone renin, which directly affects the condition of the arteries and pressure in general.

Like any beta blocker, the drug has a pronounced effect on blood pressure. The effect is also dose-dependent. That is, the higher the concentration of the active substance in the blood, the more significantly the blood pressure drops. This must be taken into account when selecting a treatment regimen.

Decreased heart oxygen demand

The so-called antianginal effect. Achieved by optimizing metabolic processes in cardiac structures.

The point is to achieve high-quality metabolism. Compared to normal conditions. The intensity of myocardial contractions decreases, but the pumping function practically does not suffer.

There is one exception to the above: with increasing dosage, the ability of cardiac structures to fully contract is inhibited.

Therefore, you should not abuse the drug, it is extremely dangerous.

Attention:

Bisoprolol is suitable for long-term use; in order to avoid negative consequences, it is recommended to carefully select the dosage.

Restoring normal heart rhythm

Beta blockers combat various forms of heart rate disorders. They are most effective against tachycardia: supraventricular in the first place.

Bisoprolol helps restore normal heart rhythm, but it is not able to fight dangerous forms of disorders, such as group extrasystole, ventricular fibrillation.

In such a situation, special antiarrhythmic drugs are additionally prescribed: Amiodarone, Quinidine.

In the case of sinus tachycardia, the drug can be used in isolated form as the main drug, including for stopping acute attacks of arrhythmia.

Inhibition of adrenaline receptors

Often, changes in heart rate are caused by the influence of adrenal hormones on cardiac structures.

The drug allows you to eliminate the excessive effect of these substances on the heart and restore normal rhythm, therefore Bisoprolol tablets are used as a first aid measure for tachycardia.

If the dosage is exceeded, whether controlled or random, selectivity is lost. That is, Bisoprolol also begins to act as a beta-2 adrenergic blocker.

Receptors of this type are located in organs: the uterus, bronchi, etc. Therefore, negative health consequences are possible and even probable: spasm of the respiratory tract and others. This result is even more dangerous for pregnant women at any stage of gestation.

Read more about beta-1 and beta-2 adrenergic blockers in this article.

The product is available in tablet form. In addition to the main substance, the composition includes additional ones that do not have actual pharmacological activity.

They give the drug the necessary physical characteristics, increase the digestibility of the component and the solubility of the tablet in the gastrointestinal tract.

Compatibility with other drugs

It is known that the compatibility of Bisoprolol and products containing clonidine allows the use of these drugs simultaneously, but it is unacceptable to discontinue both medications at the same time. Stop taking one drug first, and after a few days - the second. When using medications that reduce the volume of catecholamines, the effectiveness of beta-blockers may increase. It is necessary to inform your doctor about all medications prescribed by other specialists. The doctor must regularly monitor the patient’s condition, otherwise the likelihood of hypotension and bradycardia increases.

The product can be used for diabetes. The drug has no effect on hypoglycemia in most cases, but if tachycardia provoked by this factor develops, regular use of Bisoprolol can mask the symptoms. The medication in question does not interfere with the restoration of blood glucose to normal levels.

Features of taking Bisoprolol for blood pressure

The drug belongs to the group of selective beta-blockers, which means that it mainly affects the cardiovascular system and does not affect the bronchi. It is still not recommended to prescribe the drug to patients with severe emphysema and obstructive diseases of the bronchial tree.

There is a drop in the activity of renin, which regulates blood pressure and homeostasis

It is recommended to start the prescription with the minimum effective dosage; you can gradually increase the dose for hypertension, reaching up to 10 milligrams per day. This amount of Bisoprolol can be prescribed for heart failure. You need to reach the maximum dose within three months; you should not suddenly stop taking the drug.

Tablets are taken once a day with good maintenance of the hypotensive effect. Taking the drug does not depend on food intake; it is advisable to take it in the first half of the day or during breakfast. The product has a minimal number of side effects and does not affect the potency of men.

The product is available on the market; there are more brands producing the drug. Bisoprolol can be prescribed to older people; no special dose selection is required. The medicine is used in patients with type 2 diabetes mellitus; it does not affect cholesterol levels in the body.

Release form and composition

The drug is produced in the form of film-coated tablets, packaged in blister packs, 20, 30 or 50 pieces in a cardboard box. The tablets are round, biconvex, their color varies from beige to beige with a yellowish tint, at the break - from white to almost white.

The active substance is bisoprolol fumarate, in 1 tablet - 2.5 mg, 5 mg or 10 mg.

Excipients – microcrystalline cellulose, calcium hydrogen phosphate dihydrate, corn starch, colloidal anhydrous silicon dioxide, magnesium stearate, sodium starch glycolate (type A), opadry II (including polyvinyl alcohol, partially hydrolyzed, talc, macrogol 3350, white coloring pigment colors (contains titanium dioxide E 171)).

How to use?

Bisoprolol belongs to the group of selective beta1-blockers. The product is available in the form of tablets, each of which has a coating - a thin film that makes it easier to take.

How to take Bisoprolol is described in detail in the instructions included with the drug. Usually it is drunk in the morning before breakfast on an empty stomach. The entire daily dose is used at one time, swallowed immediately, without chewing. As a rule, 5 to 10 mg are prescribed per day. The daily dose of Bisoprolol for an adult should not be more than 20 mg. Special conditions of administration have been developed for those who have been diagnosed with problems with the functioning of the kidneys and (or) liver (the highest daily dose is halved to 10 mg).

Efficiency features, what else is important

The effectiveness of Bisoprolol for hypertension is confirmed by reviews that have been published in large numbers on the World Wide Web. As the manufacturer explains, the positive effect is due to a reduction in minute volume of blood circulation. In addition, the active ingredient of the drug stimulates peripheral vessels and inhibits the renin-angiotensin-aldosterone system. Baroreceptors under the influence of Bisoprolol become more sensitive. For hypertension, the primary effect can be observed a few days after the start of treatment (but no later than five), and stabilization of the patient’s condition is observed after one or two months from the start of treatment.

The effect that eliminates heart complications after a sore throat is also confirmed by reviews of Bisoprolol. As the manufacturer explains, effectiveness is guaranteed by the fact that, under the influence of the active component, the myocardium receives the required volume of oxygen, as heart rate decreases, diastole becomes longer, and myocardial perfusion is of better quality. Diastolic pressure increases, and the muscle fibers in the ventricles of the heart stretch more effectively.

What else should you pay attention to?

Despite the indications of Bisoprolol, in some cases with angina pectoris the drug is not as effective. This is explained by the specifics of the disease: it is known that all drugs from the group of beta-blockers do not produce results in approximately every fifth patient. As a rule, this is due to coronary atherosclerosis, in which a low ischemic threshold is observed. The effectiveness of the drug decreases if a person has been smoking for a long time, as well as with impaired subendocardial blood flow.

Before prescribing Bisoprolol, the doctor checks the external respiration functions of patients with a significant bronchopulmonary history. If the patient uses contact lenses, you need to remember that the use of Bisoprolol in some cases provokes a decrease in the secretion of tear fluid. With established pheochromocytoma, there is a possibility of a specific form of hypertension if it was not possible to achieve effective alpha-blockade. When choosing Bisoprolol for the treatment of patients with diagnosed thyrotoxicosis, it is necessary to remember that the drug cannot be abruptly discontinued.

Side effects

People taking Bisoprolol may experience the following unpleasant side effects:

• Often:
• Uncommon: AV conduction disturbance;
• orthostatic hypotension (a drop in pressure with loss of consciousness);
• depression;
• convulsions and myasthenia gravis;
• bronchospasm in patients with a history of COPD or asthma;
• sleep problems;

Side effects

Bisoprolol has a number of side effects that occur quite often. Negative manifestations after using Bisoprolol worry patients in the first two weeks after starting treatment. It is recommended to inform your doctor about them, but the drug is not discontinued immediately; the dosage may be reduced.

The drug for high blood pressure has fewer side effects than older generation beta blockers.

The annotation also states some undesirable manifestations in the form of: headache and loss of coordination

From all body systems the following is observed:

• reducing heart rate;
• weakness and apathy, depression;
• headache and dizziness;
• paresthesia in the limbs;
• the appearance of shortness of breath during physical work, swelling;
• decreased pressure during changes in body position (orthostatic collapse);
• dyspeptic disorders;
• liver dysfunction, skin icterus.

"Bisoprolol" has the effect of increasing the patient's sensitivity to allergens. All allergic reactions may worsen while taking the drug. Allergic rhinitis appears, bronchial asthma worsens. Skin diseases such as eczema and psoriasis worsen. On the blood side, there is a decrease in the number of platelets and leukocytes, an increase in bilirubin and liver enzymes.

Prices of substitutes in tablets

The cost of Bisoprolol analogues and substitutes may vary significantly. The price depends on the manufacturer. Domestic drugs are cheaper than foreign ones. Therefore, some analogues may be cheaper than the original or more expensive.

Analogues of Russian production Bisoprolol

Name Description Aritel A complete analogue of bisoprolol produced in Russia. It has the same composition and is used in the same medical cases as the main drug. Biprol One of the cheapest Russian-made generics. It is prescribed for hypertension of various etymologies, for angina pectoris and chronic ischemic disease of the heart muscle. Amlodipine The active substance, amlodipine besilate, helps with angina pectoris and can be the main treatment for arterial hypertension. Niperten bisoprolol fumarate with a similar dosage and packaging, suitable for patients with cardiovascular problems

Use with caution in diabetes mellitus.

Ukrainian substitutes

• Bisoprolol-KV, 30–60 rubles, one of the most inexpensive analogues of bisoprolol produced in Ukraine, has similar indications and features of use. Available in blisters of 10 and 30 tablets of 5 and 10 mg.
• Bisoprolol-Ratiopharm, 140–460 rubles, an active adrenergic receptor blocker, in combination with diuretics and inhibitors, is used in the complex treatment of chronic heart failure.
• Bisoprolol-Sandoz, 80–340 rubles, a complete synonym for the main drug. Side effects include possible dizziness, headache, bradycardia, possible reactions from the gastrointestinal tract: nausea, vomiting.
• Bisoprolol-Astropharm, 30–55 rubles, has the same active ingredient as the title drug, is absorbed by the intestinal walls and enters the bloodstream in the amount of about 90% of the original dose. Does not depend on food intake, maximum observed in blood plasma 2–3 hours after ingestion.

What blood pressure does Metoprolol help with? indications for use

Have you been trying to cure HYPERTENSION for many years? Head of the Institute of Treatment: “You will be amazed at how easy it is to cure hypertension by taking it every day...

In the treatment of hypertension and some other cardiovascular diseases, beta-blockers are used as part of complex therapy or as an independent medicine. One of these drugs is Metoprolol, indications for use and complete instructions for which are worth considering.

• What does it help with?
• Instructions for use
• Metoprolol during pregnancy
• Contraindications
• Side effects
• Compatibility of Metoprolol and alcohol
• Analogs
• Metoprolol or Bisoprolol – which is better?
• Concor or Metoprolol - which is better?
• Metoprolol or Egilok - which is better?
• Metoprolol or Anaprilin - which is better?

special instructions

Treatment with the drug is usually long-term. The patient should not independently change the prescribed dosage or voluntarily interrupt the course of treatment. Abrupt withdrawal of the drug can provoke unwanted complications, so treatment is completed gradually, with a gradual reduction in the dose. This rule is especially relevant for patients with chronic heart failure and coronary artery disease.

In rare cases, the use of Bisoprolol can provoke the development of lichen planus or lead to psoriatic skin rashes. Doctors warn that in smoking patients the effectiveness of the drug is reduced, and in the category of patients who use contact lenses, a decrease in the production of tear fluid may be observed. If depressive conditions develop, drug therapy should be discontinued.

Overdose

If the patient intentionally or accidentally exceeds the recommended doses of Bisoprolol, arrhythmia and a sharp decrease in heart rate may occur. These conditions are caused by the appearance of difficulty breathing and the development of heart failure.

When an overdose of Bisoprolol occurs, urgent gastric lavage is necessary. The patient should be given a drip for intoxication effects on the body. Symptoms characteristic of exceeding doses of Bisoprolol:

1. Slowing heart rate.
2. Heart rhythm disturbance, characterized by the appearance of new impulses.
3. Simple arrhythmia.
4. Disturbance in the conduction of electrical impulses from the atria to the ventricles.
5. A sharp drop in pressure.
6. Blueness of fingers on all extremities.
7. Labored breathing.
8. Dizziness.

An overdose of Bisoprolol requires hospitalization of the patient in the cardiology department for a number of procedures. In cases where pulmonary edema is not diagnosed, several droppers are given until the desired effect occurs and the condition is alleviated. For seizures, doctors prescribe Diazepam.

Drug interactions

It is not recommended to use bisoprolol with these drugs:

• blockers of calcium slow channels, for example, verapamil (myocardial contractility may decrease);
• first class antiarrhythmic drugs, for example, phenytoin and quinidine (may decrease cardiac contractility);
• centrally acting antihypertensives, such as moxonidine and rilmenidine (may decrease cardiac output).

Bisoprolol can be used with these drugs, but with restrictions:

• parasympathomimetics (increases the risk of bradycardia);
• third class antiarrhythmic drugs, for example, amiodarone (may worsen AV patency impairment);
• mefloquine (increases the risk of bradycardia);
• some adrenergic agonists, for example, isoprenaline and dobutamine (the effect of both drugs may be reduced);
• radiopaque iodine-containing diagnostic intravenous agents (the risk of developing various anaphylactic reactions increases);
• allergens used for immunotherapy (the risk of developing systemic allergic reactions increases)

The list is incomplete, so if there is a need for simultaneous use with other drugs, first consult with your doctor about potential side effects.

How does it interact with other medications?

Not all medications can be taken simultaneously with Bisoprolol and its analogues.

Negative compatibility of all beta blockers with insulin and other medications that lower blood sugar levels:

1. They cannot be combined with some drugs intended for general anesthesia (hydrocarbon derivatives, as well as phenytoin), since there is a high probability of a sharp decrease in blood pressure.
2. Bisoprolol's ability to reduce blood pressure significantly weakens the effect of non-steroidal anti-inflammatory drugs and hormonal contraceptives.
3. When taking beta blockers and some cardiac glycosides simultaneously, there is a risk of developing deep bradycardia and even cardiac arrest.
4. Also, you cannot combine Bisoprolol with sedatives and alcohol - such a combination will only increase the depression of the central nervous system.

Important! Therefore, when treating with drugs of this group, the factor of possible incompatibility should always be taken into account.

Special attention: Drivers and people whose activities involve potential danger should discuss a different drug treatment regimen with their doctor. It may be better to take this medicine in the evening in such situations.

Contraindications

Bisoprolol is contraindicated for use in the following conditions:

• arterial hypotension (systolic pressure less than 100 mmHg);
• severe forms of bronchial asthma and obstructive pulmonary disease;
• severe peripheral circulatory disorders, Raynaud's syndrome;
• lactation period;
• sick sinus syndrome;
• bradycardia (heart rate less than 60 beats/min);
• cardiomegaly (without signs of heart failure);
• acute heart failure or chronic heart failure in the stage of decompensation (requiring inotropic therapy);
• cardiogenic shock;
• 2nd and 3rd degree atrioventricular block, without pacemaker;
• sinoatrial block;
• simultaneous use of floctafenine, sultopride;
• simultaneous intravenous administration of verapamil, diltiazem;
• age under 18 years (efficacy and safety have not been established);
• simultaneous use of MAO inhibitors with the exception of MAO-B;
• hereditary lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome;
• pheochromocytoma (without simultaneous use of alpha-blockers);
• metabolic acidosis;
• hypersensitivity to bisoprolol, components of the drug and other beta-blockers.

Additional consultation with a doctor is required regarding the use of Bisoprolol during a strict diet and desensitizing (antiallergic) therapy.

Effects of bisoprolol

Adrenaline and norepinephrine affect the body by acting on different types of receptors. Beta-1 adrenergic receptors predominate in the heart and some other organs. Beta-2 adrenergic receptors are located in the bronchi, vascular wall, digestive tract, adipose tissue, and pancreas. Bisoprolol is a selective beta-blocker because it predominantly blocks beta-1 adrenergic receptors. The lack of influence of the drug on the second type of receptor allows one to avoid many side effects and expand the range of use of the drug.

Interaction with beta-1 adrenergic receptors of adrenaline and norepinephrine (catecholamines) can aggravate the health condition in the presence of cardiac pathology. Taking bisoprolol reduces the toxic effect of catecholamines, reduces the severity of symptoms, and slows down the progression of cardiac pathology.

Beta-1 adrenergic receptors are found in various organs, which leads to a variety of effects of bisoprolol on the functioning of the body, including restrictions on the use of the drug in some diseases.

Bisoprolol blocks beta-1 adrenergic receptors, limiting the possibility of interaction of adrenergic substances with them. The therapeutic effects of the drug are associated with the ability to weaken the effect of norepinephrine and adrenaline on the activity of the heart.

Effects of the use of beta-blockers. Click on photo to enlarge

Features of Bisoprolol

Bisoprolol (synonym Concor) as a beta-1 blocker helps reduce heart rate and reduce atrioventricular conduction. In addition, the drug, if used in large doses, can also block beta-2 adrenergic receptors in the bronchi and vascular smooth muscles. Note that Bisoprolol is included in the WHO List of Essential Medicines.

Compound

The active ingredient of this medicine is bisoprolol, and 1 tablet of the drug contains 5 or 10 mg of bisoprolol hemifumarate.
Lactose, cellulose, magnesium stearate and some others are used as auxiliary ingredients. Depending on the color of the tablet, the dye used is:

• RV 22812 - yellow;
• RV 27215 - beige.

Release forms

The drug is available in the form of film-coated tablets. The color of the round pill varies from beige yellow to beige. The edge of the tablet is white.

As for packaging, depending on the number of tablets, it can be:

• cardboard with contour cells (10 pieces);
• cardboard with a polymer or glass jar packed in it (30 pieces).

In pharmacies in Moscow and other Russian cities, the cost of the medicine ranges from 45 rubles.

Pharmacological action and pharmacodynamics

Bisoprolol is used as a hypotensive, antianginal, and antiarrhythmic agent. The active substance prevents the β-1-adrenergic receptors of the “motor” from acting, reducing heart rate and myocardial contractility. The intracellular current of Ca2+ ions also decreases.

• Antianginal action. This is achieved due to the fact that the myocardial oxygen demand decreases due to a lower heart rate and a decrease in contractility; it also has a positive effect on improving the perfusion of the heart muscle - myocardium.
• Antiarrhythmic action. This drug has a depressing effect on the conduction of impulses in the antegrade and retrograde directions through the AV node.
• Hypotensive effect. It is achieved by reducing the activity of the renin-angiotensin system.

The maximum effect of Bisoprolol is achieved 60-180 minutes after oral administration. It can last throughout the day (24 hours).

Pharmacokinetics

• Absorption and distribution. Absorption is 80 to 90 percent regardless of food intake. At the same time, connections with blood plasma proteins are about 30%. The substance can be excreted in mother's milk, but in small amounts.
• Metabolism and excretion. Half the dose is metabolized in the liver. Approximately 98% is excreted in urine.

The effect of bisoprolol on coronary heart disease

With coronary artery disease, there is a discrepancy between the needs of the heart muscle for oxygen and its supply with the blood through the network of coronary vessels. Bisoprolol does not change the amount of oxygen delivered, but reduces the load on the heart and its need for blood supply. This is achieved through the following mechanisms:

1. Bisoprolol reduces heart rate and the duration of the period of relaxation of the heart muscle. The flow of blood to the cells occurs mainly during this period, since when the heart contracts, the coronary arteries in the thickness of the myocardium are compressed.
2. A decrease in contraction force and blood pressure reduces the oxygen demand of cardiomyocytes.
3. Under the influence of the drug, the pressure in the left ventricle of the heart decreases between contractions, which leads to improved blood supply to the myocardium.
4. Blockade of the toxic effects of high concentrations of catecholamines.

The consequence of ischemic heart disease is myocardial infarction, in which necrosis of the heart muscles occurs due to lack of oxygen

The use of bisoprolol for coronary artery disease can reduce the load on the heart and reduce the risk of coronary complications. The drug provides the following positive changes in the condition of patients:

• reduces the frequency of angina attacks;
• increases load tolerance;
• prevents the development of arrhythmias or has a therapeutic effect in case of existing tachycardia or extrasystolic arrhythmia;
• reduces the likelihood of complications - myocardial infarction, sudden coronary death;
• slows the progression of chronic heart failure.

Recommendations when choosing tablets

Among pharmaceutical preparations containing bisoprolol, preference should be given to the original Concor. The products of European factories TEVA and KRKA also enjoy authority, so choose Bisoprolol produced by them. They have a higher degree of purification and quality compared to others. When purchasing a drug from a Russian manufacturer, you need to take a closer look at the cost. Too low a price is a sign of poor quality. Which analogs of the drug Bisoprolol (Metoprolol, Lokren or Nibilet) should I choose among beta-adrenergic receptor blockers? All of these remedies have a similar effect on the body, so focus on the price and frequency of use per day

Lokren is the most long-acting drug, but also the most expensive.

Note! Atenolol causes disruption of various body systems, so it is now almost never used.

If you are choosing what to replace Bisoprolol with, pay attention to Amlodipine. It acts by a different mechanism - it blocks calcium channels

It is a priority remedy for hypertension.

Reviews about the drug

1. Initially, I didn’t want to take Bisoprolol because I had read about a large number of side effects and contraindications. But the attending physician convinced me of the advisability of the appointment. Indeed, the product was well tolerated in the first weeks, and it helped me correct my blood pressure without additional medications. It’s very convenient to take one tablet a day, I don’t forget to drink them. I am pleased with the affordable price of the drug.
2. I switched to Bisoprolol after Nebivalol. Both drugs helped well, but Bisoprolol is more accessible and convenient to take. I am an allergy sufferer with diabetes, but I have not noticed any increased allergic reactions, everything proceeds as usual. I correct diabetes with diets and glucose-lowering medications, which combine well with Bisoprolol. The prescription sheet was corrected not only by the therapist, but also by the treating endocrinologist.

Originally posted 2017-12-12 17:06:02.

Bisoprolol for arrhythmia has been proven effective

When considering the indications of Bisoprolol, one should not lose sight of arrhythmia. The effectiveness of taking medication in patients with this disorder is ensured by the drug’s inhibition of factors that provoke the corresponding state of the body. Spontaneous arousal becomes almost impossible.

The drug stands out favorably against the background of non-selectively acting beta-blockers, since the side effects of Bisoprolol on other organs are much less at an average therapeutic dose. First of all, this applies to those systems where there are beta2-adrenergic receptors. The negative impact on carbon and sodium metabolism is also reduced (the latter does not accumulate in the body).

Analogues of the drug

Many patients who have been prescribed the medicine Bisoprolol are looking for information on the topic: “instructions for use of Bisoprolol analogues.” Having considered the first part, we will find out what can replace the medicine.

All similar drugs are conventionally divided into two groups. The first has the same active substance and structural structure. Representatives of tablets are Coronal, Concor, Bisokard, Aritel, Corbis, etc.

The following drugs have a similar therapeutic effect: Nebivolol, Nebilet, Atenolol, Betacard, Etecor, etc.

Brief characteristics of Bisoprolol analogues:

Atenolol is a cardioselective beta blocker. Helps reduce systolic and diastolic indicators, IOC and SV, helps reduce heart rate and pulse at rest and stress. The dose varies from 25 to 50 mg per day. The average is 100 mg. Cheap product, cost 20-30 rubles. Betacard is prescribed for the treatment of hypertension, heart and blood vessel diseases

Recommended with extreme caution in case of liver failure. At the beginning of treatment, 25-50 mg is prescribed, the dosage is gradually increased until the optimal therapeutic effect. Nebivolol has the main active ingredient, the name of which is similar to the name of the drug

The medicine can increase the ejection fraction, reduce heart rate and blood pressure during rest and exercise. The dosage is determined individually. Taken for ischemic heart disease, chronic nervous system disease, hypertension. With caution in case of VSD, cardiogenic shock, depressive syndrome. The price of the drug varies from 200 to 400 rubles.

Any of the medications described above can be a substitute for Bisoprolol. This is necessary in cases where the patient has medical contraindications, which means there is a high risk of harm from taking it.

They also replace the medicine in situations where the patient has developed side effects or there is poor dynamics of blood pressure reduction.

The video in this article with advice from a cardiologist is intended to help hypertensive patients in choosing medications.

Instructions for use of the drug Bisoprolol

This drug should be used only as prescribed by your doctor. Each package of Bisoprolol always contains indications for use. Reviews show that sometimes doctors recommend their patients a slightly different course of treatment. It depends on the disease, age, and characteristics of the body. It is usually recommended to use no more than 20 mg of the drug per day. This is the norm for an adult. One tablet is usually 5 mg. It does not need to be chewed, but must be swallowed with plenty of water. The same recommendations are included in the instructions for use for the drug "Bisoprolol". Reviews left by people who have used it show that after completing the course of treatment, they feel much better.

If the patient is diagnosed with arterial hypertension or coronary heart disease, then it is necessary to take 2 tablets per day, usually in the morning and evening. At the first stage of treatment, the dose may be smaller - only 5 mg per day or one tablet. Under no circumstances should you exceed the norm on your own. If the medicine does not help, then you first need to consult a doctor and act on his recommendation.

Before prescribing this drug, specialists check the functioning of other organs and pay special attention to the heartbeat. Before taking pills, the patient himself should check his pulse rate.

How many days does the course of treatment with Bisoprolol last, what is the maximum period of use?

If it is chronic heart failure, then for initial use it is recommended to take pills with a concentration of 2.5 mg.

Bisoprolol, what is the maximum period of use:

• This concentration is taken only in the first 7 days; from days 7 to 14, the concentration of the substance doubles. From days 14 to 21, the concentration of the substance should be 3.75. And from 4 to 8 weeks take 5 mg.
• It is possible to increase the dose to 7.5 mg. After week 12, the maximum concentration prescribed is 10 mg. In general, the doctor regulates the concentration, depending on the characteristics of the disease and the presence of contraindications.
• This slow increase in concentration is necessary to get the body used to the substance and to minimize side effects. That is, the maximum daily dose is 10 mg.

drug

Contraindications

Basic

Like most medications, Bisoprolol has some contraindications for use, namely:

• OSN;
• cardiogenic and other types of shock;
• sudden CV failure;
• severe bronchial asthma;
• sinoatrial block;
• bradycardia;
• second and third degree AV block;
• spontaneous angina;
• significant enlargement of the heart;
• pulmonary edema;
• sinus node weakness syndrome;
• CHF with decompensation;
• hypotension (below 100 mm Hg);
• Raynaud's disease;
• acidosis (acidosis);
• late stages of peripheral circulatory diseases;
• pheochromocytoma.

Also, in addition to the presence of these ailments, contraindications to taking Bisoprolol may be:

• simultaneous use of MAO inhibitors (except MAO-B);
• the patient's age is less than 18 years;
• simultaneous use with floctafenine and (or) sultopride;
• excessive sensitivity to any of the components of the drug.

Features of treatment

As noted earlier, only a qualified specialist has the right to prescribe treatment with beta blockers. The attending physician, based on laboratory and other types of examination:

• makes a conclusion about the need to prescribe Bisoprolol,
• calculates the optimal daily dose of the drug for a particular patient;
• writes a prescription to the patient, according to which the medicine is given to him at the pharmacy.

Special instructions: For adult patients, the maximum permissible dose is 20 mg per day. An overdose of the drug threatens a sharp decrease in blood pressure, severe bradycardia and the development of heart failure. In such situations, it is urgent to perform gastric lavage followed by the administration of activated carbon (1 tablet per 10 kg of weight)

A little bit of history

The idea to release a similar drug appeared in 1967. She worked on its creation (she was then and is still part of the group). It was in that year that scientists first obtained such a substance as a beta1-blocker. Further, based on it, two subtypes of adrenergic receptors were obtained. These are such as b1-adrenergic receptor and b2-adrenergic receptor. This drug "Bisoprolol" belongs to the selective group of beta1-blockers. They are marked as highly selective and differ from other substances in their potency.

Interaction

Inadmissible combinations with Bisoprolol:

• Floctafenine;
• Sultopride.

Not recommended combinations:

• with antihypertensive drugs that are characterized by a central mechanism of action;
• with calcium antagonists;
• with MAO inhibitors (except for MAO-B inhibitors).
• The drug is prescribed with caution with:
• sympathomimetics;
• Amifostine;
• cardiac glycosides (digitalis preparations);
• anticholinesterase drugs;
• non-steroidal anti-inflammatory drugs;
• antihypertensive drugs that increase the risk of hypotension (for example, tricyclic antidepressants, phenothiazines or barbiturates);
• sympathomimetics, which are characterized by the ability to activate β-adrenergic receptors;
• ergotamine derivatives;
• calcium antagonists, which belong to the group of dihydropyridine derivatives;
• Baclofen;
• anesthetics;
• insulin preparations and oral antidiabetic agents;
• parasympathomimetics;
• local blockers;
• antiarrhythmic drugs of class I and III.

Compound

One tablet of the drug "Bisoprolol-Prana" contains 5 and 10 mg of bisoprolol hemifumarate as an active substance. The presence of magnesium stearate, corn starch, cellulose with a microcrystalline structure, crospovidone, colloidal silicon oxide, and dehydrated calcium hydrogen phosphate makes it possible to formulate the drug and ensure the necessary solubility and bioavailability.

The film shell of the 5 mg dosage contains yellow iron oxide, polyethylene glycol (grade 400), titanium dioxide, and silicone. The coating that envelops the large pill contains another coloring agent in the form of red iron oxide.

Side effects

After using the medication, the following adverse reactions of the body may be observed:

• stomach ache;
• potency disorders;
• hypotension;
• mental or sleep disorders;
• muscle weakness;
• signs of bronchial obstruction;
• conjunctivitis;
• increased muscle twitching;
• vomit;
• dizziness;
• bradycardia;
• headache;
• sweating;
• paresthesia of the limbs;
• fatigue;
• diarrhea;
• flushes of blood to the face;
• nausea;
• constipation

The drug "Bisoprolol" and pregnancy

This drug should never be used by pregnant or breastfeeding women. There are exceptions when the patient needs this medicine when bearing a child, but it should be stopped if about 72 hours remain before birth. If this is not possible, then the newborn should be under the supervision of doctors from the first minutes of birth. A child may develop hypoglycemia after taking this drug, and this disease may manifest itself in the first three days.

Why do you take Bisoprolol tablets?

• This drug is used to normalize high blood pressure that occurs for various reasons.
• Bisoprolol is used in the treatment of angina pectoris, a disease characterized by pain and discomfort in the chest.
• This medication is used in therapeutic therapy in the post-infarction period, as well as for arrhythmia and chronic heart failure.

Tablets for high blood pressure (antihypertensive drugs) in the modern classification are represented by 4 main groups: diuretics (diuretics), antiadrenergics (alpha- and beta-blockers, drugs that are called “central-acting drugs”), peripheral vasodilators, calcium antagonists and ACE inhibitors ( angiotensin-converting enzyme).

This list does not include antispasmodics, such as papaverine, since they give a weak hypotensive effect, slightly reducing blood pressure by relaxing smooth muscles, and their purpose is somewhat different.

Many people also include folk remedies as blood pressure medications, but this is, in general, everyone’s business, but we will consider them, since in many cases they are really effective as an auxiliary treatment, and in some (at the initial stage of arterial hypertension) even completely replace the main one.

This statement is absolutely true. A set of blood pressure pills prescribed at a clinic usually includes diuretics:

• Given the fast and powerful action of loop diuretics (furosemide), they are prescribed in combination with other blood pressure medications, mainly in order to quickly achieve the desired effect, for example, during a hypertensive crisis. For constant and long-term use, diuretics of this group are not very suitable, since they quickly remove microelements, in particular potassium and sodium, the lack of which results in arrhythmias and other troubles for the patient, which are described in the article on diuretics.
• As a rule, the use of loop diuretics requires protection of the heart muscle, which is achieved by prescribing potassium-containing drugs (panangin, asparkam) and a potassium-rich diet.
• Thiazide diuretics have proven themselves very well, as monotherapy in the initial stages of hypertension (indapamide, arifon) or in combination with ACE inhibitors. Even with long-term use, the above diuretics do not lead to hypokalemia, arrhythmia and other consequences, that is, they generally do not have a negative effect on the body.
• Potassium-sparing diuretics (veroshpiron, spironolactone) have weak hypotensive abilities, so they are usually considered as a medicine for blood pressure in combination with other diuretics - thiazide or loop.

Diuretic tablets for blood pressure are not prescribed for arterial hypertension (AH) accompanying severe renal failure. The only exception in this case is furosemide. Meanwhile, for hypertensive patients with symptoms of hypovolemia or signs of severe anemia, diuretics such as furosemide and ethacrynic acid (uregitis) are strictly contraindicated.

If hypertension accompanies diabetes mellitus, then they try not to consider hypothiazide or prescribe it with great caution. Veroshpiron is bypassed if the patient’s biochemical blood test shows an increased level of potassium or if 1-2 degree atrioventricular block is registered.

They are heterogeneous, differ from each other in their mechanism of action, and therefore are grouped into groups:

1. Drugs acting inside the neuron (“central” action), these include guanethidine and rauwolfia alkaloids: reserpine, raunatine;
2. Central agonists, representatives of which are clonidine (clonidine, hemitone, catapressan) and methyldopa (dopegyt, aldomet);
3. Blockers of peripheral α-receptors, which are represented by prazolin (pratsiol, minipress - a selective antagonist of postsynaptic α-receptors);
4. β-adrenergic receptor blockers: non-selective - propranalol (Anaprilin, Obzidan), oxprenolol (Trazicor), nadolol (Korgard), sotalol, pindolol (Wisken), timolol; cardioselective - cordanum (talinolol), atenolol, metoprolol (betaloc, specicor);
5. Blockers of α- and β-adrenergic receptors, which include labetolol (trandate, albetol).

Of course, these groups have differences, both among themselves and within themselves, which we will try to understand by giving a brief description of some of the representatives.

After taking the tablet, the active substance is 80–90% absorbed by the body, regardless of food intake. Once in the blood, bisoprolol fumarate begins to affect the body:

• reduces plasma renin activity;
• under the influence of the drug, the need for oxygen in the heart muscle decreases;
• reduces heart rate;
• AV conduction is inhibited;
• symptoms of ischemia are eliminated.

Bisoprolol lowers blood pressure (this occurs by reducing cardiac output)

Medicines similar in action and composition

The modern pharmaceutical market is distinguished by a rich assortment of effective beta blockers. Therefore, drugs with similar pharmacological kinetics, from both domestic and foreign manufacturers, are not difficult to find today. One of the main advantages of a large selection is the cost, which in this case varies over a very wide range.

High-quality analogues of Bisoprolol have an identical mechanism of action, or they contain the same active component. All drugs in this series are sold in pharmacies only with a doctor's prescription.

Important point! The patient must agree with the doctor on the intention to replace the usual remedy with a more effective, in his opinion, analogue.

Below is a table that shows the price and briefly describes the characteristics of popular Russian-made generics.

The most effective foreign analogues

As a note: It’s easy to buy affordable analogues in a pharmacy chain. If the drug specified in the prescription is not available for sale, the pharmacist is obliged to offer one of the analogues that has the same active ingredient.

Summarizing everything that was said earlier, we can say with confidence that modern beta blockers have changed the lives of many people for the better. Bisoprolol and its analogues significantly improve the condition of patients and instill in their hearts hope for a full life. Thanks to the unique properties of drugs in this series, today hypertension and angina are not a death sentence, but only a condition that can be controlled with the help of these drugs. But the patient must always remember that the treatment process requires regular medical supervision.

The standard treatment regimen for various pathologies looks like this:

Please note: Considering that pressure readings of 120/80 are considered normal, therefore the grounds for using Bisoprolol at pressures above these figures can be considered quite justified. But this should be decided by the doctor.

Difference from regular Bisoprolol

Medications called “Bisoprolol” and “Bisoprolol-Prana” are Russian pharmaceutical products. The difference between these drugs lies in the qualitative and quantitative composition of the auxiliary ingredients.

The active substance that directly affects the body is identical. Therefore, both drugs have the same effect.

Analogs

Analogues of medicines are:

• structural;
• by mechanism of action.

Structural analogs are drugs that have a similar chemical composition. In relation to Bisoprolol these are:

• Biprol;
• Bisogamma;
• Niperten;
• Bisoprolol Prana;
• Concor;
• Bisomore;
• Bioscard;
• Corbis;
• Bidop;
• Aritel Cor.

Drugs with a similar mechanism of action may differ in their composition, but the effect on the body will be identical. These are drugs such as:

• Atenolol;
• Betacard;
• Betalok;
• Coradnum;
• Metozok;
• Metoprolol;
• Metokor;
• Nebilet;
• Estekor.

Adverse reactions

Side effects when taking the drug can manifest themselves in the form of dizziness, headache, bradycardia, arterial hypotension, numbness of the extremities, nausea and vomiting.

Considering the above, it is not recommended to take the drug for persons engaged in hazardous work, as well as when driving a vehicle.

An overdose can manifest itself in the form of arrhythmia, pronounced bradycardia, a significant drop in blood pressure, heart failure, blue hands, shortness of breath, dizziness, bronchospasms, and convulsive attacks.

As you can see, the consequences of an overdose of Biosporol can be very serious, which is an additional incentive to be careful in taking it and do it only as prescribed by the attending physician.

Another argument in favor of this is that Bisoprolol should in no case be combined with taking Floctafenin and Sultopride, and should also be used with caution when using a large list of other medications.

Despite the doctor’s prescription, before taking it, you must read the instructions and this section in order to avoid negative consequences from combining these drugs.

Indications for the drug Bisoprolol allow it to be used by all hypertensive patients. However, no one is immune from the development of side effects.

The cardiologist prescribes the dosage and regimen for taking Bisoprolol. If you ignore your doctor's recommendations and take too many tablets, symptoms of a drug overdose may appear. It's easy to recognize them:

• bradycardia (slow heart rate). It appears regardless of the pressure at which the drug was taken;

Taking this medication can cause dizziness and a feeling of flushing of the face.

• a sharp decrease in blood pressure;
• arrhythmia (unstable pulse);
• exacerbation of heart failure;
• change in color of nails, fingers of the lower and upper extremities;
• labored breathing;
• convulsive spasms of muscle tissue;
• dizziness, sometimes fainting.

At the first symptoms of a drug overdose, the patient should take activated charcoal and call an ambulance (go to the hospital for gastric lavage). If Bisoprolol at low pressure caused worsening of hypotension, the patient should lie down so that the head is lower than the level of the lower extremities.

Treatment with tablets of this group is long-term, so patients wonder whether Bisoprolol can cause side effects. Compared to other antihypertensive drugs, these capsules do not cause many uncomfortable symptoms. In most cases, adverse reactions are observed at high dosages of the active substance (from 10 mg). The most frequently recorded reactions of the body are:

• disturbances in heart rhythm and blood circulation in the extremities, symptoms of chronic failure of the myocardial muscle appear;

Taking this medication may cause insomnia and other sleep disorders.

• migraine, dizziness, in rare cases, loss of consciousness;
• loss of strength, rapid fatigue even from light work;
• sleep disturbance (insomnia, nightmares, sometimes hallucinations);
• there is a decrease in hearing acuity, a feeling of dry eyes due to a decrease in the reproductive capacity of tear fluid;
• disruption of the digestive system - constipation or, conversely, diarrhea;
• muscle cramps and muscle weakness sometimes appear;
• in case of individual intolerance to the components of the drug, local allergic reactions appear in the form of rash, skin itching, redness, exacerbation of the clinical picture of psoriasis;
• In men, potency and libido decrease.

Bisoprolol in the treatment of complex heart rhythm disorders during pregnancy

Heart rhythm disturbances during pregnancy, according to various authors, occur in 20-40% of women (1). The main causes of arrhythmias can be divided into extracardiac, cardiac and arrhythmias, the etiology of which has not been established (idiopathic, primary electrical heart disease).

Table. Blood pressure level and Holter ECG monitoring indicators in pregnant women during treatment with bisoprolol

Extracardiac factors include functional and organic lesions of the central nervous system, dysfunction of the autonomic nervous system with a predominance of the tone of the sympathetic department or a decrease in the tone of the parasympathetic department, endocrine diseases, primarily diseases of the thyroid gland, electrolyte imbalance, mechanical and electrical injuries, hypo- and hyperthermia, excessive physical activity, intoxication with alcohol, nicotine, coffee, medications. Medicines such as sympathomimetics, cardiac glycosides, diuretics, most psychotropic drugs, some antiarrhythmic drugs and antibiotics can cause rhythm and conduction disturbances.

Cardiac factors that can cause cardiac arrhythmias are coronary heart disease, congenital and acquired heart defects, including valve prolapse, arterial hypertension, inflammatory and non-inflammatory myocardial lesions, heart failure, diagnostic procedures and operations on the heart and coronary vessels, some congenital diseases of the cardiovascular system.

Pregnancy, even in practically healthy women, can be a factor provoking the development of heart rhythm disturbances. This is facilitated by gestational changes in the woman’s body relating to hemodynamic, electrophysiological and neurohumoral parameters. In particular, hormones of the sympathetic-adrenal system (SAS) have a proarrhythmogenic effect, the activity of which increases significantly during pregnancy, reflecting the adaptation of the woman’s body to new conditions for the functioning of the “mother-placenta-fetus” system (2, 3). Changes leading to an increase in the activity of the SAS can occur at the level of the central nervous system, which is manifested by a decrease in central inhibitory influences and a decrease in the sensitivity of baroreceptors, an increase in the impulse activity of sympathetic nerves, facilitation of ganglion impulse transmission, increased release of norepinephrine into the synoptic fissure and disruption of its metabolism in this area. cracks. Along with this, the peripheral link of the SAS also changes - the density and/or sensitivity of adrenergic receptors, the interaction of receptor-contractile proteins. The indirect effect of SAS on the level of blood pressure and heart rate occurs through stimulation of the synthesis of renin, vasopressin, the occurrence of insulin resistance, disruption of the functional state of the endothelium and other mechanisms (4,5). All these processes can lead to various heart rhythm disturbances, the treatment of which during pregnancy is a complex and responsible task, because the issue of not only improving the clinical condition and quality of life of a woman, but also the condition of the fetus and newborn is being resolved.

One of the most common heart rhythm disturbances during pregnancy is extrasystole, which in almost half of patients occurs without any organic changes in the cardiovascular system (CVS), gastrointestinal tract, or endocrine system. The main causes of extrasystole during pregnancy are considered physiological changes in hemodynamics, emotional arousal, drinking alcohol, coffee, strong tea, smoking, overeating, and abuse of spicy foods. Of great importance is the electrolyte imbalance towards hypomagnesemia and hypokalemia, the use of drugs - sympathomimetics, caffeine, as well as neurocirculatory dystonia and organic damage to the cardiovascular system, in particular, previous myocarditis, heart defects, cardiomyopathies, etc.

The treatment strategy for cardiac arrhythmias is determined by the basic rule: the prescription of antiarrhythmic drugs should be avoided if the arrhythmia does not pose a threat to the patient’s life. If medication is necessary, treatment approaches are the same as for non-pregnant women. At the same time, the possible effect of the drug on the physiological course of pregnancy, childbirth, and the condition of the fetus and newborn should be taken into account. In Russia there is no classification of drugs according to safety criteria for the fetus, and therefore it is possible to use the American classification of drugs and food products by the Food and Drug Administration (FDA) (6). According to these criteria, there are 5 categories of medicines.

1. Controlled studies have shown no risk to the fetus.
2. Lack of evidence of risk to the fetus: a risk to the fetus has been found in animals, but not in humans, or there is no risk in the experiment, but there is insufficient research in humans.
3. A risk to the fetus cannot be excluded: side effects have been identified in animals, but there is insufficient research in humans. The expected therapeutic effect of the drug may justify its use despite its potential risk to the fetus.
4. Strong evidence of risk: There is a proven risk to the fetus in humans, but the expected benefit to the expectant mother may outweigh the potential risk to the fetus.
5. Use during pregnancy cannot be justified: a drug that is dangerous to the fetus when the negative effect on the fetus exceeds the potential benefit from this drug in the expectant mother.

The drugs of choice for the treatment of extrasystole during pregnancy are verapamil and beta-blockers.

Beta-blockers (BAB) according to the classification of E. Vaughan-Williams (1971) belong to class II antiarrhythmic drugs. The principal mechanism of the inhibitory effect of beta blockers on adrenoreactive structures is to weaken or eliminate the effects associated with the excitation of β1-adrenergic receptors by catecholamines, which cause increased heart rate, increased automaticity of the atrioventricular node and myocardial excitability, increased impulse conduction speed, increased myocardial contractility, decreased refractory period , activation of lipolysis. Excitation of β2-adrenergic receptors by catecholamines leads to dilation of arterioles, decreased tone of smooth muscles of the bronchi, bladder, uterine tone during pregnancy, tremor of skeletal muscles, inhibition of the release of histamine, leukotrienes in mast cells during allergic reactions of type I, hypokalemia, increased hepatic glycogenolysis (7) . Cardioselective beta blockers contribute to a lesser extent to increasing the tone of peripheral arteries, which is very important during pregnancy, when peripheral vascular resistance is physiologically reduced, including in the “mother-placenta-fetus” system. The degree of cardioselectivity (effect on β1/β2 receptors) for metoprolol is 1:35, for bisoprolol - 1:75, while for non-cardioselective propranolol the cardioselectivity index was 1.8:1. The later any drug, including beta blockers, is prescribed during pregnancy, the lower the risk of its negative impact on the course of pregnancy and the condition of the fetus. There are reports of a slowdown in intrauterine development of the fetus in women who took propranolol during pregnancy and atenolol in the first trimester of pregnancy, while the use of this drug, like other beta blockers, from the second trimester is considered safe for the fetus and newborn (8). Data from a few randomized studies on the use of beta blockers in the treatment of hypertension during pregnancy have shown their greater clinical efficacy, safety for the fetus and newborn, and the absence of a negative effect on the physiological course of pregnancy and childbirth (9-11).

Cardioselective beta blockers without intrinsic sympathomimetic activity include bisoprolol, which in experimental studies on the reproductive characteristics of animals did not have a teratogenic effect at a dose of 375 and 77 times the MRL, depending on weight and body surface area, respectively, but its fetotoxicity was noted in these supramaximal doses (increased number of late fetal resorptions). The drug has established itself as an active antihypertensive and antiarrhythmic drug in patients with hypertension and arrhythmias of organic origin.

The purpose of the study was to study the clinical effectiveness and safety of bisoprolol in pregnant women with frequent ventricular extrasystole.

Patients and research methods

Under observation in the specialized cardiology department for pregnant women with diseases of the cardiovascular system of City Clinical Hospital No. 67 were 32 patients in the second trimester of pregnancy aged 19-47 years (average age 27.3±3.8 years), of which 30 women were multipregnant and 2 – primigravidas. All patients gave informed consent to participate in the examination and treatment. A comprehensive clinical and laboratory examination included, along with the routine, a blood test for electrolytes - potassium and sodium, thyroid hormones T3, T4, TSH using the radioimmune method, ECG in dynamics, Echo-CG with Dopplerography in continuous and pulsed modes using standard methods on the device “Acuson 128 XP/10” (USA), 24-hour Holter ECG monitoring was performed on the “Medilog Prima” device on days 1-2 of hospital stay and after 3 weeks of treatment with bisoprolol. All pregnant women were observed by an obstetrician. The activity of the sympathetic-adrenal system was assessed by the value of β-adrenoreception of erythrocyte membranes (β-ARM) using the author’s method, based on changes in the osmoresistance of erythrocytes in the presence of a beta-blocker using a set of reagents “ARM-AGAT” (Agat-Med LLC, Moscow) (12) . Bisoprolol (Concor, Nycomed) was used as an antiarrhythmic drug; treatment began with 2.5 mg under the control of blood pressure, heart rate, ECG and subjective state; if the dose was ineffective, it was doubled, and subsequently, if necessary, increased to 10 mg per day. The majority of patients (28 people) received 5 mg of bisoprolol and 4 people. – 10 mg of the drug per day. The course of treatment in hospital averaged 3 weeks. The effectiveness of treatment was assessed by subjective sensations and the results of Holter ECG monitoring.

Statistical processing of the study results was carried out using the “Biostatistics, Version 4.03” software package using standard methods of variation statistics and Student’s test to assess differences in paired measurements of indicators. The difference was considered significant at p

Results and discussion

During the initial examination, according to Holter ECG monitoring, frequent ventricular extrasystoles were registered in all examined patients; the number of extrasystoles per day ranged from 8 thousand to 50 thousand, in some (6 people) with couplets (from 13 to 80 per day) and triplets (in 4 people, the number of triplets – from 3 to 150 per day), ventricular tachycardia runs were registered in 5 women (from 1 to 5 per day) with a heart rate from 156 to 229 per minute. These rhythm disturbances corresponded to class III-IV according to the classification of B.Lawn and N.Wolff (1971). Arrhythmia in all patients was manifested by pronounced subjective sensations - a feeling of interruptions and fading of the heart, palpitations, sometimes accompanied by fear, sweating, and weakness. It should be noted that in the majority of subjects (26 people, 81.3%), arrhythmia appeared during pregnancy, in the remaining 6 people. (18.7%) it was present before pregnancy, but with increasing gestational age, subjective tolerability of arrhythmia became worse.

According to the anamnesis and comprehensive clinical and laboratory examination, in half of the patients the cause of arrhythmia was organic or functional changes in the cardiovascular system: corrected congenital heart disease (4 people), dilated cardiomyopathy (2 people), hypertrophic cardiomyopathy without obstruction of the left ventricular outflow tract (1 person .), mitral valve prolapse with mitral regurgitation of II (6 people) and III degree (2 people), post-myocardial cardiosclerosis (1 person). In 16 women, no changes in the cardiovascular system, thyroid gland or biochemical parameters were detected, and these arrhythmias were regarded as idiopathic. As mentioned above, pregnancy causes pronounced hemodynamic changes in a woman’s body due to an increase in body weight due to the growth of the placenta and the increasing weight of the fetus, increased metabolism, the development of physiological hypervolemia, and the formation of uteroplacental blood flow. During gestation, physiological myocardial hypertrophy develops - myocardial mass increases by 10-31% by the end of the third trimester and after childbirth, myocardial mass quickly returns to its original level. In pregnant women, cardiac output increases by 15-50% and stroke volume by 13-29%, blood flow speed increases by 50-83%, heart rate is 15-20 beats per minute higher than pre-pregnancy heart rate, general peripheral vascular resistance decreases by an average of 12-34% (13-15). These hemodynamic factors can act as proarrhythmogenic mechanisms contributing to the development of various cardiac arrhythmias.

The proarrhythmogenic effect is also enhanced by physiological hypersympathicotonia, identified during examination in patients with arrhythmia. Analysis of β-ARM values ​​showed significant fluctuations in this indicator among the examined people - from 25 to 85.5 conventional units. units (on average 39.1±2.8 conventional units). According to the conditions of the method, β-ARM values ​​exceeding 20 arb. units, indicate desensitization of adrenergic receptors under the influence of increased concentrations of endogenous catecholamines in individuals with high SAS activity (11). The high values ​​of β-ARM that we discovered are consistent with the results of other authors who showed that the gestational period is characterized by high functional activity of the SAS (2, 3). It should be noted that in some patients this indicator significantly exceeded the average physiological norms, and in 3 women it reached 70-80.5 conventional units. units Such β-ARM values ​​were recorded in the group of patients with idiopathic extrasystole, which gave us grounds to consider severe hypersympathicotonia as the main proarrhythmogenic factor in this category of patients.

According to the results of treatment, 26 women showed a significant improvement in their clinical condition, which was manifested by a significant decrease in the number of extrasystoles per day according to Holter ECG monitoring (Table 1). It is important to emphasize that paired extrasystoles - doublets and triplets - completely disappeared in 4 patients or decreased by an average of 57% in 3 patients compared to the baseline; no episodes of ventricular tachycardia were recorded. We did not detect a significant decrease in systolic (BPs) and diastolic (BPd) blood pressure.

Treatment with bisoprolol was ineffective in 6 patients (3 of them with organic CVS ​​pathology). One patient had hypertrophic cardiomyopathy, the second had mitral valve prolapse with grade III mitral regurgitation, and the third woman was diagnosed with idiopathic arrhythmia. It should be emphasized that the analysis of the adrenoreactivity indicator revealed a significant increase in all three patients with idiopathic arrhythmia - their β-ARM values ​​exceeded 70 conventional units, while the average for the group β-ARM was 39.1±2. 8 conventional units Such high levels of β-ARM indicate pronounced desensitization of adrenergic receptors, as a result of which there are no “points of application” for beta blockers on the cell membrane. Similar data on adrenergic receptor desensitization under the influence of excessively high concentrations of endogenous catecholamines were obtained in experimental studies in our work, which showed the absence of the hypotensive effect of betaxolol in hypertensive patients with high β-ARM values ​​(16). After inpatient treatment, all 26 patients were recommended to continue taking bisoprolol in an individually selected clinically effective dose, and they continued to be observed by us in the consultative and diagnostic center of City Clinical Hospital No. 67.

An analysis of perinatal outcomes was assessed in 13 of 26 patients observed by us at the consultative and diagnostic center and who gave birth in the specialized maternity hospital of City Clinical Hospital No. 67. All women gave birth independently at 39-40 weeks of pregnancy with a full-term fetus with an Apgar score at the 5th minute 8-9 points. The weight of newborns ranged from 2300 g (in a woman with dilated cardiomyopathy) to 3200-4300 g in all other women. At the same time, researchers note the possibility of symptoms of β-blockade in the form of fetal distress, bradycardia, hypoglycemia and intrauterine growth retardation in children whose mothers took beta blockers (17). In our study, no such or any other complications from the fetus or newborn were noted.

Thus, bisoprolol in pregnant women with complex heart rhythm disorders (class III-IV according to B.Lawn and N.Wolff) is an effective antiarrhythmic drug, does not affect the physiological course of pregnancy and childbirth and does not have a negative effect on the condition of the fetus and newborn.

conclusions

1. Bisoprolol is an effective antiarrhythmic drug in the treatment of complex cardiac arrhythmias (class III-IV according to B.Lawn and N.Wolff) in pregnant women with organic diseases of the cardiovascular system and idiopathic arrhythmia.
2. In patients with an adrenoreactivity index (β-ARM) of 70 arb. units and more, bisoprolol is ineffective due to pronounced desensitization of adrenergic receptors under conditions of high activity of the sympathetic-adrenal system.
3. Treatment of pregnant women with complex heart rhythm disorders with bisoprolol does not affect the physiological course of pregnancy and childbirth and does not have a negative effect on the condition of the fetus and newborn.
4. The study of the adrenoreactivity indicator based on the β-ARM value can be a prognostic criterion for the individual sensitivity of patients to β-blockers.

Effect on blood pressure

The main direction of use of the drug is hypertension of varying severity. Thus, Bisoprolol-Prana has an effect that reduces pressure in the vessels of the circulatory system.

After consuming the drug, the active substances are actively absorbed into the blood. After 2.5 hours the concentration reaches its maximum.

About 95% of the drug is excreted from the body by the kidneys, the rest by the liver.

Reception for various pathologies

If the patient has pheochromocytoma, then when taking Bisoprolol-Pran, paradoxical arterial hypertension may develop. This can be avoided by first achieving effective α-blockade.

Taking Bisoprolol-Pran against the background of thyrotoxicosis may mask some of its clinical manifestations. You should not suddenly stop taking this medication, as the symptoms of the disease may worsen.

If surgical treatment is planned, then Bisoprolol-Prana should be discontinued two days before general anesthesia is performed. If the drug was taken during this period, the anesthetic drug should be selected so that the negative inotropic effect is minimal.

The effectiveness of the drug may be reduced if the patient smokes for a long time.

Restrictions on taking Bisoprolol

This drug should be used with caution by people who have diseases such as diabetes mellitus, hypoglycemia, metabolic acidosis, thyrotoxicosis, 1st degree atrioventricular block, vasospasmatic angina. Also, this medication should not be used by patients on a strict diet, or by those undergoing a course such as desensitizing therapy.

With a diagnosis such as heart failure, the drug Bisoprolol cannot be used during an exacerbation. Reviews show that in this case, the use of this medicine can only worsen your health. Also, with this diagnosis, this medicine should not be used if the pulse is less than 60 beats per minute. It is also contraindicated in case of low systolic blood pressure, especially if it is below 100 mmHg.

Composition of the drug "Bisoprolol"

If we consider the constituent components of this drug, we can see that the main element is the substance bisoprolol fumarate itself. All Bisoprolol tablets contain 5 grams of this substance. Reviews from patients show that after the first use of this drug, their health improves significantly. No medicine can be made without auxiliary elements. So, this drug also includes croscarmellose sodium or primelose, povidone or medium molecular weight polyvinyl lyrolidone, progelatin starch, colloidal silicon dioxide, as well as a little talc, microcrystalline cellulose, lactose or milk sugar and magnesium stearate.

Most medicines have a smooth, pleasant-tasting coating. This also applies to the drug "Bisoprolol". Reviews show that the tablets are easy to swallow and do not leave an unpleasant taste in the mouth. This is all thanks to components such as macrogol (polyethylene glycol), titanium dioxide, opadry 2. The pleasant color of the tablets is obtained due to the dye used - iron oxide (2).

Undesirable consequences

The drug "Bisoprolol-Prana" can provoke various side effects that affect the central and peripheral areas of the nervous system. They manifest themselves as headaches, fatigue, sleep disturbances, depression and hallucinations.

Undesirable processes in the heart and blood vessels are caused by orthostatic hypotension, hot flashes, sweating, slow heartbeat and myocardial failure.

Other manifestations of side effects are reduced secretion of the lacrimal gland, the development of conjunctivitis, diarrhea, itching of the skin, constipation, nausea, muscle weakness and cramps. Obstructive symptoms may appear in the bronchi.

Pharmacological properties

The drug has antiarrhythmic, hypotensive and antianginal (anti-ischemic) effects. It blocks beta1-adrenergic receptors of the heart, reduces heart rate and cardiac output. Bisoprolol reduces the conduction of electrical excitation through the heart, i.e. atrioventricular conduction.

In large doses (more than 0.02 g), the drug has a blocking effect on beta2-adrenergic receptors, mainly in the smooth muscles of blood vessels and bronchi. The maximum effect of the drug develops 1-3 hours after administration and continues throughout the day.

What is the difference

Often, patients, when choosing the right medicine, try to find out which one is more effective: Concor or Bisoprolol? It is impossible to answer this question unambiguously, because both drugs contain the same active ingredient. The development of this product was patented by a German company that produced the medicine under the Concor brand. When the patent expired, many generics of the original drug appeared on the pharmaceutical market. Among them, Bisoprolol is a medicine produced by domestic manufacturers.

Thus, the only difference is that practically the same drug is produced by different manufacturers.

Can bisoprolol be used by pregnant women?

Doctors prescribe taking the drug for the complex treatment of arterial hypertension. Its clinical effect is used in the treatment of many cardiac pathologies, such as:

• angina pectoris;
• cardiac ischemia;
• chronic form of heart failure;
• myocardial infarction;
• tachycardia;
• mitral valve prolapse.

Medicine can be prescribed for both treatment and prevention of illnesses. In case of angina pectoris, it is the prevention of heart attacks; in case of ischemia, it is a relief of the condition. But most often the indication for use is arterial hypertension.

Before taking bisoprolol for heart failure, after a heart attack, for tachycardia and extrasystole, for other problems of the cardiovascular system, the patient should carefully read the doctor’s recommendations. The instructions for use at what pressure, how and how much to take will tell you more about bisoprolol, but it’s difficult to understand the terminology on your own. It is better to rely on the experience and competence of the doctor prescribing the pills.

To fully experience the blood pressure-lowering effect of the medication, you need to take it in the morning on an empty stomach or with breakfast. Food does not have a particular effect on the absorption of the active substance and its subsequent activity. In case of high blood pressure, swallow the tablet without chewing, washing it down with a sufficient volume of water.

Initially, the doctor recommends starting treatment with small doses - 5 mg once a day. If necessary, the dosage of the drug is further increased to 10 mg per day. The highest amount of the drug that can be taken per day is 20 mg, provided that the drug is well tolerated by the body and does not cause serious adverse reactions.

Elderly patients do not need to adjust the dosage of the drug; for patients with renal failure, the dose of the drug was reduced to 10 mg per 24 hours. One of the advantages of bisoprolol is that it is taken once a day; it is very convenient and effective.

For patients with severe chronic heart failure, bisoprolol is prescribed if their health condition has been stable for the last 1.5 months. There is no need to adjust your medication intake for 2 weeks before prescribing bisoprolol. Therapy will be prescribed in combination with ACE inhibitors, cardiac glycosides, and diuretics.

The standard dosage of the drug for heart failure is 1.25 mg per day for a week, in the 2nd 7-day week the drug is taken at 2.5 mg per day, in the third week – 3.75 mg, and from 4 to 8 weeks inclusive, 5 mg of the drug per day is prescribed. From 8 to 12 weeks, increase the dose of bisoprolol to 7.5 mg, and after the end of 12 weeks, therapy is carried out at a dosage of 10 mg of the drug per day. This is the maximum possible dose for patients with this disease.

The scope of application of Bisporolol, as well as its compatibility in combinations with other drugs, dosage regimen and frequency of administration are determined by the basic physiological properties of the biochemically active substance:

1. It has pronounced anti-ischemic properties (it normalizes myocardial trophism), its intake can significantly reduce heart rate and myocardial contractility, which significantly reduces the need for cardiomyocytes for oxygen and improves blood supply to the heart muscle. In addition, the drug is characterized by a pronounced hypotensive effect: it reduces the peripheral vascular resistance and significantly reduces cardiac output (due to this, the drug significantly reduces the IOC - an indicator of the minute volume of blood that the heart pumps per unit time). Accordingly, this drug is used in almost all cases of coronary artery disease, including variant angina.
2. The drug significantly reduces heart rate - in other words, under its influence a negative inotropic effect is realized, and sympathy is also inhibited, with all the ensuing consequences. That is, it can be used for tachycardia.
3. AV conduction slows down - this property clearly indicates the antiarrhythmic effect of this drug. Accordingly, this makes it possible to use the drug in the treatment of AF, as well as supraventricular or ventricular arrhythmia.
4. It is also used in the complex therapy of heart failure (CHF), in combination with diuretics, angiotensin-converting enzyme inhibitors and diuretics, but such prescriptions are rarely found, because they are justified only in conditions of elevated blood pressure, which is quite rare in CNF.
5. The drug has scientifically confirmed its effectiveness in treating cardiac arrhythmias and arrhythmias manifesting against the background of mitral valve prolapse or thyrotoxicosis (hyperthyroidism).

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Step therapy is recommended, which is carried out in fairly small doses. At the same time, it is necessary to note that the optimal dosage of the proposed drug is prescribed and selected only by the attending physician, because if the schedule is violated and if the dosage is incorrectly selected, cardiovascular collapse may occur.

However, there are general recommendations that patients should familiarize themselves with before they begin a therapeutic course that requires the use of Bisoprolol:

1. It is strongly recommended to take the drug early in the morning.
2. Food intake does not play any role in relation to the treatment regimen. In no case should the tablets be crushed or crushed - accordingly, the recommendation of many pharmacists regarding the permissibility of dividing a Bisoprolol tablet in half does not stand up to criticism.
3. For convenience, the tablets are washed down with water - although in principle, you can drink it with anything - most importantly, non-alcoholic drinks.
4. Regarding the duration of use, Bisoprolol is used only for life, and if it is discontinued, then only if certain contraindications are detected, or if there are adverse side effects of this pharmaceutical. And then, it is necessary to begin a gradual reduction in the dose, and not stop taking the drug abruptly.

If the data from the obtained clinical studies show negative results, then in such a situation it is necessary to adjust the dosage of the drug, and in difficult cases, temporarily suspend the implementation of the therapeutic regimen. After the patient’s objective condition has stabilized, the consumption of Bisoprolol is resumed.

A separate clinical group includes patients whose health is characterized by pathology of liver or kidney function, since Bisoprolol directly affects the functioning of these organs. Please note that during the treatment of CNC in patients with functional and/or morphological pathologies of the liver and kidneys, the dose of Bisoprolol should be prescribed with caution based on the considerations that the data on its effect on the body in the situations under consideration is clearly insufficient to provide accurate guarantees and recommendations .

For elderly patients (over 60 years old), selection of a special dosage of the drug is not necessary; general recommendations are still valid.

Regarding the mechanism of physiological action on the human body, the following points can be noted:

1. The biochemically active substance, after entering the general bloodstream, is 80–90% absorbed by the body, completely independent of food intake.
2. The drug reduces the physiological activity of plasma renin.
3. Directly under the influence of the drug, the myocardial need for oxygen is stopped.

As with other medications, Bisoprolol tablets must be accompanied by instructions. This is not only a kind of guidance on the use of the drug, but also a warning about possible contraindications and side effects, as well as a list of situations when Bisoprolol is indicated for the patient. Of course, it is necessary to familiarize yourself with the information provided in this instruction not only for the sick person himself, but also for his attending physician if he is encountering Bisoprolol for the first time.

Awareness is the first step to ensure the effectiveness of all therapies. In addition, given that this medication is used in cases where a person has problems with the cardiovascular system, the patient’s life can often depend on the correct use of the medicine. This means that the instructions for use of Bisoprolol require especially careful reading and careful adherence to the recommendations published in it.

Various pathologies of the cardiovascular system are diagnosed in many people every year. Diseases are rapidly becoming younger, which is caused by an unbalanced diet and a sedentary lifestyle. Pharmaceutical companies produce modern drugs that can be used to treat and prevent heart and vascular diseases, while trying to minimize the number of adverse reactions. One of these medicines is Concor, the instructions for use of which will help you figure out at what pressure the medicine helps.

Diseases of the cardiovascular system occur in almost every modern person. They are accompanied by regular surges in blood pressure. Therefore, every person suffering from such an illness is looking for the most effective means to normalize blood pressure, since this condition interferes with comfortable life. One of the most effective medications is Bisoprolol, the instructions for use of which should be studied in detail, and also consider the pressure at which it is used.

Adverse events and overdose

Overdose and side effects of Bisoprolol for hypertension develop in case of violation of the treatment regimen or recommended doses. List of secondary adverse reactions:

The medicine may make a person feel tired.

• fatigue;
• vertigo;
• hyperemia of the face and neck;
• headache;
• sleep disorders;
• arrhythmias;
• hypotension;
• decreased heart rate;
• reflex tachycardia;
• heartbeat;
• conduction disorders;
• decreased tolerance to carbohydrates;
• hearing impairment;
• drug-induced hepatitis;
• depression;
• convulsions.

The Vidal reference book of medicinal substances describes that an overdose is manifested by critically low blood pressure. Acute heart failure, arrhythmia, decreased blood glucose concentration and bronchospasm are common manifestations of an overdose of Bisoprolol. With low pressure, filtration in the kidneys stops and acute renal failure develops. Medical care depends on the clinical symptoms and condition of the patient. There were no deaths reported after exceeding doses of the medication.

Interaction of the drug with other drugs

With high blood pressure, simultaneous use of this medicine with drugs that lower blood pressure enhances their effect. Take with extreme caution:

• insulin or pills that lower blood sugar. The drug bisoprolol fumarate enhances their effect, but at the same time suppresses the main symptoms of hypoglycemia;
• if an operation is to be performed, the anesthesiologist should know about taking these tablets, because their active substance, together with anesthesia, impairs the functioning of the heart muscle;

In cases where a person is forced to take complex therapy with Bisoprolol and another drug that lowers blood pressure, the therapeutic effect becomes stronger

• It is strictly contraindicated to take Floctofenin and Sultopride simultaneously with tablets;
• Clonidine is prescribed only after complete completion of the course of bisoprolol fumarate. Especially if the patient has high blood pressure. The simultaneous use of these drugs causes an exacerbation of hypertension;
• Taking symptomatic medications (drops for a runny nose, cough syrup) weakens the effect of bisoprolol fumarate on the body.

The medicine is incompatible with MAO inhibitors. However, it can be taken together with MAO-B inhibitors.