Instructions for use CONCOR® (CONCOR)

Pharmacological properties of the drug Concor cor

Bisoprolol (INN - bisoprololum) is a selective β1-adrenergic receptor blocker. When used in therapeutic doses, it does not have BSA and clinically significant membrane-stabilizing properties. Reduces plasma renin activity, reduces myocardial oxygen demand, and reduces heart rate (at rest and during exercise). By blocking β1-adrenergic receptors of the heart in low doses, it reduces the catecholamine-stimulated formation of cAMP from ACE, reduces the intracellular current of calcium ions, and has a negative chrono-, dromo- and inotropic effect (inhibits conduction excitability, slows down AV conduction). The antianginal effect is due to a decrease in myocardial oxygen demand as a result of a decrease in heart rate, a slight decrease in contractility, prolongation of diastole, and improved myocardial perfusion. When increasing the dose above the therapeutic one, it has a β2-adrenergic blocking effect. Concor Cor has a hypotensive effect due to a decrease in cardiac output, inhibition of renin secretion by the kidneys, as well as an effect on the baroreceptors of the aortic arch and carotid sinus. In case of hypertension (arterial hypertension), the effect occurs after 2–5 days, stable effect occurs after 1–2 months. With prolonged use, bisoprolol reduces increased peripheral vascular resistance. When used in average therapeutic doses, in contrast to non-selective β-blockers, it has a less pronounced effect on organs containing β2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism, does not cause delay sodium ions (Na+) in the body. The severity of the atherogenic effect does not differ from the effect of propranolol. After taking the drug orally, bisoprolol is well absorbed from the gastrointestinal tract. Bioavailability is about 90% and is independent of food intake. The maximum concentration is reached after 1–3 hours. Binding to blood plasma proteins is about 30%. The effect of primary passage through the liver is insignificant (about 10%). About 50% of bisoprolol is biotransformed in the liver with the formation of inactive metabolites. The main metabolites found in blood plasma and urine do not exhibit pharmacological activity. The pharmacokinetics of bisoprolol is linear. Its concentration in blood plasma is proportional to the administered dose in the dose range from 5 to 20 mg. The maximum concentration in blood plasma is reached after 2–3 hours. Bisoprolol is distributed quite widely. The volume of distribution is 3.5 l/kg. Communication with blood plasma proteins is about 35%. The total clearance is 15.6 ± 3.2 l/h, with renal clearance being 9.6 ± 1.6 l/h. The half-life is 10–12 hours. Approximately 98% is excreted from the body in the urine, 50% unchanged, the rest in the form of metabolites, approximately 2% of the dose is excreted in the feces. No dose adjustment is required for patients with mild to moderate hepatic or renal impairment.

Use of the drug Concor cor

The tablets should be taken with a small amount of liquid in the morning before, during or after breakfast. The tablets should not be chewed or crushed into powder. Initiation of treatment for chronic heart failure with Concor Cor requires a special titration phase and regular medical supervision. Treatment of chronic heart failure with Concor Cor begins in accordance with the following titration scheme. Individual adaptation may be required depending on how well the patient tolerates the prescribed dose, i.e. the dose can only be increased if the previous dose was well tolerated.

* To ensure the above dosage regimen, it is recommended to use the drug Concor in subsequent stages of treatment.

The maximum recommended dose for the treatment of chronic heart failure is 10 mg of bisoprolol once a day. Patients are advised to take the dose of the drug selected by the doctor, unless adverse reactions occur. After starting treatment with the drug at a dose of 1.25 mg (1/2 t of Concor Cor tablet), the patient should be observed for about 4 hours (monitoring heart rate, blood pressure, conduction disturbances, signs of worsening heart failure). During or after the titration phase, a temporary worsening of heart failure symptoms, fluid retention, hypotension, or bradycardia may occur. In this case, it is recommended, first of all, to pay attention to the selection of the dosage of concomitant basic therapy (optimize the dose of the diuretic and/or ACE inhibitor) before reducing the dosage of Concor Cor. Treatment with Concor Cor should only be interrupted if absolutely necessary. After stabilization of the patient's condition, re-titration should be carried out, or treatment should be continued. No dose adjustment is usually required for patients with mild to moderate hepatic or renal impairment. For patients with a marked decrease in renal function (creatinine clearance less than 20 ml/min) and with severe liver dysfunction, the daily dose should not exceed 10 mg. In any case, the dose is selected individually. Treatment with Concor Cor is usually long-term. If necessary, treatment can be interrupted and resumed subject to certain rules. Treatment should not be interrupted suddenly, especially in patients with coronary artery disease. If discontinuation of treatment is necessary, the dosage of the drug should be reduced gradually.

Reviews from doctors

Chamorovsky A. N., cardiologist, work experience 9 years

Concor is a gold standard selective beta blocker that is effective for use in patients with coronary artery disease. Has an effect aimed at reducing the number of heart contractions. Used in patients with heart failure. The drug has an affordable price, which allows it to be used in the treatment of different groups of the population.

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Zafiraki V.K., cardiologist, 18 years of experience

Concor is an original drug, but it is not much more expensive than generics. At the same time, the original drug is the standard of therapeutic effect and safety, and generics can only come close to the original. Well tolerated, side effects typical of beta blockers are rare. Concor is one of the safest in its class.

Sometimes a drug's reputation is damaged if it is used for other purposes. Then there will be no result, and the patient will remain disappointed. Not every pain in the chest, even if on the left, in the region of the heart, is angina. Accordingly, Concor, although it has angina therapy among its indications, will not help if the pain is of a different origin. Only a doctor can figure out what kind of pain it is.

Contraindications to the use of Concor Cor

Hypersensitivity to bisoprolol or any of the components of the drug and other beta-adrenergic receptor blockers; shock (cardiogenic shock), collapse; AV blockade II–III degree, sick sinus syndrome, severe sinoatrial block, bradycardia (heart rate ≤50 beats/min), Prinzmetal angina; arterial hypotension (systolic blood pressure ≤90 mm Hg), history of severe forms of asthma and COPD; late stages of peripheral circulatory disorders, Raynaud's disease; simultaneous use of MAO inhibitors (except for MAO type B inhibitors), psoriasis (including family history), pheochromocytoma, pregnancy and lactation.

Side effects of the drug Concor cor

From the nervous system: increased fatigue, dizziness, headache, sleep disturbances, depression may be observed (especially at the beginning of therapy), rarely - hallucinations (usually mild and disappear within 1-2 weeks), sometimes - paresthesia. On the part of the organ of vision: visual disturbances, decreased tear production (must be taken into account when wearing contact lenses), conjunctivitis. From the cardiovascular system: in some cases - orthostatic hypotension, bradycardia, AV conduction disturbances, decompensation of heart failure with the development of peripheral edema, at the beginning of treatment - deterioration of the condition of patients with intermittent claudication or Raynaud's syndrome. From the respiratory system: in isolated cases - shortness of breath (in patients prone to bronchospasm). From the gastrointestinal tract : in some cases - diarrhea, constipation, nausea, abdominal pain, increased activity of liver enzymes in the blood serum (AST, ALT), hepatitis. From the musculoskeletal system: in some cases - muscle weakness, cramps, arthropathy affecting one or more joints (mono- or polyarthritis). From the endocrine system: decreased glucose tolerance (with latent diabetes mellitus) and masking of signs of hypoglycemia, in some cases - increased TG levels in the blood, potency disorders. On the skin: sometimes - itching, skin hyperemia, increased sweating, rash. When treated with beta-adrenergic receptor blockers, hair loss, hearing impairment or tinnitus, weight gain, mood changes, short-term memory loss, allergic rhinitis, and priapism are observed in some cases.

Side effects of Concor and Concor Cora

Common undesirable body reactions may include slow heartbeat, hypotension, nausea, and poor health.

In addition, the following side effects may occur during therapy:

• bradycardia, worsening of chronic heart failure, numbness, severe decrease in blood pressure, orthostatic hypotension;
• dizziness, loss of consciousness, headache, depression, insomnia, nightmares;
• attacks of bronchial asthma;
• cramps, muscle weakness;
• hearing damage, conjunctivitis;
• diarrhea, vomiting;
• increased levels of liver enzymes in the blood;
• decreased potency;
• alopecia;
• itching, rash, redness of the skin, allergic rhinitis.

A product with a minimal amount of active ingredient has a similar list of side effects that occur when using it.

Special instructions for the use of the drug Concor cor

Concor Cor should not be used during pregnancy and breastfeeding due to the lack of reliable clinical data confirming the safety of the drug. During pregnancy, Concor Cor should only be recommended if the benefit to the mother outweighs the risk of side effects to the fetus. In exceptional cases, the use of bisoprolol during pregnancy should be discontinued 72 hours before the expected due date due to the possibility of bradycardia, hypoglycemia and respiratory depression in the newborn. If discontinuation of the drug is not possible, then after birth the newborn should be under medical supervision. Symptoms of hypoglycemia may occur during the first 3 days. In some cases, beta-adrenergic receptor blockers may cause the development or exacerbation of psoriasis. In patients taking β-adrenergic blockers, due to weakened adrenergic feedback regulation, anaphylactic reactions may be more severe. Due to the individual nature of reactions to the drug, the ability to drive vehicles or operate machinery may be reduced. To a greater extent, this applies to the initial stage of treatment and changes in the dose of the drug, as well as with the simultaneous use of alcohol. There are no clinical data on the effectiveness and safety of Concor Cor in children.

Compound similarities

Both products have the same composition, so they can be considered different forms of the same medication. In both versions of the drug, the active ingredient is bisoprolol fumarate.

In addition to the main component, the tablets of both types of medicine contain the following compounds that play an auxiliary role:

• calcium hydrogen phosphate;
• corn starch;
• colloidal form of silicon dioxide;
• MCC;
• magnesium stearate;
• crospovidone.

The tablet shells of both drugs also have a similar composition, with the exception of a set of dyes that give the drugs their color. Concor tablets have a light orange color due to the content of yellow iron oxide tablets in the shell, which is absent in the Concor Cora shell.

The drugs have antiarrhythmic, hypotensive, and antianginal properties.

Interactions of the drug Concor cor

With simultaneous use, Concor Cor may enhance the effect of antihypertensive drugs. With the simultaneous use of bisoprolol and reserpine, methyldopa, clonidine or guanfacine, a sharp decrease in heart rate is possible. When Concor Cor is used together with clonidine, digitalis preparations, and guanfacine, cardiac conduction disorders may develop. When Concor is used together with verapamil or diltiazem and other antiarrhythmic drugs, a decrease in blood pressure is possible, and the risk of developing or worsening bradycardia, AV block, cardiac arrest and heart failure increases (IV administration of calcium channel blockers and antiarrhythmic drugs during Concor therapy should be avoided Cor).Nifedipine can lead to a significant decrease in blood pressure. Phenytoin with intravenous administration and drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressive effect and the likelihood of a decrease in blood pressure when used while taking bisoprolol. The effectiveness of insulin and oral hypoglycemic drugs may change during treatment with Concor Cor (masks the symptoms of developing hypoglycemia: tachycardia, increased blood pressure). The clearance of lidocaine and xanthines may decrease due to a possible increase in their concentration in the blood plasma, especially in patients with an initially increased clearance of theophylline under the influence of smoking. NSAIDs, corticosteroids and estrogens weaken the hypotensive effect of bisoprolol (Na+ retention, blockade of prostaglandin synthesis by the kidneys). With the simultaneous use of Concor Cor and sympathomimetics (including cough suppressants, eye drops and nasal drops), the effect of bisoprolol may be weakened. Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs can lead to an excessive decrease in blood pressure. The effect of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins may be prolonged during treatment with bisoprolol. Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedatives and hypnotics increase CNS depression. Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. The treatment break between taking MAO inhibitors and bisoprolol should be at least 14 days. Non-hydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders. Ergotamine increases the risk of developing peripheral circulatory disorders; sulfasalazine increases the concentration of bisoprolol in the blood plasma; Rifampin shortens the half-life. With the simultaneous use of ergotamine derivatives (including ergotamine-containing migraine drugs) and Concor Cor, the severity of peripheral circulatory disorders may increase. With the simultaneous use of Concor Cor and rifampicin, the half-life of bisoprolol may slightly decrease (increasing the dose of Concor is usually not required).

Patient reviews

Vadim, Stavropol

I have heart arrhythmia and have attacks of tachycardia. I can recommend the drug as a fast-acting remedy for arrhythmia; you can forget about attacks of tachycardia.

The advantages of the drug are underestimated. Side effects that arise when taking it: increased fatigue, poor attention, headache, slight dizziness, and most importantly, dry eye syndrome - severe pain in the eyes appears, and it’s simply impossible to work at the computer!

You should be careful with a weak pulse at night, how many times have you woken up from acute lack of air.

Olga B., Krasnodar

Concor is an effective drug for high blood pressure. The advantage of its use is its positive effect on both the heart and blood vessels. The cost of this drug is low. The only inconvenience is that you have to take the pills constantly. If I forget to drink, my blood pressure rises again.

Overdose of Concor Cor, symptoms and treatment

Symptoms: arrhythmia, ventricular extrasystole, severe bradycardia, AV block, marked decrease in blood pressure, acute heart failure, hypoglycemia, acrocyanosis, difficulty breathing, bronchospasm, dizziness, fainting, convulsions. Treatment: gastric lavage and administration of adsorbent drugs; symptomatic therapy: in case of developed AV block, intravenous administration of 1–2 mg of atropine, epinephrine or placement of a temporary pacemaker; for ventricular extrasystole - lidocaine (class IA drugs are not used); with a pronounced decrease in blood pressure, the patient should be in a position with the foot end of the bed raised; if there are no signs of pulmonary edema - intravenous plasma replacement solutions; if ineffective - administration of epinephrine, dopamine, dobutamine (to maintain chronotropic and inotropic effects and eliminate the pronounced decrease in blood pressure); for heart failure - cardiac glycosides, diuretics, glucagon; for convulsions - intravenous diazepam; for bronchospasm - β2-adrenergic stimulants by inhalation.