Concor Cor, 2.5 mg, film-coated tablets, 30 pcs.
The effectiveness and tolerability of bisoprolol may be affected by the simultaneous use of other drugs. Such interaction can also occur in cases where 2 drugs are taken after a short period of time. The doctor must be informed about taking other drugs, even if they are taken without a doctor’s prescription (i.e. over-the-counter drugs).
Combinations not recommended
Class I antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and cardiac contractility.
BMCCs such as verapamil and, to a lesser extent, diltiazem, when used simultaneously with bisoprolol, can lead to a decrease in myocardial contractility and impaired AV conduction. In particular, intravenous administration of verapamil to patients taking beta-blockers can lead to severe arterial hypotension and AV block.
Centrally acting antihypertensives (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and cardiac output, as well as vasodilation due to a decrease in central sympathetic tone. Abrupt withdrawal, especially before discontinuation of beta-blockers, may increase the risk of developing rebound hypertension.
Combinations requiring special caution
BMCC, dihydropyridine derivatives (for example, nifedipine, felodipine, amlodipine), when used simultaneously with bisoprolol, may increase the risk of developing arterial hypotension. In patients with CHF, the risk of subsequent deterioration in cardiac contractility cannot be excluded.
Class III antiarrhythmic drugs (eg amiodarone) may worsen AV conduction disturbances.
The effect of topical β-blockers (for example, eye drops for the treatment of glaucoma) may enhance the systemic effects of bisoprolol (lowering blood pressure, lowering heart rate).
Parasympathomimetics, when used simultaneously with bisoprolol, may enhance AV conduction disturbances and increase the risk of developing bradycardia.
The hypoglycemic effect of insulin or oral hypoglycemic agents may be enhanced. Signs of hypoglycemia - in particular tachycardia - may be masked or suppressed. Such interactions are more likely when using non-selective beta-blockers.
Agents for general anesthesia may increase the risk of cardiodepressive effects, leading to arterial hypotension (see "Special Instructions").
Cardiac glycosides, when used simultaneously with bisoprolol, can lead to an increase in impulse conduction time and, thus, to the development of bradycardia.
NSAIDs may reduce the hypotensive effect of bisoprolol.
The simultaneous use of Concor® Cor with β-adrenergic agonists (for example, isoprenaline, dobutamine) may lead to a decrease in the effect of both drugs.
The combination of bisoprolol with adrenergic agonists that affect β- and α-adrenergic receptors (for example, norepinephrine, epinephrine) may enhance the vasoconstrictor effects of these drugs that occur with the participation of α-adrenergic receptors, leading to an increase in blood pressure. Such interactions are more likely when using non-selective beta-blockers.
Antihypertensive drugs, as well as other drugs with a possible antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines), may enhance the hypotensive effect of bisoprolol.
Mefloquine, when used simultaneously with bisoprolol, may increase the risk of bradycardia.
MAO inhibitors (except MAO B inhibitors) may enhance the hypotensive effect of beta-blockers. Concomitant use may also lead to the development of a hypertensive crisis.
Concor® Cor
Termination of therapy and “withdrawal syndrome”
You should not abruptly interrupt treatment with bisoprolol or change the recommended dose without first consulting your doctor, as this may lead to a temporary deterioration in heart function. Treatment should not be interrupted suddenly, especially in patients with coronary artery disease (increased severity of angina attacks, the development of myocardial infarction and the occurrence of ventricular arrhythmias in patients with coronary artery disease with sudden cessation of beta-blockers have been noted). If discontinuation of treatment is necessary, the dose of bisoprolol should be reduced gradually. In case of significant worsening of angina or development of acute coronary syndrome, bisoprolol should be temporarily resumed.
Diseases for which the drug should be used with caution
Bisoprolol should be used with caution in the following cases:
- severe forms of COPD and non-severe forms of bronchial asthma;
- diabetes mellitus with significant fluctuations in blood glucose concentrations: bisoprolol may mask symptoms of hypoglycemia (a marked decrease in blood glucose concentrations), such as tachycardia, palpitations or increased sweating;
- strict diet;
— carrying out desensitizing therapy;
— atrioventricular block of the first degree;
- vasospastic angina (Prinzmetal's angina); cases of coronary spasm have been observed. Despite its high beta1 selectivity, angina attacks cannot be completely excluded when taking bisoprolol in patients with Prinzmetal's angina. You should take the drug with extreme caution;
- mild to moderate peripheral arterial circulation disorders (increased symptoms may occur at the beginning of therapy);
- psoriasis (including history).
Diseases of the cardiovascular system
Beta blockers should not be used in decompensated chronic heart failure until the patient's condition has stabilized.
At the initial stages of using bisoprolol, patients need constant monitoring.
Beta blockers may cause bradycardia. If the resting heart rate decreases to less than 50-55 beats/min, the dose should be reduced or discontinued taking bisoprolol.
Like other beta blockers, bisoprolol may cause a prolongation of the PQ interval on the ECG. Bisoprolol should be used with caution in patients with first degree atrioventricular block.
Non-selective beta-blockers may increase the frequency and duration of anginal attacks in patients with vasospastic angina (Prinzmetal's angina) due to alpha-receptor-mediated coronary artery vasoconstriction. Cardioselective beta1-blockers (including bisoprolol) should be used with caution in vasospastic angina.
To date, there is insufficient data regarding the use of bisoprolol in patients with CHF in combination with type 1 diabetes mellitus, severe renal and/or liver dysfunction, restrictive cardiomyopathy, congenital heart defects or heart valve disease with severe hemodynamic disturbances. Also, sufficient data have not yet been obtained regarding patients with CHF with myocardial infarction within the last 3 months.
Respiratory system
Despite the fact that selective beta-blockers have a lesser effect on the function of the respiratory system than non-selective beta-blockers, patients with chronic obstructive pulmonary disease COPD and mild forms of bronchial asthma should be prescribed bisoprolol with extreme caution and only if possible the benefits of its use outweigh the potential risks. For bronchial asthma or COPD, simultaneous use of bronchodilators is indicated.
In patients with bronchial asthma, there may be an increase in airway resistance, which requires a higher dose of beta2-agonists.
In patients with COPD, bisoprolol prescribed in combination therapy for the treatment of heart failure should be started at the lowest possible dose, and patients should be carefully monitored for the appearance of new symptoms (eg, shortness of breath, exercise intolerance, cough).
Major surgery and general anesthesia
If surgical interventions are necessary, the anesthesiologist should be warned that the patient is taking beta-blockers (risk of drug interactions with the development of severe bradyarrhythmias, reduction of reflex tachycardia and arterial hypotension). It is recommended not to stop taking bisoprolol in the perioperative period unless clearly necessary (since beta-adrenergic receptor blockade reduces the risk of arrhythmias and myocardial ischemia during induction of anesthesia and tracheal intubation). If it is necessary to interrupt treatment with bisoprolol before surgery, the drug should be discontinued at least 48 hours before surgery.
Pheochromocytoma
In patients with pheochromocytoma, bisoprolol can only be prescribed while using alpha-blockers.
Thyrotoxicosis
With hyperthyroidism, beta-blockers (including bisoprolol) can mask tachycardia and reduce the severity of symptoms of thyrotoxicosis. Abrupt withdrawal of the drug can cause exacerbation of symptoms of the disease and the development of thyrotoxic crisis.
Hypersensitivity reactions
Beta blockers, including bisoprolol, may increase sensitivity to allergens and the severity of anaphylactic/hypersensitivity reactions due to decreased adrenergic compensatory regulation by beta blockers. The use of conventional therapeutic doses of egschnephrine (adrenaline) while taking beta-blockers does not always lead to the achievement of the desired clinical effect.
Caution should be exercised when prescribing bisoprolol to patients with a history of severe hypersensitivity reactions or undergoing desensitization.
Psoriasis
When deciding on the use of bisoprolol in patients with psoriasis, the expected benefits of the drug should be carefully weighed against the possible risk of exacerbation of psoriasis.
Contact lenses
Patients who use contact lenses should take into account that the use of beta-blockers may reduce the production of tear fluid.
Concor Cor
Use during pregnancy and breastfeeding
The use of Concor Cor during pregnancy is possible only if the expected benefit to the mother outweighs the potential risk to the fetus.
Beta blockers reduce blood flow to the placenta and may affect fetal development. Blood flow in the placenta and uterus should be closely monitored, as well as the growth and development of the unborn child, and in case of dangerous manifestations in relation to pregnancy or the fetus, alternative therapeutic measures should be taken. The newborn should be carefully examined after birth. In the first 3 days of life, symptoms of decreased blood glucose and heart rate may occur.
There is no data on the excretion of bisoprolol in breast milk or the safety of bisoprolol in infants. If it is necessary to use the drug during lactation, the issue of stopping breastfeeding should be decided.
Use for liver dysfunction
Use the drug with caution in case of liver failure.
Use for renal impairment
The drug should be used with caution in chronic renal failure.
special instructions
The patient should not abruptly interrupt treatment or change the recommended dose without first consulting a doctor, as this may lead to a temporary deterioration in heart function. Treatment should not be interrupted suddenly, especially in patients with coronary artery disease. If discontinuation of treatment is necessary, the dose should be reduced gradually.
Monitoring the condition of patients taking Concor Cor should include measuring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), conducting an ECG, determining blood glucose in patients with diabetes (once every 4-5 months). months). In elderly patients, it is recommended to monitor renal function (once every 4-5 months).
The patient should be trained in the method of calculating heart rate and instructed about the need for medical consultation if heart rate is <50 beats/min.
Before starting treatment, it is recommended to conduct a study of external respiratory function in patients with a burdened bronchopulmonary history.
In approximately 20% of patients with angina, beta blockers are ineffective. The main reasons: severe coronary atherosclerosis with a low ischemic threshold (heart rate <100 beats/min) and increased end-diastolic volume of the left ventricle, impairing subendocardial blood flow.
Beta blockers are less effective in smokers.
Patients who use contact lenses should take into account that during treatment with the drug, the production of tear fluid may decrease.
When using the drug Concor Cor in patients with pheochromocytoma, there is a risk of developing paradoxical arterial hypertension (if effective alpha-blockade is not previously achieved).
In case of thyrotoxicosis, Concor Cor can mask certain clinical signs of thyrotoxicosis (for example, tachycardia). Abrupt discontinuation of the drug in patients with thyrotoxicosis is contraindicated as it can increase symptoms.
In diabetes mellitus, the use of the drug may lead to masking of tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, Concor Cor practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentrations to normal levels.
When using clonidine simultaneously, its use can be discontinued only a few days after discontinuation of the drug Concor Cor.
It is possible that the severity of the hypersensitivity reaction may increase and there will be no effect from usual doses of epinephrine against the background of a burdened allergic history.
If planned surgical treatment is necessary, the drug should be discontinued 48 hours before general anesthesia. If the patient took the drug before surgery, he should select a drug for general anesthesia with minimal negative inotropic effects.
Reciprocal activation of the vagus nerve can be eliminated by intravenous atropine (1-2 mg).
Drugs that deplete catecholamine stores (including reserpine) may enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect a significant decrease in blood pressure or bradycardia.
Patients with bronchospastic diseases can be prescribed cardioselective blockers in case of intolerance and/or ineffectiveness of other antihypertensive drugs. If the dose of Concor Cor is exceeded, there is a risk of developing bronchospasm.
If increasing bradycardia (heart rate <50 beats/min), a pronounced decrease in blood pressure (systolic blood pressure <100 mm Hg), or AV blockade is detected in elderly patients, it is necessary to reduce the dose or discontinue treatment.
It is recommended to discontinue therapy with Concor Cor if depression develops.
Treatment should not be abruptly interrupted due to the risk of developing severe arrhythmias and myocardial infarction. The drug is discontinued gradually, reducing the dose over 2 weeks or more (reduce the dose by 25% in 3-4 days).
The drug should be discontinued before testing the content of catecholamines, normetanephrine, vanillinmandelic acid, and antinuclear antibody titers in the blood and urine.
Impact on the ability to drive vehicles and operate machinery
Bisoprolol does not affect the ability to drive a car in a study of patients with coronary artery disease. However, due to individual reactions, the ability to drive a car or work with technically complex mechanisms may be impaired. Particular attention should be paid to this at the beginning of treatment, after changing the dose, and also when consuming alcohol at the same time.
