Cardiodelective blocker? -Adrenoreceptors that do not have an internal sympathomimetic and membrane

Preparation: Egilov ®
Active substance: Metoprolol (metoprolol)
ATH code: C07AB02
CFG: Beta 1 -adrenoblocator
Reg. Number: P №015639 / 01
Registration date: 12/29/06
Owner reg. Undoj: EGIS PHARMACEUTICALS PLC (Hungary)

Dosage form, composition and packaging

Pills White or almost white, round, double-screwed, with a cross-shaped dividing line and a double mole on one side and engraving "E435" - on the other side, odorless.

Excipients:

Pills White or almost white, round, double-screw, with risky on one side and engraving "E434" - on the other side, odorless.

Excipients:cellulose microcrystalline, sodium carboxymethyl starch, silicon colloidal dioxide, povidone, magnesium stearate.

30 pcs. - Dark glass banks (1) - Cardboard packs.
60 pcs. - Dark glass banks (1) - Cardboard packs.

Pills White or almost white, round, double-screw, with risky on one side and engraving "E432" - on the other side, odorless.

Excipients:cellulose microcrystalline, sodium carboxymethyl starch, silicon colloidal dioxide, povidone, magnesium stearate.

30 pcs. - Dark glass banks (1) - Cardboard packs.
60 pcs. - Dark glass banks (1) - Cardboard packs.

Description of the drug is based on officially approved instructions for use and approved by the manufacturer for.

PHARMACHOLOGIC EFFECT

Cardiodelective blocker? -Adrenoreceptors that does not have internal sympathomimetic and membrane-stabilizing activity. It has antihypertensive, anti-naiginal and antiarrhythmic effect.

Blocking in low doses? 1 -adrenoreceptors of the heart reduces the formation of CATCHOLAMINS, the formation of CAMF from ATP, reduces the intracellular current Ca 2+, has a negative chrono-, dromo-, butmol and inthropic effect (regenerates heart rate, inhibits conductivity and excitability, reduces myocardial reductions).

OPS at the beginning of the use of the drug (in the first 24 hours after oral reception) Increases, after 1-3 days of use, it returns to the initial level, with further use - decreases.

Antihypertensive action is due to a decrease heart Emission and the synthesis of renin, the oppression of the activity of the renin-angiotensin system and the central nervous system, the restoration of the sensitivity of the aortic arc baroreceptors (there is no amplification of their activity in response to decreased blood pressure) and as a result, a decrease in peripheral sympathetic effects. Reduces increased blood pressure at rest, with physical stress and stress.

Hell decreases after 15 minutes, the maximum - after 2 hours; The action is preserved for 6 hours. A stable decrease is observed after several weeks of regular reception.

The antiagonal effect is determined by a decrease in the need of myocardium in oxygen as a result of a decrease in heart rate (lengthening of diastole and improved myocardial perfusion) and a reduction, as well as a decrease in the sensitivity of myocardium to the effects of sympathetic innervation. Reduces the frequency and severity of angina attacks and increases the tolerability of physical exertion.

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased sympathetic activity nervous system, increasing the content of CAMF, arterial hypertension), reducing the speed of spontaneous excitation of sine and ectopic rhythm drivers and the slowdown in AV conduction (mainly in the antegradine and, to a lesser extent, in retrograde directions through AV-node) and for additional ways.

With sucanementaricular tachycardia, atrial flication, sinus Tachycardia With functional diseases of the heart and hyperthyroidism, CSS regenerates and can even lead to the restoration of sinus rhythm.

Warns the development of migraine.

With many years of reception, it reduces the cholesterol content in the blood.

When used in medium therapeutic doses, has a less pronounced effect on organs containing? 2 -adrenoreceptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi, uterus) and on carbohydrate exchange.

When used in high doses (more than 100 mg / day), has a blocking effect on both subtypes? -Adrenororeceptors.

Pharmacokinetics

Suction

Quickly and completely (95%) is absorbed from the gastrointestinal tract. C max in plasma is achieved after 1.5-2 hours after intake. Bioavailability is 50%. In the course of treatment, bioavailability increases to 70%. Eating increases bioavailability by 20-40%.

Distribution

V D is 5.6 l / kg. Bonding with blood plasma proteins - 12%. Penetrates the BGB and placental barrier. It stands out with breast milk in minor quantities.

Metabolism

Metoprolol is bioferded in the liver. Metabolites do not possess pharmacological activity.

Election

T 1/2 is an average of 3.5-7 hours. Metoprolol is almost completely excreted in the urine for 72 hours. About 5% dose is output unchanged.

Pharmacokinetics in special clinical cases

In pronounced disorders of the liver function, bioavailability and T 1/2 metoprolol increases, which may require a dose correction.

With violation of the kidney function T 1/2 and the systemic clearance of metoprolol do not significantly change.

Indications

Arterial hypertension (in monotherapy or in combination with other antihypertensive drugs), incl. hyperkinetic type;

IBS (secondary prevention of myocardial infarction, prevention of angina attacks);

Heart rhythm violations (supertoday arrhythmias, ventricular extrasystole);

Hyperthyroidism (as part of comprehensive therapy);

Prevention of migraine attacks.

Dosing mode

For arterial hypertension Assign in a daily dose of 50-100 mg / day in 1 or 2 receptions (in the morning and evening). With an insufficient therapeutic effect, a gradual increase in daily dose is possible up to 100-200 mg.

For stenzardia, Nongertard Arrhythmiafor preventing migraine attacks prescribed at a dose of 100-200 mg / day in 2 receptions (in the morning and evening).

For secondary prevention of myocardial infarction Assign in the average daily dose of 200 mg in 2 receptions (in the morning and evening).

For functional violations of cardiac activity accompanied by Tachycardiaprescribed in a daily dose of 100 mg in 2 receptions (in the morning and evening).

W. elderly patients, patients with impaired kidney function, as well as, if necessary, the hemodialysis change of the dosage mode is not required.

W. patients S. pronounced violations Functions of the liver The drug should be applied in smaller doses, due to the slowdown in metoprolol metabolism.

Tablets should be taken inside during or immediately after meals. Tablets can be divided by half, but not chew.

SIDE EFFECT

From the CNS and the peripheral nervous system: increased fatigue, weakness, headache, slowing down the rate of mental and motor reactions; Rarely - paresthesias in the limbs, depression, anxiety, reduced ability to concentrate attention, drowsiness, insomnia, nightmarish dreams, confusion of consciousness or short-term memory violation, asthenic syndrome, muscle weakness.

From the senses: Rarely - reduction of vision, decrease in the secretion of tear fluid, xerophthalm, conjunctivitis, noise in the ears.

From the side of the cardiovascular system: sinus bradycardia, heartbeat, decreased blood pressure, orthostatic hypotension; Rarely - reduced myocardial reduction, temporary aggravation of symptoms of chronic heart failure, arrhythmia, increased peripheral circulatory disorders (cooling lower extremities, Reina syndrome), myocardial conductivity disorders; In isolated cases - AV blockade, cardialia.

From side digestive system: nausea, vomiting, abdominal pain, diarrhea, constipation, dry mouth, change in taste; increasing the activity of hepatic transaminases; Rarely hyperbilirubinemia.

Dermatological reactions: hives, skin itch, rash, exacerbation of psoriasis, psoriazo-like skin changes, skin hyperemia, examine, photodermatosis, strengthening, reversible alopecia.

From the respiratory system: Nasal congestion, embankment of exhalation (bronchospasm when prescribed in high doses or predisposed patients), shortness of breath.

From the endocrine system: hypoglycemia (in patients receiving insulin); Rarely - hyperglycemia.

From the hematopopitation system: Thrombocytopenia, agranulocytosis, leukopenia.

Others: Pain in the back or joints, a slight increase in body weight, a decrease in libido and / or potency.

Contraindications

Cardiogenic shock;

AV blockade II and III degree;

Synoyatrial blockade;

Pronounced bradycardia (heart rate less than 50 q / min);

Heart failure in the decompensation stage;

Angiospast angina (angina printela);

Pronounced arterial hypotension (systolic blood pressure below 100 mm Hg);

Lactation period;

Simultaneous reception of Mao inhibitors;

Simultaneous V / in the introduction of verapamil;

Increased sensitivity to metoprolol and other drug ingredients.

FROM caution It should be prescribed a drug with diabetes mellitus, metabolic acidosis, bronchial asthma, chronic obstructive pulmonary disease (lung emphysema, chronic obstructive bronchitisirritation of diseases peripheral vessels (Intermittent lameness, Reino syndrome), chronic liver failure, chronic renal failure, Miasthenia, Feochromocytoma, AV Blocade I degree, thyrotoxicosis, depression (including in history), psoriasis, pregnancy, as well as children and teenagers under the age of 18, elderly patients.

Pregnancy and lactation

The use of egilok during pregnancy is possible only when the intended benefit for the mother exceeds potential risk For fetal. If it is necessary to prescribe the drug during this period, careful monitoring of the state of the fetus and a newborn is needed for 48-72 hours after childbirth, since intrauterine growth delay, bradycardia, arterial hypotension, respiratory depression, hypoglycemia are possible.

The influence of metoprolol on the newborn during breastfeeding is not studied, therefore women who host Egils should stop breastfeeding.

SPECIAL INSTRUCTIONS

When appointing the drug, Egils should regularly monitor heart disease and blood pressure. The patient must be warned that at heart rate less than 50 ° C. / min. Consultation of the doctor.

In patients with diabetes mellitus, the level of glucose in the blood should be regularly monitored and, if necessary, adjust the dose of insulin or oral hypoglycemic drugs.

The appointment of egilok patients with chronic heart failure is possible only after reaching the compensation step.

In patients receiving egilos, it is possible to increase the severity of the reactions of hypersensitivity (against the background of a burdened allergological anamnesis) and the lack of effect from the introduction of conventional doses of epinephrine (adrenaline).

Against the background of the use of Egilok, it is possible to aggravate the symptoms of the impairment of peripheral blood circulation.

Egilk should be canceled gradually, consistently reducing its dose within 10 days. With a sharp discontinuation of treatment, cancellation syndrome may occur (enhancing angina attacks, an increase in blood pressure). During the period of canceling the drug, patients with angina must be under careful medical supervision.

With the walls of the voltage, the selected dose of the drug should provide heart rate at rest in the range of 55-60 ° C. / min, with a load - no more than 110 ° C. / min.

Patients using contact lenses, I must take into account that against the background of the treatment of beta-adrenoblockers, it is possible to reduce the products of the tear fluid.

Metoprolol can mask some clinical manifestations of hyperthyroidism (tachycardia). A sharp cancellation in patients with thyrotoxicosis is contraindicated because it is capable of strengthening symptoms.

In diabetes mellitus, the egilock can mask the symptoms of hypoglycemia (tachycardia, sweating, increased blood pressure).

When prescribing metoprolol, patients with bronchial asthma require the simultaneous use of beta 2 -adrenomimetics.

In patients with pheochromocyte Egilov should be used in combination with alpha-adrenoblockers.

Before carrying out any surgical intervention, it is necessary to inform the anesthesiologist about the treatment of therapy Egilom (the choice of the drug for general anesthesia with minimal negative inotropic effect); Cancellation of the drug is not required.

When prescribing the drug, elderly patients should be regularly monitored by the liver function. The correction of the dosing regime is required only in the case of the appearance of the elderly patients with increasing bradycardia, a pronounced reduction of blood pressure, AV blockade, bronchospasm, ventricular arrhythmias, severe liver function disorders. Sometimes it is necessary to stop the treatment.

Special monitoring of patients with depressive disorders In history. In the event of the development of depression, EGILOV should be canceled.

With the simultaneous use of egillee with clonidine in case of cancellation of the egilok, clonidine should be canceled in a few days (due to the risk of cancellation syndrome).

Preparations that reduce catecholamine reserves (for example, reserpine) can enhance the effect of beta-adrenobloclars, so patients taking such combinations of drugs should be under constant medical supervision to identify excessive decline in Hell or Bradycardia.

Use in pediatrics

Efficiency and safety of the use of egiloca children and adolescents under the age of 18 not defined.

Impact on the ability to driving vehicles and control mechanisms

In patients whose activities require increased attentionThe question of the appointment of the drug outpatient should be solved only after estimating the patient's individual reaction.

OVERDOSE

Symptoms: severe sinus bradycardia, dizziness, nausea, vomiting, cyanosis, arterial hypotension, arrhythmia, ventricular extrasystole, bronchospasm, fainting; With acute overdose - cardiogenic shock, loss of consciousness, coma, AV blockade up to the development of a full transverse blockade and stopping heart, cardialgy.

The first signs of overdose appear after 20 minutes after the reception.

Treatment: stomach washing, appointment of adsorbents, symptomatic therapy: With a pronounced decrease in the blood pressure - the situation of the Trendelenburg, in the case of acute arterial hypotension, bradycardia and threatening heart failure - in / in (with an interval of 2-5 min), the introduction of beta-adrenostimulants or in / in the introduction of 0.5-2 mg of atropine sulfate, in the absence positive effect - Dopamine, Dobutamin or Norepinephrine. As subsequent measures, it is possible to assign 1-10 mg of glucagon, formulation of a transgeneous intracarordial electrostimulator. With bronchospaisme - in / in the introduction of beta 2 -adnostimulants, during cramps - slow to / in the introduction of diazepam. Metoprolol is poorly excreted by hemodialysis.

Medicinal interaction

With the simultaneous use of Egilock with MAO inhibitors, a significant increase in hypotensive action is possible. The break between the reception of Mao and Egilok inhibitors should be at least 14 days.

Simultaneous in / in the introduction of verapamil can provoke a heart stop, the simultaneous purpose of nifedipine leads to a significant decrease in blood pressure.

Means for inhalation anesthesia (hydrocarbon derivatives) while simultaneous use with egilomes increase the risk of oppression contractile function Myocardium and the development of arterial hypotension.

With the simultaneous use of beta-adrenostimulants, theophylline, cocaine, estrogens, indomethacin and other NSAIDs reduce the hypotensive effect of the egilock.

With the simultaneous use of egilock and ethanol, an increase in the depressing effect on the CNS is noted.

With the simultaneous use of egilock with the alkaloids of the ardines, the risk of peripheral circulatory disorders increases.

With the simultaneous use of egilos increases the effect of oral hypoglycemic drugs and insulin and increases the risk of hypoglycemia.

With the simultaneous use of egillets with antihypertensive agents, diuretics, nitrates, calcium channel blockers risk the risk of arterial hypotension.

With the simultaneous use of egillee with verapamil, diltiazem, antiarrhythmic drugs (amiodar), reserpine, methyldop, clonidine, guangaphycin, means for general anesthesia and heart glycosides, an increase in the severity of the CSS demolition and the oppression of AV conductivity may be observed.

Inductors of liver microsomal enzymes (rifampicin, barbiturates) accelerate metoprolol metabolism, which leads to a decrease in the concentration of metoprolol in the blood plasma and decrease the effect of the egilock.

Inhibitors of liver microsomal enzymes (cimetidine, oral contraceptives, phenothiazines) increase the concentration of metoprolol in blood plasma.

Allergens used for immunotherapy, or allergens extracts for samples for sharing with Egiloma, increase the risk of systemic allergic reactions or anaphylaxis.

Egilov, while simultaneously use, reduces xanthin clearance, especially in patients with initially increased theophylline clearance under the influence of smoking.

With simultaneous use with egiloma, lidocaine clearance decreases and the concentration of lidocaine in plasma increases.

With the simultaneous use of egilos, the effect of non-polarizing minelaxants will increase and prolongs; Extensions the effect of indirect anticoagulants.

When used with ethanol, the risk of pronounced decrease in blood pressure increases.

Conditions of vacation from pharmacies

The drug is released by the prescription.

Terms and Storage Terms

List B. The drug should be stored in an inaccessible place at a temperature of 15 ° to 25 ° C. Shelf life is 5 years.

Catad_pgroup beta adrenoblays

Aegil from tablets - official instruction For use

Registration number:

LP 001351-13.12.2011

Trade name of the drug:

Egilov ® S.

International UnPatented Name:metoprolol

Dosage form: tablets of prolonged action covered with film shell

Structure:1 tablet contains: active ingredient: 23.75 mg, 47.5 mg, 95 mg or 190 mg metoprolol succinate,what corresponds to 25 mg, 50 mg, 100 mg or 200 mg of metoprolol tartrate, respectively; excipients: Cellulose Microcrystalline 73.9 / 147.8 / 295.6 / 591.2 mg, methylcellulose 11,87 / 23.75 / 47.5 / 95 mg, glycerol 0.24 / 0.48 / 0.95 / 1.9 mg, corn starch 1.94 / 3.87 / 7.75 / 15.5 mg, ethylcellulose 11,43 / 22.85 / 45.7 / 91.4 mg, magnesium stearate 1.87 / 3.75 / 7.5 / 15 mg. Tablet shell (LP 770 sepifylm white) 3.75 / 7.5 / 15/30 mg: microcrystalline cellulose (5-15%). Hypromellos (60-70%), stearic acid (8-12%), titanium dioxide (E-171) (10-20%).

Description:oval twofold white-colored tablets, covered with film shell, with risky on both sides.

Pharmacological group:beta1 adrenoblocator selective

ATX code:C07Av02.

Pharmacological properties

Pharmacodynamics

Metoprolol-β 1 -adrenoblocator, blocking β 1 -receptors in doses of significantly smaller than doses required for blocking β 2-receptors.

Metoprolol has a minor membrane-stabilizing effect and does not show the activity of a partial agonist.

Metoprolol reduces or inhibits an agonistic effect, which is provided on the heart activities of catecholamines that are distinguished by nervous and physical stress. This means that metoprolol has the ability to impede the increase in heart rate (heart rate), minute volume and enhancement of the reduction of the heart, as well as increased arterial pressure (Hell) caused by a sharp emission of catecholamines.

In contrast to the usual tableted dosage forms of selective β 1 -adrenobloclars (including metoprolol Tartrate), when the method of metoprolol is used, a constant concentration of blood plasma is observed and a steady clinical effect (β 1-block) is provided for more than 24 hours. Due to the lack of significant maximum concentrations in the blood plasma, the drug is characterized by a higher β 1-selectivity compared to conventional tableted forms of metoprolol. In addition, the potential risk is largely reduced. side Effectsobserved at maximum concentrations The drug in blood plasma, for example, bradycardia and weakness in the legs when walking. Patients with symptoms of obstructive pulmonary diseases, if necessary, can be prescribed metoprolol Succinate prolonged action in combination with β 2 -adrenomimetics. With the joint use with β 2 - adrenomimetics, the metoprolol succinate of a prolonged action in therapeutic doses to a lesser extent affects the bronchitations caused by β 2 -adrenomimetics than non-selective β-adrenoblays. Metoprolol to a lesser extent than non-selective β-adrenoblays, affects insulin products and carbohydrate metabolism. Effect of drug on cardiovascular system Under hypoglycemia, it is significantly less pronounced compared to non-selective β-adrenoblockers.

The use of the drug in arterial hypertension leads to a significant decrease in blood pressure for more than 24 hours, both in the position of lying and standing and at exercise. At the beginning of therapy, metoprolol is noted an increase in vascular resistance. However long reception It is possible to reduce the blood pressure due to the reduction of vascular resistance with a constant cardiac emission.

Pharmacokinetics

In each tablet, the metoprolol of prolonged action succinate contains a large number of Microgranules (pellets), allowing to carry out the controlled release of the metoprolol of succinate. Outside, each microgranule (pellet) is covered with a polymer shell, which makes it possible to provide controlled release of the drug substance.

The action of prolonged tablets comes quickly. IN gastrointestinal (GCC) Tablet Disintegrates on separate micrographs (pellets), which act as independent units and provide a uniform controlled release of metoprolol (zero-order kinetics) for more than 20 hours. The release rate of the active substance depends on the acidity of the medium. Duration therapeutic effect After taking the drug in the dosage form of a tablet of prolonged action is more than 24 hours. The half-life of the free metoprolol is an average of 3.5-7 h.

The drug is completely absorbed after taking inside. Systemic bioavailability after the intake of a single dose is approximately 30-40%. Metoprolol is subjected to oxidative metabolism in the liver. Three main metabolite metoprolol did not detect the clinically significant β-blocking effect. About 5% of the dose for administration inside is derived by the kidneys unchanged, the rest of the drug is displayed as metabolites. Communication with blood plasma proteins is low, approximately 5-10%.

Indications for use

Arterial hypertension.

Angina.

Stable chronic heart failure with availability clinical manifestations (II-IV functional class (FC) according to the NYHA classification) and the abnormal function of the left ventricle (as auxiliary therapy to the main treatment of chronic heart failure).

Reducing mortality and frequency of re-infarction after acute phase Myocardial infarction.

Heart rhythm disturbances, including superthydrochloric tachycardia, reducing the frequency of ventricles during atrial fibrillation and ventricular extrasystoles.

Functional violations of cardiac activity, accompanied by tachycardia.

Prevention of migraine attacks.

Contraindications

Increased sensitivity to metoprolol, other components of the drug or to other β-adrenoblockers.

Atrioventricular blockade of II and III degree, heart failure in decompensation stage, patients receiving long-term or course therapy in inthropic means and acting on beta-adrenoreceptors, clinically significant sinus bradycardia (heart rate less than 50 ° C / min), weakness syndrome sinus node, Cardiogenic shock, severe disorders of peripheral blood circulation with the threat of the development of gangrenes, arterial hypotension (systolic blood pressure of less than 90 mm Hg), pheochromocytoma without simultaneous reception of alpha-adrenobloclars.

Suspicion of acute myocardial infarction at heart rate less than 45 ° C / min, PQ interval more than 0.24 seconds, systolic blood pressure less than 100 mm Hg.

The simultaneous use of monoaminoxidase inhibitors (Mao) (with the exception of Mao-in inhibitors).

Intravenous administration of "slow" calcium canals of verapamil type.

Age up to 18 years (efficiency and security are not established)

Carefully:atrioventricular blockade of I degree, angina printela, bronchial asthma, chronic obstructive pulmonary disease, diabetes, severe renal failure, heavy liver failure, Metabolic acidosis, simultaneous use with heart glycosides, miastic, pheochromocytoma (with simultaneous adrenal adrenoblasts), thyrotoxicosis, depression, psoriasis, reflecting peripheral vessels ("intelligent" chromoty, Reino syndrome), elderly age.

Application during pregnancy and in breastfeeding period

Since well-controlled research on the use of metoprolol during pregnancy was not carried out, the use of the drug Egil ® C in the treatment of pregnant women is possible only if the benefit for the mother exceeds the risks for the embryo / fetus.

Like other hypotensive agents, β-adrenoblays can cause side effects, for example, bradycardia in the fetus, newborns or children who are on breastfeeding. The amount of metoprolol, released into breast milk, and β-blocking effect in a child on breastfeeding (when taking a metoprolol mother in therapeutic doses), are insignificant. Despite the fact that in breastfeeding children, when prescribing therapeutic doses of the drug, the risk of developing side effects of low (the exception is children with metabolic disorders), It is necessary to carefully follow the appearance of the signs of the blockade of beta-adrenoreceptors.

Method of application and dose

Egilov ® s is designed for daily reception once a day, it is recommended to take the drug in the morning. Pill Egyot ® C should swallow, drinking liquid. Tablets (or tablets separated by half) should not be chewed or crumbling. Meal does not affect the bioavailability of the drug. When selecting a dose, it is necessary to avoid the development of bradycardia.

Arterial hypertension

50- 100 mg once a day. If necessary, the dose can be increased to 200 mg per day or add another hypotensive agent, preferably a diuretic and a "slow" calcium channels (BMKK). Maximum daily dose With ag - 200 mg / day.

Angina

100-200 mg Egilov ® at once a day. If necessary, another antiagonal drug can be added to therapy.

Stable chronic heart failure with the presence of typical manifestations and impaired systolic function of the left ventricle

Patients must be in the stage of stable chronic heart failure without episodes of exacerbation over the past 6 weeks and unchanged in basic therapy during the last 2 weeks.

Therapy of chronic heart failure beta-adrenoblockers can sometimes lead to a temporary deterioration of the flow of CHF. In some cases, it is possible to continue therapy or a reduction in the dose, in some cases there may be the need to cancel the drug.

Stable chronic heart failure, II functional classRecommended initial dose of the drug Egil * from the first 2 weeks 25 mg once a day. After 2 weeks, the dose can be increased to 50 mg once a day, and further can double every 2 weeks.

Supporting dose for long-term treatment 200 mg of the drug Egil * from once a day.

Stable chronic heart failure, III-IV functional classRecommended initial dose for the first 2 weeks 12.5 mg of the drug Egyot * C ( 1/2 tablets 25 mg) once a day. The dose is selected individually. During the period of increasing the dose, the patient must be under observation, since some patients have symptoms of chronic heart failure can progress.

After 1-2 weeks, the dose can be increased to 25 mg of the drug Egil * from once a day. Then after 2 weeks, the dose can be increased to 50 mg once a day. Patients who are well transferred to the drug can double the dose every 2 weeks before reaching the maximum dose of 200 mg of the drug Egil * from once a day. In the case of arterial hypotension and / or bradycardia, it may be necessary to correct the doses of main therapy or a reduction in the dose of the drug Egilov® S. Arterial hypotension at the beginning of therapy does not necessarily indicate that this dose of the drug Egil * C will not be transferred with further long treatment. However, the increase in the dose is possible only after stabilizing the patient's condition. It may be necessary to control the kidney function.

Disturbance of heart rhythm100-200 mg once a day.

Supporting treatment after myocardial infarctionTarget dose - 100-200 mg / day, in one (or two) reception.

Functional violations of cardiac activity accompanied by Tachycardia100 mg once a day. If necessary, the dose can be increased to 200 mg per day. Prevention of migraine attacks100-200 mg once a day.

Violation of kidney function

There is no need to adjust the dose in patients with impaired kidney function.

Violation of the liver function

Usually, due to the low degree of communication with blood plasma proteins, the dose correction is not required. However, with severe violation of the liver function (in patients with severe liver cirrhosis or portoring anastomosis), a dose reduction may be required.

Elderly age

There is no need to adjust the dose in older patients.

Side effect

The drug is well tolerated by patients, side effects are mainly light and reversible.

To estimate the frequency of cases, the following criteria were used: very often (\u003e 10%), often (1-9.9%), infrequently (0.1-0.9%), rarely (0.01-0.09%) and very rarely (<0,01 %).

The cardiovascular system:often - bradycardia, orthostatic hypotension (very rarely accompanied fainting), cooling limbs, heartbeat; infrequently - peripheral swelling, pain in the heart, temporary increase of symptoms of heart failure, AV blockade of I degree; Cardiogenic shock in patients with acute myocardial infarction; rarely - other heart conduction disorders, arrhythmias; Very rarely - gangrena in patients with preceding severe peripheral circulation disorders.

Central nervous system:very often - increased fatigue; Often-collections, headache; Infrequently - paresthesia, convulsions, depression, weakening attention, drowsiness or insomnia, nightmares; rarely increased nervous excitability, anxiety, impotence / sexual dysfunction; Very rare -aming / memory disorders, depression, hallucinations.

Gastrointestinal tract:often - nausea, pain in the abdomen, diarrhea, constipation; infrequently vomiting; Rarely - dry oral mucosa.

Liver:rarely - liver function disorders; Very rarely - hepatitis.

Skin:infrequently - rash (in the form of urticaria), increased sweating; rarely - hair loss; Very rarely - photosensitization, exacerbation of the flow of psoriasis.

Respiratory system:often - shortness of breath in physical effort; infrequently - bronchospasm; Rarely-crinis.

Feeling authorities:rarely - violations, dryness and / or eye irritation, conjunctivitis; Very rarely - ringing in the ears, violations of taste sensations.

From the skeletal muscular system:very rarely - arthralgia

Metabolism:infrequently - an increase in body weight.

Blood:very rarely thrombocytopenia.

Overdose

Symptoms:in case of overdose by Metoprolol, the symptoms from the cardiovascular system are most serious, but sometimes, especially in children and adolescents, symptoms from the CNS and the suppression of pulmonary function, bradycardia, AV blockade of I-III degree, asistolia, a pronounced decrease in blood pressure, weak peripheral perfusion, heart failure, cardiogenic shock; inhibition of light functions, apnea, as well as increased fatigue, violation of consciousness, loss of consciousness, tremor, convulsions, increased sweating, paresthesia, bronchospasm, nausea, vomiting, esophagic spasm, hypoglycemia (especially in children) or hyperglycemia, hypercalemia; renal impairment; transient miasthenic syndrome; The accompanying intake of alcohol, hypotensive drugs, chinidine or barbiturates may worsen the patient's condition. The first signs of overdose can be observed after 20 minutes -2ch after receiving the drug.

Treatment:purpose activated coal, if necessary, washing the stomach.

Atropine (0.25-0.5 mg V / B for adults, 10-20 μg / kg for children) must be assigned before washing the stomach (due to the risk of stimulating the wandering nerve). If necessary, maintaining the patency of the respiratory tract (intubation) and adequate ventilation of the lungs. Replenishing the volume of circulating blood and glucose infusion. ECG control. Atropine 1.0-2.0 mg V / B, if necessary, repeat the introduction (especially in the case of vagus symptoms). In the case of (suppression) of myocardial depression, the infusion administration of dobutamine or dopamine can also be used glucagon 50-150 μg / kg in / in with an interval of 1 min. In some cases, the epinephrine (adrenaline) therapy may be effectively addicted. When arrhythmia and extensive ventricular (QRS), a complex of infusion is administered with a 0.9% solution of sodium chloride or sodium hydrocarbonate. It is possible to formulate an artificial rhythm driver. When the heart is stopped, resuscitation activities may be needed due to overdose. To relieve bronchospasm, terbutalin can be used (injectable or by inhalation). Conducted symptomatic treatment.

Interaction with other drugs

Metoprolol is a substrate of the CYP2D6 isoenzyme, in connection with which preparations inhibiting the CYP2D6 isoenzyme (County, terbinafin, steamsetin, fluoxetine, sertalin, celecoxib, conpaphenone and diphenhydramine) can affect the plasma concentration of metoprolol.

The joint use of the drug Egilov ® with the following drugs should be avoided:

Bribeuric acid derivatives:barbiturates (the study was carried out with a pentobarbital) enhance metoprolol metabolism, due to induction of enzymes.

Preparenon:when prescribed a conpaphenone with four patients receiving treatment with metoprolol, an increase in the plasma concentration of metoprolol 2-5 times was noted, while two patients had side effects characteristic of metoprolol. Probably, the interaction is due to the inhibitory of the propaphenone, like a quinidine, metoprolol metabolism by means of the cytochrome system of the CYP2D6 of the CYP2D6 isoenzyme. Taking into account the fact that the proppanone has the properties of the β-adrenoblocker, the sharing of metoprolol and the proppanone is not recommended.

Verapamil:the combination of -adrenoblockers (atenolol, propranolol and pindolol) and verapamil can cause bradycardia and lead to a decrease in blood pressure. Verapamil and β-adrenobloclars have a complementary effect on an inhibitory effect on atri-ventricular conductivity and the function of the sinus node.

The combination of the drug Egilov ® with the following drugs may require a dose correction:

Amiodaron:The joint use of amiodarone and metoprolol can lead to severe sinus bradycardia. Taking into account the extremely long period of half-life amiodarone (50 days), it should take into account the possible interaction after a long time after the cancellation of amiodarone.

Antiarrhythmic media I class:Antiarrhythmic agents I class and β-adrenobloclars can lead to summation of a negative inotropic effect, which can lead to serious hemodynamic side effects in patients with impaired left ventricular function. There should also be avoided by a similar combination in patients with sinus node weak syndrome and violation of AV conductivity.

The interaction is described on the example of dyspeyramide.

Non-steroidal anti-inflammatory drugs (NSAIDs):NSAIDs weaken the antihypertensive effect of β-adrenobloclars. This interaction is documented for indomethacin. Probably the described interaction will not be noted when interacting with Sululdak. Negative interaction was noted in studies with diclofenac.

Diphenhydramine:Diphenhydramine reduces metoprolol metabolism to α-hydroxymetoprolol 2.5 times. At the same time, an increase in the action of metoprolol is observed.

Diltiaze:Diltialand and β-adrenobloclars mutually enhance the inhibitory effect on AV conductivity and the function of the sinus node. With a combination of metoprolol with diltiazem, cases of pronounced bradycardia were noted.

Epinephrine:10 cases have been reported on the pronounced arterial hypertension and bradycardia in patients who have taken non-selective β-adrenoblays (including pendolol and propranolol) and epinephrine obtained. The interaction is also noted in the group of healthy volunteers. It is assumed that such reactions may be observed when applying epinephrine together with local anesthetics in case of random hit in the vascular direction. It is assumed that this risk is much lower when applying cardiolective β-adrenobloclars.

Phenylpropanolamine:Phenylpropanolamine (Norefedrine) in a single dose of 50 mg can cause an increase in diastolic blood pressure to pathological values \u200b\u200bin healthy volunteers. Propranolol mainly prevents the increase in the blood pressure caused by Phenylpropanol Amin. However, β-adrenobloclars can cause the reaction of paradoxical arterial hypertension in patients receiving high doses of phenylpropanolamine. A few cases have been reported hypertensive crisis Against the background of taking phenylpropanolamine.

County;County inhibits metoprolol metabolism in a special group of patients with rapid hydroxylation (in Sweden approximately 90% of the population), causing mainly a significant increase in the plasma concentration of metoprolol and the increase in the β-blockade. It is believed that such interaction is characteristic of other β-adrenoblockers, in the metabolism of which is involved in cytochrome P450 CYP2D6 isoenzyme.

Clonidine:Hypertensive reactions with a sharp cancellation of the clonidine can be enhanced with the joint acceptance of β-adrenobloclars. With co-use, in the event of the cancellation of the clonidine, the cessation of the reception of β-adrenobloclars should be started a few days before the cancellation of the clonidine.

Rifampicin:Rifampicin can enhance metoprolol metabolism, reducing the plasma concentration of metoprolol.

Patients simultaneously taking metoprolol and other β-adrenoblays (in the medicinal form of eye drops) or monoamico-oxidase inhibitors (MAO) must be under thorough observation. Against the background of receiving β-adrenoblockers, inhalation anesthetics enhance the cardiodepressive effect. Against the background of the reception of β-adrenoblockers to patients receiving hypoglycemic drugs inward, the dose correction may be required.

The plasma concentration of metoprolol may increase when taking cimetidine or hydralazine.

Cardiac glycosides with joint use with β-adrenoblockers can increase the time of atrioventricular conduction and cause bradycardia.

special instructions

Patients receiving β-adrenoblays should not be administered intravenously blockers "slow" calcium verapamila type.

Patients with obstructive pulmonary disease are not recommended to assign β-adrenoblays. In the event of poor tolerability of other hypotensive tools or their ineffectiveness, metoprolol can be prescribed, since it is a selective drug. It is necessary to prescribe a minimally effective dose, if necessary, it is possible to prescribe β2-adrenomimetics.

With the use of β2-adrenoblockers, the risk of their influence on the carbohydrate exchange or the possibility of masking symptoms of hypoglycemia is significantly less than when using non-selective β-adrenobloclars.

In patients with chronic heart failure in the decompensation stage, it is necessary to achieve the stage of compensation both before and during treatment with the drug Egilov ® S.

Very rarely in patients with violation of AV conduction, deterioration may occur (possible outcome - AV blockade). If against the background of treatment, bradycardia developed, the dose of the drug Egilov ® C should be reduced or should gradually cancel the drug.

Metoprolol may worsen the symptoms of the peripheral circulation disorders mainly due to the decline in blood pressure.

Care should be exercised when prescribing to patients with severe renal failure, with metabolic acidosis, joint appointment with cardiac glycosides.

In patients receiving β-adrenoblays, anaphylactic shock occurs in a more severe form. The use of adrenaline in therapeutic doses does not always lead to the achievement of the desired clinical effect on the background of taking metoprolol. Patients with a feuhromocytoy, in parallel with the drug Egil ® C should be assigned an alpha adrenoblor.

In the case of surgical intervention, an anesthesiologist should be informed, that the patient takes Egilov ® S. Patients who will have surgical intervention, It is not recommended to stop the treatment of β-adrenoblockers.

Clinical research data on efficiency and safety in patients with severe stable heart failure (IV classification classification of NYHA) are limited.

Patients with symptoms of heart failure, combined with acute myocardial infarction and unstable angina, were excluded from research on the basis of which the testimony was determined. The effectiveness and safety of the drug for this group of patients is not described. Application in heart failure in the decompensation stage is contraindicated.

The sharp cancellation of the β-adrenoblocker can lead to an increase in the symptoms of the CHF and increase the risk of myocardial infarction and sudden death, especially in patients of the group high risk, in connection with which, it should be avoided. If necessary, cancellation of the drug should be carried out gradually, for at least 2 weeks, with a double decrease in the dose of the drug at each stage, until the final dose of 12.5 mg (1/2 tablets of 25 mg) should be taken At least 4 days before the complete cancellation of the drug. When symptoms appear, a slower discharge mode is recommended.

Impact on the ability to control vehicles

Care must be taken when driven by vehicles and classes potentially hazardous species Activities requiring increased concentration of attention due to the risk of dizziness and increased fatigue when applying the drug Egilov ® S.

Form release

Tablets of prolonged action coated with film shell 25 mg, 50 mg, 100 mg, 200 mg. 10 tablets in a PVC blister / PE / PVDX // Aluminum foil. 3 or 10 blisters along with instructions for use in a cardboard pack.

SHELF LIFE

3 years. Do not use the drug after the expiration date.

STORAGE CONDITIONS

At a temperature not higher than 30 ° C. Keep out of the reach of children.

Conditions of vacation

Released on the recipe.

Registration certificate holder

CJSC Pharmaceutical Plant Egis, 1106 Budapest, ul. Kerezturi, 30-38 Hungary

Representation of CJSC Pharmaceutical Plant Egis (Hungary) Moscow 121108, Moscow, ul. Ivan Franko, d. 8,

Manufacturer:Int Asian Pharmal Ltd. - India (Plot software. 457/458, Sarkhej-Bavla Highway, Matoda-382 210. Tal.: Sanand, Ahmadabad India)

Egilos - the preparation of a group of beta1-adrenobloclars produces an antiagonal (skewing of myocardial oxygen), a hypotensive effect.

It reduces the heart rate in oxygen, increases endurance with IHD, reduces the risk of angina attacks, danger of heart attack. Used medicine in complex therapy of ischemic disease, arrhythmias, angina heart, heart failure, in the treatment of migraine and hyperthyroidism.

Assign take Egil For states caused by an increase in blood pressure and hypoxia (oxygen starvation) of cardiac tissues, due to its complex positive effect on the heart and hypotensive effect. It is recommended for arrhythmia, migraine, high blood pressure, if there are no contraindications.

Release form and composition

Produced in the form of white tablets for reception inside:

• Egil Conventional: Round tablets, double-screw with a dosage of 25 mg - with a cross-shaped line on one side and the number "E 435" - on the other;
• Egil normal action: with a dosage of 50,100 mg of risk - on the one hand and "E 434" and "E 432" - on the other;
• Egilot Retard All dosages: oblong two-buckle tablets covered with a white shell, have a risk on both sides.
• Egilov S. All dosages: White tablets of oval bobbin shape with risk on both sides.

The active substance is metoprolol Tartrate. In one capsule of Egilov and Egyot Retard - 25, 50, 100 mg of the active substance (metoprolol Tartrate). In the enhylock with the active substance - metoprolol succinate (25-200 mg). Auxiliary substances: microcrystalline cellulose, povedium, sodium carboxymethyl, starch, magnesium stearate, colloidal silicon dioxide (titanium), etc.

Store 5 years at room temperature. Apply by recipe from cardiologist.

Egilos has a common action, and Egilos C and Egilot Retard - prolonged (extended), which reduces the likelihood of side effects. All varieties of the drug produces the pharmaceutical concern "EGIS PHARMACEUTICALS PLC" (Hungary). There is one more kind - a cheap analogue of Egilok C - Egilok SR (Egilok SR), manufactured by licensed by the Pharmaceutical Plant Intas Pharmaceuticals Ltd (India).

All forms of drug are considered the same, the active substance is in them - different salts of metoprolol (tartrate and succinate), which in the body decay and metoprolol is distinguished. The difference only in the absorption rate and the occurrence of the effect, as well as the composition of the auxiliary substances.

The cost of the drug: in Russia 125 rubles, in Kiev - 57-90 UAH.

Pharmacological properties

The active substance of the drug blocks beta 1 - adrenoreceptors of the heart, which gives a decrease in the frequency of heart cuts, the power of myocardial cuts and the volume pushed into the aort of blood.

Egilk reduces pressure. With long-term use of the enhylok, the risk of sudden death from stroke, heart attack, hypertensive crises, heart pathologies is reduced. By improving the heart of oxygen, the drug increases human activity, reduces the risk of angina attacks.

Egilov and Egilot Retard are used if a patient has hyperthyroidism or hyperkinetic cardiac syndrome for complex disease therapy.

Egilov and Egilov C are prescribed to avoid supertoday arrhythmia. These drugs are shown in heart failure.

Egilot Retard is used in conjunction with diuretic (diuretic) preparations, heart glycosides and ACE inhibitors.

In violation of the work of the left heart ventricle (systolic phase) and heart failure, more efficient Egilov S. This form of the drug reduces the likelihood of a deadly outcome at the later stages of a heart attack, eliminates tachycardia, violation of myocardium.

Egilk propagates repeated attacks of angina, repeated attacks after a heart attack. The medicine does not cure these diseases of the heart, but increases the endurance of the patient with physical, emotional loads, maintaining the normal work of the heart.

Eliminating the symptoms of heart disease, allows a person to lead a normal life.

The active component of the Egilok metaprolol reduces the exciting effect on the heart of the sympathetic nervous system, reduces the heart rate and blood pressure. Gradually reduces the resistance of peripheral vessels and gives a hypotensive effect. Due to the decrease in blood pressure and heart abbreviations, the need of myocardium in oxygen is reduced. Due to this, the patient's condition is improving, angina attacks become less common.

Instructions for use

Explore instructions for the use of Egilock: with what pressure It is prescribed, doses, features and contraindications of the drug.

Egil tablets are taken regardless of the time of reception of food, preferably at the same time of the day. The dose is selected individually taking into account the testimony of the patient, increasing gradually, but not more than 200 mg / day.

The medicine is prescribed with such pathologies:

1. At elevated pressure.
2. Stenzardia (Breast pain - "Breast toad").
3. Migraine (pulsating headache in any zone of head - occipient, temporal, frontal).
4. Tachycardia (increasing Czech-90 and\u003e).
5. (Slow out heart rate).
6. Functional disorders in the work of the heart.
7. Atrial febrily.

To protect yourself from the risk of damage to health using the drug from pressure, you need to carefully read the instructions, familiarize yourself with the features of the medication (contraindications, side effects, compatibility with other means) and follow the recommendations of the doctor. Do not exceed permissible doses, follow the status changes.

To reduce blood pressure, an initial dose of 25- 50 mg for 2 receptions (in the morning and evening). In the absence of the desired effect, the dose may increase the attending physician.

Treatment of angina assumes 25-50 mg / day with a possible increase of up to 200 mg and adding a 2nd drug to obtain the desired result. It is necessary to ensure that the heart rate is alone and during the load did not go beyond: 55-60 - 110 ° C / min.

After myocardial infarction, 100-200 mg / day are prescribed for maintenance therapy, with arrhythmia 25-50 mg 2-3 r. / Day. With insufficient efficiency, the dose increases to 200 mg, or the 2nd preparation against arrhythmia is connected.

Upon attacks of migraine, the egilos prescribe 100 mg per day in 2 receptions. Elderly patients and patients with liver pathology or kidney dose do not increase.

Maximum therapeutic effect Comes 1.5 hours after reception. About 95% of the drug biotransforms (processes) the liver, 5% of the body remove the kidneys.

In the treatment of egilomes, reduces the release of the tear fluid and discomfort may occur in patients using contact lenses. If surgery to be surgical, it is necessary to prevent anesthesiologist about it, so that he can choose adequate anesthesia.

Complete treatment is necessary smoothly, reducing the dose (every 2 weeks). With a sharp cancellation, the patient's condition may worsen.

Contraindications of Egiloka

Possessing big spectrum Indications, the drug has a number of contraindications. It can be used, only making sure that there are no contraindications.

It is dangerous for patients with slow heartbeat (50-60 ° C / min. And less), sinus node weakness syndrome.

It is undesirable to use in cases of a synoatrial blockade and with peripheral circulatory disorders. It is impossible to take hypotonized (reduced pressure< 90-100 мм рт.ст.). Не рекомендуется пить при беременности, чтобы избежать вредного воздействия на плод. Препарат может вызвать аллергию при гиперчувствительности к его составляющим.

If the patient has contraindications, it is necessary to reduce the dose of the drug, control the body's response to the reception of the egilock in small doses or select another drug.

The drug is prohibited from Take:

• heart failure during decompensation;
• cardiogenic shock;
• during breastfeeding period;
• hypersensitivity to drug components;
• synoinatrial and atrioventricular blockade (2-3rd degree);
• (decrease in blood pressure);
• angiospast angina.

Side effects

Studies, observations of doctors and patient reviews made it possible to compile a list of side effects from various organs and human systems.

Side Effects in the treatment of Egilomes:

The cardiovascular system:

• pain in the heart;
• heartbeat, arrhythmia;
• swelling of the limbs (Egilot Retard, Egilov C);
• strengthening signs of heart failure;
• in patients after a heart attack;
• bradycardia;
• ortostatic hypotension (a sharp drop of blood pressure during the upset);
• fainting;
• cold in lower limbs.

Nervous system:

• dizziness and headache;
• anxiety;
• fatigue;
• depression;
• reducing the concentration of attention;
• excitability;
• convulsions;
• Paresthesia (violation of sensitivity, "Pogwellery").

PCT:

• nausea, vomiting;
• abdominal pain;
• dry mouth mucosa;
• or diarrhea;
• liver pathology (stagnant bile, yellowing of the skin, eye proteins, dark urine);
• raising bilirubin in the blood;
• hepatitis (Egil C).

Respiratory system :

• shortness of breath during exercise;
• rhinitis;
• bronchospasm;

Skin:

• excessive sweating;
• urticaria (blister and itching);
• rash, skin itching;
• photosensibilization ( increased sensitivity skin to the sun rays);
• exanthema (skin rash);
• redness skin Pokrov.

Feeling authorities:

• vision impairment;
• violation of taste;
• dryness, eye irritation;
• tinnitus;
• conjunctivitis (inflammation of the mucous eye).
  

On the initial stages Taking medication arises a feeling of fatigue.

These effects are temporary and weak. If some of the effects manifests itself bright and long, it is necessary to stop taking the drug and consult a doctor.

Overdose

If the dose of the drug is exceeded, dizziness and bradycardia may occur, sometimes nausea and vomiting. Blood pressure may decrease. Sometimes the patient is exceeded by the dose of egiloca, arrhythmias, ventricular extrasystolia are observed and a faint.

IN heavy cases With a cardiogenic shock, the patient can lose consciousness and go to whom, a heart stop can occur. With a large dose of medication, such symptoms are manifested between 20 minutes to 2 hours after the reception.

If this happened to the patient necessary:

• rinse the stomach;
• give adsorbents;
• put horizontally, lifting the legs above the head (if pressure dropped);
• beta-adrenostimulants are introduced intravenously (if bradycardia, heart failure developed);
• dopamine, Dobutamine, Norepinefrin, if the measures taken did not help.

Doctors apply different types of therapy, focusing on the symptoms and patient's condition. If this happens at home, you must immediately call ambulance, explaining the essence of the problem.

Egilok analogues

There are many analogues of the drug, but before their use requires a consultation of a cardiologist, but they cannot replace the original to fully. Analogs: Vazocardin, Betalki, Corvitol, Lydalok, Methodoxy, Metolol, Metolol, Emzok, metoprolol.

It is forbidden to use the egilock with drugs:

• the hypotensive impact of metoprolol may decrease when the joint use of angiloc and beta-adrenoblockers (theophylline, indomethacin, estrogens);
• when taking with verapamil, it can lead to a heart stop.
• effluent negative action on the central nervous system simultaneous reception with ethanol;
• the likelihood of hypoglycemia increases when mixing the egillee with insulin and hypoglycemic means.

Extra popular among the hypertensive of Egilov is the drug produced by Hungary. Having a lower pressure action, at the same time EGILOP facilitates the state affected by complications of hypertension and atherosclerosis of the heart. It helps the drug and diseases directly with high blood pressure not related. Many patients prefer Egilov, ignoring analogues that are quite a few. What does them encourage them to a specific choice?

Instructions for use

The name "Egilos" - trademark, this medicine Manufacturer (Hungary). There are Indian Egilos.

MNH Egiloka - metoprolol. This is a main active substance supplemented with auxiliary: anhydrous colloidal silicon dioxide, microcrystalline cellulose, magnesium stearate, sodium carboxymethyl staircase and povidone. Dosage form of release: Tablets.

The auxiliary components serve to preserve the base (active substance - metoprolol of the tartrate) before use. They serve enterosorbents, emulsifiers, fillers, stabilizers. The components are arranged so that ensure the stability of the composition and preservation of the drug. Once in the body, they help the main component fully show the right action.

Latin Egilok - Egilok, and in force Denote: Metoprolol Tartat, if it is a high-speed form. Prolonged Egilot Retard contains another compound of metoprolol - succinate. Accordingly, Metoprolol succinate.

Tablets are dosed in milligrams on active substance, Three dosage types: 25, 50, 100 mg. All of them are white or close to white colors, double-screwed. On tablets less (25 mg) dosage, the surface is marked with a cross-shaped notch. This makes it easier to divide the pills when there are even less doses. Typically - at the beginning of the drug when the optimal dosage is selected, it is necessary.

Tablets of large dosages have risks to help careful. The smell does not have a tablet drug.

Pharmacological group, action mechanism

Pharmacotherapeutic group of Egiloka: beta1 adrenoblocators. Egilos refers to cardiolective - electoral action-oriented drugs and feeding its coronary vessels.

Selective beta1-adrenoblocators at reasonable dosage work only with β1 adrenoreceptors, only them block them. Another type responsible for breathing, tooling the fetus, the periphery vessels - β2-adrenoreceptors - quietly continues to work, the egilos is not sent to them. The medicine is purposefully moving towards the intended purpose, finds receptors for which it is created. By contacting them, the egilos does not allow catecholars to produce a strong body shake in provoking factors:

1. Emotional voltage;
2. Increased physical exertion;
3. A sharp change of weather (almost 100% of the "vascular" patients) react to this deterioration.

The sympathetic system under the action of egiloca reduces the activity against myocardium. Egilov, blocking β1-adrenoreceptors, slows down the pulse, reduces four important values \u200b\u200bat once: the frequency of heart abbreviations, the amount of cardiac output, the strength of the contractility and the figuration of blood pressure.

Such support to the heart and its vessels improves the quality of life, significantly prolongs it.

When blocking beta1-adrenoreceptors, the heart works calmly. Its blood flow is fully carried out and without overload, at the time of relaxation (phase diastole) of the ventricles. Group medications are a successful find of pharmacists. Egilov () - typical representative A number of beta adrenoblockers.

The problem of having high ad patients - left-detection dysfunction, increasing the ventricle from excess load (blood pressure) on it. Regular long-lasting egilock reception allows you to reverse this pathology. The ventricle, without experiencing overload, changes the dimensions: returns closer to normal.

Normalization of the size and functions of the left ventricle, the restoration of the time needed for relaxation (diastole) has a direct effect on the survival of patients. Mortality from vascular disasters, especially in men, is significantly reduced. From what makes the Tablets Egilov: to prevent such misfortunes as heart attacks, strokes, cases of sudden death. If the hypertension is moderate, "soft", then the healing effect is brighter expressed.

The need for the heart muscle in admission to blood oxygen - decreases, the blood flow is increasing. The preload on the heart decreases, he does not need so much effort to make blood pumping, as before taking medication. Oxygen is reduced better than it happened at high heart rate and pressure.

The selectivity of Egilok is an advantage over non-selective medicines of the same group. It almost does not manifest (with adequate doses) spiring effect on the respiratory muscles (bronchi), as well as the smooth muscles of the walls of peripheral vessels. It does not affect the fabrics of the muscles not included in the myocardial zone. It works only cardiologically, with a positive effect.

Egilos is good for diabetics: without affecting metabolic processes, he does not provoke hypoglycemia. Insulin secretion does not depend on the presence in the blood of metoprolol (egilock). Cholesterol indicators with prolonged therapy Egyotom - significantly decrease.

Pharmacokinetics

The absorption of the active substance after the passage through the metabolic liver barrier occurs quickly. The process with an increase in the percentage of bioavailability is improved if the Tablets of Egilock, according to the instructions for its use, are used together with food. The liver controls everything entering the gastrointestinal tract, so it is easier to "slip" to "slip". It becomes an accessible to the body by 40% than the on an empty stomach. Metabolites Therapeutic activity of the egiloca is losing.

The percentage of metoprolol binding by blood proteins varies. He is small healthy liverBut reaches 10% - with its pathology.

The conclusion of the drug is carried out by the kidneys. It can slow down in renal failure, but it does not cause tangible harm.

Indications for use

For Egilok, the testimony for its use is similar to the use of other beta-adrenobloclars. From which these pills are prescribed, it is possible to understand, exploring the mechanism of action of the Egilock. Apply the drug at:

• Hypertensive disease of all stages (arterial hypertension) - monotherapy or, as a component in the complex of drugs;
• Tahiaritia (tachycardia) of inorganic genesis - functional reversible malfunctions;
• Arrhythmias having organic Causes: Tachycardia Supported, paroxysmal, extrasystolia atrial, ventricular, religorage;
• Angina stress, stable flow;
• Prevention of migraine exacerbation, prevention of pain attacks;
• Hyperthyroidism (removal of symptoms, addition of specific therapeutic methods);
• Complicated by infarction of angina - Egilos in the complex of basic therapeutic measures. Treatment of post-infarction state, simultaneous repetition prevention, preventing a new heart attack.

Instructions for use indicates with what pressure is effective Egyptions. He is prescribed to any of the stages of this disease. With a small exceeding the rate of indicators, the drug can help one (monotherapy). Then the instructions for use are provided for at least 25 mg of Egilok to receive can already be enough.

Ischemia is a narrowing, infringement. In fact there is no infringement, there is a strong narrowing of the feeding arteries. In acute cases and - the blockage of them, the closure of the lumen during atherosclerosis (plaques are broken), thrombosis (blocking of the vessel thrombo). When the vascular clearance is narrowed, myocardial nutrition is inevitably violated. Egilok relaxes the vessels, facilitates the passage of blood on them to myocardium. IBS is the shape of angina "with experience", the dangerous phase. Improving blood supply, heart feed, Egilk helps him hold out.

Applied after heart attacks, protects against repeated, increases survival

Such are happening in neurosis, in dystonia suffering, other disorders of the nervous system or cardiovascular. Among the whole complex of symptoms tachycardia often goes forward the rest. It bothers more, generates fear, herself enhances and enhances the rest of the symptoms. Better beta-blockers means there is no. Egilk Uymet is a frequent pulse and, having some anxiolytic, anti-trial action, will calm down. At the same time, another unpleasant symptoms will go: fear, sweating, tremor. Not even having organic heart changes anxiety Not good. The drug will help everyone return to the norm.

Arityimia Organic Genesis

Complex, heavy rhythm disorders. Caused by different reasons: atherosclerosis, violation of the conductivity of myocardial pulses, sinus node pathology. Beta blockers arrange rhythm at tachycardia (reduce heart rate). Some types of ecstasistol are amenable to Egilok, rhythm is aligned. Or extrasystoles at least become less likely, they acquire a sinus rhythm instead of a disorderly. Medicine Egils is used sometimes even with implicitly expressed bradycardia - according to life indications. Care here is needed special, but the patient's life is saved - it is necessary. Even Egil 25 may be an exception, it is divided, it is dosed at first a quarter of such a pill. And this small dose of the right influence will still have. Almost not slowing down pulse abbreviations.

Instructions for use Bradycardia refers to the contraindications of Egilok, but reviews of practicing cardiologists testify: sometimes, the smallest doses - it is necessary. Grinding (again contrary to the instructions), right under the tongue - for speed action. This will save life in an acute situation, and the selection of other drugs is already.

If the heart rate allows (not too small), the beta-blockers will be outlined with such a diagnosis. Attacks of angina, it is not naedible with the addition of the word "voltage", arise in physical or mental overvoltage. Accepted constantly eclip tension removes. The attacks become rare and weakly manifest.

Migraine, prevention of attacks

The disease is common, but is not studied. The culprit of pain today is considered to be dilated (expansion) of brain vessels from overflowing their blood and high pressure.

Reduced blood pressure, Egille warns, blocks dilatation.

Additionally, the anti-time operation works: it is noted that anxious faces of migraine attacks are frequent phenomenon. There is no anxiety - no migraine.

The disease beta blockers is not treated. But with auxiliary purpose they are used. Egilk will help to relieve a frequent pulse characteristic. Along the way, the flow intensity is reduced, tremor, the blood pressure. The symptoms of the manifestation of hyperthyroidism are smoothed, for patient well-being it is important.

Prevention of repeated heart attacks

The drug in the complex with others helps protect a person from the danger of repetition of a heart attack. The second heart attack loose heart may not withstand. Here, the role of drugs and the ability of the doctor to navigate in their selection, building tactics of treatment, vital.

Now you know what Egille helps. It's time to know when it is not shown. Contraindications for receiving Egiloka serve:

Application with caution

• Feochromocytoma - a combination of alpha-adrenoblockers is necessary, no egilos apply without them.
• Sugar diabetes - the effect of dose-dependent, under large doses, the stimulation of hypoglycemia is not excluded.
• Metabolic acidosis - intervention may be observed in the beta-adrenoblar exchange rate faction with an unpredictable result.
• Bronchial asthma - a slight impact on controlling respiratory system The second type receptors are β2-adrenoreceptors occasionally from sensitive, patients with asthma, patients are found.
• Commissioning endarterite, pathology of the periphery vessels.
• Insufficiency - renal, hepatic: Clearance problems are possible, slow down the conclusion, an increase in the concentration of the drug above the recommended - in the body.
• Depression is the stage of exacerbation or remission.
• The tendency to allergies - if necessary, the introduction of anti-shock preparations (adrenaline) the body may not respond to them under the action of Egilock.
• Hyperthyroidism (thyrotoxicosis) - increased hormonal activity affected by a non-deception thyroid gland Requires careful selection of drugs and doses even for symptomatic treatment.
• COPD - severe lung diseases make a respiratory system sensitive even to almost neutral selective beta blockers. The cardiolectivity of Egilok does not exclude microprodes to other systems. If they are violated by the disease, special control is required.

Pregnancy, Lactation

If both are risking: the mother is from the abolition of Egilok, the fruit - from its use, doctors correlate risks. If possible, pick up a pregnant gentle child drug. If such an opportunity is excluded, and you need Egilov (according to life testimony), try to save both. The effect of the drug on the developing organism is carefully monitored.

The newborn immediately examines, check for possible pathological deviations of systems and organs.

If there are those intensive therapy, try to adjust negative influence The obtained intrauterine drug.

Under supervision, the child may be long.

Method of application, dosage

Take the drug, without connecting the time of reception - with food. No need to wait moments before or after eating. You can - right along with meals, so even better learns. The daily dose of Egilok is divided according to the recommendations of the instructions for two receptions - morning and evening. Minimum is set based on the state of concomitant diseases. With small doses - begin. By gradual selection reach optimal. At each such boosting "step" delayed up to two weeks - check efficiency.

The daily maximum: 200 mg, no longer follows, the risk of side manifestations will increase. In case of exceeding the recommended daily dose, the selectivity of Egilock is partially lost. The active ingredient can start blocking both types of adrenoreceptors, which cannot be allowed. The doctor's appointments should be scrupulously: he knows how much to appoint, and takes into account all the features of the drug.

The dosage of Egilok by type of disease can and should differ. There may be the same doses in some diagnoses.

The dosage of Egiloca varies from the initial - 25 mg to the maximum - 200 mg. Selection individual, stepped. Reception according to the scheme: Morning + Evening, the dose is divided into half. Start on the most comfortable dose, providing the expected effect. Arterial hypertension, revealed on time, at the stage of the beginning, can be adjusted by monotherapy Egiloma. With a stubborn flow of illness, high blood pressure, add well-combined drugs of other groups lowering pressure.

Start with 25 or 50 mg, as of the patient and the general portability of drugs. This dosage with IHD takes twice or three times per day. You can bring a daily dose to 200 mg. If such a quantity is transferred poorly, and the smaller - due to the proper effect, leave in a normal tolerant quantity. Correct treatment with an increase of another medication that complements the egilos facilitating the patient's condition.

Functional Tahiaritmia

Purpose: Morning and evening - 50 mg. If the effect is insufficient - 100 mg. Usually monotherapy helps well.

Extrasystole, Tachycardia

Start with 25 or 50 mg. Multiplicity of reception: three times per day. With good tolerability, but low efficiency, the dose increases. Do not exceed the maximum bar - 200 mg. You can practice combined treatment of arrhythmias. It is better to start - stationary.

Stable angina stress

The treatment regimen is similar to the IBS therapy, since the CHA is formed when angina progression and is one of its stages.

Prevention of migraine attacks

Selection of dose - individual. This is usually 100 mg, divided into two receptions. Either - maximum daily dust dose. Also shared in half, it is accepted twice (Morning + Evening).

If migraine attacks are rare, constant reception does not practice. Approximation of the attack is characterized by precursors (reduction of vision, glorifying bright spots before eyes). When such precursors are available, Egilos at a pre-selected dose are immediately taken. Continue a few days.

With frequently annoying migraines, Egilos is shown to use - constantly

Up to four receptions per day. Maximum daily dose or - close to it (150 - 100 mg).
Prevention of repeated heart attacks. Maximum or half daily dose of means (200 or 100 mg). It is divided into two, reception: morning and evening.

Side effects

Egilos has side effectsWhat is explained: the medicine, even with its selectivity, is in systemic bloodstream. Organisms are different, reactivity - too. Not everyone will suit that the majority is useful. Unwanted effects from the reception of Egilock:

• Headache, dizziness;
• Oppression or activation of nervous processes: from excessive excitability, to severe fatigue;
• Sexual dysfunction - a decrease in libido / potency;
• Amneticoconfabulant syndrome (memory problems);
• Reinforced unmotivated anxiety;
• Feeling of cold feet;

• Drying mucous mouth;
• Insomnia or drowsiness;
• Symptomatic aggravation of heart failure;
• Ortostatic hypotension;
• Hallucinations;
• Painful heartbeat;
• Cardiogenic shock;
• Liver failure;
• Abdominal pain,
• Heartbeat violation;
• Constipation;

• Gangrene (due to the weighting of the impaired peripheral blood circulation);
• Vomiting;
• Tinnitus;
• Conjunctivitis;
• Distortion of taste perception;
• Reduction of vision;
• Rhinitis;
• Alopecia;
• Bronchospasm;
• Irritation of the mucous eye;
• Photosensite;
• Shortness of breath in the load;
• Hives;
• Arthralgia;
• Strong sweating;
• Stressed weight gain.

Blockade of myocardial departments (atrial and ventricular);

Bronchospasm;

Hypoglycemia;

Sonya (cyanosis) of skin;

Unconscious;

Flip in whom.

Overdose of the egill medication against the background of therapy with declining drug drugs, taking barbiratov, in the presence of accepted ethanol in the body - more dangerous. Symptoms are enhanced, the forecast is worsening.

Help need urgent, hospitalization is required, a complex of rehabilitation activities.

Before arriving soon, if the consciousness is saved, you can give enterosorbent, try to cause vomiting.

Medicinal interaction

Joint reception with hypotensive drugs cause an additive effect. Combined therapy is assigned, begins and controlled by a doctor. The total action is the purpose of such treatment, but it should not be excessive. Busting with doses is dangerous hypotension that can cause a number of complications. Some of them are more dangerous to lifting pressure.

It is risky to combine egilov and other beta-blockers with calcium channel blockers (slow). Especially dangerous intravenous use of verapamila, there is a threat of asystole (heart stop).

Antiarrhythmics taken inward (cordaron, chinin) can provoke an atrioventricular blockade. Pronounced bradycardia is not excluded.

Do not combine egilov with cardiac glycosides: can suffer the conductive heart function, severe bradycardia develop.

Resern, some other antihypertensive drugs are not combined with Egiloma, a representative of beta-adrenoblockers. The situation is fraught with hypotension, bradycardia.

If the clonidine is still accepted with Egyotom, the long-term use of Klonidin is not practicing. Cancellations are impossible at the same time. The order is observed such: at first the reception of metoprolol (Egilok) is stopped. Clonidine remains "in the drug menu" for a few more days. Then he is canceled. If you do otherwise, to remove the clonidine first - the likelihood of two consequences is great. The development of a hypertensive crisis and the formation of drug addiction occurs.

The depressing CNS funds (neuroleptics, tranquilizers, ethanol and other substances of this action) are cumulatively with egilomes can cause a critical hypotension. Let us need emergency measures Recovery. And if the receiving beta-blocker gives anesthesia, the risk of asistolia arises.

Do not combine with the augiloma of alpha and beta sympathomimetics (sharply - hypotension, clinically significant bradycardia, is a great risk of heart stop).

Ergotamine gives a vesseloring effect, the beta blocker can confront him in such a combination.

Incompatibility with medicines at Egilok a lot. NSAID - anti-inflammatory drugs of this type reduce its effectiveness.

Sakharosynizing and insulin activity is in a pair with egilomes - increase (risk of hypoglycemia).

Estrogens "interfere with" beta blockers reduce pressure

Inhibitors of various enzymes, neurotransmitters - the effect of the drug is reinforced by increasing its concentration in the body.

Barbirati and other enzyme inductors depress metoprolol, the action of the Egilock is weakening.

If substances that block nodes (ganglia) of the sympathetic NA (nervous system), and the drugs of one group with ejilomes (beta-adrenoblockers) are used, even when it is eye drops - need special control. The reactions of the body on these combinations are unpredictable.

special instructions

Analogs

Egilos, as discloses instructions for use, the same metoprolol (the price and place of production differ).

The medicine is effective, common, many people are necessary. Analogues in the country and the world of Egilok - a lot. The majority is given a name that coincides with the active substance, some - by firms producing them. The price of Egilok is not the lowest, not low: for thirty tablets 100 mg patient pays 130 - 150 rubles. You can buy a cheap analogue of Egilock, instruction, composition, properties - the same: metoprolol (coordinating the replacement with the doctor) - German, the same package - 55 rubles.

The most famous analogues are:

• Metoprolol: Russia, Poland;
• Lidalok: Russia;
• Metoprolol Teva: Israel;
• Metolol: Russia;
• Metoprolol Ratiopharm: Germany;
• Emzok: Germany;
• Metoprolol Organizer: Russia;
• Metoprolol Zentiv: Slovenia;
• Egilot Retard (prolonged): Switzerland, Hungary;
• Metoprolol-OBL: Russia;
• Metoprolol Sukcinate: India;
• Metozok: Russia;
• Metokor ADIFARM: Bulgaria;
• Metoprolol Tartrate: Ukraine;
• Corvitol 50: Germany;
• Betalok, Botok Zok (prolonged): Sweden, France;
• Methodographer: Russia, Poland;
• Metoprolol-acry: Russia;
• Vazocardin: Slovenia;
• Betalok: Sweden;
• Egilov with (prolonged): Hungary;
• CERS: Romania;
• Egilov: Hungary.

Vacation - by recipe.