From what tablets Concor 2.5. Concor - the duration of admission in the treatment of diseases of the cardiovascular system. After a heart attack

International non-proprietary name:

Bisoprolol (Bisoprolol)

Tradename: Concor ® Kor

Dosage form:

film-coated tablets

Compound
1 film-coated tablet contains:
Active substance: Bisoprolol hemifumarate (bisoprolol fumarate (2:1)) - 2.5 mg
Auxiliary ingredients:
Core: anhydrous calcium hydrogen phosphate, corn starch, colloidal silicon dioxide, microcrystalline cellulose, crospovidone, magnesium stearate.
Film shell: hypromellose 2910/15, macrogol 400, dimethicone 100, titanium dioxide (E 171).

Description
Film-coated tablets, 2.5 mg:
White, heart-shaped, biconvex film-coated tablets, scored on both sides.

Pharmacotherapeutic group:

beta 1 - blocker

ATC Code: C07AB07

Pharmacotherapeutic properties

Pharmacodynamics
Selective beta 1 - blocker, without its own sympathomimetic activity, does not have a membrane stabilizing effect. Reduces plasma renin activity, reduces myocardial oxygen demand, reduces heart rate (HR) (at rest and during exercise). It has antihypertensive, antiarrhythmic and antianginal effects. Blocking in low doses beta 1-adrenergic receptors of the heart, it reduces the formation of cAMP from ATP stimulated by catecholamines, reduces the intracellular current of calcium ions, has a negative chrono-, dromo-, batmo- and inotropic effect (inhibits conduction and excitability, slows down atrioventricular conduction).
With an increase in the dose above the therapeutic one, it has a beta 2 -adrenergic blocking effect.
The total peripheral vascular resistance at the beginning of the drug, in the first 24 hours, slightly increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors), which after 1-3 days returns to the original, and decreases with long-term administration.
The hypotensive effect is associated with a decrease in the minute volume of blood, sympathetic stimulation of peripheral vessels, a decrease in the activity of the renin-angiotensin system (it is of great importance for patients with initial renin hypersecretion), restoration of sensitivity in response to a decrease in blood pressure (BP) and an effect on the central nervous system ( CNS). With arterial hypertension, the effect occurs after 2-5 days, stable action - after 1-2 months.
The antianginal effect is due to a decrease in myocardial oxygen demand as a result of a decrease in heart rate, a slight decrease in contractility, lengthening of diastole, and improvement in myocardial perfusion. The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and a slowdown in atrioventricular (AV) conduction (mainly in antegrade and, to a lesser extent, in retrograde directions through the atrioventricular node) and along additional pathways. When used in medium therapeutic doses, unlike non-selective beta-blockers, it has a less pronounced effect on organs containing beta 2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism, does not cause retention of sodium ions (Na+) in the body; the severity of the atherogenic action does not differ from the action of propranolol.

Pharmacokinetics
Suction. Bisoprolol is almost completely (>90%) absorbed from the gastrointestinal tract. Its bioavailability due to negligible "first pass" metabolism through the liver (at the level of about 10%-15%) is about 85-90% after oral administration. Eating does not affect bioavailability. Bisoprolol exhibits linear kinetics, with plasma concentrations being proportional to the administered dose over the dose range of 5 to 20 mg. The maximum plasma concentration is reached after 2-3 hours.
Distribution. Bisoprolol is distributed quite widely. The volume of distribution is 3.5 l/kg. Communication with proteins of a blood plasma reaches about 35%; capture by blood cells is not observed.
Metabolism. Metabolized by the oxidative pathway without subsequent conjugation. All metabolites are highly polar and are excreted by the kidneys. The main metabolites found in blood plasma and urine do not show pharmacological activity. Data obtained from experiments with human liver microsomes in vitro show that bisoprolol is metabolized primarily by CYP3A4 (about 95%), and CYP2D6 plays only a small role. Withdrawal. The clearance of bisoprolol is determined by the balance between its excretion through the kidneys in the form of an unchanged substance (about 50%) and oxidation in the liver (about 50%) to metabolites, which are then also excreted by the kidneys. The total clearance is 15.6 ± 3.2 l / h, and the renal clearance is 9.6 ± 1.6 l / h. The half-life is 10-12 hours.

Indications for use
- chronic heart failure

Contraindications
Concor ® Cor should not be used to treat patients with the following conditions:

hypersensitivity to bisoprolol or to any of the components of the drug (see section "Composition") and to other beta-blockers;

acute heart failure, chronic heart failure in the stage of decompensation;

shock caused by impaired cardiac function (cardiogenic shock), collapse;

atrioventricular block II and III degree, without a pacemaker;

sick sinus syndrome;

sinoatrial blockade;

severe bradycardia (heart rate less than 50 bpm);

Prinzmetal's angina;

a pronounced decrease in blood pressure (systolic blood pressure less than 90 mm Hg. Art.);

severe forms of bronchial asthma and chronic obstructive pulmonary disease in history;

late stages of peripheral circulatory disorders, Raynaud's disease;

pheochromocytoma (without the simultaneous use of alpha-blockers);

metabolic acidosis;

simultaneous administration of monoamine oxidase (MAO) inhibitors, with the exception of MAO-B;

age up to 18 years (efficacy and safety have not been established).
With caution: liver failure, chronic renal failure, myasthenia gravis, thyrotoxicosis, diabetes mellitus, atrioventricular block I degree, depression (including history), psoriasis, old age. Use during pregnancy and lactation
During pregnancy, Concor ® Cor should only be recommended if the benefit to the mother outweighs the risk of developing side effects at the fetus. As a rule, beta-blockers reduce blood flow in the placenta and may affect the development of the fetus. Blood flow in the placenta and uterus should be carefully 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 delivery. In the first three days of life, symptoms of low blood glucose and heart rate may occur.
There are no data on the excretion of bisoprolol into breast milk or the safety of exposure to bisoprolol in infants. Therefore, taking Concor ® Cor is not recommended for women during breastfeeding. Dosage and administration
The tablets should be taken with a small amount of liquid in the morning before, during or after breakfast. Tablets should not be chewed or crushed into powder.
The beginning of the treatment of chronic heart failure with Concor ® Cor requires a special titration phase and regular medical supervision.
The preconditions for treatment with Concor ® Core are as follows:

chronic heart failure without signs of exacerbation in the previous six weeks,

practically unchanged basic therapy in the previous two weeks,

treatment with optimal doses of ACE inhibitors (or other vasodilators in case of intolerance to ACE inhibitors), diuretics and, optionally, cardiac glycosides.
Treatment of chronic heart failure with Concor ® Kor begins in accordance with the following titration scheme. This may require individual adaptation depending on how well the patient tolerates the prescribed dose, i.e. the dose can be increased only if the previous dose was well tolerated.

* To ensure the above dosing regimen at subsequent stages of treatment, it is recommended to use the drug Concor ® .

The maximum recommended dose in the treatment of chronic heart failure is 10 mg of bisoprolol 1 time per day. Patients are advised to take the dose of the drug selected by the doctor if no adverse reactions occur.
After starting treatment with the drug at a dose of 1.25 mg (1/2 tablet of Concor ® KOR), the patient should be observed for about 4 hours (control of heart rate, blood pressure, conduction disturbances, signs of worsening heart failure).
During the titration phase or after it, a temporary worsening of the course of heart failure, fluid retention in the body, arterial hypotension or bradycardia may occur. In this case, it is recommended, first of all, to pay attention to the selection of the dosage of concomitant basic therapy (optimize the dose of diuretic and / or ACE inhibitor) before reducing the dosage of Concor ® Cor. Treatment with Concor ® Cor should be interrupted only if absolutely necessary. After stabilization of the patient's condition, re-titration should be carried out, or treatment should be continued. Duration of treatment for all indications
Treatment with Concor ® Cor is usually a long-term therapy. If necessary, treatment can be interrupted and resumed subject to certain rules.
Treatment should not be interrupted suddenly, especially in patients with ischemic heart disease. If it is necessary to stop treatment, then the dosage of the drug should be reduced gradually. Special patient groups
Impaired kidney or liver function:
Treatment of arterial hypertension or angina pectoris:

In case of impaired liver or kidney function, mild or moderate, usually does not require dose adjustment.

With severe renal dysfunction (creatinine clearance less than 20 ml / min.) And in patients with severe liver disease, the maximum daily dose is 10 mg.
Elderly patients:
Dose adjustment is not required. Side effect
The frequency of the adverse reactions listed below was determined according to the following:
-very often: ≥ 1/10;
- often: > 1/100,<1/10;
- infrequently: >1/1000,<1/100;
-rarely: >1/10,000,<1/1000;
-very rarely:< 1/10 000, включая отдельные сообщения. The cardiovascular system
Very often: decrease in heart rate (bradycardia, especially in patients with chronic heart failure); often: arterial hypotension (especially in patients with chronic heart failure), manifestation of angiospasm (increased peripheral circulatory disorders, feeling of coldness in the extremities (paresthesia); infrequently: impaired atrioventricular conduction, orthostatic hypotension, decompensation of heart failure with the development of peripheral edema. Nervous system
At the beginning of the course of treatment, disorders of the central nervous system may temporarily appear, infrequently: dizziness, headache, asthenia, fatigue, sleep disturbances, and mental disorders (infrequently depression, rarely hallucinations, nightmares, convulsions). Usually these phenomena are mild and disappear, as a rule, within 1-2 weeks after the start of treatment. organs of vision
Rare: blurred vision, decreased tearing (should be taken into account when wearing contact lenses); very rare: conjunctivitis. Respiratory system
Rare: allergic rhinitis. Uncommon: bronchospasm in patients with bronchial asthma or obstructive airways disease. Gastrointestinal tract
Often: nausea, vomiting, diarrhea, constipation, dryness of the oral mucosa; rarely: hepatitis. Musculoskeletal system
Infrequently: muscle weakness, cramps in the calf muscles, arthralgia. allergic reactions
Rare: hypersensitivity reactions such as pruritus, skin redness, sweating, rash. Very rare: alopecia. Beta-blockers can exacerbate psoriasis. genitourinary system
Very rare: erectile dysfunction. Laboratory indicators
Rarely: increased levels of liver enzymes in the blood (ACT, ALT), increased levels of triglycerides in the blood. In some cases: thrombocytopenia, agranulocytosis. Overdose
Symptoms: arrhythmia, ventricular extrasystole, severe bradycardia, atrioventricular block, marked decrease in blood pressure, acute heart failure, hypoglycemia, acrocyanosis, shortness of breath, bronchospasm, dizziness, fainting, convulsions.
Treatment: gastric lavage and the appointment of adsorbing drugs; symptomatic therapy: with developed atrioventricular blockade, intravenous administration of 1-2 mg of atropine, epinephrine, or setting up a temporary pacemaker; with ventricular extrasystole - lidocaine (class IA drugs are not used); with a pronounced decrease in blood pressure - the patient should be in the Trendelenburg position; if there are no signs of pulmonary edema, intravenous plasma-substituting solutions; if ineffective, the administration of epinephrine, dopamine, dobutamine (to maintain the chronotropic and inotropic action and eliminate a pronounced decrease in blood pressure); in heart failure - cardiac glycosides, diuretics, glucagon; with convulsions - intravenous diazepam; with bronchospasm - beta 2 - adrenostimulants inhalation. Interaction with other drugs
The effectiveness and tolerability of drugs may be affected by the simultaneous use of other drugs. This interaction can also occur when two drugs are taken after a short period of time. The doctor must be informed that you are taking other medicines, even if you are taking them without a prescription.
Allergens used for immunotherapy or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving bisoprolol.
Iodine-containing radiopaque diagnostic agents for intravenous administration increase the risk of developing anaphylactic reactions.
Phenytoin when administered intravenously, drugs for inhalation general anesthesia (derivatives of hydrocarbons) increase the severity of the cardiodepressive effect and the likelihood of lowering blood pressure.
The effectiveness of insulin and oral hypoglycemic drugs may change during treatment with bisoprolol (masks the symptoms of developing hypoglycemia: tachycardia, increased blood pressure).
The clearance of lidocaine and xanthines (except for diphylline) may decrease due to a possible increase in their plasma concentration, especially in patients with initially increased clearance of theophylline under the influence of smoking.
Non-steroidal anti-inflammatory drugs, glucocorticosteroids and estrogens weaken the hypotensive effect of bisoprolol (Na + retention, blockade of prostaglandin synthesis by the kidneys).
Cardiac glycosides, methyldopa, reserpine and guanfacine, calcium channel blockers (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, atrioventricular block, cardiac arrest and heart failure. Nifedipine can lead to a significant decrease in blood pressure.
Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs can lead to an excessive decrease in blood pressure.
The action of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins during treatment with bisoprolol may be prolonged.
Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedatives and hypnotics increase CNS depression. Simultaneous use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. A break in treatment between taking MAO inhibitors and bisoprolol should be at least 14 days. Non-hydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders.
Ergotamine increases the risk of developing peripheral circulatory disorders; sulfasalazine increases the concentration of bisoprolol in the blood plasma; rifampicin shortens the half-life. special instructions
Do not stop treatment abruptly and do not change the recommended dosage without first consulting your doctor, as this can lead to a temporary deterioration in the activity of the heart. Treatment should not be interrupted suddenly, especially in patients with ischemic heart disease. If discontinuation of treatment is necessary, the dosage should be reduced gradually.
Monitoring the condition of patients taking Concor ® should include measuring heart rate and blood pressure (at the beginning of treatment - daily, then 1 time in 3-4 months), ECG, determination of blood glucose in patients diabetes(1 time in 4-5 months). In elderly patients, it is recommended to monitor kidney function (1 time in 4-5 months). The patient should be taught how to calculate heart rate and should be instructed to consult a doctor if the heart rate is less than 50 bpm.
Before starting treatment, it is recommended to conduct a study of the function of external respiration in patients with a burdened bronchopulmonary history.
Approximately 20% of patients with angina, beta-blockers are ineffective. The main causes are severe coronary atherosclerosis with a low ischemia threshold (heart rate less than 100 bpm) and an increased end-diastolic volume of the left ventricle, which impairs subendocardial blood flow.
In "smokers" the effectiveness of beta-blockers is lower.
Patients using contact lenses should take into account that during treatment, a decrease in the production of lacrimal fluid is possible.
When used in patients with pheochromocytoma, there is a risk of developing paradoxical arterial hypertension (if effective alpha-blockade has not been previously achieved).
In thyrotoxicosis, Concor ® may mask certain clinical signs of thyrotoxicosis (eg, tachycardia). Abrupt discontinuation of the drug in patients with thyrotoxicosis is contraindicated, as it can exacerbate symptoms. In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentration to normal levels.
While taking clonidine, its reception can be stopped only a few days after Concor ® is canceled.
It is possible to increase the severity of the hypersensitivity reaction and the lack of effect from the usual doses of epinephrine against the background of an aggravated allergic history. If it is necessary to carry out planned surgical treatment, the drug should be discontinued 48 hours before general anesthesia. If the patient took the drug before surgery, he should choose a drug for general anesthesia with a minimally negative inotropic effect.
Reciprocal activation of the vagus nerve can be eliminated by intravenous atropine (1-2 mg).
Drugs that reduce catecholamine stores (including reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect a pronounced 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 the drug is exceeded, there is a risk of developing bronchospasm.
If increasing bradycardia (heart rate less than 50 beats / min.), A pronounced decrease in blood pressure (systolic blood pressure below 100 mm Hg), atrioventricular blockade is detected in elderly patients, it is necessary to reduce the dose or stop treatment. It is recommended to stop therapy if depression develops.
You can not abruptly interrupt treatment because of the risk of developing severe arrhythmias and myocardial infarction. Cancellation of the drug is carried out gradually, reducing the dose for 2 weeks or more (reduce the dose by 25% in 3-4 days). It is necessary to cancel the drug before examining the content of catecholamines, normetanephrine and vanillinmandelic acid in the blood and urine; titers of antinuclear antibodies. Influence on the ability to drive a car and complex mechanisms
Bisoprolol does not affect the ability to drive a car in the study of patients suffering from diseases of the coronary vessels of the heart. 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 with the simultaneous use of alcohol. Release form
Film-coated tablets 2.5 mg.
10 tablets in PVC/Al blister.
3, 5 or 10 blisters, together with instructions for use, are placed in a cardboard box. Storage conditions
Store at a temperature not exceeding 25 °C. Keep out of the reach of children. Best before date
3 years. Do not use after the expiration date. Terms of dispensing from pharmacies
On prescription. Manufacturer
Merck KGaA, Germany Manufacturer's address:
Frankfurter Strasse 250 64293 Darmstadt, Germany
Frankfurterstrasse 250 64293 Darmstadt, Germany Presented in Russia and the CIS:
"Nycomed Austria GmbH", Austria: Claims of consumers should be sent to the address: 119048 Moscow, st. Usacheva, d. 2, building 1

It blocks β1-adrenergic receptors with high selectivity, shows low selectivity for adrenergic β2 receptors and does not carry out internal sympathomimetic activity.

As a result, cardiac output and peripheral vascular resistance decrease, renin activity decreases, and a decrease in blood pressure is achieved. In order to successfully control arterial hypertension, it is important to figure out how to take Concor correctly: before meals or after and how many times, can you drink it at night and how long can you take Concor without a break. You also need to understand how to treat them with comorbidities and how to stop drinking Concor if necessary to cancel it.

How to take Concor with high blood pressure?

In hypertension, the dosage of the drug should be gradually increased under the control of the level of blood pressure, the starting dose is 5 mg. Patients with diastolic pressure less than 105 mm Hg. Art. treatment begins with 2.5 mg.

If the target blood pressure indicator has not been reached, then the daily dosage of the drug is increased in steps of 1.25–2.5 mg and gradually increased to 10 mg. The dose may be increased, but Concor should not be taken more than 20 mg.

Patients often have questions related to the rational dosing of drugs and the correct regimen, especially if it is necessary to take Concor with several drugs at the same time.

The remedy is intended for long-term treatment, therefore, for proper treatment, you need to clearly understand how many times to drink the drug - 1 or 2 times a day, when to drink it: in the morning or in the evening, and whether Concor can be taken at night.

The patient needs to understand:

• how to link treatment with food intake;
• drink Concor before or after meals;
• how long does it take for the medicine to work?
• what is the duration of the therapeutic effect.

The instructions for use provide only one indication of how to take it according to the time of day: the drug is advised to be taken on an empty stomach in the morning or with meals, it does not indicate whether Concor can be drunk at night. There are no restrictions on the number of reception, as well as warnings about the evening reception.

1 or 2 times a day?

The answer to the questions of those who want to do things their own way, deviating from the recommendations, and wondering if it is possible to take Concor twice and at night, is simple: it is possible, but not necessary. There are several reasons why you need to follow the instructions:

• duration of action;
• change in the severity of the effect per day;
• the relationship between the amount of medication taken and errors in the dosing regimen.

The number of doses of the drug is determined by the duration of action. The half-life of bisoprolol is 10.5 hours, and it lasts more than a day, while the residual effect 24 hours after taking the drug is reduced by less than a third compared to the maximum effect during the day. Therefore, there is no need to take Concor several times. In addition, the ability to take the drug once and its relationship with food intake simplify treatment and increase patient adherence to the chosen regimen.

Foreign studies have established that with an increase in the frequency of administration, the number of people who violate the regimen of drug use increases. So, when prescribing tablets 2 times a day, every third violates the regimen, with three times the use of errors allows almost half of the patients, forgetting to take the medicine on time.

Incorrect fulfillment of prescriptions leads to a decrease in the effectiveness of treatment and may lengthen the time for selecting the required dose. Simplifying the treatment regimen improves prescription fulfillment. The option is considered optimal in terms of convenience when you need to take one dosage unit of the drug once in the morning, which is associated with a meal in time.

Whether it is possible to take Concor twice a day is determined only by the doctor who prescribes and controls the treatment, he also determines how long Concor can be taken. Patients should not make independent decisions about changing their treatment regimen.

When: morning or evening?

When analyzing the question of how to drink Concor correctly: when to take it (in the morning or in the evening), how best to drink and why - you will have to pay attention to the points of its influence and the features of the functioning of the body.

The effects of bisoprolol are provided by its ability to reversibly block β1-adrenergic receptors related to the sympathetic division of the autonomic nervous system. Under its influence, the stimulating effect of adrenaline on the heart and blood vessels decreases. Therefore, it matters at what time to take Concor.

The vegetative part of the nervous system is characterized by a daily cycle of activation and inhibition processes, which are reflected in the heart and blood vessels. During the day you can see:

• increased heart rate;
• increased vascular tone;
• increase in blood pressure.

At night, the opposite is true.

In the daytime, the sympathetic part of the autonomic system is activated and the activity of the parasympathetic is reduced, which is characterized by an increase in the frequency of heart contractions and an increase in blood pressure in awake people. In stressful situations and during physical exertion, under the influence of sympathoadrenal stimuli, the load on the heart increases, vasoconstriction occurs, and blood pressure rises even more and the heart rate increases.

During the period of nocturnal sleep, the energy reserves of the body are restored due to an increase in the influence of parasympathetic autonomics and a decrease in the activity of the sympathetic department of the nervous system. Wherein:

• cardiac activity slows down;
• the pulse slows down;
• vascular tone decreases and blood pressure decreases.

On average, during the day, blood pressure indicators during sleep and wakefulness in one person differ by 15 mm Hg. Art.

Average blood pressure by age

Can I take it in the evening (at night)?

Taking Concor in the evening creates the highest concentration of the drug during the period of natural decrease in the effects of the sympathoadrenal system and will not have the desired effect during the period of its increase, which will lead to insufficient control of hypertension with the same drug load on the liver and kidneys as with morning medication.

The creation of a high level of an adrenergic blocker with the activation of the parasympathetic autonomic system can increase the risk of adverse manifestations of the heart and blood vessels, which will not be timely diagnosed and eliminated during sleep.

For evening reception:

• the maximum effect of the drug occurs during the period of lowering blood pressure;
• during the period of maximum blood pressure, the effect is reduced;
• increases the risk of arrhythmias and other side effects at night.

Before meals or after?

You need to understand why the connection between the use of the drug and food is important and how to take Concor correctly - on an empty stomach or after a meal - in case of missing a dose of medication. The manufacturer recommends drinking the medicine before meals or with the first meal, advising to drink it with water.

But there are cases when the patient cannot eat after taking the medicine or forgets to take it before breakfast.

The ratio of medication to food is determined by:

• the degree of absorption of the drug;
• water and fat solubility;
• effect on the stomach and intestines.

For Concor, the first two factors are taken into account.

Bisopolol is characterized by high bioavailability: 90% of the drug enters the bloodstream and the presence of food does not change the degree of its absorption. But at the same time, different products have different times for splitting and staying in the stomach. Therefore, when the drug is taken with food, its absorption rate will slow down due to the fact that the amount of gastric and intestinal contents increases. Slowing the rate of drug entry into the blood will increase the time to maximum effect. When taking the medicine after a meal, its slow absorption is observed, therefore it is more correct to drink Concor before meals.

How long does it take to work?

Concor should be taken constantly, it creates a lasting effect that develops over several hours.

To understand how long Concor works, you need to know:

• concentration periods;
• food influence;
• the speed of development of the effect at the site of action.

The time to reach the highest concentration is 2.5-3.5 hours, the maximum hypotensive effect occurs 3-4 hours after taking Concor.

Can it be taken at low pressure?

Concor helps to normalize blood pressure in hypertension due to its hypotensive effect, and this is not the only advantage. In chronic heart failure, it is used not to lower blood pressure, but to reduce the load on the heart.

A decrease in vasospasm reduces peripheral resistance, while the same volume of blood is pumped with less heart energy and less pressure. The heart muscle itself does not receive blood during the contraction phase, since the heart vessels fill during diastole with a relaxed myocardium. With a decrease in the frequency of contractions, the duration of diastole increases and the heart itself receives more nutrients and oxygen while slowing down.

Heart failure (HF) can also occur with normal and low blood pressure. Since the drug has a clinically significant hypotensive effect, patients with heart failure need to clearly know whether Concor can be taken at low pressure.

The degree of decrease in blood pressure can be different, the lowest level is indicated as. Hypotension is defined as a condition in which the systolic blood pressure is less than or equal to 90 mm Hg. Art. Acute hypotension is a condition accompanied by a sharp decrease in blood pressure by 20% or more compared to baseline. In acute cases, the use of Concor and other pressure-reducing agents is contraindicated.

Concor is contraindicated in symptomatic arterial hypotension, that is, with a constant level of systolic blood pressure less than 90 mm Hg. Art. or a frequent decrease to such values ​​in the presence of clinical manifestations: dizziness, weakness, collaptoid states.

In cases where there are no contraindications and there are conditions requiring the use of Concor, then it can and should be used when prescribed by the attending physician. Including - and in patients with low blood pressure.

With low pressure, you need to take Concor:

• in reduced dosages;
• with a slow increase in dose;
• under close medical supervision.

Therefore, it is desirable to carry out such treatment with Concor in medical institutions.

How to take with low blood pressure?

There are several features in how to take Concor with low blood pressure. The drug is prescribed in reduced doses, they are gradually titrated. The starting dosage is 1.25 mg, every week the dose is increased by the same amount of medication.

Such a selection of treatment is carried out by an experienced physician who already has experience in choosing a bisoprolol therapy regimen.

Possible dosing regimen:

• 7 days - 1.25 mg;
• 8-14 days - 2.5 mg;
• further - 3.75 mg.

When taking Concor by patients with low blood pressure, careful monitoring of blood pressure and pulse is mandatory.

Special instructions for treatment

Care must be taken in patients with:

• bronchial asthma;
• anaphylaxis;
• diabetes;
• obliterating or endarteritis;
• atrioventricular blockade of the 1st degree.

Anesthesia may require discontinuation of the drug a few days before the operation, so it is imperative to inform the anesthetist about taking Concor.

During treatment, it is necessary to gradually increase the dose, up to the need for its titration. You can not abruptly stop taking the medicine, the abolition of Concor should be gradual.

Interaction with other drugs

Most antihypertensive drugs potentiate the hypotensive effect when used together, the strength of the combination can significantly exceed their effect alone and cause severe acute hypotension.

Concor should not be combined with clonidine, as well as with other drugs with a central action. The hypotension caused by them can cause acute heart failure.

The combined use of Concor with antiarrhythmic drugs enhances their negative effect on the conduction of excitation in the heart muscle and can cause bradycardia and reduce the strength of muscle contractions of the heart. Concor should not be taken if used:

• Lidocaine;
• Verapamil;

The interaction of Concor with other drugs requires increased attention when used with many drugs: and other antiarrhythmic drugs, anesthetics, adrenergic blockers for local use, cardiac glycosides.

Non-steroidal anti-inflammatory drugs can weaken the hypotensive effect of bisoprolol, so you should not take Concor with diclofenac, nimesulide or ibuprofen - this may be accompanied by an increase in blood pressure.

You can take Concor while using herbal sedatives and antihypertensives.

How long can the drug be treated?

The product is intended for long-term treatment. When determining how much Concor can be taken for hypertension, the following is taken into account:

• effectiveness of hypertension control;
• change in heart rate;
• other actions of the drug.

With good tolerance and adequate pressure control, Concor can be taken for as long as required, sometimes for life. In heart failure, Concor is prescribed in the form of courses, in these cases, the duration of Concor's administration will be several weeks or months.

How to cancel correctly?

Bisoprolol has a cumulative effect and abrupt discontinuation of Concor can cause a withdrawal syndrome in the form of an exacerbation of the disease and an increase in pathological manifestations: increased pressure, aggravation of heart failure.

You need to know how to stop drinking Concor correctly, without causing a worsening of the course of the disease. Before canceling Concor, the specialist explains to the patient the importance of gradually giving up the medicine so that the cancellation does not coincide with the moment when it simply ended and the patient decides not to buy it anymore.

Concor stop taking gradually with a number of precautions:

• its dose is gradually reduced - it can be halved in a week, you can completely stop taking Concor when it is reduced to 2.5 mg per day or a quarter of the main dose;
• in the process of dose reduction and withdrawal, regular monitoring of blood pressure and pulse is necessary;
• in diabetes, control glucose levels.

Is it possible to take with arrhythmia of the heart?

Some patients need to know if Concor can be taken for cardiac arrhythmias. Concor can only be taken for certain types. It slows down the passage of nerve impulses in the sympathetic nerves, slowing down the heart rate - it is not used in case of impaired conduction and automatism.

It is contraindicated in the following arrhythmias:

• atrioventricular blockade II - III degree;
• sick sinus syndrome;
• sinoatrial block;
• bradycardia with clinical symptoms.

It is used for other types, such as: tachyarrhythmias, extrasystoles, as well as in patients with an installed pacemaker.

Can Concor be treated with insulin resistance?

The drug can be used in people with concomitant diabetes of all types, therefore it is possible to take Concor with insulin resistance. It is necessary to take into account such points:

• bisoprolol increases the hypoglycemic effect of hypoglycemic drugs and insulin;
• it is possible to lubricate the manifestations of hypoglycemia by slowing down the work of the heart.

When treating patients with diabetes, carefully monitor blood glucose levels.

Useful video

For more information about Concor tablets, see this video:

Conclusion

1. Reliable pressure control, ease of dosing and a relatively small number of restrictions in use have ensured frequent recommendations to take Concor.
2. The high selectivity of the action of bisoprolol on adrenoreceptors allows it to be taken by patients who are contraindicated in others.
3. However, there are a number of warnings and features that need to be taken into account and taken Concor, adhering to the recommendations for its use.

And bisoprolol fumarate in a ratio of 2:1 as active ingredients.

Excipients: calcium hydrophosphate, corn starch, colloidal silicon dioxide, microcrystalline cellulose, crospovidone, magnesium stearate.

Shell composition: hypromellose , , iron oxide yellow, macrogol 400 , titanium dioxide .

Release form

Concor tablets are coated with a light orange shell, heart-shaped, biconvex, with serifs on both edges.

Release forms for Concor (dosage 5 and 10 mg):

• ten such tablets in a blister, five or three such blisters in a carton;
• or 25 such tablets in a blister, two such blisters in a carton;
• or 30 such tablets in a blister, one such blister in a carton.

For Concor 10 mg, there is an additional form of release:

• 30 tablets in a blister, three of these blisters in a carton.

pharmachologic effect

Concor is a medicine that has antiarrhythmic, hypotensive, antianginal action.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

The medical preparation Concor is selective beta-1-blocker without sympathomimetic action. This honey drug also does not have a membrane-stabilizing effect.

The use of the drug Concor does not affect the condition of the respiratory tract and metabolic processes in which beta-2-adrenergic receptors .

INN (international non-proprietary name) drugs: "bisoprolol".

It does not have a strong negative inotropic effect. Lowers tone sympathoadrenal system , suppresses beta-1-adrenergic receptors hearts.

With a single dose in patients with no chronic heart failure bisoprolol reduces the number of heartbeats, stroke volume of the heart, ejection fraction and myocardial oxygen demand. With long-term therapy, increased total peripheral vascular resistance decreases.

The maximum effect occurs three hours after administration. When appointed bisoprolol once a day, its effect lasts 24 hours. The maximum decrease in pressure is recorded 12-14 days after the start of therapy.

Pharmacokinetics

bisoprolol absorbed from the intestine by 90%. Bioavailability - 90%. Food intake does not affect bioavailability. Concentrations bisoprolol in plasma are proportional to accepted doses in the range of 5-20 mg. The highest concentration in the blood occurs 3 hours.

Plasma protein binding approaches 30%. All derivatives are excreted by the kidneys and are not pharmacologically active. The half-life is 11-12 hours.

Indications for use Concor

Indications for the use of the drug:

• chronic heart failure ;
• cardiac ischemia ;

Contraindications

Contraindications to the use of Concor:

• acute form heart failure;
• decompensated chronic heart failure;
• AV block 2-3 degrees;
• cardiogenic shock;
• sinoatrial blockade;
• bradycardia;
• a pronounced decrease in pressure;
• and COPD;
• metabolic acidosis;
• heavy changes peripheral arterial circulation;
• pheochromocytoma;
• age less than 18 years;
• to the components of the drug.

Side effects of Concor

Reviews of side effects are not uncommon, most often reporting a slow heartbeat, hypotension, nausea, and a deterioration in well-being.

• From the circulatory system: bradycardia , worsening , numbness of the extremities, a strong decrease in pressure, orthostatic hypotension .
• From the nervous system and psyche: dizziness, loss of consciousness, headache, nightmares.
• From the respiratory system: an attack.
• From the musculoskeletal system: convulsions , muscle weakness.
• From the senses: hearing loss,.
• From the digestive system: nausea, vomiting, increased levels AST and ALT in blood.
• From the genitourinary system: potency disorders.
• From the side of the skin: .
• Allergic reactions: itching, rash, redness of the skin,.

Instructions for use Concor (Method and dosage)

The instruction on Concor tablets prescribes to take the drug orally, once a day, in the morning. Instructions for use of the drug also indicate that it should be washed down with a small amount of water, without chewing.

How to take Concor for arterial hypertension and angina pectoris

The dose of pressure medication Concor is selected individually, taking into account the clinic of the disease and the patient's condition. The initial dose is 5 mg once a day. If necessary, it is increased by 5 mg once a day. During therapy and the highest recommended dose is 20 mg per day.

In chronic course heart failure the usual regimen of therapy includes the use ACE inhibitors or angiotensin blockers, diuretics, beta-blockers and cardiac glycosides.

A prerequisite for drug therapy is a stable chronic course. heart failure without exacerbations. The maximum recommended dose for the treatment of this pathology is 10 mg once a day.

At the moment, there is not enough data on the use of the drug in children, from which Concor tablets are not recommended for children under 18 years of age.

How long can the drug be taken

The abstract does not limit the duration of the drug. Authoritative Internet resources, such as Wikipedia, also do not give clear instructions on this issue, reporting only that the course of treatment is long-term and is determined by the attending physician.

There is insufficient data on the use of the drug in patients with chronic heart failure complicated by of the first type, severe lesions of the liver and kidneys, or congenital heart defects with severe hemodynamic disorders, from which the drug Concor in this category of patients should be prescribed with caution.

Overdose

Overdose symptoms: bradycardia , strong pressure drop, AV block, bronchospasm, hypoglycemia and acute heart failure.

Treatment: stop taking the medicine, start symptomatic therapy.

At bradycardia intravenous administration is indicated. With a strong decrease in pressure - intravenous administration vasopressor drugs and plasma-substituting solutions .

With an exacerbation chronic heart failure - introduction diuretics and vasodilators .

At AV block - appointment beta-agonists , if necessary - the installation of an artificial pacemaker.

At hypoglycemia - administration of glucose solution.

Interaction

Antiarrhythmic drugs first class when combined with bisoprolol can reduce the conduction and contractility of the heart.

Antihypertensive drugs taken from bisoprolol may cause bradycardia , decreased cardiac output and vasodilation .

Combinations requiring caution

Antiarrhythmic drugs 3 classes (amiodarone) and parasympathomimetics exacerbate AV conduction disturbances.

β-blockers topical application activate systemic effects bisoprolol .

Action hypoglycemic agents enhanced when used with bisoprolol .

cardiac glycosides when used together with bisoprolol lead to the development bradycardia.

Non-steroidal anti-inflammatory drugs reduce the hypotensive effect bisoprolol.

Application bisoprolol With non-selective adrenomimetics reinforces vasoconstrictor effects these funds, leading to an increase in pressure.

Mefloquine when used with bisoprolol can increase development bradycardia.

MAO inhibitors amplify hypotensive effect of beta-blockers.

Terms of sale

Released by prescription.

Storage conditions

Keep away from children. Store at temperatures up to 30 °C.

Best before date

Five years.

special instructions

Use with caution in the following cases:

• with symptoms hypoglycemia ;
• conducting desensitizing treatment;
• Prinzmetal's angina ;
• strict diet;
• mild or moderate impairment of peripheral circulation from the arteries;
• AV block first degree;

Concor's analogs

Coincidence in the ATX code of the 4th level:

Due to the relatively high price of the drug, patients often have a question: how to replace Concor. Bicard, Bisocard, Bisoprolol Sandoz, Bisoprolol-Apotex, Bisoprolol-Maxpharma, Bisoprolol-Richter, Bisoprofar, Bisostad,- this is just a small list of what Concor can replace.

There is also a Russian analogue of Concor - the drug Biprol . The medicine and its analogues are in different price categories; the price of analogs, as a rule, is lower. For example, the aforementioned Concor substitute Biprol 5 mg No. 28 will cost 133-145 rubles, which is almost three times cheaper than the drug from Merck of the same dosage.

children

With alcohol

The compatibility of Concor and alcohol is a frequent topic of discussion for patients taking this remedy. Alcohol is not compatible with any adrenoblockers due to the risk of orthostatic hypotension.

During pregnancy and lactation

Reviews about Concore

Reviews of doctors about pills for pressure Concor as a whole fit into the average picture of reports of beta-blockers. The drug has its advantages and disadvantages.

The forums also contain ample evaluations of the drug's effectiveness. The most frequently asked question: do Concor tablets lower blood pressure? It should be remembered that the effectiveness is highly dependent on the individual characteristics of each individual patient.

Nebilet or Concor - which is better?

Both drugs belong to the group of beta-blockers. from a theoretical point of view, it has a stronger vasodilating effect and more often causes undesirable effects (headaches) due to excessive vasodilating action. In this case, the drug of choice is Concor.

Egilok or Concor - which is better?

Similar in almost all respects means. One drug can be easily replaced during treatment with another. 5 mg of Concor is equivalent to 50 mg .

Lokren or Concor - which is better?

Compared to Concor, it has a more prolonged effect, greater affinity for specific receptors and, therefore, the most stable plasma concentration. Medicine prices are comparable.

Coronal or Concor - which is better?

These funds are interchangeable analogues with the same active ingredient. more affordable from a financial point of view, so the choice between drugs should be made based on considerations of economic feasibility and the individual characteristics of the patient.

Bisoprolol or Concor - which is better?

The answer to this question is identical to the previous answer. These drugs are analogues, but bisoprolol has a lower price.

What is the difference between Concor Cor and Concor?

The most common question of the comparative effectiveness of drugs: how does Concor differ from Concor Core ? Both drugs contain as an active ingredient bisoprolol . The main difference between the drugs in the presence of tablets with a dosage of 2.5 mg in Concor Cor.

Concor price, where to buy

In Russia, the price of Concor 5 mg No. 50 ranges from 306-340 rubles, buying 50 tablets of 10 mg will cost 463-575 rubles. The cost of the medicine (5 mg No. 50) in Moscow starts from 313 rubles.

The price of Concor tablets in Ukraine 10 mg No. 50 averages 162 hryvnia.

• Internet pharmacies in Russia Russia
• Internet pharmacies in Ukraine Ukraine
• Internet pharmacies of Kazakhstan Kazakhstan

ZdravCity

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Concor am tab. 10mg+10mg n30CJSC Pharm.zavod EGIS

Concor am tab. 10mg+5mg n30CJSC Pharm.zavod EGIS

Concor cor tab. p/o captivity 2.5mg №30Merck KGaA/LLC Nanolek

Concor tab. p / o captivity. 5mg #50Merck KGaA/LLC Nanolek

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Concor AM (0.01 + 0.005 No. 30 tab.)

Concor AM (tab. 5mg + 5mg No. 30)

Concor (tab. 10mg №30)

Concor Core

Concor (tab. 5mg №30)

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Concor core 2.5 mg n30 tablMerck KGaA/LLC "Nanolek"

Concor 10 mg n30 tablMerck Sante s.a.s./Nanolek OOO

In this article, you can read the instructions for using the drug Concor. Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Concor in their practice are presented. A big request to actively add your reviews about the drug: did the medicine help or not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Analogues of Concor in the presence of existing structural analogues. Use for the treatment of high blood pressure, coronary artery disease, stable angina and heart failure in adults, as well as during pregnancy and lactation. Side effects and alcohol consumption with medication.

Concor- selective beta1-blocker, without its own sympathomimetic activity, does not have a membrane stabilizing effect.

It has only a slight affinity for beta2-adrenergic receptors of the smooth muscles of the bronchi and blood vessels, as well as for beta2-adrenergic receptors involved in the regulation of metabolism. Therefore, bisoprolol (the active substance of the drug Concor) generally does not affect the resistance of the respiratory tract and metabolic processes in which beta2-adrenergic receptors are involved.

The selective effect of the drug on beta1-adrenergic receptors persists beyond the therapeutic range.

Bisoprolol does not have a pronounced negative inotropic effect.

Bisoprolol reduces the activity of the sympathoadrenal system by blocking the beta1-adrenergic receptors of the heart.

With a single oral administration in patients with coronary artery disease without signs of chronic heart failure, bisoprolol reduces heart rate, reduces the stroke volume of the heart and, as a result, reduces the ejection fraction and myocardial oxygen demand. With long-term therapy, the initially elevated OPSS decreases. A decrease in plasma renin activity is considered as one of the components of the hypotensive action of beta-blockers.

The maximum effect of the drug is achieved 3-4 hours after ingestion. Even with the appointment of bisoprolol 1 time per day, its therapeutic effect persists for 24 hours due to the fact that its T1 / 2 from blood plasma is 10-12 hours. As a rule, the maximum reduction in blood pressure is achieved 2 weeks after the start of treatment.

Pharmacokinetics

After oral administration, Concor is almost completely (> 90%) absorbed from the gastrointestinal tract. Eating does not affect bioavailability. The clearance of bisoprolol is determined by the balance between excretion by the kidneys unchanged (about 50%) and metabolism in the liver (about 50%) to metabolites, which are also excreted by the kidneys.

Indications

• arterial hypertension;
• IHD: stable angina;
• chronic heart failure.

Release forms

Film-coated tablets 5 mg and 10 mg.

Coated tablets 2.5 mg (Concor Cor).

Instructions for use and dosage

The drug is taken orally 1 time per day. The tablets should be taken with a small amount of liquid in the morning before, during or after breakfast. Tablets should not be chewed or crushed into powder.

Arterial hypertension and angina pectoris

The dose is selected individually, primarily taking into account the heart rate and the patient's condition.

As a rule, the initial dose is 5 mg 1 time per day. If necessary, the dose can be increased to 10 mg 1 time per day. In the treatment of arterial hypertension and angina pectoris, the maximum recommended dose is 20 mg 1 time per day.

Chronic heart failure

The standard regimen for the treatment of chronic heart failure includes the use of ACE inhibitors or angiotensin 2 receptor antagonists (in case of intolerance to ACE inhibitors), beta-blockers, diuretics and, optionally, cardiac glycosides. At the beginning of the treatment of chronic heart failure with Concor, a special titration phase is required under regular medical supervision.

A prerequisite for treatment with Concor is stable chronic heart failure without signs of exacerbation.

Treatment with Concor begins in accordance with the following titration scheme. This may require individual adaptation depending on how well the patient tolerates the prescribed dose, i.e. the dose can be increased only if the previous dose was well tolerated.

To ensure an appropriate titration process at the initial stages of treatment, it is recommended to use bisoprolol in dosage form tablets of 2.5 mg.

The recommended initial dose is 1.25 mg 1 time per day. Depending on individual tolerance, the dose should be gradually increased to 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg 1 time per day. Each subsequent increase in dose should be carried out at least 2 weeks later. If an increase in the dose of the drug is poorly tolerated by the patient, then a dose reduction is possible.

During titration, regular monitoring of blood pressure, heart rate and the severity of symptoms of chronic heart failure is recommended. The aggravation of the symptoms of the course of chronic heart failure is possible from the first day of using the drug.

If the patient does not tolerate the maximum recommended dose of the drug, then a gradual dose reduction should be considered.

During the titration phase or after it, a temporary worsening of the course of chronic heart failure, arterial hypotension or bradycardia is possible. In this case, it is recommended, first of all, to adjust the doses of concomitant therapy drugs. You may also need to temporarily reduce the dose of the drug Concor or cancel it. After stabilization of the patient's condition, the dose should be re-titrated, or treatment should be continued.

Duration of treatment for all indications

Treatment with Concor is usually long-term.

Elderly patients do not require dose adjustment.

Because there is not enough data on the use of the drug Concor in children, it is not recommended to prescribe the drug to children under 18 years of age.

To date, there is insufficient data on the use of Concor in patients with chronic heart failure in combination with type 1 diabetes mellitus, severe renal and / or liver dysfunction, restrictive cardiomyopathy, congenital heart disease or valvular heart disease with severe hemodynamic disorders. Also, until now, sufficient data have not been obtained regarding patients with chronic heart failure with myocardial infarction during the last 3 months.

Side effect

• bradycardia (in patients with chronic heart failure);
• aggravation of symptoms of chronic heart failure (in patients with chronic heart failure);
• sensation of coldness or numbness in the extremities;
• a pronounced decrease in blood pressure (especially in patients with chronic heart failure);
• orthostatic hypotension;
• dizziness;
• headache;
• loss of consciousness;
• depression;
• insomnia;
• hallucinations;
• decreased tearing (should be taken into account when wearing contact lenses);
• hearing impairment;
• conjunctivitis;
• bronchospasm in patients with bronchial asthma or a history of obstructive airways disease;
• nausea, vomiting;
• diarrhea, constipation;
• muscle weakness;
• muscle cramps;
• potency disorders;
• skin itching;
• rash;
• hyperemia of the skin;
• allergic rhinitis;
• asthenia (in patients with chronic heart failure);
• increased fatigue.

Contraindications

• acute heart failure;
• chronic heart failure in the stage of decompensation, requiring therapy with drugs with a positive inotropic effect;
• cardiogenic shock;
• AV blockade 2 and 3 degrees, without a pacemaker;
• SSSU;
• sinoatrial blockade;
• severe bradycardia (HR< 60 уд./мин.);
• pronounced decrease in blood pressure (systolic blood pressure<100 ммрт.ст.);
• severe forms of bronchial asthma and COPD in history;
• severe disorders of the peripheral arterial circulation, Raynaud's disease;
• pheochromocytoma (without the simultaneous use of alpha-blockers);
• metabolic acidosis;
• age up to 18 years (not enough data on efficacy and safety);
• hypersensitivity to the components of the drug.

Use during pregnancy and lactation

The use of Concor during pregnancy is possible only if the intended 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 carefully monitored, as well as the growth and development of the unborn child should be monitored, and in case of adverse manifestations in relation to pregnancy or the fetus, alternative therapeutic measures should be taken. The newborn should be carefully examined after delivery. In the first 3 days of life, symptoms of bradycardia and hypoglycemia may occur.

There are no data on the excretion of bisoprolol in breast milk. Taking the drug Concor is not recommended for women during lactation. If necessary, the use of the drug during lactation, breastfeeding should be discontinued.

special instructions

The patient should not abruptly stop treatment and change the recommended dose without first consulting a doctor, as this may lead to a temporary deterioration in the activity of the heart. Treatment should not be interrupted suddenly, especially in patients with CAD. If discontinuation of treatment is necessary, the dose should be reduced gradually.

Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol (alcohol), sedatives and hypnotics increase CNS depression.

At the initial stage of treatment with Concor, patients require constant medical supervision.

The drug should be used with caution in diabetes mellitus with significant fluctuations in blood glucose concentration (symptoms of severe hypoglycemia, such as tachycardia, palpitations or excessive sweating may be masked), in patients on a strict diet, during desensitizing therapy, AV blockade of the 1st degree , Prinzmetal's angina, mild to moderate peripheral arterial circulation disorders (at the beginning of therapy, there may be an increase in symptoms), with psoriasis (including history).

Respiratory system: in bronchial asthma or COPD, the simultaneous use of bronchodilators is indicated. In patients with bronchial asthma, an increase in airway resistance is possible, which requires a higher dose of beta2-agonists.

Allergic reactions: beta-blockers, including Concor, may increase the sensitivity to allergens and the severity of anaphylactic reactions due to the weakening of adrenergic compensatory regulation under the action of beta-blockers. Therapy with epinephrine (adrenaline) does not always give the expected therapeutic effect.

When conducting general anesthesia, the risk of blockade of beta-adrenergic receptors should be taken into account. If it is necessary to stop therapy with Concor before surgery, this should be done gradually and completed 48 hours before general anesthesia. The anesthesiologist should be warned that the patient is taking Concor.

In patients with pheochromocytoma, Concor can only be prescribed against the background of the use of alpha-blockers.

During treatment with Concor, the symptoms of hyperthyroidism may be masked.

Influence on the ability to drive vehicles and control mechanisms

Concor does not affect the ability to drive vehicles according to the results of a study in 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 with the simultaneous use of alcohol.

drug interaction

The effectiveness and tolerability of bisoprolol may be affected by the simultaneous use of other drugs. This interaction can also occur when two drugs are taken after a short period of time. The doctor must be informed about the use of other drugs, even if the use is carried out without a prescription.

Treatment of chronic heart failure

Class 1 antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and cardiac contractility.

Blockers of slow calcium channels 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 blockade. Centrally acting antihypertensives (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and a decrease in cardiac output, as well as to vasodilation due to a decrease in central sympathetic tone. Abrupt withdrawal, especially before the withdrawal of beta-blockers, may increase the risk of developing "rebound" arterial hypertension.

Combinations requiring special care

Treatment of arterial hypertension and angina pectoris

Class 1 antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and myocardial contractility.

All indications for the use of the drug Concor

Blockers of slow calcium channels, dihydropyridine derivatives (for example, nifedipine, felodipine, amlodipine), when used simultaneously with bisoprolol, may increase the risk of arterial hypotension. In patients with chronic heart failure, the risk of a subsequent deterioration in the contractile function of the heart cannot be excluded.

Class 3 antiarrhythmic drugs (for example, amiodarone), when used simultaneously with Concor, may increase AV conduction disturbance.

The action of topical beta-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 increase the disturbance of AV conduction and increase the risk of developing bradycardia.

With simultaneous use with the drug Concor, it is possible to increase the hypoglycemic effect of insulin or hypoglycemic agents for oral administration. Symptoms of hypoglycemia, in particular tachycardia, may be masked or suppressed. Such an interaction is more likely with the use of non-selective beta-blockers.

General anesthetics can increase the risk of cardiodepressive effects, leading to arterial hypotension.

Cardiac glycosides, when used simultaneously with bisoprolol, can lead to an increase in impulse conduction time, and thus to the development of bradycardia.

Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the hypotensive effect of Concor.

Simultaneous use of the drug Concor with beta-agonists (for example, isoprenaline, dobutamine) may lead to a decrease in the effect of both drugs.

The combination of bisoprolol with adrenomimetics that affect alpha and beta adrenoreceptors (for example, norepinephrine, epinephrine) can enhance the vasoconstrictor effects of these drugs, due to the action on alpha adrenoreceptors, leading to an increase in blood pressure. Such an interaction is more likely with the use of non-selective beta-blockers.

Antihypertensive agents, as well as other agents with a possible antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines) can enhance the hypotensive effect of bisoprolol.

Mefloquine, when used simultaneously with bisoprolol, can increase the risk of developing bradycardia.

MAO inhibitors (with the exception of MAO B inhibitors) may enhance the hypotensive effect of beta-blockers. Simultaneous use can also lead to the development of a hypertensive crisis.

Analogues of the drug Concor

Structural analogues for the active substance:

• Aritel;
• Aritel Core;
• Bidop;
• Biol;
• Biprol;
• Bisogamma;
• Bisocard;
• Bisomore;
• bisoprolol;
• Bisoprolol-Lugal;
• Bisoprolol-Prana;
• Bisoprolol-ratiopharm;
• Bisoprolol-Teva;
• bisoprolol hemifumarate;
• bisoprolol fumarate;
• Concor Core;
• Corbis;
• Cordinorm;
• Coronal;
• Niperten;
• Tirez.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases that the corresponding drug helps with and see the available analogues for the therapeutic effect.

Concor is a fairly effective medicine belonging to the group of beta-blockers. It is available as a heart-shaped film-coated tablet with a pale yellow tint.

They are biconvex, have a double-sided notch for easy dosing. The active component of the product is bisoprolol fumarate.

Tablets are produced with a dosage of the active substance 5, 10 mg. The composition of the drug includes additional components: silicon dioxide, MCC (microcrystalline cellulose), calcium hydrogen phosphate, magnesium stearate, corn starch, crospovidone.

The shell consists of dimethicone, hypromellose, dye, titanium dioxide, macrogol. The drug goes on sale in packs of 10 - 30 pieces. How to take Concor correctly will be described in detail in the article.

• 1 How to use
• 2 Dosage of the drug
  • 2.1 Arterial hypertension and angina pectoris
  • 2.2 Chronic heart failure
• 3 Duration of treatment
• 4 Special instructions
• 5 Overdose
• 6 Side effects
• 7 Pregnancy and breastfeeding
• 8 Interactions with other drugs
• 9 Useful video

Mode of application

Patients are often interested in when it is better to take Concor in the morning or in the evening, whether it is possible to drink it in the evening and at night. Doctors strongly advise to use the remedy in the morning.

Tablets Concor

To the question of how to take Concor before or after meals, any cardiologist or therapist will definitely answer: before or during a meal. The tablet is swallowed whole, washed down with water

Dosage of the drug

The amount and method of using this drug directly depends on the pathology that the patient has.

Arterial hypertension and angina pectoris

About how to drink Concor with hypertension, only a doctor can reliably tell during an examination, consultation.

Usually, the doctor prescribes the dose individually, guided by data on the pulse, severity of symptoms, and the patient's condition.

Often start with 5 mg once a day.

Sometimes with a mild course, half a tablet is enough for patients. In more severe conditions, the dosage is doubled (10 mg once a day). A further increase in the daily use of the drug is permissible in exceptional cases at the discretion of the physician. The maximum dose is 20 mg.

Corrects the scheme of how to take Concor with high blood pressure, doctor, based on the resulting therapeutic effect, heart rate.

Chronic heart failure

Traditionally, the therapy for this diagnosis includes beta-blockers, diuretics, ACE inhibitors. At the beginning of treatment with Bisoprolol, a special titration stage is carried out under the close supervision of a specialist. A prerequisite for making a decision on inclusion in the Concor scheme is CHF without exacerbation.

To ensure that the patient passes the titration phase correctly, the initial dosage of the drug is 1.25 mg.

Every two weeks, subject to normal tolerance, the amount of the drug is increased according to the following principle: 2.5 mg, 3.75 mg, 5 mg, 7.5 mg, 10 mg. If during the next increase in the dose the patient feels a significant deterioration, the daily intake of the drug is reduced or the condition is corrected with the help of other means included in the therapy regimen.

Cases of weakly expressed negative dynamics during this phase are quite frequent. After the body adapts to the drug, unpleasant symptoms disappear, but during titration, monitoring of pressure, pulse, and well-being should be daily.

Duration of treatment

Concor is designed for long-term use. In some cases, doctors prescribe a life-long use of this medication to reduce the severity of the manifestations of diseases, stabilize the condition, and maintain a comfortable level of pressure.

special instructions

Therapy with the drug must not be abruptly interrupted, especially for people with coronary artery disease. If you need to stop taking this medication, you should “leave” it slowly, gradually reducing the dosage used. It is also impossible to change the scheme prescribed by the doctor on your own, because this can worsen the functioning of the heart.

The first months of admission should be under medical supervision. Particularly carefully, this remedy is prescribed for the following comorbidities:

• diabetes with a wide range of fluctuations in plasma sugar levels with the likelihood of masking the symptoms of hypoglycemia;
• Prinzmetal's angina;
• bronchospasm;
• bronchial asthma;
• the period of desensitizing treatment;
• psoriasis;
• AV blockade of the first degree;
• strict diet;
• weakly, moderately expressed pathological changes in the peripheral circulation;
• anesthesia.

It should be noted that in patients with asthma, COPD, bronchodilators should be used in parallel with bisoprolol therapy. The drug reduces the risk of arrhythmias, myocardial ischemia during general anesthesia, so it cannot be canceled before surgery.

At the same time, it is imperative to inform the resuscitator several days in advance about taking the drug, so that the doctor correctly selects the drugs for anesthesia and excludes the possibility of unwanted interactions that provoke blockade of beta-adrenergic receptors, bradycardia, asystole.

All beta-blockers have the ability to increase sensitivity to substances that provoke allergic reactions, worsen anaphylaxis.

Concor can mask the clinic of hypothyroidism. With pheochromocytoma, it is used exclusively in a duet with alpha-blockers.

In most cases, the drug does not have any effect on the control of the machine, mechanisms. However, there have been isolated cases of violations of these tasks due to individual reactions of the body.

Overdose

• a sharp decrease in pressure;
• AV block;
• spasm in the bronchi;
• hypoglycemia;
• bradycardia.

When registering the above symptoms, you should immediately stop the use of this remedy, consult a doctor on an emergency basis. With severe bradycardia, Atropine is administered parenterally.

With a sharp drop in pressure, vasopressors, plasma-substituting media are given. Exacerbation of CHF justifies the need for injections of diuretics, vasodilators. For hypoglycemia, glucose is given by vein. AV block is treated with epinephrine.

Side effects

Undesirable effects from taking the drug vary in occurrence. So, the most common side effects include the following:

• nausea (with CHF);
• dizziness;
• high fatigue;
• headache;
• bradycardia (with CHF);
• exacerbation of CHF symptoms;
• diarrhea;
• severe hypotension;
• asthenia;
• vomit;
• constipation;
• paresthesia.

Infrequently occurring phenomena:

• asthenia (with GB);
• insomnia;
• depression;
• bradycardia (with hypertension);
• hypotension;
• conduction disorder;
• bronchospasm in BA;
• muscle weakness;
• convulsions.

Rarely in the control groups, the following symptoms were recorded:

• loss of consciousness;
• nightmares;
• hallucinations;
• decrease in tear fluid;
• hearing impairment;
• hepatitis;
• allergic rhinitis;
• potency disorders;
• skin reactions;
• increase in ALT, AST.

The following phenomena are extremely rare:

• conjunctivitis;
• alopecia.

Pregnancy and breastfeeding

This remedy is prescribed to pregnant women only in case of a significant excess of benefits for the mother over the possible risks for the child.

Concor, like all beta-blockers, reduces fetoplacental blood flow, which can slow down, disrupt the development of the embryo in the uterus.

That is why a woman using this medicine should be under the supervision of doctors. In the first days, the baby is carefully examined. This is necessary to exclude malformations, violations in the functioning of systems. The child may experience hypoglycemia, low heart rate for the first day.

The excretion of bisoprolol with milk, its effect on the baby has not been reliably studied. It is not recommended to use the medicine while breastfeeding. If it is not possible to avoid taking the substance, the child must be transferred to the mixture without fail.

Interaction with other drugs

There are combinations that should not be used in CHF. So, first-class antiarrhythmic drugs (Lidocaine, Propafenone, Disopyramide and others) can increase the severity of the inotropic effect.

Verapamil, Diltiazem in combination with the agent under discussion have a bad effect on the ability of the heart muscle to contract, and can induce atrioventricular blockade.

Centrally acting anti-pressure drugs (Rilmenidine, Methyldopa) may worsen CHF symptoms. Possible decrease in heart rate, vasodilation, decreased ejection.

With IHD, AH, Lidocaine, Disopyramide, Phenytoin and other first-class antiarrhythmics should be used with extreme caution. Dihydropyridine can induce a sharp decrease in pressure. Amiodarone and other drugs in this group increase the negative effect on atrioventricular conduction.

Glaucoma drops, if they contain beta-adrenergic blockers, can lead to a doubling of the overall effect of the active ingredient of Concor.

Strengthen the hypoglycemic effect can tablets used in diabetes, insulin. Anesthetics increase the risk of cardiac muscle depression. All parasympathomimetics increase the risk of bradycardia.

When this drug is combined with barbiturates, tricyclic antidepressants, the risk of hypertension increases significantly. Dobutamine and other beta-sympathomimetics, when used simultaneously with Bisoprolol, mutually reduce their therapeutic effects. NSAIDs reduce the drug's ability to lower blood pressure.

It is known that MAO inhibitors increase the hypotensive effect of the drug, Mefloquine increases the risk of bradycardia, and the simultaneous use of beta-adrenergic blockers can be fraught with a hypertensive crisis.

Useful video

When should I take Concor? How long does the drug take to work? All about the correct reception of Concor in the video:

In conclusion, it should be said that Concor has established itself as a fairly reliable, effective antihypertensive drug. But he, like all products of the pharmaceutical industry, has a long list of side, undesirable effects, so only a specialist can decide on the appropriateness of its use.

The information on the site is for reference and generalizing, collected from publicly available sources and cannot serve as a basis for making a decision on the use of medicines in the course of treatment.

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