It is able to reduce the minute volume of blood, to improve perfusion of the heart muscle, eliminate arrhythmogenic effects (e.g., tachycardia), and so forth, however it is prescribed for hypertension, angina pectoris, sinus tachycardia and similar diseases and deviations.
Structure and Composition
The drug is available as a pale yellow pellets, round, with Valium, biconvex. The key component is bisoprolol, which is contained in the tablet in an amount of 5 to 10 mg, depending on the dosage.
additional substances are:
- microcrystalline cellulose;
- magnesium stearate;
- colloidal silicon dioxide;
- sodium lauryl sulfate;
- corn starch.
The shell consists of the following:
- titanium dioxide;
- yellow iron oxide;
- macrogol 400;
- Valium.
Indications
Coronal prescribed for hypertension, Coronary artery disease, angina, myocardial infarction (secondary prevention).
The drug is used to treat patients with cardiac arrhythmias: sinus tachycardia, ventricular and supraventricular arrhythmias, arrhythmias on the background of hyperthyroidism, mitral valve prolapse.
Therapeutic
Coronal is a hypotensive agent, belonging to the group of selective beta1-blockers. Bisoprolol, acting as active drug substances, reduces enzyme renin activity in blood plasma, significantly reduces the need for cardiac muscle additional supply of oxygen and reduces the heart rate, both at rest, and during physical loads. Coronal has a pronounced antihypertensive, antianginal and antiarrhythmic action.
The mechanism of action of bisoprolol is blocking beta1-adrenergic receptors located directly in the heart, at the expense of in greatly reduced production of cyclic AMP from adenosine triphosphate (ATP), stimulated catecholamines. Also, this effect allows for lower intracellular calcium ions, to trim the frequency of heart contractions suppress excitability and conductivity, and also to reduce the degree of myocardial contractility. On the first day of reception, an increase in total peripheral vascular resistance, but after some time this effect disappears and OPSS decreases during prolonged therapy.
In large doses Coronal can act as beta2-adrenergic blocker.
The degree of absorption of the drug from 80% to 90%. Food intake does not affect the absorption Coronal. The maximum serum concentration observed after 1.5-3.5 hours after consumption.
The ability to create a connection with blood proteins averages 30%. Bisoprolol significantly penetrate the blood-brain and the placental barrier, as well as a small amount excreted in breast milk.
As a result of biotransformation in the liver inactive metabolites are formed.
The half - from 10 to 12 hours. 98% display memory means and only 2% with bile.
Pregnancy
Coronal can be used during pregnancy only after the analysis of the ratio of "benefit to the mother - the risk to the fetus."
Contraindications
- Hypotension (systolic pressures below 100 mmHg, especially in myocardial infarction);
- Raynaud's disease;
- Chronic obstructive pulmonary disease and asthma in history;
- Later stages of peripheral circulatory disorders;
- Cardiomegaly (no symptoms of heart failure);
- Concomitant use sultopride and floctafenine;
- Acute heart failure;
- sick sinus syndrome;
- Shock (including cardiogenic);
- Chronic heart failure (decompensation step);
- AV-block II-III level (without pacemaker);
- Bradycardia;
- Sinoatrial block;
- Simultaneous treatment with inhibitors of monoamine oxidase (MAO), except for the application of MAO-B inhibitors;
- Lactation;
- Age 18 years (the safety and efficacy of the drug in patients in this age group have not been established);
- Hypersensitivity to the drug and other beta-blockers.
Coronal should be taken with caution for the following diseases / conditions:
- Restrictive cardiomyopathy;
- Prinzmetal angina;
- Chronic heart failure with myocardial infarction within the last three months;
- Congenital heart disease or valvular disease with severe hemodynamic compromise;
- Depression (including history);
- Psoriasis;
- Liver failure;
- Diabetes decompensated;
- Renal impairment (creatinine clearance less than 20 mL per minute);
- Metabolic acidosis;
- Pheochromocytoma (while the use of alpha blockers);
- AV-block I degree;
- Severe allergic reactions in the anamnesis.
The drug is also prescribed with caution to pregnant women, elderly patients, patients, observe a strict diet, as well as during desensitizing immunotherapy extracts of allergens and allergens.
How to take Coronal under increased pressure?
As indicated in the instructions for use, Coronal appointed interior, on an empty stomach in the morning, without chewing.
Recommended 2.5-5 mg taken once drug. The dose may be increased if necessary to 10 mg (once per day).
Adult Coronal maximum daily dosage is 20 mg. For patients with significant impairment of liver function or renal function, the maximum daily dose is 10 mg.
Side effects
Coronal under certain circumstances can cause a number of side effects:
- Endocrine system: rarely - hypoglycemia (in patients receiving insulin), hyperglycemia (in patients with type 2 diabetes mellitus);
- Musculoskeletal system: Infrequent - localized in the gastrocnemius muscle cramps, muscle weakness, arthralgia;
- Respiratory system: infrequently - shortness of breath (when used in high doses) and / or in predisposed patients - laryngo and bronchospasm; rarely - allergic rhinitis, nasal congestion;
- Sensory organs: rarely - impaired hearing, reduced secretion of tear fluid, blurred vision, pain and dryness of the eyes; very rarely - conjunctivitis;
- Digestive System: often - nausea, dryness of the oral mucosa, diarrhea, vomiting, constipation; rarely - hepatitis, increased liver transaminases;
- Central nervous system: rarely - depression, asthenia, fatigue, headache, dizziness, insomnia or drowsiness; rarely - seizures, hallucinations and nightmares;
- Cardiovascular system: very often - sinus bradycardia; often - lowering blood pressure, a manifestation of vasospasm (paresthesia, coldness of the lower extremities, increased peripheral circulatory disorders); infrequently - orthostatic hypotension, impaired AV-conduction, peripheral edema, chronic decompensated heart failure;
- Hematopoietic system: in some cases - agranulocytosis, thrombocytopenia;
- Skin: rarely - skin flushing, increased sweating; very rarely - flow exacerbation of psoriasis, psoriasiform skin reactions, alopecia;
- Allergic reactions: seldom - rash, pruritus, urticaria;
- Other: rarely - a withdrawal syndrome associated with increased blood pressure and increased angina attacks, hypertriglyceridemia; very rarely - a violation of potency.
Overdose
Coronal in overdose may develop the following symptoms: arrhythmia, bradycardia, ventricular arrhythmia, atrioventricular block, CHF, reduce blood pressure, cyanosis hands or fingernails, bronchospasm, respiratory difficulties, syncope, dizziness, seizures.
Overdose Treatment: gastric lavage, administration of adsorbing drugs, symptomatic therapy:
- In the case which developed atrioventricular block - intravenous atropine 1.2 mg epinephrine or optionally pacemaker staging
- By reducing blood pressure - to bring the patient in the Trendelenburg position
- With the development of ventricular extrasystole - lidocaine (not used class of drugs 1a)
- In the absence of phenomena of pulmonary edema - intravenous plasma expander, in case of inefficiency - Introduction dopamine, epinephrine, dobutamine (to eliminate severe hypotension and maintain inotropic and chronotropic actions)
- When bronchospasm - inhaled β2-agonists
- In convulsions - intravenously administering diazepam
- In heart failure - diuretics, cardiac glycosides, glucagon.
special instructions
Requires regular monitoring of blood pressure and heart rate (HR) (daily at the beginning of therapy, then 1 every 3-4 months) conducting an electrocardiogram (ECG), to determine the level of blood glucose in patients with diabetes mellitus (1 every 4-5 months).
The patient must be trained in the method of calculating heart rate and instructed to visit to a doctor at a heart rate below 50 bpm (beats / min).
Because of the threat of myocardial infarction and severe arrhythmias prohibited sharply to interrupt reception Coronal - the dose should be reduced by 14 days or more (25% in 3-4 days) to complete the cancellation means.
Patients with a history of bronchopulmonary lesions, recommended the study of respiratory function.
Approximately 20% of patients with angina use of beta-blockers is ineffective due to increased end-diastolic volume left ventricular subendocardial modifies blood flow, severe coronary atherosclerosis and low threshold ischemia (less than 100 beats / min).
Therapy may mask some of the manifestations of hyperthyroidism (in particular tachycardia), patients with the disease because of the risk of worsening of his symptoms is prohibited sudden discontinuation of treatment Coronal.
In the presence of pheochromocytoma may appear paradoxical hypertension (if previously unable to achieve effective alpha adrenoblockade).
Patients wearing contact lenses should be borne in mind that the treatment can be reduced production of lachrymal fluid.
Diabetic patients bisoprolol is able to mask tachycardia caused by hypoglycemia. Practically does not slow down the restoration of normal blood glucose levels and exacerbating hypoglycemia, insulin provoked.
The effect of beta-blockers reduced by smoking.
When combined with the use of clonidine can stop receiving the last only a few days after discontinuation of bisoprolol.
May worsen the severity of hypersensitivity reactions and effects absent from conventional doses of epinephrine with aggravated allergic history.
During the planned surgical operation is required to cancel reception Coronal 48 hours before general anesthesia. In the event that the patient has taken before the operation means, it is recommended to choose the drugs for general anesthesia, have a minimal negative inotropic effect.
Reciprocal activation of the vagus nerve (vagal) eliminated after intravenous injection of atropine (1.2 mg).
Activity of beta-blockers may be enhanced when combined with reducing agents stocks catecholamines (including reserpine), thereby constant medical supervision is necessary to detect the possible development of bradycardia or expressed BP lowering.
The course of treatment is recommended to stop the development of depression.
Patients with existing disease may apply bronhospasticheskimi cardioselective blockers in ineffectiveness or intolerant of other antihypertensives. In case of overdose there is a risk of bronchospasm.
elderly patients are recommended to reduce the dose or to cancel reception expressed during the development of lowering blood pressure (systolic blood pressure below 100 mm Hg. v.) increasing bradycardia (less than 50 beats / min), AV-block.
Use of the drug is stopped prior to the study of blood and urine content vanillylmandelic acid, normetanephrine, catecholamines, antinuclear antibody titers.
During the period of treatment is required to exercise caution when driving or other complex mechanisms.
Interaction with other drugs
Do not take Coronal simultaneously with calcium channel blockers (these include verapamil and diltiazem), antihypertensive agents (clonidine, moxonidine, reserpine, methyldopa, guanfacine, preparations digitalis). Failure to comply with these recommendations may cause the development or worsening of bradycardia, heart failure, AV-blockade, lowering blood pressure.
Receiving sympathomimetic drugs, such as antitussives, nasal and eye drops, may reduce the therapeutic efficacy Coronal.
The collection and ergotamine derivatives Coronal promotes disruption of peripheral blood circulation. In preparing the patient for surgery under general anesthesia is necessary to inform the anesthesiologist about taking the drug.
Analogs tablets Coronal
Coronal analogues of the drug are:
- Konkor contains as active component bisoprol. This is the original product that has been clinically tested and proven effective. He is available in tablets and is recommended for the treatment of adult patients, including pregnant women.
- Prestilol tableted combined preparation. Its active components are bisoprolol and perindopril, they enhance the therapeutic effect of each other. Indications for use are hypertension in adults. Prestilol forbidden to prescribe to women in the state and breastfeeding.
- Biprol Plus is a combined drug containing as active substances bisoprolol and hydrochlorothiazide. Available drug tablets and is recommended for patients who require the simultaneous reception of the antihypertensive and diuretic. Biprol Plus is contraindicated in pregnant, lactating and juvenile patients.
- Niperten Combination medicament manufactured in tablets, the active components, which are bisoprolom and amplodipin. Both compounds lower the blood pressure, but have a different mechanism of action. The drug is recommended for adult patients, which the doctor has prescribed concomitant use of amlodipine and bisoprola.
Coronal price
Coronal drug in 2018 can be purchased for an average of 130 rubles.
Conditions of supply and storage
The drug is sold in pharmacies by prescription. Tablets should be stored away from children in a cool, dry place, away from direct solneyh rays on the packaging. The shelf life of the drug is 3 years from the date of manufacture indicated on the package.
At the end of the shelf life Coronal tablets for disposal.