Cordinorm Cor, tablets 2.5mg 90 pcs

Cronic Heart Failure

Active ingredient

Composition

One tablet contains

the active ingredient – bisoprolol fumarate 2.5mg

excipients:

lactose monohydrate,

microcrystalline cellulose,

magnesium stearate,

crospovidone

90 pc

How to take, the dosage

The drug is administered to patients with chronic heart failure (with ejection fraction< 35% according to echocardiography (EchoCG)) who are in stable condition without exacerbation within the last 6 weeks. At the same time, the previous therapy should not be changed for at least 2 weeks. The drug is administered in combination with an angiotensin-converting enzyme inhibitor (ACEI) (or other vasodilator), diuretics and, if necessary, cardiac glycoside.

Treatment of stable chronic insufficiency with Cordinorm Cor requires gradual dose increase according to drug tolerance:

1.25 mg once daily for 1 week, if well tolerated, increase to
2.5 mg once daily for the next week, if well tolerated, increase to
3.75 mg once daily for the next week, if well tolerated, increase to
5 mg once daily for the next 4 weeks, if well tolerated, increase to
7.5 mg once daily for the next 4 weeks, if well tolerated, increase to
10 mg once daily for maintenance therapy.

Patients with liver or kidney function abnormalities of mild or moderate severity as well as elderly patients do not usually require dosage adjustment.

The maximum daily dose of the preparation is 10 mg.
Tablets should be taken without chewing and with small amount of fluid. It is recommended to take the drug in the morning on an empty stomach or during breakfast. The duration of treatment is determined individually. It is recommended that the drug be withdrawn gradually, reducing the dose slowly (this is especially important in patients with coronary heart disease (CHD).

Interaction

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 drugs for intravenous administration increase the risk of anaphylactic reactions. Phenytoin when administered intravenously, drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressant effect and the likelihood of BP decrease.

It changes the effectiveness of insulin and oral hypoglycemic drugs, masks the symptoms of developing hypoglycemia (tachycardia, BP increase). It reduces clearance of lidocaine and xanthines (except diphylline) and increases their plasma concentrations, especially in patients with initially increased clearance of theophylline due to smoking.
Hypotensive effect is weakened by nonsteroidal anti-inflammatory drugs (Na+ ions retention and blockade of prostaglandin synthesis by kidneys), glucocorticosteroids and estrogens (Na+ ions retention).

Cardiac glycosides, methyldopa, reserpine and guanfacine, slow calcium channel blockers (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of bradycardia, AV block, cardiac arrest and cardiac insufficiency. Diuretics, clonidine, sympatholytics, hydralazine, and other hypotensive drugs can lead to excessive BP lowering. It prolongs the effect of nondepolarizing myorelaxants and the anticoagulant effect of coumarins.

Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedatives and sleeping pills increase CNS depression. Unhydrogenated ergot alkaloids increase the risk of peripheral circulatory disorders. Ergotamine increases the risk of peripheral circulatory disorders; sulfasalazine increases plasma concentration of bisoprolol; rifampicin shortens the elimination half-life.

Special Instructions

Control of patients taking Cordinorm Cor should include monitoring of HR and BP (at the beginning of treatment – daily, then once every 3-4 months), electrocardiography (ECG), determination of blood glucose in diabetic patients (once every 4-5 months). The patient should be instructed about the method of heart rate calculation, and about the necessity of medical consultation in case the heart rate is less than 50 beats per minute.

Prior to treatment it is recommended to make external respiratory function tests in patients with poor bronchopulmonary history.

In about 20% of angina patients beta-adrenoblockers are not effective. The main reasons are severe coronary left ventricular end-diastolic volume that impairs subendocardial blood flow. In “smokers” the effectiveness of beta-adreno-blockers is lower.

r Thyrotoxicosis Cordinorm Cor may mask certain clinical signs of thyrotoxicosis (e.g., tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated as it may exacerbate the symptoms.
When the drug is used in patients with pheochromacytoma there is a risk of developing paradoxical hypertension.
In diabetics it may mask the tachycardia caused by hypoglycemia.

Contraindications

Side effects

Frequently
– increased fatigue, unmotivated weakness, dizziness, headache
– visual disturbances, decreased tear fluid secretion (should be considered when the patient wears contact lenses), conjunctivitis
– orthostatic hypotension, especially in patients with heart failure.orthostatic hypotension, especially in patients with heart failure, bradycardia, atrioventricular (AV) conduction disturbances, decompensation of heart failure with the development of peripheral edema; At the beginning of treatment a worsening of conditions is possible in patients with intermittent claudication or Raynaud’s syndrome.
– nausea, abdominal pain, diarrhea, constipation, vomiting, dry mouth, changes of laboratory indexes of liver function, increased level of liver enzymes (ALT, AST), hepatitis.muscle weakness, muscle cramps, arthropathy with lesions of one or more joints (mono- or polyarthritis)
– decrease in glucose tolerance (in latent diabetes) and masked signs of hypoglycemia (in patients receiving insulin), in some cases – increase in triglycerides in the blood
– decreased libido and/or potency
– skin itching, development of psoriasis or exacerbation of the existing disease or rashes
– paresthesias

Rarely

– anxiety, irritability, sleep disturbance, depression, confusion (especially in elderly patients), hallucinations (usually mild and lasting 1-2 weeks), nightmares, vivid dreams, depression
– drowsiness – dyspnea (bronchospasm in high doses or in predisposed patients)
– reddening of the skin, increased sweating, rash
– hearing impairment
– hearing loss.br> – hearing impairment
– allergic rhinitis

Very rare

– alopecia

Overdose

Symptoms: arrhythmia, ventricular extrasystole, marked bradycardia, AV block, decreased BP, heart failure, cyanosis of the finger nails or palms, difficulty breathing, bronchospasm, dizziness, fainting, seizures.

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