With caution : liver failure, chronic renal failure, myasthenia gravis, thyrotoxicosis, diabetes mellitus, AV block I degree, depression (including history), psoriasis, allergic winstrol pills reactions (in history), advanced age.pregnancy and lactation : possible if the benefit to the mother outweighs the risk of side effects in the fetus and child. allocate data bisoprolol passes into breast milk is not. Therefore, if necessary, use during lactation, breast-feeding should be discontinued.
Dosing and Administration
Inside, in the morning on an empty stomach, not liquid, once. Arterial hypertension and coronary heart disease: prevention of attacks of angina is recommended to take 5 mg once daily. If necessary to increase the dose of 10 mg 1 time per day. The maximum daily dose – 20 mg. In patients with impaired renal function at creatinine clearance (CC) of less than 20 mL / min, or with severe liver problems, the maximum daily dose – 10 mg. Dose adjustment in elderly patients is not required. Chronic heart failure Start the treatment of chronic heart failure drug Niperten requires a mandatory holding period of a special selection of doses. Prerequisites for the start of therapy as follows:
CHF without exacerbating symptoms in the previous six weeks,
- almost invariable basic therapy in the previous two weeks,
- treatment optimal doses of angiotensin converting enzyme inhibitors (ACE) inhibitors (and vasodilators, in case of intolerance to ACE inhibitors), diuretics, and, if necessary, cardiac glycosides.
Treatment is prescribed in accordance with this scheme selection of doses.
The individual patient’s response to the assigned therapy, t. E. The dose can be increased only if the previous dose was well tolerated.
Side effect On the part of the central nervous system and peripheral nervous system : fatigue, weakness, dizziness, headache, sleep disorders, depression, anxiety, confusion, or momentary loss of memory, hallucinations, asthenia, myasthenia gravis, paresthesia in the extremities (in patients with “intermittent” claudication and Raynaud’s syndrome), tremor, seizures (including the calf muscles). On the part of the organ of vision : visual disturbances, reduced secretion of tear fluid, dryness and soreness of eyes, conjunctivitis. cardio-vascular system : sinus bradycardia, palpitations , conduction disturbances infarction, AV block (up to the development of a complete transverse winstrol pills blockade and heart failure), arrhythmia, weakening of the myocardial contractility, development (widening) CHF (swelling of ankles, feet, shortness of breath), reduced blood pressure, orthostatic hypotension, a manifestation of vasospasm (gain disorders peripheral circulation, cooling of the lower extremities, Raynaud’s syndrome), pain in the chest. From the digestive system : dryness of the oral mucosa, nausea, vomiting, abdominal pain, constipation or diarrhea, abnormal liver function (dark urine, yellow skin or sclera, cholestasis), changes in taste. The respiratory system : nasal congestion, difficulty breathing when administered at high doses (loss of selectivity) and / or in predisposed patients – laryngo and bronchospasm. from endocrine system : hyperglycemia (in patients with non-insulin dependent diabetes) hypoglycemia (in patients receiving insulin), hypothyroid state. Allergic reactions: itching, rash, urticaria. For the skin : increased sweating, flushing of the skin, rash, psoriasiform skin reactions, exacerbation of psoriasis, alopecia. Laboratory findings : thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia, changes in activity liver enzymes (increased alanine aminotransferase (ALT), asparaginaminotransferazy (the ACT), bilirubin, triglycerides. Effects on the fetus : intrauterine growth retardation, hypoglycemia, bradycardia Other:. back pain, arthralgia, weakening of libido, reduced potency, “cancellation” syndrome ( increasing angina attacks, increased blood pressure).The maximum recommended dose Niperten drug is 10 mg 1 time a day.
After the start of treatment with 1.25 mg (1/2 a tablet 2.5 mg) of the patient should be observed for about 4 hours (control heart rate, blood pressure disorders conduction ECG signs of worsening congestive heart failure).
During the selection period, or after the dose may be a temporary worsening of heart failure flow, fluid retention, hypotension or bradycardia. In this case it is recommended first of all to pay attention to the selection of accompanying basal dose therapy (diuretic dose optimization and / or ACE inhibitor), before the drug dose reduction Niperten. Drug treatment should be interrupted only if absolutely necessary.
After stabilization, the patient should undertake a re-titration or continue treatment.
Overdose symptoms : arrhythmia, ventricular premature beats, bradycardia, AV block, marked reduction in blood pressure, heart failure, cyanosis of nails of fingers or palms, shortness of breath, bronchospasm, dizziness, fainting, seizures. Treatment : gastric lavage and the appointment of absorbent; Symptomatic therapy: which developed at AV blockade – intravenous infusion of 1-2 mg of atropine, epinephrine or staging a temporary pacemaker; with ventricular arrhythmia – lidocaine (IA class of drugs does not apply); -bolnoy while lowering blood pressure should be in the Trendelenburg position; if there are no signs of pulmonary edema – intravenous plasma-solutions, with the ineffectiveness nutshell epinephrine, dopamine, dobutamine (to maintain the chronotropic and inotropic effects and elimination of significant decrease in blood pressure); heart failure – cardiac glycosides, diuretics, glucagon; in convulsions – diazepam intravenously; with bronchospasm – ß 2 adrenostimulyatory inhalation.
Interaction with other drugs allergens used for immunotherapy, or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients winstrol pills receiving bisoprolol.Iodine-containing X-ray contrast agent for intravenous administration increases the risk of anaphylactic reactions.