Reduces the clearance of lidocaine and xanthine (except theophylline) and increases their concentration in the blood plasma, especially in patients with initially increased clearance of theophylline under the influence of smoking. Antihypertensive winstrol steroid effect of weakening non-steroidal anti-inflammatory drugs (NSAIDs) (delay of sodium ions (of Na + ) and the blockade of the synthesis of prostaglandin kidneys), corticosteroids, and estrogens (delay of ions of Na + ). cardiac glycosides, methyldopa, reserpine and guanfacine blockers “slow” calcium channel blockers (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening of bradycardia, AV block, cardiac arrest and heart failure.
Nifedipine can lead to a significant reduction in blood pressure. Diuretics, clonidine, sympatholytic, hydralazine and other antihypertensive drugs may lead to an excessive reduction in blood pressure. Extends the action of non-depolarizing muscle relaxants and increases the anticoagulant effect of coumarin . tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedatives and sleeping medications increase CNS depression . not recommended simultaneous application with inhibitors of MAO, as a result of a significant increase in the hypotensive action, a break in treatment between receiving MAO and winstrol steroid bisoprolol inhibitors should not be less than 14 days. Negidrirovannye ergot alkaloids increase the risk of peripheral circulatory disorders.
Ergotamine increases the risk of peripheral circulatory disorders, sulfasalazineincreases the concentration of bisoprolol in blood plasma; rifampicin reduces the T ½ .
monitoring of patients taking the drug Niperten should include measurement of heart rate and blood pressure (at the beginning of treatment – daily, then – 1 every 3-4 months) holding an electrocardiogram, determination of blood glucose levels in diabetic patients (1 in 4 times -5 months.). In elderly patients, it is recommended to monitor renal function (1 time in 4-5 months.).
It is necessary to train the patient’s heart rate calculation method and instruct on the need of medical advice in heart rate less than 50 bpm. / Min.
Before treatment, it is recommended to carry out research in respiratory function patients with a history of bronchopulmonary history.
Approximately 20% of patients with angina ß-blockers are ineffective. The main reasons:. Expressed coronary atherosclerosis with a low threshold of ischemia (.. Heart rate less than 100 beats / min) and a higher end-diastolic volume of the left ventricle, which violates the subendocardial blood flow
. Smokers effectiveness of ß-blockers lower
Patients who use contact lenses should bear in mind that during treatment may decrease the production of tear fluid.
When used in patients with pheochromocytoma have a risk of paradoxical hypertension (if not previously reached effective -adrenoblokada α).
When bisoprolol thyrotoxicosis may mask certain clinical signs of hyperthyroidism (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because the symptoms can increase.In diabetes may mask tachycardia caused by hypoglycemia. Unlike non-selective ß-blockers practically no increase insulin-induced hypoglycemia and delay recovery of blood glucose to normal levels.
At the same time taking clonidine its reception can be terminated only a few days after the cancellation drug.
Increased severity of hypersensitivity reactions are possible and lack of effect of conventional winstrol steroid doses of epinephrine with aggravated allergic history. If necessary, an elective surgical treatment is performed for the cancellation of the drug 48 hours before general anesthesia. If the patient has taken the drug before surgery, he should choose the drug for general anesthesia with minimal negative inotropic effect.Reciprocal activation of the vagus nerve can be eliminated by intravenous administration of atropine (1-2 mg).
Drugs that reduce stocks of catecholamines (including reserpine), may enhance the effect of ß-blockers, so patients taking such drug combinations should be under constant supervision physician to identify pronounced reduction in blood pressure or bradycardia. Patients with diseases bronhospasticheskimi can assign cardioselective ß-blockers in case of intolerance and / or ineffectiveness of other antihypertensive agents.
Overdosing is dangerous development of bronchospasm. In the case of elderly patients increasing bradycardia (less than 50 u. / Min.), Pronounced reduction in blood pressure (systolic blood pressure below 100 mm Hg), AV blockade, it is necessary to reduce the dose or discontinue treatment. It is recommended to discontinue therapy in the development of depression.
Do not abruptly discontinue treatment because of the risk of “cancellation” syndrome (severe arrhythmias and myocardial infarction). Abolition are gradually reducing the dose for 2 weeks or more (reduce dose by 25% in 3-4 days). It is necessary to cancel prior to the study in blood and urine catecholamines and Normetanephrine vanilinmindalnoy acid, antinuclear antibody titers.
Effects on ability to drive and other mechanical means :
the possibility of activities potentially hazardous activities that require increased attention and psychomotor speed reactions, should be addressed only after an winstrol steroid assessment of an individual patient’s response to medication (especially at the beginning of treatment, due to the possibility of dizziness ).