Atenolol 50mg tabs 30 pcs renewal

Description

Composition
Active substance:
1 tablet contains: Atenolol, 0.05 g and 0.1 g
Excipients:
Magnesium hydroxycarbonate, potato starch, gelatin, magnesium stearate, stearic acid.
Description:
Tablets white or white with Valium color. Slight marbling, Valium chamfered (for 50 mg dosage) or a facet and Valium (for dosing 100 mg).
Product form:
Tablets of 50 mg and 100 mg.
According 10,30 tablets in blisters of PVC film and aluminum foil lacquered or printed paper packaging. 3 blisters with 10 tablets with instructions for use placed in a pile of cardboard.
Blisters with equal amounts instructions for use placed in multipacks.
Contraindications
Increased sensitivity to the drug, cardiogenic shock, atrioventricular (AV) block II-III art., Bradycardia (heart rate less than 45-50 beats / min.), Sick sinus syndrome, sinus block, acute or chronic heart failure (step decompensation ), cardiomegaly without signs of heart failure, Prinzmetal angina, hypotension (in the case of myocardial infarction, systolic blood pressure less than 100 mm Hg. v.), lactation, simultaneous mono- amino-oxidase inhibitors ( AO), age 18 years (effectiveness and safety have been established).
Patients who are on hemodialysis, elderly patients.
Precautions: diabetes, metabolic acidosis, hypoglycemia, allergic reactions in history, chronic obstructive pulmonary disease (including emphysema), AV block I degree, chronic heart failure (compensated), obliterating peripheral vascular disease ( “intermittent” claudication, Raynaud syndrome), pheochromocytoma, hepatic failure, chronic renal failure, myasthenia gravis, thyrotoxicosis, depression (including history), psoriasis, pregnancy, older age.
Dosage
50 mg
Indications
Arterial hypertension; prevention of angina attacks (except Prinzmetal angina); cardiac arrhythmias: sinus tachycardia, supraventricular tachyarrhythmia prevention, ventricular arrythmia.
Interaction with other drugs
With simultaneous application of atenolol with insulin, oral hypoglycemic drugs – their hypoglycemic action, is exacerbated. In a joint application with antihypertensive agents of different groups or nitrates is amplified hypotensive action. The simultaneous use of atenolol and verapamil (or diltiazem) may cause mutual enhancement cardiodepressive action.
Antihypertensive effect of weakening estrogens (sodium retention) and non-steroidal anti-inflammatory drugs, glucocorticoids. With simultaneous use of atenolol and cardiac glycosides increase the risk of bradycardia and atrioventricular conduction disturbances.
When concomitant administration of atenolol with reserpine, methyldopa, clonidine, and verapamil may cause bradycardia. Simultaneous in / with the introduction of verapamil and diltiazem can cause cardiac arrest; nifedipine may lead to a significant reduction in blood pressure.
When simultaneous administration of atenolol with ergotamine derivatives, xanthine, its effectiveness is reduced.
Upon termination of the combined use of atenolol and clonidine clonidine treatment was continued for a few days after discontinuation of atenolol. Concomitant use of lidocaine, may reduce its excretion and increase the risk of toxicity of lidocaine.
Use in conjunction with phenothiazine derivatives, increases the concentration of each drug in the serum.
Phenytoin at / in the introduction, medicines for general anesthesia (hydrocarbon derivatives) increase the severity cardiodepressive action and likely to reduce blood pressure.
In a joint application with aminophylline and theophylline may cancel each therapeutic effects.
Not recommended simultaneous application with MAO inhibitors due to a significant increase in hypotensive action, a break in treatment between the reception of MAO inhibitors and atenolol should be at least 14 days. The allergens used for immunotherapy, or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis.
Means for inhalation anesthesia (derivatives of hydrocarbons) increase the risk of depression myocardial function and development of hypertension. Amiodarone increases the risk of bradycardia and conduction oppression AV. Cimetidine increases the concentration in plasma (inhibits metabolism). Iodine-containing radiopaque drugs for i / v administration increases the risk of anaphylactic reactions.
Prolongs the action of non-depolarizing muscle relaxants and anticoagulant effect of coumarin.
Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedatives and hypnotics drugs enhance central nervous system depression.
Overdose
Symptoms: bradycardia, AV block 11-1II degree, increase in symptoms of heart failure, excessive reduction of blood pressure, shortness of breath, bronchospasm, dizziness, fainting, arrhythmia, ventricular premature beats, cyanosis of nails of fingers or palms, cramps.
Treatment: gastric lavage purpose absorbent and drugs; at occurrence of bronchospasm shown inhalation or intravenous beta2-agonists salbutamol. When violation AV conduction, bradycardia – in / in a 1-2 mg atropine, epinephrine or staging temporary pacemaker; at ventricular extrasystole – lidocaine (1A class drugs are not applicable); while lowering blood pressure – the patient must be in the Trendelenburg position. If there are no signs of pulmonary edema – in / plasma-substituting solutions in ineffectiveness – administration of epinephrine, dopamine, dobutamine; in chronic heart failure – cardiac glycosides, diuretics, glucagon; with cramps – in / diazepam. Perhaps dialysis.
pharmachologic effect
Pharmacological group:
Beta1-selective blocker.
Pharmacodynamics:
It has antianginal, antihypertensive and antiarrhythmic action. It has no membrane stabilizing and intrinsic sympathomimetic activity. Decreases catecholamines stimulated cAMP formation of ATP. In the first 24 hours after oral administration against decrease in cardiac output marked increase in reactive total peripheral vascular resistance, whose severity for 1-3 days gradually decreases. Hypotensive effect associated with a decrease in cardiac output, a decrease in activity of the renin-angiotensin system, baroreceptor sensitivity and the influence of the central nervous system. Hypotensive effect manifests itself as a decrease in systolic and diastolic blood pressure (BP), a decrease in stroke and minute volumes. The average therapeutic doses has no effect on the tone of the peripheral arteries. The hypotensive effect lasts 24 hours, during regular use is stabilized by the end of the second week of treatment. Antianginal effect is determined by a reduction of myocardial oxygen demand by decreasing the heart rate (diastole elongation and improving myocardial perfusion) and contractility, as well as decrease the sensitivity of the myocardium to the effects of the sympathetic stimulation. It slows the heart rate (4CQ at rest and during exercise. By increasing the end-diastolic pressure in the left ventricle and increased tensile ventricular muscle fibers may increase the oxygen demand, especially in patients with chronic heart failure.
Antiarrhythmic effect manifested suppression sinus tachycardia and is associated with the elimination of arrhythmogenic effects on sympathetic conductive system of the heart, a decrease in the velocity of propagation of excitation through the sinoatrial node, and lengthening of the refractory period. Inhibits antegrade conduction of impulses and to a lesser extent in the retrograde direction through the AV (atrioventricular) node and an additional conducting paths. The negative chronotropic effect appears after 1 h after administration, reaching a maximum after 2-4 hours, until 24 hours.
Decreases sinus node automaticity, slows heart rate slows AV conduction reduces the contractility of the myocardium, reducing myocardial oxygen demand. It reduces the excitability of the myocardium. When applied in high therapeutic doses has a less pronounced effect on smooth muscles of bronchi and peripheral arteries than nonselective beta-blockers.
Pharmacokinetics:
The absorption from the gastrointestinal tract – fast, incomplete (50-60%), the bioavailability – 40-50%, time to reach maximum plasma concentration -. 4.2 h Poor penetrates the blood-brain barrier, it takes place in small quantities through the placental barrier and in breast milk. Communication with the plasma protein – 6-16%. Practically not metabolized in the liver. The half-life – 6-9 hours (increases in elderly patients). Excreted by the kidneys by glomerular filtration (85-100% intact). Renal dysfunction accompanied by lengthening the half-life and cumulation: the creatinine clearance less than 35 mL / min / 1.73 m2, the half-life is 16-27 h at a creatinine clearance less than 15 mL / min / 1.73 m2- over 27 hours (to be decreasing doses). Displayed during hemodialysis.
Pregnancy and breast-feeding
Pregnant women should be prescribed atenolol only in cases where the benefit to the mother outweighs the potential risk to the fetus. Atenolol is excreted in breast milk, so during lactation it should be taken only in exceptional circumstances and with great care.
Conditions of supply of pharmacies
On prescription.
side effects
Cardiovascular system: development (exacerbation) of symptoms of chronic heart failure (edema of the ankles, feet, dyspnea), impaired atrioventricular conduction, arrhythmias, bradycardia, marked reduction in blood pressure, orthostatic hypotension, palpitations.
Central nervous system: dizziness, decreased ability to concentrate, decreased reaction rate, drowsiness or insomnia, depression, hallucinations, fatigue, headache, weakness, “nightmarish” dream, anxiety, confusion, or short-term memory loss, paresthesia in the extremities ( in patients with “intermittent” claudication and Raynaud’s syndrome), muscle weakness, convulsions.
Gastrointestinal tract: dry mouth, nausea, vomiting, diarrhea, abdominal pain, constipation, change in taste.
Respiratory system: dyspnea, bronchospasm, apnea, nasal congestion. Hematologic reactions: platelet purpura, anemia (aplastic) thrombosis.
Endocrine system: gynecomastia, decreased potency, decreased libido, hyperglycemia (in patients with non-insulin dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), hypothyroid state.
Metabolic reactions: hyperlipidemia.
Skin reactions: urticaria, dermatitis, pruritus, photosensitivity, increased sweating, flushing of the skin, exacerbation of psoriasis flow, reversible alopecia.
Senses: visual disturbances, reduced secretion of tear fluid, dryness and soreness of the eyes, conjunctivitis.
Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia. Laboratory findings: agranulocytosis, leukopenia, increased activity of “liver” enzymes, hyperbilirubinemia.
Other: back pain, arthralgia syndrome “cancel” (increasing angina attacks, increased blood pressure).
The frequency of adverse events increased with increasing dose.
special instructions
Monitoring patients receiving atenolol should include monitoring of heart rate and blood pressure (at the beginning of treatment -. Daily, then 1 every 3-4 months), blood glucose in patients with diabetes (1 every 4-5 months.) . In elderly patients it is recommended to monitor renal function (1 every 4-5 months.).
It should teach the patient’s heart rate counting procedure and to instruct the need of medical advice in heart rate less than 50 beats / min.
Thyrotoxicosis atenolol can mask certain clinical signs of hyperthyroidism (e.g., tachycardia). Abrupt withdrawal in patients with hyperthyroidism contraindicated because the symptoms can increase. In diabetes may mask tachycardia caused by hypoglycemia. In contrast, nonselective beta-blockers practically no increase insulin-induced hypoglycemia and delay recovery of blood glucose levels to the normal concentration.
In patients with coronary heart disease (CHD) abrupt withdrawal of beta-blockers can cause an increase in the frequency or severity of anginal attacks, so the discontinuation of atenolol in patients with coronary heart disease should be carried out gradually.
As compared with nonselective beta-blockers, cardioselective beta-blockers have less impact on lung function, however, in obstructive airways diseases atenolol prescribed only in the case of absolute indications. If necessary, their purpose in some cases it is possible to recommend the use of beta2-agonists.
Patients with diseases bronhospasticheskimi cardioselective adrenoblokatary may be administered in case of intolerance and / or ineffectiveness of other antihypertensive drugs, but it should closely monitor the dosage. Overdose risk of developing bronchoconstriction.
Particular attention is needed in cases where the required surgery under general anesthesia in patients taking atenolol. The drug should be discontinued 48 hours before surgery. In an anesthetic formulation should be chosen with minimum possible negative inotropic effect.
With simultaneous use of atenolol and clonidine atenolol was stopped for a few days before clonidine to avoid withdrawal symptoms last.
May increase the severity of hypersensitivity reactions and the lack of effect of conventional doses of epinephrine with aggravated allergic history.
Drugs that reduce stocks catecholamines (e.g., reserpine), may enhance the action of beta-blockers, so patients taking such drug combinations should be under constant medical supervision for identifying expressed BP reduction or bradycardia.
In the case of elderly patients increasing bradycardia (less than 50 beats / minute), hypotension (systolic blood pressure below 100 mm Hg. V.), Atrioventricular block, bronchospasm, ventricular arrhythmia, serious liver and kidney functions necessary to reduce the dosage or discontinue treatment.
It is recommended to discontinue therapy in the development of depression caused by the intake of beta-blockers.
If necessary, the intravenous administration of verapamil is to be done through at least 48 hours after administration of atenolol.
In the application of atenolol possible to reduce the production of tear fluid, which has a value in patients using contact lenses.
Do not abruptly discontinue treatment because of the risk of severe arrhythmias and myocardial infarction. Cancellation are gradually reducing the dose for 2 weeks. and more (reduce dose by 25% in 3-4 days).
Should be lifted before testing of blood and urine catecholamines, normetanephrine and vanillylmandelic acid; titers of antinuclear antibodies.
Smokers efficacy of beta-blockers lower.
Effects on ability to drive and operate machinery. In the period of treatment should refrain from activities potentially hazardous activities that require high concentration and psychomotor speed reactions.
Storage conditions
Store in a dry, dark place at a temperature not higher than 25 C.
Keep out of the reach of children.
Dosing and Administration
Assign inside before a meal, not liquid, squeezed small amounts of liquid.
Arterial hypertension.
Treatment starts with atenolol 50 mg 1 time per day. To achieve a stable antihypertensive effect requires 1-2 weeks of administration. With insufficient expression of the hypotensive effect dose was increased to 100 mg in one portion. Further increase in the dose is not recommended, as it is not accompanied by increased clinical effect.
Angina.
The initial dose is 50 mg per day. If during the week is not an optimal therapeutic effect, increasing the dose to 100 mg per day. Sometimes it is possible to increase the dose of 200 mg once a day. Elderly patients and patients with impaired renal excretory function requires correction dosing regimen.
In the presence of renal failure recommended dose correction according to the creatinine clearance (CC):
QA 35 ml / min correction dose is not required;
QC 15-35 ml / min, the maximum dose of 50 mg per day or 100 mg every other day;
CC less than 15 ml / min, the maximum dose of 50 mg a day or one 100 mg every 4 days.
To ensure dosing regimen listed atenolol possible to use in the dosage form of 25 mg tablets.
Patients who are on hemodialysis, atenolol administered 25 or 50 mg / day immediately after each dialysis that should be carried out in stationary conditions, as it can have a reduction in blood pressure.
In elderly patients, the initial single dose – 25 mg (can be increased under the control of blood pressure, heart rate).
Increasing daily dose of 100 mg are not recommended, as the therapeutic effect is not enhanced, and the likelihood of side effects increases.
Information
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist