Coronal tab p / 10 mg of the film 100 pcs


Coronal tab p / 10 mg of the film 100 pcs



Active substance:
1 tablet contains: bisoprolol fumarate 5.0 mg or 10.0 mg.
Microcrystalline cellulose, corn starch, sodium lauryl sulfate, colloidal silicon dioxide, magnesium stearate; film coating: hypromellose, macrogol 400, titanium dioxide, iron oxide yellow dye (E 172) or colorant ferric oxide red (E 172).
Tablets 5 mg: Round biconvex pale yellow scored tablet, film-coated.
10 mg Tablets: round biconvex light pink scored tablet, film-coated.
Product form:
Film-coated tablets of 5 mg, 10 mg. 10 or 15 tablets in a blister of PVC / PE / PVDC-AL or blister Al / Al. At 1, 3, 6 or 10 blisters 10 tablets or 2 or 4 blisters with 15 tablets with instructions for use placed in a cardboard box.
Increased sensitivity to the drug and other beta drenoblokatoram, shock (including cardiogenic), acute heart failure, chronic heart failure decompensation, AV blockade II – III degrees (without pacemaker), sinoatrial block, sick sinus syndrome , bradycardia, cardiomegaly (without heart failure), hypotension (systolic blood pressure less than 100 mm Hg, particularly in myocardial infarction..); asthma and chronic obstructive pulmonary disease in history; simultaneous reception of inhibitors of monoamine oxidase (MAO) (except of inhibitors MAO-B), and concomitant use floctafenine sultopride, late stage peripheral circulatory disorders, Raynaud’s disease, lactation, age 18 years (effectiveness and safety are installed).
Hepatic failure, renal failure (creatinine clearance less than 20 mL / min), metabolic acidosis, pheochromocytoma (with concomitant use of alpha blockers), diabetes decompensation, atrioventricular block I degree, Prinzmetal angina, restrictive cardiomyopathy, congenital heart defects or defects heart valves with severe hemodynamic compromise, chronic heart failure, myocardial infarction within the last 3 months, psoriasis, depression (including namneze), severe allergic reaction in history, pregnancy, older age, strict diet, conducting desensitizing immunotherapy allergens and allergen extracts.
10 mg
Arterial hypertension; Ischemic heart disease: prevention of angina attacks.
Interaction with other drugs
The 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 radiopaque drugs for intravenous administration to increase the risk of anaphylactic reactions. Phenytoin intravenous administration, drugs for inhalation anesthesia (hydrocarbon derivatives) increase the severity cardiodepressive steps and probability of lowering blood pressure. Changes effectiveness of insulin and hypoglycemic agents for oral administration, masking the symptoms of developing hypoglycemia (tachycardia, hypertension). Reduces the clearance of lidocaine and xanthine (except dyphylline) and increases their concentration in plasma, especially in patients with initially increased clearance of theophylline under the influence of smoking. Antihypertensive effects of impaired non-steroidal anti-inflammatory drugs (delay sodium ions (Na +) and blockade of prostaglandin synthesis by the kidneys), glucocorticoids and estrogens (delay sodium ions). 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 cause an excessive decrease of blood pressure. Nedepolyariziruyuschih prolongs the action of muscle relaxants and increases the anticoagulant effect of coumarin. Three – and tetracyclic antidepressants, antipsychotics (neuroleptics, including sultopride), ethanol, sedatives and hypnotics drugs enhance central nervous system depression, can induce cardiac arrhythmia, orthostatic hypotension and bradycardia. Not recommended simultaneous application with monoamine oxidase inhibitors, due to significant gain antihypertensive action, break in treatment between taking monoamine oxidase inhibitors and bisoprolol should be at least 14 days. Non-hydrogenated ergot alkaloids increase the risk of peripheral circulatory disorders. Ergotamine increases the risk of peripheral circulatory disorders; sulfasalazine increases the concentration of bisoprolol in the plasma; rifampin shortens the half-life of the drug. There is a potential risk of an additive effect with the development of hypotension and / or significant bradycardia, when used in conjunction with beta-blockers for topical administration (eye drops). There is a decrease of the antihypertensive effect of the drug during treatment with epinephrine and norepinephrine. The likelihood of violations of automaticity, conduction and contractility of the heart is increased (relative) during therapy with quinidine drugs (mefloquine, chloroquine). In case of shock or hypotension due floctafenine, when used together may reduce compensatory cardiovascular reactions. While the use of baclofen or amifostine also noted increased antihypertensive effect.
Symptoms: arrhythmia, ventricular arrythmia, bradycardia, AV block, marked decrease in blood pressure, congestive heart failure, acrocyanosis, shortness of breath, bronchoconstriction, dizziness, fainting, convulsions.
Treatment: gastric lavage purpose absorbent and drugs; Symptomatic therapy: which developed when AV blockade – intravenous (i / v) 2.1 mg atropine, epinephrine or staging temporary pacemaker; with ventricular arrhythmia – lidocaine (Class Ia drugs are not used); at lowering blood pressure – the patient must be in position Trendelnburga; if no signs of pulmonary edema – intravenous plasma-substituting solutions in ineffectiveness – administration of epinephrine, dopamine, dobutamine (to maintain chronotropic and inotropic action and eliminate expressed lowering blood pressure); in heart failure – cardiac glycosides, diuretics, glucagon; in convulsions – diazepam intravenously; with bronchospasm – beta2- adrenostimulyatorov inhalation.
pharmachologic effect
Pharmacological group:
Beta1-selective blocker.
Selective beta1-adrenergic blocker without own sympathomimetic activity, has no membrane stabilizing effect. Reduces plasma renin activity, reduces myocardial oxygen demand, reduce heart rate (HR) (at rest and during exercise). It has antihypertensive, antiarrhythmic and antianginal effects. Blocking in low doses beta1-adrenergic receptors of the heart, stimulated by catecholamines reduces the formation of cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP), reduces intracellular calcium ion current has a negative chronotropic, dromo-, BATM and inotropic effects (heart rate slows, inhibits conduction and excitability and reduces myocardial contractility). With increasing doses renders beta2-adrenergic blocking action. Total peripheral vascular resistance (TPR) at the beginning of the drug in the first 24 hours after ingestion is increased (as a result of reciprocal increase in the activity of alpha-adrenoceptor stimulation and removal beta2- adrenoceptor) after 1-3 days returns to its original value, while reduced long-term appointment. Antihypertensive action associated with a decrease in cardiac output, peripheral vascular sympathetic stimulation, decreased activity of the renin-angiotensin-aldosterone system (important for patients with initial hypersecretion renin), and central nervous system (CNS), the restoration of the aortic arch baroreceptor sensitivity (not happening enhance their activity in response to a decrease in blood pressure (BP)) and, as a result, decrease in peripheral sympathetic influences. When hypertension effect occurs within 2-5 days, stable operation – in 1-2 months. Antianginal effect due to a decrease in myocardial oxygen demand as a result of deceleration of heart rate, decrease contractility elongation diastole, improvement of myocardial perfusion as well as decreased sensitivity of the myocardium to the effects of the sympathetic innervation. It reduces the number and severity of angina attacks and increases exercise tolerance. 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 (CHF). Antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased sympathetic nervous system activity, increasing the content of cyclic AMP, hypertension), decrease of the spontaneous excitation rate sinus and ectopic pacemaker and deceleration of the atrioventricular (AV) of (mainly activity in response to a decrease in the antegrade and, to a lesser extent, in the retrograde direction through the AV node) and additional routes. When applied in high therapeutic doses, unlike nonselective beta-blockers, has a less pronounced effect on organs containing beta 2-adrenoreceptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchial and uterine) and carbohydrate metabolism, does not cause delays sodium ions (Na +) in the body; atherogenic action expression is not different from that of propranolol. When used in large doses (200 mg or more) has a blocking effect on both beta-adrenergic subtypes, primarily bronchial and vascular smooth muscle.
Absorption – 80 – 90%, food intake does not affect absorption. The maximum plasma concentration occurs within 1 – 3 hours, connection with blood plasma proteins about 30%. The permeability of the blood-brain barrier and the placental barrier – low secretion breast milk – low. It is metabolized in the liver to inactive metabolites, elimination half-life of 10-12 hours. About 98% of kidney, of which 50% are output in unchanged form, less than 2% in the bile.
Pregnancy and breast-feeding
When pregnancy Coronal prescribed only under strict indications when the intended benefits to the mother outweighs the potential risk to the fetus. 72 hours prior to delivery the drug should be discontinued Coronal in connection with the possible development of the fetus / newborn bradycardia, hypotension, hypoglycemia and respiratory depression. If the reception Coronal preparation required during lactation, breast-feeding should be discontinued.
Conditions of supply of pharmacies
On prescription.
side effects
Frequency: Very frequent (more than or equal to 1/10); frequently (more than 1/100, less than 1/10); infrequently (more than 1/1000, 1/100 less); slowly (over 1/10000, 1/1000 less); very rare (less than 1/10000, including isolated reports).
On the part of the central nervous system: rarely – fatigue, asthenia, dizziness, headache, drowsiness or insomnia, depression, rarely, hallucinations, night “nightmares” seizures.
From the senses: rarely – visual disturbances, reduced secretion of tear fluid, dryness and soreness of the eyes, hearing loss; very rarely – conjunctivitis.
Cardio-vascular system: very often – sinus bradycardia, often-lowering blood pressure, a manifestation of vasospasm (strengthening of peripheral blood circulation, cooling of the lower extremities, paresthesia), rarely – a violation of atrioventricular conduction, orthostatic hypotension, decompensated chronic heart failure, peripheral edema .
From the digestive system: often – dryness of the oral mucosa, nausea, vomiting, diarrhea, constipation, rarely – hepatitis.
The respiratory system: rarely – shortness of breath when administered at high doses (loss of selectivity) and / or in predisposed patients – laryngo and bronchospasm; seldom – nasal congestion, allergic rhinitis.
From endocrine system: rarely – hyperglycemia (in patients with type 2 diabetes), hypoglycemia (in patients receiving insulin).
Allergic reactions: rarely – itching, rash, urticaria.
For the skin: rarely – increased sweating, flushing of the skin, very rarely – psoriasiform skin reactions, exacerbation of the symptoms of psoriasis, alopecia.
On the part of the musculoskeletal system: rarely – muscle weakness, cramps in the calf muscles, arthralgia.
Laboratory findings: rarely – increased activity of “liver” transaminases, hypertriglyceridemia, in some cases – thrombocytopenia, agranulocytosis.
Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia.
Other: very rarely – a violation of potency, rarely – syndrome “cancel” (increasing angina attacks, increased blood pressure).
special instructions
Application of coronal drug in children under 18 years is contraindicated as efficacy and safety have been established. Monitoring patients receiving Coronal 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 in patients with diabetes (1 in 4 times -5 months). In elderly patients it is recommended to monitor renal function (1 every 4-5 months). It should teach the patient the method of calculation of heart rate and the need to instruct the medical consultation at a heart rate less than 50 beats / min. Before treatment is recommended to study the external breathing function in patients with a history of bronchopulmonary history. Approximately 20% of patients with angina, beta-blockers are ineffective. The main reasons – severe coronary atherosclerosis low threshold ischemia (heart rate less than 100 beats / min) and a higher final diastolic volume of the left ventricle, which violates the subendocardial bloodstream. The “smoking” the effectiveness of beta-blockers lower. Patients who use contact lenses should bear in mind that during treatment may decrease the production of tear fluid. When applied in patients with pheochromocytoma are at risk of paradoxical hypertension (if not previously achieved effective alpha adrenoblockade). Thyrotoxicosis bisoprolol 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 to normal levels. At the same time taking clonidine his appointment may be terminated only a few days after discontinuation of the drug Coronal. May increase the severity of hypersensitivity reactions and the lack of effect of conventional doses of epinephrine with aggravated allergic history. In case of need for surgical planning preparation carried cancellation for 48 hours prior to general anesthesia. If the patient took the drug before surgery, he must pick a medicament for general anesthesia with minimal negative inotropic effect. Reciprocal activation of the vagus nerve can be eliminated intravenous atropine (2.1 mg). Drugs that reduce stocks catecholamines (including, reserpine), may enhance the action of beta-blockers, so patients taking such drug combinations should be under constant medical supervision for identifying expressed lowering blood pressure or bradycardia. Patients with diseases bronhospasticheskimi can assign cardioselective beta-blockers in case of intolerance and / or ineffectiveness of other antihypertensive drugs. Overdose risk of developing bronchoconstriction. In the case of elderly patients increasing bradycardia (less than 50 beats / min) expressed by the lowering of blood pressure (systolic blood pressure below 100 mm Hg. V.), AV blockade is necessary to reduce the dosage or discontinue treatment. It is recommended to discontinue therapy in the development of depression. The drug should be lifted before assay in blood and urine catecholamines, normetanephrine and vanilinmindalnoy acid; titers of antinuclear antibodies.
Effect on the ability to drive mechanisms and
During the period of treatment must be careful when driving and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions.
Storage conditions
At a temperature of not higher than 25 C.
Keep out of the reach of children.
Dosing and Administration
Coronal taken orally on an empty stomach in the morning, without chewing, with a small amount of liquid
When hypertension and coronary heart disease (prevention of attacks of stable angina), the initial dose is 2.5 – 5 mg 1 time per day. If necessary to increase the dose of 10 mg 1 time per day. The maximum daily dose – 20 mg / day. Patients with impaired renal function when creatinine clearance less than 20 mL / min or with severe hepatic impairment maximum daily dose – 10 mg.
No dose adjustment in elderly patients is not required.
Features of action of the drug at the first reception or its cancellation: Do not abruptly discontinue treatment because of the risk of developing the syndrome “cancel” (severe arrhythmias and myocardial infarction). Cancellation are gradually reducing the dose for 2 weeks or more (dose reduced by 25% in 3-4 days).
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist

Additional information

Weight0.100 kg


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