Contraindications
Concor should not be used for the following diseases:
- cardiogenic shock;
- acute heart failure;
- chronic heart failure (CHF) in the stage of decompensation, which requires the use of inotropic therapy;
- sinoatrial block;
- atrioventricular (AV) block of II–III degree in patients without a pacemaker;
- severe bradycardia with heart rate less than 60 beats per minute;
- sick sinus syndrome;
- severe arterial hypotension [systolic blood pressure (BP) below 100 mmHg];
- Raynaud's syndrome or severe peripheral arterial circulation disorder;
- severe form of bronchial asthma;
- chronic obstructive pulmonary disease in severe form;
- metabolic acidosis;
- pheochromocytoma (without simultaneous use of alpha-blockers);
- age under 18 years;
- breastfeeding period;
- hypersensitivity to the components of the drug.
Nebilong, 5 mg, tablets, 30 pcs.
Beta blockers should not be used in patients with untreated chronic heart failure until the condition has stabilized.
Abrupt cessation of the use of beta-blockers is unacceptable.
The withdrawal of beta-blockers should be carried out gradually over 10 days (up to 2 weeks in patients with coronary heart disease).
The effectiveness of beta-blockers in smokers is lower than in non-smoking patients. In patients with mild to moderate liver dysfunction, as well as impaired renal function (creatinine clearance more than 20 ml/min), caution must be exercised.
In elderly patients (over 65 years of age), monitoring of renal function is necessary (once every 4–5 months) (due to age-related changes in renal function).
The use of Nebilong in patients with severely impaired liver function and severely impaired renal function (creatinine clearance less than 20 ml/min) is contraindicated (see section "Contraindications".)
For exertional angina, the dose of the drug should ensure that the heart rate at rest is within the range of 60–80 beats/min, and during exercise - no more than 110 beats/min.
Beta-blockers can cause bradycardia: the dose should be reduced or the drug discontinued if the heart rate is less than 55–60 beats/min. (see section “Contraindications”).
Beta blockers should be used with caution in the following patient groups:
- with peripheral circulatory disorders, as these symptoms may worsen;
- with first-degree atrioventricular block, since beta-blockers negatively affect the impulse conduction time;
- with Prinzmetal's angina due to unopposed alpha-receptor-mediated vasoconstriction of the coronary artery: beta-adrenergic antagonists may increase the number and duration of angina attacks.
Patients who use contact lenses should take into account that the use of beta-blockers may reduce the production of tear fluid.
When performing surgical interventions, the anesthesiologist should be warned that the patient is taking Nebilong. Continuation of beta blockade reduces the risk of arrhythmia during general anesthesia and intubation. If preparation for surgery involves interruption of beta-blockade, beta-adrenergic antagonists should be discontinued at least 24 hours before surgery.
Anesthetics that cause myocardial depression should be used with caution. Vagal reactions in the patient can be prevented by intravenous atropine.
Nebilong does not affect plasma glucose concentrations in patients with diabetes mellitus. However, caution should be exercised when treating these patients because nebivolol may mask certain symptoms of hypoglycemia (eg, tachycardia, palpitations) caused by the use of hypoglycemic agents. Abrupt withdrawal of the drug can cause exacerbation of symptoms of the disease and the development of thyrotoxic crisis.
Plasma glucose concentrations should be monitored once every 4–5 months. (in patients with diabetes mellitus).
With hyperfunction of the thyroid gland, Nebilong can mask certain clinical signs of thyrotoxicosis (for example, tachycardia). Abrupt withdrawal in patients with hyperthyroidism is contraindicated as it can worsen symptoms.
Beta blockers may increase sensitivity to allergens and the severity of anaphylactic reactions. Nebivolol may cause severe reactions to a number of allergens when administered to patients with a history of severe anaphylactic reactions to these allergens. These patients may not respond to the usual doses of epinephrine (adrenaline) used to treat anaphylactic shock.
Beta blockers should be used with caution in patients with chronic obstructive pulmonary disease, as bronchospasm may increase.
Monitoring blood pressure and heart rate at the beginning of taking the drug should be daily.
When deciding whether to use Nebilong in patients with psoriasis, the expected benefits should be carefully weighed against the possible risk of exacerbation of psoriasis.
Nebivolol may give a positive result in a doping test.
Impact on the ability to drive vehicles and machinery
The effect of nebivolol on the ability to drive vehicles and operate machinery has not been studied. Due to the possible occurrence of side effects, such as dizziness and increased fatigue, during treatment with the drug, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Doses and method of administration Concor
Dosage and method of use of the drug Concor
Concor is taken orally (do not chew or crush) once a day with a glass of water, regardless of meals. But there is a dependence on the time of day. The medicine should be taken exclusively in the first half of the day, that is, you cannot take Concor during the day, evening or at night.
As for the duration of therapy, it is determined by the body’s reaction and the decision of the attending physician.
- Arterial hypertension and angina pectoris
The dose of the drug is calculated taking into account the heart rate and general condition of the patient.
To begin with, Concor is prescribed 5 mg, one tablet per day. Then they go up to 10 mg. And in the treatment of hypertension and angina pectoris, the maximum recommended dose is 20 mg per day.
- Chronic heart failure without signs of exacerbation
Initially, 1.25 mg once a day. If the patient tolerates the dosage well, then it is gradually increased every two weeks to 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg.
If the dosage is poorly tolerated, then it should be reduced. The maximum recommended dose is 10 mg per day.
Side effects
Taking Concor may be accompanied by side effects:
- From the nervous system: increased fatigue, dizziness, headache, sleep disturbances, depression may be observed (especially at the beginning of therapy), rarely - hallucinations (usually mild and disappear within 1-2 weeks), sometimes - paresthesia.
- On the part of the organ of vision: visual disturbances, decreased tear production (must be taken into account when wearing contact lenses), conjunctivitis.
- From the cardiovascular system: in some cases - orthostatic hypotension, bradycardia, AV conduction disturbances, decompensation of heart failure with the development of peripheral edema, at the beginning of treatment - deterioration of the condition of patients with intermittent claudication or Raynaud's syndrome.
- From the respiratory system: in isolated cases - shortness of breath (in patients prone to bronchospasm).
- From the gastrointestinal tract: in some cases - diarrhea, constipation, nausea, abdominal pain, increased activity of liver enzymes in the blood serum (AST, ALT), hepatitis.
- From the musculoskeletal system: in some cases - muscle weakness, cramps, arthropathy affecting one or more joints (mono- or polyarthritis).
- From the endocrine system: decreased glucose tolerance (with latent diabetes mellitus) and masking of signs of hypoglycemia, in some cases - increased TG levels in the blood, potency disorders.
- On the skin: sometimes - itching, skin hyperemia, increased sweating, rash. When treated with beta-adrenergic receptor blockers, hair loss, hearing impairment or tinnitus, weight gain, mood changes, short-term memory loss, allergic rhinitis, and priapism are observed in some cases.
Nebilong N tab 12.5mg/5mg N30 (Micro Labs)
The withdrawal of beta-blockers should be carried out gradually over 10 days (up to 2 weeks in patients with coronary artery disease). Monitoring blood pressure and heart rate at the beginning of taking the drug should be daily. In elderly patients, monitoring of renal function is necessary (once every 4-5 months). For exertional angina, the selected dose of the drug should ensure the heart rate at rest within the range of 55-60 beats/min, with a load of 110 beats/min. Patients who use contact lenses should take into account that the use of beta-blockers may reduce the production of tear fluid. Nebivolol does not affect plasma glucose concentrations in patients with diabetes mellitus. However, caution should be exercised when treating these patients because nebivolol may mask certain symptoms of hypoglycemia (eg, tachycardia) caused by the use of hypoglycemic agents. Monitoring the concentration of glucose in the blood plasma should be carried out once every 4-5 months (in patients with diabetes mellitus). Beta blockers should be used with caution in patients with COPD as bronchospasm may be increased. In case of hyperfunction of the thyroid gland, the drug neutralizes tachycardia. The effectiveness of beta-blockers in smokers is lower than in non-smoking patients. During therapy with beta-blockers, an exacerbation of psoriasis is possible. Patients with this disease should prescribe Nebilong N with caution. During therapy with Nebilong N, it is necessary to monitor the acid-base status and electrolyte content (potassium, sodium, calcium). During long-term treatment, it is necessary to carefully monitor the clinical symptoms of water-electrolyte imbalances, primarily in patients at high risk: patients with diseases of the cardiovascular system and impaired liver function; in case of severe vomiting or when signs of water-electrolyte imbalance appear, such as dry mucous membrane of the cavity, feeling of thirst, weakness, lethargy, drowsiness, anxiety, muscle pain or cramps, muscle weakness, arterial hypotension, oliguria, tachycardia, complaints from the side Gastrointestinal tract. Hypokalemia can be avoided by the use of potassium-containing drugs or foods rich in potassium (fruits, vegetables), especially in the case of increased potassium loss (increased diuresis, prolonged treatment or concomitant treatment with cardiac glycosides or corticosteroid drugs. Thiazides have been shown to increase the excretion of magnesium by the kidneys: this can lead to hypomagnesemia. With reduced renal function, monitoring of creatinine clearance is necessary. In such patients, the drug can cause azotemia, and cumulative effects may develop. If renal dysfunction is obvious, with the onset of oliguria, the possibility of discontinuing the drug should be considered. Patients with impaired liver function or with progressive liver diseases, thiazides are prescribed with caution, since a slight disturbance of the water-electrolyte balance, as well as the ammonium content in the blood serum, can cause hepatic coma.In patients with peripheral circulatory disorders, caution must be exercised when prescribing the drug Nebilong N. Alcohol, barbiturates, and narcotic drugs increase orthostatic hypotensive effect of thiazide diuretics. Thiazides can reduce the amount of iodine bound to serum proteins without showing signs of thyroid dysfunction (due to hydrochlorothiazide). Patients with pheochromocytoma should not be prescribed Nebilong N until treatment with alpha-blockers has been prescribed. In this case, it is necessary to control blood pressure. It is recommended to discontinue therapy with Nebilong N if depression caused by taking a beta-blocker (due to the content of nebivolol) develops. Particular attention is required in cases of surgery under general anesthesia in patients taking beta-blockers. Such patients should discontinue Nebilong N 48 hours before surgery and notify the anesthesiologist that the patient is taking Nebilong N. A drug with minimal negative inotropic effect should be selected as a means for general anesthesia. If there is a history of anaphylactic reactions, regardless of the cause of their occurrence, especially during desensitizing therapy, treatment with Nebilong N (due to the content of nebivolol) may increase the risk of allergic reactions and contribute to the development of resistance to treatment with epinephrine (adrenaline) in usual doses Patients with hyperuricemia have an increased risk of developing attacks of exacerbation of gout. In this case, the dose of Nebilong N should be selected individually under the control of the concentration of uric acid in the blood serum. Before studying the function of the parathyroid glands, treatment with Nebilong N must be stopped, since transient hypercalcemia may occur while taking it. Effect on the ability to drive vehicles and operate machinery. During therapy, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Concor during pregnancy
Reception during pregnancy is limited
Expectant mothers should be extremely careful when choosing certain medications. In the case of Concor, you can take it only if the benefit to the mother’s body is greater than the damage. Concor should not be taken during lactation, since the baby receives bisoprolol and auxiliary components through breast milk. If discontinuation of the drug is not possible, then breastfeeding should be discontinued.
Interaction with other drugs and alcohol
Combination of Concor with other medications
The instructions for the drug Concor describe in some detail the compatibility with other drugs, because there is a list of drugs with which the Concor tandem is prohibited. Concor can be used in conjunction with analogues and generics, but such a combination must be discussed with your doctor so that an overdose does not occur and the blood pressure does not drop below normal levels.
Concor and Amlodipine
Amplodipine is an antihypertensive drug used for high blood pressure. The attending physician may prescribe a similar tandem if he believes that Concor will be ineffective. It is worth remembering that patients with heart failure cannot take Amplodipine and Concor together.
Concor and Arifon
Arifon - a diuretic indapamide - in combination with the beta blocker Concor is an effective complex in the treatment of hypertension. Concor lowers blood pressure, and Arifon reduces the volume of circulating blood, thus protecting the patient from signs of heart failure.
But Arifon has a side effect - it flushes potassium from the body, which can cause hypokalemia.
Concor and Lozap
The active substance of the drug Lozap, losartan potassium, is intended for the treatment of arterial hypertension. That is, it does not allow peripheral vessels to spasm and thereby does not allow blood pressure to rise. Concor and Lozap enhance each other's effects. Concor works to reduce cardiac output, while Lozap dilates arterioles and reduces peripheral pressure. As a result, blood pressure returns to normal.
The combination of drugs Concor and Lozap is most effective when the degree of arterial hypertension is quite high, and treatment with one drug is not so effective.
Concor and Enap
The simultaneous use of Concor and Enap or Enalapril, which are based on the same active ingredient - enalapril, should be prescribed with caution, since the drugs can enhance the effect of each other. So, the instructions say: with the simultaneous use of beta-blockers, methyldopa, nitrates, calcium channel blockers, hydralazine, prazosin, the antihypertensive effect may be enhanced. That is, blood pressure that was already reduced with the help of the drug Concor can decrease further.
Enap is good for kidney disease, excess weight and a history of diabetes. Concor is indicated for use in patients with heart rhythm disturbances, tachycardia, and frequent attacks of angina. But if the resting heart rate is 50 - 60 beats/min, and there are conduction blockades, then you should take Enap, since Concor will only worsen these conditions.
The combined use of Concor and Enalapril lowers blood pressure and slows the progression of complications from the heart and kidneys. If you experience constant weakness, dizziness and fatigue during use, you should immediately inform your doctor.
Concor and Prestarium
Like all other ACE inhibitors, Prestarium combines well with the β1-blocker Concor. They are prescribed in tandem for high blood pressure, when the use of one drug is ineffective, reducing the risk of fatal complications for people with heart failure, obesity, diabetes, and chronic kidney disease.
But the decision to prescribe the combination Concor + Prestarium is made by the attending physician.
Prestarium itself is not as effective a medicine as Concor. If the pressure is 180/105 mmHg. Art., then it must be taken in combination with other drugs for hypertension.
Concor and Moxonidine
Concomitant use of Moxonidine with β-blockers such as Concor is not recommended. This can lead to a decrease in myocardial contractility and increased bradycardia
Concor and Lorista
Lorista is a generic version of the drug Lozap. That is, it contains the same active ingredient as the original drug, but it has not passed all stages of clinical trials. Generic status makes medicines cheaper without losing their properties. Lorista contains valsartan, a drug belonging to the group of sartans, which are prescribed for the development of a dry cough due to ACE inhibitors. The combination of Concor and Lorista is inferior in strength to the combination of Concor and any ACE inhibitor, since Lorista does not reduce the risk of complications of coronary artery disease.
NEBILONG
Interaction
Floctafenine: in case of shock or hypotension;
caused by taking floctafenine, beta-blockers weaken the compensatory mechanisms of the cardiovascular system. Sultopride; increased risk of ventricular arrhythmia, especially of the “pirouette” type.
With the simultaneous use of beta-blockers with blockers of “slow” calcium channels (SCBC) (verapamil and diltiazem), the negative effect on myocardial contractility and AV conductivity increases. IV administration of verapamil is contraindicated while using nebivolol.
When nebivolol is used simultaneously with antihypertensive drugs, nitroglycerin or BMCC, severe arterial hypotension may develop (special caution is required when combined with prazosin). When used simultaneously with antiarrhythmic drugs, the risk of cardiodepressive effects and bradycardia increases when combined with any antiarrhythmic drug. With amiodarone, the risk of atrioventricular block also increases. The risk of sotalol-induced ventricular arrhythmia is increased by amiodarone, dronedarone, procainamido and quinidine (avoid concomitant use).
With simultaneous use of nebivolol with cardiac glycosides, there was no increase in the effect on slowing down AV conduction.
The simultaneous use of nebivolol and drugs for general anesthesia could cause suppression of reflex tachycardia and increase the risk of developing arterial hypotension.
There is no clinically significant interaction between nebivolol and nonsteroidal anti-inflammatory drugs (NSAIDs). Acetylsalicylic acid as an antiplatelet agent can be used simultaneously with nebivolol.
Glucocorticosteroids and estrogens, gestagens weaken the antihypertensive effect of beta-blockers.
The simultaneous use of tricyclic antidepressants, barbiturates and phenothiazine ethanol derivatives, anxiolytics, and hypnotics may enhance the antihypertensive effect of nebivolol.
Allergens used for immunotherapy or allergen extracts for skin testing increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving nebivolol.
Iodine-containing radiocontrast agents for intravenous administration increase the risk of anaphylactic reactions.
Pharmacokinetic interaction.
When used simultaneously with drugs that inhibit serotonin reuptake, or other drugs that are biotransformed with the participation of the CYP2D6 isoenzyme, the metabolism of nebivolol is slowed down, which may lead to the risk of developing bradycardia.
With simultaneous use, nebivolol had no effect on the pharmacokinetic parameters of digoxin:
When used simultaneously with cimetidine, the concentration of nebivolol in the blood plasma increases (there are no data on the effect on the pharmacological effects of the drug). Concomitant use of ranitidine had no effect on the pharmacokinetic parameters of nebivolol.
Rifampin increases the metabolism of nebivolol.
With simultaneous use of nebivolol with nicardipine, the concentrations of active substances in the blood plasma increased slightly, but this does not have clinical significance.
Concomitant administration of ethanol, furosemide, or hydrochlorothiazide did not affect the pharmacokinetics of nebivolol.
There is no clinically significant interaction between nebivolol and warfarin.
When used concomitantly, sympathomimetic agents inhibit the activity of nebivolol.
When nebivolol is used together with insulin and oral hypoglycemic agents, the symptoms of hypoglycemia (tachycardia, tremor) may be masked.
Concor and alcohol
Drinking alcohol with Concor
It is known that when drinking alcohol, blood vessels dilate for a short time, that is, the heartbeat accelerates. True, after a short amount of time the opposite happens - vasospasm. And a sharp rise in blood pressure is not the most pleasant, but also not the most dangerous, thing that can await a patient taking Concor. The instructions directly state that Concor and alcohol are incompatible. The central nervous system is depressed, and the patient’s psychomotor abilities deteriorate. Also, do not forget that the medicine and alcohol will be excreted through one excretory system - the kidneys. This can lead to organ damage, and in some cases functional impairment may develop. Internal bleeding may begin, a hypertensive crisis, pulmonary edema, and vascular collapse may begin. But the worst result of taking Concor and alcohol together is death.
Therefore, doctors strongly recommend that you stop drinking alcohol while taking Concor.
Analogs
When choosing analogues, it is important to understand that each of them has its own indications for use, side effects, contraindications, active substances, etc. It is important to consult a doctor and not change the drug yourself.
Which is better: Concor, Bisoprolol, Coronal?
All of these drugs contain the same active substance - bisoprolol. They have similar contraindications and indications for use.
Bisoprolol is used to treat arterial hypertension, tachycardic heart rhythm disorders, ischemia, heart failure and various forms of arrhythmia. It is considered antihypertensive and lowers blood pressure. Patients whose blood pressure is 90 mm or lower (hypotension) are prohibited from taking Bisoprolol. It is easier to tolerate by patients and there is less risk of complications when taking it. This applies to diabetes mellitus, respiratory tract diseases, and hypotension.
Coronal is a generic drug Concor, that is, it has the same spectrum of pharmacological action as the original drug, but differs in strength. Coronal also reduces pain and blood pressure, improves blood supply to the heart muscle, and normalizes heart rhythm. But Coronal does not have such a noticeable effect on the patient’s heart rate.
Which is better: Concor, Betalok Zok, Betalok or Egilok?
The active ingredient in the drugs Betalok ZOK, Betalok and Egilok is the same - metoprolol.
The effectiveness of Concor and Betaloc ZOK in reducing blood pressure and stopping attacks of tachycardia is the same. The duration of the therapeutic effect lasts more than a day. But only a cardiologist has the right to prescribe Concor or Betaloc ZOK, having studied the risk factors, medical history and individual sensitivity of the patient to the components of the drug.
Betaloc is a medicine for hypertension, angina and heart failure. Today it is considered obsolete. He was replaced by Betalok ZOK.
Egilok, like Concor, is effective for high blood pressure, but since the active components are different, there are differences. Compared to Concor, Egilok acts very quickly (15-20 minutes after taking the tablet), but this means that the duration of the therapeutic effect is not so long. The drug should be taken two to three times a day during or after meals.
Which is better: Concor, Nebivolol or Nebilet?
The drugs have a positive effect on the heart with high blood pressure, chronic heart failure, ischemia, tachycardia, but Nebilet and its almost complete analogue Nebivolol are based on the active component - nebivolol, which is capable of dilating peripheral vessels and reducing cardiac output. This adds to its effectiveness as an antihypertensive agent.
The active substance nebivolol promotes the production of nitric oxide, which relaxes blood vessels for a longer period. Unlike Concor, it does not contribute to the patient’s weight gain. Since nebivolol dilates blood vessels, it acts faster, but the effect does not last long.
Nebilet and differing from it solely in the degree of purification and, accordingly, in price, Nebivolol is also used for hypertension and coronary heart disease. But it is contraindicated in patients with low blood pressure, cardiogenic shock, severe heart failure, diseases of the respiratory system and liver. Not for use by children, pregnant and lactating women. Treatment should not be started if you have diabetes, thyroid dysfunction, psoriasis or in old age. Concor is safer for the elderly, children and patients with breathing problems.
Concor or Sotahexal
The active ingredient in Sotahexal, sotalol hydrochloride, copes well with arrhythmia and lowers blood pressure. Contraindicated for use in patients with hypotension.
Sotahexal can cause side effects in the form of bronchospasms, disorders of carbohydrate and lipid metabolism.
Concor, compared to Sotahexal, is easier to tolerate and more effective for patients suffering from chronic heart failure. Also, Concor has a lower risk of complications. This applies to diabetes mellitus (Sotahexal increases hypoglycemia), respiratory diseases, and hypotension. But Sotahexal is more often prescribed for arrhythmic disorders.
Concor or Anaprilin
Anaprilin is a “veteran” of beta-blockers. Time-tested drug. However, since it affects not only the adrenergic receptors of the heart muscle, side effects and dangerous complications develop much more often when taking anaprilin. Therefore, cardiologists advise using new generation beta-blockers, for example, Concor.
Take care of your heart and blood vessels.
Be healthy!
Nebilong N
Nebivolol
Pharmacodynamic interaction
The simultaneous use of nebivolol with floctafenine is contraindicated, as there is a risk of developing severe arterial hypotension or shock.
The simultaneous use of nebivolol and sultopride is contraindicated, as the risk of ventricular arrhythmia, especially ventricular tachycardia of the “pirouette” type, increases.
Combinations not recommended
When used simultaneously with class I antiarrhythmic drugs (quinidine, hydroquinidine, cibenzoline, flecainide, disopyramide, lidocaine, mexiletine, propafenone), the negative inotropic effect may be enhanced and the conduction time through the atrioventricular node may be prolonged.
With the simultaneous use of beta-blockers with blockers of “slow” calcium channels (SCBC) (verapamil and diltiazem), the negative effect on myocardial contractility and AV conductivity increases.
IV administration of verapamil is contraindicated while taking nebivolol.
When used simultaneously with centrally acting antihypertensive drugs (clonidine, guanfacine, moxonidine, methyldopa, rilmenidine), the course of heart failure may worsen due to a decrease in sympathetic tone (decreased heart rate and cardiac output, symptoms of vasodilation). In case of abrupt withdrawal of these drugs, especially before discontinuation of nebivolol, the development of “rebound” arterial hypertension is possible.
Combinations to use with caution
When used simultaneously with class III antiarrhythmic drugs (amiodarone), the effect on conduction time through the atrioventricular node may be enhanced.
The simultaneous use of nebivolol and general anesthesia may suppress reflex tachycardia and increase the risk of arterial hypotension.
When nebivolol is used simultaneously with insulin and oral hypoglycemic agents, the symptoms of hypoglycemia (palpitations, tachycardia) may be masked.
Concomitant use of nebivolol with baclofen and amifostine leads to increased arterial hypotension.
Combinations to Consider
With simultaneous use of nebivolol with cardiac glycosides, atrioventricular conduction may slow down.
Nebivolol does not affect the pharmacokinetic parameters of digoxin.
The simultaneous use of nebivolol and dihydropyridine BMCC (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nitrendipine) may increase the risk of arterial hypotension. An increased risk of further reduction in myocardial contractility in patients with heart failure cannot be excluded.
When combined with antihypertensive drugs, nitroglycerin, severe arterial hypotension may develop (special caution is required when combined with prazosin).
The simultaneous use of tricyclic antidepressants, barbiturates and phenothiazine derivatives may enhance the antihypertensive effect of nebivolol.
There is no clinically significant interaction between nebivolol and nonsteroidal anti-inflammatory drugs (NSAIDs).
Acetylsalicylic acid as an antiplatelet agent can be used simultaneously with nebivolol.
When used concomitantly, sympathomimetic agents inhibit the pharmacological activity of nebivolol.
Pharmacokinetic interaction
When used simultaneously with drugs that inhibit serotonin reuptake, or other drugs that are biotransformed with the participation of the CYP2D6 isoenzyme (for example, paroxetine, fluoxetine, thioridazine, quinidine), the metabolism of nebivolol slows down, its concentration in the blood plasma increases, which may lead to an increased risk of developing severe bradycardia and adverse events.
When used simultaneously with cimetidine, the concentration of nebivolol in the blood plasma increases (there are no data on the effect on the pharmacological effects of the drug).
Concomitant use of ranitidine had no effect on the pharmacokinetic parameters of nebivolol.
With simultaneous use of nebivolol with nicardipine, the concentrations of active substances in the blood plasma increase slightly, but this does not have clinical significance.
Concomitant use of ethanol, furosemide or hydrochlorothiazide does not affect the pharmacokinetics of nebivolol.
No clinically significant interaction between nebivolol and warfarin has been established.
Hydrochlorothiazide
Combinations not recommended
— With lithium preparations (renal clearance of lithium decreases, its toxicity increases).
- It is recommended to periodically monitor the potassium level in the blood serum and ECG during simultaneous use with cardiac glycosides and drugs that prolong the QT interval (risk of developing ventricular tachycardia of the “pirouette” type).
- Corticosteroids, ACTH (adrenocorticotropic hormone) or glycyrrhizic acid (found in licorice root) - a marked decrease in electrolytes, in particular, the risk of hypokalemia.
- Amphotericin B (for intravenous administration), stimulant laxatives - hydrochlorothiazide may increase electrolyte imbalance, especially hypokalemia.
Combinations to use with caution
- Salicylates - when taking high doses of salicylates, hydrochlorothiazide can enhance their toxic effect on the central nervous system.
- Other drugs (eg, cisapride, difemanil methyl sulfate, erythromycin intravenous, halofantrine, ketaxerine, mizolastine, sparfloxacin, terfenadine, vincamine intravenous).
- NSAIDs (including cyclooxygenase-2 (COX-2) inhibitors) - may reduce the diuretic, natriuretic and antihypertensive effect of diuretics.
In some patients with impaired renal function (eg, elderly or dehydrated patients, including those taking diuretics) receiving NSAID therapy, including COX-2 inhibitors, treatment with angiotensin II receptor antagonists or angiotensin-converting enzyme (ACE) inhibitors may cause further deterioration of kidney function, including the development of acute renal failure. These effects are reversible. The simultaneous use of these drugs should be used with caution in patients with impaired renal function.
- I A class of antiarrhythmic drugs (for example, quinidine, disopyramide);
- Class III antiarrhythmic drugs (for example, amiodarone, dofetilide) and sotalol;
- some antipsychotics (for example, thioridazine, chlorpromazine, levomepromazine, trifluoperazine, sulpiride, amisulpride, tiapride, haloperidol, droperidol);
- cardiac glycosides (hypokalemia and hypomagnesemia associated with the action of thiazide diuretics) can increase the toxicity of cardiac glycosides;
- non-depolarizing muscle relaxants (their effect may be enhanced);
- metformin should be used with caution due to the risk of developing lactic acidosis due to impaired renal function caused by hydrochlorothiazide;
- amantadine (the clearance of amantadine may be reduced by hydrochlorothiazide, which leads to an increase in the concentration of amantadine in the blood plasma and possible toxicity);
- pressor amines (for example, epinephrine (adrenaline), norepinephrine (norepinephrine)) - decrease in the severity of the response to taking pressor amines;
- antihypertensive drugs (their effect is potentiated, there may be a need for dose adjustment);
- hypoglycemic agents for oral administration and insulin (their effectiveness decreases, hyperglycemia may develop), dose adjustment of hypoglycemic agents may be required;
- medicines used to treat gout (probenecid, sulfinpyrazone and allopurinol): dose adjustment of uricosuric drugs may be required, since hydrochlorothiazide may cause an increase in serum uric acid concentrations. Thiazide diuretics may increase the incidence of increased reactions; simultaneous use of cyclosporine increases the risk of hyperuricemia and exacerbation of gout;
- cardiac glycosides, hypokalemia and hypomagnesemia caused by the use of thiazide diuretics, increases the risk of developing arrhythmias during treatment with cardiac glycosides;
- ethanol, barbiturates and general anesthesia, which enhance the effect of orthostatic hypotension;
- calcium salts, vitamin D - risk of developing hypercalcemia. If it is necessary to use calcium supplements, the dose is selected under the control of calcium levels in the blood serum;
- anticholinergics (for example, atropine, biperiden): increase the bioavailability of thiazide diuretics by reducing gastrointestinal motility;
- methyldopa: isolated cases of hemolytic anemia have been described with simultaneous use;
- carbamazepine: risk of developing symptomatic hyponatremia;
- anxiolytics and hypnotics - increased antihypertensive effect;
- antifungal agents increase the risk of hypokalemia if thiazides are used in combination with amphotericin B, fluconozole Cmax increases;
- theophylline - increases the risk of hypokalemia;
- iodine-containing contrast agents - with dehydration caused by taking diuretics, the risk of acute renal failure increases, especially when high doses of iodine-containing drugs are administered. Before administering such drugs, the patient must be rehydrated.
Pharmacokinetic interactions
- cholestyramine and colestipol - in the presence of anion exchange resins, the absorption of hydrochlorothiazide is impaired. Cholestyramine and colestipol in a single dose bind hydrochlorothiazide and reduce its absorption in the gastrointestinal tract by 85% and 43%, respectively;
- cytostatic agents, for example, cyclophosphamide, methotrexate, fluorouracil: the myelosuppressive effect increases by slowing elimination from the body.
