Aritel, 5 mg, film-coated tablets, 30 pcs.
Patients should not interrupt treatment with the drug abruptly and change the recommended dose without first consulting a doctor, because this may lead to a temporary deterioration in heart function.
Treatment should not be interrupted suddenly, especially in patients with coronary artery disease. If discontinuation of treatment is necessary, the dose should be reduced gradually.
Monitoring of patients taking bisoprolol should include monitoring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), ECG, blood glucose concentration in patients with diabetes (once every 4-5 months). In elderly patients, it is recommended to monitor renal function (once every 4–5 months). The patient should be taught how to calculate heart rate and instructed about the need for medical consultation if the heart rate is less than 50 beats/min.
Before starting treatment, it is recommended to conduct a study of external respiratory function in patients with a burdened bronchopulmonary history.
In approximately 20% of patients with angina, β-blockers are ineffective. The main causes are severe coronary atherosclerosis with a low ischemic threshold (heart rate less than 100 beats/min) and increased end-diastolic volume of the left ventricle, impairing subendocardial blood flow.
In smokers, the effectiveness of β-blockers is lower.
Patients using contact lenses should take into account that during treatment the production of tear fluid may decrease.
When used in patients with pheochromocytoma, there is a risk of developing paradoxical arterial hypertension (if effective α-blockade is not previously achieved).
In hyperthyroidism, the drug may mask certain clinical signs of thyroid hyperfunction, such as tachycardia. Abrupt withdrawal of the drug in patients with hyperthyroidism is contraindicated, as it can increase symptoms.
In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose to normal levels.
When taking clonidine simultaneously, it can be discontinued only a few days after discontinuation of Aritel® and Aritel® Cor.
It is possible that the severity of hypersensitivity reactions and the lack of effect from usual doses of epinephrine (adrenaline) may increase against the background of a burdened allergological history.
If planned surgical treatment is necessary, the drug should be discontinued 48 hours before general anesthesia. If the patient took the drug before surgery, he should select a drug for general anesthesia with minimal negative inotropic effect. The anesthesiologist should be warned that the patient is taking Aritel® or Aritel® Cor.
Reciprocal activation of the vagus nerve can be eliminated by intravenous atropine (1–2 mg).
Drugs that reduce the reserves of catecholamines (including reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect arterial hypotension or bradycardia. Patients with bronchospastic diseases can be prescribed cardioselective blockers in case of intolerance and/or ineffectiveness of other antihypertensive drugs, but the dosage should be strictly monitored. An overdose is dangerous due to the development of bronchospasm.
In case of increasing bradycardia (less than 50 beats/min), arterial hypotension (SBP below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe liver and kidney dysfunction in elderly patients, it is necessary to reduce the dose or stop treatment.
It is recommended to discontinue therapy if depression caused by taking β-blockers develops.
Treatment should not be abruptly interrupted due to the risk of developing severe arrhythmias and myocardial infarction. Cancellation is carried out gradually, reducing the dose over 2 weeks or more (reduce the dose by 25% in 3-4 days).
Should be discontinued before testing the content of catecholamines, normetanephrine and vanillylmandelic acid in the blood and urine; antinuclear antibody titers.
Impact on the ability to drive vehicles or perform work that requires increased speed of physical and mental reactions.
During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Aritel® Plus (Arital® Plus)
With the simultaneous use of the drug Aritel® Plus with phenytoin (with intravenous administration) and drugs for inhalation general anesthesia (hydrocarbon derivatives), the severity of the cardiodepressive effect and the likelihood of an excessive decrease in blood pressure (due to the content of bisoprolol in the drug) may increase.
The clearance of lidocaine and xanthines may decrease due to a possible increase in their concentrations in the blood plasma, especially in patients with an initially increased clearance of theophylline (due to the content of bisoprolol in the drug).
With the simultaneous use of calcium and/or vitamin D preparations in high doses, hypercalcemia may develop and the risk of metabolic acidosis increases (due to the content of hydrochlorothiazide in the preparation).
Aritel® Plus is contraindicated for use in combination with floctafenine, sultopride, MAO inhibitors (except for MAO type B inhibitors).
It is possible to enhance the hypotensive effect of the drug Aritel® Plus when used simultaneously with antidepressants, neuroleptics, blockers of “slow” calcium channels (SCBC) (amlodipine, felodipine, nifedipine, nicardipine, nimodipine, nitrendipine), angiotensin-converting enzyme inhibitors (incl. captopril, enalapril), irbesartan, diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs.
The hypotensive effect of Aritel® Plus may be weakened when administered simultaneously with glucocorticosteroids (for systemic use), estrogens, non-steroidal anti-inflammatory drugs (indomethacin, piroxicam, naproxen, phenylbutazone) and tetracosactide.
When used simultaneously with Aritel® Plus, the effect of non-depolarizing muscle relaxants and the anticoagulant effect of coumarin derivatives may be enhanced.
Cardiac glycosides, methyldopa, reserpine, guanfacine, BMCC (verapamil, diltiazem, amlodipine, felodipine, nifedipine, nicardipine, nimodipine, nitrendipine), antiarrhythmic drugs, as well as drugs that can initiate arrhythmias (astemizole, bepridil, erythromycin, halofantrine, pentamidine, sparfloxacin, terfenadine), increase the risk of developing and/or worsening bradycardia, atrioventricular block and chronic heart failure. When used simultaneously with sotalol, hypokalemia and the development of ventricular arrhythmias are possible.
With the simultaneous use of Aritel® Plus with lithium salts, the concentration of the latter in the blood may increase to a toxic level.
The effectiveness of insulin and oral hypoglycemic agents may be reduced.
Non-hydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders.
When using the drug Aritel® Plus simultaneously with allergens used for immunotherapy, or with allergen extracts for skin tests, as well as with allopurinol or with iodine-containing X-ray diagnostic agents for intravenous administration, the risk of developing allergic reactions increases.
When Aritel® Plus is co-administered with mefloquine, bradycardia may develop; with carbamazepine - hyponatremia; with cyclosporine - an increase in serum creatinine is possible.
Sulfasalazine increases the concentration of bisoprolol in the blood plasma; rifampicin - shortens the half-life of bisoprolol.
ARITEL KOR
special instructions
Do not abruptly interrupt treatment with the drug or change the recommended dose without first consulting your doctor, as this may lead to a temporary deterioration in heart function.
Treatment should not be interrupted suddenly, especially in patients with coronary heart disease. If discontinuation of treatment is necessary, the dose should be reduced gradually. Monitoring of patients taking bisoprolol should include monitoring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), ECG, blood glucose concentration in patients with diabetes (once every 4-5 months). In elderly patients, it is recommended to monitor renal function (once every 4-5 months). The patient should be taught how to calculate heart rate and instructed about the need for medical consultation if the heart rate is less than 50 beats/min.
Before starting treatment, it is recommended to conduct a study of external respiratory function in patients with a burdened bronchopulmonary history.
In approximately 20% of patients with angina, beta blockers are ineffective. The main causes are severe coronary atherosclerosis with a low ischemic threshold (heart rate less than 100 beats/min) and increased end-diastolic volume of the left ventricle, impairing subendocardial blood flow.
In smokers, the effectiveness of beta-blockers is lower.
Patients using contact lenses should take into account that during treatment the production of tear fluid may decrease.
When used in patients with pheochromocytoma, there is a risk of developing paradoxical arterial hypertension (if effective alpha-blockade is not previously achieved).
In hyperthyroidism, the drug may mask certain clinical signs of hyperthyroidism (hyperthyroidism), for example, tachycardia. Abrupt withdrawal of the drug in patients with hyperthyroidism is contraindicated, as it can increase symptoms.
In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose to normal levels.
When taking clonidine concomitantly, it can be discontinued only a few days after stopping the drug Aritel® Cor.
It is possible that the severity of hypersensitivity reactions may increase and there will be no effect from usual doses of epinephrine (adrenaline) against the background of a burdened allergological history.
If planned surgical treatment is necessary, the drug should be discontinued 48 hours before general anesthesia. If the patient took the drug before surgery, he should choose a drug for general anesthesia with minimal negative inotropic effect. You should notify your anesthesiologist that you are taking Aritel® Cor. Reciprocal activation of the vagus nerve can be eliminated by intravenous atropine (1-2 mg).
Medicines that reduce the supply of catecholamines (including reserpine) may enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect arterial hypotension or bradycardia. Patients with bronchospastic diseases can be prescribed cardioselective blockers in case of intolerance and/or ineffectiveness of other antihypertensive drugs, but the dose should be strictly monitored. An overdose is dangerous due to the development of bronchospasm.
If patients develop increasing bradycardia (less than 50 beats/min), arterial hypotension (systolic blood pressure below 100 mm Hg), atrioventricular block, bronchospasm, ventricular arrhythmias, severe liver and kidney dysfunction, it is necessary to reduce the dose or discontinue treatment. It is recommended to discontinue therapy if depression caused by taking beta-blockers develops.
Treatment should not be abruptly interrupted due to the risk of developing severe arrhythmias and myocardial infarction. Cancellation is carried out gradually, reducing the dose over 2 weeks or more (reduce the dose by 25% in 3-4 days).
Should be discontinued before testing the content of catecholamines, normetanephrine and vanillinmandelic acid in the blood and urine; antinuclear antibody titers.
