Concor Cor, 30 pcs., 2.5 mg, film-coated tablets

Pharmacological properties of the drug Concor cor

Bisoprolol (INN - bisoprololum) is a selective β1-adrenergic receptor blocker. When used in therapeutic doses, it does not have BSA and clinically significant membrane-stabilizing properties. Reduces plasma renin activity, reduces myocardial oxygen demand, and reduces heart rate (at rest and during exercise). By blocking β1-adrenergic receptors of the heart in low doses, it reduces the catecholamine-stimulated formation of cAMP from ACE, reduces the intracellular current of calcium ions, and has a negative chrono-, dromo- and inotropic effect (inhibits conduction excitability, slows down AV conduction). The antianginal effect is due to a decrease in myocardial oxygen demand as a result of a decrease in heart rate, a slight decrease in contractility, prolongation of diastole, and improved myocardial perfusion. When increasing the dose above the therapeutic one, it has a β2-adrenergic blocking effect. Concor Cor has a hypotensive effect due to a decrease in cardiac output, inhibition of renin secretion by the kidneys, as well as an effect on the baroreceptors of the aortic arch and carotid sinus. In case of hypertension (arterial hypertension), the effect occurs after 2–5 days, stable effect occurs after 1–2 months. With prolonged use, bisoprolol reduces increased peripheral vascular resistance. When used in average therapeutic doses, in contrast to non-selective β-blockers, it has a less pronounced effect on organs containing β2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism, does not cause delay sodium ions (Na+) in the body. The severity of the atherogenic effect does not differ from the effect of propranolol. After taking the drug orally, bisoprolol is well absorbed from the gastrointestinal tract. Bioavailability is about 90% and is independent of food intake. The maximum concentration is reached after 1–3 hours. Binding to blood plasma proteins is about 30%. The effect of primary passage through the liver is insignificant (about 10%). About 50% of bisoprolol is biotransformed in the liver with the formation of inactive metabolites. The main metabolites found in blood plasma and urine do not exhibit pharmacological activity. The pharmacokinetics of bisoprolol is linear. Its concentration in blood plasma is proportional to the administered dose in the dose range from 5 to 20 mg. The maximum concentration in blood plasma is reached after 2–3 hours. Bisoprolol is distributed quite widely. The volume of distribution is 3.5 l/kg. Communication with blood plasma proteins is about 35%. The total clearance is 15.6 ± 3.2 l/h, with renal clearance being 9.6 ± 1.6 l/h. The half-life is 10–12 hours. Approximately 98% is excreted from the body in the urine, 50% unchanged, the rest in the form of metabolites, approximately 2% of the dose is excreted in the feces. No dose adjustment is required for patients with mild to moderate hepatic or renal impairment.

Concor Cor tablets 2.5 mg 30 pcs. in St. Petersburg

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Concor® Cor tablets should be taken once a day with a small amount of liquid in the morning before, during or after breakfast. The tablets should not be chewed or crushed into powder.

The standard treatment regimen for CHF includes the use of ACE inhibitors or angiotensin II receptor antagonists (in case of intolerance to ACE inhibitors), β-blockers, diuretics and, optionally, cardiac glycosides. Initiation of treatment for CHF with Concor® Cor requires a special titration phase and regular medical supervision.

The precondition for treatment with Concor® Cor is stable CHF without signs of exacerbation.

Treatment of CHF with Concor® Cor begins in accordance with the following titration scheme. Individual adaptation may be required depending on how well the patient tolerates the prescribed dose, i.e. the dose can only be increased if the previous dose was well tolerated.

The recommended starting dose is 1.25 mg once daily. Depending on individual tolerance, the dose should be gradually increased to 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg once a day. Each subsequent dose increase should be carried out at least 2 weeks later.

If increasing the dose of the drug is poorly tolerated by the patient, a dose reduction may be possible.

The maximum recommended dose for the treatment of CHF is 10 mg of Concor® Cor 1 time per day.

During titration, regular monitoring of blood pressure, heart rate and the severity of CHF symptoms is recommended. Worsening of the symptoms of CHF is possible already from the 1st day of using the drug.

If the patient does not tolerate the maximum recommended dose of the drug, a gradual dose reduction should be considered.

During the titration phase or after it, temporary worsening of CHF, arterial hypotension or bradycardia may occur. In this case, it is recommended, first of all, to adjust the doses of concomitant therapy drugs. It may also be necessary to temporarily reduce the dose of Concor® Cor or discontinue it.

After stabilization of the patient's condition, the dose should be re-titrated or treatment should be continued.

Duration of treatment

Treatment with Concor® Cor is usually long-term therapy.

Special patient groups

Impaired kidney or liver function:

- if there is mild or moderate impairment of liver or kidney function, dosage adjustment is usually not required;

- in case of severe renal dysfunction (Cl creatinine <20 ml/min) and in patients with severe liver diseases, the maximum daily dose is 10 mg; increasing the dose in such patients should be carried out with extreme caution.

Elderly patients:

no dose adjustment is required.

Children:

Since there is not enough data on the use of Concor® Cor in children, it is not recommended to prescribe the drug to children under 18 years of age.

To date, there is insufficient data on the use of Concor® Cor in patients with CHF in combination with type 1 diabetes mellitus, severe renal and/or liver dysfunction, restrictive cardiomyopathy, congenital heart defects or heart valve disease with severe hemodynamic disturbances. Also, sufficient data have not yet been obtained regarding patients with CHF with myocardial infarction within the last 3 months.

Use of the drug Concor cor

The tablets should be taken with a small amount of liquid in the morning before, during or after breakfast. The tablets should not be chewed or crushed into powder. Initiation of treatment for chronic heart failure with Concor Cor requires a special titration phase and regular medical supervision. Treatment of chronic heart failure with Concor Cor begins in accordance with the following titration scheme. Individual adaptation may be required depending on how well the patient tolerates the prescribed dose, i.e. the dose can only be increased if the previous dose was well tolerated.

* To ensure the above dosage regimen, it is recommended to use the drug Concor in subsequent stages of treatment.

The maximum recommended dose for the treatment of chronic heart failure is 10 mg of bisoprolol once a day. Patients are advised to take the dose of the drug selected by the doctor, unless adverse reactions occur. After starting treatment with the drug at a dose of 1.25 mg (1/2 t of Concor Cor tablet), the patient should be observed for about 4 hours (monitoring heart rate, blood pressure, conduction disturbances, signs of worsening heart failure). During or after the titration phase, a temporary worsening of heart failure symptoms, fluid retention, hypotension, or bradycardia may occur. In this case, it is recommended, first of all, to pay attention to the selection of the dosage of concomitant basic therapy (optimize the dose of the diuretic and/or ACE inhibitor) before reducing the dosage of Concor Cor. Treatment with Concor Cor should only be interrupted if absolutely necessary. After stabilization of the patient's condition, re-titration should be carried out, or treatment should be continued. No dose adjustment is usually required for patients with mild to moderate hepatic or renal impairment. For patients with a marked decrease in renal function (creatinine clearance less than 20 ml/min) and with severe liver dysfunction, the daily dose should not exceed 10 mg. In any case, the dose is selected individually. Treatment with Concor Cor is usually long-term. If necessary, treatment can be interrupted and resumed subject to certain rules. Treatment should not be interrupted suddenly, especially in patients with coronary artery disease. If discontinuation of treatment is necessary, the dosage of the drug should be reduced gradually.

Concor® Cor

Termination of therapy and “withdrawal syndrome”

You should not abruptly interrupt treatment with bisoprolol 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 artery disease (increased severity of angina attacks, the development of myocardial infarction and the occurrence of ventricular arrhythmias in patients with coronary artery disease with sudden cessation of beta-blockers have been noted). If discontinuation of treatment is necessary, the dose of bisoprolol should be reduced gradually. In case of significant worsening of angina or development of acute coronary syndrome, bisoprolol should be temporarily resumed.

Diseases for which the drug should be used with caution

Bisoprolol should be used with caution in the following cases:

- severe forms of COPD and non-severe forms of bronchial asthma;

- diabetes mellitus with significant fluctuations in blood glucose concentrations: bisoprolol may mask symptoms of hypoglycemia (a marked decrease in blood glucose concentrations), such as tachycardia, palpitations or increased sweating;

- strict diet;

— carrying out desensitizing therapy;

— atrioventricular block of the first degree;

- vasospastic angina (Prinzmetal's angina); cases of coronary spasm have been observed. Despite its high beta1 selectivity, angina attacks cannot be completely excluded when taking bisoprolol in patients with Prinzmetal's angina. You should take the drug with extreme caution;

- mild to moderate peripheral arterial circulation disorders (increased symptoms may occur at the beginning of therapy);

- psoriasis (including history).

Diseases of the cardiovascular system

Beta blockers should not be used in decompensated chronic heart failure until the patient's condition has stabilized.

At the initial stages of using bisoprolol, patients need constant monitoring.

Beta blockers may cause bradycardia. If the resting heart rate decreases to less than 50-55 beats/min, the dose should be reduced or discontinued taking bisoprolol.

Like other beta blockers, bisoprolol may cause a prolongation of the PQ interval on the ECG. Bisoprolol should be used with caution in patients with first degree atrioventricular block.

Non-selective beta-blockers may increase the frequency and duration of anginal attacks in patients with vasospastic angina (Prinzmetal's angina) due to alpha-receptor-mediated coronary artery vasoconstriction. Cardioselective beta1-blockers (including bisoprolol) should be used with caution in vasospastic angina.

To date, there is insufficient data regarding the use of bisoprolol in patients with CHF in combination with type 1 diabetes mellitus, severe renal and/or liver dysfunction, restrictive cardiomyopathy, congenital heart defects or heart valve disease with severe hemodynamic disturbances. Also, sufficient data have not yet been obtained regarding patients with CHF with myocardial infarction within the last 3 months.

Respiratory system

Despite the fact that selective beta-blockers have a lesser effect on the function of the respiratory system than non-selective beta-blockers, patients with chronic obstructive pulmonary disease COPD and mild forms of bronchial asthma should be prescribed bisoprolol with extreme caution and only if possible the benefits of its use outweigh the potential risks. For bronchial asthma or COPD, simultaneous use of bronchodilators is indicated.

In patients with bronchial asthma, there may be an increase in airway resistance, which requires a higher dose of beta2-agonists.

In patients with COPD, bisoprolol prescribed in combination therapy for the treatment of heart failure should be started at the lowest possible dose, and patients should be carefully monitored for the appearance of new symptoms (eg, shortness of breath, exercise intolerance, cough).

Major surgery and general anesthesia

If surgical interventions are necessary, the anesthesiologist should be warned that the patient is taking beta-blockers (risk of drug interactions with the development of severe bradyarrhythmias, reduction of reflex tachycardia and arterial hypotension). It is recommended not to stop taking bisoprolol in the perioperative period unless clearly necessary (since beta-adrenergic receptor blockade reduces the risk of arrhythmias and myocardial ischemia during induction of anesthesia and tracheal intubation). If it is necessary to interrupt treatment with bisoprolol before surgery, the drug should be discontinued at least 48 hours before surgery.

Pheochromocytoma

In patients with pheochromocytoma, bisoprolol can only be prescribed while using alpha-blockers.

Thyrotoxicosis

With hyperthyroidism, beta-blockers (including bisoprolol) can mask tachycardia and reduce the severity of symptoms of thyrotoxicosis. Abrupt withdrawal of the drug can cause exacerbation of symptoms of the disease and the development of thyrotoxic crisis.

Hypersensitivity reactions

Beta blockers, including bisoprolol, may increase sensitivity to allergens and the severity of anaphylactic/hypersensitivity reactions due to decreased adrenergic compensatory regulation by beta blockers. The use of conventional therapeutic doses of egschnephrine (adrenaline) while taking beta-blockers does not always lead to the achievement of the desired clinical effect.

Caution should be exercised when prescribing bisoprolol to patients with a history of severe hypersensitivity reactions or undergoing desensitization.

Psoriasis

When deciding on the use of bisoprolol in patients with psoriasis, the expected benefits of the drug should be carefully weighed against the possible risk of exacerbation of psoriasis.

Contact lenses

Patients who use contact lenses should take into account that the use of beta-blockers may reduce the production of tear fluid.

Contraindications to the use of Concor Cor

Hypersensitivity to bisoprolol or any of the components of the drug and other beta-adrenergic receptor blockers; shock (cardiogenic shock), collapse; AV blockade II–III degree, sick sinus syndrome, severe sinoatrial block, bradycardia (heart rate ≤50 beats/min), Prinzmetal angina; arterial hypotension (systolic blood pressure ≤90 mm Hg), history of severe forms of asthma and COPD; late stages of peripheral circulatory disorders, Raynaud's disease; simultaneous use of MAO inhibitors (except for MAO type B inhibitors), psoriasis (including family history), pheochromocytoma, pregnancy and lactation.

Side effects of the drug Concor cor

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.

Special instructions for the use of the drug Concor cor

Concor Cor should not be used during pregnancy and breastfeeding due to the lack of reliable clinical data confirming the safety of the drug. During pregnancy, Concor Cor should only be recommended if the benefit to the mother outweighs the risk of side effects to the fetus. In exceptional cases, the use of bisoprolol during pregnancy should be discontinued 72 hours before the expected due date due to the possibility of bradycardia, hypoglycemia and respiratory depression in the newborn. If discontinuation of the drug is not possible, then after birth the newborn should be under medical supervision. Symptoms of hypoglycemia may occur during the first 3 days. In some cases, beta-adrenergic receptor blockers may cause the development or exacerbation of psoriasis. In patients taking β-adrenergic blockers, due to weakened adrenergic feedback regulation, anaphylactic reactions may be more severe. Due to the individual nature of reactions to the drug, the ability to drive vehicles or operate machinery may be reduced. To a greater extent, this applies to the initial stage of treatment and changes in the dose of the drug, as well as with the simultaneous use of alcohol. There are no clinical data on the effectiveness and safety of Concor Cor in children.

Concor Cor

Use during pregnancy and breastfeeding

The use of Concor Cor during pregnancy is possible only if the expected benefit to the mother outweighs the potential risk to the fetus.
Beta blockers reduce blood flow to the placenta and may affect fetal development. Blood flow in the placenta and uterus should be closely monitored, as well as the growth and development of the unborn child, and in case of dangerous manifestations in relation to pregnancy or the fetus, alternative therapeutic measures should be taken. The newborn should be carefully examined after birth. In the first 3 days of life, symptoms of decreased blood glucose and heart rate may occur.

There is no data on the excretion of bisoprolol in breast milk or the safety of bisoprolol in infants. If it is necessary to use the drug during lactation, the issue of stopping breastfeeding should be decided.

Use for liver dysfunction

Use the drug with caution in case of liver failure.

Use for renal impairment

The drug should be used with caution in chronic renal failure.

special instructions

The patient should not abruptly interrupt treatment or change the recommended dose without first consulting a doctor, as 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 the condition of patients taking Concor Cor should include measuring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), conducting an ECG, determining blood glucose in patients with diabetes (once every 4-5 months). months). In elderly patients, it is recommended to monitor renal function (once every 4-5 months).

The patient should be trained in the method of calculating heart rate and instructed about the need for medical consultation if heart rate is <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 reasons: severe coronary atherosclerosis with a low ischemic threshold (heart rate <100 beats/min) and increased end-diastolic volume of the left ventricle, impairing subendocardial blood flow.

Beta blockers are less effective in smokers.

Patients who use contact lenses should take into account that during treatment with the drug, the production of tear fluid may decrease.

When using the drug Concor Cor in patients with pheochromocytoma, there is a risk of developing paradoxical arterial hypertension (if effective alpha-blockade is not previously achieved).

In case of thyrotoxicosis, Concor Cor can mask certain clinical signs of thyrotoxicosis (for example, tachycardia). Abrupt discontinuation of the drug in patients with thyrotoxicosis is contraindicated as it can increase symptoms.

In diabetes mellitus, the use of the drug may lead to masking of tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, Concor Cor practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentrations to normal levels.

When using clonidine simultaneously, its use can be discontinued only a few days after discontinuation of the drug Concor Cor.

It is possible that the severity of the hypersensitivity reaction may increase and there will be no effect from usual doses of epinephrine against the background of a burdened allergic 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 effects.

Reciprocal activation of the vagus nerve can be eliminated by intravenous atropine (1-2 mg).

Drugs that deplete catecholamine stores (including reserpine) may enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect a significant decrease in blood pressure or bradycardia.

Patients with bronchospastic diseases can be prescribed cardioselective blockers in case of intolerance and/or ineffectiveness of other antihypertensive drugs. If the dose of Concor Cor is exceeded, there is a risk of developing bronchospasm.

If increasing bradycardia (heart rate <50 beats/min), a pronounced decrease in blood pressure (systolic blood pressure <100 mm Hg), or AV blockade is detected in elderly patients, it is necessary to reduce the dose or discontinue treatment.

It is recommended to discontinue therapy with Concor Cor if depression develops.

Treatment should not be abruptly interrupted due to the risk of developing severe arrhythmias and myocardial infarction. The drug is discontinued gradually, reducing the dose over 2 weeks or more (reduce the dose by 25% in 3-4 days).

The drug should be discontinued before testing the content of catecholamines, normetanephrine, vanillinmandelic acid, and antinuclear antibody titers in the blood and urine.

Impact on the ability to drive vehicles and operate machinery

Bisoprolol does not affect the ability to drive a car in a study of patients with coronary artery disease. However, due to individual reactions, the ability to drive a car or work with technically complex mechanisms may be impaired. Particular attention should be paid to this at the beginning of treatment, after changing the dose, and also when consuming alcohol at the same time.

Interactions of the drug Concor cor

With simultaneous use, Concor Cor may enhance the effect of antihypertensive drugs. With the simultaneous use of bisoprolol and reserpine, methyldopa, clonidine or guanfacine, a sharp decrease in heart rate is possible. When Concor Cor is used together with clonidine, digitalis preparations, and guanfacine, cardiac conduction disorders may develop. When Concor is used together with verapamil or diltiazem and other antiarrhythmic drugs, a decrease in blood pressure is possible, and the risk of developing or worsening bradycardia, AV block, cardiac arrest and heart failure increases (IV administration of calcium channel blockers and antiarrhythmic drugs during Concor therapy should be avoided Cor).Nifedipine can lead to a significant decrease in blood pressure. Phenytoin with intravenous administration and drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressive effect and the likelihood of a decrease in blood pressure when used while taking bisoprolol. The effectiveness of insulin and oral hypoglycemic drugs may change during treatment with Concor Cor (masks the symptoms of developing hypoglycemia: tachycardia, increased blood pressure). The clearance of lidocaine and xanthines may decrease due to a possible increase in their concentration in the blood plasma, especially in patients with an initially increased clearance of theophylline under the influence of smoking. NSAIDs, corticosteroids and estrogens weaken the hypotensive effect of bisoprolol (Na+ retention, blockade of prostaglandin synthesis by the kidneys). With the simultaneous use of Concor Cor and sympathomimetics (including cough suppressants, eye drops and nasal drops), the effect of bisoprolol may be weakened. Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs can lead to an excessive decrease in blood pressure. The effect of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins may be prolonged during treatment with bisoprolol. Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedatives and hypnotics increase CNS depression. Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. The treatment break between taking MAO inhibitors and bisoprolol should be at least 14 days. Non-hydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders. Ergotamine increases the risk of developing peripheral circulatory disorders; sulfasalazine increases the concentration of bisoprolol in the blood plasma; Rifampin shortens the half-life. With the simultaneous use of ergotamine derivatives (including ergotamine-containing migraine drugs) and Concor Cor, the severity of peripheral circulatory disorders may increase. With the simultaneous use of Concor Cor and rifampicin, the half-life of bisoprolol may slightly decrease (increasing the dose of Concor is usually not required).

Concor Cor, 30 pcs., 2.5 mg, film-coated tablets

The effectiveness and tolerability of bisoprolol may be affected by the simultaneous use of other drugs. Such interaction can also occur in cases where 2 drugs are taken after a short period of time. The doctor must be informed about taking other drugs, even if they are taken without a doctor’s prescription (i.e. over-the-counter drugs).

Combinations not recommended

Class I antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and cardiac contractility.

BMCCs such as verapamil and, to a lesser extent, diltiazem, when used simultaneously with bisoprolol, can lead to a decrease in myocardial contractility and impaired AV conduction. In particular, intravenous administration of verapamil to patients taking beta-blockers can lead to severe arterial hypotension and AV block.

Centrally acting antihypertensives (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and cardiac output, as well as vasodilation due to a decrease in central sympathetic tone. Abrupt withdrawal, especially before discontinuation of beta-blockers, may increase the risk of developing rebound hypertension.

Combinations requiring special caution

BMCC, dihydropyridine derivatives (for example, nifedipine, felodipine, amlodipine), when used simultaneously with bisoprolol, may increase the risk of developing arterial hypotension. In patients with CHF, the risk of subsequent deterioration in cardiac contractility cannot be excluded.

Class III antiarrhythmic drugs (eg amiodarone) may worsen AV conduction disturbances.

The effect of topical β-blockers (for example, eye drops for the treatment of glaucoma) may enhance the systemic effects of bisoprolol (lowering blood pressure, lowering heart rate).

Parasympathomimetics, when used simultaneously with bisoprolol, may enhance AV conduction disturbances and increase the risk of developing bradycardia.

The hypoglycemic effect of insulin or oral hypoglycemic agents may be enhanced. Signs of hypoglycemia - in particular tachycardia - may be masked or suppressed. Such interactions are more likely when using non-selective beta-blockers.

Agents for general anesthesia may increase the risk of cardiodepressive effects, leading to arterial hypotension (see "Special Instructions").

Cardiac glycosides, when used simultaneously with bisoprolol, can lead to an increase in impulse conduction time and, thus, to the development of bradycardia.

NSAIDs may reduce the hypotensive effect of bisoprolol.

The simultaneous use of Concor® Cor with β-adrenergic agonists (for example, isoprenaline, dobutamine) may lead to a decrease in the effect of both drugs.

The combination of bisoprolol with adrenergic agonists that affect β- and α-adrenergic receptors (for example, norepinephrine, epinephrine) may enhance the vasoconstrictor effects of these drugs that occur with the participation of α-adrenergic receptors, leading to an increase in blood pressure. Such interactions are more likely when using non-selective beta-blockers.

Antihypertensive drugs, as well as other drugs with a possible antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines), may enhance the hypotensive effect of bisoprolol.

Mefloquine, when used simultaneously with bisoprolol, may increase the risk of bradycardia.

MAO inhibitors (except MAO B inhibitors) may enhance the hypotensive effect of beta-blockers. Concomitant use may also lead to the development of a hypertensive crisis.

Overdose of Concor Cor, symptoms and treatment

Symptoms: arrhythmia, ventricular extrasystole, severe bradycardia, AV block, marked decrease in blood pressure, acute heart failure, hypoglycemia, acrocyanosis, difficulty breathing, bronchospasm, dizziness, fainting, convulsions. Treatment: gastric lavage and administration of adsorbent drugs; symptomatic therapy: in case of developed AV block, intravenous administration of 1–2 mg of atropine, epinephrine or placement of a temporary pacemaker; for ventricular extrasystole - lidocaine (class IA drugs are not used); with a pronounced decrease in blood pressure, the patient should be in a position with the foot end of the bed raised; if there are no signs of pulmonary edema - intravenous plasma replacement solutions; if ineffective - administration of epinephrine, dopamine, dobutamine (to maintain chronotropic and inotropic effects and eliminate the pronounced decrease in blood pressure); for heart failure - cardiac glycosides, diuretics, glucagon; for convulsions - intravenous diazepam; for bronchospasm - β2-adrenergic stimulants by inhalation.