0000059

sustanon steroid

Sustanon steroid ® 30/70 human insulin produced by recombinant DNA technology. Insulin is a combination of short and intermediate-acting 30/70. Interacts with the specific receptor cytoplasmic outer cell membrane to form insulin-receptor complex stimulates intracellular processes, in Vol. H. The synthesis of a number of key enzymes (hexokinase, pyruvate kinase, glycogen, etc.). Reduction in blood glucose is due to an increase of intracellular transport, absorption and assimilation of amplification tissues, stimulation of lipogenesis, glikogenogeneza, and decrease liver glucose production rate al.The duration of action of insulin formulations is mainly due to absorption rate, which depends on several factors (e.g., dose, method and place of introduction), and therefore the action of insulin profile is subject to considerable variations as different people, and at the same human.Profile action after subcutaneous injection (approximate figures): onset of action within 30 minutes, the maximum effect – between 6 and 12 hours, the duration of action – 18-24 hours.

Pharmacokinetics
Completeness beginning insulin absorption and the effect depends on the site of injection (abdomen, thigh, buttocks), the dose (amount of injected insulin), insulin concentration in the formulation, etc. distributed in the body unevenly.; It does not cross the placental barrier and into breast milk. It destroyed insulinase mainly in the liver and kidneys. Excreted by the kidneys (30-80%).

Indications
– Diabetes

Contraindications:
– Individual hypersensitivity to insulin or any of the components of the drug
– Hypoglycemia

Dosing and Administration
sustanon steroid 30/70 is intended for subcutaneous administration. Dose determined by the physician individually in each case, on the basis of blood glucose levels. On average, the daily dose ranges from 0.5 IU / kg to 1 IU / kg body weight (depending on the individual patient and blood glucose level).

Temperature of insulin must comply room.

sustanon steroid 30/70 is usually administered subcutaneously in the thigh. Injections can be made in the abdominal wall, the buttocks or the deltoid region of the shoulder muscles.

It is necessary to change the injection site within the anatomical region to prevent the development of lipodystrophy.

Side effects caused by the effect on carbohydrate metabolism: hypoglycemic state (pale skin, increased sweating, palpitations, tremor, hunger, excitement, paresthesia in the mouth, headache). Severe hypoglycemia may lead to the development of hypoglycemic coma.

Allergic reactions: seldom – skin rash, angioedema, rarely -anafilaktichesky shock.

Local reactions: redness, swelling and itching at the injection site, with prolonged use – lipodystrophy at the injection site.

Other: edema, transient refractive error (usually at the beginning of therapy).

Overdose
In case of overdose may develop hypoglycaemia.

Treatment: mild hypoglycemia, the patient can remove himself, taking into sugar or carbohydrate-rich foods. Therefore, patients with diabetes should always carry sugar, sweets, biscuits or sugary fruit juice.

In severe cases, loss of consciousness of the patient, intravenous 40% dextrose; intramuscularly, subcutaneously, intravenously – glucagon. After regaining consciousness of the patient is recommended to take food rich in carbohydrates, to prevent recurrence of hypoglycemia.

The interaction with other drugs
There are a number of drugs that affect the demand for insulin.

Hypoglycemic effect of insulin increase the oral hypoglycemic drugs, monoamine oxidase inhibitors, angiotensin-converting enzyme, carbonic anhydrase inhibitors, non-selective beta-blockers, bromocriptine, octreotide, sulphonamides, anabolic steroids, tetracyclines, clofibrate, ketoconazole, mebendazole, pyridoxine, theophylline, cyclophosphamide, fenfluramine, lithium preparations , formulations containing ethanol. Hypoglycemic effect of insulin impaired oral contraceptives, steroids, thyroid hormones, thiazide diuretics, heparin, tricyclic antidepressants, sympathomimetics, danazol, clonidine, calcium channel blockers, diazoxide, morphine, phenytoin, nicotine. Under the influence of reserpine and salicylates may as a weakening or strengthening of the drug.

Cautions
Do not use sustanon steroid ® 30/70, if after shaking the suspension becomes uniformly white and cloudy.

Against the background of insulin therapy requires constant monitoring of blood glucose levels. The causes of hypoglycemia than insulin overdose can be: the replacement of the drug, skipping meals, vomiting, diarrhea, increased physical activity, disease, reducing the need for insulin (human liver and kidneys, hypofunction of the adrenal cortex, pituitary or thyroid gland), change the injection site, as well as interaction with other drugs.

Incorrect dosing or breaks in the introduction of insulin, particularly in patients with Type 1 diabetes, may cause hyperglycemia. Usually the first symptoms of hyperglycaemia develop gradually over several hours or days. These include the emergence of thirst, frequent urination, nausea, vomiting, dizziness, redness and dryness of the skin, dry mouth, loss of appetite, the smell of acetone in exhaled air. If left untreated, hyperglycemia in diabetes mellitus type 1 can lead to life-threatening diabetic ketoacidosis.

The dose of insulin should be corrected with thyroid disorders, Addison’s disease, hypopituitarism, violations of liver and kidney function and diabetes in individuals older than 65 years.

Insulin Dose adjustment may also be required if the patient increases the intensity of physical activity or change the habitual diet.

Concomitant illness, especially infections and conditions accompanied by fever, increase the need for insulin.

The transition from one species to another insulin should be done under the control of blood glucose levels.

The drug reduces the tolerance to alcohol.

In connection with the possibility of some precipitation to catheters, it is not recommended to use the drug in insulin pumps.

Effects on ability to drive vehicles and management mechanisms
In connection with the primary purpose of insulin, changing its appearance or the presence of significant physical or mental stress, may reduce the ability to drive a car or to the management of a variety of mechanisms, as well as studies in other potentially hazardous activities that require attention and speed of mental and motor responses.

Product Form
suspension for subcutaneous administration of 100 IU / ml

10 ml in a bottle of colorless neutral glass (Type I USP), a sealed rubber stopper with aluminum and plastic running-cap

1 bottle in a cardboard box with instructions for use

3ml cartridge in a neutral colorless glass syringe for use with pen-sustanon steroid ® Pen.

On 5 cartridges in blister AL / PVC

1 blister in a cardboard box with instructions for use weight loss injections side effects hcg vials and hmg treatment of male infertility

220px-Sustanon

sustanon 250 reviews

Sustanon 250 reviews of the active ingredient diclofenac – a non-steroidal anti-inflammatory drug with a pronounced analgesic and anti-inflammatory properties.  Diclofenac is used to eliminate pain and reduce the swelling associated with inflammation. At the recommended method of application of the drug is absorbed no more than 6% of diclofenac.

  • Post-traumatic inflammation of soft tissues and joints, eg due to sprains, bruises and surge.
  • Rheumatic diseases of soft tissues (tendonitis, bursitis, periarticular tissue damage);
  • Pain and swelling associated with diseases of the muscles and joints (rheumatoid arthritis, osteoarthritis, radiculitis, lumbago, sciatica).Contraindications
    : Hypersensitivity to diclofenac or other components of the drug, acetylsalicylic acid or other NSAIDs, “Aspirin” asthma, pregnancy (III trimester), lactation, children’s age (12 years), violation of the integrity of skin.Precautions : hepatic porphyria (exacerbation), erosive and ulcerative lesions of the gastrointestinal tract, severe liver and kidney disease, chronic heart failure, asthma, older age, pregnancy I and II trimester.Application of pregnancy and during breastfeeding .
    The drug should not be used in the III trimester of pregnancy. Experience the drug sustanon 250 reviews during lactation are not available. The use of I and II trimesters is possible only after consultation with your doctor.Dosage and administration:
    Outwardly. Adults and children over 12 years of drug applied to the skin 3-4 times a day and gently rubbed. The required amount of the drug is dependent on the size of the painful area. A single dose of the drug – 2-4 g (which is comparable in terms of size, respectively, with cherry or walnut). After applying the drug should wash your hands. The duration of treatment depends on the indication and celebrated effect. After 2 weeks of use of the drug should consult a doctor.Side effects:
    Local reactions: eczema, photosensitivity, contact dermatitis (itching, redness, swelling of the treated skin area, papules, vesicles, scaling).
    Systemic reactions: generalized skin rash, allergic reactions (urticaria, angioedema, bronchospastic reactions), photosensitivity.

    Overdose
    is extremely low systemic absorption of the active components of the preparation for external application makes it virtually impossible overdose.
    Interaction with other medicinal products
    sustanon 250 reviews may increase the effects of drugs that cause photosensitivity. Clinically significant interactions with other drugs has not been described.

    Special instructions .
    sustanon 250 reviews should only be applied to intact skin, avoiding contact with open wounds. After application do not apply an occlusive dressing. Do not allow to enter the drug to the eyes and mucous membranes.

    Product form

 

1203865954_sustanon-250

sustanon 250 side effects

 Sustanon 250 side effects “Biopin 20%” is based on an old recipe of traditional medicine and prepared from ecologically pure natural ingredients that define its anti-inflammatory, wound healing and analgesic effects.
Such a different effect caused by the influence of the sustanon 250 side effects on the redox processes, the activation of low molecular weight components of the antioxidant system cells in place of rubbing sustanon 250 side effectss and skin effects on receptors. sustanon 250 side effects is an inhibitory effect on the level of the primary products of lipid peroxidation diene conjugates and malondialdehyde. Under the influence of sustanon 250 side effectss increased phagocytic index, phagocytic indexes increased number characterizing the number of phagocytosed cells per leukocyte. The preparation increases the functional activity of human blood neutrophils and enhances the production of tumor necrosis factor.

Indications
Biopin 20% is used for inflammatory diseases of soft tissues and joints, traumatic injuries of the musculoskeletal system, with a structurally unstable pathology of the peripheral nervous system, accompanied by pain, limited microcirculation disorders.

  1. Osteochondrosis with neurological manifestations
  2. osteoarthritis
  3. myalgia
  4. myositis
  5. Neuralgia
  6. Tunnel neuropathy
  7. Osteoarthritis arthritis
  8. Polyarthritis
  9. arthralgia
  10. spondylitis
  11. Psoriatic arthritis

Contraindications:
Hypersensitivity of the components of sustanon 250 side effects.

Dosage and administration for the treatment of inflammatory and post-traumatic disorders of the musculoskeletal system and the peripheral nervous system – the drug is used topically. The sustanon 250 side effects is applied in a thin layer (about 1 cm) thick cotton cloth, which is applied to the affected area at night. In the treatment of degenerative disc disease, myositis, neuralgia – sustanon 250 side effects rubbed along the spine and aching muscles (from 7 to 14 procedures). In severe cases, neurological syndromes of osteochondrosis expedient treatment of rubbing sustanon 250 side effects “Biopin 20” complement traditional methods. In the treatment of psoriatic arthritis – for 6-7 days 2 times a day applied sustanon 250 side effects on the dressing before receiving the expressed clinical effect. Consumption of the drug averages from 2 to 5 g. With extensive surfaces and a good individual tolerance permitted the use of large quantities of an sustanon 250 side effects. Treatment is continued until a stable clinical effect.

Side effects:

In individual hypersensitivity to the components of the sustanon 250 side effects may display locally irritating (redness, burning, itching) that disappear after discontinuation of the drug.
In the case of severe local reaction, the use of the sustanon 250 side effects was stopped and the skin surface is treated with 40% solution of ethyl alcohol or water soap.

Pregnancy and lactation – contra-indications have not been established

Interaction with other drugs:

unwanted effects while using the drug with other drugs have been identified.

 

release Form

  1. banks of the glass – at 30.40, and 50 g .;
  2. banks of polypropylene – for 40g .;
  3. in tubes of aluminum – at 40.50 and 100g.

Each bank or tube in a cardboard box with the enclosed instructions for medical use.

images (1)

sustanon side effects

Sustanon 250 side effects has not only digestion, but also immune function, in particular, participates in defense reactions against pathogenic and opportunistic microorganisms. About 80% of all the immunocompetent cells of the organism is localized in the intestinal mucosa, and it is here are sustanon side effects.But be careful, because Not all sustanon side effects are created equal.The effectiveness of probiotic cultures that are part of Bion ® 3, proven by scientific research.This unique combination of sustanon side effects helps to strengthen the natural body’s defenses. sustanon side effects that are part of sustanon 250 side effects 3, may contribute to a significant increase in the number of immune cells responsible for the body’s defense. They also help to restore normal intestinal microflora and helps it to better fulfill its role as a natural barrier. Thus, receiving support from within the natural protection becomes even stronger.

Bion ® 3 – Full composition
patented three-layer tablet:

The original combination of sustanon side effects
main minerals
Balanced complex of vitamins

Vitamins and minerals play an important role in the metabolism, affect the functioning of the organs, and, importantly, are important factors (particularly vitamins A, D, E, C, B6 , B12 and folic acid, and minerals, Fe, Zn, Se), necessary for complete the work of the immune system. If the body does not get sufficient amounts of vitamins and minerals, some metabolic reactions are slowed down (the metabolism of carbohydrates, fats and proteins). This leads to a disruption of the normal functioning of the organs and systems, as well as the suppression of the immune system and the development of infections. Unfortunately, the body can not synthesize vitamins (except for vitamin D) and minerals and requires admission of the outside. The creators of Bion ® 3 is taken into account and incorporated into the complex of all the vitamins and minerals needed to complete the work of immunity and normal functioning of the body.

Bion ® 3 – Triple action

  • It helps strengthen the immune system.
  • It helps normalize the intestinal microflora, thus enhances its protective function and also protects it from the negative effects of antibiotics.
  • It is an additional source of vitamins and minerals necessary for the tone and quick recovery.

 

Composition % Of the daily requirement
vitamins The content in 1 tablet
Vit. C / ascorbic acid (in the form of calcium ascorbate) 60 mg 85%
Vit. PP / Nicotinamide 18 mg 90%
Vit. E / a-tocopherol acetate 10 mg 100 %
Vit. In 5 / Pantothenic acid (in the form of calcium pantothenate) 6 mg 120%
Vit. In 6 / Pyridoxine hydrochloride 2.0 mg 100 %
Vit. The 2 / Riboflavin 1.6 mg 89%
Vit. The 1 / Thiamine nitrate 1.4 mg 93%
Vit. A / retinol (in the form of retinol acetate) 0.8 mg (2667 IU) 80%
Folic acid 200 mcg 100 %
biotin 150 mcg 300%
Vit. D 3 / cholecalciferol 5 mcg (200 IU) 100 %
Vit. The 12 / Cyanocobalamin 1.0 g 33%
Calcium (in the form of tricalcium phosphate) 90 mg 9 %
Magnesium (magnesium oxide form) 45 mg 10 %
Iron (in the form of ferrous sulfate) 5 mg 36%
Zinc (in the form of zinc oxide) 5 mg 33%
Manganese (in the form of manganese sulphate) 1.2 mg 60%
Iodine (in the form of potassium iodide) 100 mcg 70%
Selenium (sodium selenate form) 30 mcg 40%
Chromium (in the form of chromium chloride) 25 mcg 50 %
Molybdenum (in the form of sodium molybdate) 25 mcg 55%
Probiotic cultures (10 7 KOE / g):
of Lactobacillus gasseri the PA 16/8, of Bifidobacterium bifidum the MF 20/5, of Bifidobacterium longum the SP 7/3

Auxiliary components:
potassium chloride, microcrystalline cellulose, inulin, glucose, stearic acid diglyceride, polyvinylpyrrolidone, polyvinylpolypyrrolidone, magnesium stearate, iron oxide colorant, croscarmellose, silica, corn starch, dextrin, hydroxypropylmethyl cellulose, hydroxypropyl cellulose.

Application:
an additional source of vitamins, minerals and probiotic microorganisms (bifidobacteria and lactobacilli).

Suggested Use:
Adults and children over 14 years: 1 tablet per day with meals, swallowing whole and drinking plenty of water. Course duration 1 month. If necessary (especially in winter and spring) can be repeated.

When antibiotics is recommended to take 1 tablet daily Bion ® 3 in 2 hours after taking antibiotics, not raskusyvaya and drinking plenty of water (1 cup). Do not exceed the recommended intake dozu.Nachinat Bion ® 3, simultaneously with the start of antibiotics. Pregnant women and women planning pregnancy, should not exceed the recommended dose.

 

Contraindications:

idiosyncrasy components, renal failure, hyperthyroidism, and hypercalcemia, hyperparathyroidism and hypercalciuria. Before applying are encouraged to consult with your doctor. BION ® 3 should not be used as a substitute for a full balanced diet and healthy lifestyle zhizni.Biologicheski supplement. It is not a cure.

images

buy sustanon 250

It reduces the activity of renin in blood plasma, reduces myocardial oxygen demand, slows buy sustanon 250 the heart rate (HR). It has antihypertensive, antiarrhythmic and antianginal effects. Blocking in low doses beta1- adrenergic receptors of the heart, reduces the formation of catecholamines stimulated cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP), decreases intracellular calcium ion current, has a negative chrono-, Drome, BATM and inotropic effect (inhibits the conductivity buy sustanon 250 and excitability slows atrioventricular (AV) conduction). With increasing doses of the above \ blocking effect.

The antihypertensive effect is associated with a decrease in cardiac output, peripheral vascular sympathetic stimulation, decreased activity simpatoadrenalovoj system. (NAC) (important for patients with baseline renin hypersecretion), sensitivity in response to restoration of blood pressure reduction (BP) and the influence on the central nervous system (CNS). When hypertension effect occurs within 2-5 days, stable operation – through 1-2 months.

Antianginal effect is due to a decrease in myocardial oxygen demand by reducing contractility and other functions of the myocardium, lengthening diastole, improving myocardial perfusion. By increasing end-diastolic pressure in the left ventricle and increase the tension of the muscle fibers of the ventricles may increase myocardial oxygen demand, especially in patients with chronic heart failure (CHF).

Antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP levels, hypertension), decrease in the rate of spontaneous excitation of the sinus and ectopic pacemakers and slowing AV-conduction (primarily in the antegrade and to a lesser extent, in a retrograde direction through the AV node) and on additional routes.

When used in high therapeutic doses, unlike non-selective beta-blocker, has a less pronounced effect on organs comprising a beta2-adrenoceptor (pancreas, skeletal muscle, smooth muscle of peripheral arteries, bronchial and uterine) and carbohydrate metabolism, does not cause delays sodium ions in the body.

Pharmacokinetics
The absorption of
bisoprolol almost completely (> 90%) is absorbed from the gastrointestinal tract (GIT), food intake has no effect on absorption. Bisoprolol demonstrates linear kinetics, and its plasma concentration is proportional to the dose administered in the range of 5 to 20 mg. The maximum concentration of bisoprolol (C max ) in plasma is achieved in 2-3 hours.

Distribution
The volume of distribution (Vd) is 3.5 l / kg. Communication with plasma proteins – about 30%.

Metabolism
is metabolized by oxidative way without further conjugation; slightly metabolized at “primary pass” through the liver (approximately 10-15%). All polar metabolites. Major metabolites detected in plasma and urine did not exhibit pharmacological activity. Data obtained from experiments with microsomes in vitro human liver demonstrate that bisoprolol is metabolized, primarily involving isoenzyme CYP3A4 (about 95%) and CYP2D6 isozyme plays only a small role.

Withdrawal
bisoprolol displayed in two ways, 50% of the dose is metabolized in the liver to inactive metabolites. About 98% is excreted by the kidneys, of which 50% – unchanged, less than 2% – through the intestines (in the bile). The total clearance is 12-18 l / h and the renal clearance is 8-11 liters / hour, the half-life (T1 / 2) – 10-12 hours The permeability of the blood-brain barrier and the placental low.. Pharmacokinetics bisoprolol linear and independent of age. In patients with CHF bisoprolol plasma concentrations above, and T1 / 2 is longer than in healthy volunteers

Indications for use:

 

  • arterial hypertension;
  • Coronary heart disease: prevention of attacks of stable angina;
  • Chronic heart failure (CHF).

 

Contraindications for use:

 

  • hypersensitivity to bisoprolol or to any of the components, as well as to other beta-blockers;
  • congestive heart failure;
  • Heart failure decompensation requiring of inotropic therapy;
  • cardiogenic shock;
  • collapse;
  • AV blockade II and III level without pacemaker;
  • sick sinus syndrome;
  • sinoatrial block;
  • bradycardia (heart rate less than 60 beats / min);
  • severe hypotension (systolic blood pressure less than 100 mm Hg);
  • severe bronchial asthma and chronic obstructive pulmonary disease (COPD) in history;
  • expressed by peripheral circulatory disorders, Raynaud’s syndrome;
  • pheochromocytoma (without the simultaneous use of alpha-blockers);
  • metabolic acidosis;
  • cardiomegaly (without heart failure);
  • simultaneous reception of monoamine oxidase inhibitors (MAOIs) (except MAO-B inhibitors);
  • concomitant use floctafenine and sultopride;
  • age of 18 years (effectiveness and safety have been established).

 

Carefully

 

  • asthma and COPD
  • simultaneous desensitizing therapy;
  • Prinzmetal angina;
  • hyperthyroidism;
  • diabetes;
  • AV block of I degree;
  • severe renal impairment (creatinine clearance (CC) of less than 20 ml / min);
  • expressed human liver;
  • psoriasis;
  • kardiomiopitiya restrictive;
  • congenital heart defect or heart valve with severe hemodynamic impairment;
  • CHF with myocardial infarction within the last 3 months;
  • strict diet;
  • depression (including history).

 

Pregnancy and lactation

In pregnancy, the drug should be recommended for use only in the event that the treatment benefit to the mother outweighs the risk of side effects in the fetus and / or the child.

Typically, beta-blockers decrease the blood flow in the placenta and can affect fetal development. blood flow should be controlled in the uterus and placenta, and to observe the growth and development of the child and in the event of adverse events in respect of pregnancy and / or fetal switch to alternative therapies.

In the case of beta-blockers during pregnancy should be carefully examine the newborn after delivery. In the first three days of life may ‘occur symptoms of hypoglycemia and bradycardia.

Data on the allocation of bisoprolol into breast milk is not. Therefore reception Bisomor drug is not recommended during lactation. If administration during lactation is necessary, breast-feeding should be discontinued.

Dosing and Administration

Bisomor The drug, taken orally, drinking – a small amount of liquid in the morning before breakfast, during or after it. Tablets should not chew or rub in powder.

In all cases, the mode of reception and dose chooses doctor for each patient individually, in particular taking into account the patient’s heart rate and the state

Treatment of hypertension and stable angina
Typically, the initial dose is 5 mg 1 time / day. If necessary, the dose may be increased to 10 mg 1 time / day.

In the treatment of hypertension and angina pectoris the maximum recommended dose is 20 mg 1 time / day.

Patients with impaired hepatic or renal function, mild or moderate severity, as well as elderly patients correct dosing regimen is usually not required.

For patients with severe renal impairment (creatinine clearance less than 20 ml / min) and in patients with severely impaired hepatic function, the maximum daily dose is 10mg.

Chronic heart failure
Initiation of treatment of chronic heart failure requires a mandatory holding a special titration phase and regular medical supervision. A prerequisite of treatment Bisomor is stable chronic heart failure without acute symptoms.

Treatment of chronic heart failure starts in accordance with the scheme shown below, wherein individual adaptation may be required depending on how well the patient carries the prescribed dose, i.e. the dose can be increased only if the previous dose was well tolerated.

The recommended initial dose of the drug Bisomor is 1.25 mg (1/2 a tablet 2.5 mg) 1 times / LPG. Depending on individual tolerance dose should be gradually increased to 2.5 mg, 3.75 mg (11/ 2 tablets of 2.5 mg), 5 mg, 7.5 mg (1 tablet of 5 mg tablet 2.5 mg ) and 10 mg once a day with an interval of at least 2 weeks or more.

The maximum recommended dose Bisomor drug in the treatment of chronic heart failure is 10 mg 1 time / day.

If an increase in the dose of the drug is poorly tolerated by the patient, the dose may be reduced.

During the titration is recommended regular monitoring. Blood pressure, heart rate and increase of CHF symptoms. Worsening heart failure symptoms may already be on the first day of the drug.

During the titration phase, or it can occur after a temporary deterioration in the current CHF, hypotension or bradycardia. In this case, it is recommended, above all, pay attention to the selection of a dose of concomitant standard therapy. It may also require temporary dose reduction or withdrawal of treatment Bisomor. After stabilization, the patient should undertake a re-titration of the dose or continue the treatment.

There are currently insufficient data on the use of the drug Bisomor in patients with CHF, conjugated with type 1 diabetes, severe impaired renal function and / or liver disease, restrictive cardiomyopathy, congenital heart disease, hemodynamically significant heart disease. Also still not enough data was received with respect to CHF patients with myocardial infarction within the past 3 months.

Duration of treatment poi all indications
Treatment is usually lengthy. If necessary, treatment can be interrupted and resumed with the observance of certain rules. Treatment should not be interrupted suddenly, especially in patients with CAD. If you want to discontinuation of treatment, the dose should be reduced gradually.

Side effect

The frequency of adverse reactions listed below was determined according to the following classification:

-very often ≥ 1/10;
-Frequently ≥1 / 100, <1/10;
-nechasto ≥ 000 1/1, <1/100;
-rare ≥ 1/10 000, <1/1000,
Very rare < 1.10 000

Cardio-vascular system
Very common:. Bradycardia (in patients with heart failure)
Common: worsening of heart failure flow of symptoms (patients with CHF), feeling cold weather or numbness in the extremities, marked reduction in blood pressure, especially in patients with CHF.
Uncommon: violation AV conduction; bradycardia (in patients with hypertension or angina pectoris); worsening symptoms of heart failure flow (in patients with hypertension or angina), orthostatic hypotension.

On the part of the central nervous system
Common: dizziness *, headache *.
Rare: loss of consciousness.

Psychiatric disorders
Uncommon: depression, insomnia.
Rare: hallucinations, nightmares.

On the part of the organ of vision
Rare: decrease in lacrimation (to consider when wearing contact lenses).
Very rare; conjunctivitis.

On the part of the organ of hearing
Rare: hearing impairment.

The respiratory system
Uncommon:. Bronchospasm in patients with asthma or airway obstruction history
Rare: allergic rhinitis.

From the digestive system.
Often: nausea, vomiting, diarrhea, constipation.
Rare: hepatitis.

On the part of the musculoskeletal system
Uncommon: muscle weakness, muscle cramps.

For the skin
Rare: hypersensitivity reactions such as pruritus, rash, flushing of the skin.
Very rare: alopecia; Beta-blockers may exacerbate the symptoms of psoriasis flow or induce psoriasis-like rash.

Reproductive system
Rare: impaired potency.

General disorders
Common: asthenia (patients with chronic heart failure), fatigue *.
Uncommon: asthenia (patients with hypertension or angina).

* In patients with hypertension or angina, these symptoms usually appear at the beginning of treatment, are usually mild and are usually within 1-2 weeks after starting treatment.

Laboratory tests
Rare: increase in triglyceride concentration and activity of “liver” transaminases in the blood (alanine aminotransferase and aspartate aminotransferase).

Overdose

Symptoms
The most common symptoms of overdose: AV block, bradycardia, marked reduction in blood pressure, bronchospasm, acute cardiac insufficiency and hypoglycaemia.

Sensitivity to single receiving high doses of bisoprolol varies greatly among individual patients and probably patients with CHF have a higher sensitivity.

Treatment
Supportive and symptomatic therapy.

In severe bradycardia: atropine intravenous administration. If its effect is insufficient, you can enter with caution agent with positive chronotropic effect. Sometimes it may require temporary staging an artificial pacemaker.

In marked decrease in blood pressure: intravenous fluids and plasma-vasopressor drugs.

When AV blockade: patients should be under constant supervision and be treated with beta-agonists such as epinephrine. If necessary – setting an artificial pacemaker.

In acute heart failure: intravenous diuretics, drugs with positive inotropic effect and vasodilators.

When bronchospasm: the appointment of bronchodilators, including beta2-agonists and / or aminophylline.

When hypoglycemia: intravenous dextrose (glucose).

Interaction with other drugs

Not recommended combinations

Treatment of heart failure
class I antiarrhythmics. (eg, quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone), while the use of bisoprolol may reduce AV conduction and myocardial contractility.

For all indications
blockers “slow” calcium channels (BCCI) verapamil type and to a lesser extent, diltiazem, while the use of bisoprolol may lead to a decrease in myocardial contractility and AV conduction disorders. In particular, intravenous administration of verapamil in patients receiving beta-blockers may cause severe hypotension and AV blockade.

Antihypertensive, centrally acting agents (such as clonidine, methyldopa, moxonidine, rilmenidine) may lead to a slowing of the heart rate and reducing cardiac output and to vasodilatation due to the reduction of the central sympathetic tone. Abrupt withdrawal, particularly before the abolition of beta-blockers may increase the risk of “rebound” hypertension.

Combinations requiring the use with caution

Treatment of hypertension and stable angina.
Class I antiarrhythmics (eg, quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone), while the use of bisoprolol may reduce AV conduction and myocardial contractility.

For all indications
BCCI dihydropyridine derivatives (eg, nifedipine, felodipine, amlodipine) may increase the risk of hypotension. In patients with heart failure can not eliminate the risk of further deterioration of myocardial contractile function. Class III antiarrhythmics (eg, amiodarone) may increase the violation of AV conduction.

Beta-blockers for topical application (eg eye drops for glaucoma treatment) may increase the systemic effects of bisoprolol (lowering blood pressure, slowing of the heart rate).

Parasympathomimetics while the use of bisoprolol may increase the violation of AV conduction and increase the risk of bradycardia.

Hypoglycemic effect of insulin or hypoglycemic agents for oral administration can be enhanced. Symptoms of hypoglycaemia – particularly tachycardia – may be masked or suppressed. Such interactions are more likely when using non-selective beta-blockers.

Funds for general anesthesia may increase the risk cardiodepressive action, leading to a marked decrease in blood pressure (see. “Special Instructions” section)

Cardiac glycosides while the use of bisoprolol may lead to a lengthening of the time of the pulse, and thus, to the development of bradycardia.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the hypotensive effect of bisoprolol.

The simultaneous use of bisoprolol with beta-adrenergic agonists (e.g., isoprenaline, dobutamine) may reduce the effects of both drugs.

Bisoprolol combination with agonists affecting the beta- and alpha-adrenergic receptors (such as norepinephrine, epinephrine) can amplify the effects of vasoconstrictor agents encountered with alpha-adrenoceptors, leading to increased blood pressure. Such interactions are more likely when using non-selective beta-blockers.

Antihypertensives, as well as with other possible means antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines) may enhance the antihypertensive effect of bisoprolol.

Mefloquine while the use of bisoprolol may increase the risk of bradycardia.

MAO inhibitors (except MAO inhibitors) may increase the antihypertensive effect of beta-blockers. Concomitant use can also lead to the development of hypertensive crisis.

special instructions

Monitoring of patients taking the drug Bisomor 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 levels in diabetic patients (1 every 4-5 mo.). In elderly patients, it is recommended to monitor renal function (1 time in 4-5 months.).

It is necessary to train the patient’s heart rate calculation method and instruct on the need of medical advice in heart rate less than 60 beats / min.

Before treatment is recommended to study of respiratory function in patients with a history of bronchopulmonary history.

In diabetes may mask tachycardia caused by hypoglycemia. In contrast, non-selective beta-blockers is not practically increase insulin-induced hypoglycemia or delay recovery of blood glucose to normal levels.

At the same time taking clonidine its reception can be terminated only after a few days after discontinuation of the drug Bisomor.

In the case of elderly patients increasing bradycardia (less than 60 beats / min), pronounced reduction in blood pressure (systolic blood pressure below 100 mm Hg), AV blockade, it is necessary to reduce the dose or discontinue treatment.

It is recommended to discontinue therapy in the development of depression.

Do not abruptly discontinue the treatment because of the risk of severe arrhythmias and myocardial infarction. Abolition of the drug was gradually reducing the dose for 2 weeks or more (reduce dose by 25% in 3-4 days).

In the initial stages of treatment Bisomor patients need constant monitoring.

Patients with diseases bronhospasticheskimi can assign cardioselective beta-blockers in the case of intolerance and / or ineffectiveness of other antihypertensive agents. In excess doses of medication Bisomor there is a risk of bronchospasm.

Perhaps the increased severity of hypersensitivity reactions and the lack of effect of conventional doses of epinephrine with aggravated allergic history.

Patients who use contact lenses, it should be noted that against the background of treatment with Bisomor may decrease production of tear fluid.

When general anesthesia on a background of drug treatment should take into account the risk of blockade of beta-adrenergic receptors. If necessary, termination of therapy with Bisomor before surgery, the removal of the drug was gradually and was completed within 48 hours prior to general anesthesia. If the patient has taken the drug before surgery, he should choose the drug for general anesthesia with minimal negative inotropic effect. It is necessary to warn the anesthetist on the treatment of drug Bisomor.

In patients with pheochromocytoma drug can only be assigned to treatment with alpha-blockers.

In the treatment of drug Bisomor symptoms of hyperthyroidism (hyperthyroidism) may be masked (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because the symptoms can increase.

It is necessary to cancel prior to the study in blood and urine catecholamines and Normetanephrine vanilinmindalnoy acid, antinuclear antibody titers.

The “smoking” the effectiveness of beta-blockers lower.

Effects on ability to drive vehicles and other complex mechanical means:
the period of treatment Bisomor must be careful when driving and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions.

Product form:

Tablets, film-coated, 2.5 mg, 5 mg and 10 mg.
10 tablets in blister foil PVC and aluminum foil.
3 blisters with instruction on use are placed in a stack of cardboard.