Antihypertensive drugs are prescribed to treat hypertension. These are medications that have a complex effect on the functioning of the heart, blood vessels, and other organs that affect blood pressure. Aritel tablets are prescribed for blood pressure if the patient has problems with heart rhythm. This is a drug that belongs to the pharmacological group of beta-blockers. The tablets are taken according to an individual regimen, which is drawn up by the attending physician based on examination and tests. Self-medication is excluded.
Brief information about the drug
Release form
The drug is available in the form of tablets that are taken orally. Round tablets are film-coated. Tablets are produced with different amounts of the main substance in the composition: 5 or 10 mg. The dosage is prescribed on the package. The kit includes instructions for using Aritel.
Compound
The main active ingredient of the drug is bisoprolol. The composition may contain 5 or 10 mg of the substance.
Other components of the drug:
- potato starch;
- polyvinylpyrrolidone;
- hydroxypropyl methylcellulose;
- lactobiose;
- silica;
- MCC;
- magnesium stearate;
- magnesium silicate.
Packaging of Aritel tablets
pharmachologic effect
The drug has an antihypertensive, antianginal, antiarrhythmic effect.
, ZAO, Russia.
Storage conditions and periods
The drug must be stored out of the reach of children at a temperature not exceeding 20 degrees.
The shelf life of the medicinal product is 2 years from the date of manufacture.
Conditions for dispensing from a pharmacy
The drug is sold in pharmacies with a doctor's prescription.
Price
The cost of Aritel tablets is 117 rubles per pack.
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Pharmacodynamics: mechanism of action on pressure
The drug belongs to the pharmacological class of beta-blockers. Aritel reduces blood pressure and restores normal heart rhythm. The drug reduces the heart rate at rest or during activity, reduces the myocardial oxygen demand, reduces the minute volume of circulating blood, and suppresses the excitability and conductivity of the heart. After the first dose of tablets, the total peripheral vascular resistance increases and then returns to initial values. Subsequently, there is a decrease in total peripheral vascular resistance.
Aritel belongs to the group of beta-blockers
The drug lowers blood pressure by suppressing the activity of the renin-angiotensin-aldosterone system and reducing circulating blood volume.
The tablets have an antianginal effect, reduce myocardial oxygen demand, reduce heart rate, and lengthen diastole.
The drug blocks factors that lead to arrhythmia: normalizes heart rate, reduces pressure, accelerates atrioventricular conduction.
If the prescribed dosage is observed, the drug does not have a negative effect on the bronchi, pancreas, peripheral arteries, carbohydrate metabolism, and does not lead to sodium retention.
Aerosol Aritel
Instructions for medical use of the drug
Description of pharmacological action
A selective β1-blocker, without its own sympathomimetic activity, does not have a membrane-stabilizing effect. It has only slight affinity for β2-adrenergic receptors of the smooth muscles of the bronchi and blood vessels, as well as for β2-adrenergic receptors involved in the regulation of metabolism. Therefore, bisoprolol generally does not affect airway resistance and metabolic processes in which β2-adrenoreceptors are involved. As a rule, the maximum reduction in blood pressure is achieved 2 weeks after the start of therapy. Bisoprolol reduces the activity of the sympathoadrenal system by blocking β1-adrenergic receptors of the heart. When administered once orally in patients with coronary artery disease without signs of chronic heart failure (CHF), bisoprolol reduces heart rate, reduces stroke volume and, as a result, reduces ejection fraction and myocardial oxygen demand. With long-term therapy, the initially elevated TPR decreases. A decrease in renin activity in blood plasma is considered as one of the components of the antihypertensive effect of β-blockers.
Indications for use
— chronic heart failure; - arterial hypertension; — coronary heart disease: prevention of attacks of stable angina.
Release form
film-coated tablets 5 mg; contour packaging 10, cardboard pack 3; film-coated tablets 5 mg; contour packaging 10, cardboard pack 5; film-coated tablets 5 mg; contour packaging 10, cardboard pack 10; film-coated tablets 5 mg; contour packaging 30, cardboard pack 1; film-coated tablets 10 mg; contour packaging 10, cardboard pack 3; film-coated tablets 10 mg; contour packaging 10, cardboard pack 5;
Pharmacokinetics
Suction. Bisoprolol is almost completely (more than 90%) absorbed from the gastrointestinal tract. Its bioavailability due to negligible first-pass metabolism (at approximately 10%) is approximately 90% after oral administration. Food intake does not affect bioavailability. Bisoprolol exhibits linear kinetics, with plasma concentrations being proportional to the dose administered over a dose range of 5 to 20 mg. Cmax in blood plasma is reached after 2–3 hours. Distribution. Bisoprolol is distributed quite widely. Vd is 3.5 l/kg. The binding to plasma proteins reaches approximately 30%. Metabolism. Metabolized via the oxidative pathway without subsequent conjugation. All metabolites are polar (water-soluble) and are excreted by the kidneys. The main metabolites found in blood plasma and urine do not exhibit pharmacological activity. Data obtained from experiments with human liver microsomes in vitro show that bisoprolol is metabolized primarily by the CYP3A4 isoenzyme (about 95%), and the CYP2D6 isoenzyme plays only a minor role. Excretion. The clearance of bisoprolol is determined by the balance between excretion by the kidneys unchanged (about 50%) and metabolism in the liver (about 50%) to metabolites, which are also excreted by the kidneys. The total clearance is 15 l/h. T1/2 - 10-12 hours. There is no information on the pharmacokinetics of bisoprolol in patients with CHF and concurrent impairment of liver or kidney function.
Use during pregnancy
During pregnancy, Aritel should be recommended for use only if the benefit to the mother outweighs the risk of side effects in the fetus. In general, beta blockers reduce blood flow to the placenta and may affect fetal development. Blood flow in the placenta and uterus should be monitored, as well as the growth and development of the unborn child should be monitored; if adverse events occur in relation to pregnancy and/or the fetus, alternative methods of therapy should be used. The newborn should be carefully examined after birth. In the first three days of life, symptoms of hypoglycemia and bradycardia may occur. There is no data on the excretion of bisoprolol into breast milk. Therefore, taking Aritel is not recommended for women during breastfeeding. If it is necessary to take Aritel during lactation, breastfeeding should be stopped.
Contraindications for use
- hypersensitivity to bisoprolol or any of the excipients and other β-blockers; - lactase deficiency, lactose intolerance, glucose-galactose malabsorption; - cardiogenic shock, collapse; - acute heart failure; — CHF in the stage of decompensation, requiring inotropic therapy; — AV block II and III degrees without a pacemaker; sinoatrial block; sick sinus syndrome; severe bradycardia (heart rate less than 50 beats/min); - severe forms of bronchial asthma or COPD; - pronounced decrease in blood pressure (sBP less than 90 mm Hg); - severe peripheral circulatory disorders or Raynaud's syndrome; - pheochromocytoma (without simultaneous use of α-blockers); - metabolic acidosis; - lactation period; - simultaneous use of MAO inhibitors (with the exception of MAO-B inhibitors); - simultaneous use with floctafenine and sultopride; - age under 18 years (efficacy and safety have not been established). With caution: carrying out desensitizing therapy; Prinzmetal's angina; hyperthyroidism; type 1 diabetes mellitus and diabetes mellitus with significant fluctuations in blood glucose concentrations; AV block of the first degree; severe renal failure (creatinine Cl less than 20 ml/min); severe liver dysfunction; psoriasis; restrictive cardiomyopathy; congenital heart defects or heart valve disease with severe hemodynamic disturbances; CHF with myocardial infarction within the last 3 months; pheochromocytoma (with concomitant use of α-blockers); strict diet.
Side effects
The frequency of the adverse reactions listed below was determined as follows: very often (≥ 1/10); often (≥ 1/100, From the central nervous system: often - dizziness*, headache*; infrequently - increased fatigue; rarely - loss of consciousness. General disorders: often - asthenia (in patients with CHF), increased fatigue*; infrequently - asthenia (in patients with arterial hypertension or angina pectoris).Mental disorders: infrequently - depression, insomnia; rarely - hallucinations, nightmares. From the skin: rarely - hypersensitivity reactions, such as itching, rash, hyperemia of the skin; very rarely - alopecia. β-blockers can exacerbate the symptoms of psoriasis or cause a psoriasis-like rash. From the genitourinary system: rarely - impaired potency, weakened libido, Peyronie's disease, cystitis, renal colic, polyuria. From the musculoskeletal system: infrequently - muscular weakness, muscle cramps. From the digestive system: often - nausea, vomiting, diarrhea, constipation; rarely - hepatitis. From the hematopoietic organs: in some cases - thrombocytopenia, agranulocytosis. From the respiratory system: infrequently - bronchospasm in patients with bronchial asthma or a history of airway obstruction; rarely - allergic rhinitis. On the part of the organ of vision: rarely - decreased lacrimation (should be taken into account when wearing contact lenses); very rarely - conjunctivitis. On the part of the hearing organ: rarely - hearing impairment. From the cardiovascular system: very often - bradycardia (in patients with CHF); often - worsening symptoms of CHF (in patients with CHF), a feeling of coldness and numbness in the extremities, a pronounced decrease in blood pressure, especially in patients with CHF; uncommon - AV conduction disturbance, bradycardia (in patients with arterial hypertension or angina pectoris), worsening of symptoms of CHF (in patients with arterial hypertension or angina pectoris), orthostatic hypotension. Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia. From the reproductive system: rarely - impaired potency. Laboratory indicators: rarely - increased concentration of triglycerides and activity of hepatic transaminases (AST, ALT) in the blood. * In patients with arterial hypertension or angina pectoris, these symptoms usually appear at the beginning of the course of treatment, are mild and disappear within 1–2 weeks after the start of treatment.
Directions for use and doses
Orally, in the morning before, during or after breakfast, 1 time per day with a sufficient amount of liquid. The tablets should not be chewed or crushed into powder. CHF. Initiation of treatment for CHF with Aritel requires a special titration phase and regular medical supervision. The precondition for treatment with Aritel is stable CHF without signs of exacerbation. Treatment of CHF with Aritel begins in accordance with the following titration scheme. This may require individual adaptation 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 an appropriate titration process, it is recommended to use the drug in lower doses in the initial stages of treatment. The recommended starting dose is 1.25 mg (0.5 tablets of 2.5 mg) once a day. Depending on individual tolerance, the dose should be gradually increased to 2.5; 3.75 (1.5 tablets of 2.5 mg); 5; 7.5 (1 tablet of 5 mg and 1 tablet of 2.5 mg) and 10 mg once a day with an interval of at least two weeks. If increasing the dose of the drug is poorly tolerated by the patient, a dose reduction may be possible. The maximum daily dose for the treatment of CHF is 10 mg 1 time per day. During titration, regular monitoring of blood pressure, heart rate and symptoms of increasing severity of heart failure is recommended. Worsening of the symptoms of CHF is possible from the first day of using the drug. During the titration phase or after it, a temporary worsening of CHF, arterial hypotension or bradycardia may occur. In this case, it is recommended first of all to adjust the dose of concomitant therapy. A temporary reduction in the dose of Aritel® or discontinuation of treatment may also be required. After stabilization of the patient's condition, the dose should be re-titrated or treatment should be continued. Arterial hypertension and coronary artery disease (prevention of attacks of stable angina). For arterial hypertension and coronary artery disease, the drug is prescribed 5 mg once a day. If necessary, the dose is increased to 10 mg 1 time per day. In the treatment of arterial hypertension and angina pectoris, the maximum daily dose is 20 mg 1 time per day. It is possible to use the drug bisoprolol in another dosage form (2.5 mg tablets with a score). In all cases, the doctor selects the dosage regimen and dosage individually for each patient, in particular taking into account the individual characteristics and condition of the patient. Special groups of patients Impaired renal or hepatic function. For mild or moderate hepatic or renal dysfunction, no dose adjustment is usually required. In case of severe renal dysfunction (creatinine Cl less than 20 ml/min) and in patients with severe liver disease, 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. To date, there is insufficient data regarding the use of Aritel® in patients with CHF associated with type 1 diabetes mellitus, severe renal and/or liver dysfunction, restrictive cardiomyopathy, congenital heart disease or hemodynamically determined heart disease. Also, sufficient data have not yet been obtained regarding patients with CHF with myocardial infarction within the last 3 months.
Overdose
Symptoms: AV block, bradycardia, decreased blood pressure, bronchospasm, acute heart failure and hypoglycemia. Treatment: First of all, it is necessary to stop taking the drug and begin supportive symptomatic therapy. For severe bradycardia: intravenous administration of atropine. If the effect is insufficient, a drug with a positive chronotropic effect can be administered with caution. Sometimes temporary placement of an artificial pacemaker may be necessary. With a pronounced decrease in blood pressure: intravenous administration of plasma-substituting solutions and administration of vasopressors. For AV block: Patients should be closely monitored and treated with β-agonists such as epinephrine. If necessary, install an artificial pacemaker. In case of exacerbation of CHF: intravenous administration of diuretics, drugs with a positive inotropic effect, as well as vasodilators. For bronchospasm: use of bronchodilators, incl. β2-sympathomimetics and/or aminophylline. For hypoglycemia: intravenous administration of dextrose (glucose).
Interactions with other drugs
Not recommended combinations For the treatment of CHF. Class I antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and cardiac contractility. In the treatment of CHF, arterial hypertension, stable angina. CCBs 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 rebound hypertension. Combinations requiring special caution In the treatment of arterial hypertension, stable angina. Class I antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and myocardial contractility. In the treatment of CHF, arterial hypertension, stable angina. CCB derivatives of dihydropyridine (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 contractile function 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 antihypertensive effect of bisoprolol. Concomitant use of the drug 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 antihypertensive effect of bisoprolol. Mefloquine, when used simultaneously with bisoprolol, may increase the risk of bradycardia. MAO inhibitors (except MAO-B inhibitors) may enhance the antihypertensive effect of β-blockers. Concomitant use may also lead to the development of a hypertensive crisis. Contraindicated combinations Floctafenine: β-adrenergic blockers may interfere with the compensatory cardiovascular responses to floctafenine-induced hypotension. Sultopride: There is a risk of ventricular arrhythmia.
Special instructions for use
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 concomitantly, it can be discontinued only a few days after stopping the drug Aritel. 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. The anesthesiologist should be warned that the patient is taking Aritel. 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 a car 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.
Storage conditions
In a dry place, at a temperature not exceeding 25 °C. Keep out of the reach of children.
Best before date
24 months
ATX classification:
C Cardiovascular system
C07 Beta blockers
C07A Beta blockers
C07AB Selective beta1-blockers
C07AB07 Bisoprolol
What does Aritel help with?
Indications for use of Aritel:
- arrhythmias;
- ventricular extrasystoles;
- acceleration of sinus rhythm;
- chronic heart failure;
- stable angina;
- hypertension;
- heart attack prevention.
The drug is prescribed to patients with hypertension to prevent complications
When use is contraindicated
Absolute contraindications
You should not take Aritel if you have high blood pressure in the following cases:
- heart failure;
- cardiogenic shock;
- sinus rhythm disturbance;
- atrioventricular block 2 or 3 degrees;
- severe form of bronchial asthma;
- low blood pressure;
- Raynaud's disease;
- breastfeeding period;
- use of monoamine oxidase inhibitors;
- individual intolerance to components;
- hypolactasia;
- galactosemia.
Use with caution
Relative contraindications to the use of Aritel for high blood pressure:
- variant angina;
- thyrotoxicosis;
- insulin-dependent diabetes;
- 1st degree atrioventricular block;
- kidney failure;
- liver failure;
- congenital heart defects with hemodynamic impairment.
For people with kidney pathologies, the medicine is prescribed with caution.
Contraindications
- cardiogenic shock;
- collapse;
- acute heart failure;
- chronic heart failure in the stage of decompensation, requiring inotropic therapy;
- AV blockade II and III degrees (without electrical stimulator);
- sinoatrial block;
- SSSU;
- severe bradycardia (heart rate less than 50 beats/min);
- arterial hypotension (systolic blood pressure <90 mm Hg);
- severe peripheral circulatory disorders or Raynaud's syndrome;
- severe bronchial asthma;
- severe COPD;
- simultaneous use of MAO inhibitors (except for MAO type B);
- simultaneous use of floctafenine and sultopride;
- pheochromocytoma (without simultaneous use of alpha-blockers);
- metabolic acidosis;
- lactation period;
- children and adolescents under 18 years of age (efficacy and safety have not been established);
- lactase deficiency, lactose intolerance, glucose/galactose malabsorption syndrome;
- hypersensitivity to the components of the drug and other beta-blockers.
The drug should be used with caution when carrying out desensitizing therapy; Prinzmetal's angina; hyperthyroidism; type 1 diabetes mellitus and diabetes mellitus with significant fluctuations in blood glucose concentrations; AV blockade of the first degree; severe renal failure (creatinine clearance less than 20 ml/min); severe liver dysfunction; psoriasis; restrictive cardiomyopathy; congenital heart defects or heart valve disease with severe hemodynamic disturbances; chronic heart failure with myocardial infarction within the last 3 months; pheochromocytoma (with concomitant use of alpha-blockers); following a strict diet.
Instructions for use and dosage
The drug is taken orally. The tablets should be taken whole with drinking water. Eating food has no effect on taking pills. Aritel should be taken once a day.
Arterial hypertension and coronary artery disease
The daily dosage for hypertension and coronary heart disease is 5 mg. Gradually the dosage is increased to 10 mg per day. The maximum daily dose for hypertension is 20 mg. In old age there is no need to adjust the dosage.
When taking Aritel tablets for a course, you need to monitor your heart rate and blood pressure.
Chronic heart failure
For CHF, the recommended dosage is 1.25 mg per day. Doctors recommend replacing Aritel with the main analogue Aritel Cor, which is taken half a tablet per day. If the patient tolerates the tablets well, the dose is increased to 2.5–10 mg per day. The maximum permissible dose for chronic heart failure is 10 mg per day.
In the first days of therapy, symptomatic signs of heart failure may increase. If your health worsens, the daily dosage is reduced.
special instructions
You should not abruptly interrupt therapy or change the prescribed dose on your own, without medical advice, as this may lead to a short-term deterioration in heart function. Sudden cessation of taking Aritel, especially in case of coronary heart disease, is not recommended. If it is necessary to stop treatment, the dose should be reduced gradually.
During the period of therapy, monitoring of the patients' condition is indicated, including monitoring of heart rate and blood pressure (first - every day, then - once every 3-4 months), ECG, blood glucose concentration against the background of diabetes mellitus (once every 4-5 months), as well as kidney function (elderly patients; 1 time every 4-5 months). If your heart rate is less than 50 beats/min, you should consult a specialist.
In case of a burdened bronchopulmonary history, it is recommended to conduct a study of external respiratory function before starting therapy.
The effectiveness of Aritel in smoking patients is lower.
In approximately 20% of cases, drug treatment for angina pectoris is ineffective. Possible causes: severe coronary atherosclerosis with a low ischemic threshold (heart rate up to 100 beats/min) and increased end-diastolic volume of the left ventricle, disrupting subendocardial blood flow.
During therapy, the production of tear fluid may decrease, which must be taken into account when using contact lenses.
With pheochromocytoma, there is a possibility of paradoxical arterial hypertension (in cases where effective α-blockade has not been achieved in advance).
In patients with hyperthyroidism, Aritel therapy may mask certain clinical symptoms of the disease, for example, tachycardia. Sudden discontinuation of treatment in such patients is contraindicated, since there is a high probability of increased symptoms.
The use of the drug for diabetes mellitus can mask tachycardia associated with hypoglycemia. Aritel practically does not increase hypoglycemia, which is caused by insulin, and does not delay the restoration of blood glucose levels to normal values.
In case of combined use with clonidine, its use can be stopped only a few days after Aritel is discontinued.
In case of a burdened allergy history, there may be no effect from the use of usual doses of adrenaline (epinephrine) and an increase in the manifestations of hypersensitivity reactions may be observed.
When elective surgery is necessary, Aritel should be discontinued 48 hours before general anesthesia. If the patient took the drug before surgery, for general anesthesia it is necessary to select a drug with the least negative inotropic effect. The anesthesiologist must be informed about the drug taken.
Reciprocal activation of the vagus nerve can be eliminated by administering atropine (intravenously at a dose of 1-2 mg).
Strengthening the effect of Aritel is possible when combined with drugs that reduce catecholamine reserves (including reserpine). In this regard, the condition of patients taking this combination should be monitored in order to detect bradycardia or arterial hypotension. For bronchospastic diseases, it is possible to prescribe cardioselective adrenergic blockers in cases of ineffectiveness/intolerance of other antihypertensive drugs, however, the prescribed dosage regimen must be strictly observed. In case of overdose, there is a possibility of bronchospasm.
Elderly patients in cases of developing bradycardia (less than 50 beats/min), arterial hypotension (systolic pressure below 100 mmHg), AV blockade, ventricular arrhythmias, bronchospasm, severe renal/liver dysfunction, dose reduction or discontinuation of therapy is indicated . Also, discontinuation of Aritel is necessary if treatment-related depression occurs.
Due to the likelihood of severe arrhythmias and myocardial infarction, Aritel cannot be abruptly discontinued. Treatment should be completed gradually, reducing the dose by 25% every 3-4 days.
Before conducting a study of the content of normetanephrine, catecholamines and vanillylmandelic acid in the urine and blood, the drug must be discontinued.
While taking Aritel, patients are advised to be careful when driving vehicles and performing work that requires increased concentration and rapid psychomotor reactions.
Adverse reactions
When you have high blood pressure, you should drink Aritel with caution due to possible side effects of the components on the body:
- dizziness;
- sinus rhythm disturbance;
- increased symptoms of heart failure;
- paresthesia;
- severe decrease in blood pressure;
- fatigue;
- gagging;
- indigestion.
Less common:
- fainting;
- depression;
- sleep disorders;
- itching;
- psoriasis;
- skin rashes;
- impotence;
- decreased sex drive;
- ureteral colic;
- myasthenia gravis;
- seizures;
- decrease in the number of platelets in the blood;
- decreased leukocyte levels;
- hepatitis;
- bronchospasm;
- decreased production of tear fluid;
- inflammation of the conjunctiva;
- hearing impairment.
Conjunctivitis may appear as a side reaction to taking pills
Overdose of a drug
Overdose is expressed in characteristic symptoms:
- acute heart failure;
- a strong decrease in pressure to critical levels;
- atrioventricular block;
- bradycardia;
- decreased blood glucose levels;
- bronchospasm.
If there are signs of overdose, you should consult a doctor who will prescribe symptomatic treatment:
- violation of sinus rhythm - administration of atropine;
- lowering blood pressure - taking vasopressors;
- heart failure - taking diuretics, vasodilators;
- decrease in blood glucose - administration of glucose;
- narrowing of the lumen of the bronchi - taking bronchodilators;
- atrioventricular block - taking beta-adrenergic agonists.
Interaction with other drugs
Contraindicated combinations
Aritel should not be prescribed for high blood pressure simultaneously with Sultopride, as this can lead to the development of ventricular extrasystole.
It is not recommended to combine the drug Aritel for blood pressure with other antiarrhythmic drugs and calcium channel blockers, as the risk of decreased atrioventricular conduction and cardiac contractility increases.
Taking Clonidine, Moxonidine tablets, Methyldopa, Rilmenidine provokes a strong decrease in heart rate and a decrease in cardiac output.
Combinations requiring caution
The drug Aritel for blood pressure is prescribed with caution in combination with:
- Amiodarone;
- Hydralazine;
- Mefloquine;
- eye drops from the group of beta blockers;
- general anesthesia drugs;
- cardiac glycosides;
- diuretics;
- sympatholytic agents;
- non-steroidal anti-inflammatory drugs;
- glucocorticoids;
- estrogens;
- tricyclics;
- psychotropic drugs;
- antipsychotics;
- ethanol;
- sleeping pills;
- antidiabetic drugs;
- insulin;
- ergot alkaloids.
To avoid the wrong combination of Aritel with other drugs, it must be taken as prescribed by a doctor.
Use of Aritel during pregnancy and breastfeeding
During pregnancy, Aritel should be recommended for use only if the benefit to the mother outweighs the risk of side effects in the fetus. In general, beta blockers reduce blood flow to the placenta and may affect fetal development. Blood flow in the placenta and uterus should be monitored, as well as the growth and development of the unborn child should be monitored; if adverse events occur in relation to pregnancy and/or the fetus, alternative methods of therapy should be used. The newborn should be carefully examined after birth. In the first three days of life, symptoms of hypoglycemia and bradycardia may occur.
There is no data on the excretion of bisoprolol into breast milk. Therefore, taking Aritel is not recommended for women during breastfeeding. If it is necessary to take Aritel during lactation, breastfeeding should be stopped.
