Instructions for use CORVITOL

Corvitol represents a group of beta-blockers. The drug has a one-component composition. The advantages include a sufficient level of efficiency and reasonable cost. It is prescribed to patients of all ages. Moreover, in most cases the dosage is not recalculated.

Corvitol represents a group of beta-blockers.

Release form, composition and packaging

The medicine is characterized by a solid structure. You can purchase it in 2 versions: tablets with a dosage of the active substance of 50 and 100 mg. The main component is metoprolol tatrate. Other compounds in the composition do not show activity during therapy. These include:

• lactose monohydrate;
• croscarmellose sodium;
• magnesium stearate;
• povidone;
• highly dispersed silicon dioxide;
• talc.

The drug is produced in a package containing 3 or 5 blisters (10 tablets each).

The drug is produced in a package containing 3 or 5 blisters (10 tablets each).

Pharmacological action of Corvitol

The medicine is characterized by the absence of internal sympathomimetic activity. It has a weakly expressed membrane stabilizer. Main properties:

• normalization of blood pressure in hypertension;
• calming effect: the medicine helps normalize heart rhythm;
• symptoms of myocardial ischemia are eliminated.

The drug has a depressant effect on the central nervous system, further reducing the intensity of the renin synthesis process. This ensures a hypotensive effect. Under the influence of Corvitol, the level of sensitivity of the aortic baroreceptors decreases, and blood pressure decreases.

The antianginal (calming) effect is due to a decrease in heart rate. In addition, the need for oxygen in the heart muscle tissue decreases. As a result of these processes, sensitivity to sympathetic interventions disappears. Myocardial perfusion is restored, diastole increases.

When using the drug, the need for oxygen in the cardiac muscle tissue decreases.

This reduces the likelihood of developing angina pectoris and reduces the frequency of these attacks in patients. In addition, this pathological condition is much easier to tolerate. Increases resistance to more intense physical activity. In pathologies accompanied by tachycardia, the heart rhythm is normalized. The drug is characterized by anti-migraine action.

The peak activity of Corvitol occurs after 120 minutes, with the highest concentration of metoprolol in plasma. The active substance is absorbed from the stomach in a significant amount (95% of the total dose). The metabolization process involves the liver (transformation of the active substance occurs here) and the kidneys (excretion of metabolites). The drug in question can cross the blood-brain barrier.

Factors that contribute to an increase in the bioavailability of Corvitol are noted: liver cirrhosis, food intake. In both cases, this figure increases by 20-40%. Substances that are released during the metabolization process are characterized by activity as beta-blockers. With severe liver damage, the bioavailability of the drug may decrease. In this case, the intensity of the metabolization process decreases, since it occurs in this organ. The half-life of the drug components varies from 1 to 9 hours.

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Pharmacological properties of the drug Corvitol

Metoprolol is a weakly lipophilic β-adrenergic receptor blocker. It has relative selectivity for β1-adrenergic receptors, does not have sympathomimetic activity, and has a weak membrane-stabilizing effect. Metoprolol reduces the strength and frequency of heart contractions, the speed of impulse conduction in the AV junction and the activity of renin in the blood plasma. After oral administration, metoprolol is almost completely (approximately 95%) absorbed from the digestive tract. Due to the fact that metoprolol is subject to pronounced first-pass metabolism through the liver, its systemic bioavailability is 50%. The maximum concentration of metoprolol in the blood plasma is achieved within 1.5–2 hours. Metoprolol binds to plasma proteins by approximately 12%. The half-life of metoprolol is 3–5 hours. The drug is excreted from the body mainly through urine (95%).

What does Corvitol help with?

It is advisable to use this remedy for the following pathological conditions:

• arterial hypertension;
• angina pectoris (prevention of attacks, reducing the intensity of their symptoms);
• heart rhythm disturbances, for example, tachycardia, arrhythmia, etc.;
• myocardial infarction and signs of ischemia;
• prevention of migraine.

The drug can be used as an independent remedy. This is due to the sufficient level of effectiveness of Corvitol. In addition, it is allowed to be prescribed together with other antihypertensive drugs.

Dosage regimen

The treatment regimen is selected taking into account a number of factors: the type of disease, the general condition of the patient’s body, age, and the presence of other pathologies of the cardiovascular system. The tablets are taken after meals, which avoids an uncontrolled increase in the activity of the drug. They should not be chewed. You need to take the tablets with water. Various dosage regimens depending on the type of disease:

• Attacks of angina, hypertension. The recommended daily dose is 0.1 g. It is permissible to use 1 or 2 pieces. per day, if necessary, increase the dose. The maximum daily amount is 0.2 g. In this case, the drug is divided into 2 doses: 0.1 g in the morning and in the evening.
• Myocardial infarction. Tablets should be taken in small doses: 0.025-0.05 g. The break between doses is 12 hours. If necessary, this amount is increased several times. In this case, the maximum daily dose is 0.1-0.2 g. However, in this case, it is necessary to monitor the condition of the patient’s body using an ECG and changes in blood pressure levels.
• Heart rhythm disturbances: 0.05-0.1 g of the drug is prescribed. This dose can be taken once or divided into 2 doses.
• Prevention of migraine attacks. The daily amount of medication is 0.1 g. It can be divided into 2 doses or taken at a time. When acute signs of the pathological condition are eliminated, the dose is reduced. This is done on an individual basis.

The duration of the course depends on the condition of the patient’s body and the type of pathology.

Side effects of Corvitol

The drug contributes to the appearance of many negative reactions from different systems:

• Central nervous system: constant anxiety, agitated or, conversely, drowsy state, sleep disturbance, sensitivity disorder, deterioration of reactions (motor, mental), weakening of the body, fatigue, dizziness, memory impairment, impaired consciousness, weakness in soft tissues, depression.
• CVS: swelling, arterial hypotension, bradycardia, rapid heartbeat, dizziness, loss of consciousness, shortness of breath, increased intensity of signs of peripheral vascular disease, which is often accompanied by impaired microcirculation, deterioration of cardiac muscle conductivity.
• There is a possibility of hearing loss and decreased visual acuity. There is a decrease in the intensity of the lacrimal gland (the secretion is produced less intensively). The mucous membranes become drier. Sometimes conjunctivitis is diagnosed.
• External integument: hyperhidrosis develops, this pathology is accompanied by increased sweating, alopecia (this is a reversible process), and the manifestations of psoriasis intensify. Some patients are diagnosed with photodermatosis. The outer skin may turn red.
• Gastrointestinal tract: the structure of feces changes, nausea and vomiting occurs, pain in the abdomen, taste buds cease to fulfill their main task, and dryness appears in the oral cavity.
• Respiratory dysfunction.
• The risk of developing hyperglycemia, hypoglycemia, and hypothyroidism increases.
• The functioning of the hematopoietic system is disrupted, which can lead to a change in the composition of the biological fluid.
• Sometimes allergies develop. This pathological condition is accompanied by a rash and itching. People prone to allergic reactions develop urticaria.
• Weight gain and decreased libido are rarely observed. If you suddenly stop taking the drug, angina appears and blood pressure increases (signs of withdrawal syndrome).

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Side effects of the drug Corvitol

At the beginning of treatment or when used in high doses, increased fatigue, dizziness, depressive disorders, confusion, mild headache, sleep disturbances, and nightmares may occur. Sometimes nausea, vomiting, gastralgia, constipation or diarrhea occur; shortness of breath on exertion, less often - bronchospasm; paresthesia, feeling of coldness in the extremities, muscle weakness or muscle cramps; increased pain in patients with intermittent claudication; orthostatic hypotension, which is sometimes accompanied by loss of consciousness, slow pulse, functional disorders of the heart (AV conduction disorders), increased symptoms of heart failure (peripheral edema), pain in the heart and palpitations, bradycardia and increased angina attacks; in some cases - dry mouth, conjunctivitis and decreased secretion of the lacrimal glands; in isolated cases - disorders of libido and potency, weight gain, hair loss, visual impairment, hearing impairment, tinnitus; hypersensitivity reactions - itching, skin hyperemia, rash; in some cases - changes in the functional state of the liver, hepatitis, arthritis, thrombo- and leukocytopenia, allergic rhinitis. Cases of intensification of existing peripheral circulatory disorders, as well as short-term amnesia, have been described. In rare cases, manifestation of latent diabetes mellitus or deterioration of the condition of patients with diabetes mellitus is possible.

Contraindications for use

The medicine has many limitations:

• hypersensitivity to any of the components in the composition; there is also a ban on the use of other active substances contained in adrenoblocker analogues;
• bradycardia, accompanied by obvious signs;
• severe pathologies caused by impaired peripheral circulation;
• sinoatrial blockade and blockade of II, III degree;
• heart failure;
• hypotension;
• Prinzmetal's angina;
• acute myocardial infarction.

A number of relative contraindications are also noted. For example, it is permissible only for health reasons to prescribe the drug to patients with pheochromocytoma and diabetes mellitus. This group also includes severe forms of hepatic and renal dysfunction, first-degree AV block, bronchial asthma, metabolic acidosis, and some lung diseases (emphysema).

Special instructions for the use of the drug Corvitol

As a result of individual reactions to the drug, the ability to drive vehicles or operate machinery may decrease, especially at the beginning of treatment or when changing the drug, as well as while taking alcohol. In some patients, β-adrenergic receptor blockers may cause the development of psoriasis or its worsening, or the occurrence of psoriasiform exanthema. The drug is used with extreme caution and under strict control in patients with diabetes mellitus (due to the possibility of developing hypoglycemia); AV blockade of the first degree; in patients on a long-term strict diet or fasting during intense physical activity (severe hypoglycemic conditions are possible); in patients with impaired liver function. Patients with pheochromocytoma are prescribed only after treatment with α-adrenergic receptor blockers. During pregnancy (especially in the first trimester), the drug should be prescribed only according to strict indications, taking into account the benefit/risk ratio. There is evidence that metoprolol reduces placental circulation, which may result in fetal growth disturbances. Miscarriages, premature birth or intrauterine fetal death have been reported with the use of other β-adrenergic receptor blockers. Metoprolol passes into breast milk in significant quantities, so breastfed children whose mothers take the drug require medical supervision. The content of the drug in breast milk can be reduced by taking it 3-4 hours before feeding.

special instructions

During Corvitol therapy, it is recommended to monitor blood glucose, heart rate and blood pressure.

It is important to complete the course of therapy correctly. In this case, the dose is reduced gradually. The cancellation period is 10 days.

In some pathological conditions, for example, bronchial asthma, beta2-blockers are additionally prescribed. Patients with pheochromocytoma are recommended to use alpha-blockers along with Corvitol.

Elderly patients require monitoring of liver parameters. If bradycardia develops, the dosage is recalculated.

Driving a car during treatment is prohibited. This is due to an increased hypotensive effect, the likelihood of dizziness, blurred vision, impaired consciousness and the development of other negative reactions.

Use during pregnancy and breastfeeding

A special feature of Corvitol is its ability to be excreted from the body through breast milk and also penetrate the placenta. However, even exposure to small doses of the drug can lead to irreparable consequences. There is no reliable information about the safety of Corvitol, so you need to stop treatment with this drug during lactation.

Treatment with Corvitol during pregnancy and lactation should be discontinued.

Use in children

It is prohibited to use the medicine in patients under 18 years of age.

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Use for renal impairment

The drug can be prescribed in this case. No adjustment of the amount of active ingredient metoprolol is required.

Corvitol

Monitoring of patients taking beta-blockers includes monitoring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), blood glucose concentration in patients with diabetes (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 the heart rate is less than 50/min.

It is possible that the severity of allergic reactions may increase (against the background of a burdened allergic history) and there will be no effect from the administration of usual doses of epinephrine.

In elderly patients, it is recommended to monitor kidney function (once every 4-5 months). May increase symptoms of peripheral arterial circulation disorders. Patients with cardiac arrhythmias whose systolic blood pressure is below 100 mm Hg should be given IV only if special precautions are taken (there is a risk of a further decrease in blood pressure). The drug is discontinued gradually, reducing the dose over 10 days.

In case of arterial hypertension, the effect occurs after 2-5 days, a stable effect is observed after 1-2 months.

For exertional angina, the selected dose of the drug should ensure the heart rate at rest within the range of 55-60 beats/min, and during exercise - no more than 110 beats/min. In smokers, the effectiveness of beta-blockers is lower.

In combination therapy with clonidine, the latter should be discontinued several days after metoprolol is discontinued in order to avoid a hypertensive crisis. At a dose above 200 mg/day, cardioselectivity decreases.

Metoprolol may mask some clinical manifestations of thyrotoxicosis (for example, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because 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 concentrations to normal levels.

If necessary, beta2-agonists are used as concomitant therapy for patients with bronchial asthma; for pheochromocytoma - alpha-blockers.

If surgical intervention is necessary, it is necessary to warn the anesthesiologist about the therapy being performed (choosing a drug for general anesthesia with minimal negative inotropic effect); discontinuation of the drug is not recommended.

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

Drugs that reduce catecholamine reserves (for example, reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect an excessive decrease in blood pressure or bradycardia.

If elderly patients develop increasing bradycardia (less than 50/min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV block, bronchospasm, ventricular arrhythmias, severe liver and kidney dysfunction, it is necessary to reduce the dose or stop treatment . It is recommended to discontinue therapy if skin rashes appear and depression develops caused by taking beta-blockers.

The drug is discontinued gradually, reducing the dose over 10 days. If treatment is abruptly stopped, withdrawal syndrome may occur (increased angina attacks, increased blood pressure). When discontinuing the drug, special attention should be paid to patients with angina pectoris.

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

During pregnancy, it is prescribed only for strict indications (due to the possible development of bradycardia, hypotension, hypoglycemia and respiratory paralysis in the newborn). Treatment must be interrupted 48-72 hours before delivery. In cases where this is not possible, it is necessary to ensure strict monitoring of newborns for 48-72 hours after delivery.

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.

Overdose

With regular increases in dose, the following manifestations occur:

• state of shock;
• loss of consciousness;
• coma;
• AV block, rarely - cardiac arrest;
• dizziness;
• bradycardia;
• severe decrease in pressure;
• arrhythmia;
• respiratory dysfunction;
• nausea.

To eliminate these manifestations, it is recommended to rinse the patient’s stomach. Sorbents are prescribed. After this, symptomatic therapy is started taking into account the clinical picture.

In case of overdose, it is recommended to rinse the patient's stomach.

Drug interactions

When Corvitol is used simultaneously with MAO inhibitors, blood pressure is greatly reduced. There is a break of at least 14 days between taking these drugs.

It is prohibited to administer Verapamil during Corvitol therapy, which can lead to death due to cardiac arrest.

General anesthesia agents help lower blood pressure and suppress myocardial activity.

Ethanol has a depressant effect on the central nervous system during treatment with this drug.

Beta-agonists, some NSAIDs, Cocaine - they all help reduce the effectiveness of Corvitol.

Insulin can lead to hypoglycemia.

If diuretics, other antihypertensive drugs or Nitroglycerin are used simultaneously, blood pressure is significantly reduced.

It is best not to use Corvitol in combination with other medications.

The heart rate decreases if you use general anesthesia, cardiac glycosides and a number of drugs: Diltiazem, antiarrhythmics, Guanfacine, Reserpine, Alpha-methyldopa, Clonidine.

Rifampicin and barbiturates increase the rate of metabolism of metoprolol.

Cimetidine, phenothiazines and oral contraceptives provoke an increase in the concentration of the active component in plasma.

Iodine-based contrast agents used during hardware examinations cause an increased risk of developing anaphylactic reactions.

Metoprolol increases the concentration of lidocaine in plasma.

Interactions of the drug Corvitol

Use intravenous administration of verapamil, diltiazem or antiarrhythmic drugs (eg disopyramide) with caution in patients taking Corvitol. With simultaneous use of Corvitol and:

• insulin or oral hypoglycemic agents - their effect may be enhanced or prolonged, while the symptoms of hypoglycemia (especially tachycardia and tremor) may be masked or disappear, so regular monitoring of blood glucose levels is necessary;
• tricyclic antidepressants, barbiturates, phenothiazines, nitroglycerin, diuretics, vasodilators and other antihypertensive drugs (for example, prazosin) - the hypotensive effect may be enhanced;
• calcium antagonists of the dihydropyridine group, in addition to enhancing the hypotensive effect, heart failure may develop;
• calcium antagonists of other groups (verapamil, diltiazem) or other antiarrhythmic drugs (for example disopyramide) - arterial hypotension, bradycardia and other cardiac arrhythmias, heart failure may develop;
• cardiac glycosides, reserpine, methyldopa, guanfacine, clonidine - threatening bradycardia may develop;
• epinephrine, norepinephrine or other sympathomimetics - possible increase in blood pressure;
• indomethacin and rifampicin - the hypotensive effect may decrease and the elimination of metoprolol may be impaired;
• narcotic drugs - the hypotensive effect is enhanced. In this case, an additive negative inotropic effect of both drugs is noted;
• peripheral muscle relaxants - may cause increased neuromuscular blockade, therefore, before administering anesthesia, the anesthesiologist should be warned that the patient is using metoprolol;
• alcohol - may increase the inhibitory effect.

Analogs

Common substitutes:

• Atenolol;
• Betalok (Switzerland);
• Metozok (Akrikhin, Russia);
• Metokard (Poland);
• Atenolol (Darnitsa, Ukraine)
• Vasocardin (Slovakia), etc.