Egilok 50mg tablets 60 (Metoprolol)
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Cardioselective blocker β-adrenergic receptors.
Metoprolol suppresses the effect of increased activity of the sympathetic system on the heart, and also causes a rapid decrease in heart rate, contractility, cardiac output and blood pressure.
With arterial hypertension, metoprolol reduces blood pressure in patients in a standing and lying position. The long-term antihypertensive effect of the drug is associated with a gradual decrease in OPSS. With arterial hypertension prolonged use of the drug leads to a statistically significant decrease in the mass of the left ventricle and an improvement in its diastolic function. In men with mild or moderate arterial hypertension, metoprolol reduces mortality from cardiovascular causes (primarily sudden death, fatal and non-fatal heart attack and stroke).
Like other beta-blockers, metoprolol reduces myocardial oxygen demand by reducing systemic blood pressure, heart rate and myocardial contractility. A decrease in heart rate and a corresponding lengthening of diastole when taking metoprolol provide an improvement in blood supply and the absorption of oxygen by the myocardium with impaired blood flow. Therefore, with angina pectoris, the drug reduces the number, duration and severity of attacks, as well as asymptomatic manifestations of ischemia, and improves the physical performance of the patient. In myocardial infarction, metoprolol reduces the mortality rate, reducing the risk of sudden death. This effect is primarily due to the warning episodes of ventricular fibrillation. A decrease in the mortality rate can also be observed with the use of metoprolol both in the early and late phase of myocardial infarction, as well as in patients at high risk and patients with diabetes mellitus. The use of the drug after myocardial infarction reduces the likelihood of non-fatal repeated heart attack. In chronic heart failure against the background of idiopathic hypertrophic obstructive cardiomyopathy of metoprolol tartrate, taken in low doses (2×5 mg / day) with a gradual increase in dose, significantly improves heart function, quality of life and physical endurance of the patient.
With supraventricular tachycardia, atrial fibrillation and ventricular extrasystole, metoprolol reduces the frequency of ventricular contractions and the number of ventricular extrasystoles.
In therapeutic doses, the peripheral vasoconstrictor and bronchoconstrictor effects of metoprolol are less pronounced than the same effects of non-selective beta-positive adrenergic blockers.
Compared with non-selective beta-blockers, metoprolol has less effect on insulin production and carbohydrate metabolism, does not increase the duration of hypoglycemia attacks.
Metoprolol causes a slight increase in the concentration of triglycerides and a slight decrease in the concentration of free fatty acids in the blood serum. There is a significant decrease in the total concentration of serum cholesterol after the use of metoprolol for several years.
Indications for use
- arterial hypertension (in monotherapy or in combination with other antihypertensive drugs);
- functional disorders of cardiac activity, accompanied by tachycardia;
- IHD (secondary prevention of myocardial infarction, prevention of angina attacks);
- heart rhythm disturbances (supraventricular arrhythmias, ventricular extrasystole);
- hyperthyroidism (as part of complex therapy);
- prevention of migraine attacks.
- cardiogenic shock;
- AV blockade of II and III degrees;
- sinoatrial blockade;
- sinus bradycardia (heart rate <50 beats / min);
- heart failure in the stage of decompensation;
- severe peripheral circulatory disorders;
- age up to 18 years (due to the lack of sufficient clinical data);
- simultaneous intravenous administration of verapamil;
- severe form of bronchial asthma;
- pheochromocytoma without the simultaneous use of alpha-blockers;
- hypersensitivity to metoprolol or any other component of the drug;
- hypersensitivity to other beta-blockers.
Due to insufficient clinical data, Egiolok ® contraindicated in acute myocardial infarction, accompanied by heart rate <45 beats / min, with an interval of PQ >240 ms, and systolic blood pressure <100 mm Hg.
With caution, the drug should be prescribed for diabetes mellitus; metabolic acidosis; bronchial asthma; COPD; renal / hepatic insufficiency; myasthenia gravis; pheochromocytoma (with simultaneous use with alpha-blockers); thyrotoxicosis; AV-blockade of I degree, depression (including in the anamnesis); psoriasis; obliterating diseases of peripheral vessels (intermittent claudication, Raynaud's syndrome); pregnancy; during lactation; elderly patients; patients with a burdened allergic history (possibly a decrease in response with the use of adrenaline).
Use in pregnancy and lactation
Application the drug is not recommended during pregnancy. The use of the drug is possible only when the intended benefit to the mother exceeds the potential risk to the fetus. If it is necessary to prescribe the drug during pregnancy, careful monitoring of the condition of the fetus and newborn for 48-72 hours after childbirth is necessary, since the development of bradycardia, arterial hypotension, hypoglycemia and respiratory depression is possible.
Despite the fact that when using the drug in therapeutic doses, only a small amount of metoprolol is excreted in breast milk, the condition of the newborn should be monitored (bradycardia is possible). The use of the drug during lactation is not recommended. If necessary, the drug Egilok ® breastfeeding should be discontinued during lactation.
Use in case of impaired liver function
In cirrhosis of the liver, a dose change is usually not required due to low binding of metoprolol to blood plasma proteins. With severe liver failure (for example, after portocaval bypass surgery), it may be necessary to reduce the dose of the drug Egilok ® .
With caution, the drug should be prescribed for liver failure.
Use in renal dysfunction
In patients with impaired renal function, no change in the dosing regimen is required.
With caution, the drug should be prescribed for renal failure.
Use in childrenDue to the lack of sufficient clinical data, the drug is not recommended for use in children and adolescents under the age of 18 years.
Use in elderly patientsWith caution, the drug should be prescribed to elderly patients.
When prescribing the drug Egilok ® heart rate and blood pressure should be monitored regularly. It is necessary to teach the patient the method of calculating heart rate and instruct about the need for medical advice at heart rate <50 beats / min.
In patients with diabetes mellitus, blood glucose levels should be regularly monitored and, if necessary, the dose of insulin or oral hypoglycemic drugs should be adjusted.
When using the drug in a dose exceeding 200 mg / day, cardioselectivity decreases.
The appointment of Egilok to patients with chronic heart failure is possible only after reaching the stage of compensation.
In patients taking Egilok ® , it is possible to increase the severity of hypersensitivity reactions (against the background of a burdened allergic history) and the lack of effect from the introduction of conventional doses of epinephrine (adrenaline).
Anaphylactic shock may be more severe in patients taking Egilok ® .
Against the background of the use of Egilok, it is possible to aggravate the symptoms of peripheral circulatory disorders.
Egilok ® should be canceled gradually, consistently reducing its dose for 14 days. With a sharp cessation of treatment, it is possible to increase attacks of angina pectoris and the risk of developing coronary disorders. During the period of withdrawal of the drug, patients with coronary artery disease should be under close medical supervision.
With angina pectoris of tension, the selected dose of the drug Egilok ® must provide a resting heart rate of 55-60 beats / min, at load - no more than 110 beats / min.
Patients using contact lenses should take into account that against the background of treatment with beta-blockers, it is possible to reduce the production of tear fluid.
Egilok ® may mask some clinical manifestations of hyperthyroidism (for example, tachycardia). Abrupt withdrawal of the drug in patients with thyrotoxicosis is contraindicated, since it can increase the symptoms.
In diabetes mellitus, taking Egilok can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentration to a normal level.
When prescribing metoprolol to patients with bronchial asthma, simultaneous use of beta is necessary 2 - Adrenomimetics.
In patients with pheochromocytoma Egilok ® should be used in combination with alpha-blockers.
Before any surgical intervention, it is necessary to inform the surgeon / anesthesiologist about the therapy with Egilok (the choice of a drug for general anesthesia with minimal negative inotropic effect); cancellation of the drug is not required.
Drugs that reduce the supply of catecholamines (for example, reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision for excessive reduction in blood pressure or bradycardia.
When prescribing the drug to elderly patients, liver function should be regularly monitored. Correction of the dosing regimen is required only in case of increasing bradycardia in elderly patients (<50 beats / min), a pronounced decrease in blood pressure (systolic blood pressure <100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe violations of liver function. Sometimes it is necessary to stop treatment.
Patients with severe renal insufficiency are advised to monitor kidney function.
Special monitoring of the condition of patients with depressive disorders should be carried out. In the case of the development of depression caused by the use of beta-blockers, therapy should be discontinued.
If progressive bradycardia occurs, the dose should be reduced or the drug should be discontinued.
Use in pediatrics
Due to the lack of sufficient clinical data, the drug is not recommended for use in children and adolescents under the age of 18 years.
Influence on the ability to drive vehicles and control mechanisms
Caution must be exercised when driving vehicles and when engaging in potentially hazardous activities that require increased concentration of attention (risk of dizziness and fatigue).
Dosage and Administration
With angina pectoris, supraventricular arrhythmias, for the prevention of migraine attacks, are prescribed at a dose of 100-200 mg / day in 2 doses (morning and evening).
For the secondary prevention of myocardial infarction, it is prescribed in an average daily dose of 200 mg in 2 doses (morning and evening).
With functional disorders of cardiac activity, accompanied by tachycardia, it is prescribed in a daily dose of 100 mg in 2 doses (morning and evening).
Tablets should be taken orally during or immediately after a meal. Tablets can be divided in half, but not chewed.
Symptoms: a pronounced decrease in blood pressure, sinus bradycardia, AV blockade, heart failure, cardiogenic shock, asystole, nausea, vomiting, bronchospasm, cyanosis, hypoglycemia, loss of consciousness, coma. The symptoms listed above may increase with simultaneous use with ethanol, antihypertensive drugs, quinidine and barbiturates.
The first symptoms of an overdose appear after 20 min-2 h after taking the drug.
Treatment: careful monitoring of the patient is necessary (control of blood pressure, heart rate, respiratory rate, kidney function, blood glucose concentration, serum electrolytes) in the intensive care unit. If the drug has been taken recently, gastric lavage with activated charcoal can reduce further absorption of the drug (if washing is not possible, vomiting can be induced if the patient is conscious). In case of excessive decrease in blood pressure, bradycardia and the threat of heart failure - intravenously, with an interval of 2-5 minutes, the introduction of beta-adrenomimetics (until the desired effect is achieved) or intravenous administration of 0.5-2 mg of atropine. In the absence of a positive effect - dopamine, dobutamine or norepinephrine (norepinephrine). With hypoglycemia - the introduction of 1-10 mg of glucagon, the installation of a temporary pacemaker. With bronchospasm - the introduction of beta 2 - Adrenomimetics. With convulsions - slow intravenous administration of diazepam. Hemodialysis Ineffective.
Egilok ® is usually well tolerated by patients. Side effects, as a rule, are mild and reversible. The side effects listed below have been reported in clinical trials and with the therapeutic use of metoprolol. In some cases, the relationship of an undesirable phenomenon with the use of the drug is not reliably established. The following parameters for the frequency of side effects are defined as follows: very often (>10%), often (1-9.9%), infrequently (0.1-0.9%), rarely (0.01-0.09%), very rarely, including individual messages (<0.01%).
From the nervous system: very often - increased fatigue; often - dizziness, headache; rarely - increased excitability, anxiety; infrequently - paresthesia, convulsions, depression, decreased concentration, drowsiness, insomnia, nightmares; very rarely - amnesia / memory impairment, depression, Hallucinations.
From the cardiovascular system: often - bradycardia, orthostatic hypotension (in some cases, syncopal conditions are possible), cooling of the lower extremities, a feeling of palpitations; infrequently - temporary increase in symptoms of heart failure, cardiogenic shock in patients with myocardial infarction, AV-blockade of the I degree; rarely - conduction disorders, arrhythmia; very rarely - gangrene (in patients with peripheral circulatory disorders).
From the respiratory system: often - shortness of breath with physical exertion; infrequently - bronchospasm in patients with bronchial asthma; rarely - rhinitis.
From the digestive system: often - nausea, abdominal pain, constipation or diarrhea; infrequently - vomiting; rarely - dryness of the oral mucosa, impaired liver function.
From the skin: infrequently - urticaria, increased sweating; rarely - alopecia; very rarely - photosensitivity, exacerbation the course of psoriasis.
From the senses: rarely - visual impairment, dryness and / or irritation of the eyes, conjunctivitis; very rarely - ringing in the ears, a violation of taste sensations.
From the reproductive system: rarely - impotence / sexual dysfunction.
Other: infrequently - an increase in body weight; very rarely - arthralgia, thrombocytopenia.
Application of the drug Egilok ® should be discontinued if any of the above effects reaches a clinically significant intensity, and its cause cannot be reliably established.
- EGIS Pharmaceuticals
- Dosage form
- 50 mg
- Number of tablets
- INN Russian
- Russian title