Egilok tablets 100mg №60

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Egilok tabl 100mg vial No. 60 in a pack. No. 1
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Tablets are white or almost white, round, biconvex, scored on one side and engraved “E432” on the other side, odorless. The main active ingredient Metoprolol Release form Tablets are white or almost white, round, biconvex, with a score on one side and engraved “E432” on the other side, odorless. Dosage 100mg per vial No. 60 Special instructions Against the background of metoprolol treatment, a decrease in the production of lacrimal fluid is possible, which is important for patients using contact lenses. Completion of a long course of treatment with metoprolol should be carried out gradually (at least within 10 days) under the supervision of a physician. The simultaneous use of metoprolol with MAO inhibitors is not recommended. In combination therapy with clonidine, the latter should be discontinued a few days after the abolition of metoprolol, in order to avoid a hypertensive crisis. With simultaneous use with hypoglycemic agents, correction of their dosing regimen is required. A few days before anesthesia, it is necessary to stop taking metoprolol or choose an anesthetic agent with a minimal negative inotropic effect. Influence on the ability to drive vehicles and control mechanisms In patients whose activities require increased attention, the issue of using metoprolol on an outpatient basis should be decided only after assessing the patient’s individual response. Pharmacological action Cardioselective beta1-blocker without internal sympathomimetic activity. It has antihypertensive, antianginal and antiarrhythmic effects. Reduces the automatism of the sinus node, reduces heart rate, slows down AV conduction, reduces myocardial contractility and excitability, reduces cardiac output, reduces myocardial oxygen demand. Suppresses the stimulating effect of catecholamines on the heart during physical and psycho-emotional stress. It causes a hypotensive effect, which stabilizes by the end of the 2nd week of course use. In angina pectoris, metoprolol reduces the frequency and severity of attacks. Normalizes the heart rhythm with supraventricular tachycardia and atrial fibrillation. In myocardial infarction, it helps to limit the zone of ischemia of the heart muscle and reduces the risk of developing fatal arrhythmias, reduces the possibility of recurrence of myocardial infarction. When used in medium therapeutic doses, it has a less pronounced effect on the smooth muscles of the bronchi and peripheral arteries than non-selective beta-blockers. Pharmacokinetics After oral administration, metoprolol is rapidly and almost completely absorbed from the gastrointestinal tract, Cmax of the active substance in the blood plasma is reached after 1-2 hours. After absorption, metoprolol is largely subjected to the “first pass” effect through the liver. It is intensively metabolized in the liver with the participation of isoenzymes of the cytochrome P450 system with the formation of non-active metabolites. T1 / 2 of metoprolol from plasma is 3-4 hours and does not change during the course of treatment. More than 95% of the dose taken is excreted by the kidneys, of which only 3% is unchanged. Indications for use Arterial hypertension, prevention of angina attacks, cardiac arrhythmias (supraventricular tachycardia, extrasystole), secondary prevention after myocardial infarction, hyperkinetic cardiac syndrome (including with hyperthyroidism, NCD). Prevention of migraine attacks. Dosage and administration When taken orally, the average dose is 100 mg / day in 1-2 doses. If necessary, the daily dose is gradually increased to 200 mg. With a / in the introduction of a single dose – 2-5 mg; in the absence of effect, re-introduction is possible after 5 minutes. Maximum doses: when taken orally, the daily dose is 400 mg; when administered intravenously, a single dose is 15-20 mg. Use during pregnancy and lactation Use during pregnancy is possible only if the intended benefit to the mother outweighs the potential risk to the fetus. Metoprolol crosses the placental barrier. Due to the possible development of bradycardia, arterial hypotension, hypoglycemia and respiratory arrest in a newborn, metoprolol must be canceled 48-72 hours before the planned delivery date. After delivery, it is necessary to ensure strict control over the condition of the newborn for 48-72 hours. Metoprolol is excreted in breast milk in small quantities. Use during lactation is not recommended. Precautions Use with caution in patients with chronic obstructive airways disease, diabetes mellitus (especially with a labile course), Raynaud’s disease and obliterating diseases of peripheral arteries, pheochromocytoma (should be used in combination with alpha-blockers), severe renal and hepatic dysfunction. Interaction with other drugs When used simultaneously with antihypertensive drugs, diuretics, antiarrhythmic drugs, nitrates, there is a risk of developing severe arterial hypotension, bradycardia, AV blockade. With simultaneous use with barbiturates, the metabolism of metoprolol is accelerated, which leads to a decrease in its effectiveness. With simultaneous use with hypoglycemic agents, it is possible to enhance the effect of hypoglycemic agents. With simultaneous use with NSAIDs, it is possible to reduce the hypotensive effect of metoprolol. With simultaneous use with opioid analgesics, the cardiodepressive effect is mutually enhanced. With simultaneous use with peripheral muscle relaxants, it is possible to increase the neuromuscular blockade. With simultaneous use with means for inhalation anesthesia, the risk of inhibition of myocardial function and the development of arterial hypotension increases. With simultaneous use with oral contraceptives, hydralazine, ranitidine, cimetidine, the concentration of metoprolol in the blood plasma increases. With simultaneous use with amiodarone, arterial hypotension, bradycardia, ventricular fibrillation, asystole are possible. With simultaneous use with verapamil, Cmax in blood plasma and AUC of metoprolol increase. The minute and stroke volume of the heart, pulse rate, and arterial hypotension decrease. Perhaps the development of heart failure, dyspnea and blockade of the sinus node. With intravenous administration of verapamil while taking metoprolol, there is a risk of cardiac arrest. With simultaneous use, it is possible to increase bradycardia caused by digitalis glycosides. With simultaneous use with dextropropoxyphene, the bioavailability of metoprolol increases. With simultaneous use with diazepam, a decrease in clearance and an increase in the AUC of diazepam are possible, which can lead to an increase in its effects and a decrease in the speed of psychomotor reactions. With simultaneous use with diltiazem, the concentration of metoprolol in the blood plasma increases due to inhibition of its metabolism under the influence of diltiazem. The effect on the activity of the heart is additively suppressed due to the slowing down of the impulse through the AV node caused by diltiazem. There is a risk of developing severe bradycardia, a significant decrease in stroke and minute volume. With simultaneous use with lidocaine, a violation of the excretion of lidocaine is possible. With simultaneous use with mibefradil in patients with low activity of the CYP2D6 isoenzyme, it is possible to increase the concentration of metoprolol in the blood plasma and increase the risk of developing toxic effects. With simultaneous use with norepinephrine, epinephrine, other adreno- and sympathomimetics (including in the form of eye drops or as part of antitussives), some increase in blood pressure is possible. With simultaneous use with propafenone, the concentration of metoprolol in the blood plasma increases and a toxic effect develops. It is believed that propafenone inhibits the metabolism of metoprolol in the liver, reducing its clearance and increasing serum concentrations. With simultaneous use with reserpine, guanfacine, methyldopa, clonidine, severe bradycardia may develop. With simultaneous use with rifampicin, the concentration of metoprolol in the blood plasma decreases. Metoprolol may cause a slight decrease in the clearance of theophylline in smoking patients. Fluoxetine inhibits the CYP2D6 isoenzyme, which leads to inhibition of the metabolism of metoprolol and its accumulation, which can enhance the cardiodepressive effect and cause bradycardia. A case of lethargy development is described. Fluoxetine and mainly its metabolites are characterized by a long T1 / 2, so the possibility of drug interaction remains even several days after fluoxetine is discontinued. There are reports of a decrease in the clearance of metoprolol from the body when used simultaneously with ciprofloxacin. With simultaneous use with ergotamine, it is possible to increase peripheral circulatory disorders. With simultaneous use with estrogens, the antihypertensive effect of metoprolol decreases. With simultaneous use, metoprolol increases the concentration of ethanol in the blood and prolongs its excretion. Contraindications II and III degree AV blockade, sinoatrial blockade, bradycardia (heart rate less than 50 bpm), SSSU, arterial hypotension, stage IIB-III chronic heart failure, acute heart failure, cardiogenic shock, metabolic acidosis, severe peripheral circulatory disorders, hypersensitivity to metoprolol. Composition In 1 tab. metoprolol tartrate 100 mg Excipients: microcrystalline cellulose, sodium carboxymethyl starch, anhydrous colloidal silicon dioxide, povidone, magnesium stearate. Overdose Symptoms: severe sinus bradycardia, dizziness, nausea, vomiting, cyanosis, arterial hypotension, arrhythmia, ventricular extrasystole, bronchospasm, syncope; in acute overdose – cardiogenic shock, loss of consciousness, coma, AV blockade up to the development of complete transverse blockade and cardiac arrest, cardialgia. The first signs of an overdose appear 20 minutes to 2 hours after ingestion. Treatment: gastric lavage, administration of adsorbents, symptomatic therapy: with a pronounced decrease in blood pressure – the Trendelenburg position, in case of acute arterial hypotension, bradycardia and threatening heart failure – in / in (with an interval of 2-5 minutes) the introduction of beta-agonists or in / in the introduction of 0.5-2 mg of atropine sulfate, in the absence of a positive effect – dopamine, dobutamine or norepinephrine. As follow-up measures, it is possible to prescribe 1-10 mg of glucagon, the setting of a transvenous intracardiac pacemaker. With bronchospasm – intravenous administration of beta2-agonists, with convulsions – slow intravenous administration of diazepam. Metoprolol is poorly excreted by hemodialysis. Side effects From the side of the cardiovascular system: possible bradycardia, arterial hypotension, AV conduction disturbances, the appearance of symptoms of heart failure. From the digestive system: at the beginning of therapy, dry mouth, nausea, vomiting, diarrhea, constipation are possible; in some cases – violations of the liver. From the side of the central nervous system and peripheral nervous system: at the beginning of therapy, weakness, fatigue, dizziness, headache, muscle cramps, a feeling of cold and paresthesia in the extremities are possible; possible decrease in the secretion of lacrimal fluid, conjunctivitis, rhinitis, depression, sleep disturbances, nightmares. From the hemopoietic system: in some cases – thrombocytopenia. From the endocrine system: hypoglycemic conditions in patients with diabetes mellitus. From the respiratory system: in predisposed patients, symptoms of bronchial obstruction may appear. Allergic reactions: skin rash, itching. Storage conditions Keep out of the reach of children at a temperature of 15 ° to 25 ° C. Buy Egilok tablets 100mg No. 60 Price for Egilok tablets 100mg No. 60