Nebilong, pills 10mg, 30pcs

Composition

1 tab. contains nebivolol 10 mg

Pharmacological action

Nebilong is a cardioselective beta-blocker of the third generation with vasodilating properties.

The Active ingredient is a racemate consisting of two enantiomers: D-nebivolol and L-nebivolol.

Nebivolol is a competitive and selective blocker of β1-adrenergic receptors (affinity for β1-adrenergic receptors is 288 times higher than for β2-adrenergic receptors), in addition, it has a mild vasodilating effect by modulating the release of relaxing factor (NO) from the vascular endothelium.

Nebivolol reduces heart rate and blood pressure at rest and during exercise, reduces the final diastolic pressure of the left ventricle, reduces OPSS, improves diastolic function of the heart (reduces filling pressure), increases the ejection fraction; causes an antianginal effect in patients with coronary heart disease.

The optimal antihypertensive effect appears after 1-2 weeks of treatment. In some cases, the maximum effect is achieved after 4 weeks.

Indications

Essential (primary) arterial hypertension, CHD.

Use during pregnancy and lactation

Use during pregnancy is possible only under strict indications (due to the possible development of bradycardia, hypotension, hypoglycemia and respiratory paralysis in newborns).

Nebivolol should be discontinued 48-72 hours before delivery. In cases where this is not possible, strict monitoring of newborns should be provided for 48-72 hours after delivery.

Contraindications

Bronchial asthma, decompensated chronic heart failure, untreated pheochromocytoma, severe liver function disorders, depression, angiospastic angina (Prinzmetal angina), peripheral vascular obliterating diseases (intermittent claudication syndrome), arterial hypotension, cardiogenic shock, bradycardia (heart rate less than 50 beats/min), SSR, AV block II and III degrees, myasthenia gravis, muscle weakness, children and adolescents under 18 years of age, hypersensitivity to nebivolol.

Side effects

From the central nervous system and peripheral nervous system:  headache, dizziness, fatigue, paresthesia, depression, decreased ability to concentrate, drowsiness, insomnia, nightmares, hallucinations.

From the digestive system:  nausea, constipation, diarrhea, dry mouth.

From the cardiovascular system:  bradycardia, orthostatic hypotension, shortness of breath, edema, heart failure, AV block, cardiac arrhythmias, Raynaud’s syndrome, cardialgia.

Allergic reactions:  skin rash.

Other services:  bronchospasm (including in the absence of obstructive pulmonary diseases in the anamnesis), photodermatosis, hyperhidrosis, rhinitis.

Interaction

When used concomitantly with Class I antiarrhythmic drugs, amiodarone may increase the negative inotropic effect and inhibit AV conduction.

When used concomitantly with calcium channel blockers (verapamil and diltiazem), the negative inotropic effect and inhibition of AV conduction are enhanced.

When used concomitantly with sympathomimetics, the pharmacological activity of nebivolol is suppressed.

When used concomitantly with anaesthetic agents, reflex tachycardia may be suppressed and the risk of hypotension may increase.

Concomitant use with tricyclic antidepressants, barbiturates, and phenothiazine derivatives may increase the antihypertensive effect of nebivolol.

Concomitant use with cimetidine may increase the concentration of nebivolol in blood plasma.

How to take, course of use and dosage

Adults for oral use-2.5-5 mg / day. in the morning.

The optimal effect develops after 1-2 weeks of treatment, and in some cases – after 4 weeks.

If necessary, the daily dose is increased to 10 mg / day.

For patients over 65 years of age, the initial dose is 2.5 mg / day. If necessary, the daily dose can be increased to 5 mg.

Overdose

Symptoms: bradycardia, hypotension, bronchospasm, and acute heart failure.

Treatment: In case of overdose or hypersensitivity reaction, the patient should be monitored by a doctor and treated in the intensive care unit. It is necessary to determine the concentration of blood glucose. Gastric lavage, the appointment of laxatives and enterosorbents will prevent the absorption of drug residues in the gastrointestinal tract.

In the treatment of bradycardia, atropine or methylatropine is prescribed. In case of hypotension, a replacement transfusion of plasma and the introduction of catecholamines are performed. The effect of beta-adrenergic blockade can be eliminated by slow intravenous use of isoprenaline hydrochloride, starting with a dose of 5 mcg / min, or dobutamine, starting with a dose of 2.5 mcg / min, until the desired effect is obtained.

If there is no effect, the possibility of intravenous use of glucagon 50-100 mcg/kg should be considered. If necessary, the injection can be repeated after one hour, followed by an infusion of glucagon at a dose of 70 mcg / kg / h.

Special instructions

Nebilong should be used with caution in patients with renal insufficiency, hyperthyroidism, allergic diseases, psoriasis, persons over the age of 65 years and patients with diabetes mellitus. Beta-blockers should be discontinued gradually over 10 days (up to 2 weeks in patients with CHD). At the beginning of treatment, blood pressure and heart rate should be monitored daily.

The effectiveness of beta-blockers in smokers is lower than in non-smokers. Nebivolol has no effect on glucose levels in patients with diabetes mellitus, but nebivolol may mask certain signs of hypoglycemia (tachycardia, rapid heartbeat) caused by the use of hypoglycemic drugs. If nebivolol is needed in patients with psoriasis, the expected benefit of therapy and the possible risk of psoriasis exacerbation should be carefully evaluated.

Beta-blockers should be used with caution with increased thyroid function due to the fact that under the influence of beta-blockers, tachycardia can be leveled. Nebivolol may increase the symptoms of peripheral circulatory disorders.

Patients who wear contact lenses should take into account that the use of beta-blockers may reduce the production of tear fluid. When performing surgical procedures, the anesthesiologist should be warned that the patient is taking beta-blockers.

Blood glucose monitoring should be performed once every 4-5 months (in patients with diabetes mellitus). Monitoring of laboratory parameters of renal function should be carried out once every 4-5 months (in elderly patients). Use in children is not recommended.

Form of production

Pills.

Storage conditions

At a temperature of 15-30 °C

Shelf life

3 years

Active ingredient

Nebivolol

Conditions of release from pharmacies

By prescription

Dosage form

Tablets

Description

For pregnant women as prescribed by a doctor, for Nursing mothers as prescribed by a doctor, For adults as prescribed by a doctor

Indications

Arrhythmia, Angina, Hypertension, Heart Failure