Bisoprolol and amlodipine combination how to take them. Concor AM: a new fixed combination of bisoprolol and amlodipine for effective blood pressure control. Directions for use and doses
Almost every person who has heart problems or suffers from high blood pressure is familiar with the drug, because it is usually the first thing doctors prescribe.
This high-quality drug, the active ingredient of which is bisoprolol, has proven itself, therefore it is often used in complex treatment together with other medications.
In the instructions for the drug Concor, compatibility with other medications is described especially carefully, since there is a whole list of drugs with which it is strictly forbidden to use it. We will talk about them in detail in our article.
The drug, which belongs to the group of beta-blockers, is successfully used to treat a whole range of diseases of the cardiovascular system. Its main active ingredient, bisoprolol, blocks the effect of adrenaline and other catecholamines, as well as stimulating nerve impulses of the central nervous system, on the heart muscle.
Concor tablets
The drug has a gentle effect, but the effect is not observed instantly, but only after an appropriate course of treatment.
As a result of intake, the frequency and strength of heart contractions decreases, due to which the need of the heart muscle for oxygen is reduced, in addition, the heart rhythm is normalized.
Unlike some analogue drugs, bisoprolol acts selectively only on the heart muscle, with virtually no effect on other internal organs - bronchi, pancreas, due to which the likelihood of side effects is noticeably reduced.
The drug is prescribed in the presence of the following pathologies:
- high blood pressure;
- cardiac ischemia;
- angina pectoris;
- stage of compensation for chronic heart failure.
People who regularly use this drug as a course reduce the likelihood of a heart attack and other consequences of hypertension.
Compatibility with drugs with similar effects
You should be careful with various centrally acting antihypertensive drugs, such as Reserpine, Guanfacine, Moxonidine and Methyldop.
Their combination can lead to a sharp disturbance in heart rhythm and a further rise in pressure.
Pay attention to other medications that directly or indirectly reduce blood pressure, for example, antispasmodics, diuretics, barbiturates; they can also enhance the effect of the drug and lead to an attack of hypotension.
However, in some cases, the attending physician may prescribe drugs with an antihypertensive effect together with Concor if he believes that it alone will be ineffective, as a rule, this is one of the following drugs:
- Amlodipine, which is used for high blood pressure. However, the answer to the question of whether Concor and Amlodipine can be taken will be negative if there is heart failure;
- with a diuretic and vasodilator effect, used for hypertension, with a minimum of side effects. Concor and Indapamide have good compatibility;
- Noliprel- another drug that can reduce blood pressure, which is classified as potent;
- Cardiomanil– a drug based on aspirin, previously often used to treat hypertension. Is it possible to take Concor and Cardiomagnyl together? Based on recent studies, its effectiveness and safety are questionable and, as a rule, it is not currently prescribed.
Amlodipine tablets
No less dangerous is taking cardiac glycosides, which are usually used by people with heart failure; when used simultaneously, conduction is impaired, which can provoke atrioventricular block.
It is dangerous to prescribe Concor in combination with various adrenergic agonists that stimulate alpha and beta receptors; in this case, peripheral pressure may increase.If you are already taking them, you should stop taking them and wait at least 2 weeks before you start using Concor.
Your doctor should tell you all the medications you use, since even those applied topically may increase the effect of taking them together, such as beta-blocker eye drops for glaucoma.
Drugs that reduce effectiveness
When taking medications, it should be taken into account that drugs of the opposite direction weaken its effect. First of all, these include beta-agonists dobutamine or isoprenaline.
Below is a whole list of drugs that negatively affect the effectiveness of taking Concor, including:
- female sex hormones estrogens;
- glucocorticosteroids (Hydrocortisone, Prednisolone, Dexamethasone, etc.);
- anti-inflammatory non-steroidal drugs (Acetylsalicylic acid, Analgin, Paracetamol, etc.).
It is not necessary to stop taking them when treating hypertension, however, it should be taken into account that the effect will be lower and the doctor’s attention should be focused on this; in some cases, he may increase the dosage.
Medicines to be taken with caution
There are special instructions for people with diabetes.
If they use insulin and hypoglycemic medications in tablets, they must take into account that bispoprolol, the main active ingredient of Concor, potentiates their effect.
An additional danger of co-administration is that Concor reduces the manifestations of tachycardia, which in diabetics is a signal of a decrease in blood sugar levels, due to which the patient may miss a dangerous symptom and a hypoglycemic coma may develop.
Video on the topic
Instructions for use of the drug:
As you can see, the list of medications that are not recommended to be taken together with Concor is very extensive. Some combinations simply reduce the effectiveness of taking the drug, and some can lead to very unpleasant consequences. That is why this drug should only be prescribed by a doctor, having previously discussed with the patient all the medications he is currently using. Tell your doctor not only about certified drugs from the pharmacy chain, but also about dietary supplements and herbs, if you take them.
Hypertension reduces the quality of life and provokes the development of severe complications of target organs. You can prevent their damage by using new generation high blood pressure pills. They are synthesized in such a way as to bring maximum benefit, with a minimum number of side effects and contraindications. Many modern drugs have other advantages, for example, a combined effect due to the combination of several main ingredients in the composition. This phenomenon makes them even more popular, since it is enough to take only 1 tablet a day, instead of 2-3.
Features of modern medicines
New blood pressure medications stabilize the functioning of the heart muscle, nervous system, kidneys and blood vessels. The patient's symptoms of hypertension are relieved, endurance to exercise increases and a significant increase in resistance to stressful situations is observed.
The following list of advantages is typical for new generation blood pressure medications:
- They have a prolonged effect due to the technology of slow release of the main active substance or its gradual accumulation in the body. Due to the effect they have, within 24 hours new blood pressure medications improve the functioning of the heart, kidneys and central nervous system, and also protect against attacks of arterial hypertension.
- They are able to influence exclusively certain systems of the body, thereby reducing the likelihood of developing side effects. This property of modern drugs is especially in demand among older people.
- They do not affect the psycho-emotional background of a person even with prolonged use.
- They do not cause bronchospasm, so their use is allowed even for respiratory diseases, unlike the first generations of beta-blockers.
- Helps reduce hypertrophy (pathological increase in the mass of the left ventricle). Simple blood pressure lowering agents cannot effectively perform this function.
- They do not affect libido (sexual desire) and physical activity of the patient.
- Stimulate metabolic processes associated with lipids and uric acid. For outdated diuretics of the thiazide group and beta-blockers, a similar effect is not typical.
- Stimulates the excretory function of the kidneys.
Such properties of new generation high blood pressure medications will improve the patient’s quality of life and significantly reduce the likelihood of complications and side effects. Among the disadvantages of modern tablets is the high cost.
List of newest tablets
Treatment for hypertension involves taking medications to lower blood pressure. They are included in the list of groups below:
- diuretics;
- bate-adrenergic blockers;
- calcium antagonists;
- ACE inhibitors;
- sartans.
Each group has its own disadvantages and advantages. Scientists are striving to expand their range, creating new and more effective drugs to lower blood pressure every year.
Diuretics
Diuretics are used to reduce the amount of excess moisture in the body. The latest generation of drugs from this group last longer and cause less harm to the patient. You can see their list below:
Beta-adrenergic blockers prevent adrenaline from affecting the heart muscle. After taking them, the patient’s blood pressure drops and the risk of developing complications of hypertension is reduced. New drugs from this group differ from more outdated options in their pronounced vasodilatory effect due to the blocking of alpha-adrenergic receptors. Their list is as follows:
- "Bisoprolol" represents a cardioselective group. It will lower blood pressure by blocking exclusively beta-1 blockers localized in the heart muscle. The effect provided shields it from the influence of adrenaline, as a result of which the intensity of myocardial contractions decreases, arrhythmia is eliminated and blood vessels dilate. It is not recommended to use the drug for bradycardia, hypotension and atrioventricular block.
- "Celiprolol" blocks beta-1 and alpha-2 adrenergic receptors, producing a pronounced vasodilator and hypotensive effect. When a stressful situation occurs, it reduces the heart rate and minute volume of blood pumped, which protects against high blood pressure. The advantage of the drug is the low likelihood of developing bronchospasm. It is advisable not to use it in case of cardiogenic shock, bradycardia and atrioventricular block.
ACE inhibitors
Angotensin-converting enzyme inhibitors prevent the formation of angiotensin II, which increases heart rate and constricts blood vessels. You can see the newest blood pressure-lowering drugs representing this group below:
- Ramipril helps to cope even with the malignant form of hypertension. It is also prescribed for diabetes, nephropathy and left ventricular hypertrophy. It increases the sensitivity of cells to insulin, improves blood flow in the heart and kidneys, and reduces resistance in the pulmonary vessels. It is not recommended to use the drug for arterial stenosis and angioedema.
- Perindopril is prescribed to hypertensive patients suffering from heart failure as a daily medication. It improves the elasticity of the arteries and reduces the pressure in the pulmonary capillaries. With prolonged use of the drug, the reverse process of left ventricular hypertrophy begins. It is contraindicated mainly in case of individual intolerance to the composition.
- Enalapril is used for hypertension accompanied by frequent crises. The effect lasts throughout the day and is enhanced by its mild diuretic properties. The drug is especially valued for improving coronary and renal blood flow and reducing platelet aggregation. It is better not to use it for angioedema and porphyria.
Sartans
Sartans do not inhibit the production of angiotensin, but block the receptors that perceive it, which is why they differ from angotensin-converting enzyme inhibitors. The effect provided is much more reliable and has less chance of developing adverse reactions. A list of modern drugs for lowering blood pressure from this group can be seen below:
Calcium blockers
Calcium antagonists block the entry of the element into the cells of the heart and blood vessels. A similar effect is manifested by a decrease in the intensity of myocardial contractions and vascular tone. The list of newer calcium channel blockers is as follows:
Modern combination drugs
Scientists have created many effective drugs with a combined effect against high blood pressure. Below is a list of them:
Modern tablets used for high blood pressure have a wide spectrum of action and are virtually devoid of the disadvantages of previous generations. They are selected depending on the patient’s condition and his individual characteristics. It is advisable to use combination drugs only when monotherapy is ineffective. Prescribing them on your own is dangerous for your health, since you need to take into account the contraindications of several active substances. It is recommended to entrust the preparation of a treatment regimen to an experienced cardiologist or therapist.
In the treatment of arterial hypertension (AH), both single-component and combined drugs are used that affect physiological mechanisms in the heart and blood vessels. Combination antihypertensive drugs include Concor AM; it is considered a fairly effective drug with a convenient dosage.
The medicine is well tolerated by patients (according to reviews), and receives positive recommendations from therapists and cardiologists due to the presence of combinations of two active components in the composition.
The drug contains a selective and calcium channel blocker. The drug is available in four combinations of active components:
- 5 mg bisoprolol / 5 mg amlodipine;
- 5 mg bisoprolol / 10 mg amlodipine;
- 10 mg bisiprolol / 5 mg amlodipine;
- 10 mg bisoprolol / 10 mg amlodipine.
Various combinations of components allow the attending physician to choose the optimal dosage option for the drug. It is possible to accurately select the combination during the patient’s previous treatment with single-component drugs.
At the beginning of antihypertensive therapy, the doctor selects drugs from different pharmacological groups, observing the reaction. Based on the dynamics of blood pressure (BP), the body’s sensitivity to the active ingredients and on the basis of examinations, the doctor can adjust the dosage and prescribe additional drugs for maximum therapeutic effect with a minimum of side effects.
The combination of amlodipine and bisoprolol in one drug allows the doctor and patient to simplify the way they take medications. In the form of Concor AM, instead of two drugs, you need to take one, which has a more pronounced therapeutic effect.
What is the difference between Concor and Concor AM?
This is a single-component antihypertensive drug that contains only one active substance - bisoprolol fumarate. There is no second active substance in the medicine. This is the only way Concor differs from Concor AM. In the second drug, a selective beta-blocker is combined with a calcium channel blocker, amlodipine. Concor's nosological list (which drugs help with) includes not only. The drug is prescribed for (), angina, and also for congestive heart failure. Concor AM has a more limited list of diseases that can be corrected with this drug.
What is it used for?
The drug is intended for the correction of hypertension, primary and secondary. The drug can be taken only on the recommendation of the attending physician based on examination of the patient. The specialist must conduct a physical examination, perform an electrocardiogram and ultrasound of the heart (if necessary), examine the structure of the fundus (it is damaged by hypertension).
The final diagnosis is based on measuring blood pressure over time. If the indicators are consistently exceeded 140/90 mmHg. Art. A diagnosis of arterial hypertension is made.
The doctor is faced with a choice between different groups of drugs that have a hypotensive effect by influencing the mechanisms that cause an increase in blood pressure. The choice of active substance is based on the patient’s health status and is selected in such a way as to obtain the maximum therapeutic effect and minimize side effects.
A beta-blocker inhibits the reaction of beta-adrenergic receptors to the action of the adrenal hormones adrenaline and norepinephrine, under the influence of which inotropic reactions occur. Bisoprolol, suppressing beta-adrenergic receptors, acts as follows:
- slows down the pulse (HR);
- reduces the conductivity of the heart muscle;
- reduces myocardial contractility;
- reduces the heart's need for oxygen;
A calcium channel blocker is a drug that selectively stops the flow of calcium ions into cells through “slow” L-type channels. CCB has a negative inotropic and vasodilating effect. Amlodipine produces the following effects:
- affects the transmembrane entry of calcium ions into cardiomyocytes during excitation, reducing the breakdown of adenosine triphosphate (ATP);
- reduces the force of contraction and the heart’s need for oxygen;
- reduces vascular tone, preventing vasospasm;
- reduces afterload on the heart;
- increases blood flow in ischemic areas of the heart;
- slows down the appearance of atherosclerotic plaques.
CCB has a different mechanism of action on the heart and blood vessels; it produces a pronounced hypotensive effect. In combination, a CCB and a beta-blocker help to effectively reduce blood pressure and keep it within normal limits due to a synergistic effect. The drugs complement each other, exerting a selective effect on the mechanisms that cause an increase in blood pressure. There are no other side effects associated with negative inotropic and vasodilating effects.
Consequences of arterial hypertension for the human body
Instructions for use
The instructions for use recommend taking the drug Concor AM in the dosage form selected by the doctor. The specialist prescribes medicine based on an examination of blood pressure dynamics and general health. The reception scheme is simple:
- one tablet of the drug once a day;
- reception time - morning;
- You can take the tablet both before and after meals.
Concor is usually taken for a long time as maintenance therapy.
Indications
Indications for taking Concor AM are obvious, both according to the instructions for use and the pharmacological group of both components in the drug. The drug is listed as an antihypertensive drug and should be taken if hypertension is diagnosed.
Important! You should not prescribe medication yourself if symptoms of hypertension appear. Even if there is a family history of hypertension, and the medicine helps friends, acquaintances or relatives, this is not a reason to take drugs.
Only a doctor should choose the medicine, dosage, and duration of the course. When taken independently, the patient has no guarantee that the drug will give the desired therapeutic effect without side effects.
How to use?
If before taking Concor the patient was taking single-component drugs for the treatment of hypertension - a selective beta-blocker or a calcium channel antagonist, then you can start taking the medication without interruption, at the dosage prescribed by the doctor.
If there is no effect, or if the hypotensive effect is not sufficiently pronounced, it is not recommended to increase the dosage on your own. You need to consult a doctor.
Dosage
The minimum dosage of the drug corresponds to Concor AM 5/5. At the initial stage of antihypertensive therapy, 5 mg of bisoprolol and 5 mg of amlodipine are sufficient to determine the body's reaction to the active substances. If the therapeutic effect is sufficient, then the doctor can transfer the patient to Concor AM 5/10 1–2 weeks after the start of treatment. If the antihypertensive effect is insufficient, the patient is transferred to Concor AM 10/10.
special instructions
There are several groups of patients who are prescribed selective beta-blockers and calcium channel blockers with increased caution. If it is necessary to use these groups of drugs, the minimum dosage is selected.
- Patients with functional liver diseases should take no more than 5 mg of amlodipine per day, since it is eliminated from the body more slowly. The dose of bisoprolol should be no more than 10 mg. The optimal form of the drug in this case is Concor AM 5/5 or Concor AM 5/10.
- Patients with impaired renal function should take Concor AM with caution. In this case, the maximum dosage of bisoprolol does not exceed 10 mg per day. Concor AM 5/10 and Concor 10/10 are allowed. For patients undergoing dialysis, a minimum dosage of amlodipine is recommended.
Side effects
While taking Concor, side effects may occur that may be associated with the action of bisoprolol and amlodipine separately. Both substances equally often have the following side effects: 
- headache, dizziness, asthenia;
- slow heartbeat;
- severe decrease in blood pressure;
- dyspeptic symptoms (nausea, heartburn);
- allergic reactions to the drug.
Bisoprolol may be associated with a decrease in tear production and discomfort when using contact lenses. Amlodipine may have an effect on the central nervous system and cause sleep disturbances, depression, anxiety and increased excitability.
Compatibility of the drug with alcohol
People with problems with the heart and blood vessels should drink alcohol in minimal quantities or avoid it altogether. Alcohol tends to constrict blood vessels after temporarily dilating. Despite the fact that the instructions for use do not describe the effect of amlodipine and bisoprolol on the pharmacokinetics of ethanol, it is not recommended to use antihypertensive drugs with alcohol. This can lead to the development of excessive drug exposure in the form of a drop in blood pressure, bradycardia and heart failure.
Contraindications
- severe form;
- individual sensitivity to the components of the drug;
- aortic stenosis;
- after a heart attack;
- weakness of sinus rhythm.
The effect of Concor on patients of childhood and adolescence has not been sufficiently studied, therefore taking drugs under 18 years of age is prohibited. Drugs are prescribed to pregnant women in cases where the benefit to the mother is greater than the side effect on the fetus. It is prohibited to take drugs while breastfeeding, since CCBs penetrate into mother's milk.
Amlodipine + Bisoprolol
Compound
Amlodipine; Bisoprolol
Therapeutic indications
Provided in the section Therapeutic indications Amlodipine + Bisoprolol Amlodipine + Bisoprolol Therapeutic indications in the instructions for the medicine Amlodipine + Bisoprolol
More...close
Arterial hypertension: replacement of therapy with monocomponent drugs amlodipine and bisoprolol in the same doses.
Directions for use and doses
Provided in the section Directions for use and doses Amlodipine + Bisoprolol the information is based on data about another medicine with exactly the same composition as the medicine Amlodipine + Bisoprolol(Amlodipine, Bisoprolol). Be careful and be sure to check the information on the section Directions for use and doses in the instructions for the medicine Amlodipine + Bisoprolol directly from the package or from a pharmacist in a pharmacy.
More...close
Inside, in the morning, regardless of food intake, without chewing. The score is intended only to facilitate breaking for ease of swallowing. Not for dividing into equal doses!
The selection and titration of the dose individually for each patient is carried out by the doctor during the prescription of monocomponent drugs containing the active ingredients included in the drug Concor ® AM.
Duration of treatment
Treatment with Concor ® AM is usually long-term therapy. Treatment should not be stopped abruptly, because this may lead to a temporary deterioration of the clinical condition. Especially treatment should not be abruptly stopped in patients with coronary artery disease. A gradual dose reduction is recommended.
Liver dysfunction. In patients with impaired liver function, the elimination of amlodipine may be slowed down. A special dosage regimen for this group of patients has not been determined, however, the drug in this case should be prescribed with caution.
For patients with severe liver dysfunction, the maximum daily dose of bisoprolol is 10 mg.
Renal dysfunction. In patients with mild or moderate renal impairment, dosage regimen adjustment is usually not required. Amlodipine is not eliminated by dialysis. Patients undergoing dialysis should be prescribed amlodipine with extreme caution.
For patients with severe renal impairment (creatinine clearance less than 20 ml/min), the maximum daily dose of bisoprolol is 10 mg.
Elderly patients. Elderly patients can be prescribed the usual doses of the drug. Caution is required only when increasing the dose.
Contraindications
Provided in the section Contraindications Amlodipine + Bisoprolol the information is based on data about another medicine with exactly the same composition as the medicine Amlodipine + Bisoprolol(Amlodipine, Bisoprolol). Be careful and be sure to check the information on the section Contraindications in the instructions for the medicine Amlodipine + Bisoprolol directly from the package or from a pharmacist in a pharmacy.
More...close
Amlodipine
severe arterial hypotension;
shock (including cardiogenic);
unstable angina (with the exception of Prinzmetal angina);
hemodynamically unstable heart failure after acute myocardial infarction;
left ventricular outflow tract obstruction (eg, clinically significant aortic stenosis).
Bisoprolol
acute heart failure or chronic heart failure (CHF) in the stage of decompensation, requiring inotropic therapy;
cardiogenic shock;
AV block II and III degrees, without pacemaker;
sick sinus syndrome (SSNS);
sinoatrial block;
severe bradycardia (heart rate less than 60 beats/min);
symptomatic arterial hypotension;
severe forms of bronchial asthma;
severe peripheral arterial circulation disorders or Raynaud's syndrome;
pheochromocytoma (without simultaneous use of alpha-blockers);
metabolic acidosis;
Amlodipine/bisoprolol combination
hypersensitivity to amlodipine, other dihydropyridine derivatives, bisoprolol and/or any of the excipients;
children under 18 years of age (efficacy and safety have not been established).
Carefully: chronic heart failure (including non-ischemic etiology, functional class III-IV according to the classification NYHA); liver failure; renal failure; hyperthyroidism; type 1 diabetes mellitus; diabetes mellitus with significant fluctuations in blood glucose concentrations; strict diet; simultaneously administered desensitizing therapy; 1st degree AV block, Prinzmetal's angina; mild to moderate peripheral arterial circulation disorder; psoriasis (including history); pheochromocytoma (with simultaneous use of alpha-blockers); severe forms of chronic obstructive pulmonary disease and non-severe forms of bronchial asthma; carrying out general anesthesia; elderly age; arterial hypotension; aortic stenosis; mitral stenosis; hypertrophic obstructive cardiomyopathy; acute myocardial infarction (during the first month); simultaneous use with inhibitors or inducers of the CYP3A4 isoenzyme.
Side effects
Provided in the section Side effects Amlodipine + Bisoprolol the information is based on data about another medicine with exactly the same composition as the medicine Amlodipine + Bisoprolol(Amlodipine, Bisoprolol). Be careful and be sure to check the information on the section Side effects in the instructions for the medicine Amlodipine + Bisoprolol directly from the package or from a pharmacist in a pharmacy.
More...close
Adverse reactions observed when using active ingredients separately are presented below depending on the frequency of their occurrence: very often ≥1/10; often ≥1/100 and<1/10; нечасто ≥1/1000 и <1/100; редко ≥1/10000 и <1/1000; очень редко <1/10000, включая отдельные случаи; частота неизвестна (невозможно оценить на основании имеющихся данных).
Amlodipine
From the blood and lymphatic system: very rarely - leukopenia, thrombocytopenia.
From the immune system: very rarely - allergic reactions.
very rarely - hyperglycemia.
Mental disorders: uncommon - insomnia, mood changes (including anxiety), depression; rarely - confusion.
From the nervous system: often - drowsiness, dizziness, headache (especially at the beginning of treatment); infrequently - fainting, hypoesthesia, paresthesia, dysgeusia, tremor; very rarely - muscle hypertension, peripheral neuropathy.
From the side of the organ of vision: often - visual impairment (including diplopia).
infrequently - tinnitus.
From the gastrointestinal tract: often - nausea, abdominal pain, dyspepsia, change in bowel habits (including constipation or diarrhea); infrequently - vomiting, dryness of the oral mucosa; very rarely - gastritis, gingival hyperplasia, pancreatitis.
very rarely - hepatitis, jaundice, increased levels of liver enzymes*.
From the heart: often - a feeling of palpitations; uncommon - arrhythmia (bradycardia, ventricular tachycardia, atrial fibrillation); very rarely - myocardial infarction.
From the side of blood vessels: often - hot flashes; infrequently - pronounced decrease in blood pressure; very rarely - vasculitis.
often - shortness of breath; infrequently - cough, rhinitis.
From the kidneys and urinary tract: infrequently - pollakiuria, urination disorder, nocturia.
infrequently - impotence, gynecomastia.
very often - peripheral edema; often - increased fatigue, asthenia; Uncommon: chest pain, pain, general malaise.
often - swelling of the ankles, muscle cramps; uncommon - arthralgia, myalgia, back pain.
For the skin and subcutaneous tissues: uncommon - alopecia, purpura, skin discoloration, increased sweating, itching, rash, exanthema, urticaria; very rarely - angioedema, exudative erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, Quincke's edema, photosensitivity.
infrequently - weight gain, weight loss.
Isolated cases of extrapyramidal syndrome have been reported.
Bisoprolol
Metabolism and nutrition: rarely - increased triglyceride concentrations.
Mental disorders: infrequently - depression, sleep disturbance; rarely - hallucinations, nightmares.
From the nervous system: often - headache**, dizziness**; infrequently - insomnia; rarely - fainting.
From the side of the organ of vision: rarely - decreased lacrimation (should be taken into account when wearing contact lenses); very rarely - conjunctivitis.
Hearing and labyrinth disorders: rarely - hearing impairment.
From the heart: infrequently - impaired AV conduction, bradycardia, worsening symptoms of CHF.
From the side of blood vessels: often - a feeling of coldness or numbness in the limbs; infrequently - hypotension.
From the respiratory system, chest and mediastinal organs: uncommon - bronchospasm in patients with a history of bronchial asthma or obstructive pulmonary disease; rarely - allergic rhinitis.
From the gastrointestinal tract: often - nausea, vomiting, diarrhea, constipation.
From the liver and biliary tract: rarely - hepatitis.
For the skin and subcutaneous tissues: rarely - hypersensitivity reactions, such as itching, rash, hyperemia of the skin; very rarely - alopecia; beta-blockers may exacerbate the symptoms of psoriasis or cause a psoriasis-like rash.
From the musculoskeletal system and connective tissue: Uncommon: muscle weakness, muscle cramps.
From the genital organs and breast: rarely - impotence.
General disorders and disorders at the injection site: often - increased fatigue**; infrequently - exhaustion**.
Laboratory and instrumental data: rarely - increased activity of liver transaminases in the blood AST, ALT.
*In most cases with cholestasis.
** These symptoms appear especially often at the beginning of the course of treatment. Typically, these phenomena are mild in nature and usually disappear within 1-2 weeks after the start of treatment.
Overdose
Provided in the section Overdose Amlodipine + Bisoprolol the information is based on data about another medicine with exactly the same composition as the medicine Amlodipine + Bisoprolol(Amlodipine, Bisoprolol). Be careful and be sure to check the information on the section Overdose in the instructions for the medicine Amlodipine + Bisoprolol directly from the package or from a pharmacist in a pharmacy.
More...close
Amlodipine
Symptoms: a pronounced decrease in blood pressure with the possible development of reflex tachycardia and excessive peripheral vasodilation (risk of developing severe and persistent arterial hypotension, including the development of shock and death).
Treatment: gastric lavage, administration of activated charcoal, maintaining cardiovascular function, monitoring indicators of heart and lung function, giving an elevated position to the lower extremities, monitoring blood volume and diuresis. Intensive symptomatic therapy. To restore vascular tone, use vasoconstrictor drugs (in the absence of contraindications to their use); to eliminate the consequences of blockade of calcium channels - intravenous administration of calcium gluconate. Hemodialysis is ineffective.
Bisoprolol
Symptoms: The most common symptoms of overdose are: AV block, severe bradycardia, marked decrease in blood pressure, bronchospasm, acute heart failure and hypoglycemia. Sensitivity to a single high dose of bisoprolol varies widely among individual patients and patients with CHF are likely to be highly sensitive.
Treatment:
If an overdose occurs, first of all it is necessary to stop taking the drug and begin supportive symptomatic therapy.
With severe bradycardia: intravenous administration of atropine. If the effect is insufficient, a drug with a positive chronotropic effect can be administered with caution. Sometimes a temporary pacemaker may be needed.
With a pronounced decrease in blood pressure: intravenous administration of plasma-substituting solutions and vasopressor drugs. IV administration of glucagon may also be indicated.
With AV block (II or III degree): patients should be closely monitored and treated with beta-agonists such as epinephrine and isoprenaline infusions. If necessary, install a pacemaker.
In case of exacerbation of CHF: intravenous administration of diuretics, drugs with a positive inotropic effect, as well as vasodilators.
For bronchospasm: prescription of bronchodilators, incl. beta 2-adrenergic agonists and/or aminophylline.
For hypoglycemia: IV administration of dextrose (glucose).
Bisoprolol is practically not dialyzable.
Pharmacodynamics
Provided in the section Pharmacodynamics Amlodipine + Bisoprolol the information is based on data about another medicine with exactly the same composition as the medicine Amlodipine + Bisoprolol(Amlodipine, Bisoprolol). Be careful and be sure to check the information on the section Pharmacodynamics in the instructions for the medicine Amlodipine + Bisoprolol directly from the package or from a pharmacist in a pharmacy.
More...close
This drug has pronounced antihypertensive and antianginal effects due to the complementary action of two active ingredients: the CCB - amlodipine and the selective beta 1-blocker - bisoprolol.
Amlodipine
Mechanism of action. Amlodipine blocks calcium channels, reduces the transmembrane transition of calcium ions into the cell (more into vascular smooth muscle cells than into cardiomyocytes).
The antihypertensive effect of amlodipine is due to a direct relaxing effect on vascular smooth muscle cells, which leads to a decrease in peripheral vascular resistance.
The mechanism of antianginal action is not fully understood; it may be associated with the following two effects:
1. The expansion of peripheral arterioles reduces peripheral vascular resistance, i.e. afterload. Since amlodipine does not cause reflex tachycardia, myocardial energy and oxygen consumption is reduced.
2. Dilatation of large coronary arteries and coronary arterioles improves oxygen supply to both normal and ischemic areas of the myocardium. Thanks to these effects, the supply of oxygen to the myocardium is improved even with spasm of the coronary arteries (Prinzmetal's angina or unstable angina).
In patients with arterial hypertension, taking the drug once a day causes a clinically significant decrease in blood pressure in the supine and standing positions throughout the entire 24-hour interval between doses of the drug. Due to the slow development of the antihypertensive effect of amlodipine, it does not cause acute arterial hypotension.
In patients with angina, taking the drug once a day increases the total time of physical activity, the time before the development of an angina attack, as well as the time until a significant decrease in the ST1 mm interval and reduces the frequency of angina attacks and the need for sublingual nitroglycerin.
Amlodipine is not associated with any adverse metabolic effects or changes in plasma lipids. Can be used in patients with asthma, diabetes and gout.
Bisoprolol
Mechanism of action. Bisoprolol is a selective beta 1-blocker, without its own sympathomimetic activity, and does not have a membrane-stabilizing effect.
It has only slight affinity for beta 2 -adrenergic receptors of the smooth muscles of the bronchi and blood vessels, as well as for beta 2 -adrenergic receptors involved in the regulation of metabolism. Therefore, bisoprolol generally does not affect airway resistance and metabolic processes in which beta 2 adrenergic receptors are involved.
The selective effect of the drug on beta 1-adrenergic receptors persists beyond the therapeutic range.
Bisoprolol does not have a pronounced negative inotropic effect.
The maximum effect of the drug is achieved 3-4 hours after oral administration.
Even when bisoprolol is prescribed once a day, its therapeutic effect persists for 24 hours due to the 10-12-hour half-life of blood plasma. As a rule, the maximum antihypertensive effect is achieved 2 weeks after the start of treatment.
Bisoprolol reduces the activity of the sympathoadrenal system by blocking beta 1 adrenergic receptors of the heart.
When administered once orally in patients with coronary artery disease without signs of CHF, bisoprolol reduces heart rate, reduces the stroke volume of the heart and, as a result, reduces the 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 hypotensive effect of beta-blockers.
Pharmacokinetics
Provided in the section Pharmacokinetics Amlodipine + Bisoprolol the information is based on data about another medicine with exactly the same composition as the medicine Amlodipine + Bisoprolol(Amlodipine, Bisoprolol). Be careful and be sure to check the information on the section Pharmacokinetics in the instructions for the medicine Amlodipine + Bisoprolol directly from the package or from a pharmacist in a pharmacy.
More...close
Amlodipine
Suction. Amlodipine is well absorbed after oral administration. Cmax in blood plasma is observed after 6-12 hours. Taking the drug with food does not affect its absorption.
Absolute bioavailability is 64-80%. Tmax of amlodipine in plasma is similar in elderly and young patients.
Distribution. Apparent Vd is 21 l/kg. C ss in blood plasma (5-15 ng/ml) is achieved 7-8 days after starting the drug. Research in vitro showed that circulating amlodipine is approximately 97.5% bound to plasma proteins.
Metabolism and excretion. Amlodipine undergoes extensive metabolism in the liver. Approximately 90% of the dose taken is converted into inactive pyridine derivatives. Approximately 10% of the dose taken is excreted unchanged in the urine. Approximately 60% of the amount of inactive metabolites is excreted by the kidneys and 20-25% through the intestines. The decrease in plasma concentration is biphasic. The final T1/2 is approximately 35-50 hours, which allows the drug to be administered once a day. The total clearance is 7 ml/min/kg (25 l/h in a patient weighing 60 kg). In elderly patients it is 19 l/h.
Amlodipine clearance tends to decrease with a subsequent increase in AUC and T1/2 in elderly patients. An increase in AUC and T1/2 in patients with congestive heart failure is expected for this age group of patients studied.
In patients with renal failure, no significant changes in the pharmacokinetics of amlodipine were observed. Amlodipine is not dialysable.
Patients with hepatic impairment due to decreased clearance resulting in a longer half-life and an increase in AUC of approximately 40-60% should be given lower initial doses.
Bisoprolol
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 its plasma concentrations being proportional to the dose taken in the range from 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 and excretion. 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.
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. Since excretion occurs through the kidneys and liver to the same extent, dose adjustment is not required for patients with mild to moderate hepatic or renal impairment. The total clearance is 15 l/h. T 1/2 - 10-12 hours.
Pharmacological group
Provided in the section Pharmacological group Amlodipine + Bisoprolol the information is based on data about another medicine with exactly the same composition as the medicine Amlodipine + Bisoprolol(Amlodipine, Bisoprolol). Be careful and be sure to check the information on the section Pharmacological group in the instructions for the medicine Amlodipine + Bisoprolol directly from the package or from a pharmacist in a pharmacy.
More...close
- Combined antihypertensive drug (selective β 1-blocker + slow calcium channel blocker (SCBC) [Beta-blockers in combinations]
- Combined antihypertensive drug (selective β 1-adrenergic blocker + slow calcium channel blocker (SCBC) [Calcium channel blockers in combinations]
Interaction
Provided in the section Interaction Amlodipine + Bisoprolol the information is based on data about another medicine with exactly the same composition as the medicine Amlodipine + Bisoprolol(Amlodipine, Bisoprolol). Be careful and be sure to check the information on the section Interaction in the instructions for the medicine Amlodipine + Bisoprolol directly from the package or from a pharmacist in a pharmacy.
More...close
Amlodipine
CYP3A4 inhibitors: Amlodipine should be used with caution concomitantly with CYP3A4 inhibitors.
Strong and moderate inhibitors of CYP3A4 (protease inhibitors such as indinavir, saquinavir and ritonavir, azole antifungals such as fluconazole and itraconazole, macrolides such as erythromycin or clarithromycin, verapamil or diltiazem) may increase plasma concentrations of amlodipine to clinically significant levels. These changes may be more pronounced in elderly patients, requiring clinical monitoring of amlodipine concentrations and dose adjustment if necessary.
CYP3A4 inducers: simultaneous use with CYP3A4 inducers (including rifampicin, St. John's wort) may lead to a decrease in the concentration of amlodipine in the blood plasma.
Amlodipine should be used with caution concomitantly with CYP3A4 inducers.
Dantrolene (infusion): In animals, fatal ventricular fibrillation and cardiovascular failure due to hyperkalemia were observed after administration of verapamil and dantrolene intravenously.
Tacrolimus: There is a risk of increased blood levels of tacrolimus when coadministered with amlodipine, but the pharmacokinetic mechanism of this interaction is not fully understood. To avoid tacrolimus toxicity, blood levels should be monitored in patients undergoing treatment and the dose of tacrolimus adjusted if necessary.
Cyclosporine: You should consider monitoring cyclosporine levels in patients who have undergone a kidney transplant while taking amlodipine, and reduce the dose of cyclosporine if necessary.
Simvastatin: simultaneous use with amlodipine may lead to an increase in the concentration of simvastatin in the blood plasma. Coadministration of amlodipine 10 mg with simvastatin 80 mg resulted in a 77% increase in simvastatin exposure compared to simvastatin alone. The dose of simvastatin in patients receiving amlodipine should be limited to 20 mg once daily.
Taking amlodipine with grapefruit or grapefruit juice is not recommended due to the possible increase in the bioavailability of amlodipine, which leads to a high blood pressure lowering effect.
Cimetidine, aluminum/magnesium (in antacids) and sildenafil do not affect the pharmacokinetics of amlodipine.
Amlodipine may enhance the antihypertensive effect of other antihypertensive drugs.
Amlodipine does not affect the pharmacokinetics of atorvastatin, digoxin, ethanol (drinks containing alcohol), warfarin.
BKK, such as verapamil and to a lesser extent, diltiazem, when used simultaneously with bisoprolol, can lead to a decrease in myocardial contractility, a pronounced decrease in blood pressure and impaired AV conduction. In particular, intravenous administration of verapamil to patients taking beta-blockers can lead to severe arterial hypotension and AV blockade.
Centrally acting antihypertensives(such as clonidine, methyldopa, moxonidine, rilmenidine) when used simultaneously with bisoprolol can lead to a decrease in heart rate and a decrease in 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 caution
BKK, dihydropyridine derivatives (for example nifedipine), when used simultaneously with bisoprolol, they may increase the risk of developing arterial hypotension.
In patients with CHF, the risk of subsequent deterioration in cardiac contractility cannot be excluded.
Class I antiarrhythmic drugs(for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conductivity and myocardial contractility.
Class III antiarrhythmic drugs(eg amiodarone) may increase AV conduction disturbances.
Parasympathomimetics when used simultaneously with bisoprolol, they may increase AV conduction disturbances and increase the risk of developing bradycardia.
Action of beta blockers for topical use (for example, eye drops for the treatment of glaucoma) may enhance the systemic effects of bisoprolol (lowering blood pressure, lowering heart rate).
Hypoglycemic effect insulin or oral hypoglycemic agents may increase. Beta blockade may mask signs of hypoglycemia, particularly tachycardia. Such interactions are more likely when using non-selective beta-blockers.
Means for general anesthesia may weaken reflex tachycardia and increase the risk of developing arterial hypotension (see “Special Instructions”).
Cardiac glycosides when used simultaneously with bisoprolol, they can lead to an increase in AV conduction time and the development of bradycardia.
NSAIDs may reduce the antihypertensive effect of bisoprolol.
The simultaneous use of bisoprolol with beta-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 beta and alpha adrenergic receptors (for example, norepinephrine, epinephrine) may enhance the vasoconstrictor effects of these drugs that occur with the participation of alpha 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.
Combinations to consider
Mefloquine when used simultaneously with bisoprolol, it may increase the risk of bradycardia.
MAO inhibitors(with the exception of MAO-B inhibitors) may enhance the antihypertensive effect of beta-blockers. Concomitant use may also lead to the development of a hypertensive crisis.
Rifampicin slightly shortens the half-life of bisoprolol. As a rule, no dose adjustment is required.
Ergotamine derivatives when used simultaneously with bisoprolol, they increase the risk of developing peripheral circulatory disorders.
Prohibited during pregnancy
Prohibited during breastfeeding
Prohibited for children
Has restrictions for older people
Has limitations for liver problems
Has limitations for kidney problems
The combination of bisoprolol and amlodipine includes many modern medicines, both domestic and imported. They are available in the form of tablets for oral use. The therapeutic effect of the use of drugs is achieved precisely through the combination of bisoprolol with amlodipine.
These substances have different principles of action on the body, but at the same time they combine well with each other. The combination of amlodipine and bisoprolol is used in the drugs Alotendin, Concor AM, Sobicombi.
Medicinal properties, mechanism of action
The drug in question has a hypotensive and antianginal effect. Amlodipine belongs to the BMCC group, and bisoprolol belongs to the beta1-blockers.
Effects of amlodipine
Under the influence of amlodipine, calcium channels are blocked, thereby reducing the penetration of calcium ions through the cell membrane. The substance relaxes vascular smooth muscle cells. By reducing the resistance of peripheral vessels, a long-term hypotensive effect is achieved.
Amlodipine relieves an attack of angina for a long period of time, making it possible to increase the total duration of physical activity. This reduces the risk of relapse of the pathology and reduces the need for regular use of nitroglycerin.
Effect of bisoprolol
Bisoprolol is a beta1-blocker that does not have a membrane-stimulating effect on the body. Even with a single daily use of the drug, its effect persists throughout the day. However, a persistent hypotensive effect can be achieved only after 7-14 days of treatment.
A single oral dose of bisoprolol promotes:
- slowing of the pulse in patients suffering from coronary artery disease without signs of CHF;
- decrease in stroke volume;
- decrease in ejection fraction and myocardial oxygen demand.
Bisoprolol also affects the concentration of the hormone renin in the body. By reducing it, it is possible to achieve a lasting hypotensive effect. In parallel, with prolonged use of the drug, there is a decrease in the indicators of peripheral vascular resistance, which were initially elevated in patients with coronary artery disease.
Which substance is more effective?
Many patients ask their doctor what is better - Amlodipine or Bisoprolol. No therapist or cardiologist can answer this definitively. If we talk about effectiveness, then bisoprolol is undoubtedly stronger than amlodipine. However, it can cause much more severe side effects, and also does not combine well with other medications, or is not combined with them at all.
Complementary mechanism of action of drugs on the cardiovascular system in hypertension
Therefore, in this situation there is only one way out: do not self-medicate, but consult a doctor. Only a specialist will be able to weigh all the risks and prescribe the medicine needed for a particular patient to treat hypertension or coronary artery disease.
Analogues and substitutes
You can replace drugs with these active ingredients only with drugs that contain amlodipine and atenolol instead of bisoprolol. Among them are:
Bisoprolol can be replaced with atenolol only in extreme circumstances, when it is impossible to find combination drugs that contain it in combination with amlodipine.
List of combination drugs with amlodipine and bisoprolol
So, are amlodipine and bisoprolol the same thing or not? If you study the chemical composition of these substances and the mechanism of their effect on the human body, you can clearly see that these are completely different elements. But at the same time, bisoprolol and amlodipine have good compatibility and are included in many combined antihypertensive drugs. They have identical indications, limitations, route of administration, and adverse reactions, which are described below.
A list of the most popular medicines with these active ingredients is given below:
Indications, contraindications
Medicines containing these substances are prescribed to patients with arterial hypertension and coronary artery disease. The drugs can be used both in isolation and as part of complex treatment.
Combined medications are not recommended for patients with:
These restrictions relate primarily to the use of the substances in question separately. If we talk about their combination, then medications containing them in their composition are contraindicated in case of individual intolerance to the components of the tablets, lactation and children under 18 years of age.
During pregnancy, a combination of these drugs can be prescribed to a woman only for vital indications. The treatment regimen is developed by a specialist based on the severity of the patient’s condition. Throughout the entire treatment course, a pregnant woman should be under close supervision of the attending physician.
Instructions for use and drug interactions
Amlodipine should be taken simultaneously with Bisoprolol, regardless of the time of the last meal. It is recommended to take the tablet without chewing it in the morning with plenty of water.
The daily dose is calculated individually, but it should not exceed 1 tablet. The drug requires long-term use.
For patients with impaired hepatic and renal function, a special dosage regimen is not needed. However, it is important to ensure that no more than 10 mg of medication is taken per day. The ratio of active components is not taken into account. Discontinuation of the drug should occur with a gradual reduction in the dose used until complete cessation of taking the tablets.
A brief description of the drug interactions of each of the elements under consideration is given separately in the table.
| Substance name | Valid combinations | Invalid interactions |
|---|---|---|
| Amlodipine | The substance can be used along with the use of:
|
In parallel, amlodipine is not recommended to be combined with:
|
| Bisoprolol | The combination of bisoprolol with many medications is impractical and even dangerous. By themselves, beta2-blockers can cause serious side effects, so you should know which drugs they should not be combined with. | Thus, bisoprolol is strictly forbidden to be taken in parallel with:
|
As you can see, bisoprolol does not combine well with other medications. With some, it categorically cannot be combined. In view of this, before starting to take this remedy, be sure to consult your doctor and tell him what other medications you are currently taking. Perhaps a specialist will select for you a substitute for the drug in question.
Possible adverse reactions
Improper use of the drug can cause the development of a number of unwanted reactions from the body. The intensity and characteristics of their manifestation depend on the influence of which active substance they were provoked.
Thus, amlodipine can lead to:
Swelling, skin allergic reactions, nausea, stool disorders, vomiting, gastralgia - this is just the bare minimum list of side effects that can result from amlodipine alone. As for bisoprolol, it can cause negative reactions in the body, manifested by:
- cephalgia;
- vertigo;
- feeling cold or numb in the arms or legs;
- decrease in blood pressure;
- allergic rhinitis;
- peptic disorders;
- increased fatigue.
Adverse reactions often occur not only due to improper use of the medicine. Many patients note their occurrence at the beginning of therapy. When the body gets used to it, unwanted reactions go away on their own. And only if this does not happen, you should consult a doctor.
