Coronal - at what pressure is appointed? Instructions and references

Coronale is a medicinal product of antihypertensive, antiarrhythmic and antianginal action, selective beta 1-blocker.

It has an antihypertensive effect (reduce blood pressure), also reduces pain on the left side of the chest and restores the heart rhythm. Also, the Coronale action is aimed at preventing the entry of calcium ions into the cardiac muscle, which leads to a decrease in the intake of signals that cause excitation and inhibition in the myocardium.

Thus, the frequency of heart attacks decreases.

Clinical and pharmacological group

Beta1-adrenoblocker.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much does the Coronal cost? The average price in pharmacies is at the level of120 rubles.

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Form of issue and composition

The drug Coronale is available in the form of tablets for oral administration. The tablets are covered with a protective film shell, convex on both sides and packed in blisters of 10 pieces (3-5 blisters each in a cardboard bundle).

Active substance - bisoprolol fumarate:

• 1 tablet of light yellow color - 5 mg;
• 1 tablet of light pink color - 10 mg.

Auxiliary components: corn starch, microcrystalline cellulose, sodium lauryl sulfate, magnesium stearate, silicon dioxide colloid.

Composition of the film shell: Macrogol 400, hypromellose, titanium dioxide (E171).

In addition to the shell:

• Tablets of 5 mg: iron dye oxide yellow (E172);
• Tablets of 10 mg: ferric oxide red oxide (E172).

Pharmacological effect

The coronale has antihypertensive, antianginal, antiarrhythmic action. Small doses of the drug contribute to blocking cardiac beta-blockers, reducing intracellular calcium current, conduction inhibition, excitability, decrease in heart rate and myocardial contractility.

In the first day after the application of the Coronal, the total peripheral resistance increases. After two to three days it decreases to the initial level, continuing to decrease with prolonged therapy. Due to the hypotensive effect of the drug, the minute volume of blood decreases, the activity is inhibited reninangiotensin system, the normal sensitivity of baroreceptors on aortic arch. The coronal also has a direct effect on the central nervous system.

In patients with arterial hypertension, a decrease in pressure occurs after 2-5 days after the start of Coronale. After 1-2 months, there is a steady hypotensive effect. Angina after receiving Coronale decreases due to improved muscle cardiac perfusion, lengthening diastole, reducing the oxygen consumption of the heart muscle.

Indications for use

Admission Coronale (10 mg) is prescribed for patients who have been diagnosed with persistent arterial hypertension, ischemia and stable angina.

Also, pills are prescribed for other cardiac pathologies:

• prolapse of the two-leaf valve;
• supraventricular tachyarrhythmia, if combined with an accelerated sinus rhythm;
• violation of the heart rhythm of the supraventricular or ventricular localization;
• atrial fibrillation, formed against a background of intoxication with thyroid hormones.

Coronal tablets with a dosage of 5 mg are prescribed as a secondary prevention of myocardial infarction, as well as in cases where minor cardiac pathologies have been identified.

Contraindications

Before starting therapy with the drug, the accompanying instructions should be studied in detail. Coronale tablets are contraindicated in the presence of the following conditions:

1. Atrioventricular blockade (AV-blockade) of II and III degree (without artificial pacemaker);
2. Syndrome of weakness of the sinus node (SSSU);
3. Cardiomegaly (no signs of heart failure);
4. Pronounced bradycardia;
5. Raynaud's disease;
6. Acute congestive heart failure;
7. Chronic heart failure (CHF) in the stage of decompensation;
8. Shock (including cardiogenic);
9. Sinoatrial block;
10. Simultaneous use of floktaphenin and sultopride;
11. Breastfeeding period;
12. Age under 18 years (safety and efficacy not established);
13. Arterial hypotension (the upper arterial pressure (BP) is below 100 mm of mercury (Hg. st.), especially with myocardial infarction);
14. Late stages of peripheral circulation;
15. Bronchial asthma and chronic obstructive pulmonary disease (COPD) in history;
16. Combined administration of monoamine oxidase inhibitors (MAO) (except MAO type B inhibitors);
17. Hypersensitivity to the components of the drug or other beta-blockers.

In the period of therapy by the Coronel strict medical control is necessary for the following diseases and conditions:

1. Angina of princemetal;
2. AV-blockade of the 1st degree;
3. Restrictive cardiomyopathy;
4. Psoriasis;
5. Severe allergic reactions in the anamnesis;
6. Conducting desensitizing immunotherapy with allergens and allergen extracts;
7. Compliance with a strict diet;
8. Renal failure (creatinine clearance (CK) less than 20 ml / min);
9. CHF with myocardial infarction during the last 3 months;
10. Congenital heart diseases or heart valve defects with severe hemodynamic disorders;
11. Depression (including history);
12. Metabolic acidosis;
13. Liver failure;
14. Pheochromocytoma (with concomitant use of alpha-blockers);
15. Diabetes mellitus in the stage of decompensation;
16. Elderly age.

Use in pregnancy and lactation

In pregnancy, the Coronale is prescribed only according to strict indications if the intended benefit to the mother exceeds the potential risk to the fetus. For 72 hours before the birth of the drug Coronale should be discontinued in connection with the possible development in the fetus / newborn bradycardia, arterial hypotension, hypoglycemia and respiratory depression.

If taking Coronal is necessary during lactation, breastfeeding should be discontinued.

When taking bisoprolol in pregnancy, the fetus may have intrauterine growth retardation, hypoglycemia, bradycardia.

Dosage and route of administration

In the instructions for use indicated: Tablets Coronal should be taken orally, in the morning on an empty stomach, without liquid, with a small amount of liquid.

• With arterial hypertension and IHD (prevention of attacks of stable angina pectoris) the initial dose is 2.5-5 mg 1 time / day. If necessary, increase the dose to 10 mg 1 time / day. The maximum daily dose is 20 mg.

In patients with impaired renal function with CC <20 ml / min or with severe impairment of liver function, the maximum daily dose is 10 mg.

Dose adjustments in elderly patients are not required.

Side effects

Coronale under certain circumstances can cause a number of side effects:

1. From the viewpoint - conjunctivitis, dryness and soreness of the eyes, visual impairment, a decrease in the secretion of tear fluid;
2. Gastrointestinal tract - vomiting, abdominal pain, diarrhea, constipation, taste change, dryness of the oral mucosa, etc .;
3. On the part of the endocrine system - hyper- or hypoglycemia, hypothyroid status;
4. Respiratory system - nasal congestion and difficulty breathing;
5. Effects from the nervous system - weakness, dizziness, headache, increased fatigue, depression, anxiety, hallucinations, short-term memory loss, tremor;
6. Hemopoiesis - leukopenia, agranulocytosis;
7. Cardiovascular system - sinus bradycardia, arrhythmia, aggravation of chronic heart failure, chest pain, manifestation angiospasm, lowering of arterial pressure, orthostatic hypotension, weakening of myocardial contractility or disturbance of its conductivity.

A number of allergic, dermatological and other reactions are also possible.

Overdose

At a significant excess of the dose, arrhythmia, ventricular extrasystole, severe bradycardia, AV blockade, arterial hypotension, acute heart failure, acrocyanosis, difficulty breathing, bronchospasm, dizziness, fainting, convulsions.

When these symptoms occur, you should wash your stomach and take adsorbents. Symptomatic therapy is also indicated. When AV-blockade - 1-2 mg of atropine, epinephrine intravenously or the introduction of a temporary pacemaker. With ventricular extrasystole, intravenous lidocaine is indicated. With reduced pressure, it is worth accepting the Trendelenburg position. If the symptoms of pulmonary edema are absent, plasma-substituting solutions are injected intravenously, with ineffectiveness of the agent, epinephrine, dopamine, dobutamine is administered. Signs of heart failure require the use of cardiac glycosides, diuretics, glucagon. With cramps, diazepam is administered, with bronchospasm - beta-2-adrenostimulants.

special instructions

Before you start using the drug, read the special instructions:

1. Before the start of therapy, it is recommended to perform a study of the function of external respiration in patients with a history of bronchopulmonary anamnesis.
2. During the reception of the Coronal it is necessary to conduct an electrocardiogram on a regular basis, to control the heart rate and blood pressure (in beginning of therapy - every day, later - 1 time in 3-4 months), to determine the level of glucose in the blood in patients with diabetes (1 time in 4-5 months). Patients with advanced age should be monitored kidney function (1 time in 4-5 months).
3. In smoking patients, the effectiveness of Coronale is reduced.
4. It should be borne in mind that in some patients with angina pectoris (approximately in 20% of cases), beta-blockers may be ineffective, which is associated with severe coronary atherosclerosis with low threshold of ischemia (heart rate less than 100 beats per minute) and an increased end-diastolic volume of the left ventricle that violate the subendocardial blood flow.
5. When using Coronale in patients with pheochromocytoma, there is a risk of paradoxical arterial hypertension (if an effective alpha-adrenoblockade was not achieved in advance).
6. Patients who use contact lenses, it is necessary to take into account that during the therapy, the production of tear fluid can be reduced.
7. It is impossible to abruptly discontinue treatment for patients with thyrotoxicosis, as this may increase the symptoms of the disease.
8. With the simultaneous use of Coronale with clonidine, the latter can be discontinued only a few days after the end of therapy.
9. Bisoprolol in diabetes mellitus can mask a hypoglycemia-induced tachycardia.
10. In a burdened allergic anamnesis, it is possible to increase the severity of hypersensitivity reactions and the lack of effect from usual doses of epinephrine.
11. When developing depression, therapy is recommended to be interrupted.
12. Before the scheduled surgical treatment, the Coronale should be discontinued 48 hours before the start of the general anesthesia. If the patient has taken the drug before the operation, a drug with a minimal negative inotropic effect is selected for general anesthesia.
13. Reducing stocks of catecholamines drugs (including reserpine) can enhance the action of beta-blockers, so patients who take such combinations medicines, it is necessary to be under the constant supervision of the doctor for the timely detection of bradycardia or a pronounced lowering of the arterial pressure.
14. Before the study of the content in the urine and blood of catecholamines, vanillindrimic acid, normetanephrine, antinuclear antibody titres, the drug should be discarded.
15. To avoid the development of myocardial infarction and severe arrhythmias, it is impossible to interrupt treatment drastically. Cancellation should be carried out gradually, reducing the dose for 14 days or more (every 3-4 days the dose is reduced by 25%).
16. When older patients develop an increasing bradycardia (less than 50 beats per minute), AV blockade, expressed lowering blood pressure (systolic pressure below 100 mm Hg), you need to reduce the daily dose or interrupt therapy.

Care should be taken during the therapy period when driving vehicles and mechanisms, as well as other potentially hazardous activities requiring increased concentration and psychomotor reactions.

Drug Interactions

When using the drug, it is necessary to take into account the interaction with other drugs:

1. In combination with rifampicin, T1 / 2 bisoprolol is shortened.
2. The combination with iodine-containing radiocontrast agents increases the risk of anaphylactic reactions.
3. When bisoprolol is combined with allergens for immunotherapy or allergen extracts for skin tests, severe systemic allergic reactions are possible.
4. Coronal changes the effectiveness of insulin and oral hypoglycemic drugs.
5. In combination with phenytoin for intravenous administration, means for inhalation of general anesthesia (derivatives of hydrocarbons) increases the cardiodepressive effect and the risk of lowering blood pressure is high.
6. NSAIDs, GCS and estrogens weaken the antihypertensive effect of Coronale.
7. The drug reduces the clearance of lidocaine and xanthines (except diphylline) and increases their concentration in the plasma, which is more typical for smokers.
8. In combination with nifedipine, a significant reduction in blood pressure is possible.
9. Coronale in combination with cardiac glycosides, methyldopa, reserpine and guanfacynlm, blockers of slow calcium channels, amiodarone and other antiarrhythmic drugs increases the risk of bradycardia, AV blockade, cardiac arrest and cardiac insufficiency.
10. In combination with taking diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive coronale causes an excessive decrease in blood pressure.
11. It is not recommended to combine Coronal with MAO inhibitors, the interval between admission should be 14 days.
12. The coronal extends the action of nondepolarizing muscle relaxants and the anticoagulant effect of coumarins.
13. In combination with unhydrogenated ergot alkaloids, ergotamine, the risk of peripheral circulation disorders is increased.
14. Sulfasalazine increases plasma concentrations of bisoprolol.
15. When co-administered with beta-blockers for topical administration, there is a risk of an additive effect with the development of hypotension and / or a significant bradycardia.
16. During therapy with quinidine drugs in combination with the Coronale there is a risk of violations of automatism, conduction and contractility of the heart increases (mutually).
17. The antihypertensive effect of Coronale is reduced by the use of adrenaline and norepinephrine.
18. In the case of shock or arterial hypotension caused by floktaphenin, when combined, it is possible to reduce compensatory cardiovascular reactions.
19. With the simultaneous use of tricyclic and tetracyclic antidepressants, neuroleptics, ethanol, sedatives and hypnotics drugs increase oppression of the central nervous system, can cause heart rhythm disturbances, bradycardia and orthostatic hypotension.
20. With simultaneous use with baclofen or amifostine also increased antihypertensive effect.

Reviews

We picked up some reviews of people taking the drug Coronale:

1. Olga. The second time the coronale is prescribed for the treatment of ventricular e / systole. The first time I did not drink, I tried once again the floor of the pill-it was very bad. The second time I tried, it's not "fucked up". I tell the doctor, they do not go to me and I drink anaprili, she again writes them to me (((
2. Dmitriy. It lowers heart rate. The pressure is almost not affected. That is, it helps with tachycardia with low blood pressure.
3. Natalia. In my far from old age, problems with increased blood pressure began. The cardiologist has appointed or nominated this preparation, as a variant of a choice in my case. 2-3 days reception and he acted! The drug works by lowering the heart rate, so it's dangerous to take it without the doctor's appointment! I recommend starting with a minimum dosage and, if necessary, raising it to the level that the doctor has prescribed. It is also impossible to drop sharply in any case, gradually reduce the dosage within about a week. The price is very affordable, but only a doctor should prescribe! The medicine suited me and helped me a lot!
4. Ilya. In my opinion, this medicine is best suited for treatment, weakening of arterial hypertension. First, excellent absorption, and this is often one of the most important factors, because when buying a medicine we want it to start acting immediately. Secondly, unlike similar drugs a good percentage of excretion, which can not help distinguishing this medicine for the better. Of all these preparations, the coronale is perhaps the most optimal solution for acquiring and receiving.

Analogues

The analogues of the Coronal are:

• Aritel;
• Aritel Cor;
• Bidop;
• Biol;
• Biprol;
• Bisogamma;
• Bisocardium;
• Bisomore;
• Bisoprolol;
• Concor;
• Concor Cor;
• Corbis;
• Cordinorm;
• Coronale;
• Niperten;
• Thyrez.

Before using analogues, consult your doctor.

Storage conditions and shelf life

Tablets should be stored away from children in a cool dry place, avoiding direct sunlight on the packaging.

Shelf life of the drug is 3 years from the date of manufacture, indicated on the package. At the end of the shelf life of Coronel tablets are subject to disposal.

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