Concor (5, 10 mg) tablets

Concor - the drug, which is a selective beta1-adrenoblocker, lowers blood pressure, has an antianginal effect, reduces the heart rate.

It is used for ischemic heart disease, chronic form of heart failure. Peak action of the drug is achieved 3-4 hours after oral administration.

Even with the appointment of a concor, 1 times a day, its antihypertensive effect is maintained throughout the day due to a long half-life of 10-12 hours. As a rule, the stabilization of blood pressure at the target level is achieved in two weeks from the start of the drug course.

Clinical and pharmacological group

Beta1-adrenoblocker.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much does Concor cost in pharmacies? The average price is at the level of220 rubles.

Form of issue and composition

The drug form of Concor - tablets: biconvex, covered with a film coat of pale yellow or pale orange color, heart-shaped (10, 25 or 30 tablets in a blister, 1, 2, 3 or 5 blisters in a cardboard bundle).

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The active substance - bisoprolol hemifumarate (bisoprolol fumarate (2: 1)), the content of 1 tablet, depending on the color of the shell:

Pale yellow - 5 mg;
Pale orange - 10 mg.

Additional components: fine corn starch powder, silicon dioxide colloidal anhydrous, microcrystalline cellulose (MCC), anhydrous calcium hydrophosphate, magnesium stearate, crospovidone.

Composition of the film coat: hypromellose, dimethicone 100, iron dye oxide yellow (E172), macrogol 400, titanium dioxide (E171), iron oxide red (E172).

Tablets 2.5 mg

Note that tablets at a dosage of 2.5 mg with the active substance bisoprolol fumarate are in another medical preparation called Concor Cor. The price is from 150 rubles.

The preparation under considerationConcorhas a dosage of only 5 and 10 mg of active ingredient.

Pharmacological effect

Concor - beta adrenoblocker without membrane stabilizing action, which does not have symptomatic activity. The effect of the active substance of the drug is aimed at reducing the activity of the sympathoadrenal system and blocking the cardiac beta-1 adrenergic receptors.

A single application of Concor in patients who have no signs of chronic heart failure leads to a reduction in fractions ejection, reduction of the heart rate, normalization of the stroke volume of the heart, and reduction of the oxygen demand of the myocardium. The use of the drug for a long time helps to reduce the increased total peripheral vascular resistance. After taking the drug, the maximum effect is observed after 3-4 hours and persists throughout the day. Concor does not affect the reduction in heart rate.

Reception of the drug is accompanied by a decrease in pressure approximately 2 weeks after the start of therapy.

Indications for use

As indicated in the official instructions to Concor, this drug is designed to treat:

Ischemic heart disease (CHD);
Arterial hypertension;
Stenocardia of tension;
Myocardial infarction (for the purpose of secondary prevention);
Chronic heart failure.

Also, Concor, according to the instructions, can be administered to patients who have a rhythm disorder, in particular when:

Sinus tachycardia;
Ventricular or supraventricular extrasystole;
Arrhythmia, developed against the background of mitral valve prolapse;
Thyrotoxicosis.

Contraindications

There are many contraindications to taking the drug, among which:

marked decrease in pressure;
bronchial asthma and COPD;
metabolic acidosis;
pheochromocytoma;
age is less than 18 years;
acute form of heart failure;
decompensated chronic heart failure;
AV-blockade of 2-3 degrees;
cardiogenic shock;
sinoatrial blockade;
bradycardia;
severe changes in peripheral arterial blood circulation;
an allergy to the components of the drug.

Use in pregnancy and lactation

Pregnancy and lactation are contraindications to the appointment of a medicinal drug Concor.

The fact that adrenoblockers can cause a contraction of the muscles of the uterus, and can provoke miscarriage or premature birth. In addition, the possibility of negative effects on the fetus can not be ruled out completely, as Concor reduces blood flow in the placenta.

Large-scale clinical studies on the use of this drug in pregnant women were not carried out for obvious reasons. Concorcine tablets were used to treat pregnant women only in those cases when the benefits of prescribing repeatedly exceeded the risk of fetal pathology. But even with this kind of use, the drug should be stopped two to three days before the expected childbirth, and the newborn must be under a constant supervision of the doctor for at least three days.

Dosage and route of administration

The instructions for use indicate that Concor is taken orally 1 time / day. Tablets should be taken with a small amount of liquid in the morning before breakfast, during or after it. They should not be chewed or ground into powder.

Treatment with Concor is usually long-term.

Chronic heart failure

The standard treatment regimen for chronic heart failure includes the use of ACE inhibitors or angiotensin receptor antagonists II (in case of intolerance to ACE inhibitors), beta-adrenoblockers, diuretics and, optionally, cardiac glycosides. At the beginning of the treatment of chronic heart failure, Concor requires a special phase of titration under regular medical supervision.

A precondition for the treatment with Concor is a stable chronic heart failure without signs of exacerbation.

Treatment with Concor begins with the following titration scheme. In this case, individual adaptation may be required depending on how well the patient tolerates the prescribed dose, i.e., The dose can be increased only if the previous dose is well tolerated.

To ensure the appropriate titration process at the initial stages of treatment, it is recommended to use bisoprolol in the dosage form of a 2.5 mg tablet.
The recommended initial dose is 1.25 mg 1 time / day. Depending on the individual tolerability, the dose should be gradually increased to 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg 1 time / day. Each subsequent increase in the dose should be carried out at least 2 weeks later. If the increase in the dose of the drug is poorly tolerated by the patient, then a dose reduction is possible.
The maximum recommended dose for the treatment of chronic heart failure is 10 mg 1 time / day.

During titration, regular monitoring of blood pressure, heart rate and degree of symptoms of chronic heart failure is recommended. The worsening of the symptoms of the course of chronic heart failure is possible already from the first day of application of the drug.

If the patient does not tolerate the maximum recommended dose of the drug, then the possibility of a gradual dose reduction should be considered.

During the titration phase or after it, temporary deterioration of the course of chronic heart failure, arterial hypotension or bradycardia is possible. In this case, it is recommended, first of all, to correct the doses of concomitant therapy. It may also require a temporary reduction in the dose of Concor or its cancellation. After stabilization of the patient's condition, a repeated titration of the dose should be performed, or the treatment should be continued.

Arterial hypertension and stable angina

The dose is selected individually, primarily taking into account the heart rate and the patient's condition.

As a rule, the initial dose is 5 mg 1 time / day. If necessary, the dose can be increased to 10 mg 1 time / day. In the treatment of hypertension and angina, the maximum recommended dose is 20 mg 1 time / day.

Special patient groups

Older patients do not need a dose adjustment.
Because There is not enough data on the use of Concor in children, it is not recommended to prescribe the drug to children and adolescents under the age of 18 years.
At the expressed infringements of function of kidneys (KK less than 20 ml / mines) and at patients with serious diseases of a liver the maximum daily dose makes 10 mg. Increase in the dose in such patients should be done with extreme caution.
Patients with violations of the liver or kidneys of mild or moderate severity, as well as elderly patients, correction of the dosing regimen, as a rule, is not required.

To date, there is insufficient data on the use of Concor in patients with chronic heart failure in combination with type 1 diabetes mellitus expressed impaired renal and / or liver function, restrictive cardiomyopathy, congenital heart disease or heart valve disease with severe hemodynamic disorders. Also, sufficient data have not yet been obtained regarding patients with chronic heart failure with myocardial infarction during the last 3 months.

Side effects

Reviews of side effects are not uncommon, most often reported on slowing of heart rate, hypotension, nausea and deterioration of well-being.

From the skin: alopecia.
From the sense organs: damage to the ear, conjunctivitis.
From the genitourinary system: a violation of potency.
On the part of the respiratory system: an attack of bronchial asthma.
From the musculoskeletal system: convulsions, muscle weakness.
Allergic reactions: itching, rash, skin redness, allergic rhinitis.
On the part of the digestive system: diarrhea, nausea, vomiting, increase in the level of AST and ALT in the blood.
From the nervous system and psyche: dizziness, loss of consciousness, headache, depression, insomnia, nightmares.
From the cardiovascular system: bradycardia, worsening of the course of chronic heart failure, numbness of the extremities, a strong decrease in pressure, orthostatic hypotension.

The withdrawal syndrome

In "heavy" cores with a sharp discontinuation of Concor tablets, the development of a so-called withdrawal syndrome is possible, which is manifested by the following symptoms:

aggravation of the course of angina pectoris;
tachycardia more than 90 beats per minute in the absence of physical activity;
a sharp increase in blood pressure until the development of hypertensive crisis;
appearance of signs of heart failure;
a variety of cardiac rhythm disturbances associated with the formation of abnormal pathological sources of rhythm in the cardiac system (extrasystole, paroxysmal tachycardia attacks).

It should be noted that the likelihood of withdrawal syndrome with a sharp discontinuation of Concor tablets, as well as the severity of its symptoms, depends not on the duration of the period of taking the drug, but on the severity of the disease that caused the need for its administration.

Especially dangerous is the abrupt discontinuation of the course in such pathologies as:

high degree of arterial hypertension;
cardiac ischemia;
propensity to develop life-threatening tachyarrhythmias (cardiac arrhythmias accompanied by increased heart rate).

How to cancel reception correctly Concor

To avoid the development of withdrawal syndrome, the dose of Concor is reduced gradually. In this case, you should constantly monitor blood pressure and heart rate. A single scheme for the abolition of Concor tablets does not exist, since the likelihood of developing a withdrawal syndrome depends on the magnitude of the maintenance dose and the severity of the disease, which served as an indication for the purpose of the drug.

Typically, doctors advise to reduce the maintenance dose of 1.25 mg of active substance (that is, a quarter tablet containing 5 mg of bisoprolol) per week, focusing on the severity of pathological symptoms.

Overdose

The most common symptoms are: AV blockade, marked decrease in blood pressure, severe bradycardia, acute heart failure, hypoglycemia, bronchospasm.

With a single admission of a high dose of bisoprolol, the sensitivity in individual patients varies greatly. Probably, for patients with chronic heart failure sensitivity is increased.

In case of an overdose, you should stop taking Concor and take maintenance symptomatic therapy.

With severe bradycardia, intravenous atropine is recommended. If these measures are not enough, you can carefully introduce a drug with a positive chronotropic effect. In some cases, a temporary setting of an artificial pacemaker is performed.

In the case of a marked decrease in blood pressure, intravenous administration of vasopressor preparations and plasma-substituting solutions is recommended.

With AV blockade, continuous monitoring of the patient should be ensured and beta-adrenomimetic therapy (eg, epinephrine) should be prescribed. In some cases, it is advisable to temporarily set up an artificial pacemaker.

In the case of exacerbation of chronic heart failure, intravenous diuretics, vasodilators and agents with a positive inotropic effect are recommended.

Bronchodilators are prescribed bronchodilators, including beta2-adrenomimetics and / or aminophylline.

In hypoglycemia, intravenous glucose (dextrose) is recommended.

special instructions

At the initial stage of treatment with Concor, patients need constant medical supervision.

The patient should not abruptly discontinue treatment and change the recommended dose without first consulting a doctor, as this can lead to a temporary deterioration in the heart. Treatment should not be interrupted suddenly, especially in patients with ischemic heart disease. If discontinuation of treatment is necessary, the dose should be reduced gradually.

Caution should be used in diabetes mellitus with significant fluctuations in blood glucose (symptoms of severe hypoglycemia, such as tachycardia, palpitations or excessive sweating may be masked), in patients on a strict diet, with desensitizing therapy, AV-blockade I degree, angina Prinzmetal, violations peripheral arterial circulation of mild and moderate degree (at the beginning of therapy there may be an increase in symptoms), with psoriasis (including in the anamnesis).

Allergic reactions:beta-blockers, including the Concor drug, can increase sensitivity to allergens and the severity of anaphylactic reactions due to the weakening of adrenergic compensatory regulation under the action of beta-adrenoblockers. Epinephrine (epinephrine) therapy does not always produce the expected therapeutic effect.
Respiratory system:with bronchial asthma or COPD simultaneous application of bronchodilating agents is shown. In patients with bronchial asthma, an increase in airway resistance may be required, which requires a higher dose of beta2-adrenomimetics.
In patients with pheochromocytomaConcor can be prescribed only against the background of the use of alpha-blockers.
When conducting general anesthesiashould take into account the risk of blockade of β-adrenergic receptors. If it is necessary to discontinue therapy with Concor before surgery, it should be done gradually, and completed 48 hours before the general anesthesia. An anesthetist should be warned that the patient is taking Concor.

When treating Concor with symptomshyperthyroidismcan be masked.

Drug Interactions

The tolerability and efficacy of bisoprolol can be influenced by any drugs that are simultaneously taken (even after a short period of time) so the doctor should be warned about the use of other medicines, including those that are taken without a prescription.

Uncommon combinations:

In the treatment of chronic heart failure: Class I antiarrhythmics (such as lidocaine, disopyramide, propafenone, phenytoin, quinidine, flecainide) with simultaneous application with bisoprolol may reduce the contractility of the heart and AV conduction.
With all indications for the use of Concor: slow calcium channel blockers such as verapamil and diltiazem can reduce the contractility of the myocardium and disrupt AV-conduction. With intravenous administration of verapamil, it is possible to develop severe arterial hypotension and AV blockade. Hypotensive drugs of central action (moxonidine, methyldopa, rilmenidine, clonidine) can lead to a decrease in cardiac output, decreasing heart rate, vasodilation. With a sharp cessation of their use, especially before the withdrawal of Concor, the risk of developing ricochet arterial hypertension increases.

Combinations that require special care in the treatment of angina and hypertension: Class I antiarrhythmics.

Combinations that require special care, regardless of indications for the use of Concor, in connection with possible undesirable reactions of interaction:

Mefloquine - risk of bradycardia;
Class III antiarrhythmic agents (eg, amiodarone) -increase AV-conduction disturbance;
Nonsteroidal anti-inflammatory drugs - decreased hypotensive effect of bisoprolol;
Parasympatomimetiki - increased disturbance of AV conduction, increased risk of bradycardia;
Means for general anesthesia - the risk of cardiodepressive action leading to arterial hypotension;
Cardiac glycosides - increased pulse time and bradycardia development;
Beta-adrenomimetics (eg, isoprenaline, dobutamine) - decreased effectiveness of both drugs;
Antihypertensive drugs and drugs with a possible antihypertensive effect (for example, barbiturates, tricyclic antidepressants, phenothiazines) - increased hypotensive effect of bisoprolol;
Beta-blockers for topical application (eg eye drops for the treatment of glaucoma) - strengthening of systemic effects of bisoprolol (decrease in heart rate, decrease in blood pressure);
Insulin and oral hypoglycemic agents - an increase in their hypoglycemic action (with the symptoms of hypoglycemia can be suppressed or masked);
Blockers of slow calcium channels, which are derivatives of dihydropyridine (for example, felodipine, nifedipine, amlodipine) - the risk of developing arterial hypertension, with CHF - worsening of the contractile function of the heart;
Adrenomimetics that affect α- and β-adrenergic receptors (eg, epinephrine and norepinephrine) - enhance their vasoconstrictor effect, leading to an increase in blood pressure;
Monoamine oxidase inhibitors (except type B) -increase of hypotensive action of bisoprolol, development of hypertensive crisis.

Reviews

We picked up some reviews of people who used the drug Concor:

Irina. As anew born! The pulse was 90-100. Now I do not notice. The pressure was normalized. It was 220/110. Now 160/90. Very drug free. The truth is + Vazar I drink. Life has become much easier.
Hope. I began to take Concor as prescribed by a cardiologist, it took only a week, I'm happy with the pressure in the norm and the next day, I tried a lot, but the pressure was jumping, this the drug works, I have not had the pressure 120/80 for a long time, but he could, I do not know what will happen next, what kind of pills will come out, but so far everything is smooth and well, thank the doctor.
Valentina. Two years ago, I suffered an arterial crisis, which led to a risk of developing neurological disorders. Before that, I was under pressure, but I did not attach any importance to this. In the hospital, I took a blood test, and it turned out that I had type II diabetes. The cardiologist wrote me a concor. In the instructions to the medicine, I read that people with diabetes are prescribed with caution. I accept Concor already the second year, there are no side effects. The pressure stabilized, and my overall condition improved.

In general, the reviews on the Concore product indicate that it lowers high blood pressure and reduces the heart rate. The main drawbacks in the opinion of the interviewed people are the frequent development of side effects, withdrawal syndrome and a relatively high cost.

Analogues

Structural analogues of Concor according to the active substance:

Aritel;
Aritel Cor;
Bidop;
Biol;
Biprol;
Bisogamma;
Bisocardium;
Bisomore;
Bisoprolol;
Bisoprolol-Lugal;
Bisoprolol-Prana;
Bisoprolol-ratopharm;
Bisoprolol-Teva;
Bisoprolol hemifumarate;
Bisoprolol fumarate;
Concor Cor;
Corbis;
Cordinorm;
Coronale;
Niperten;
Thyrez.

Before using analogues, consult your doctor.

What is better Concor or Coronale?

The coronale also contains bisoprolol, it is produced by a company from Slovakia. These drugs are equally active, but the Coronal at a cost is at least 100 rubles from the drug Concor.

Thus, the main difference is only in the price and advertised drugs.