Instructions for Nebilet (Nebivolol) pills
Description:
White tablets, round, double-bulged, with a cross-shaped insect for division.
1 tab
Nebyvolol hydrochloride micronized 5.45 mg,
which corresponds to the content of Nebyvolol 5 mg
Auxiliary substances: lactose monohydrate - 141.75 mg, starch corn - 46 mg, sodium crosscarmellosis - 13.8 mg, hypromellosis 15 mPa×s - 4.6 mg , polysorbate 80 - 0.46 mg, cellulose microcrystalline - 16.1 mg, silicon coloid dioxide - 0.69 mg, magnesium stearate - 1.15 mg.
ATX codes
C07AB12 Nebivolol
Pharmacological groups / Group membership:
Beta<SUB>1</SUB>-adrenoblocator III generation with vasodilating properties
Active substance:
non-bivolol
Pharmacy Group
Beta1 adrenderer selective
Retention Terms
The drug Nebilet should be stored in a place not accessible to children at a temperature not exceeding 25°C.
Shelf life
Shelf life - 3 years.
Pharmaceuticals:
Cardioselic beta1 adrenoblocator. It has hypotensive, anti-anginal and anti-arrhythmic effects. Reduces the elevated AD in peace, physical stress and stress. Competitively and selectively blocks postsynaptic b1-adrenoreceptors, making them inaccessible to catheholamins, modulates release of endothelial vasodilating factor nitrogen oxide (NO).
Nebivololol is a racemate of two antiomers: SRRR-nebivolol (D-nebivolol) and RSSS-nebivolol (L-nebivolol), combining two pharmacological actions:
D-non-bivolol is a competitive and highly selective blockage of α1-adrenoreceptors;
L-nebivolol has a soft vasodilating effect by modulating the release of vasodilating factor (NO) from the vascular endothelium.
Hypotensive action is also caused by the decrease of the Renin-angiotensin-aldosterone system (RAAS) activity (it is not directly correlated with the change of the activity of renin in the blood plasma).
Sustainable hypotensive action develops in 1-2 weeks of regular drug Nebilet use, and in some cases - in 4 weeks, stable action is noted in 1-2 months.
Reducing myocardial demand for oxygen (reduction of HSS and reduction of preloading and postload), reduces the number and severity of stenocardial attacks and increases the portability of physical load.
The anti-arrhythmic action is caused by the suppression of pathological automatic heart (including in the pathological area) and the deceleration of AV conductivity.
Testimonials:
arterial hypertension
ischemic heart disease: prevention of stress stenocardial attacks
Chronic heart failure (in combination therapy).
Method of application, course and dosage:
The tablets are taken in, 1 time/day, preferably always at the same time of day, regardless of the meal, having a sufficient amount of liquid.
Average daily dose for treatment of arterial hypertension and IBS is 2.5-5 mg (1/2-1 tab.). Nebilet can be used in monotherapy or in combination with other means that reduce AD.
For patients with kidney failure and patients over 65 years of age, the recommended initial dose is 2.5 mg (1/2 tab.)/day. If necessary, the daily dose can be increased to a maximum of 10 mg (2 tab. to 5 mg per 1 dose).
Treatment of chronic heart failure must begin with a slow increase in the dose to achieve an individual optimal maintenance dose. Dose collection at the beginning of treatment should be carried out according to the following scheme, with intervals of 1 to 2 weeks and based on the patient's tolerability of this dose: A dose of 1.25 mg of non-bivolol (1/4 tab. to 5 mg) 1 time/day can be increased first to 2.5-5 mg (1/2 tab. to 5 mg or 1 tab. to 5 mg) and then to 10 mg mg (2 tab. to 5 mg) 1 time/day.
The maximum daily dose is 10 mg 1 time per day.
At the beginning of the treatment and at each increase of the dose, the patient must be at least 2 hours under the supervision of a doctor to ensure that the clinical condition remains stable (especially AD, HSS, conductivity disorders, as well as symptoms of worsening of the course of chronic heart failure).
Pill division rules
To divide the pill, place the pill on a solid, level surface of the cross-shaped insect upwards, push the pill with both index fingers. To get 1/4 pills repeat the same steps with 1/2 pills.
Overdose:
Symptoms: A pronounced decrease in AD, nausea, vomiting, cyanosis, sinus bradycardia, AV-blockade, bronchospasm, loss of consciousness, cardiogenic shock, coma, cardiac arrest.
Treatment: stomach washing, activated carbon intake. In the case of a pronounced reduction in AD, the patient should be given a horizontal position with his feet raised, if necessary, in the introduction of liquid and vasopressors. In case of bradycardia, it is necessary to enter in/in 0.5-2 mg of atropine in the absence of positive effect. In case of AV-block (II-III st.) it is recommended in/in introduction of beta-adrenostimulators, in case of their ineffectiveness it is necessary to consider the issue of putting an artificial driver of rhythm. In the case of heart failure, treatment begins with the introduction of cardiac glycosides and diuretics, in the absence of effect it is advisable to introduce dopamine, dobutamine or vasodilators. For bronchospasmus, be used in/in stimulants, b2-adrenoreceptors. In the case of gastric estrasistoly - lydokain (antiarrhythmic IA class drugs Nebilet cannot be introduced).
Drug Interaction:
Pharmaceutical Interaction
At the same time, the use of beta-adrenoblocators with slow calcium channel blockers (verapamyl and diltiase) increases the negative effect on myocardial acidification and AV conductivity.
Contradicted in/in the introduction of verapamyl against the background of the application of nebivolol.
When simultaneously using non-bivolol with hypotensive agents, nitroglycerin or slow calcium channel blockers, a pronounced arterial hypotension can develop (special care is required when combined with prasozine).
At the same time, the application of nebivolol with antiarrhythmic preparations of the I class and with amyodarone may increase the negative inotrophic action and extend the time of excitation on preserdiums.
When using Nebyvolol with heart glycozides simultaneously, no effect on the deceleration of AV conductivity was detected.
Simultaneous use of nebivolol and drugs Nebilet for general anesthesia can cause suppression of reflex tachycardia and increase the risk of development of arterial hypotension.
No clinically significant Nebyvolol-NPA interaction has been established.
Simultaneous use of nebivolol with tricyclic antidepressants, barbiturates and phenotiazine derivatives can increase the hypotensive effect of nebivolol.
Pharmaceutical Interaction:
When simultaneously using non-bivolol with preparations that ingibate the reverse seizure of serotonin, or other means that biotransformate with the participation of the isoferment CYP2D6, the concentration of nebivolol in the blood plasm, metabolism of nebivol, increases Acid is slowing down, which may lead to the risk of bradycardia.
When used simultaneously with digoxin, non-bivolol has no effect on pharmacokinetic digoxin parameters.
When simultaneously using non-bivolol with cymethideine, the concentration of nebivolol in the blood plasma increases.
Simultaneous application of non-bivolol and ranitidin does not affect pharmacokinetic particles
