Acrydilol - instructions for use, dose, side effects, contraindications

Excipients: ludypress LCEE [lactose monohydrate 94.7-98.3%, povidone 3-4%] - 81.95 mg, sodium carboxymethyl starch 0.9 mg, magnesium stearate 0.9 mg.

One tablet (12.5 mg) contains:

active substance: carvedilol in terms of 100% substance - 12.5 mg;

Excipients: ludypress LCEE [lactose monohydrate 94.7-98.3%, povidone 3-4%] - 95.3 mg, sodium carboxymethyl starch - 1.1 mg, magnesium stearate 1.1 mg.

One tablet (25 mg) contains:

active substance: carvedilol in terms of 100 % substance - 25 mg;

Excipients: Ludite LCEE [lactose monohydrate 94.7-98.3%, povidone 3-4%] - 190.6 mg, sodium carboxymethyl starch - 2.2 mg, magnesium stearate - 2.2 mg.

Description:Tablets from white to white with a creamy shade of color. A slight "marble" is allowed. Tablets 6.25 mg - round planocylindrical, with a facet and a risk; tablets 12,5 mg - square with rounded corners, biconcave with crosswise notching on one side and engraving AL1 - on the other; tablets 25 mg - oval, biconcave with partial notching on both sides and engraving AL2 - on one side.

Pharmacotherapeutic group:Alpha- and beta-blocker

ATX: & nbsp

C.07.A.G.02 Carvedilol

Pharmacodynamics:

Carvedilol - blocker of alpha1, beta1, and beta2-adrenoreceptors, has an organoprotective effect, is an antioxidant that removes free oxygen radicals, has an antiproliferative effect against smooth muscle cells of the vessel walls. Carvedilol is a racemic mixture R(+) and S(-) stereoisomers, each of which has the same alpha-adrenergic blocking and antioxidant properties. Beta-adrenoblokiruyuschee action carvedilol is non-selective and is due to levorotatory S(-) stereoisomer.

Carvedilol does not have its own sympathomimetic activity and, like propranolol, has membrane-stabilizing properties. Blocking beta-adrenoreceptors, it reduces the activity of the renin-angiotensin-aldosterone system, reducing the release of renin, so fluid retention (characteristic of selective alpha-blockers) occurs rarely.

Selectively blocking alpha 1-adrenergic receptors, carvedilol reduces the overall peripheral vascular resistance.

Carvedilol does not adversely affect the lipid profile, maintaining a normal ratio of high and low density lipoproteins (HDL / LDL).

In patients with hypertension carvedilol lowers blood pressure (BP) due to the combined blockade of beta and alpha 1-adrenergic receptors. Reduction of blood pressure is not accompanied by a simultaneous increase in the total peripheral vascular resistance, which is observed with the use of nonselective beta-blockers. The heart rate (heart rate) decreases somewhat. Kidney blood flow and kidney function in patients with hypertension persist. Shown, that carvedilol does not change the shock volume of blood and reduces the overall peripheral vascular resistance; does not impair blood supply to organs and peripheral blood flow, including in skeletal muscles, forearms, lower limbs, skin, brain and carotid artery. Coldness of limbs and increased fatigue during exercise are rare. The hypotensive effect of carvedilol in hypertension persists for a long time.

Patients with ischemic heart disease carvedilol has anti-ischemic and antianginal action (an increase in the total duration of exercise, time to development of the segment depression ST depth of 1 mm and the time before the onset of an attack of angina pectoris), persisting with prolonged therapy. Carvedilol reliably reduces the need for myocardium in oxygen and the activity of the sympathoadrenal system. Also reduces preload (pulmonary wedge wedge pressure and pulmonary capillary pressure) and postnagruzka (general peripheral vascular resistance).

Carvedilol lowers the mortality rate and reduces the frequency of hospitalizations, reduces symptoms and improves left ventricular function in patients with chronic heart failure of ischemic and non-ischemic origin. The effects of carvedilol are dose-dependent.

Pharmacokinetics:

After oral administration carvedilol quickly absorbed. Carvedilol is a carrier protein that acts as a pump in the lumen of the intestine, glycoprotein P. The maximum concentration in the blood plasma (C_max) is reached after about 1 hour.Absolute bioavailability of carvedilol is approximately 25%.

Carvedilol has a high lipophilicity. About 98-99% of carvedilol binds to blood plasma proteins. Its volume of distribution is approximately 2 l / kg. Carvedilol undergoes biotransformation in the liver by oxidation and conjugation with the formation of a number of metabolites. 60-75% of the absorbed drug is metabolized by "primary passage" through the liver. The existence of intestinal-hepatic circulation of the starting material is shown.

The metabolism of carvedilol by oxidation is stereoselective. RThe (+) stereoisomer is metabolized mainly by CYP2D6 and CYP1A2, a S(-) stereoisomer - mainly using CYP2D9 and to a lesser extent by CYP2D6. Other cytochrome P450 isoenzymes involved in the metabolism of carvedilol include CYP3A4, CYP2E1 and CYP2C19. Maximum concentration R(+) stereoisomer in plasma is approximately 2 times greater than that for S(-) stereoisomer.

R(+) stereoisomer is metabolized, mainly by hydroxylation. Slow metabolizers CYP2D6 it is possible to increase the plasma concentration of carvedilol, first of all, R(+) stereoisomer, which is reflected in an increase in alpha-adrenergic blocking activity of carvedilol.

As a result of demethylation and hydroxylation of the phenolic ring, 3 metabolites are formed (their concentrations are 10 times lower than the concentration of the starting material) with beta-adrenoblocking activity (in the 4'-hydroxyphenol metabolite it is approximately 13 times stronger than in carvedilol itself). 3 active metabolites have less pronounced vasodilating properties than carvedilol. 2 of the hydroxycarbazole metabolites of carvedilol are extremely powerful antioxidants, and their activity in this respect is 30-80 times greater than that of carvedilol.

The half-life of carvedilol is about 6 hours, the plasma clearance is about 500-700 ml / min. Excretion occurs mainly through the intestine, the main way of excretion is with bile. A small part of the dose is excreted by the kidneys in the form of various metabolites.

Pharmacokinetics in specific patient groups

Patients with impaired renal function

With prolonged therapy with carvedilol, the intensity of renal blood flow is maintained, the glomerular filtration rate does not change.

In patients with arterial hypertension and impaired renal function, the area under the concentration-time curve (AUC), half-life and maximum plasma concentrations do not change. Renal excretion of unchanged drug in patients with renal insufficiency decreases, however, changes in pharmacokinetic parameters are not very pronounced.

Patients with impaired hepatic function

In patients with cirrhosis of the liver, the systemic bioavailability of the drug is increased by 80% due to a decrease in the expression of metabolism in the "primary passage" through the liver. Consequently, carvedilol contraindicated in patients with clinical manifestations of liver dysfunction.

Patients with heart failure

In patients suffering from heart failure, the clearance R(+) and S(-) stereoisomers of carvedilol is significantly reduced. Pharmacokinetics R(+) and S(-) stereoisomers of carvedilol in heart failure significantly changes.

Elderly patients

Age does not have a statistically significant effect on the pharmacokinetics of carvedilol in patients with arterial hypertension.

Children

Data on the pharmacokinetics of the drug in patients under 18 years of age are limited.

Patients with diabetes mellitus

In patients with type 2 diabetes mellitus and hypertension carvedilol does not affect the concentration of glucose in the blood on an empty stomach and after eating, the level of glycosylated hemoglobin (HbA₁) or a dose of hypoglycemic agents for oral administration. In patients with type 2 diabetes mellitus carvedilol does not cause a decrease in glucose tolerance. In patients with arterial hypertension who have insulin resistance (metabolic syndrome), but without concomitant diabetes mellitus, carvedilol improves insulin sensitivity. Similar results were obtained in patients with arterial hypertension and type 2 diabetes mellitus.

Indications:

- Arterial hypertension (in monotherapy or in combination with other antihypertensive drugs, for example, blockers of "slow" calcium channels or diuretics);

- cardiac ischemia (including in patients with unstable angina and painless myocardial ischemia);

- chronic heart failure.

Treatment of stable and symptomatic mild, moderate and severe chronic heart failure (II-IV functional class by classification NYHA) ischemic or non-ischemic genesis in combination with angiotensin-converting enzyme (ACE) inhibitors and diuretics, with or without cardiac glycosides (standard therapy), in the absence of contraindications.

Contraindications:

Hypersensitivity to carvedilol or any component of the drug; acute and chronic heart failure in the stage of decompensation, requiring intravenous injection of inotropes; clinically significant impairment of liver function; age under 18 years (effectiveness and safety not established); atrioventricular blockade of II and III degree (except for patients with an artificial pacemaker); pronounced bradycardia (heart rate less than 50 beats per minute); syndrome of weakness of the sinus node (including sinoauric blockade); severe arterial hypotension (systolic blood pressure less than 85 mm Hg); cardiogenic shock; pheochromocytoma without simultaneous use of alpha-blockers; anamnestic indications for bronchospasm and bronchial asthma; lactose intolerance, lactase deficiency, glucose-galactose malabsorption.

Carefully:

In chronic obstructive pulmonary disease (COPD), depression,myasthenia gravis, hypoglycaemia, atrioventricular blockade of the first degree, thyrotoxicosis, with extensive surgical interventions and general anesthesia, prinzmetal angina, diabetes mellitus, peripheral circulatory disorders, pheochromocytoma suspected, renal insufficiency, psoriasis, allergic anamnesis.

Pregnancy and lactation:

Beta-adrenoblockers reduce placental blood flow, which can lead to intrauterine fetal death and premature birth. In addition, the fetus and newborn can develop unwanted reactions (in particular, hypoglycemia and bradycardia, complications from the heart and lungs). Studies in animals have not revealed a teratogenic effect in carvedilol.

There is no sufficient experience of using the drug Acridilol® in pregnant women. Carvedilol contraindicated in pregnancy, except when the possible benefits of its use in the mother exceed the potential risk to the fetus.

In animals carvedilol and its metabolites penetrate into breast milk. Data on the penetration of carvedilol into breast milk in humans are absent, therefore,if the drug is needed during lactation, breastfeeding should be discontinued.

Dosing and Administration:

Inside, regardless of food intake, with enough liquid.

Arterial hypertension

The recommended initial dose is 12.5 mg once a day for the first 2 days of therapy, then 25 mg once a day. If necessary, in the future, the dose can be increased at intervals of at least 2 weeks, bringing to the maximum recommended dose of 50 mg once a day (or divided into 2 divided doses).

Cardiac ischemia

The recommended initial dose is 12.5 mg twice a day for the first 2 days, then 25 mg twice a day. If necessary, the dose can then be increased at intervals of at least 2 weeks, bringing to the highest daily dose of 100 mg divided into 2 doses.

Chronic heart failure

The dose is selected individually, careful monitoring of the doctor is necessary. In patients receiving cardiac glycosides, diuretics and ACE inhibitors, their doses should be adjusted before treatment with the drug Acridilol®.

The recommended initial dose is 3.125 mg (1/2 tablet at 6.25 mg) 2 times a day for 2 weeks.With good tolerance, the dose is increased at intervals of at least 2 weeks to 6.25 mg twice a day, then to 12.5 mg twice a day, then to 25 mg twice a day. The dose should be increased to the maximum dose, which is well tolerated by the patient. The recommended maximum dose is 25 mg twice a day for all patients with severe chronic heart failure and for patients with mild to moderate chronic heart failure with a body weight of less than 85 kg. In patients with mild and moderate chronic heart failure and body weight of more than 85 kg - the recommended maximum dose is 50 mg 2 times a day.

Before each dose increase, the physician should examine the patient to identify a possible increase in symptoms of chronic heart failure or vasodilation. With a transient increase in the symptoms of chronic heart failure or fluid retention in the body, the dose of diuretics should be increased, in some cases it is necessary to reduce the dose of the drug Acridilol® or temporarily cancel it.

Symptoms of vasodilation can be eliminated by reducing the dose of diuretics.If the symptoms persist, you can lower the dose of the ACE inhibitor (if the patient takes it), and then, if necessary, the dose of the drug Acridilol®. In this situation, the dose of Acridilol® should not be increased until symptoms of worsening chronic heart failure or hypotension improve.

If treatment with the drug Acridilol® is interrupted for more than 1 week, then its use is resumed at a lower dose, and then increased in accordance with the recommendations given above. If treatment with the drug Acridilol® is interrupted for more than 2 weeks, then its appointment should be resumed at a dose of 3.125 mg (1/2 tablet at 6.25 mg) 2 times a day, then select the dose in accordance with the recommendations above.

Dosing in special patient groups

Impaired renal function

Existing data on the pharmacokinetics in patients with varying degrees of renal impairment (including renal failure) suggest that patients with moderate to severe renal insufficiency do not need to adjust the dose of Acrydilol®.

Impaired liver function

Acrydilol® is contraindicated in patients with clinical manifestations of liver dysfunction.

Elderly patients

Data that would dictate the need for dose adjustment are not available.

Side effects:

The incidence of adverse reactions is classified according to the recommendations of the World Health Organization (WHO): very often (> 10%); often (> 1%, <10%); infrequently (> 0.1%, <1%); rarely (> 0.01%, <0.1%); very rarely (<0.01%), including isolated cases. The frequency of adverse reactions, with the exception of dizziness, visual impairment and bradycardia, does not depend on the dose of the drug.

Undesirable reactions in patients with chronic heart failure

From the central nervous system: very often - dizziness, headache (usually mild and occurring more often at the beginning of treatment); asthenia (including, increased fatigue), depression.

From the side of the cardiovascular system: often - bradycardia, postural hypotension, marked decrease in blood pressure, edema (including generalized, peripheral, depending on the position of the body, edema of the perineum, swelling of the lower extremities, hypervolemia,fluid retention); infrequently - syncope (including presyncopal), atrioventricular block and heart failure during the period of dose increase.

From the digestive system: often - nausea, diarrhea, vomiting.

On the part of the organs of hematopoiesis: rarely - thrombocytopenia; very rarely - leukopenia. From the side of metabolism: often - weight gain, hypercholesterolemia; in patients with existing diabetes mellitus - hyperglycemia or hypoglycemia, violations of glycemic control.

Other: often - visual impairment; rarely renal failure and renal dysfunction in patients with diffuse vasculitis and / or renal dysfunction.

Undesirable reactions in patients with arterial hypertension and coronary heart disease

The nature of side effects from the cardiovascular system in the treatment of hypertension and prolonged therapy of coronary heart disease is similar to that of chronic heart failure, but their frequency is somewhat less.

From the central nervous system: often - dizziness, headache and general weakness, usually light and emerging, in particular, at the beginning of treatment; infrequently - mood lability, sleep disturbances, paresthesia.

From the side of the cardiovascular system: often - bradycardia, postural hypotension, syncopal conditions (infrequently), especially at the beginning of therapy; infrequent peripheral circulatory disorders (cold extremities, exacerbation of intermittent claudication syndrome and Raynaud's syndrome), atrioventricular block, angina (pain in the chest), development or aggravation of chronic heart failure and peripheral edema.

From the respiratory system: often - bronchospasm and shortness of breath in predisposed patients; rarely - nasal congestion.

From the digestive system: often - dyspeptic disorders (including nausea, abdominal pain, diarrhea); infrequently - constipation, vomiting.

From the side of the skinin: infrequently - skin reactions (skin rash, dermatitis, urticaria and skin itching).

Laboratory indicators: very rarely - an increase in the activity of "hepatic" transaminases - alanine aminotransferase (ALT), aspartate aminotransferase (ACT) and gamma glutamyltransferase, thrombocytopenia and leukopenia.

Other: often - pain in the limbs, reducing tear and eye irritation; infrequently - decreased potency,impaired vision; rarely - dryness of the oral mucosa and urination disorders; very rarely - exacerbation of psoriasis, sneezing, flu-like syndrome.

Separate cases of allergic reactions.

Possible development of alopecia.

Rare cases of urinary incontinence in women, reversible after drug withdrawal, are registered.

Overdose:

Symptoms: marked decrease in blood pressure, bradycardia, heart failure, cardiogenic shock, cardiac arrest; possible respiratory disorders, bronchospasm, vomiting, confusion and generalized convulsions.

Treatment: in addition to general activities, it is necessary to monitor and correct vital signs, if necessary - in the intensive care unit.

The patient should be laid on his back (with raised legs). With bradycardia, it is advisable to administer atropine (0.5-2 mg intravenously) and / or glucagon (1-10 mg intravenously struino, then 2.5 mg per hour as a continuous infusion). To maintain the function of the ventricle, the administration of glucagon intravenously or sympathomimetics (dobutamine, epinephrine (adrenaline)) at various doses, depending on body weight and response to ongoing therapy, under conditions of continuous monitoring of circulatory rates.In the case of bradycardia resistant to treatment, the use of an artificial pacemaker is indicated. When bronhospazme enter beta-adrenomimetiki in the form of an aerosol (if ineffectiveness - intravenously) or aminophylline intravenously. When convulsions are intravenously slowly injected diazepam or clonazepam. Since a severe overdose with symptoms of shock may prolong the half-life of carvedilol and remove the drug from the depot, it is necessary to continue supporting therapy for a long time. The duration of maintenance / detoxification therapy depends on the severity of the overdose, it should continue until the patient's clinical condition is stabilized.

Interaction:

Pharmacokinetic interaction

Because the carvedilol is both a substrate and an inhibitor of glycoprotein P, when it is simultaneously administered with preparations transported with glycoprotein P, the bioavailability of the latter can increase. In addition, the bioavailability of carvedilol can be altered by the action of inducers or inhibitors of the glycoprotein P.

Inhibitors and inducers of isoenzymes CYP2D6 and CYP2C9 can stereoselectively alter the systemic and / or presystemic metabolism of carvedilol, leading to an increase or decrease in concentrations R(+) and S(-) stereoisomers of carvedilol in blood plasma. Some examples of such interactions are listed below.

Digoxin

With simultaneous administration of carvedilol and digoxin, digoxin concentrations increase by about 15%. At the beginning of therapy with carvedilol, when selecting its dose or canceling the drug, regular monitoring of the concentration of digoxin in the blood plasma is recommended.

Cyclosporin

Due to inhibition of glycoprotein P activity in the intestine, carvedilol increases the absorption of cyclosporine when taken orally. In connection with the expressed individual fluctuations in the concentration of cyclosporin, careful monitoring of its concentration after the initiation of carvedilol therapy and, if necessary, appropriate correction of the daily dose of cyclosporine is recommended. In the case of intravenous administration of cyclosporine, no interaction with carvedilol is expected.

Rifampicin

Rifampicin reduces plasma concentrations of carvedilol, most likely by induction of the glycoprotein P,leading to a decrease in carvedilol absorption in the intestine and a decrease in its antihypertensive effect.

Amiodarone

In connection with the increase in concentration S(-) stereoisomer of carvedilol, the risk of an increase in beta-adrenergic blocking action is possible.

Fluoxetine

In patients with heart failure, simultaneous administration of fluoxetine (an inhibitor CYP2D6) leads to stereoselective suppression of carvedilol metabolism - an increase in the average AUC for R(+) by 77%. However, there were no clinical symptoms of this interaction.

Pharmacodynamic interaction

Insulin silt hypoglycemic agents for oral administration

Drugs with beta-adrenoblocking properties may increase the hypoglycemic effect of insulin or hypoglycemic agents for oral administration. Symptoms of hypoglycemia, especially tachycardia, can be masked or weakened. Patients receiving insulin or hypoglycemic agents for oral administration are encouraged to regularly monitor blood glucose concentrations.

Drugs that reduce the content of catecholamines

Patients taking concomitantly with beta-adrenergic blocking properties and catecholamine-lowering agents (for example, reserpine and monoamine oxidase inhibitors) should be carefully monitored for the risk of arterial hypotension and / or severe bradycardia.

Digoxin

Combination therapy of agents with beta-adrenergic blocking properties and digoxin can lead to an additional delay in atrioventricular conduction.

Verapamil, diltiazem, amiodarone Other antiarrhythmics

Simultaneous administration with carvedilol may increase the risk of atrioventricular conduction.

Clonidine

Simultaneous administration of clonidine with drugs with beta-adrenoblocking properties may potentiate an antihypertensive and bradycardic effect. If you plan to stop combination therapy with a drug with beta-adrenergic blocking properties and clonidine, you should first cancel the beta-blocker, and after a few days you can cancel clonidine, gradually reducing its dose.

Blocks of "slow" calcium channels (BCCI)

With the simultaneous administration of carvedilol and diltiazem, there were isolated cases of conduction disorders (rarely - with disturbances in hemodynamic parameters).As in the case of other drugs with beta-adrenergic blocking properties, the appointment of carvedilol along with BCCC, such as verapamil or diltiazem, it is recommended to carry out under the control of an electrocardiogram and a BP.

Hypotensive drugs

Like other drugs with beta-adrenergic blocking activity, carvedilol may enhance the effect of other concurrently taken antihypertensive drugs (eg, alpha 1-blockers) or drugs that cause arterial hypotension as a side effect.

Means for general anesthesia

It should be carefully monitored for the main indicators of life of the body during general anesthesia in connection with the possibility of a synergistic negative inotropic action of carvedilol and funds for general anesthesia.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Joint reception of NSAIDs and beta-blockers can lead to an increase in blood pressure and a decrease in blood pressure control.

Bronchodilators (beta-adrenomimetics)

Since noncardioselective beta-blockers interfere with the bronchodilating effect of bronchodilators, which are beta-adrenergic receptor stimulants, careful monitoring of patients receiving these drugs is necessary.

Special instructions:

Chronic heart failure

In patients with heart failure, during the adjustment of the dose of the drug Acridilol®, there may be an increase in symptoms of chronic heart failure or fluid retention. If such symptoms occur, it is necessary to increase the dose of diuretics and not increase the dose of the drug Acridilol® to stabilize the hemodynamics.

Sometimes it is necessary to reduce the dose of the drug Acridilol or, in rare cases, temporarily cancel the drug. Such episodes do not prevent further correct selection of the dose of the drug Acridilol®.

Acrydilol® is used with caution in combination with cardiac glycosides (possibly excessive deceleration AVconductivity).

Kidney function in chronic heart failure

In patients with heart failure and low blood pressure (systolic blood pressure less than 100 mm Hg), coronary heart disease and diffuse vessel changes and / or kidney failure, patients with heart failure and low blood pressure were found to have reversible impairment of renal function. The dose of the drug is selected depending on the functional state of the kidneys.

COPD

Patients with COPD (including bronchospastic syndrome) who do not receive oral or inhalation β₂-adrenomimetics, Acridilol® is prescribed only if the possible benefits of its use exceed the potential risk. In the presence of the initial predisposition to bronchospastic syndrome with the reception of the drug Acridilol® as a result of increased resistance to the respiratory tract may develop shortness of breath. At the beginning of admission and with an increase in the dose of the drug Acridilol®, these patients should be carefully observed, reducing the dose of the drug when the initial signs of bronchospasm appear.

Diabetes

Presence of beta-adrenoblocking properties in the preparation does not exclude the possibility of manifestation of latent diabetes mellitus, decompensation of already existing diabetes mellitus or oppression of the contrinular system.

With caution, the drug is prescribed to patients with diabetes, because it can mask or relieve the symptoms of hypoglycemia (especially tachycardia). In patients with heart failure and diabetes mellitus, the use of the drug Acridilol® may be accompanied by violations of glycemic control.

Diseases of peripheral vessels

Caution is needed when administering Acridilol to patients with peripheral vascular disease (including Reynaud's syndrome), since beta-blockers may increase the symptoms of arterial insufficiency.

Thyrotoxicosis

Like other beta-blockers, Acrydilol® can reduce the symptoms of thyrotoxicosis.

General anesthesia and extensive surgery

Caution is required in patients undergoing general surgery under general anesthesia, because of the possibility of summing up the negative effects of the drug Acridilol® and the means for general anesthesia.

Bradycardia

Acrydilol® can cause bradycardia, with a decrease in heart rate of less than 55 beats per minute, the dose should be reduced.

Hypersensitivity

Care must be taken when prescribing Acridilol to patients with anamnestic indications of severe hypersensitivity reactions or a course of desensitization, since beta-blockers can increase sensitivity to allergens and the severity of anaphylactic reactions.

Psoriasis

Patients with anamnestic indications of the occurrence or exacerbation of psoriasis with beta-blockers, Acridilol® can only be prescribed after a thorough analysis of the possible benefits and risks.

Simultaneous reception of blockers of "slow" calcium channels (BCCC)

In patients who simultaneously take BCCC such as verapamil or diltiazem, as well as other antiarrhythmic drugs, it is necessary to regularly monitor the ECG and blood pressure.

Pheochromocytoma

Patients with pheochromocytoma before starting any beta-blocker should appoint an alpha-blocker. Although Acridilol® has both beta and alpha-adrenergic blocking properties, there is no experience of its use in such patients, so it should be used with caution in patients with suspected pheochromocytoma.

Angina pectoris

Non-selective beta-blockers can provoke the appearance of pain in patients with Prinzmetal angina. These patients do not have experience with the appointment of Acridilol®. Although its alpha-adrenergic blocking properties can prevent similar symptoms, prescribe carvedilol in such cases should be done with caution.

Contact lenses

Patients who use contact lenses should remember the possibility of reducing the amount of tear fluid.

The "cancellation" syndrome

Treatment with the drug Acridilol is a long time. It should not be stopped abruptly, it is necessary to gradually reduce the dose of the drug at weekly intervals. This is especially important in patients with ischemic heart disease.

If surgical intervention with general anesthesia is necessary, the surgeon / anesthesiologist must be alerted to prior therapy with the drug Acridilol®.

During the treatment, alcohol consumption is excluded.

Effect on the ability to drive transp. cf. and fur:

During the period of treatment with the drug Acridilol®, care must be taken when driving vehicles and engaging in other potentially hazardous activities requiring increased attention and speed of psychomotor reactions.

Form release / dosage:

Tablets 6.25 mg, 12.5 mg and 25 mg.

Packaging:

For 10 tablets in a planar cell package.

3 contour mesh packages together with instructions for use in a pack of cardboard.

Storage conditions:

In a dry, protected from light place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:P N000983 / 01

Date of registration:01.05.2012

The owner of the registration certificate:AKRIKHIN HFK, JSC AKRIKHIN HFK, JSC Russia

Manufacturer: & nbsp

AKRIKHIN HFK, JSC Russia

Representation: & nbspAKRIKHIN OJSC AKRIKHIN OJSC Russia

Information update date: & nbsp15.12.2014

Illustrated instructions

Instructions

Acridilol® (Acridilole® )