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

Excipients: lactose monohydrate - 61.5 mg; microcrystalline cellulose - 30.0 mg; silicon dioxide colloidal - 2.0 mg; crospovidone - 3.0 mg; magnesium stearate 1.0 mg;

film sheath: [hypromellose - 1.8 mg, talc 0.6 mg, titanium dioxide 0.31 mg, macrogol 4000 (polyethylene glycol 4000) 0.27 mg, iron dye oxide yellow 0.02 mg] or [film dry yellow film membrane , containing hypromellose - 60%, talc - 20%, titanium dioxide - 10.33%, macrogol 4000 (polyethylene glycol 4000) - 9% and iron dye oxide yellow - 0.67%] - 3.0 mg.

Dosage 5 mg

active substance: bisoprolol fumarate 5.0 mg;

Excipients: lactose monohydrate - 59.0 mg; microcrystalline cellulose - 30.0 mg; silicon dioxide colloidal - 2.0 mg; crospovidone - 3.0 mg; magnesium stearate 1.0 mg;

film sheath: [hypromellose - 1.8 mg, talc 0.6 mg, titanium dioxide 0.33 mg, macrogol 4000 (polyethylene glycol 4000) 0.27 mg] or [membrane film dry white, containing hypromellose - 60%, talc - 20%, titanium dioxide 11%, macrogol 4000 (polyethylene glycol 4000) 9%] 3.0 mg.

Dosage of 10 mg

active substance: bisoprolol fumarate - 10.0 mg;

Excipients: lactose monohydrate - 118.0 mg; microcrystalline cellulose - 60.0 mg; silicon dioxide colloid - 4.0 mg; crospovidone 6.0 mg; magnesium stearate - 2.0 mg;

film sheath: [hypromellose - 3,6 mg, talc - 1,2 mg, titanium dioxide - 0,66 mg, macrogol 4000 (polyethylene glycol 4000) - 0,54 mg] or [film membrane dry white, containing hypromellose - 60%, talc - 20%, titanium dioxide - 11%, macrogol 4000 (polyethylene glycol 4000) - 9%] - 6.0 mg.

Description:

Round, biconvex tablets, covered with a film shell of white or almost white color (dosages of 5 mg and 10 mg) or yellow (dosage of 2.5 mg). On the cross section, the nucleus is white or almost white in color.

Pharmacotherapeutic group:Beta1-blocker selective

ATX: & nbsp

C.07.A.B Selective beta-blockers

C.07.A.B.07 Bisoprolol

Pharmacodynamics:

Bisoprolol - selective beta₁-adrenoceptor without its own sympathomimetic activity, does not possess membrane-stabilizing action. Reduces the activity of renin plasma, reduces the need for myocardium in oxygen, reduces the heart rate (heart rate) (at rest and with exercise). Has antihypertensive, antiarrhythmic and anti-anginal action. Blocking in low doses of beta₁-adrenoceptors of the heart, reduces catecholamine-stimulated formation of cyclic adenosine monophosphate (cAMP) from adenosine triphosphate, reduces the intracellular current of calcium ions,has a negative chrono-, dromo-, batmo- and inotropic action (inhibits conduction and excitability, slows atrioventricular (AV) conductivity).

When the dose is increased above the therapeutic dose, beta₁-adrenoblocking action.

The total peripheral vascular resistance at the beginning of the use of the drug (in the first 24 hours) increases somewhat (as a result of the reciprocal increase in the activity of alpha-adrenoreceptors), returns to the initial one after 1-3 days, and decreases with prolonged use.

Antihypertensive effect is associated with a decrease in the minute volume of blood, sympathetic stimulation of peripheral vessels, a decrease in the activity of the sympathoadrenal system (important for patients with initial hypersecretion of renin), restoration of sensitivity in response to lowering blood pressure (BP) and affecting the central nervous system (CNS). With arterial hypertension, the effect occurs after 2-5 days, a stable effect - after 1-2 months.

Antianginal effect is caused by a decrease in myocardial oxygen demand as a result of a decrease in heart rate, a slight decrease in contractility, diastole lengthening, and improvement in myocardial perfusion.

Antiarrhythmic effect is caused by the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and slowing AV conduct (mainly in antegrade and, to a lesser extent, in the retrograde direction through AV node) and on additional paths.

When used at average therapeutic doses, in contrast to non-selective beta-blockers, it exerts a less pronounced effect on organs containing betaa₂-adrenoceptors (pancreas, skeletal muscles, smooth musculature of peripheral arteries, bronchi and uterus) and carbohydrate metabolism, does not cause retention of sodium ions in the body.

The maximum effect of the drug is achieved 3-4 hours after ingestion. Even with the appointment of bisoprolol once a day, its therapeutic effect persists for 24 hours, thanks to a 10-12-hour half-life (T_1/2) from the blood plasma. Typically, the maximum reduction in blood pressure is achieved 2 weeks after the start of treatment.

Pharmacokinetics:

Suction

Bisoprolol is almost completely (more than 90%) absorbed from the gastrointestinal tract. Its bioavailability due to minor metabolization during "primary passage" through the liver (at about 10%) is about 90% after ingestion. Eating does not affect absorption. Bisoprolol demonstrates linear kinetics, and its concentrations in the blood plasma are proportional to the dose taken in the range of 5 to 20 mg. The maximum concentration in the blood plasma is achieved in 2-3 hours.

Distribution

Bisoprolol is distributed quite widely. The volume of distribution is 3.5 l / kg. The connection with blood plasma proteins reaches approximately 35%; the capture of blood cells is not observed. Permeability through the blood-brain barrier and the placental barrier is low.

Metabolism

Metabolized by the oxidative pathway without subsequent conjugation. All metabolites have a strong polarity and are excreted by the kidneys. The main metabolites found in blood plasma and urine, do not show pharmacological activity. Data obtained as a result of experiments with microsomes of human liver in vitro, show that bisoprolol is metabolized primarily by isoenzyme CYP3A4 (about 95%), and isoenzyme CYP2D6 plays only a small role.

Excretion

Bisoprolol clearance is determined by the balance between excretion through the kidneys in the form of unchanged substance (about 50%) and oxidation in the liver (about 50%) to metabolites, which are then excreted by the kidneys. The total clearance is 15.6 ± 3.2 l / h, with a kidney clearance of 9.6 ± 1.6 l / h. T_1/2is 10-12 hours.

Pharmacokinetics in specific patient groups

Patients with impaired hepatic and renal function

Since excretion takes place in the kidneys and in the liver equally, patients with impaired liver function or with renal insufficiency do not need to adjust the dose.

Elderly patients

The pharmacokinetics of bisoprolol is linear and does not depend on age.

Patients with chronic heart failure (CHF)

In patients with CHF, the level of bisoprolol in the blood plasma is higher, and T_1/2increases to 17 hours compared with healthy volunteers.

There is no information on the pharmacokinetics of bisoprolol in patients with CHF and simultaneous impairment of liver or kidney function.

Indications:

- Arterial hypertension;

- ischemic heart disease (IHD) (prevention of attacks of stable angina pectoris);

- chronic heart failure.

Contraindications:

- Hypersensitivity to bisoprolol or to any of the excipients (see section "Composition");

- acute heart failure, CHF in the stage of decompensation, requiring inotropic therapy;

- cardiogenic shock;

- atrioventricular (AV) blockade of II and III degree, without an electrocardiostimulator;

- syndrome of weakness of the sinus node;

- sinoatrial blockade;

- bradycardia (heart rate less than 60 beats / min);

- severe arterial hypotension (systolic blood pressure less than 100 mm Hg);

- severe forms of bronchial asthma;

- severe peripheral arterial circulation or Raynaud's syndrome;

- pheochromocytoma (without simultaneous use of alpha-blockers);

- metabolic acidosis;

- age under 18 years (insufficient data on the effectiveness and safety of this age group);

- lactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome.

Carefully:

- Desensitizing therapy;

- angina of Prinzmetal;

- hyperthyroidism;

- Type I diabetes mellitus and diabetes mellitus with significant fluctuations in blood glucose concentration;

- AV blockade of the 1st degree;

- marked renal failure (creatinine clearance (CC) less than 20 ml / min);

- severe liver dysfunction;

- psoriasis;

- restrictive cardiomyopathy;

- Congenital heart disease or heart valve disease with severe hemodynamic disorders;

- CHF with myocardial infarction during the last three months;

- severe forms of chronic obstructive pulmonary disease (COPD);

- strict diet.

Pregnancy and lactation:

Pregnancy

Bisoprolol does not have direct cytotoxic, mutagenic and teratogenic effects, but it has pharmacological effects that can have harmful effects on the course of pregnancy and / or on the fetus or on the newborn. Usually beta-adrenoblockers reduce placental perfusion, which leads to a slowing of fetal growth, fetal death, miscarriage or premature birth. The fetus and newborn child may experience pathological reactions, such as intrauterine growth retardation, hypoglycemia, bradycardia.

During pregnancy bisoprolol should be recommended only if the benefit to the mother exceeds the risk of side effects in the fetus.

As a rule, beta-adrenoblockers reduce blood flow in the placenta and can affect the development of the fetus. Blood flow in the placenta and uterus should be closely monitored, and the growth and development of the unborn child should be monitored, and alternative therapies should be taken if pregnancy and / or fetus are undesirable.

You should carefully examine the newborn after delivery. In the first three days of life, bradycardia and hypoglycemia may occur.

Breastfeeding period

There is no data on the isolation of bisoprolol in breast milk. Therefore, taking the drug Bisoprolol is not recommended for women during lactation.

If you need to use the drug during lactation, breastfeeding should be discontinued.

Dosing and Administration:

Inside, in the morning, not liquid, once a day with a small amount of liquid, regardless of food intake. Tablets should not be chewed or ground into a powder.The dose of the drug in all cases is chosen by the doctor for each patient individually, taking into account the patient's condition, treatment effectiveness and heart rate.

Treatment of arterial hypertension and ischemic heart disease (prevention of attacks of stable angina)

It is recommended to start taking 1 tablet 5 mg once a day. In some cases, the initial dose may be 2.5 mg once daily. If necessary, increase the dose to 10 mg once a day. The maximum daily dose is 20 mg.

Treatment of CHF

The standard treatment regimen for CHF includes the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor agonists (in the case of intolerance to ACE inhibitors), beta-blockers, diuretics and, optionally, cardiac glycosides. Initiation of CHF treatment with a drug Bisoprolol requires mandatory conduct of a special phase of titration and regular medical supervision.

A prerequisite for drug treatment Bisoprolol is stable CHF without signs of exacerbation.

Treatment of CHF with a drug Bisoprolol starts according to the following titration scheme. Individual adaptation may be required depending on theon how well the patient tolerates the prescribed dose, that is, the dose can be increased only if the previous scheme was well tolerated.

To ensure the following dosage regimen for CHF, it is possible to use bisoprolol from other manufacturers in the dosage form of a 2.5 mg tablet with a risk (to obtain dosages of 1.25 mg and 3.75 mg).

The recommended initial dose is 1.25 mg once daily. 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 once daily. Each subsequent increase in the dose should be carried out at least two weeks later.

If the increase in the dose of the drug is poorly tolerated by the patient, a dose reduction is possible.

The maximum recommended dose for CHF is 10 mg of the drug Bisoprolol once a day.

During the titration of the dose, regular monitoring of blood pressure, heart rate and severity of CHF symptoms is recommended. The aggravation of the symptoms of CHF is possible from the first day of the drug.

If the patient does not tolerate the maximum recommended dose of the drug, a gradual dose reduction is possible.

During or after titration, temporary worsening of CHF, arterial hypotension, or bradycardia may occur. In this case, it is recommended, first of all, to correct the doses of concomitant therapy. It may also be necessary to temporarily reduce the dose of the drug Bisoprolol 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.

Duration of treatment

Treatment with drug Bisoprolol usually is long-term. The duration of therapy is determined by the doctor.

Patients with impaired renal or hepatic function

If violations of the liver or kidneys of mild or moderate degree usually do not need to adjust the dose.

In patients with severe renal dysfunction (CC less than 20 ml / min) or with severe impairment of liver function, the maximum daily dose is 10 mg. Increasing the dose in such patients should be carried out with extreme caution. Elderly patients

Dose adjustments in elderly patients are not required.

Other categories of patients

To date, there is insufficient data on the use of the drug Bisoprolol in patients with CHF associated with type 1 diabetes mellitus, severe renal and / or liver dysfunction, restrictive cardiomyopathy, congenital heart disease or heart disease with severe hemodynamic disorders. Also, sufficient data have not yet been obtained regarding patients with CHF with myocardial infarction during the last three months.

Side effects:

Classification of the incidence of adverse events according to recommendations

World Health Organization (WHO):

very often ≥1 / 10;

often from ≥ 1/100 to <1/10;

infrequently from ≥ 1/1000 to <1/100;

rarely from ≥ 1/10000 to <1/1000;

very rarely <1/10000, including individual messages;

frequency is unknown - but it is not possible to establish the frequency of occurrence of available data.

Disturbances from the nervous system:

often - dizziness, * headache *, asthenia (in patients with CHF), fatigue, sleep disturbances, depression, anxiety;

infrequently - asthenia (in patients with arterial hypertension or angina pectoris), drowsiness or insomnia, depression;

rarely - hallucinations, "nightmarish" dreams, confusion or short-term memory loss, myasthenia gravis, tremor, muscle cramps.Usually, these phenomena are of an easy nature and usually take place within 1-2 weeks after the start of treatment.

Disturbances on the part of the organ of sight:

rarely - impaired vision, reduced secretion of tear fluid;

very rarely - dryness and soreness of the eyes, conjunctivitis.

Violations from the organ of hearing and labyrinth:

rarely - noise in the ears, hearing loss, ear pain.

Heart Disease:

very often bradycardia;

often - aggravation of CHF symptoms (in patients with CHF);

infrequently infringement AV conduction, decompensation of CHF;

rarely - withdrawal syndrome (increased angina attacks, increased blood pressure).

Vascular disorders:

often marked decrease in blood pressure (especially in patients with CHF), manifestation of angiospasm (increased peripheral circulatory disturbance, coldness of the lower extremities, paresthesia);

infrequently - orthostatic hypotension, peripheral edema.

Gastrointestinal disorders:

often - nausea, vomiting, diarrhea, constipation, dryness of the oral mucosa, abdominal pain;

very rarely - a change in taste.

Disturbances from the liver and bile ducts:

rarely - hepatitis.

Disturbances from the respiratory system, chest and mediastinal organs:

infrequently - bronchospasm in patients with bronchial asthma or airway obstruction in anamnesis, chest pain;

rarely - nasal congestion.

Immune system disorders:

rarely - skin itching, skin rash, hives, allergic rhinitis.

Disturbances from the skin and subcutaneous tissues:

rarely - hypersensitivity reactions, such as pruritus, rash, skin hyperemia, increased sweating, exanthema, psoriasis-like skin reactions;

very rarely - exacerbation of psoriasis symptoms, alopecia.

Disturbances from muscular, skeletal and connective tissue:

infrequently - arthralgia, pain in the back.

Laboratory and instrumental data:

rarely - increased activity of "hepatic" transaminases (alanine aminotransferase, aspartate aminotransferase), increased bilirubin concentration, hypertriglyceridemia;

in some cases - thrombocytopenia, leukopenia, agranulocytosis.

Disorders from the reproductive system and mammary glands:

rarely - a violation of potency, a weakening of the libido.

* In patients with hypertension or angina pectoris, especially these symptoms appear at the beginning of the course of treatment.Usually, these symptoms are mild and usually occur within 1-2 weeks after the start of treatment.

Overdose:

Symptoms

Arrhythmia, ventricular extrasystole, AV block, bradycardia, marked reduction of blood pressure, worsening CHF flow (increase in edema, bradycardia or slowing of the heart rate, lowering blood pressure), shortness of breath, bronchoconstriction, acute heart failure, hypoglycemia, cyanosis nails of fingers or hands, dizziness, fainting, convulsions.

The sensitivity to a single dose of a high dose of bisoprolol varies greatly among individual patients and, probably, patients with CHF are highly sensitive.

Treatment

In the event of an overdose, it is first necessary to stop taking the drug, to gastric lavage, appoint adsorbing drugs and start supporting symptomatically.

With severe bradycardia: intravenous administration of atropine. If the effect is insufficient, with caution, you can enter a drug that has a positive chronotropic effect. Sometimes it may be necessary to temporarily set up an artificial pacemaker.

With a pronounced decrease in blood pressure: intravenous injection of plasma-substituting solutions and vasopressive drugs.

When AV blockade: patients should be under constant supervision, and receive treatment with beta-adrenomimetics, such as epinephrine. If necessary - staging an artificial pacemaker.

With exacerbation of the course of CHF: intravenous injection of diuretics, drugs with a positive inotropic effect, as well as vasodilators.

When bronhospazme: the appointment of bronchodilators, including beta₂adrenomimetics and / or aminophylline.

When hypoglycemia: intravenous glucagon injection or intravenous dextrose (glucose).

Hemodialysis is ineffective.

Interaction:

The effectiveness and tolerability of bisoprolol may be affected by the simultaneous use of other drugs. This interaction can also occur when two drugs are taken in a short time.

The physician should be informed about the use of other medicines, even if they are used without the doctor's prescription (that is, over-the-counter medications).

Unrecommended combinations

Class I antiarrhythmics (eg, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone) with simultaneous application with bisoprolol may reduce AV conduction and contractility of the myocardium.

Blocks of "slow" calcium channels (BCCI) type verapamil and, to a lesser extent, diltiazem, with simultaneous application with bisoprolol may lead to a decrease in myocardial contractility and disruption AV conductivity. In particular, intravenous administration of verapamil to patients taking beta-blockers can lead to severe arterial hypotension and impairment AV conductivity.

Hypotensive means of central action (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and a decrease in cardiac output, as well as to the appearance of symptoms of vasodilation due to a decrease in the central sympathetic tone. Abrupt cancellation, especially before the abolition of beta-blockers may increase the risk of developing "ricochet" hypertension.

Combinations, requiring special care

BCCC derivatives of dihydropyridine (eg, nifedipine, felodipine, amlodipine) with simultaneous application with bisoprolol may increase the risk of developing arterial hypotension. In patients with heart failure, the risk of subsequent deterioration of the contractile function of the heart can not be ruled out.

Antiarrhythmic drugs of III class (eg, amiodarone) with simultaneous application with bisoprolol may increase the disruption AV conductivity.

Act beta-blockers for topical application (eg, eye drops for the treatment of glaucoma) can enhance the systemic effects of bisoprolol (lowering blood pressure, decreasing heart rate).

Parasympathomimetics with simultaneous use with bisoprolol may increase the violation AV conductivity and increase the risk of developing a bradycardia.

Hypoglycemic action insulin or hypoglycemic agents for oral administration may be enhanced. Symptoms of hypoglycemia, in particular tachycardia, can be masked or suppressed. Such interaction is more likely when using non-selective beta-blockers.

Means for general anesthesia

They are able to increase the risk of cardiodepressive action, leading to arterial hypotension (see section "Special instructions").

Cardiac glycosides

With simultaneous use with bisoprolol may lead to an increase in the timing of the impulse, and thus, to the development of bradycardia.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Can reduce the antihypertensive effect of bisoprolol.

Simultaneous use of the drug Bisoprolol from beta-adrenomimetics (e.g., isoprenaline, dobutamine) can lead to a decrease in the effect of both drugs.

The combination of bisoprolol with adrenomimetics, affecting the alpha and beta-adrenoreceptors (for example, norepinephrine, epinephrine) may enhance the vasoconstrictor effects of these agents that occur with the participation of alpha-adrenergic receptors, leading to an increase in blood pressure. Such interactions are more likely when using nonselective beta-blockers.

When bisoprolol is combined with norepinephrine and epinephrine can be observed aggravation of intermittent claudication.

Hypotensive drugs, as well as other agents with a possible antihypertensive effect (eg, tricyclic antidepressants, barbiturates, phenothiazines) can enhance the antihypertensive effect of bisoprolol.

Allergens, used for immunotherapy, or allergen extracts for skin tests increase the risk of developing anaphylactic reactions.

Clearance lidocaine and xanthines (except theophylline) may decrease due to a possible increase in their concentration in the blood plasma, especially in patients with initially elevated clearance of theophylline under the influence of smoking.

Tricyclic and tetracyclic antidepressants, antipsychotic drugs (antipsychotics), ethanol, sedatives and hypnotics increase the inhibition of the central nervous system.

Diuretics, sympatholytics, hydralazine and other antihypertensives can lead to excessive blood pressure lowering.

Act Nondepolarizing muscle relaxants and anticoagulant effect coumarins during the treatment with bisoprolol may be prolonged.

Meflokhin

At simultaneous application with bisoprolol it is capable to increase risk of development of a bradycardia.

MAO inhibitors (except for MAO B inhibitors)

Can enhance the antihypertensive effect of beta-blockers. Simultaneous application can also lead to the development of hypertensive crisis.The interval between taking MAO inhibitors and bisoprolol should be at least 14 days.

Rifampicin

Perhaps a slight decrease in the half-life of bisoprolol due to rifampicin induction of hepatic isoenzymes of cytochrome P450. Usually dose adjustment is not required.

Derivatives of ergotamine

Unhydrated alkaloids of ergot increase the risk of peripheral circulatory disorders. Ergotamine increases the risk of peripheral circulatory disorders.

Sulfasalazine increases the concentration of bisoprolol in the blood plasma.

Special instructions:

Do not interrupt drug treatment Bisoprolol abruptly and do not change the recommended dose without first consulting a doctor, as this can lead to a temporary worsening of the heart. Treatment should not be interrupted suddenly, especially in patients with ischemic heart disease. If cessation of treatment is necessary, then the dose should be reduced gradually.

At the initial stages of treatment with the drug Bisoprolol patients need constant monitoring.

The drug should be used with caution in the following cases:

- severe forms of COPD and non-severe forms of bronchial asthma;

- diabetes mellitus with significant fluctuations in blood glucose concentration: symptoms of marked decrease in glucose concentration (hypoglycemia), such as tachycardia, palpitations or excessive sweating, may be masked;

- strict diet;

- conducting desensitizing therapy;

- AV blockade of the 1st degree;

- angina of Prinzmetal;

- violation of peripheral arterial blood flow of mild and moderate degree (at the beginning of therapy there may be an increase in symptoms);

- psoriasis (including in the anamnesis).

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 will require a higher dose of betaa₂-adrenomimetics. Patients with COPD bisoprolol, prescribed in complex therapy for the treatment of heart failure, should be prescribed, starting with the lowest possible dose, and in patients carefully monitor the appearance of new symptoms (eg, dyspnea, intolerance to physical exertion, cough).

Allergic reactions: beta-blockers, including the drug Bisoprolol, can increase the 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.

General anesthesia: when conducting general anesthesia, the risk of blockade of beta-adrenergic receptors should be considered. If it is necessary to stop therapy with the drug Bisoprolol before surgical intervention, it should be done gradually and completed 48 hours before the general anesthesia. An anesthesiologist should be warned that you are taking the drug Bisoprolol.

Pheochromocytoma: in patients with a tumor of the adrenal glands (pheochromocytoma), the drug Bisoprolol can be appointed only against the background of the use of alpha-blockers.

Hyperthyroidism: with drug treatment Bisoprolol symptoms of hyperfunction (hyperthyroidism) of the thyroid gland can be masked.

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

A drug Bisoprolol does not affect the ability to drive vehicles according to the results of the study of patients with IHD.However, due to individual reactions, the ability to drive vehicles or work with technically complex machinery can be disrupted. This should be paid special attention at the beginning of treatment, after changing the dose, as well as with the simultaneous use of alcohol.

Form release / dosage:

Film coated tablets, 2.5 mg, 5 mg and 10 mg.

Packaging:

10, 15 or 30 tablets in a planar cell packaging made of a polyvinylchloride film and aluminum foil.

1, 2, 3, 5 or 6 contour cell packs of 10 tablets, or 1, 2 or 4 contour packs of 15 tablets, or 1 or 2 contour packs of 30 tablets together with instructions for use in a pack of cardboard.

Storage conditions:

In the dark place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

2 years.

Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-001168

Date of registration:11.11.2011 / 30.11.2016

Expiration Date:Unlimited

The owner of the registration certificate:VERTEKS, AO VERTEKS, AO Russia

Manufacturer: & nbsp

VERTEKS, AO Russia

Representation: & nbspVERTEKS CJSC VERTEKS CJSC Russia

Information update date: & nbsp05.04.2017

Illustrated instructions

Instructions

Bisoprolol (Bisoprolol)