Carvedilol Canon - instructions for use, dose, side effects, contraindications

Excipients: calcium hydrophosphate dihydrate 38.55 mg, giprolose (hydroxypropyl cellulose) 2.5 mg, croscarmellose sodium (impellosis) 2 mg, lactose monohydrate (milk sugar) 50 mg, magnesium stearate 0.7 mg.

Dosage 12.5 mg

1 tablet contains:

active substance: carvedilol 12.5 mg;

Excipients: calcium hydrophosphate dihydrate 50 mg, giprolose (hydroxypropyl cellulose) 3.5 mg, croscarmellose sodium (impellosis) 3 mg, lactose monohydrate (milk sugar) 70 mg, magnesium stearate 1 mg.

Dosage of 25 mg

1 tablet contains:

active substance: carvedilol 25 mg;

Excipients: calcium hydrophosphate dihydrate 70 mg, giprolose (hydroxypropylcellulose) 5.3 mg, croscarmellose sodium (impellose) 4.5 mg, lactose monohydrate (sugar milk) 93.7 mg, magnesium stearate 1.5 mg.

Description:Tablets are round, flat-cylindrical, with a facet and a risk, white or almost white. Allowed a slight marble.

Pharmacotherapeutic group:Alpha- and beta-blocker

ATX: & nbsp

C.07.A.G.02 Carvedilol

Pharmacodynamics:

Carvedilol - blocker alpha1 beta1 - and beta2-adrenergic receptors, exerts vasodilating, antianginal and antiarrhythmic action. 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, it has membrane-stabilizing properties. The vasodilating effect is mainly due to the blockade of alpha 1-adrenergic receptors. Due to vasodilation, the overall peripheral vascular resistance (OPSS) decreases.

Beta-adrenoceptor blocking, it reduces the activity of the renin-angiotensin-aldosterone system (RAAS) reducing renin release, therefore, fluid retention characteristic of selective alpha-adrenergic blockers, occurs rarely. Carvedilol It has no marked effect on the lipid profile, while maintaining normal ratio lipoproteins and low density lipoproteins (HDL / LDL).

Efficiency

Arterial hypertension

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 the blood and reduces the OPSS; 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 antihypertensive effect of carvedilol in hypertension persists for a long time.

Cardiac ischemia

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 time before the onset of an attack of angina pectoris), which persists 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 postnagruzku (OPSS).

Chronic heart failure

Carvedilol lowers the death rate and reduces the frequency of hospitalization, 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:

Suction

After oral administration carvedilol quickly absorbed from the gastrointestinal tract. Carvedilol is the substrate of the transporter protein glycoprotein P, which acts as a pump in the lumen of the intestine. Glycoprotein P plays a major role in the bioavailability of certain drugs. The maximum concentration in the blood plasma (C_mOh) is reached approximately in 1 hour after intake. Absolute bioavailability of carvedilol is about 25%: 30% for Rand 15% for S-form. Eating does not affect bioavailability.

Distribution

Carvedilol has a high lipophilicity. About 98-99% of carvedilol binds to blood plasma proteins. Its volume of distribution is approximately 2 l / kg.

Metabolism

Carvedilol undergoes biotransformation in the liver by oxidation and conjugation to form 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.

The metabolism of carvedilol by oxidation is stereoselective. RThe stereoisomer is metabolized mainly by isoenzymes CYP2D6 and C YP1A2, a S- stereoisomer - mainly by isoenzyme CYP2D9 and to a lesser extent by means of an isoenzyme CYP2D6. Other isoenzymes of cytochrome P450 involved in the metabolism of carvedilol include isoenzymes CYP3A4, CYP2E1 and CYP2C19.

Maximum concentration Ris approximately 2 times higher than that for Slt; / RTI & gt;

RThe stereoisomer is metabolized mainly by hydroxylation.The "slow" isoenzyme metabolizers CYP2D6 it is possible to increase the plasma concentration of carvedilol, first of all, R-stereoisomer, which is manifested 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. Two of the hydroxycarbazole metabolites of carvedilol are extremely potent antioxidants, and their activity in this respect is 30-80 times greater than that of carvedilol.

Excretion

The half-life (T₁_/2) carvedilol is about 6 hours, plasma clearance is about 500-700 ml / min. Excretion occurs mainly through the intestines with bile. A small part of the dose is excreted by the kidneys in the form of various metabolites.

Pharmacokinetics the special patents

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), T₁_/2 and C_max do not change. Renal excretion of unchanged carvedilol in patients with renal insufficiency decreases, but changes in pharmacokinetic parameters are not very pronounced. Carvedilol is an effective tool for the treatment of patients with renovascular hypertension, including in patients with chronic renal failure, as well as in patients on hemodialysis or who underwent kidney transplantation. Carvedilol causes a gradual decrease in blood pressure both on the day of hemodialysis and on days without hemodialysis, and its antihypertensive effect is comparable to that in patients with normal renal function.

During the course of hemodialysis carvedilol is not excreted because it does not pass through the dialysis membrane, probably due to the fact that it strongly binds to blood plasma proteins.

Carvedilol penetrates the placental barrier, penetrates into breast milk.

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 severe impairment of liver function (see section "Contraindications").

Patients with chronic heart failure (CHF)

Patients with CHF clearance R- and Scarbo-idyl is significantly lower compared to the previously observed clearance in healthy volunteers. These results suggest that pharmacokinetics R- and SThe stereoisomers of carvedilol in heart failure change significantly.

Patients of elderly and senile age

Age does not have a statistically significant effect on the pharmacokinetics of carvedilol in patients with arterial hypertension. According to clinical studies, the tolerability of carvedilol in patients with hypertension or ischemic heart disease of the elderly and senile does not differ from that in patients of younger age.

Children

Data on the pharmacokinetics of the drug in patients under 18 years of age are currently 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 some clinical studies, it has been shown that in patients with type 2 diabetes mellitus carvedilol does not cause a decrease in glucose tolerance. In patients with hypertension who had insulin resistance (syndrome X), 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);

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

- xheart 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;

- severe hepatic impairment;

- 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;

- severe forms of bronchial asthma or bronchospasm (in anamnesis);

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

- lactose intolerance, lactase deficiency, glucose-galactose malabsorption;

- terminal stage of occlusive diseases of peripheral vessels;

- age to 18 years (efficacy and safety not established).

Carefully:With caution, the drug is used in a weakened allergological history, chronic obstructive pulmonary disease (COPD), depression, myasthenia gravis, hypoglycemia, atrioventricular blockade of the I degree, thyrotoxicosis, with extensive surgical interventions and general anesthesia, angina Prinzmetal, diabetes mellitus, occlusive diseases of peripheral vessels, with suspicion of pheochromocytoma, renal failure, psoriasis.

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 carvedilol in pregnant women. Carvedilol Canon is contraindicated during pregnancy, except in cases of extreme necessity, if the potential benefit to the mother exceeds the risk to the fetus.

Carvedilol and its metabolites penetrate into breast milk, so if taking the drug is necessary during lactation, breastfeeding should be discontinued.

Dosing and Administration:

Inside, regardless of food intake, with enough liquid.

Arterial hypertension

The recommended initial dose is 6.25-12.5 mg (1 tablet of 6.25 mg or 1/2 tablets of 12.5 mg - 1 tablet of 12.5) 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 the antianginal effect is insufficient, the dose can be increased at intervals of not less than 2 weeks, bringing to the highest daily dose equal to 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 Carvedilol Canon.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 to moderate chronic heart failure and a body weight of more than 85 kg, the recommended maximum dose is 50 mg twice a day.

Before every increase in the dose, a doctor's examination is necessary to detect a possible increase in the 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, although sometimes it is necessary to reduce the dose of the drug or temporarily abolish it.

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

If treatment with Carvedilol Canon 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 Carvedilol Canon is interrupted for more than 2 weeks, then its reappointment should be resumed at a dose of 3.125 mg (1/2 tablet at 6.25 mg) 2 times per day, then the dose is selected in accordance with the recommendations above.

Dosing the special patents

Impaired renal function

In patients with moderate and severe degree of renal failure, correction of the dose of Carvedilol Canon is not required.

Impaired liver function

Carvedilol Canon is contraindicated in patients with clinical manifestations of liver dysfunction (see section "Contraindications").

Elderly patients

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

Side effects:

Classification of WHO frequency of development of side effects: very often -> 1/10 appointments (> 10%); often from> 1/100 to <1/10 of appointments (> 1% and <10%); infrequently - from> 1/1000 to <1/100 of prescriptions (> 0.1% and <1%); rarely from> 1/10000 to <1/1000 appointments (> 0.01% and <0.1%); very rarely - <1/10000 prescriptions (<0.01%).

The frequency of some undesirable effects such as dizziness, arterial hypotension, bradycardia and visual disturbance is proportional to the dose size and is more often developed in patients with CHF. With the development of serious adverse effects, drug treatment should be discontinued.

Violations of the blood and lymphatic system

Rarely: thrombocytopenia.

Very rarely: leukopenia.

Disorders from the endocrine system

Often: in patients with existing diabetes mellitus - hyperglycemia or hypoglycemia, a violation of glycemic control.

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.

Disorders from the metabolism and nutrition

Often: weight gain, hypercholesterolemia.

Disturbances from the nervous system

Often: dizziness, headache (usually mild and occurring more often at the beginning of treatment), asthenia (including increased fatigue), depression.

Rarely: changes in mood / thinking, sleep disturbance, paresthesia, loss of consciousness.

Disturbances on the part of the organ of sight

Often: eye irritation, reduced tearing (pay attention when using contact lenses).

Very rarely: impaired vision.

Disorders from the cardiovascular system

Very often: orthostatic hypotension.

Often: aetiology.

Rarely: violation of cardiac conduction, aggravation of the course of angina pectoris, worsening of the clinical picture of heart failure (especially with increasing doses), marked decrease in blood pressure, palpitation, fainting, coldness of hands and feet, fluid retention, hypervolemia, edema (including generalized, peripheral, depending on the position of the body, swelling of the perineum, swelling of the lower extremities).

Very rarely: syncopal conditions (including presyncopal), occlusive disorders of peripheral circulation, exacerbation of the syndrome of "intermittent" lameness and Raynaud's syndrome.

Disturbances from the respiratory system, organs of the chest and mediastinum

Rarely: bronchospasm and shortness of breath in predisposed patients, nasal congestion.

Very rarely: sneezing.

Disorders from the gastrointestinal tract

Often: nausea, diarrhea, abdominal pain, dryness of the oral mucosa.

Rarely: vomiting, decreased appetite, flatulence, constipation.

Very rarely: increased activity of "hepatic" transaminases -alanine aminotransferase (ALT), aspartate aminotransferase (ACT) and gamma-glutamyl transferase (GGT).

Disturbances from the skin and subcutaneous tissues

Very rarely: exacerbation of psoriasis, exfoliative dermatitis, alopecia.

Disturbances from musculoskeletal and connective tissue

Rarely: myasthenia gravis, pain in the muscles, bones, spine.

Disorders from the kidneys and urinary tract

Rarely: violation of urination, incontinence in women, reversible after drug withdrawal.

Very rarely: renal failure and renal dysfunction in patients with diffuse vasculitis and / or impaired renal function, edema.

Violations of the genitals and mammary gland

Infrequent: decreased potency.

General disorders and disorders at the site of administration

Often: general weakness.

Infrequent: a reaction of increased sensitivity (itching, rash, hives).

Very rarely: "tides" of blood to the skin of the face, flu-like syndrome.

Undesirable reactions the patients with chronic heart failure

Disturbances from the nervous system

Very often: dizziness, headache (usually mild and arising at the beginning of treatment), asthenia (including increased fatigue), depression.

Disorders from the cardiovascular system

Often: bradycardia, postural hypotension, marked decrease in blood pressure, edema (including generalized, peripheral, depending on the position of the body, swelling of the perineum, edema of the lower extremities, hypervolemia, fluid retention).

Infrequently: syncopal conditions (including presyncopal), atrioventricular blockade and heart failure during the period of dose increase.

Disorders from the gastrointestinal tract

Often: nausea, diarrhea, vomiting.

Violations of the blood and lymphatic system

Rarely: thrombocytopenia.

Very rarely: leukopenia.

Disorders from the metabolism and nutrition

Often: weight gain, hypercholesterolemia; in patients with already existing diabetes - hyperglycemia or hypoglycemia, a violation of carbohydrate metabolism.

Other violations

Often: visual impairment.

Rarely: renal failure and renal dysfunction in patients with diffuse vasculitis and / or renal dysfunction.

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. You can use the following activities:

- put the patient on his back with his legs elevated;

- with severe bradycardia - atropine 0.5-2 mg intravenously;

- for the maintenance of cardiovascular activity - glucagon 1-10 mg intravenously struino, then 2-5 mg per hour in the form of a long infusion;

- sympathomimetics (dobutamine, isoprenaline, orciprenaline or epinephrine (epinephrine)) in different doses, depending on the body weight and response to the treatment.

If the clinical picture of an overdose is dominated by a marked decrease in blood pressure, norepinephrine (noradrenaline); he is appointed in conditions of continuous monitoring of blood circulation parameters. 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:

With the simultaneous administration of carvedilol and digoxin the concentration of the latter increases 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. However, combined therapy with carvedilol and digoxin can lead to an additionalretardation of atrioventricular conduction.

In connection with the expressed individual fluctuations of concentration cyclosporine 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 reduces plasma concentrations of carvedilol, leading to a decrease in its antihypertensive effect.

Fluoxetine, ketoconazole, cimetidine, haloperidol intensify the hypotensive effect of carvedilol.

Carvedilol may increase hypoglycemia insulin or hypoglycemic agents for oral administration. When co-administration is recommended regular monitoring of blood glucose.

Patients taking concurrently carvedilol and drugs that reduce the content of catecholamines (eg, reserpine and monoamine oxidase inhibitors) should be carefully monitored because of the risk of arterial hypotension and / or bradycardia.

In patients with heart failure, concurrent administration of carvedilol with amiodarone or other antiarrhythmic agents is accompanied by a risk of an increase in beta-adrenergic blocking action. At the same time, amiodarone may increase the risk of violation AV conductivity.

Simultaneous application of carvedilol from clonidine can potentiate an antihypertensive and bradycardic effect. If you plan to stop combination therapy with these drugs, you should first cancel carvedilol, and a few days later - clonidine, gradually reducing its dose.

Simultaneous reception blockers of "slow" calcium channels (BCC) such as verapamil, diltiazem with carvedilol may increase the risk of violation of atrioventricular conduction. The administration of carvedilol along with BCCI is recommended to be performed under the control of ECG and blood pressure.

Carvedilol may enhance the effect of other concurrently taken antihypertensive drugs (for example, alpha 1-adrenoblockers) or drugs that cause arterial hypotension as a side effect.

Means for general anesthesia increase the negative inotropic and hypotensive effect of carvedilol.

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the antihypertensive effect of carvedilol.

Bronchodilators (beta-adrenergic agonists). Since noncardioselective beta-blockers inhibit the bronchodilating effect of bronchodilators, which are stimulators of beta-adrenergic receptors, careful monitoring of patients receiving these drugs is necessary.

Special instructions:

Chronic heart failure

In patients with chronic heart failure during the selection of a dose of the drug, 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 until the hemodynamic parameters stabilize. Sometimes it is necessary to reduce the dose of Carvedilol Canon or, in rare cases, temporarily cancel the drug. Such episodes do not prevent further correct selection of the dose of Carvedilol Canon.

Carvedilol Canon is used with caution in combination with cardiac glycosides (possibly excessive deceleration AV conductivity).

At the beginning of therapy with the drug Carvedilol Canon or with increasing the dose of the drug in patients, especially the elderly, there may be an excessive decrease in blood pressure, especially during the transition from the "lying" position to the "standing" position. A dose adjustment is necessary.

Kidney function in chronic heart failure

In the appointment of Carvedilol Canon to patients with chronic heart failure and low blood pressure (systolic blood pressure less than 100 mm Hg), coronary heart disease and vascular diffuse changes and / or renal failure, reversible impairment of renal function was noted. The dose of the drug is selected depending on the functional state of the kidneys.

It is recommended to monitor kidney function in patients with chronic renal failure, arterial hypotension and chronic heart failure.

COPD

Patients with COPD, including those with bronchospastic syndrome who do not receive oral or inhaled antiasthmatics,Carvedilol canon 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 drug Carvedilol Canon as a result of increased resistance to the airways may develop shortness of breath. At the beginning of admission and with an increase in the dose of the drug, Carvedilol canon of these patients must be carefully observed, reducing the dose of the drug when the initial signs of bronchospasm appear.

Diabetes

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 chronic heart failure and diabetes mellitus, the use of the drug Carvedilol Canon may be accompanied by violations of glycemic control.

Diseases of peripheral vessels

Caution is needed when prescribing Carvedilol Canon 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, Carvedilol can reduce the symptoms of thyrotoxicosis.

General anesthesia and extensive surgery

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

Bradycardia

Carvedilol can cause a bradycardia. With a decrease in heart rate of less than 55 beats / min, the dose should be reduced.

Hypersensitivity

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

Psoriasis

Patients with anamnestic indications of the emergence or aggravation of psoriasis during the use of beta-blockers, Carvedilol Canon can be prescribed only after a thorough analysis of the possible benefits and risks.

Pheochromocytoma

Patients with pheochromocytoma before starting any beta-blocker should appoint an alpha-blocker. Although carvedilol has both beta and alpha-adrenoblokiruyuschimi properties, the experience of its use in these patients is not, so it should be cautiously prescribed to patients with suspicion of pheochromocytoma.

Angina pectoris

Non-selective beta-blockers can provoke the appearance of pain in patients with Prinzmetal angina. These patients do not experience carvedilol. Although its alpha-adrenergic blocking properties can prevent this symptomatology, it is necessary to prescribe CARVEDILOL CANON in such cases 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 Carvedilol Canon is a long time. It should not be stopped abruptly, it is necessary to gradually reduce the dose of the drug at intervals of 1-2 weeks. This is especially important in patients with ischemic heart disease.

If necessarythe surgical intervention with the use of general anesthesia, it is necessary to warn the anesthesia doctor about the previous therapy with Carvedilol Canon.

During the treatment, alcohol consumption is excluded.

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

Care must be taken when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions, due to the possible development of dizziness.

Form release / dosage:

Tablets 6.25 mg, 12.5 mg and 25 mg.

Packaging:By 7, 10, 20, 28 or 30 tablets in a contour mesh box made of polyvinylchloride film and aluminum foil printed lacquered.

1, 2, 3, 4, 5, 8 contour cell packs of 7 tablets or 1, 2, 3, 4, 5, 6, 7, 8, 10 contour cell packs of 10 tablets, or 1, 2, 3, 4, 5 contour cell packs of 20 tablets, or 1, 2, 3 contour packs of 28 tablets or 1, 2, 3 contour packs of 30 tablets together with the instructions for use are placed 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:

2 years.

Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-001986

Date of registration:29.01.2013

The owner of the registration certificate:CANONFARMA PRODUCTION, CJSC CANONFARMA PRODUCTION, CJSC Russia

Manufacturer: & nbsp

CANONFARMA PRODUCTION, CJSC Russia

Representation: & nbspCANONFARMA PRODUCTION CJSC CANONFARMA PRODUCTION CJSC Russia

Information update date: & nbsp29.01.2013

Illustrated instructions

Instructions

Carvedilol Canon (Carvedilol Canon)