Has antianginal, antihypertensive and antiarrhythmic action. Decreases automaticity of sinus node, it slows the heart rate slows AV conduction, reduces myocardial contractility, reduces myocardial oxygen demand. It reduces the excitability of the myocardium. When used in medium therapeutic doses has a less pronounced effect on the smooth muscles of the bronchi and peripheral arteries than non-selective beta-blockers.
Pharmacokinetics. buy primobolan rapidly absorbed, although not completely (50%) from the gastrointestinal tract. Maximum blood concentration of the drug attained within 2-3 hours after ingestion. buy primobolan slightly bound to plasma proteins. The half-life – 6-7 hours. buy primobolan is almost completely eliminated from the body in an unmodified (unmetabolized) in the urine (85-100%). Very poorly crosses the blood-brain barrier. It penetrates through the placental barrier and is excreted in breast milk.
- arterial hypertension;
- prevention of angina attacks: except Prinzmetal angina;
- cardiac arrhythmias: sinus tachycardia, supraventricular tachyarrhythmia prevention;
- cardiopsychoneurosis on hypertonic type;ContraindicationsAtrioventricular block II and III degree, sick sinus syndrome, cardiogenic shock, acute heart failure, bradycardia, hypotension myocardial (systolic blood pressure below 100 mm Hg..), Chronic heart failure II B – III stage, sinus block, metabolic acidosis, asthma, hypersensitivity to the drug, a combination sinopril with MAO inhibitors. Atenolan not indicated for children under 18 years.special instructionsIn patients with coronary heart disease (CHD) abrupt withdrawal of beta-blockers can cause an increase in the frequency or severity of anginal attacks, so the discontinuation of buy primobolan in patients with coronary artery disease should be carried out gradually.Special attention also requires the selection of doses in patients with cardiac decompensation. Compared with the non-selective beta-blockers, beta-blockers cardioselective have less impact on lung function, however, in obstructive airways diseases Atenolan should be used only in case of absolute indications. If necessary, their purpose in some cases it is possible to recommend the use of beta2-agonists.Atenolan mask tachycardia occurring with hypoglycemia, and can prolong the hypoglycaemic response to insulin. Care should be taken while the application Atenolana and hypoglycemic agents in patients with diabetes.
Particular attention is needed in cases where the required surgery under general anesthesia in patients taking Atenolan. The drug should be discontinued 48 hours prior to surgery. As an anesthetic drug should be chosen with the minimum possible negative inotropic effect.
Caution should be prescribed to patients with psoriasis, pheochromocytoma, hyperthyroidism and myasthenia gravis, Raynaud’s disease, and a variety of obliterating diseases of the peripheral arteries, in patients with severe renal excretory function.
With simultaneous use of clonidine and Atenolana, reception Atenolana stop for a few days before clonidine to avoid withdrawal symptoms last.
If necessary, the intravenous administration of verapamil, this should be done after at least 48 hours after administration Atenolana.
When using Atenolana may decrease the production of tear fluid, which is important for patients using contact lenses.
Pregnancy and lactation
Pregnant women should be given Atenolan only in cases where the benefit to the mother outweighs the potential risk to the fetus.
buy primobolan is excreted in breast milk, so the feeding period it should be taken only in exceptional cases with great care.
Effects on ability to drive and operate machinery
Atenolan should be used with caution to drivers of vehicles and persons working with machinery, due to a possible decrease in attention.
Interaction with other drugs
In an application Atenolana with insulin antidiabetic agents – their hypoglycemic effect is enhanced.
In a joint application with antihypertensive agents or nitrates of various groups there is a strengthening of the hypotensive action. The simultaneous use of verapamil and Atenolana (or diltiazem) may cause mutual reinforcement cardiodepressive action.
With simultaneous application of cardiac glycosides Atenolana and increases the risk of bradycardia and atrioventricular conduction disturbances.
When concomitant administration Atenolana with reserpine, methyldopa, clonidine, verapamil may cause bradycardia.
At simultaneous reception Atenolana with ergotamine derivatives, xanthine nonsteroidal anti-inflammatory drugs reduces its effectiveness.
Upon termination of the combined application Atenolana clonidine and clonidine treatment is continued for several days after the cancellation Atenolana.
Concomitant use with lidocaine may reduce its excretion and increase the risk of toxic effect of lidocaine.
Use in conjunction with phenothiazine derivatives, increases the concentration of each drug in the serum.
In a joint application with aminophylline and theophylline may cancel each therapeutic effects.
Not recommended simultaneous application with MAO inhibitors.
Dosing and Administration
Assign inside before a meal, do not chew, washed down with a small amount of liquid. The mode set individually.
Treatment starts 50 Atenolana 1 mg once a day. To achieve a stable 7gipotenzivnogo effect requires 1-2 weeks of reception. With insufficient expression hypotensive effect dose was increased to 100 mg at one time. Further increase of the dose is not recommended, since it is not accompanied by increased clinical benefit.
The initial dose is 50 mg per day. If during the week is not an optimal therapeutic effect, increasing the dose to 100 mg per day for 1 or 2 divided doses.
Elderly patients and patients with impaired renal excretory function requires correction dosing regime.
In the presence of renal failure recommended dose correction according to the creatinine clearance. When creatinine clearance values above 35 ml / min / 1.73 m 2 (normal range is 100-150 ml / min / 1,73m2 ) Atenolana significant accumulation does not occur.
The recommended maximum dose for patients with renal insufficiency:
Creatinine clearance (ml / min / 1.73 m 2 ) The half-life time (h) The maximum dose 15-35 16-27 50mg daily less than 15 more than 27 50 mg every other day
Patients who are on hemodialysis, Atenolan appoint 50 mg / day immediately after each dialysis that should be carried out under steady-state conditions, as there may be a drop in blood pressure.
For secondary prevention of myocardial infarction – 100 mg 1 time per day, or 50 mg 2 times a day for 6-9 days or until discharge from the hospital.
In functional disorders of the cardiovascular system it is recommended Atenolan at a dose of 25 mg per day.
The most common side effects associated with the primary pharmacological action of the drug, and expressed as follows:
- cardiovascular system : the emergence of symptoms of heart failure, violation of atrioventricular conduction, bradycardia, hypotension, cold sensation and paresthesia in the extremities;
- central nervous system : dizziness, insomnia, decreased ability to concentrate, drowsiness, depression, hallucinations, lethargy, fatigue, headache;
- gastrointestinal tract : dry mouth, nausea, vomiting, diarrhea, abdominal pain, constipation;
- respiratory system : dyspnea, bronchospasm, apnea;
- hematologic response : platelet purpura, anemia (aplastic), thrombosis;
- Endocrine System : gynecomastia, reduced potency, libido;
- metabolic reactions : hyperlipidemia, hypoglycemia;– Skin reactions : rash, dermatitis, pruritus, photosensitivity.OverdoseSymptoms: bradycardia, atrioventricular block II and III degree, the growing symptoms of heart failure, hypotension, bronchospasm, hypoglycaemia.When overdose symptoms seek medical advice immediately.Treatment: In severe bradycardia shown intravenous administration of 1 ml of 0, 1% solution of atropine sulfate. When AV blockade II and III extent possible appointment of isoprenaline in tablets of 5 mg under the tongue (if necessary – re-admission after 2-4 hours) or intravenous drip or slow bolus of the drug at a dose of 0.5-1 mg. In the event of bronchospasm shown beta2-agonists.
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