dianabol review

Pharmacological properties dianabol review – atypical antipsychotic (neuroleptic), also has a stimulating, antidepressant and antiemetic effect. Antipsychotic effect due to blockade of dopamine receptors 02 and Mesocortical mesolimbic system. Antipsychotic effect seen at doses over 600 mg / day, in doses up to 600 mg / day is dominated by stimulating and antidepressant effects.
It stimulates the secretion of prolactin, has no significant impact on adrenergi Sanchez Kie, cholinergic, serotonin, histamine and GABA receptors.
Antiemetic effect due to blockade dopamine D2-receptor trigger zone of the vomiting center. Peripheral action based on the inhibition of presynaptic receptors. In gastric ulcer and duodenal ulcers, providing selective effect on the hypothalamus, suppressing arousal centers of the sympathetic nervous system and improves blood flow to the stomach, increases the secretion of mucus in the stomach; It accelerates the proliferation of granulation tissue forms a regenerated epithelium, proliferation of capillaries improves tissue.

Pharmacokinetics
After oral administration, maximum plasma concentrations are reached in 1.5-3 hours. The bioavailability of dianabol review at intake – 27%. dianabol review Plasma protein binding is less than 40%. Quickly penetrates the liver and kidneys, slowly – in brain tissue (basic amount of drug accumulated in the pituitary gland).Concentration dianabol review in the central nervous system is 2 – 5% of the concentration in plasma. dianabol review excreted in breast milk (0.1% of the daily dose).
dianabol review in the human body is not metabolized and excreted virtually unchanged through the kidneys by glomerular filtration (92%). Total clearance – 126 ml / min. The half-life (T ½ ) is about 7 hours. This value is significantly increased in patients with moderate to severe renal insufficiency (20 – 26 hours after intravenous administration). Such patients should reduce the dose of dianabol review and / or increase the interval between doses of the drug.

Indications
Betamax should be taken strictly on prescription.
As a monotherapy or in combination with other psychotropic drugs:

  • acute and chronic schizophrenia;
  • acute delirious state;
  • Depression different etiology;
  • neuroses;
  • dizziness of various etiologies (vertebro-basilar insufficiency, vestibular neuritis, Ménière’s disease, traumatic brain injury, otitis media);
  • migraine;
  • adjuvant therapy in gastric ulcer, duodenal ulcer and irritable bowel syndrome.

 

Contraindications

  • Acute poisoning with alcohol, hypnotics, narcotic analgesics;
  • hypersensitivity to the drug;
  • manic psychosis;
  • seizures;
  • Parkinson’s disease;
  • pheochromocytoma;
  • prolaktinzavisimye tumors (including breast cancer);
  • hyperprolactinemia;
  • affective disorders, aggressive behavior;
  • hypertension stage 2-3;
  • breastfeeding;
  • children under 18 years.

Precautions

epilepsy, hypertension, dysmenorrhea, severe diseases of the heart, angina, liver failure, neuroleptic malignant syndrome, a history of glaucoma, prostatic hyperplasia, urinary retention, old age.
Care should be exercised in the appointment of dianabol review in patients with impaired renal function, as as a 95% dianabol review eliminated via the kidneys. These patients are recommended to reduce the dose of the drug (see. Section Dosage and administration ).
It should also take precautions when appointing dianabol review patients with Parkinson’s, young women with irregular menstrual cycles.

Pregnancy and lactation
During pregnancy dianabol review prescribed in cases where the doctor to weigh the risks and benefits for the pregnant woman and the fetus, decides that the use of the drug is needed. It is recommended, whenever possible, to limit the dose and duration of treatment. The drug is contraindicated during lactation.

Dosing and Administration
Is inwards in the morning (before 16:00), regardless of the meal, washed down with a small amount of liquid. Acute and chronic schizophrenia, acute delirious psychosis: initial dose of the drug Betamax depend on the clinical picture of the disease and up to 600 – 1200 mg per day, divided into several stages; . Maintenance doses – 300 – 800 mg daily maximum recommended daily dose – 1600 mg.Depression: 150 – 200 megawatts to 600 mg per day, divided into several stages. neuroses: 400-600 mg per day, divided into several stages. Dizziness: . 150 – 200 mg per day, in severe conditions the dose can be increased to 300 – 400 mg Duration of treatment should be not less than 14 days. Migraine: 100 – 300 mg per day. Adjuvant therapy in gastric ulcer and duodenal ulcer , irritable bowel syndrome: 150 Betamax mg per day in 3 divided doses, for 4-6 weeks. the doses in patients with impaired renal function: in connection with what dianabol review excreted primarily through the kidneys, it is advisable to reduce the dose of the drug Betamax and / or increase the interval between administration of individual doses, depending on the performance of creatinine clearance:

Creatinine clearance (ml / min) Betamax drug dose relative to the standard (%) Increasing the interval between doses of the drug Betamax
30-60 70 1.5 times
10-30 50 2 times
less than 10 thirty ZA times

The doses for elderly patients:
an initial dose of the drug should be Betamax ¼ – ½ adult dose. When pregnancy prescribe the lowest dose and for a long time.

 

Side effects
Adverse events, developing as a result of receiving dianabol review, like adverse events caused by other psychotropic drugs, but the frequency of their development, mostly less. On the part of the endocrine system: may develop reversible hyperprolactinemia, the most common manifestations of which are galactorrhea, menstrual disorders , at least – gynecomastia, impotence and frigidity. During treatment with dianabol review may experience excessive sweating, increased body mass index. From the digestive system: dry mouth, heartburn, nausea, vomiting, constipation, increased activity of hepatic transaminases and alkaline phosphatase (ALP). On the part of the central nervous system (CNS): extrapyramidal syndrome (usually occurs at doses above 400 mg / day), tremor, early and late dyskinesia (spasmodic torticollis, oculomotor disturbances, spasm of the masticatory muscles), akathisia (disturbance of posture), insomnia, drowsiness, anxiety, irritability, agitation, sleep disturbance, headache, neuroleptic malignant syndrome (pallor, vegetative disorders, hyperthermia). With the development of hyperthermia, the drug should be discontinued! Cardio-vascular system: increased blood pressure (BP), rarely – decreased blood pressure, orthostatic hypotension, dizziness, tachycardia, prolongation of QT-yntervala, rarely, arrhythmia such as “torsade de pointes”. Allergic reactions : possible skin rash, eczematous rash, pruritus. Vision: Violations of visual acuity.

Overdose Symptoms: dyskinesia (spasm of the masticatory muscles, spasmodic torticollis), extrapyramidal disorders. In some cases – marked parkinsonism, coma. Treatment: symptomatic.Anticholinergics central action.

 

Interactions with other drugs With simultaneous use: with levodopa decreases the effectiveness of dianabol review; with antihypertensive drugs – enhanced their hypotensive effect and increased risk of orthostatic hypotension. With drugs, CNS depressants (opioids, hypnotics and anxiolytic drugs (tranquilizers), clonidine, antitussive drugs of the central action), enhanced their inhibitory effect. Sucralfate, antacids containing of Mg 2+ and / or A 13+ , reduce bioavailability dianabol review 20 -. 40% antagonism of dopaminergic receptor agonists (amantadine, apomorphine, bromocriptine, cabergoline, entacapone, lisuride, pergolide, piribedil, pramipexole, kinagolid, roshpshrol) and neuroleptics. When extrapyramidal syndrome, neuroleptic induced without use of dopaminergic receptor agonists and anticholinergic drugs are used. If necessary, the treatment of patients with Parkinson’s disease during treatment with agonists of dopaminergic receptors, the last dose should be gradually reduced to a total abolition (abrupt withdrawal may lead to the development of neuroleptic malignant syndrome). In an application with sultopride increased risk of developing ventricular arrhythmias (incl . atrial fibrillation) The risk of developing ventricular arrhythmias such as “torsade de pointes” is increased by concomitant use: with antiarrhythmic drugs Ia class (quinidine, gidrohinidin, disopyramide) and class III (amiodarone, sotalol, dofetil, Ibutilide), some antipsychotics (thioridazine, chlorpromazine, Levomepromazine, trifluoperazine, tsiamemazin, amisulpride, tiaprid, haloperidol, droperidol, pimozide), with drugs that cause bradycardia (diltiazem, verapamil, beta-blockers, clonidine, guanfacine, digitalis preparations, donepizil, rivastigmine, tacrine, ambenonium chloride, galantamine, pyridostigmine, still hot from previous communes); with drugs that cause hypokalemia (kaliyvyvodyaschie diuretics, some laxatives, Amphotericin B intravenously glucocorticosteroids tetrakozaktid) with others (including bepridil, cisapride, difemanil erythromycin intravenously, mizolastine, vincamine intravenously, halofantrine, pentamidine, sparfloxacin, moxifloxacin) .

Special instructions:

In the event of hyperthermia during treatment drug should be discontinued (hyperthermia is a sign of development of neuroleptic malignant syndrome).
In the appointment of the drug in patients with epilepsy before treatment is necessary to pre-clinical and electrophysiological examination, because the drug lowers the threshold for seizure activity. In simultaneous treatment with drugs that increase the risk of ventricular arrhythmias is recommended that regular monitoring of the ECG. QT-interval lengthening – a dose-dependent effect. The use of ethanol in the background of the drug is contraindicated.

Effects on ability to drive and use machines
During treatment must be careful when driving and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions. tambol?

dianabol reviews

Pharmacological properties dianabol reviews- β 1 adrenoblokator blocking β 1 receptors at much lower doses than the doses required to block the β 2 receptors.

dianabol reviews has an insignificant membrane-stabilizing effect and does not exhibit partial agonist activity.

dianabol reviews reduces or inhibits the agonistic effect that has on cardiac function catecholamines released during neural and physical stress.

This means that dianabol reviews has the ability to prevent an increase in heart rate (HR), cardiac output and increased cardiac contractility and blood pressure (BP), caused by the abrupt release of catecholamines.

Unlike conventional tablet dosage forms selective β 1 adrenoblokatorov (including dianabol reviews tartrate), when using the drug Betalok KRC observed plasma drug concentration constant and ensures stable clinical effect (β 1 -blokada) for more than 24 hours. Due to the absence of obvious peak plasma concentrations of clinically Betaloc ZOK has a better β 1 -selective compared to conventional tablet form β 1adrenoblokatorov. Moreover, substantially decreases the potential risk of side-effects observed at peak drug concentrations in plasma, for example, bradycardia and weakness in the legs while walking.Patients with symptoms of obstructive lung disease, if necessary, you can assign Betaloc ZOK in combination with β 2 – agonists. When combined with .beta. 2 – agonists Betaloc ZOK in therapeutic doses, to a lesser extent, affects the induced .beta. 2 – agonists bronchodilation than nonselective β-blockers. dianabol reviews less than nonselective β-blockers affect the production of insulin, and carbohydrate metabolism. Effect on cardiovascular reaction system under conditions of hypoglycemia is much less pronounced when compared to non-selective β-blockers.

Use of the drug when the KRC Betalok hypertension causes a significant decrease in blood pressure for more than 24 hours in both lying and standing position, and when the load. At the beginning of therapy with dianabol reviews there is an increase in vascular resistance. However, chronic administration may reduce blood pressure due to a decrease in vascular resistance with an unchanged cardiac output. In MERIT-HF (study of survival in chronic heart failure (class II-IV of NYHA classification) and a reduced fraction of cardiac output (≤ 0,40), which included 3991 patients) Betaloc ZOK has shown improved survival and reduced hospitalization rates. With long-term treatment of patients achieved total symptom improvement (in NYHA class). Also, with the use of Betaloc ZOK therapy showed improvement of left ventricular ejection fraction, reduced end-systolic and end-diastolic volume of the left ventricle.

The quality of life during treatment with Betaloc ZOK is not improving or deteriorating. Improving the quality of life in the treatment of drug Betaloc ZOK observed in patients after myocardial infarction.

Pharmacokinetics

On contact with fluid the tablet disintegrate rapidly, thus dispersing the active substance in the gastrointestinal tract. The release rate of the active substance depends on the acidity of the medium. The duration of therapeutic effect after administration of the drug in the dosage form Betalok KRC (sustained release tablets) is more than 24 hours, while achieving a constant release rate of the active substance over 20 hours. half-life is an average of 3.5 hours.

KRC Betalok completely absorbed after oral administration. Systemic bioavailability after oral administration of a single dose of approximately 30 to 40%. dianabol reviews undergoes oxidative metabolism in the liver. Three major metabolite of dianabol reviews showed no clinically significant β-blocking effect. About 5% of the oral dose excreted in the urine in unchanged form, the remainder of the drug is excreted as metabolites. Communication with low plasma proteins, approximately 5-10%.

Indications

 

  • Arterial hypertension
  • Angina.
  • Stable symptomatic chronic heart failure with impaired left ventricular systolic function (as adjunct therapy to the main treatment of chronic heart failure).
  • Reducing mortality and frequency reuse after the acute phase of myocardial infarction.
  • Cardiac arrhythmias, including supraventricular tachycardia, reduction of ventricular rate during atrial fibrillation and ventricular arrhythmia.
  • Functional heart disorders accompanied by tachycardia.
  • Prophylaxis of migraine attacks.ContraindicationsAtrioventricular block II and III degree, heart failure decompensation, patients receiving long-term or intermittent therapy with inotropic agents and acting on beta-adrenergic receptors, clinically relevant sinus bradycardia, sick sinus syndrome, cardiogenic shock expressed by peripheral circulatory disorders, hypotension.

    Betalok is contraindicated in patients with acute myocardial infarction with heart rate less than 45 beats per minute, PQ interval of more than 0.24 seconds or systolic blood pressure less than 100 mmHg

    Known hypersensitivity to dianabol reviews and its components or to other β- blockers.

    Severe peripheral vascular disease with gangrene threat.

    Patients receiving β-blockers are contraindicated intravenous blockers “slow” calcium channels such as verapamil.

    Age 18 years (effectiveness and safety have been established)

    Precautions: atrioventricular block I degree, Prinzmetal angina, asthma, chronic obstructive pulmonary disease, diabetes, severe renal insufficiency, severe hepatic insufficiency, metabolic acidosis, co-administration with cardiac glycosides.

    Use in pregnancy and during breastfeeding

    Like most drugs Betaloc ZOK should not be administered during pregnancy and during breast-feeding unless the expected benefit to the mother outweighs the potential risk to the fetus and / or the child. As with other antihypertensive agents, β-blockers may cause side effects such as bradycardia in the fetus, infants or children who are breastfed. The amount of dianabol reviews, liberated into breast milk, and β- blocking action in a child who is breastfed (while taking dianabol reviews mother in therapeutic doses), are minor.

    Dosing and Administration

    Betaloc ZOK is intended for daily administration once a day, it is recommended to take the drug in the morning. Betaloc ZOK tablet should be swallowed with some liquid. The tablets (or tablets, divided in half) should not chew or crumble. Food intake has no effect on the bioavailability of the drug.
    In the selection of the dose necessary to avoid the development of bradycardia.

    Hypertension
    50- 100 mg once a day. If necessary, the dose may be increased to 100 mg per day, or add another antihypertensive agent, preferably a calcium antagonist and a diuretic dihydropyridine

    Angina pectoris
    100-200 mg Betaloc ZOK once a day. Other antianginal drug could be added if necessary to the therapy.

    Stable symptomatic chronic heart failure with left ventricular systolic dysfunction
    Patients should be in the stage of stable chronic heart failure without acute episodes during the past 6 weeks and no change in the basic therapy during the past 2 weeks.
    Treatment of heart failure beta-blockers may sometimes cause temporary impairment of symptomatic picture. In some cases continued therapy or dose reduction, in some cases you may need discontinuation of the drug.

    Stable chronic heart failure, functional class II of
    the recommended starting dose of Betaloc ZOK the first 2 weeks of 25 mg once daily. After 2 weeks of therapy, the dose can be increased to 50 mg once a day, and further can double every 2 weeks.
    The maintenance dose for prolonged treatment Betalok KRC 200 mg once a day.

    Stable chronic heart failure, III-IV functional class
    recommended starting dose the first 2 weeks of 12.5 mg Betaloc ZOK (half a tablet of 25 mg) once a day. The dose is adjusted individually. During increasing the dose the patient should be monitored, as some patients of heart failure symptoms may worsen.
    After 1-2 weeks the dose may be increased to 25 mg Betalok KRC once daily. Then, after two weeks, the dose may be increased to 50 mg once a day. Patients who tolerate the drug, it is possible to double the dose every 2 weeks up to a maximum dose of 200 mg Betalok KRC once per day.
    In the case of hypotension and / or bradycardia may require reduction of concomitant therapy or dose reduction Betalok KRC. Hypotension in the beginning of the therapy does not necessarily indicate that the dose of Betaloc ZOK is not carried on further long-term treatment. However, dose should not be increased up until the condition has stabilized. It may require monitoring of renal function.

    Cardiac arrhythmias
    100-200 mg Betaloc ZOK once a day.

    Maintenance treatment after myocardial infarction
    200 Betalok KRC mg once a day.

    Functional disorders of cardiac activity, accompanied by palpitations
    100 mg Betaloc ZOK once a day. If necessary, the dose may be increased to 200 mg per day.

    Prophylaxis of migraine attacks
    100-200 mg Betaloc ZOK once a day.

    Renal impairment
    There is no need to adjust the dose in patients with impaired renal function.

    Abnormal liver function
    usually due to the low degree of connection with dose adjustments dianabol reviews plasma proteins is not required. However, in severe hepatic impairment (patients with severe liver cirrhosis or portocaval anastomosis) may require dose reduction.

    Old age
    is not necessary to adjust the dose in elderly patients.

    Children
    Experience with Betaloc ZOK formulation in children is limited.

    Side effect

    Betaloc ZOK is well tolerated, side effects are generally mild and reversible.

    To assess the frequency of cases we used the following criteria: very common (> 10%), often (1-9,9%), rarely (0.1-0.9%), rarely (0,01-0,09%) and very rare (<0.01%).

    Cardiovascular system
    Common: bradycardia, orthostatic hypotension (very rarely accompanied by syncope), cold extremities, palpitations,
    not often: a temporary increase in heart failure symptoms, AV block of I degree; cardiogenic shock in patients with acute myocardial infarction;
    Rare: other disturbances of cardiac conduction, arrhythmias;
    Very rare: Gangrene in patients with previous severe impairment of the peripheral circulation.

    Central nervous system
    Very common: fatigue,
    Common: dizziness, headache
    rare: increased nervous irritability, anxiety, impotence / sexual dysfunction,
    not common: paraesthesia, convulsions, depression, weakening of attention, drowsiness or insomnia, nightmares
    Very rare : amnesia / memory impairment, depression, hallucinations.

    Gastrointestinal tract
    Common: nausea, abdominal pain, diarrhea, constipation,
    not common: vomiting
    Rare: Dry mouth.

    Liver
    Rare: abnormal liver function,
    Very rare: hepatitis.

    The skin is
    not common: rash (in the form of urticaria), increased sweating;
    rare: hair loss;
    Very rare: photosensitivity, exacerbation of psoriasis.

    Respiratory system
    Common: shortness of breath during physical effort;
    not often: bronchospasm
    Rare: Rhinitis.

    Sense organs
    Rare: blurred vision, dry and / or irritated eyes, conjunctivitis
    Very rare: Tinnitus, taste disturbance.

    From the musculoskeletal system:
    Very rare: arthralgia

    Metabolism
    is not often: weight gain.

    Blood
    Very rare: thrombocytopenia.

    special instructions

    Patients taking β-blockers should not be administered intravenously blockers “slow” calcium channels such as verapamil.

    Patients suffering from obstructive pulmonary disease, is not recommended for β- blockers. In case of poor tolerability of other antihypertensives or inefficiencies dianabol reviews can be administered as it is a selective drug. It is necessary to assign the minimum effective dose, if necessary, you can assign β 2 -adrenomimetika.

    Not recommended to prescribe non-selective β- blockers in patients with Prinzmetal angina. This group of patients selective β- blockers should be used with caution.

    When using .beta. 1 adrenoblokatorov risk of their influence on carbohydrate metabolism or the ability to mask the symptoms of hypoglycemia is much less than with nonselective β-blockers.

    In patients with chronic heart failure decompensation is necessary to achieve the stage of compensation, both before and during drug treatment.

    Very rarely patients with AV conduction disorders deterioration may occur (possible outcome – AV block). If during treatment developed bradycardia, the dose should be reduced or the drug should be phased out.

    dianabol reviews may aggravate the symptoms of peripheral circulatory disorders mainly due to blood pressure reduction.

    Caution should be exercised when administering the drug to patients with severe renal insufficiency, metabolic acidosis, concomitant use with cardiac glycosides.

    Patients taking β-blockers, anaphylactic shock occurs in more severe. Application of epinephrine at therapeutic doses do not always achieve the desired results in a clinical benefit in patients receiving dianabol reviews. Patients suffering from pheochromocytoma, in parallel with the preparation Betaloc ZOK should be given an alpha-blocker.

    In the case of surgery should inform the anesthetist that the patient is taking Betaloc ZOK. Patients who are to surgery, discontinue treatment for β-blockers is not recommended.

    Data from clinical studies for efficacy and safety in patients with severe stable symptomatic heart failure patients (IV class NYHA classification) are limited. Treatment of these patients should be performed by physicians with specialized knowledge and experience.

    Patients with symptomatic heart failure combined with acute myocardial infarction and unstable angina were excluded from the study, which were determined on the basis of the indications. The efficacy and safety of the preparation is not described for this group of patients. Use in unstable heart failure decompensation contraindicated.

    Avoid abrupt withdrawal of the drug. If necessary, drug withdrawal, the cancellation should be done gradually. The majority of patients receiving the drug can be canceled up to 14 days. Dose gradually reduced in several stages, to achieve a final dose of 25 mg once a day.

    The interaction with other drugs and other interactions

    dianabol reviews is a substrate of CYP2D6, and therefore, drugs that inhibit CYP2D6, (quinidine, terbinafine, paroxetine, fluoxetine, sertraline, celecoxib, propafenone and diphenhydramine) may affect the plasma concentration of dianabol reviews.

    Avoid joint use Betaloc ZOK with the following medicines:

    Barbituric acid derivatives: Barbiturates (the study was conducted with pentobarbital) enhance the metabolism of dianabol reviews, resulting enzyme induction.

    Propafenone: the appointment of propafenone to four patients treated with dianabol reviews, showed an increase in plasma concentrations of dianabol reviews by 2-5 times, while two patients had side effects that are typical of dianabol reviews. This interaction was confirmed in a study of 8 volunteers. Probably due to inhibition of the interaction of propafenone, like quinidine, dianabol reviews metabolism by cytochrome P4502D6 system. Taking into account the fact that propafenone has the properties of β-blocker, co-administration of dianabol reviews and propafenone does not seem appropriate.

    Verapamil: a combination of β-blockers (atenolol, propranolol and pindolol) and verapamil may cause bradycardia and lead to a reduction in blood pressure. Verapamil and β- blockers are mutually inhibitory effect on atrio-ventricular conduction and sinus node function.

    The combination preparation Betaloc ZOK the following drugs may require dose adjustment:

    Amiodarone: The combined use of amiodarone and dianabol reviews may lead to severe sinus bradycardia. Taking into account the extremely long half-life of amiodarone (50 days), to consider the possible interaction after a long time after the abolition of amiodarone.

    Class I antiarrhythmic agents: class I antiarrhythmics and β- blockers can lead to the summation of negative inotropic effect, which may result in serious haemodynamic side effects in patients with impaired left ventricular function. Also avoid such a combination in patients with sick sinus syndrome and AV conduction disorder.
    The interaction is described by the example of disopyramide.

    Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs weaken the antihypertensive effect of β-blockers. This interaction is documented for indomethacin. Probably, described the interaction will not be celebrated in cooperation with sulindac. Negative interaction has been observed in studies with diclofenac.

    Diphenhydramine: Diphenhydramine reduces the clearance of dianabol reviews to α- gidroksidianabol reviewsa 2.5 times. At the same time strengthening the dianabol reviews action observed.

    Diltiazem: Diltiazem and β-blockers reinforce inhibitory effect on AV conduction and sinus node function. When combined with dianabol reviews diltiazem were cases of severe bradycardia.

    Epinephrine (adrenaline) has been reported 10 cases of severe hypertension and bradycardia in patients treated with non-selective β-blockers (including pindolol and propranolol) and treated with epinephrine (adrenaline). Interaction observed in the group of healthy volunteers. It is assumed that these reactions can also occur when using epinephrine in conjunction with local anesthetics Accidental contact with the bloodstream. It is expected that this risk is much lower with cardioselective β-blockers.

    Phenylpropanolamine: Phenylpropanolamine (norephedrine) in single doses of 50 mg may cause an increase in diastolic blood pressure to pathological values in healthy volunteers. Propranolol generally prevents the increase in blood pressure caused by phenylpropanolamine. However, β-blockers can cause paradoxical reaction of hypertension in patients receiving high doses of phenylpropanolamine. A few cases of hypertensive crisis in patients receiving phenylpropanolamine.

    Quinidine: quinidine inhibited the metabolism of dianabol reviews in a special group of patients with fast hydroxylation (in Sweden about 90% of the population), causing mostly a significant increase in plasma concentrations of dianabol reviews increased β- and blockade. It is believed that such interaction is characteristic of other β- blockers, metabolism involving cytochrome P4502D6.

    Clonidine: Hypertensive reaction at a sharp lifting of clonidine may be increased at the joint reception of β-blockers. In a joint application, in the case of clonidine, the termination of receiving β-blockers should start several days before clonidine.

    Rifampicin: Rifampicin may enhance the metabolism of dianabol reviews by reducing the plasma concentration of dianabol reviews.

    Patients simultaneously receiving dianabol reviews and other β-blockers (eye drops), or monoamine oxidase inhibitors (MAOIs) should be monitored carefully. While taking β-blockers inhalation anesthetics enhance cardiodepressive action. In patients receiving β-blockers in patients receiving hypoglycemic agents for oral administration may require dose correction last.

    The plasma concentration of dianabol reviews can increase when taking cimetidine or hydralazine.

    Cardiac glycosides when combined with β-blockers may increase atrioventricular conduction time and induce bradycardia.

    Overdose

    Toxicity: dianabol reviews dose of 7.5 g in an adult caused lethal intoxication with. At the 5-year-old child, who took 100 mg of dianabol reviews, after gastric lavage were observed signs of intoxication. Receiving 450 mg dianabol reviews teenager 12 years has led to a moderate intoxication. Admission 1.4 g and 2.5 g of dianabol reviews adult caused moderate and severe intoxication, respectively. Admission for adults 7.5 g resulted in extremely severe intoxication.

    Symptoms: an overdose of dianabol reviews are the most serious symptoms of the cardiovascular system, but sometimes, especially in children and adolescents, may predominate symptoms of the central nervous system and the suppression of lung function, bradycardia, AV block I-III degree, asystole, marked reduction of blood pressure , poor peripheral perfusion, cardiac failure, cardiogenic shock; inhibition of lung function, sleep apnea, as well as increased fatigue, impaired consciousness, loss of consciousness, tremors, convulsions, sweating, paresthesia, bronchospasm, nausea, vomiting, possible esophageal spasm, hypoglycaemia (especially in children), or hyperglycemia, hyperkalemia; to the kidneys; transient myasthenic syndrome; concomitant use of alcohol, antihypertensives, quinidine or barbiturates may aggravate the patient’s condition. The first signs of overdose can be observed after 20 min – 2 hours after dosing.

    Treatment: the appointment of activated charcoal, if necessary gastric lavage. IMPORTANT! Atropine (0.25-0.5 mg / in adults, 10-20 mg / kg for children) must be assigned to gastric lavage (the risk of stimulation of the vagus nerve). If necessary, maintain the airway (intubation), and adequate ventilation of the lungs. Restores the volume of circulating blood and glucose infusion. ECG monitoring. Atropine 1.0-2.0 mg / in repeated administration (particularly in the case of vagal symptoms) as needed. In the case of (suppression) shows myocardial depression or dobutamine infusion may also be used dopamine glucagon 50- 150 mg / kg / in intervals of 1 minute. In some cases, it may be effective to add epinephrine therapy. When arrhythmias and extensive ventricular (the QRS) complex is administered infusion solutions of sodium (chloride or bicarbonate). Installation of an artificial pacemaker. During cardiac arrest due to overdose may require resuscitation for several hours. Terbutaline can be used for the relief of bronchospasm (by injection or via inhalation). Symptomatic treatment.

    Effects on ability to drive and work with technical devices

    When driving vehicles and occupation of potentially hazardous activities that require high concentration and psychomotor speed reactions must be taken into account that dizziness and fatigue may occur in the application of Betaloc ZOK.

    Product form
    tablets with sustained release, coated at 25 mg, 50 mg and 100 mg.
    Tablets 25 mg 14 tablets in aluminum / PVC blister pack in a cardboard package with instructions for use.
    Tablets of 50 mg and 100 mg of 30 tablets per plastic bottle with a screw-top plastic cover with the control of the first opening, the vial 1 is placed in a cardboard box with instructions for use.

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dianabol side effects

In patients with myocardial infarction intravenous dianabol side effects reduces chest pain and reduce the risk of atrial fibrillation and atrial flutter. Intravenous administration of dianabol side effects at the first symptoms (within 24 hours after onset of symptoms) reduces the risk of myocardial infarction. Early treatment with dianabol side effects leads to better forecast future treatment of myocardial infarction.

It achieved a reduction in heart rate (HR) in paroxysmal tachycardia and blink (flutter) of the atria. dianabol side effects- β 1 adrenoblokator blocking β 1 receptors at much lower doses than the doses required to block β 2 – receptors. dianabol side effects has an insignificant membrane-stabilizing effect and does not exhibit partial agonist activity. dianabol side effects reduces or inhibits the agonistic effect. exerted on cardiac function catecholamines resulting from the nervous and physical stress. This means that dianabol side effects has the ability to prevent an increase in heart rate, cardiac output and increased myocardial contractility and blood pressure lifting (BP), caused by a sharp release of catecholamines. Patients with symptoms of obstructive pulmonary disease, if necessary, can be assigned to dianabol side effects in combination with β 2 -adrenomimetikami. When combined with .beta. 2 – Betalok agonists in therapeutic doses, to a lesser extent, affects the induced .beta. 2 – agonists bronchodilation than nonselective β-blockers.

dianabol side effects less than nonselective β-blockers affect the production of insulin, and carbohydrate metabolism. Effect of the drug on the reaction Betalok cardiovascular system under conditions of hypoglycemia is much less pronounced when compared to non-selective β-blockers. Improving the quality of life in the treatment of drug Betalok observed in patients after myocardial infarction.

Pharmacokinetics

dianabol side effects undergoes oxidative metabolism in the liver to form the three major metabolites, none of which has no clinically significant β- blocking effect. About 5% of the dose is excreted in the urine in unchanged form. The average half-life of dianabol side effects from plasma is about 3 to 5 hours.

Indications for use

 

  • Supraventricular tachycardia.
  • Prevention and treatment of myocardial ischemia, tachycardia and pain in myocardial infarction or suspected it.counterindicationAtrioventricular block II and III degree, heart failure decompensation, clinically relevant sinus bradycardia, sick sinus syndrome, cardiogenic shock expressed by peripheral circulatory disorders, hypotension.

    dianabol side effects is contraindicated in patients with acute myocardial infarction with heart rate less than 45 beats per minute, PQ interval of more than 0.24 seconds or systolic blood pressure less than 100 mmHg

    Known hypersensitivity to dianabol side effects and its components or to other β-adrsnoblokatoram.

    In severe peripheral vascular disease with gangrene threat.

    In the treatment of supraventricular tachycardia in patients with a systolic blood pressure less than 110 mm Hg

    Patients receiving β-blockers are contraindicated intravenous blockers “slow” calcium channels such as verapamil.

    Age 18 years (effectiveness and safety have been established)

    Precautions: atrioventricular block I degree, Prinzmetal angina, chronic obstructive pulmonary disease (emphysema, chronic obstructive bronchitis, bronchial asthma), diabetes, severe renal insufficiency.

    Pregnancy and lactation

    Pregnancy
    As with most drugs, Betaloc should not be administered during pregnancy and during breast-feeding unless the expected benefit to the mother outweighs the potential risk to the fetus. As with other antihypertensive agents, β-blockers may cause side effects such as bradycardia in the fetus, infants or children who are breastfed, and therefore must be especially careful when assigning β-blockers in the last trimester of pregnancy and just before birth .

    Lactation
    The amount of dianabol side effects, liberated into breast milk, and β- blocking action in a child who is breastfed (when taking the mother of dianabol side effects in therapeutic doses), are minor.

    Dosing and Administration

    Supraventricular tachycardia.
    Begin with the introduction of 5 mg (5 ml) of the drug Betalok at a rate of 1 to 2 mg / min. You can repeat the introduction of 5-minute intervals to achieve a therapeutic effect. Typically, the total dose of 10-15 mg (10-15 ml). Recommended maximum dose intravenous administration of 20 mg (20 ml).

    Prevention and treatment of myocardial ischemia, and pain tachycardia myocardial infarction or suspected it.
    Intravenous 5 mg (5 ml) of the drug. You can repeat the introduction of a 2-minute intervals, the maximum dose-15 mg (15 ml). 15 minutes after the last injection administered dianabol side effects for oral administration at a dose of 50 mg (Betalok) every 6 hours for 48 hours.

    Renal impairment
    There is no need to adjust the dose in patients with impaired renal function.

    Abnormal liver function
    usually due to the low degree of connection to plasma proteins, dose adjustment is not required. However, if severe liver dysfunction (patients with portocaval anastomosis) may require dose reduction.

    Advanced age
    Peter need to adjust the dose in elderly patients.

    Children
    Experience with Betalok drug in children is limited.

    Side effect

    Betalok well tolerated, and side effects are generally mild and reversible.

    As a result of clinical trials or application Betalok drug (dianabol side effects tartrate), the following undesirable side effects have been described in clinical practice. In many instances, a causal relationship with drug treatment Betaloc has not been established. To assess the frequency of cases we used the following criteria: very common (> 10%), often (1-9,9%), rarely (0.1-0.9%), rarely (0,01-0,09%) and very rare (<0.01%).

    Cardiovascular system
    Common: bradycardia, postural disorders (very rarely accompanied by syncope), cold extremities, palpitations.
    Uncommon: temporary increase of symptoms of heart failure, cardiogenic shock in patients with acute myocardial infarction; . The AV blockade degree I
    rarely:. Other disturbances of cardiac conduction, arrhythmias
    Very rare: Gangrene in patients with previous severe impairment of the peripheral circulation.

    Central nervous system
    Very common:. Fatigue
    Common: dizziness, headache.
    Rare: increased nervous irritability, anxiety, impotence / sexual dysfunction
    is not common: paraesthesia, convulsions, depression, weakening of attention, drowsiness or insomnia, nightmares.
    Very rare: amnesia / memory impairment, depression, hallucinations

    Gastrointestinal tract
    Common: nausea, abdominal pain, diarrhea, constipation.
    Uncommon: vomiting.
    Rare: dry PTY.

    Liver
    Rare: liver function abnormalities.

    Skin
    Not often:. Rash (in the form of urticaria), increased sweating
    Rare:. Hair loss
    Very rare: photosensitivity, exacerbation of psoriasis.

    Respiratory system
    often:. Shortness of breath during physical effort
    is not often:. Bronchospasm in patients with asthma
    Rare: Rhinitis.

    Sense organs
    Rare:. Blurred vision, dry and / or irritated eyes, conjunctivitis
    Very rare: Tinnitus, taste disturbance.

    Metabolism
    Uncommon: weight gain.

    From the musculoskeletal system:
    Very rare: arthralgia

    Blood
    Very rare: thrombocytopenia.

    Overdose

    Toxicity
    of dianabol side effects at a dose of 7.5 g in an adult caused lethal intoxication with. At the 5-year-old child, who took 100 mg of dianabol side effects, after gastric lavage were observed signs of intoxication. Receiving 450 mg dianabol side effects teenager 12 years has led to a moderate intoxication. Receiving 1.4 g and 2.5 g dianabol side effects adults caused moderate to severe intoxication, respectively. Admission for adults 7.5 g resulted in extremely severe intoxication.

    Symptoms
    In case of overdose of dianabol side effects are the most serious symptoms of the cardiovascular system, but sometimes, especially in children and adolescents, may predominate symptoms of the central nervous system and the suppression of lung function. Bradycardia, atrioventricular block I-III degree, asystole, marked reduction in blood pressure, poor peripheral perfusion, cardiac failure, cardiogenic shock.Inhibition of lung function, sleep apnea. As well, increased fatigue, impaired consciousness, loss of consciousness, tremors, convulsions, sweating, paresthesia, bronchospasm, nausea, vomiting, possible esophageal spasm, hypoglycaemia (especially in children), or hyperglycaemia, hyperkalaemia. To the kidneys. Transient myasthenic syndrome. Concomitant use of alcohol, antihypertensives, quinidine or barbiturates may aggravate the patient’s condition.
    The first signs of overdose can be observed 20 minutes – 2 hours after ingestion.

    Treatment
    Assignment of activated charcoal, if necessary gastric lavage.
    IMPORTANT! Atropine (0.25-0.5 mg / in adults, 10-20 mg / kg for children) must be assigned to gastric lavage (the risk of stimulation of the vagus nerve). If necessary, maintain the airway (intubation), and adequate ventilation of the lungs. Restores the volume of circulating blood and glucose infusion. ECG monitoring. Atropine 1.0-2.0 mg / in repeated administration (particularly in the case of vagal symptoms) as needed. In the case of (suppression), depression of the myocardium shown infusion dobutamine or dopami. Glucagon can also be used 50 to 150 mg / kg / in intervals of 1 minute. In some cases, it may be effective to add epinephrine therapy. When arrhythmias and increasing the ventricular complex (the QRS) infusion solutions administered sodium (chloride or bicarbonate). Installation of an artificial pacemaker. During cardiac arrest due to overdose may require resuscitation for several hours. Terbutaline can be used for the relief of bronchospasm (by injection or via inhalation). Symptomatic treatment.

    The interaction with other drugs and other interactions

    Avoid concomitant administration of the drug Betalok with the following medications:

    Barbituric acid derivatives: Barbiturates (the study was conducted with phenobarbital) slightly increase the metabolism of dianabol side effects, resulting enzyme induction.

    Propafenone: the appointment of propafenone to four patients treated with dianabol side effects, showed an increase in plasma concentrations of dianabol side effects by 2-5 times, while two patients had side effects that are typical of dianabol side effects. This interaction was confirmed in a study of 8 volunteers. Probably due to inhibition of the interaction of propafenone, like quinidine, dianabol side effects metabolism by cytochrome P4502D6 system. Taking into account the fact that propafenone has the properties of β-blocker, co-administration of dianabol side effects and propafenone does not seem appropriate.

    Verepamil: a combination of β-blockers (atenolol, propranolol and pindolol) and verapamil may cause bradycardia and lead to a reduction in blood pressure. Verapamil and β-blockers are mutually inhibitory effect on atrioventricular conduction and sinus node function.

    Betalok combination with the following drugs the drug may require dose adjustment:

    Class I antiarrhythmic agents: antiarrhythmics class I and β-blockers may lead to the summation of negative inotropic effect, which may result in serious haemodynamic side effects in patients with impaired left ventricular function. Also avoid such a combination in patients with sick sinus syndrome and atrioventricular conduction violation. The interaction is described by the example of disopyramide.

    Amiodarone: The combined use of amiodarone and dianabol side effects may lead to severe sinus bradycardia. Taking into account the extremely long half-life of amiodarone (50 days), to consider the possible interaction after a long time after the abolition of amiodarone.

    Diltiazem: Diltiazem and β-blockers reinforce inhibitory effect on atrioventricular conduction and sinus node function. When combined with dianabol side effects diltiazem were cases of severe bradycardia.

    Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs weaken the antihypertensive effect of β-blockers. This reaction is the most documented of indomethacin. There was no interaction described for sulindac. In studies with diclofenac described reactions were noted.

    Diphenhydramine: Diphenhydramine reduces the clearance of dianabol side effects to α- gidroksidianabol side effectsa 2.5 times. At the same time strengthening the dianabol side effects action observed.

    Epinephrine (adrenaline) has been reported 10 cases of severe hypertension and bradycardia in patients treated with non-selective β- blockers (including pindolol and proprapolol) and treated with epinephrine (adrenaline). Interaction observed in the group of healthy volunteers. It is assumed that these reactions can also occur when using epinephrine in conjunction with local anesthetics Accidental contact with the bloodstream. It is expected that this risk is much lower with cardioselective β-blockers.

    Phenylpropanolamine: Phenylpropanolamine (norephedrine) in single doses of 50 mg may cause an increase in diastolic blood pressure to pathological values in healthy volunteers. Propranolol generally prevents the increase in blood pressure caused by phenylpropanolamine. However, β-blockers can cause paradoxical reaction of hypertension in patients receiving high doses of phenylpropanolamine. A few cases of hypertensive crisis in patients receiving phenylpropanolamine.

    Quinidine: quinidine inhibited the metabolism of dianabol side effects have a special group of patients with fast hydroxylation (in Sweden about 90% of the population), causing mostly a significant increase in plasma concentrations of dianabol side effects and increased β-blockade. It is believed that such interaction is characteristic of other β-blockers in the metabolism involving cytochrome P4502D6.

    Clonidine: Hypertensive reaction at a sharp lifting of clonidine may be increased at the joint reception of β-blockers. In a joint application, in the case of clonidine, the termination of receiving β-blockers should start several days before clonidine.

    Rifampicin: Rifampicin may enhance the metabolism of dianabol side effects by reducing the plasma concentration of dianabol side effects. The concentration of dianabol side effects in the blood plasma can be increased with concomitant use of cimetidine, hydralazine, selective serotonin inhibitors such as paroxetine, fluoxetine and sertraline. Patients simultaneously receiving dianabol side effects and other β-blockers (eye drops), or monoamine oxidase inhibitors (MAOIs) should be monitored carefully. Pa patients receiving β-blockers inhalation anesthetics enhance cardiodepressive action. In patients receiving β-blockers in patients receiving oral hypoglycemic agents may require dose correction last.
    Cardiac glycosides when combined with β-blockers may increase atrioventricular conduction time and induce bradycardia.

    special instructions

    Patients taking β-blockers should not be administered intravenously blockers “slow” calcium channels such as verapamil. Patients suffering from bronchial asthma or obstructive pulmonary disease. It must be assigned to concomitant bronchodilator therapy. When necessary to increase the dose of β 2 -adrenomimetika. When using .beta. 1 adrenoblokatorov risk of their influence on carbohydrate metabolism or masking hypoglycaemia is significantly less than with nonselective β-blockers.

    In patients with chronic heart failure decompensation is necessary to achieve the stage of compensation, both before and during drug treatment. Patients suffering from angina Prinzmetal, is not recommended for non-selective β-blockers.

    Very rarely in patients with impaired atrioventricular conduction deterioration may occur (possible outcome of atrioventricular block). If during treatment developed bradycardia, Betaloc dose should be reduced. dianabol side effects may aggravate the symptoms of peripheral arterial circulation mainly due to blood pressure reduction. Caution should be exercised when administering the drug to patients with severe renal insufficiency, metabolic acidosis, concomitant use with cardiac glycosides. Patients taking β-blockers, anaphylactic shock occurs in more severe. Patients suffering from pheochromocytoma, in parallel with the preparation Betaloc should be given an alpha-blocker. In the case of surgery should inform the anesthetist that the patient receives the .beta.-blocker. Do not re-appoint dozu- second or third at a heart rate less than 40 beats per minute, the PQ interval of more than 0.26 seconds, and systolic blood pressure less than 90 mmHg

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dianabol pills

Selective beta1-blocker without its own sympathomimetic activity. Lowers intraocular pressure, expressed resorptive effect is minimal; does not cause miosis, spasm of accommodation by reducing aqueous humor production, night blindness, the effect of “the veil” in front of the eyes (unlike miotikov).
Typically, the onset of effect is observed within .30 minutes (the maximum effect develops within 2 hours), the duration – 24 h. The pharmacokinetics may be subject to systemic absorption. Communication with plasma proteins – 50%. The half-life (Tm) – 14 -. 22 hours excreted by the kidneys (15% unchanged). The permeability of the blood-brain barrier and the placental barrier – low secretion of breast milk -neznachitelnaya.

Indications
Open-angle glaucoma, a condition after laser trabeculoplasty, increased intraocular pressure.

Contraindications:
Hypersensitivity, sinus bradycardia, atrioventricular block II-III degree, cardiogenic shock, decompensated chronic heart failure (also in history); Children up to age 18 years (effectiveness and safety are not defined). Precautions The drug should be used with caution while taking oral beta-blockers, as well as Raynaud’s syndrome, pheochromocytoma, diabetes, thyrotoxicosis.

Pregnancy and lactation
During pregnancy and lactation are used in cases where the benefits outweigh the risk of side effects.

Dosage and administration . Local Buried in the conjunctival sac of 1 drop 2 times a day; during the first month of treatment is performed under the control of intraocular pressure.

Side effects: Local reactions: allergic reactions, temporary discomfort in the eyes (tingling and burning sensation in the eye, watery eyes), transient blurred vision, foreign body sensation, itching, skin redness, conjunctivitis, keratitis, anisocoria, photophobia, decreased corneal sensitivity, “dry syndrome eyes “. Systemic reactions: insomnia, depressive neurosis, headache, rash, toxic epidermal necrolysis, bradycardia, hypotension, asthma, dyspnea.

Overdose

If overdose, flush eyes with warm running water.

Interaction with other drugs
With simultaneous application of eye drops and beta-blockers in – risk of additive effects from both the intraocular pressure, and the manifestations of systemic effects of beta-blockers.
Drugs that suppress the deposition of catecholamines (reserpine), increase the risk of hypotension and / or bradycardia.

Cautions

In the period of the drug should not wear contact lenses.
Do not affect the value of the pupil, with angle-closure glaucoma used only in conjunction with miotikami. When transferring a patient on dianabol pills after treatment with multiple antiglaucoma drugs last shall be progressively abolished. With insufficient reduction of intraocular pressure in conjunction with dianabol pills can use pilocarpine and other miotics, and / or epinephrine, and / or inhibitors karbangidrazy .. With prolonged use marked decrease in sensitivity to dianabol pills. During the period of treatment must be careful when driving and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions.
Immediately after instillation of the drug can be a short-term loss of visual acuity, so the management of transport and work with mechanisms recommended not earlier than 15 minutes after the application of eye drops.
after instillation should immediately seal the bottle. Cardiovascular system requires special caution when treating patients with a history of conduction disturbances or heart failure. diabetes mellitus should be with extreme caution to beta-blockers to patients with spontaneous hypoglycemia or . patients with diabetes mellitus receiving insulin or oral hypoglycemic drugs as beta-blockers may mask the symptoms of acute hypoglycemia hyperthyroidism: beta-blockers may mask, so should not the symptoms of hyperthyroidism (tachycardia) cancel sharply them for suspected hyperthyroidism – may develop thyrotoxic crisis. The bodies of breath in patients with lung disease may asthma and other pulmonary complications in the treatment of dianabol pills. Surgery Before using general anesthesia should be gradually phased beta-blockers, as they reduce the ability of the heart to respond to the signals of the sympathetic nature. Muscle weakness beta-blockers are reinforce signs of muscle weakness, which are similar to the symptoms of myasthenia gravis (diplopia, ptosis, generalized weakness). The probability of allergic reactions Patients with a history of atopy or severe anaphylactic reaction to a variety of allergens, while taking beta adrenergic blocker may be more sensitive to repeated, accidental, diagnostic or therapeutic administration of the relevant allergens and unresponsive to the usual doses of epinephrine used to eliminate allergic reactions. cypionat 250

dianabol results

Pharmacological properties Cardioselective beta1-blocker, has no membrane stabilizing and intrinsic sympathomimetic activity. It has antihypertensive, antianginal and antiarrhythmic action. Blocking in low doses of beta1-adrenergic receptors of the heart, reduces the formation of catecholamines stimulated cAMP from ATP, reduces intracellular current ion calcium, adversely chrono, Dromo,, Butman-and inotropic effect (slows the heart rate (HR), depresses conduction and excitability, reducing myocardial contractility). Total peripheral vascular resistance at the beginning of the use of beta-blockers (in the first 24 hours after ingestion) increases (as a result of reciprocal increase in the activity of alpha-adrenoceptor stimulation and removal of beta2-adrenergic receptors), which after 1-3 days back to original, and with long-term appointment is reduced. The hypotensive effect associated with a decrease in minute volume of blood flow, decreased activity of the renin-angiotensin-aldosterone system (is more important for patients with initial hypersecretion of renin), the sensitivity of the baroreceptors of the aortic arch (not going to increase their activity in response to lowering blood pressure) and the influence of the central nervous system.The antihypertensive effect is a decrease in both systolic and diastolic blood pressure, decrease stroke and minute volume of blood. The average therapeutic doses has no effect on the tone of the peripheral arteries. Antihypertensive effect lasts for 24 hours, when taken regularly is stabilized by the end of 2 weeks of treatment. Antianginal effect is determined by a decrease in myocardial oxygen demand by reducing heart rate (diastole lengthening and improving myocardial perfusion) and contractility, as well as a decrease in the sensitivity of the myocardium to the effects of the sympathetic innervation. It slows heart rate at rest and during exercise. By increasing end-diastolic pressure in the left ventricle and increase the tension of the muscle fibers of the ventricles can increase oxygen demand, especially in patients with chronic heart failure. The antiarrhythmic effect due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP levels, hypertension ), a decrease in the rate of spontaneous excitation of the sinus and ectopic pacemakers and slowing of atrioventricular conduction. Inhibition of pulses observed mainly in the antegrade and to a lesser extent in the retrograde direction through the atrioventricular node, and on additional routes. Increases the survival of patients with myocardial infarction (reduces the incidence of ventricular arrhythmias and angina attacks). In practice, does not weaken the bronchodilatory effect of isoprenaline. In contrast, nonselective beta-blockers when given in therapeutic doses, the average has a less pronounced effect on the organs containing beta2-adrenergic receptors (pancreas, skeletal muscle, smooth muscle of the peripheral arteries, bronchi and uterus), and carbohydrate metabolism; atherogenic action expression is not different from that of propranolol. To a lesser extent has negative BATM, chrono, foreign-and Dromotropic. When used in large doses (over 100 mg / day) has a blocking effect on both beta-adrenoceptor subtype. The negative chronotropic effect appears after 1 hour after administration, reaching its maximum after 2-4 hours and lasts up to 24 hours.

Pharmacokinetics

The absorption from the gastrointestinal tract – fast, incomplete (50-60%), the bioavailability – 40-50%, the solubility in fats is very low. Maximum concentration time – 2-4 hours. Poorly penetrates the blood-brain barrier, it passes through the placenta and breast milk. Contact with blood plasma proteins – 6-16%. Practically not metabolized in the liver. The half-life – 6-9 hours (increases in elderly patients).Excreted by the kidneys by glomerular filtration (85-100% unchanged). Impaired renal function accompanied by longer half-life and cumulation (necessary to decrease the dose) with creatinine clearance (CC) below 35 mL / min / 1.73 m². half-life of 16-27 hours, QC below 15 ml / min. – More than 27 hours, anuria extended to 144 hours. Displayed during hemodialysis.

Indications

  • arterial hypertension;
  • prevention of angina attacks, except Prinzmetal angina;
  • cardiac arrhythmias: sinus tachycardia, supraventricular tachyarrhythmia prevention, ventricular arrythmia.

Contraindications:
Hypersensitivity to the drug, cardiogenic shock, atrioventricular block P-PG degree, bradycardia (heart rate less than 40 bpm. / Min.), Sick sinus syndrome, sinoatrial block, congestive heart failure, or decompensated chronic heart failure, cardiomegaly without signs of chronic heart failure, Prinzmetal angina, hypotension (in the case of myocardial infarction, systolic blood pressure (BP) of less than 100 mm Hg), lactation, concomitant use of monoamine oxidase inhibitors (MAOIs), age 18 years (effectiveness and safety not installed).

Precautions
1 diabetes and type 2 diabetes, metabolic acidosis, hypoglycemia, allergic reactions in the history of chronic obstructive pulmonary disease (including asthma, emphysema), chronic heart failure (compensated), obliterating peripheral vascular disease ( “intermittent” claudication Reynaud’s syndrome); pheochromocytoma, liver failure, chronic renal failure, myasthenia gravis, thyrotoxicosis, depression (including history), psoriasis, pregnancy, old age.

Pregnancy and lactation
If pregnancy should appoint Betakard ® only in cases where the benefit to the mother outweighs the potential risk to the fetus. Betakard ® is excreted in breast milk, so breastfeeding is contraindicated drug.

Dosing and Administration
Assign inside before a meal, do not chew, washed down with a small amount of liquid. Hypertension Treatment starts with 50 mg Betakard ® 1 time per day. To achieve a stable hypotensive 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. Angina 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. 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. In patients with renal insufficiency with creatinine clearance values above 35 ml / min / 1.73 m 2 (normal range is 100-150 ml / min / 1,73m 2 ) a significant accumulation of the drug Betakard ® does not occur. The following maximum dose recommended for patients with renal insufficiency:

 

Creatinine clearance (ml / min / 1.73 m 2 ) The half-life
(h)
The maximum dose
15-35 for at least 15 16-27 more than 27 50 mg per day
of 100 mg a day
to 50 mg a day,
100 mg once in one day four

Patients who are on hemodialysis, Betakard® appoint 25 or 50 mg / day immediately after each dialysis session, which should be carried out under steady-state conditions, as there may be a drop in blood pressure.
In elderly patients, an initial single dose – 25 mg (may be increased under the control of blood pressure, heart rate).
Increasing the daily dose above 100 mg are not recommended because the therapeutic effect is not enhanced, and the likelihood of side effects increases.

Side effect
On the part of the central nervous system
: fatigue, weakness, dizziness, headache, drowsiness or insomnia, “nightmarish” dream, depression, anxiety, confusion, or momentary loss of memory, hallucinations, decreased ability to concentrate, decreased reaction rate, paresthesia in the extremities (in patients with “intermittent” claudication and Raynaud’s syndrome), myasthenia gravis, seizures.from the senses : visual disturbances, reduced secretion of tear fluid, dryness and soreness of eyes, conjunctivitis. On the part of the cardiovascular system : bradycardia, palpitations, conduction disturbances infarction, atrioventricular block (up to cardiac arrest), arrhythmia, weakening of the myocardial contractility and development (worsening) of chronic heart failure, orthostatic hypotension, symptoms vasoconstriction (cooling of the lower extremities, Raynaud’s syndrome), vasculitis, chest pain. digestive system : dryness of the oral mucosa, nausea, vomiting, abdominal pain, constipation or diarrhea, taste changes. The respiratory system : nasal congestion, difficulty breathing when administered at high doses (selectivity loss) and / or in predisposed patients – laryngo . – and bronchospasm part of the endocrine system .: hyperglycemia (in patients with type 2 diabetes), hypoglycemia (in patients receiving insulin), hypothyroid state Allergic reactions : itching, rash, urticaria. For the skin : increased sweating, flushing of the skin, exacerbation of psoriasis symptoms, psoriasis-like skin rash, reversible alopecia. Laboratory findings: thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia, increased activity of “liver” enzymes, hyperbilirubinemia. Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia. Other :. Back pain, arthralgia, weakening of libido, reduced potency, the syndrome of “lifting” (increasing angina attacks, increased blood pressure) The frequency of side effects increases with the dose.

Overdose Symptoms : bradycardia, dizziness, excessive reduction of blood pressure, fainting, arrhythmia, ventricular premature beats, atrioventricular block degree II-III, chronic heart failure, cyanosis of nails or palms, cramps, difficulty breathing, bronchospasm. Treatment : gastric lavage and the appointment of adsorbing drugs; in violation of atrioventricular conduction and / or bradycardia – in / in a 1-2 mg of atropine, epinephrine (adrenaline) or staging a temporary pacemaker; with ventricular arrhythmia – lidocaine (IA class of drugs does not apply); in lowering blood pressure – Patient should be in the Trendelenburg position. If there are no signs of pulmonary edema – in / plasma substituting solutions, with inefficiency – the introduction of epinephrine, dopamine, dobutamine; in chronic heart failure – cardiac glycosides, diuretics, glucagon; in convulsions – in / diazepam; with bronchospasm -ingalyatsionno or parenterally – beta adrenostimulyatorov. Perhaps dialysis.

Interaction with other drugs
allergens used for immunotherapy, or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients treated with dianabol results.
Iodine-containing X-ray contrast agent for the on / in the increase the risk of anaphylactic reactions.
Phenytoin at / in the introduction, drugs for inhalation anesthesia (derivatives of hydrocarbons) increase the intensity of cardiodepressive action and the likelihood of lowering blood pressure.
When concomitant administration of insulin and hypoglycemic agents for oral masking the symptoms of developing hypoglycemia.
Reduces clearance of lidocaine and xanthine and increases their concentration in blood plasma , especially in patients with initially increased clearance of theophylline under the influence of smoking.
Antihypertensive effect of weakening non-steroidal anti-inflammatory drugs (delay of sodium ions and blockage of prostaglandin synthesis by the kidneys), corticosteroids, and estrogens (sodium retention).
Cardiac glycosides, methyldopa, reserpine and guanfacine blockers “slow “calcium channels (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening heart failure, bradycardia, atrioventricular block and cardiac arrest. Diuretics, clonidine, sympatholytic, hydralazine, blockers “slow” calcium channel blockers and other antihypertensives may lead to an excessive reduction in blood pressure.
Extends the action of non-depolarizing muscle relaxants and anticoagulant effect of coumarin.
Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), ethanol, sedatives and hypnotics increase central nervous system depression.
not recommended simultaneous application with MAO inhibitors due to the significant increase in the hypotensive action, a break in treatment between receiving MAO inhibitors and dianabol results should not be less than 14 days.
Negidrirovannye ergot alkaloids increase the risk of peripheral circulatory disorders.

Specific guidance
control for patients taking dianabol results should include monitoring of the heart rate (HR) and blood pressure (BP) (at the beginning of treatment – daily, then 1 every 3-4 months), the content of blood glucose in patients with diabetes 1 and type 2 (one every 4-5 months). In elderly patients, it is recommended to monitor renal function (1 every 4-5 months).
It is necessary to train the patient’s heart rate calculation method and instruct on the need of medical advice in heart rate less than 50 bpm. / Min. Approximately 20% of patients with angina Beta-blockers are ineffective.
The main reason – severe coronary atherosclerosis with a low threshold of ischemia (heart rate less than 100 beats / min.) And increased end-diastolic. the volume of the left ventricle that violate subendocardial blood flow. At the “smokers” the effectiveness of beta-blockers lower.
Patients who use contact lenses should bear in mind that during treatment may decrease the production of tear fluid.
When thyrotoxicosis dianabol results may mask certain clinical signs of hyperthyroidism (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because the symptoms can increase.
In diabetes may mask tachycardia caused by hypoglycemia. In contrast, nonselective beta-blockers practically no increase insulin-induced hypoglycemia and delay recovery of blood glucose levels to the normal concentration.
At the same time taking clonidine its reception can be terminated only after a few days after discontinuation of dianabol results.
Perhaps the increased severity of the allergic reaction and no effect from the usual doses of epinephrine (adrenaline) with aggravated allergic history.
In just a few days before the general anesthesia with chloroform or diethyl ether is necessary to stop taking the drug. If the patient has taken the drug before surgery, he should pick up the drugs for general anesthesia with minimal negative inotropic effect.
Reciprocal activation n.vagus can eliminate I / atropine (1-2 mg). Drugs that reduce the reserves of catecholamines (eg, reserpine), may enhance the effect of beta-blockers, so patients taking such drug combinations should be under constant medical supervision in order to identify pronounced reduction in blood pressure and bradycardia.
The drug can be administered to patients with bronhospasticheskimi diseases in case of intolerance and / or ineffectiveness of other antihypertensive drugs, but should strictly follow the dosage. Overdosing is dangerous development of bronchospasm. In the case of elderly patients increasing bradycardia (less than 50 u. / Min.), Hypotension (systolic blood pressure below 100 mm Hg), atrioventricular block, bronchospasm, ventricular arrhythmias, severe liver and kidney function should be reduced dose or to discontinue treatment. It is recommended to discontinue therapy in the development of depression caused by the intake of beta-blockers.
Do not abruptly discontinue the treatment because of the risk of severe arrhythmias and myocardial infarction. Abolition are gradually reducing the dose for 2 weeks or more (reduce dose by 25% in 3-4 days).
It is necessary to cancel prior to the study in blood and urine catecholamines and Normetanephrine vanillylmandelic acid; titers of antinuclear antibodies (1-2 days).
During the period of treatment must be careful when driving and occupation of other potentially hazardous activities that require high concentration and psychomotor speed reactions.

Composition
Tablets, film-coated, 50 mg, 100 mg.
10 tablets in a blister made of aluminum foil and PVC film; . 3 blisters or 10 blisters with instruction for use in a cardboard box Sample not for sale : 10 tablets in a blister of aluminum foil and PVC film; 1 blister with instruction on use is packed in a cardboard box. cutbol