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.
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%.
- Arterial hypertension
- 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.
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
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.
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.
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.
is not necessary to adjust the dose in elderly patients.
Experience with Betaloc ZOK formulation in children is limited.
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%).
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.
Common: nausea, abdominal pain, diarrhea, constipation,
not common: vomiting
Rare: Dry mouth.
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.
Common: shortness of breath during physical effort;
not often: bronchospasm
Rare: blurred vision, dry and / or irritated eyes, conjunctivitis
Very rare: Tinnitus, taste disturbance.
From the musculoskeletal system:
Very rare: arthralgia
is not often: weight gain.
Very rare: thrombocytopenia.
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.
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.
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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