шок (в т.ч. кардиогенный); - коллапс; - отек легких; - острая сердечная недостаточность; - хроническая сердечная недостаточность в стадии декомпенсации; - AV-блокада II и III степени; - синоатриальная блокада; - СССУ; - выраженная брадикардия; - стенокардия Принцметала; - кардиомегалия (без признаков сердечной недостаточности); - артериальная гипотензия (систолическое АД менее 100 мм рт.ст., особенно при инфаркте миокарда); - тяжелые формы бронхиальной астмы и ХОБЛ в анамнезе; - одновременный прием ингибиторов МАО (за исключением МАО типа В); - поздние стадии нарушения периферического кровообращения; - болезнь Рейно; - феохромоцитома (без одновременного применения альфа-адреноблокаторов); - метаболический ацидоз; - возраст до 18 лет (эффективность и безопасность не установлены); - повышенная чувствительность к компонентам препарата; - повышенная чувствительность к другим бета-адреноблокаторам. С осторожностью следует применять препарат при печеночной недостаточности, при хронической почечной недостаточности, миастении, тиреотоксикозе, сахарном диабете, AV-блокаде I степени, при депрессии (в т.ч. в анамнезе), псориазе, аллергических реакциях (в анамнезе), у пациентов пожилого возраста.
шок (в т.ч. кардиогенный); - коллапс; - отек легких; - острая сердечная недостаточность; - хроническая сердечная недостаточность в стадии декомпенсации; - AV-блокада II и III степени; - синоатриальная блокада; - СССУ; - выраженная брадикардия; - стенокардия Принцметала; - кардиомегалия (без признаков сердечной недостаточности); - артериальная гипотензия (систолическое АД менее 100 мм рт.ст., особенно при инфаркте миокарда); - тяжелые формы бронхиальной астмы и ХОБЛ в анамнезе; - одновременный прием ингибиторов МАО (за исключением МАО типа В); - поздние стадии нарушения периферического кровообращения; - болезнь Рейно; - феохромоцитома (без одновременного применения альфа-адреноблокаторов); - метаболический ацидоз; - возраст до 18 лет (эффективность и безопасность не установлены); - повышенная чувствительность к компонентам препарата; - повышенная чувствительность к другим бета-адреноблокаторам. С осторожностью следует применять препарат при печеночной недостаточности, при хронической почечной недостаточности, миастении, тиреотоксикозе, сахарном диабете, AV-блокаде I степени, при депрессии (в т.ч. в анамнезе), псориазе, аллергических реакциях (в анамнезе), у пациентов пожилого возраста.
Применение при беременности и в период грудного вскармливания
Применение при беременности и в период лактации возможно в том случае, когда ожидаемая польза терапии для матери превышает риск развития побочных эффектов у плода или грудного ребенка. Следует иметь в виду, что препарат способен вызывать внутриутробную задержку плода, гипогликемию, брадикардию. Данных о выделении бисопролола с грудным молоком нет. Поэтому при необходимости применения препарата в период лактации грудное вскармливание следует прекратить.
Способ применения и дозы
Препарат принимают внутрь, утром натощак, не разжевывая, однократно. Артериальная гипертензия и ИБС: профилактика приступов стенокардии напряженияРекомендуемая доза составляет 5 мг 1 раз/сут. При необходимости дозу увеличивают до 10 мг 1 раз/сут. Максимальная суточная доза - 20 мг. У пациентов с нарушением функции почек при КК менее 20 мл/мин, или с выраженными нарушениями функции печени максимальная суточная доза - 10 мг. Коррекции дозы у пациентов пожилого возраста не требуется. Хроническая сердечная недостаточностьНачало лечения хронической сердечной недостаточности препаратом Нипертен требует обязательного проведения специального периода подбора доз. Предварительные условия для начала терапии следующие:- хроническая сердечная недостаточность без признаков обострения в предшествующие 6 недель;- практически неизменяемая базисная терапия в предшествующие 2 недели;- лечение оптимальными дозами ингибиторов АПФ (и сосудорасширяющих средств, в случае непереносимости ингибиторов АПФ), диуретиков и, при необходимости, сердечных гликозидов. Максимальная рекомендованная доза препарата Нипертен составляет 10 мг 1 раз/сут. После начала лечения препаратом в дозе 1.25 мг (1/2 таб. 2.5 мг) пациента следует наблюдать в течение около 4 ч (контроль ЧСС, АД, нарушения проводимости на ЭКГ, симптомов ухудшения хронической сердечной недостаточности). Во время периода подбора доз или после него может произойти временное ухудшение течения хронической сердечной недостаточности, задержка жидкости в организме, артериальная гипотензия или брадикардия. В этом случае рекомендуется, прежде всего, обратить внимание на подбор дозы сопутствующей базисной терапии (оптимизировать дозу диуретика и/или ингибитора АПФ), перед снижением дозы препарата Нипертен. Лечение препаратом следует прерывать только в случае крайней необходимости. После стабилизации состояния пациента следует провести повторное титрование, либо продолжить лечение.
Побочное действие
Со стороны ЦНС и периферической нервной системы: повышенная утомляемость, слабость, головокружение, головная боль, расстройства сна, депрессия, беспокойство, спутанность сознания или кратковременная потеря памяти, галлюцинации, астения, миастения, парестезии в конечностях (у пациентов с перемежающейся хромотой и синдромом Рейно), тремор, судороги. Со стороны органа зрения: нарушение зрения, уменьшение секреции слезной жидкости, сухость и болезненность глаз, конъюнктивит. Со стороны сердечно-сосудистой системы: синусовая брадикардия, сердцебиение, нарушение проводимости миокарда, AV-блокада (вплоть до развития полной поперечной блокады и остановки сердца), аритмии, ослабление сократимости миокарда, развитие (усугубление) хронической сердечной недостаточности (отечность лодыжек, стоп, одышка), снижение АД, ортостатическая гипотензия, проявление ангиоспазма (усиление нарушения периферического кровообращения, похолодание нижних конечностей, синдром Рейно), боль в груди, синдром отмены (усиление приступов стенокардии, повышение АД). Со стороны пищеварительной системы: сухость слизистой оболочки полости рта, тошнота, рвота, боль в животе, запор или диарея, нарушения функции печени (темная моча, желтушность склер или кожи, холестаз), повышение активности АЛТ и ACT, повышение уровня билирубина, изменения вкуса. Со стороны дыхательной системы: заложенность носа, затруднение дыхания при назначении в высоких дозах (утрата селективности) и/или у предрасположенных пациентов - ларинго- и бронхоспазм. Со стороны эндокринной системы: гипергликемия (у больных инсулиннезависимым сахарным диабетом), гипогликемия (у больных, получающих инсулин), гипотиреоидное состояние. Аллергические реакции: кожный зуд, сыпь, крапивница. Дерматологические реакции: усиление потоотделения, гиперемия кожи, экзантема, псориазоподобные кожные реакции, обострение симптомов псориаза, алопеция. Со стороны костно-мышечной системы: судороги (в т.ч. икроножных мышц), боли в спине, артралгия. Со стороны половой системы: ослабление либидо, снижение потенции. Со стороны системы кроветворения: тромбоцитопения (необычные кровотечения и кровоизлияния), агранулоцитоз, лейкопения. Со стороны обмена веществ: повышение содержания триглицеридов.
Передозировка
Симптомы: аритмия, желудочковая экстрасистолия, выраженная брадикардия, AV-блокада, выраженное снижение АД, хроническая сердечная недостаточность, цианоз ногтей пальцев или ладоней, затруднение дыхания, бронхоспазм, головокружение, обморочные состояния, судороги. Лечение: промывание желудка и назначение адсорбирующих средств. Симптоматическая терапия: при развившейся AV блокаде - в/в введение 1-2 мг атропина, эпинефрина или временная постановка кардиостимулятора; при желудочковой экстрасистолии - лидокаин (препараты класса I A не применяются); при снижении АД - пациент должен находиться в положении Тренделенбурга; если нет признаков отека легких - в/в введение плазмозамещающих растворов, при неэффективности - введение эпинефрина, допамина, добутамина (для поддержания хронотропного и инотропного действия и устранения выраженного снижения АД); при сердечной недостаточности - сердечные гликозиды, диуретики, глюкагон; при судорогах - в/в диазепам; при бронхоспазме - бета2-адреностимуляторы ингаляционно.
Особые указания
Следует контролировать состояние пациентов, получающих Нипертен: измерение ЧСС и АД (в начале лечения - ежедневно, затем - 1 раз в 3-4 мес), проведение ЭКГ, определение уровня глюкозы в крови у больных сахарным диабетом (1 раз в 4-5 мес). У пациентов пожилого возраста рекомендуется контролировать функцию почек (1 раз в 4-5 мес). Следует обучить пациента методике подсчета ЧСС и проинструктировать о необходимости врачебной консультации при ЧСС менее 50 уд./мин. Перед началом лечения рекомендуется проводить исследование функции внешнего дыхания у пациентов с отягощенным бронхолегочным анамнезом. Примерно у 20% больных стенокардией бета-адреноблокаторы неэффективны. Основные причины - выраженный коронарный атеросклероз с низким порогом ишемии (ЧСС менее 100 уд./мин) и повышенный конечный диастолический объем левого желудочка, нарушающий субэндокардиальный кровоток. У курильщиков эффективность бета-адреноблокаторов ниже. Пациенты, пользующиеся контактными линзами, должны учитывать, что на фоне лечения возможно уменьшение продукции слезной жидкости. При применении препарата у пациентов с феохромоцитомой имеется риск развития парадоксальной артериальной гипертензии (если предварительно не достигнута эффективная альфа-адреноблокада). При тиреотоксикозе бисопролол может замаскировать определенные клинические признаки тиреотоксикоза (например, тахикардию). Резкая отмена у больных с тиреотоксикозом противопоказана, поскольку возможно усиление симптомов. При сахарном диабете может маскировать тахикардию, вызванную гипогликемией. В отличие от неселективных бета-адреноблокаторов практически не усиливает вызванную инсулином гипогликемию и не задерживает восстановление концентрации глюкозы в крови до нормального уровня. При одновременном применении клонидина его прием может быть прекращен только через несколько дней после отмены препарата Нипертен. Возможно усиление выраженности реакции повышенной чувствительности и отсутствие эффекта от обычных доз эпинефрина на фоне отягощенного аллергологического анамнеза. В случае необходимости проведения планового хирургического лечения отмену препарата проводят за 48 ч до начала общей анестезии. Если больной принял препарат перед хирургическим вмешательством, ему следует подобрать лекарственное средство для общей анестезии с минимально отрицательным инотропным действием. Реципрокную активацию блуждающего нерва можно устранить в/в введением атропина (1-2 мг). Лекарственные средства, снижающие запасы катехоламинов (в т.ч. резерпин), могут усилить действие бета-адреноблокаторов, поэтому пациентам, получающим такие сочетания лекарственных средств, требуется постоянное наблюдение врача на предмет выявления выраженного понижения АД или брадикардии. Пациентам с бронхоспастическими заболеваниями можно назначать кардиоселективные бета-адреноблокаторы в случае непереносимости и/или неэффективности других гипотензивных средств. Передозировка опасна развитием бронхоспазма. В случае выявления у пациентов пожилого возраста нарастающей брадикардии (менее 50 уд./мин), выраженного понижения АД (систолическое АД ниже 100 мм рт.ст.), AV-блокады, необходимо уменьшить дозу или прекратить лечение. Рекомендуется прекратить терапию при развитии депрессии. Нельзя резко прерывать лечение из-за опасности развития синдрома отмены (тяжелой аритмии и инфаркта миокарда). Отмену проводят постепенно, снижая дозу в течение 2 недель и более (снижают дозу на 25% в 3-4 дня). Нипертен следует отменить перед исследованием содержания в крови и моче катехоламинов, норметанефрина и ванилинминдальной кислоты, титров антинуклеарных антител. Влияние на способность к вождению автотранспорта и управлению механизмамиВопрос о возможности занятий потенциально опасными видами деятельности, требующими повышенного внимания и быстроты психомоторных реакций, следует решать только после оценки индивидуальной реакции пациента на препарат (особенно в начале лечения, в связи с возможностью развития головокружения).
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Со стороны дыхательной системы: заложенность носа, затруднение дыхания при назначении в высоких дозах (утрата селективности) и/или у предрасположенных пациентов - ларинго- и бронхоспазм. Со стороны эндокринной системы: гипергликемия (у больных инсулиннезависимым сахарным диабетом), гипогликемия (у больных, получающих инсулин), гипотиреоидное состояние. Аллергические реакции: кожный зуд, сыпь, крапивница. Дерматологические реакции: усиление потоотделения, гиперемия кожи, экзантема, псориазоподобные кожные реакции, обострение симптомов псориаза, алопеция. Со стороны костно-мышечной системы: судороги (в т.ч. икроножных мышц), боли в спине, артралгия. Со стороны половой системы: ослабление либидо, снижение потенции. Со стороны системы кроветворения: тромбоцитопения (необычные кровотечения и кровоизлияния), агранулоцитоз, лейкопения. Со стороны обмена веществ: повышение содержания триглицеридов."}}]},{"id":7,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: аритмия, желудочковая экстрасистолия, выраженная брадикардия, AV-блокада, выраженное снижение АД, хроническая сердечная недостаточность, цианоз ногтей пальцев или ладоней, затруднение дыхания, бронхоспазм, головокружение, обморочные состояния, судороги. Лечение: промывание желудка и назначение адсорбирующих средств. Симптоматическая терапия: при развившейся AV блокаде - в/в введение 1-2 мг атропина, эпинефрина или временная постановка кардиостимулятора; при желудочковой экстрасистолии - лидокаин (препараты класса I A не применяются); при снижении АД - пациент должен находиться в положении Тренделенбурга; если нет признаков отека легких - в/в введение плазмозамещающих растворов, при неэффективности - введение эпинефрина, допамина, добутамина (для поддержания хронотропного и инотропного действия и устранения выраженного снижения АД); при сердечной недостаточности - сердечные гликозиды, диуретики, глюкагон; при судорогах - в/в диазепам; при бронхоспазме - бета2-адреностимуляторы ингаляционно."}}]},{"id":8,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Следует контролировать состояние пациентов, получающих Нипертен: измерение ЧСС и АД (в начале лечения - ежедневно, затем - 1 раз в 3-4 мес), проведение ЭКГ, определение уровня глюкозы в крови у больных сахарным диабетом (1 раз в 4-5 мес). У пациентов пожилого возраста рекомендуется контролировать функцию почек (1 раз в 4-5 мес). Следует обучить пациента методике подсчета ЧСС и проинструктировать о необходимости врачебной консультации при ЧСС менее 50 уд./мин. Перед началом лечения рекомендуется проводить исследование функции внешнего дыхания у пациентов с отягощенным бронхолегочным анамнезом. Примерно у 20% больных стенокардией бета-адреноблокаторы неэффективны. Основные причины - выраженный коронарный атеросклероз с низким порогом ишемии (ЧСС менее 100 уд./мин) и повышенный конечный диастолический объем левого желудочка, нарушающий субэндокардиальный кровоток. У курильщиков эффективность бета-адреноблокаторов ниже. Пациенты, пользующиеся контактными линзами, должны учитывать, что на фоне лечения возможно уменьшение продукции слезной жидкости. При применении препарата у пациентов с феохромоцитомой имеется риск развития парадоксальной артериальной гипертензии (если предварительно не достигнута эффективная альфа-адреноблокада). При тиреотоксикозе бисопролол может замаскировать определенные клинические признаки тиреотоксикоза (например, тахикардию). Резкая отмена у больных с тиреотоксикозом противопоказана, поскольку возможно усиление симптомов. При сахарном диабете может маскировать тахикардию, вызванную гипогликемией. В отличие от неселективных бета-адреноблокаторов практически не усиливает вызванную инсулином гипогликемию и не задерживает восстановление концентрации глюкозы в крови до нормального уровня. При одновременном применении клонидина его прием может быть прекращен только через несколько дней после отмены препарата Нипертен. Возможно усиление выраженности реакции повышенной чувствительности и отсутствие эффекта от обычных доз эпинефрина на фоне отягощенного аллергологического анамнеза. В случае необходимости проведения планового хирургического лечения отмену препарата проводят за 48 ч до начала общей анестезии. Если больной принял препарат перед хирургическим вмешательством, ему следует подобрать лекарственное средство для общей анестезии с минимально отрицательным инотропным действием. Реципрокную активацию блуждающего нерва можно устранить в/в введением атропина (1-2 мг). Лекарственные средства, снижающие запасы катехоламинов (в т.ч. резерпин), могут усилить действие бета-адреноблокаторов, поэтому пациентам, получающим такие сочетания лекарственных средств, требуется постоянное наблюдение врача на предмет выявления выраженного понижения АД или брадикардии. Пациентам с бронхоспастическими заболеваниями можно назначать кардиоселективные бета-адреноблокаторы в случае непереносимости и/или неэффективности других гипотензивных средств. Передозировка опасна развитием бронхоспазма. В случае выявления у пациентов пожилого возраста нарастающей брадикардии (менее 50 уд./мин), выраженного понижения АД (систолическое АД ниже 100 мм рт.ст.), AV-блокады, необходимо уменьшить дозу или прекратить лечение. Рекомендуется прекратить терапию при развитии депрессии. Нельзя резко прерывать лечение из-за опасности развития синдрома отмены (тяжелой аритмии и инфаркта миокарда). Отмену проводят постепенно, снижая дозу в течение 2 недель и более (снижают дозу на 25% в 3-4 дня). Нипертен следует отменить перед исследованием содержания в крови и моче катехоламинов, норметанефрина и ванилинминдальной кислоты, титров антинуклеарных антител. Влияние на способность к вождению автотранспорта и управлению механизмамиВопрос о возможности занятий потенциально опасными видами деятельности, требующими повышенного внимания и быстроты психомоторных реакций, следует решать только после оценки индивидуальной реакции пациента на препарат (особенно в начале лечения, в связи с возможностью развития головокружения)."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"","substance":[{"id":278,"title":"Бисопролол","title_latin":"Bisoprololum","slug":"bisoprolol_278"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"Нипертен - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/7447/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/7447/share_default/"}},"diseases":[{"id":"717","title":"Эссенциальная [первичная] 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