Coreg
Coreg
Coreg (Carvedilol)Pharmacological action
Alpha - and beta adrenoblocker without internal sympathomimetic activity.
Blocks a1 - b1 and b2-adrenoretseptory.
Blocking a1-adrenoreceptors, the preparation causes expansion of peripheric vessels. Antianginal and antiarrhytmic an effect has.
At patients with an arterial hypertensia BP depression is not accompanied by depression of a peripheric blood flow. The CARDIAC CONTRACTIONS RATE decreases slightly. Coreg (Carvedilol)reduces pre-and an afterload by a myocardium. At patients with disturbance of function of a left ventricle or a circulatory unefficiency favorably influences hemodynamic indicators and improves fraction of emission and the sizes of a left ventricle. Antioxidatic an effect has, eliminating free oxygen radicals.
Does not render the expressed influence on a lipide exchange and the maintenance of a potassium, sodium and magnesium in a blood plasma.
Indications
- An arterial hypertensia (in quality mono-or the combined therapy);
- A stable stenocardia.
Dosage regimen
Dosage regimen establish individually.
At an arterial hypertensia within the first 7-14 days the initial dose for adults makes 12.5 mg/sut (or in 1 reception in the morning or to part on 2 receptions on 6.25 mg in the morning and in the evening). Then a dose enlarge to 25 mg of 1 times/sut in the morning or on 12.5 mg 2 times/days If necessary in 14 days probably once again to raise a dose.
At a stable stenocardia in the beginning of therapy the preparation is prescribed in a daily dose by of 25 mg (on 12.5 mg 2 times/sut). In 7-14 days the dose can be raised to 50 mg/sut (on 25 mg 2 times/sut). At insufficient efficiency and good shipping in 2 weeks Coreg (Carvedilol) dose can be still enlarged. The maximum daily dose at a stenocardia makes 100 mg (on 50 mg 2 times/24h).
To patients 70 years daily Coreg dose aged is more senior should not to exceed 50 mg (on 25 mg 2 times/24h).
At cancellation of a preparation the dose decline should be spent gradually within 1-2 weeks.
At the admission of the next reception the preparation should be accepted as soon as possible. However if there comes time of following reception it is necessary to accept only one single dose (without doubling).
At a break in reception of a preparation more than 2 weeks treatment from the least Coreg doses is necessary to renew.
Tablets accept after meal, washing down with a water small amount.
Side effect
From party TSNS and peripheric nervous system: a headache, giddiness, syncopal conditions, muscular delicacy (more often in the treatment beginning), dream disturbances, depression, paresthesias.
From cardiovascular system: a bradycardia, an orthostatic hypotension, a stenocardia, AV-blockade; seldom - disturbances of the peripheric circulation, an alternating lameness, heart failure advance.
From the alimentary system: dryness in a mouth, a nausea, abdominal pains, a diarrhoeia, a constipation, vomiting, rising of activity of hepatic transaminases.
From hemopoiesis system: a thrombocytopenia, a leukopenia.
Allergic reactions: dermal reactions (an exanthema, an urticaria, an itch, an eruption), a psoriasis exacerbation, a sneezing, a bronchospasm, a dyspnea (at predisposed patients).
The other:pains in extremities, augmentation of mass of a body.
Contraindications
- Chronic obstructive diseases of lungs;
- Serious hepatic insufficiency;
- The expressed bradycardia;
- AV-blockade II and III degrees (except for patients with the artificial driver of a rhythm);
- A heart failure in a decompensation stage;
- A pulmonary hypertensia;
- A cardiogenic shock;
- An arterial hypotension;
- Pregnancy;
- A lactemia (thoracal feeding);
- Children's and teenage age till 18 years;
- A hypersensibility to a preparation.
Pregnancy and lactemia
The preparation is contraindicative to application at pregnancy and in a lactemia (thoracal feeding).
Special indicatings
With care prescribe a preparation at a chronic bronchitis, an emphysema of lungs, a diabetes or a hypoglycaemia, a hyperthyroidism, diseases of peripheric vessels, a pheochromocytoma, depression, a myasthenia, a psoriasis, renal insufficiency.
In the beginning of Coreg treatment and at rising of a dose of a preparation probably sharp depression of a BP and orthostatic reactions. Giddiness up to syncopes, especially at elderly patients can be observed, at a heart failure, at application of the combined antihypertensive therapy or at application of diuretics.
The preparation is not recommended to application to patients with a low BP.
Coreg treatment should not stop sharply, in particular at patients with a stenocardia since it can lead to an aggravation of symptoms. The preparation dose decline should be gradual within 1-2 weeks.
In Coreg application is necessary to supervise function of kidneys at patients with renal insufficiency, an ischemic heart disease, diseases of peripheric vessels, an arterial hypotension and-or a heart failure. At deterioration of function of kidneys the preparation should be cancelled.
Appointment of beta adrenoblockers to patients with diseases of peripheric vessels, with a psoriasis and anaphylactic reactions in the anamnesis can lead to deterioration of a current of disease can provoke occurrence of retrosternal pains. Besides, Coreg application can reduce sensitivity of allergy tests.
Preparation appointment can mask symptoms of a thyrotoxicosis and early symptoms of a hypoglycaemia. At a diabetes the regular control of level of a glucose in blood and if necessary correction of hypoglycemic therapy is recommended.
Against Coreg application with care it is necessary to spend the general anaesthesia with use of preparations with negative inotropic action (an Aether, Cyclopropanum). Before extensive surgical interventions gradual cancellation of a preparation is recommended.
It is necessary to be careful at application of a preparation in case of the expressed metabolic acidosis.
At application of a preparation for patients with a pheochromocytoma before the therapy beginning prescribe alpha adrenoblockers.
In preparation application it is necessary to avoid the alcohol use.
It is necessary to consider, that in need of cancellation of combined Coreg therapy and Coreg should cancel the first, some days prior to gradual reduction of a dose of Clonidinum.
Use in pediatrics
Safety and efficiency of Coreg application at children and teenagers is elderly till 18 years are not established.
Influence on ability to driving of motor transport and to management of mechanisms
In preparation application it is necessary to abstain from employment by potentially dangerous kinds of the activity demanding special attention and speed of psychomotor reactions.
Overdosage
Symptoms: the expressed arterial hypotension, a bradycardia, breath disturbances (including a bronchospasm), a heart failure; in serious cases - a cardiogenic shock, disturbances of conductivity up to a cardiac standstill.
Treatment: if the patient is in consciousness, it is necessary to cause vomiting. The patient should give horizontal position with the raised feet. If necessary spend symptomatic therapy, enter agonists of adrenoreceptors.
Medicinal interaction
Against Coreg therapy and verapamil it is impossible to prescribe i.v. because of the possible expressed depression of a BP and development of disturbances of a warm rhythm.
Some antiarrhytmic preparations, preparations for a narcosis, antihypertensive preparations, antianginal preparations, other beta adrenoblockers (including applied in the form of eye drops), inhibitors MAO, warm glycosides can strengthen Coreg effect.
At simultaneous application with inductors of hepatic enzymes (for example, rifampicin, phenobarbital) Coreg concentration in a blood plasma can decrease, and at joint application with inhibitors of hepatic enzymes (for example, Cimetidinum) Coreg concentration in plasma can increase.
At simultaneous Coreg application can enlarge concentration of digoxin in a blood plasma.
Simultaneous Coreg appointment with ergot alkaloids worsens a peripheric circulation.
Coreg can strengthen action of insulin and peroral hypoglycemic preparations.
Conditions and periods of storage
B.Preparat's list should be stored in the dry place protected from light, at temperature not above 25 C. The Period of validity - 2 years.
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