Preparations from the group of adrenergic blockers are widely used in the treatment of many cardiac diseases. Among the drugs in this group, "Nebivolol" stands out significantly. Analogues of this medicine have also gained great fame due to their effectiveness. What is this medicine, how does it work, and when can it be used?
What is this drug?
"Nebivolol" belongs to the group of beta-blockers. The main action of this drug is antihypertensive (the drug reduces pressure). The effect is observed due to the selective blocking of beta receptors located in the vessels (affects beta-1-adrenergic receptors).
Currently used Nebivolol Sandoz.
This drug is a combined one, consisting of several isomers (D- and L-rotating). Such a combination of substances favorably affects the development of the clinical effect. One of the isomers is responsible for the development of the antihypertensive effect, while the second has a greater effect on the heart rate.
The drug appearedrelatively recently, in the middle of the last century. Since then, it has been widely used in the cardiological environment. "Nebivolol Sandoz" is the drug of choice in the treatment of arterial hypertension, as well as some cardiac arrhythmias.
How does the drug work and what organs are responsible for its absorption?
Pharmacokinetics
Nebivolol Sandoz is best absorbed. The drug is well absorbed in the gastrointestinal tract. Can be taken with food (absorption is not impaired). Bioavailability is relatively low - about 12 percent. If possible, co-administration of the drug with alcohol should be avoided, as side effects may develop.
Once in the blood plasma, the drug binds to albumin and forms insoluble complexes. In this bound form, the availability of the drug is about 98 percent, i.e., almost all Nebivolol Sandoz is absorbed. Its analogues go through the same path before they enter the blood plasma and do not bind to the protein.
Unabsorbed drug is excreted through the gastrointestinal tract and kidneys. Processed in the liver, where it binds to glucuronic acid.
The half-life of the drug in individuals with an accelerated metabolite is about a day. In the case of slow metabolism, "Nebivolol" can accumulate and be retained in the blood plasma for about 48 hours.
The drug does not accumulate in the tissues, which avoids itsoverdose (it is possible only if it is used in patients with kidney or liver pathology).
Indications for use
In what cases is Nebivolol prescribed, analogues of this drug or drugs with a similar pharmacological action?
The first indication for prescribing the drug is arterial hypertension. The use of beta-blockers is resorted to with the ineffectiveness of the use of ACE inhibitors (Enalapril, Captopril). In addition, Nebivolol is also used for endocrine hypertension.
Another equally important indication for the use of "Nebivolol" is coronary heart disease. With frequent exacerbations of angina pectoris, as well as for the prevention of such attacks, Nebivolol is indicated. Its analogues in this case may be even more effective than the pure drug itself.
Nebivolol is also part of combination therapy in the treatment of chronic heart failure. In this case, the drug helps to improve the work of the heart, reduce pre- and afterload on the chambers of the organ, as well as reduce pressure.
This medicine can also be used to prevent the development of hypertensive crises, as well as in persons prone to atherosclerotic lesions of the cerebral vessels.
Contraindications
When should you not use "Nebivolol"? Instructions for use usually include all those cases that have been identified clinically, when against the backgrounduse of means development of these or those complications was observed. Due to the strong antihypertensive effect, it is impossible to prescribe a remedy for severe arterial hypotension.
First of all, it is forbidden to use the drug in acute heart failure. This is due to the fact that it has an inotropic effect, which can adversely affect the body due to insufficient heart function.
With the development of pheochromocytoma, it is also forbidden to use "Nebivolol". Instructions for use indicate that with this endocrine tumor, the drug can only be used in conjunction with alpha receptor blockers.
Do not prescribe the drug to children, as well as people with existing mental he alth disorders.
"Nebivolol" is contraindicated in individuals with individual drug intolerance. When the first signs appear (lacrimation, difficulty breathing), you should immediately stop further use of the drug and switch to a safer option.
Side effects
Like any drug, Nebivolol has its own side effects. Chief among them are:
On the part of the nervous system - headache, depression, drowsiness, insomnia, hallucinations, fainting, dizziness.
Gastrointestinal side effects include nausea, constipation, dry mouth, and vomiting. Perhaps the appearance of dyspeptic disorders, and when taken together with antibiotics -dysbacteriosis.
The cardiovascular system reacts to the introduction of "Nebivolol" with bradycardia, shortness of breath, edema, the development of acute heart failure, atrioventricular blockade, Raynaud's syndrome. An overdose can lead to uncontrolled arterial hypotension, which can be complicated by collapse and fainting. In severe cases, shock develops.
Side effects of "Nebivolol" may manifest as an erythematous rash, psoriasis.
In severe cases, angioedema develops (Quincke's edema). In milder cases, uncontrollable sneezing or coughing develops.
Features of using the drug
The drug is used with caution in patients with renal insufficiency, diabetes mellitus or overproduction of thyroid hormones. Cancellation of the drug is carried out gradually, within 10-14 days. At the beginning of the course of treatment, blood pressure and heart rate should be monitored. If possible, you should stop smoking during the use of the drug. Before the upcoming operation, be sure to warn the anesthesiologist that the patient is using beta-blockers.
During the entire time of using the drug, it is imperative to control the level of sugar in the blood, especially in diabetics. In addition, the filtration capacity of the kidneys (especially the levels of creatinine and urea) should be evaluated if Nebivolol is prescribed for a long time. Instructions for use (analogueshave a similar effect) warns that the development of renal failure is possible with the irrational appointment of this drug.
It is forbidden to use the drug for children under 18 years of age, as well as for elderly patients with decompensated heart failure. This ban is primarily due to the possibility of developing metabolic disorders and the appearance of problems with pressure.
Since the use of the drug may cause dizziness, it should not be prescribed to drivers and doctors.
Use of the drug by pregnant women
Prescribing this medication to a pregnant woman is possible only after consultation with a gynecologist and therapist. The drug is used quite rarely due to the negative impact on the body of the mother and child.
The drug is prescribed only in case of emergency, as it is possible to develop bradycardia, arterial hypotension, hypoglycemia, paralysis of the respiratory center, seizures.
Three days before the expected birth, you must stop using this medication. If this is not possible, careful monitoring of the he alth of the mother and child is necessary in the early postpartum period. When using spinal anesthesia, it is imperative to warn the anesthetist about the ongoing treatment with adrenergic blockers.
It should be remembered that against the background of the use of the drug, the development of fetal hypoxia is possible. The teratogenic effect of the drug has not been proven, but there are cases of such an effect on the fetus.
If, nevertheless, "Nebivolol" is prescribed to a pregnant woman, instructions forapplication warns that the therapeutic effect of the drug may be distorted when administered with intravenous magnesium.
Interaction with drugs from other drug groups
The combined use of "Nebivolol" and class 1 antiarrhythmics may lead to an increase in the negative inotropic effect. AV block may develop. A similar effect is observed if calcium channel blockers and Nebivolol Sandoz are used simultaneously.
The instructions for prescribing the drug warns that when it is administered intravenously, cardiac arrest is possible (provided that the drug is administered together with Verapamil). In this case, an emergency cardioversion using electrical impulse therapy will be required.
There is a significant risk of developing severe arterial hypotension when prescribing a drug with Nitroglycerin.
Simultaneous administration of sympathomimetics and "Nebivolol" contributes to the inhibition of the latter.
Combined use with anesthesia drugs can lead to a sharp drop in blood pressure, which will serve as an indication for mechanical ventilation and the use of hypertensive drugs.
When prescribing a drug with insulin, it is possible to develop an overdose of the hormone and conceal the clinical signs of hypoglycemia.
Drug dosage
So in what doses should the drug be used to develop the desired clinical effect? If aNebivolol Sandoz is used, the instructions for use suggest the following dosing type.
The most optimal dose for an adult is 20 milligrams per day. The drug is taken orally in the morning on an empty stomach. The maximum effect of the dose used develops after one to two weeks from the start of treatment. If necessary, the daily amount of the drug can be increased to 10 milligrams. For elderly patients, the maximum daily dose is 5 milligrams, and the optimal for treatment is 2.5 milligrams per day. For pregnant women, the amount of the drug is selected according to clinical signs and body weight. It is best to use Nebivolol Sandoz (5mg) tablets.
If the liver or kidney function is impaired, it is better to stop using Nebivolol or prescribe it in minimal dosages.
With the simultaneous appointment of sympathomimetics and Nebivolol, the effect may be potentiated, due to which it is possible to slightly reduce the prescribed dose of the drug.
Prescribing the drug in smaller doses has no effect on the body. Perhaps the development of receptor tolerance to the drug with long-term administration of small doses of the drug.
Analogues of the drug
It is not always possible to find the necessary drug in pharmacies, so you have to resort to using analogues. Due to the expansion of the drug market, it is not difficult to find similar drugs. What drugs can replace Nebivolol?
Analogues (synonyms) of this drug are as follows:
- "Binelol";
- "Nebivator";
- "Nebivolol canon";
- "Nebivolol stada";
- "Nebivolol teva;
- "Nebicar";
- "Non-ticket";
- "Nebilong";
- "One-sky".
Each of these drugs has its positive and negative features. Some of them are enhanced better than the classic "Nebivolol". Instructions for use of each of them, however, warns of more negative effects. Therefore, only a qualified and competent doctor can help determine which drug is better.
You should not use these remedies on your own without first consulting a doctor, as in this way you can only significantly worsen your condition and harm both your he alth and the he alth of friends and loved ones.
Drug reviews
Many patients actively praise on the forums such a drug as "Nebivolol Sandoz". Reviews about it are mostly positive, since this drug helped to cure or stop the symptoms of the disease in most patients.
Despite the number of side effects that the drug has, it is considered one of the main in the treatment of high blood pressure and heart failure.
Pure "Nebivolol" also has a large number of positive reviews. Analogues of the drug are more suitable for someone, less for someone, as a result of which opinionspatients vary. It is also necessary to take into account the comorbidity, which can significantly impair the effect of the drug.
Be sure to take into account the age of patients who used this medicine.
Of all the beta-blockers used in cardiac patients, Nebivolol (analogues) is in the first place. Reviews about this medicine allow us to call it the most effective drug of this drug group.
