Egilok from what they take. The correct dosage of the antihypertensive drug Egilok

Thank you

Egilok represents medicinal product from the group of beta1-adrenergic blockers, which has antianginal, hypotensive and antiarrhythmic effects. The antianginal effect is to reduce the heart's need for oxygen and increase its endurance in conditions of coronary artery disease, which prevents angina attacks and myocardial infarction. The hypotensive effect is the ability to lower blood pressure. And the antiarrhythmic effect is to normalize the heart rhythm by stopping tachycardia and extrasystole. Thus, Egilok has a complex positive effect on the functioning of the heart, which is used in treatment of coronary artery disease, heart failure, arrhythmias, heart attacks, hyperthyroidism, migraines and other conditions associated with high blood pressure and oxygen starvation of heart tissues.

Composition, names, varieties and forms of release Egilok

Currently, the drug Egilok is available in the following three varieties:
1. Egilok tablets of the usual duration of action of 25 mg, 50 mg and 100 mg;
2. Tablets Egilok Retard with prolonged action of 50 mg and 100 mg;
3. Tablets Egilok C with prolonged action of 25 mg, 50 mg, 100 mg and 200 mg.

Accordingly, tablets with a normal duration of action in everyday speech are simply called "Egilok" and a number is added corresponding to the dosage of the active ingredient, for example, "Egilok 50" or "Egilok 25", etc. Long-acting tablets are called "Egilok Retard" and, as a rule, do not add a figure indicating the dosage. Egilok C tablets in everyday speech are often called "Egilok with succinate", since in this type of drug the active substance is contained in the form of succinate, and in Egilok Retard and Egilok with the usual duration of action in the form of tartrate. Egilok S and Egilok Retard have a prolonged action, but just Egilok has a regular one.

The three listed varieties of the drug Egilok are produced by the Hungarian pharmaceutical concern EGIS Pharmaceuticals PLC. In addition to these drugs, pharmaceutical market there is another cheaper option called Egilok SR (Egilok SR) and is produced by the Indian pharmaceutical plant Intas Pharmaceuticals Ltd under license. Egilok SR is a cheaper version of Egilok S.

All three varieties of Egilok are available in the form of tablets for oral administration. Egilok tablets with normal duration of action have a round biconvex shape and are colored white or almost white. Tablets of 25 mg on one side have a cross-shaped line, and on the other engraved "E 435". The 50 mg and 100 mg tablets are scored on one side and engraved "E 434" and "E 432" on the other, respectively.

Egilok Retard tablets of all dosages are coated white color, have an oblong biconvex shape and a risk on both sides. Tablets Egilok C of all dosages are painted white, have an oval biconvex shape and a risk on both sides.

Egilok and Egilok Retard contain as an active substance metoprolol tartrate, and Egilok C - metoprolol succinate. Both substances are different salts of metoprolol, which actually represents the active ingredient of the drug. In the body, salt breaks down and metoprolol is released from it, which has a direct therapeutic effect. Therefore, all varieties of Egilok can be considered exactly the same, because metoprolol tartrate and succinate differ only slightly in the rate of absorption into the blood and the development of a therapeutic effect.
Auxiliary components of the three varieties of Egilok are shown in the table.

Egilok	Egilok Retard	Egilok S
	Silicon dioxide, colloidal	Microcrystalline cellulose
Sodium carboxymethyl starch (type A)	magnesium stearate	Methylcellulose
Silicon dioxide, colloidal	Macrogol 6000	Glycerol
Povidone	sucrose	Corn starch
magnesium stearate	starch molasses	Ethylcellulose
	triethyl citrate	magnesium stearate
	Giproloza	Hypromellose
	Ethylcellulose	Stearic acid
	Talc	Titanium dioxide
	Titanium dioxide

Egilok - recipe

The prescription for Egilok is written as follows:
Rp.: Egilok 25 mg N 40
D.S. 1 tablet 3 times a day.

After the letters "Rp." the full name of the drug and the dosage of the active substance are indicated (in this example Egilok 25mg). Then they write the letter "N" and indicate after it a number indicating the number of tablets that need to be sold to a person in a pharmacy. On the second line of the recipe, after the letters "D. S." the schedule for taking the tablets is indicated.

Therapeutic effect of the drug

All varieties of the drug Egilok have antiarrhythmic, hypotensive and antianginal effects due to the ability of the active substance to block beta1-adrenergic receptors of the heart.

By blocking adrenergic receptors, Egilok reduces heart rate, the force of contractile movement of the myocardium and the volume of blood ejected into the aorta, and also moderately reduces blood pressure. Egilok lowers blood pressure in people standing and lying down. Long-term use of Egilok in hypertension has a beneficial effect on the heart, reducing its load and, thereby, reducing the risk of sudden cardiac death, heart attack and stroke.

In addition, Egilok reduces the heart's need for oxygen by reducing blood pressure, heart rate and strength of contractile movements of the myocardium. Reducing the heart rate and lengthening the period of relaxation of the heart (diastole) improves the blood supply to the myocardium itself and the uptake of oxygen by its cells. That is why Egilok provides improved nutrition and oxygen supply to the heart, which prevents angina attacks and increases human performance.

Regular use of Egilok can reduce the risk of sudden cardiac death in the development of myocardial infarction. The use of the drug after a heart attack prevents repeated attacks.

When using Egilok in the complex therapy of coronary artery disease, the drug normalizes the heart rhythm, preventing the appearance of extrasystoles and tachycardia. This effect creates a stable heart rhythm, which, even during attacks, is not disturbed with the development of deadly ventricular fibrillation. That is why the regular use of Egilok reduces the risk fatality with heart failure and ischemic heart disease.

Thus, we can say that Egilok is a drug for angina attacks and heart failure, since it improves the functioning of the heart and increases its stability and endurance, which allows a person to calmly endure physical and emotional stress. Egilok does not cure angina pectoris, coronary artery disease and heart failure, it only ensures the normal functioning of the heart in adverse conditions, relieving and stopping the painful symptoms of diseases and allowing a person to lead habitual image life. That is, Egilok is a drug to eliminate symptoms cardiovascular diseases and prevention of angina attacks, hypertensive crises, heart attacks and strokes.

Egilok - indications for use

In principle, all varieties of Egilok are indicated for use in the same diseases. However, due to the peculiarities and duration of the therapeutic effects, the varieties of the drug Egilok are indicated for use in various variants of the course of the same diseases. For ease of perception and to avoid confusion, indications for the use of three varieties of Egilok are given in the table.

Indications for use Egilok	Indications for use Egilok Retard	Indications for use Egilok C
Prevention of migraine attacks
Arterial hypertension (Egilok can be used as a single drug or as part of complex therapy)
Prevention of angina attacks
Prevention of repeated myocardial infarctions (Egilok is used as part of complex therapy)
	Hyperthyroidism (Egilok is used as part of complex therapy)	Elimination of ventricular extrasystoles
	Hyperkinetic Cardiac Syndrome
Prevention of ventricular extrasystoles	Prevention of supraventricular and ventricular tachycardias	Decreased ventricular rate in atrial fibrillation
Prevention of supraventricular arrhythmias	Chronic heart failure (Egilok is used in combination with diuretics, cardiac glycosides and ACE inhibitors)	Stable chronic heart failure of any functional class, combined with impaired systole of the left ventricle of the heart (Egilok is used as part of complex therapy)
		Reducing the risk of death in the late phases of myocardial infarction
		Functional disorders of cardiac activity associated with tachycardia

Egilok - instructions for use

General admission rules

Tablets of any kind of Egilok should be swallowed whole, without chewing or crushing in other ways, but with a small amount of still water. If necessary, tablets can only be broken in half according to the existing risks. Tablets can be taken regardless of food, since food does not affect the absorption of the drug into the bloodstream. However, it is recommended to take the drug during or immediately after a meal, as this reduces the risk of development and severity of side effects from the gastrointestinal tract.

The dosage of Egilok, Egilok Retard and Egilok C is selected individually, gradually increasing it to required value. Such a gradual increase in dosage to therapeutic is necessary in order to avoid bradycardia at the beginning of treatment. The maximum allowable daily dosage is 200 mg. When choosing a dosage for angina pectoris, it is necessary to focus on the pulse, which should be 55-60 beats per minute at rest, and no more than 110 during exercise.

It is not required to change the dosage in the elderly, as well as those suffering from renal or hepatic insufficiency. Reduction of the recommended dosage is required only in case of severe hepatic insufficiency. In addition, it is necessary to reduce the dosage of Egilok with the development of bradycardia with a pulse of less than 50 beats per minute, a strong decrease in pressure, AV blockade, bronchospasm, ventricular arrhythmia, or severe liver dysfunction.

Egilok is canceled slowly, reducing the dosage within 10-14 days to the minimum (25 mg for Egilok and Egilok Retard and 12.5 mg for Egilok C). The minimum dosage should be taken within 4 to 5 days, after which the drug should be completely canceled. With a sharp discontinuation of the drug, a withdrawal syndrome develops, which is manifested by increased angina pectoris and increased pressure.

Egilok treatment of various diseases

With hypertension, they begin to take Egilok 20-50 mg 2 times a day (morning and evening). If given dosage is not effective enough, then it is increased to 50-100 mg 2 times a day.

With angina pectoris and arrhythmias, they begin to take Egilok 25-50 mg 2-3 times a day, if necessary, increasing the dosage to 100 mg 2 times a day.

Prevention of a repeated heart attack consists in taking Egilok 50-100 mg twice a day.

To stop tachycardia in hyperthyroidism, it is recommended to take Egilok 50 mg 3 to 4 times a day.

With functional disorders accompanied by tachycardia (for example, vegetovascular dystonia, panic attack, etc.), Egilok is taken 50 mg 2 times a day. With inefficiency, the dosage is increased to 100 mg 2 times a day.

Egilok can provoke amplification allergic reactions therefore, people prone to allergies should take this aspect into account. Egilok also reduces the production of tears, which is important for people who use contact lenses. To prevent dry eye, they will have to use artificial tears or give up contact lenses in favor of glasses.

In the presence of heart failure, Egilok can be taken only after the compensation stage has been reached. With a gradual increase in the dosage of Egilok in heart failure, an increase in symptoms may first be observed, which gradually decreases within two weeks. Because of this feature, it is impossible to increase the dosage of Egilok sharply.

Against the background of the use of Egilok, peripheral circulation may worsen.

Egilok should be used simultaneously with beta-2-agonists in people with bronchial asthma, or with alpha-blockers in pheochromocytoma. In addition, while taking Egilok, it is impossible to administer drugs from the group of blockers intravenously. calcium channels e.g. Verapamil etc.

It is not necessary to cancel Egilok for any surgical operations, however, the anesthesiologist should be told that the person is taking this drug. In some cases, in the absence of the necessary range of drugs for anesthesia, it may be necessary to cancel Egilok 48 hours before surgery.

Egilok must be canceled when a person develops depression.

Egilok Retard should not be used by people suffering from fructose or galactose intolerance, as well as sucrose or isomaltase deficiency, since the tablets contain sucrose.

Egilok during pregnancy and breastfeeding

Any kind of Egilok during pregnancy and breastfeeding can be used only if the potential benefit to the mother outweighs all possible risks to the fetus.

When using the drug during pregnancy, it should be canceled 2 to 3 days before delivery, because otherwise the newborn may experience growth retardation, bradycardia, low blood pressure, respiratory depression and hypoglycemia after birth. If Egilok was not canceled on time, then after birth, the child's condition should be monitored for 48 to 72 hours.

Despite the fact that Egilok passes into breast milk in small quantities, it has the effects of adrenergic blockers on the baby's heart. Therefore, if it is necessary to take Egilok, breastfeeding should be canceled and the child should be transferred to artificial mixtures.

Compatibility with other drugs

When using Egilok together with drugs that are inhibitors of the CYP2D6 enzyme (quinidine, terbinafine, paroxetine, fluoxetine, sertraline, celecoxib, propafenone and diphenhydramine), fluctuations in its concentration in the blood serum may occur.

Do not use Egilok in combination with the following medicines:

Barbiturates (Phenobarbital, Phenazepam, etc.);
Propafenone;
Verapamil.

The dosage of Egilok should be adjusted when it joint application with the following drugs:

Adrenaline (epinephrine);
amiodarone;
Class I antiarrhythmics;
Beta-blockers (such as atenolol, propranolol, and pindolol);
Hydrazalin;
Guanfacine;
Diphenhydramine;
Diltiazem;
clonidine;
Methyldopa;
Non-steroidal anti-inflammatory drugs (for example, Aspirin, Paracetamol, Ibuprofen, Nimesulide, Indomethacin, Diclofenac, etc.);
norephedrine (phenylpropanolamine);
Reserpine;
Theophylline;
Quinidine;
Cimetidine;
Estrogen hormones (including combined oral contraceptives);
Ergotamine.

Cardiac glycosides (Strophanthin and others), when used simultaneously with Egilok, can provoke bradycardia. Drugs acting on the central nervous system (hypnotics, tranquilizers, antidepressants, antipsychotics and ethanol), when used simultaneously with Egilok increase the risk sharp decline blood pressure.

Egilok prolongs the effects indirect anticoagulants(for example, Warfarin, Dicoumarin, etc.).

The risk of allergic reactions increases significantly when using special solutions for skin allergy tests and iodine-containing radiopaque substances simultaneously with Egilok.

In smokers, the effects of Egilok may be much less pronounced.

Influence on the ability to control mechanisms

Against the background of taking Egilok, you can practice various types activities that require excellent concentration and high reaction speed only with caution, since the drug reduces the ability to control mechanisms due to the possible development of dizziness and increased fatigue.

Overdose

An overdose of any kind of Egilok is possible and manifests itself the following symptoms:

A strong decrease in blood pressure;
Severe bradycardia with a heart rate of less than 50 beats per minute;
Dizziness;
Cyanosis (blue lips, nails, fingertips);
Arrhythmia;
Extrasystole;
Spasm of the bronchi;
Cardiogenic shock;
AV blockade (up to complete cardiac arrest);
Pain in the heart (cardialgia);
respiratory depression;
fatigue;
Increased sweating;
Violation of sensitivity (feeling of goosebumps, etc.);
Mi asthenic syndrome.

The first symptoms of an overdose of Egilok develop 20 to 120 minutes after taking the drug. Often, overdose symptoms develop when taking alcohol, quinidine, barbiturates, or drugs to reduce pressure.

Treatment of an overdose of Egilok is carried out in intensive care, since it is necessary to take measures intensive care and constant monitoring of the human condition. If the tablets were taken within the next 40 minutes, then gastric lavage is performed and a sorbent is given to the person (for example, activated carbon, Polysorb, Polyphepan, etc.). In the future, symptomatic therapy is carried out, aimed at normalizing the main indicators of the cardiovascular system and maintaining the functioning of vital organs.

Egilok - side effects

All three varieties of Egilok are capable of provoking the development of almost identical side effects from any organs and systems. The list below shows the side effects of all three varieties of Egilok. Moreover, if any side effect is characteristic only for any one variety of Egilok, then this is indicated in brackets.
So, the side effects of Egilok are as follows:

1. From the nervous system:

fatigue;
Dizziness;
Headache;
Excitability;
convulsions;
Paresthesia (sensation of crawling and other disturbances of sensitivity);
Depression;
Deterioration of concentration;
Nightmares;
depression;

2. From the side of the cardiovascular system:

bradycardia;
Orthostatic hypotension ( sharp drop pressure when moving to a standing position);
fainting;
Cold feet;
palpitations;
Temporary increase in symptoms of heart failure;
Cardiogenic shock in people who have had a myocardial infarction;
AV block I degree;
Arrhythmia;
Pain in the region of the heart;
Edema on the extremities (for Egilok Retard and Egilok C).

3. From the gastrointestinal tract:

Nausea;
Vomit;
Dry mouth;
Violation of the liver (darkening of urine, yellowness of the sclera or skin, stagnation of bile);
Hepatitis (for Egilok C);
Increased activity of AsAT and AlAT;
An increase in the concentration of bilirubin in the blood.

4. From the side of the skin:

Increased sweating;
Alopecia (baldness);
Photosensitivity (sensitivity to sunlight);
Exacerbation of psoriasis;
Skin itching;
redness of the skin;
Exanthema.

5. From the side of the respiratory system:

Shortness of breath physical stress;
Bronchospasm;

6. From the sense organs:

visual impairment;
Dryness and irritation of the surface of the eye;
Taste disorder.

7. Others:

Weight gain;
Joint pain (arthralgia);
Thrombocytopenia of platelets in the blood);
Leukopenia (decrease in the total number of white blood cells);
Agranulocytosis (decrease in the content of neutrophils, eosinophils and basophils in the blood);
Decreased levels of high density lipoproteins (HDL) in the blood;
An increase in the level of triglycerides (TG) in the blood.

Side effects of Egilok are usually mild and temporary. If any side effect begins to appear intensely, requiring special treatment, then you should stop taking Egilok.

Contraindications for use

Varieties of Egilok have relative and absolute contraindications. In the presence of absolute drug can not be used, under no circumstances. And with relative contraindications, careful use of Egilok under the supervision of a physician is allowed.

TO absolute contraindications The use of Egilok includes the following conditions:

Hypersensitivity, intolerance or allergic reactions to drug components;
Atrioventricular (AV) block II or III degree;
Sinoatrial blockade;
Bradycardia with a heart rate of less than 50 beats per minute;
Sick sinus syndrome;
Cardiogenic shock;
Severe disorders of the peripheral circulation (for example, trophic ulcers, marble coloration of the skin of the extremities, etc.);
Heart failure in the stage of decompensation;
Age under 18;
Severe course of bronchial asthma;
Simultaneous intravenous administration Verapamil;
Acute myocardial infarction with a pulse less than 45 beats per minute, a PQ interval of more than 240 ms, and top pressure below 100 mm Hg. Art.;
Simultaneous use of drugs-inhibitors of the CYP2D6 enzyme;
Pregnancy and the period of breastfeeding;
Long-term use inotropic drugs and beta-blockers or mimetics (for Egilok C);
Prinzmetal's angina (for Egilok);
Fructose intolerance, galactose intolerance or sucrose or isomaltase deficiency (for Egilok Retard).

Relative contraindications to the use of Egilok are the following conditions:

Diabetes;

Synonyms of Egilok are the following drugs:

Betaloc solution and tablets;
Betaloc Zok tablets of prolonged action;
Vasocardin and Vasocardin Retard tablets;
Corvitol 50 and 100;
Lidaloc tablets;
Metozok tablets;
Metocard tablets;
Metocor Adifarm tablets and solution;
metoprolol tablets;
Serdol tablets.

Analogues of Egilok are the following drugs:

Aritel and Aritel Core tablets;
Atenolol tablets;
Betak tablets;
Betacard tablets;
Betaxolol tablets;
Bidop tablets;
Binelol tablets;
Biol tablets;
Biprol tablets;
Bisogamma tablets;
Bisocard tablets;
Bisomor tablets and lyophilizate;
bisoprolol tablets;
Breviblok solution;
Vero-Atenolol tablets;
Concor and Concor Cor tablets;
Corbis tablets;
Kordanum tablets;
Cordinorm tablets;
Coronal tablets;
Lokren tablets;
Nebivator tablets;
Nebivolol tablets;
Nebicor tablets;
Nebilan Lannacher tablets;
Nebilet tablets;
Nebilong tablets;
Nevotens tablets;
Niperten tablets;
OD-Neb tablets;
Tirez tablets;
Estecor tablets.

Egilok - reviews

heart rate

high efficiency

general state

Also in the reviews, people note good efficiency Egilok at course application to lower blood pressure. The advantages of the drug according to people is fast development effect, good tolerability and the possibility of long-term use for several years in a row.

In reviews of the use of Egilok for arrhythmias, people note that the drug very quickly and literally perfectly aligns the rhythm, relieving painful symptoms and restoring normal health.

Negative reviews about Egilok are associated with the development of side effects and the need to stop taking the drug. That is, negative feedback usually left by people who did not fit Egilok for some reason.

Concor or Egilok?

In principle, the therapeutic effect of Concor and Egilok is practically no different, but one drug is better for someone, and the second for another person. There is only one way to find out which drug is best for you - try taking both. If desired, you can easily replace one drug with another, knowing that 5 mg of Concor correspond to 50 mg of Egilok. However, Egilok has a little more strong action compared with Concor, so the first drug is recommended to choose if the second is ineffective.

In general, the only significant difference between Concor and Egilok is the possibility of its use with severe bradycardia (pulse less than 55 beats per minute). Therefore, with a tendency to bradycardia, Egilok is preferable.

Egilok, Egilok Retard and Egilok S - price

former USSR

Prices for all varieties of Egilok are shown in the table.

Before use, you should consult with a specialist.

Photo of the preparation

Latin name: Egilok

ATX Code: C07AB02

Active substance: Metoprolol (Metoprolol)

Manufacturer: EGIS Pharmaceuticals PLC (Hungary)

The description applies to: 10.11.17

Egilok - medicine, which is designed to treat diseases of the cardiovascular system. The use of Egilok helps to reduce the frequency of ventricular heart contractions with supraventricular tachycardia, ventricular extrasystole and atrial fibrillation.

Active substance

Metoprolol (Metoprolol).

Release form and composition

Available in the form of round, biconvex white tablets. They are sold in dark glass jars of 30 and 60 tablets, in cardboard packages.

Indications for use

myocardial infarction;
angina;
arterial hypertension;
heart rhythm disturbances;
migraine (in complex therapy);
hyperthyroidism (as part of complex treatment).

Contraindications

heart failure in the phase of decompensation;
SSSU;
sinoatrial blockade;
cardiogenic shock;
pronounced arterial hypotension;
angiospastic angina;
AV blockade of the second and third degree;
severe bradycardia;
persons under 18 years of age;
hypersensitivity to metoprolol and other components of the drug;
breastfeeding.

With extreme caution, it is prescribed for the following pathologies: metabolic acidosis, diabetes mellitus, bronchial asthma, obliterating peripheral vascular disease, chronic obstructive pulmonary disease, chronic renal failure, myasthenia gravis, psoriasis, depression, chronic liver failure and thyrotoxicosis.

Instructions for use Egilok (method and dosage)

Tablets are taken orally, regardless of the meal. For ease of swallowing, the tablet can be broken in half.

The dosage is selected individually in each case. The maximum daily dosage should not exceed 200 mg.

For the treatment of moderate or mild degree arterial hypertension, therapy should be started with 25-50 mg twice a day (in the morning and daytime). The dosage can be gradually increased to 100-200 mg per day or combined with other antihypertensive agents.

With angina pectoris, treatment begins with 25-50 mg 2-3 times a day. Gradually, the dosage can be increased to 200 mg per day.
After myocardial infarction for maintenance therapy, 100-200 mg is prescribed. Which are divided into two equivalent methods.
In violation of the heart rhythm, treatment should begin with 25-50 mg 2-3 times a day. Gradually, the dosage can be increased to 200 mg.
For the treatment of hyperthyroidism, 150-200 mg is prescribed in 3-4 doses.
With functional disorders of the heart, 50 mg is prescribed twice a day, if necessary, the dose can be increased to 200 mg.
For the prevention of migraine, it is necessary to take 100 mg in two doses, with the possibility of increasing to 200 mg.

Side effects

The use of tablets can cause the following side effects:

on the part of the cardiovascular system: palpitations, sinus bradycardia, orthostatic hypotension, decreased myocardial contractility, impaired myocardial conduction, cardialgia, arrhythmia, temporary aggravation of symptoms of chronic heart failure;
from the nervous system: weakness, fatigue, headache, inhibition of motor and mental reactions, depression, paresthesia in the limbs, insomnia or drowsiness, confusion, asthenic syndrome, nightmares, short-term memory impairment;
from the gastrointestinal tract: abdominal pain, dry mouth, constipation, nausea, vomiting, taste changes, hyperbilirubinemia;
from the hematopoietic system: leukopenia, agranulocytosis, thrombocytopenia;
from the side respiratory system: difficulty exhaling, nasal congestion, shortness of breath;
dermatological reactions: skin itching, urticaria, rash, exacerbation of psoriasis, increased sweating, photodermatosis, exanthema, skin flushing, reversible alopecia;
others: decreased libido and potency, weight gain, back pain, hypoglycemia, decreased vision, tinnitus, conjunctiva.

Overdose

An overdose of the drug is manifested by the following symptoms: sinus bradycardia, heart failure, lowering blood pressure, vomiting, nausea, cyanosis, coma, loss of consciousness. The first signs appear half an hour or 2 hours after an overdose.

Treatment is carried out in intensive care. Gastric lavage, activated charcoal are recommended, and symptomatic therapy is also used. Additionally, the introduction of norepinephrine or dobutamine is recommended; with convulsions - diazepam; with bronchospasm, beta2-agonists are prescribed.

Analogues

Analogues for the ATX code: Betaloc, Vasocardin, Metroprolol, Serdok, Emzok.

Drugs with a similar mechanism of action (coincidence of the ATC code of the 4th level): Atenolol Belupo.

Do not make the decision to change the drug yourself, consult your doctor.

pharmachologic effect

Egilok is an effective drug that belongs to beta1-blockers. Main active ingredient medication is metoprolol. This substance has hypotensive, antiarrhythmic and antianginal effects. By blocking beta1-adrenergic receptors, metoprolol reduces the excitatory effect of the sympathetic nervous system on the heart, and also instantly reduces blood pressure and heart rate. As for the hypotensive effect of the drug, it is quite long, since the resistance of peripheral vessels decreases gradually.

Prolonged use at high blood pressure may lead to a decrease in the mass of the left ventricle. The drug reduces cardiovascular mortality in males with moderately elevated blood pressure.
Due to a decrease in heart rate and blood pressure, it reduces the need for oxygen in the heart muscle, due to which the diastole is lengthened. This effect reduces the frequency of angina attacks and significantly improves the quality of life and physical condition of the patient.
Indications for Egilok are atrial fibrillation, supraventricular tachycardia and ventricular extrasystole. With these pathologies, the medicine helps to reduce the ventricular heart rate. Regular intake of the drug for several years leads to a decrease in blood cholesterol.

special instructions

Before starting therapy and during treatment, blood pressure and heart rate should be monitored. If the heart rate falls below 50 beats per minute, medical attention is required.
Patients with diabetes should regularly monitor their glucose levels and, if necessary, adjust the dosage of insulin.
It should be discontinued gradually, reducing the dosage over two weeks to avoid withdrawal syndrome, coronary disorders and angina pectoris.
Patients wearing contact lenses may experience decreased tear secretion.
Caution is advised when driving vehicles and in the classroom potentially dangerous species activities that require increased concentration.

During pregnancy and breastfeeding

Contraindicated during pregnancy and breastfeeding.

In childhood

Contraindicated in children and adolescents under 18 years of age.

In old age

Elderly people do not require dose adjustment.

For impaired renal function

Patients with impaired renal function do not require dosage adjustment.

For impaired liver function

With special care is prescribed for liver failure.

drug interaction

You can not combine the drug with MAO inhibitors and Verapamil, since it is possible to increase the toxicity of Egilok.
The effect of the drug is enhanced when taken in combination with other antihypertensive agents. In order to prevent arterial hypotension, blood pressure and the general condition of the patient should be constantly monitored.
When combined with antiarrhythmic drugs, cardiac glycosides, the risk of developing AV blockade and bradycardia increases.

There are contraindications. Please consult your doctor before taking.

Commercial names abroad (abroad) - Apo-Metoprolol, Azumetop, Beloc-Zok, Beloken, Betazok, Bloxan, Denex, Doplin, Emzok, Jeprolol, Lanoc, Lopressor, Mepronet, Metapro, Metblock, Metodura, Metohexal, Metolar, Metolol , Metomerck, Metopress, Metoros, Metostad, Metrol, Met-XL, Meto Zerok, Minax, Neobloc, Presolol, Prolaken, Prolomet-XL, Restopress, Ritmetol, Seloken, Selopral, Selozok, Sitelol, Spesicor, Starpress, Supermet, Toprol- XL, Vivalol, Zoticus.

All drugs used in cardiology,.

You can ask a question or leave a review about the medicine (please do not forget to indicate the name of the drug in the text of the message).

Preparations containing Metoprolol (Metoprolol, ATC code (ATC) C07AB02):

Common forms of release (more than 100 offers in Moscow pharmacies)
Name	Release form	Packing, pcs	Manufacturer country	Price in Moscow, r	Offers in Moscow
Betaloc - original	tablets 100mg	100	Sweden, Astra Zeneka	380- (medium 494↗) -565	285↗
	tablets 25mg	14	Sweden, Astra Zeneka	105-(medium 142)-312	902↗
Betaloc ZOK (Betaloc ZOK) - original (sustained release)	tablets 50mg	30	Sweden, Astra Zeneka	235- (average 286↗) -343	899↗
Betaloc ZOK (Betaloc ZOK) - original (sustained release)	tablets 100mg	30	Sweden, Astra Zeneka	329- (medium 416↗) -491	855↗
Vasocardin (Vasocardin)	tablets 50mg	50	Slovakia, Zentiva	53-(middle 69)-124	433↘
Vasocardin (Vasocardin)	tablets 100mg	50	Slovakia, Zentiva	93- (average 123↗) -152	678↗
Corvitol 50 (Corvitol 50)	tablets 50mg	50	Germany, Berlin-Chemie	82- (average 205↘) -273	450↘
Corvitol 100 (Corvitol 100)	tablets 100mg	50	Germany, Berlin-Chemie	112- (average 254↘) -343	414↘
Metozoc (Metozoc)	tablets 25mg	30	Russia, Akrikhin	94- (average 175↗) -203	112↘
Metozoc (Metozoc)	tablets 50mg	30	Russia, Akrikhin	173- (average 229↗) -261	139↘
Metocard (Metocard)	tablets 50mg	30	Poland, Polpharma	42-(medium 57)-75	400↗
Metocard (Metocard)	tablets 100mg	30	Poland, Polpharma	24-(average 73)-96	365↘
Metoprolol Acry	tablets 50mg	30	Russia, Akrikhin	15-(medium 45)-52	110↗
Metoprolol Ratiopharm	tablets 50mg	30, 50, 100	Germany, Ratiopharm	23-(middle 28)-32	241↗
Metoprolol Ratiopharm	tablets 100mg	30	Germany, Merkle	26-(middle 50)-76	404↗
Egilok (Egilok)	tablets 25mg	60	Hungary, Egis	100- (average 122) -142	950↗
Egilok (Egilok)	tablets 50mg	60	Hungary, Egis	98- (average 146↗) -170	959↗
Egilok (Egilok)	tablets 100mg	30 and 60	Hungary, Egis	for 30pcs: 96- (average 134↗) -365 for 60pcs: 131- (average 200↗) - 227	944↘
	tablets 50mg	30	Switzerland, Acino Pharma	119- (average 211↗) -327	700↘
Egilok Retard (sustained release)	tablets 100mg	30	Switzerland, Acino Pharma	110- (average 285) -330	600↘
Egilok C (Egilok C)	tablets 100mg	30	India, Intas	148-(medium 288)-361	155↘
Rare and discontinued forms of release (less than 100 offers in Moscow pharmacies)
Name	Release form	Packing, pcs	Country, company	Price in Moscow, r	Offers in Moscow
Betaloc - original	solution for intravenous injections 5 mg in 5 ml, ampoules	5	Sweden, Astra Zeneka	715- (middle 854↗) -976	74↗
Metoprolol (Metoprolol)	tablets 50mg	28, 30 and 40	Different	12-(medium 67)-86	71↘
Egilok C (Egilok C)	tablets 50mg	30	India, Intas	105- (average 198↘) -262	71↘
Vasocardin Retard (sustained release)	tablets 200mg	30	Slovakia, Zentiva	No	No
Metohexal (Metohexal)	tablets 100mg	20	Germany, Heksal	No	No
Metozoc (Metozoc)	tablets 100mg	30	Russia, Akrikhin	255-(medium 326)-419	48↘
Metocard retard (Metocard Retard)	tablets 200mg	30	Poland, Polpharma	No	No
Metokor Adifarm	solution for intravenous injections 1mg/ml 5ml	10	Bulgaria, Adifarm	729-730	4↗
Metolol (Metolol)	tablets 50mg	30	Austria, Merkle	No	No
Metolol (Metolol)	tablets 100mg	10	Austria, Merkle	No	No
metoprolol	tablets 25mg	60	Russia, Ozon	43-(medium 59)-86	15↗
Metoprolol (Metoprolol)	tablets 100mg	30 and 50	Serbia, Hemofarm	26- (middle 74) -111	83↗
Metoprolol Organic	tablets 25mg	60	Russia, Organika OAO	43-(medium 56)-68	18↗
Metoprolol Organic	tablets 50mg	30 and 60	Russia, Organika OAO	18-86	9↗
Egilok C (Egilok C)	tablets 25mg	30	India, Intas	112- (average 167) -299	73↗
Egilok C (Egilok C)	tablets 200mg	30	India, Intas	238-(medium 281)-317	32↗
Serdol	tablets 50mg	30	Romania, Labormed	No	No

Betaloc ZOK (original sustained release metoprolol) - official instructions for use. Prescription drug, information intended for healthcare professionals only!

Clinico-pharmacological group:

Beta1 blocker

pharmachologic effect

Cardioselective beta1-blocker without internal sympathomimetic activity. It has a slight membrane-stabilizing effect. It has antihypertensive, antianginal and antiarrhythmic effects. It suppresses the stimulating effect of catecholamines on the heart during physical and psycho-emotional stress: it prevents an increase in heart rate, an increase in blood pressure, reduces the cardiac output and reduces myocardial contractility.

Due to the peculiarities of the dosage form, a constant plasma concentration of metoprolol is maintained and a stable clinical effect of the drug is ensured for 24 hours. Due to the absence of peaks in plasma concentration, clinically Betaloc® ZOK is characterized by better beta1-selectivity compared to the traditionally used tablet forms of metoprolol. Besides, in to a large extent the potential risk of side effects observed at peak plasma concentrations of the drug (for example, bradycardia or weakness in the legs when walking) is reduced.

When used in medium therapeutic doses, Betaloc® ZOK has a less pronounced effect on the smooth muscles of the bronchi than non-selective beta-blockers. If necessary, Betaloc® ZOK in combination with beta2-agonists can be prescribed to patients with obstructive pulmonary disease.

Betaloc® ZOK has a lesser effect on insulin secretion and carbohydrate metabolism and on the activity of the cardiovascular system in conditions of hypoglycemia compared with non-selective beta-blockers.

The use of the drug Betaloc® ZOK in arterial hypertension leads to a significant decrease in blood pressure for more than 24 hours (in the supine position, standing, during exercise). At the beginning of therapy with metoprolol, an increase in OPSS is noted. At long-term use a decrease in blood pressure is possible due to a decrease in OPSS with a constant cardiac output.

In MERIT-HF, a survival study in chronic heart failure (NYHA functional class II-IV) with reduced ejection fraction (≥ 40%), including 3991 patients, Betaloc® ZOK showed an increase in survival and a decrease in the frequency of hospitalization. At long-term treatment patients achieved a general improvement in well-being, a decrease in the severity of symptoms (according to the NYHA functional classes). Also, therapy with Betaloc® ZOK showed an increase in the left ventricular ejection fraction, a decrease in the end systolic and end diastolic volumes of the left ventricle.

The quality of life during treatment with Betaloc® ZOK does not deteriorate or improves. An improvement in the quality of life during treatment with Betaloc® ZOK was observed in patients after myocardial infarction.

Pharmacokinetics

Suction and distribution

After oral administration, metoprolol is completely absorbed from the gastrointestinal tract.

The release rate of the active substance depends on the acidity of the medium. After taking a Betaloc® ZOK tablet (metoprolol sustained release dosage form), the duration of the therapeutic effect is more than 24 hours, while a constant release rate of the active substance is achieved for 20 hours.

Bioavailability after a single dose of a single dose is approximately 30-40%. The binding of metoprolol to plasma proteins is low - about 5-10%.

Metabolism

Metoprolol is biotransformed in the liver by oxidation. The three main metabolites of metoprolol did not show a clinically significant beta-blocking effect.

breeding

T1 / 2 averages 3.5 hours. About 5% of the oral dose of the drug is excreted in the urine unchanged, the rest of the drug is excreted as metabolites.

Indications for use of the drug BETALOK® ZOK

arterial hypertension;
angina;
stable symptomatic chronic heart failure with impaired systolic function left ventricle (as adjuvant therapy to the main treatment of heart failure);
maintenance treatment after the acute phase of myocardial infarction (to reduce mortality and re-infarction);
cardiac arrhythmias (including supraventricular tachycardia), as well as to reduce the frequency of ventricular contractions during atrial fibrillation and ventricular extrasystoles;
functional disorders of cardiac activity, accompanied by tachycardia;
prevention of migraine attacks.

Dosing regimen

When selecting a dose, it is necessary to avoid the development of bradycardia.

With arterial hypertension, the initial dose is 50-100 mg 1 time per day. In the absence of a clinical effect, the dose can be increased to 100 mg 1 time per day or Betaloc® ZOK can be used in combination with other antihypertensive drugs (preferably a diuretic and a calcium channel blocker, a dihydropyridine derivative).

With angina pectoris, the average therapeutic dose is 100-200 mg 1 time per day. If necessary, Betaloc® ZOK can be used in combination with other antianginal drugs.

With stable symptomatic chronic heart failure with impaired systolic function of the left ventricle, Betaloc® ZOK can be prescribed to patients who have not had exacerbation episodes in the last 6 weeks and have not had any changes in the main therapy in the last 2 weeks. Therapy of heart failure with beta-blockers can sometimes lead to a temporary worsening of the symptomatic picture. In some cases, it is possible to continue therapy or reduce the dose, and in some cases it may be necessary to discontinue the drug.

With stable chronic heart failure of functional class II, the recommended initial dose for the first 2 weeks is 25 mg 1 time per day. After 2 weeks, the dose may be increased to 50 mg once daily and then doubled every 2 weeks. The maintenance dose for long-term treatment is 200 mg once a day.

With stable chronic heart failure III and IV functional classes, the recommended initial dose for the first 2 weeks is 12.5 mg 1 time per day. The dose is selected individually. During the period of increasing the dose, the patient should be monitored, because. in some patients, symptoms of heart failure may worsen. After 1-2 weeks, the dose can be increased to 25 mg 1 time per day, then after another 2 weeks - up to 50 mg 1 time per day. If well tolerated, the dose can be doubled every 2 weeks until maximum dose 200 mg 1 time per day.

In case of arterial hypotension and / or bradycardia, it may be necessary to reduce concomitant therapy or reduce the dose of Betaloc ZOK. Arterial hypotension at the beginning of therapy does not necessarily indicate that given dose Betaloca ZOK will not be tolerated with further long-term treatment. However, doses should not be increased until the condition has stabilized. Monitoring of kidney function may also be required.

For maintenance treatment after myocardial infarction, the drug is prescribed 200 mg 1 time per day.

With cardiac arrhythmias, the drug is prescribed 100-200 mg 1 time per day.

With functional disorders of cardiac activity, accompanied by tachycardia, the dose is 100 mg 1 time per day, if necessary, the dose can be increased to 200 mg per day.

For the prevention of migraine, 100-200 mg is prescribed once a day.

Betaloc® ZOK is intended for daily intake 1 time per day (preferably in the morning). Betaloc ZOK tablet should be swallowed with liquid. Tablets can be divided in half, but should not be chewed or crushed.

When prescribing the drug to patients with impaired renal function or the elderly, there is no need to adjust the dosing regimen.

Side effect

The following criteria were used to assess the incidence of cases: very often (> 10%), often (1-9.9%), sometimes (0.1-0.9%), rarely (0.01-0.09%), very rarely (< 0.01%).

From the side of the cardiovascular system: often - bradycardia, orthostatic arterial hypotension (very rarely accompanied by fainting), cold extremities, palpitations; sometimes - a temporary increase in symptoms of heart failure, AV blockade of the first degree, cardiogenic shock in patients with acute myocardial infarction; rarely - other conduction disorders, arrhythmias; very rarely - gangrene (in patients with severe peripheral circulatory disorders).

From the side of the central nervous system and peripheral nervous system: very often - fatigue; often - dizziness, headache; sometimes - paresthesia, muscle cramps, depression, decreased ability to concentrate, drowsiness or insomnia, nightmares; rarely - nervousness, anxiety; very rarely - memory impairment, amnesia, depression, hallucinations.

From the digestive system: often - nausea, pain in the abdomen, diarrhea, constipation; sometimes - vomiting; rarely - dry mouth, abnormal liver function; very rarely - hepatitis.

From the hemopoietic system: very rarely - thrombocytopenia.

From the respiratory system: often - shortness of breath during physical exertion; sometimes - bronchospasm; rarely - rhinitis.

From the musculoskeletal system: very rarely - arthralgia.

From the sensory organs: rarely - dryness and / or irritation of the eyes, conjunctivitis, blurred vision; very rarely - ringing in the ears, taste disturbances.

Dermatological reactions: sometimes - a rash (in the form of urticaria), increased sweating; rarely - hair loss; very rarely - photosensitivity, exacerbation of psoriasis.

Other: sometimes - weight gain; rarely - impotence, sexual dysfunction.

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

Contraindications to the use of the drug BETALOC® ZOK

AV block II and III degree;
chronic heart failure in the stage of decompensation (pulmonary edema, hypoperfusion syndrome or hypotension);
long-term or intermittent therapy with inotropic agents aimed at stimulating β-adrenergic receptors;
clinically significant sinus bradycardia;
SSSU;
cardiogenic shock;
arterial hypotension;
severe impairment of peripheral arterial circulation(including with the threat of gangrene);
patients with suspected acute myocardial infarction with a heart rate of less than 45 bpm, a PQ interval of more than 0.24 s, or a systolic blood pressure of less than 100 mm Hg;
patients who are prescribed intravenous calcium channel blockers (like verapamil);
children's and adolescence up to 18 years (efficacy and safety of the drug have not been established);
hypersensitivity to the components of the drug;
hypersensitivity to other beta-blockers.

Use the drug with caution in AV blockade of the 1st degree, Prinzmetal's angina, bronchial asthma, COPD, diabetes, severe renal failure, metabolic acidosis, co-administration with cardiac glycosides.

Use of BETALOC® ZOK during pregnancy and breastfeeding

Like most drugs, Betaloc® ZOK should not be prescribed during pregnancy and during breastfeeding, unless the expected benefit to the mother outweighs the potential risk to the fetus and / or child.

Like other antihypertensive agents, beta-blockers can cause side effects, such as bradycardia in the fetus, newborn or breast-fed children. The amount of metoprolol released into breast milk, and beta-blocking effects in a breastfed child (when the mother takes metoprolol in therapeutic doses) are insignificant.

Application for violations of liver function

When prescribing the drug to patients with severe hepatic impairment (for example, in patients with severe cirrhosis or porto-caval anastomosis), a dose reduction may be required.

Application for violations of kidney function

Caution should be exercised when prescribing the drug to patients with severe renal insufficiency.

special instructions

Patients with obstructive pulmonary disease are not recommended to prescribe beta-blockers. At poor tolerance or the ineffectiveness of other antihypertensive agents, metoprolol can be prescribed, since it is a selective drug. The minimum effective dose should be prescribed, if necessary, a beta2-agonist may be prescribed.

When using beta1-blockers, the risk of affecting carbohydrate metabolism or the possibility of masking the symptoms of hypoglycemia is much less than when using non-selective beta-blockers.

In patients with chronic heart failure in the stage of decompensation, before the appointment of Betaloc® ZOK, it is necessary to achieve compensation and maintain it during treatment with the drug.

Very rarely, during therapy with Betaloc ZOK in patients with impaired conduction, the condition may worsen up to AV blockade. If bradycardia develops during treatment, the dose of the drug should be reduced or the drug should be gradually discontinued.

During the period of use of the drug, it is possible to increase the symptoms of impaired peripheral arterial circulation, mainly due to a decrease in blood pressure.

If it is necessary to prescribe Betaloc ZOK to patients with pheochromocytoma, alpha-blockers should be prescribed simultaneously.

Caution should be exercised when prescribing the drug to patients with severe renal insufficiency, with metabolic acidosis, co-administration with cardiac glycosides.

Data clinical research in terms of efficacy and safety in patients with severe stable heart failure (NYHA functional class IV) are limited. These patients should be treated by physicians with special knowledge and experience.

Patients with heart failure in combination with acute myocardial infarction and unstable angina pectoris were excluded from studies on the basis of which indications were determined for the appointment. The efficacy and safety of the drug for this group of patients has not been described. Use in unstable and decompensated heart failure is contraindicated.

Avoid abrupt discontinuation of the drug. Cancellation of the drug should be carried out gradually, within 2 weeks. The dose is reduced gradually, in several doses, until the final dose is reached - 25 mg 1 time per day.

If surgical intervention is necessary, the anesthesiologist should be warned about the therapy being carried out in order to select an anesthetic agent with a minimal negative inotropic effect, however, drug withdrawal before surgery is not recommended.

It should be borne in mind that in patients taking beta-blockers, anaphylactic shock runs more difficult.

Pediatric use

Experience with Betaloc ZOK in children is limited. The appointment of the drug in this category of patients is contraindicated.

Influence on the ability to drive vehicles and control mechanisms

When driving vehicles and engaging in potentially hazardous activities that require heightened attention and the speed of psychomotor reactions, it should be borne in mind that when taking Betaloc® ZOK, dizziness and fatigue may occur.

Overdose

Metoprolol at a dose of 7.5 g in an adult caused intoxication with a fatal outcome. A 5-year-old child who took 100 mg of metoprolol showed no signs of intoxication after gastric lavage. Reception of 450 mg of metoprolol by a teenager of 12 years old led to moderate intoxication. Ingestion of 1.4 g and 2.5 g of metoprolol by adults caused moderate and severe intoxication, respectively. Reception of 7.5 g for adults led to extremely severe intoxication.

Symptoms: the most serious are the symptoms of the cardiovascular system, but sometimes, especially in children and adolescents, symptoms from the central nervous system and suppression of pulmonary function, bradycardia, AV block I-III degree, asystole, marked decrease in blood pressure, weak peripheral perfusion, heart failure, cardiogenic shock, pulmonary depression, apnea, increased fatigue, disturbance and loss of consciousness, tremor, convulsions, increased sweating, paresthesia, bronchospasm, nausea, vomiting, esophageal spasm, hypoglycemia (especially in children) or hyperglycemia, hyperkalemia; effects on the kidneys; transient myasthenic syndrome.

Concomitant use of alcohol, antihypertensive drugs, quinidine or barbiturates may worsen the patient's condition. The first signs of an overdose can be observed 20 minutes to 2 hours after taking the drug.

Treatment: taking activated charcoal, if necessary - gastric lavage.

Atropine at a dose of 0.25-0.5 mg IV for adults and 10-20 mcg/kg for children should be given before gastric lavage (due to the risk of vagus nerve stimulation).

If necessary, maintain patency respiratory tract IVL is performed. Terbutaline can be used by injection or inhalation to relieve bronchospasm.

It is necessary to replenish the BCC, conduct an infusion of glucose. Atropine 1.0-2.0 mg IV, if necessary, repeat the introduction (especially with vagal symptoms). ECG control.

In case of myocardial depression infusion administration dobutamine or dopamine. You can use glucagon 50-150 mcg / kg IV with an interval of 1 min. In some cases, the addition of epinephrine to therapy may be effective.

With arrhythmia and an expanded ventricular (QRS) complex, sodium solutions (chloride or bicarbonate) are infused. It is possible to install an artificial pacemaker.

Cardiac arrest due to an overdose may require resuscitation for several hours.

Symptomatic treatment is carried out.

drug interaction

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

Combinations to avoid

Barbituric acid derivatives: barbiturates increase the metabolism of metoprolol due to enzyme induction (the study was conducted with phenobarbital).

Propafenone: when prescribing propafenone to 4 patients treated with metoprolol, there was an increase in the concentration of metoprolol in the blood plasma by 2-5 times, while 2 patients had side effects characteristic of metoprolol. This interaction was confirmed in a study on 8 volunteers. Probably, the interaction is due to inhibition by propafenone, like quinidine, of the metabolism of metoprolol through the CYP2D6 isoenzyme. Taking into account the fact that propafenone has the properties of a beta-blocker, the co-administration of metoprolol and propafenone does not seem appropriate.

Verapamil: The combination of beta-blockers (atenolol, propranolol and pindolol) and verapamil can cause bradycardia and lead to a decrease in blood pressure. Verapamil and beta-blockers have complementary inhibitory effects on AV conduction and function sinus node.

Combinations that may require dose adjustment of Betaloc® ZOK

Class I antiarrhythmic drugs: when combined with beta-blockers, a negative inotropic effect may accumulate, resulting in serious hemodynamic side effects in patients with impaired left ventricular function. This combination should also be avoided in patients with SSS and AV conduction disturbance. The interaction is described on the example of disopyramide.

Amiodarone: Co-administration with metoprolol may result in severe sinus bradycardia. Taking into account the extremely long T1 / 2 amiodarone (50 days), one should take into account possible interaction after a long time after the abolition of amiodarone.

Diltiazem: Diltiazem and beta-blockers mutually reinforce the inhibitory effect on AV conduction and sinus node function. When metoprolol was combined with diltiazem, there were cases of severe bradycardia.

NSAIDs: NSAIDs weaken the antihypertensive effect of beta-blockers. This interaction has been reported in combination with indomethacin and probably will not be observed in combination with sulindac. negative interaction has been noted in studies with diclofenac.

Diphenhydramine: diphenhydramine reduces the biotransformation of metoprolol to?-hydroxymetoprolol by 2.5 times. At the same time, there is an increase in the action of metoprolol.

Epinephrine (adrenaline): 10 cases of severe hypertension and bradycardia have been reported in patients taking non-selective beta-blockers (including pindolol and propranolol) and receiving epinephrine. The interaction was also noted in the group of healthy volunteers. It is assumed that similar reactions can be observed when epinephrine is used together with local anesthetics in case of accidental ingestion. vascular bed. This risk appears to be much lower with cardioselective beta-blockers.

Phenylpropanolamine: Phenylpropanolamine (norephedrine) in a single dose of 50 mg can increase diastolic blood pressure to pathological values in healthy volunteers. Propranolol mainly prevents the increase in blood pressure caused by phenylpropanolamine. However, beta-blockers can cause reactions of parodox arterial hypertension in patients receiving high doses of phenylpropanolamine. Several cases have been reported hypertensive crisis while taking phenylpropanolamine.

Quinidine: Quinidine inhibits the metabolism of metoprolol in a special group of patients with rapid hydroxylation (approximately 90% of the population in Sweden), causing mainly a significant increase in the plasma concentration of metoprolol and increased blockade of β-adrenergic receptors. It is believed that a similar interaction is also characteristic of other beta-blockers, in the metabolism of which the CYP2D6 isoenzyme is involved.

Clonidine: Hypertensive reactions with abrupt withdrawal of clonidine may be exacerbated by concomitant use of beta-blockers. When used together, if it is necessary to cancel clonidine, discontinuation of beta-blockers should begin a few days before clonidine is discontinued.

Rifampicin: Rifampicin may increase the metabolism of metoprolol, decreasing its plasma concentration. Patients simultaneously taking metoprolol and other beta-blockers (eye drops) or MAO inhibitors should be closely monitored.

Against the background of taking beta-blockers, inhalation anesthetics increase the cardiodepressive effect.

Against the background of taking beta-blockers, patients receiving oral hypoglycemic agents may require dose adjustment of the latter.

The plasma concentration of metoprolol may increase when taking cimetidine or hydralazine.

Cardiac glycosides, when used together with beta-blockers, can increase AV conduction time and cause bradycardia.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

The drug should be stored out of the reach of children at temperatures above 30°C. Shelf life - 3 years.

Dosing regimen of the drug Egilok with a normal release rate:

With arterial hypertension, a daily dose of 50-100 mg per day is prescribed in 1 or 2 doses (morning and evening). With insufficient therapeutic effect, a gradual increase in the daily dose to 100-200 mg is possible.

With angina pectoris, supraventricular arrhythmias, for the prevention of migraine attacks, a dose of 100-200 mg per day is prescribed in 2 divided doses (morning and evening).

For secondary prevention myocardial infarction is prescribed in an average daily dose of 200 mg in 2 divided doses (morning and evening).

With functional disorders of cardiac activity, accompanied by tachycardia, a daily dose of 100 mg is prescribed in 2 divided doses (morning and evening).

In elderly patients, patients with impaired renal function, and if hemodialysis is necessary, changes in the dosing regimen are not required.

In patients with severe liver dysfunction, the drug should be used in smaller doses, due to a slowdown in the metabolism of metoprolol.

Tablets should be taken orally during or immediately after a meal. Tablets can be divided in half, but not chewed.

Selective blocker of β-adrenergic receptors, has antianginal, antihypertensive and antiarrhythmic effects, reduces the automatism of the sinus node, inhibits AV conduction, reduces myocardial inotropic function and heart rate. The antihypertensive effect stabilizes at the end of the 2nd week of the drug. Reduces the number of angina attacks, reduces myocardial oxygen demand, increases exercise tolerance. In myocardial infarction, it limits the zone of ischemia of the heart muscle and prevents heart rhythm disturbance. The main advantage of the drug Egilok Retard (prolonged-release tablets) is the prolonged release of metoprolol. Therapeutic effect noted at a significantly lower concentration of metoprolol in the blood than when taking metoprolol in regular forms tablets. Therefore, it is enough to prescribe 1 tablet per day of Egilok Retard to achieve a clinical effect.
The drug is rapidly and completely absorbed from the gastrointestinal tract (95% of the dose). The absorption of metoprolol in the retard form is significantly prolonged, which leads to a uniform concentration of the drug Egilok Retard in the blood plasma and a relative bioavailability of 80% compared with the graph of the change in the content of the drug in the blood after the administration of immediate release metoprolol. Peak plasma concentration is reached 1.5 hours after oral intake and after 2-6 hours - the drug in the form of a retard. Plasma protein binding - 12%. The volume of distribution is 5.6 l/kg of body weight. Metoprolol is metabolized in the liver, its metabolites do not show activity. About 5% of the dose is excreted unchanged in the urine.

Indications for use of the drug Egilok

AG (arterial hypertension);
CAD: stable or unstable angina(with the exception of Prinzmetal's angina);
heart failure;
heart rhythm disturbances (sinus, supraventricular tachycardia; ventricular extrasystole);
arrhythmia due to prolapse mitral valve;
secondary prevention after myocardial infarction;
functional disorders of cardiac activity, accompanied by tachycardia;
hyperthyroidism;
prevention of migraine attacks.

The use of the drug Egilok

With hypertension (arterial hypertension), the initial dose of Egilok Retard is 50 mg / day in 1 dose. daily dose can be gradually increased to 100-200 mg in 1 dose. Egilok Retard can be used with other antihypertensive drugs to increase the hypotensive effect.
For the treatment of angina pectoris, the dose is 50 mg 1 time per day, with further dose titration to the clinically optimal. If necessary, the dose can be increased to 100-200 mg in 1 dose. Egilok Retard can be used with other antianginal drugs.
In heart failure, the initial dose is 25 mg / day. If necessary, every 2 weeks the dose can be increased to 50 mg, after another 2 weeks - up to 100 mg, if necessary, after 2 weeks to 200 mg.
With arrhythmia, the initial dose is 50-200 mg / day in 1 dose.
After myocardial infarction, for the purpose of its secondary prevention, the dose is selected individually under the control of heart rate and blood pressure.
For the prevention of migraine attacks, the usual dose is 100-200 mg / day in 1 dose. Tablets are taken 1 time per day (in the morning), without chewing and drinking plenty of liquid.
The drug can also be taken with food or on an empty stomach.

Contraindications to the use of the drug Egilok

G hypersensitivity to metoprolol or other components of the drug; AV block II-III degree, severe sinus bradycardia (HR ≤50 bpm), arterial hypotension, acute decompensated heart failure, severe peripheral circulatory disorders; cardiogenic shock, severe peripheral circulatory disorders, asthma, sick sinus syndrome.

Side effects of the drug Egilok

Decreased heart rate, blood pressure. There may also be a violation of AV conduction, symptoms of heart failure, depression. There may be such side effects like fatigue, headache, dizziness, sleep disturbance. In many cases, these phenomena are temporary and disappear on their own with a decrease in the dose of the drug.
Rarely, nonspecific skin reactions and cold extremities, vomiting, diarrhea, constipation, bronchospasm, thrombocytopenia, and liver dysfunction occur.
If you experience any other side effects that are not listed in the instructions, you must inform your doctor.

Special instructions for the use of the drug Egilok

The drug should be used with caution in the treatment of patients with diabetes mellitus, with diseases peripheral arteries, pheochromocytoma (it is possible to use the drug Egilok Retard only in combination with α-adrenergic receptor blockers), impaired renal and hepatic function. Before starting treatment, it is necessary to determine the function of the liver and kidneys. End therapy with Egilok Retard should be gradual. Sudden discontinuation of treatment, especially if cardiovascular pathology, may lead to deterioration of the condition (withdrawal syndrome).
The use of Egilok Retard may cause fatigue or slight dizziness. Therefore, during the period of treatment, it is necessary to refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.
If the patient seeks medical help or the need for surgical treatment, it is imperative to warn the doctor about the patient taking the drug Egilok Retard.
The appointment of the drug Egilok Retard during pregnancy and lactation is possible if the potential benefit to the mother outweighs the risk to the child.

Interactions of the drug Egilok

Caution is necessary when using the drug simultaneously with:

verapamil and diltiazem - the risk of hypotension, bradycardia, atrioventricular blockade, asystole;
clonidine - taking clonidine must be completed a few days after the end of metoprolol in order to avoid the development of a withdrawal syndrome;
narcotic drugs - the risk of developing a cardiodepressive effect;
ergotamine - increases the vasoconstrictor effect);
some drugs that affect the central nervous system: sleeping pills - bromazepam, lorazepam;
tranquilizers - chlordiazepoxide, trimetacin, tofisopam;
tri- and tetracyclic antidepressants - citalopram, moclobemide;
neuroleptics - chlorpromazine, triflupromazine - and alcohol - the risk of arterial hypotension, the effect on the central nervous system;
NSAIDs, such as indomethacin - it is possible to reduce the antihypertensive effect of metoprolol;
estrogen, such as norethindrone, norgestrel - the antihypertensive effect of metoprolol is reduced;
hypoglycemic by oral means, for example, chlorpropamide, glibenclamide, tolbutamide and insulin - enhancing their hypoglycemic effect, masking the symptoms of hypoglycemia;
curare-like muscle relaxants - increased neuromuscular blockade;
H2 receptor antagonists, such as cimetidine - it is possible to increase the bioavailability of the drug);
rifampicin, barbiturates, such as phenobarbital, secobarbital, pentobarbital - it is possible to reduce the antihypertensive effect of metoprolol.

Particular caution is required when used with ganglioblocking drugs and other β-adrenergic blockers, sympathomimetics, antiarrhythmic drugs I class.

Overdose of the drug Egilok, symptoms and treatment

Symptoms: arterial hypotension, sinus bradycardia, AV blockade, heart failure, cardiogenic shock, asystole, nausea, vomiting, cyanosis, bronchospasm, loss of consciousness, coma.
Treatment: gastric lavage, activated charcoal, in severe hypotension - β-adrenergic agonists (norepinephrine) or intravenous atropine (with bradycardia). If there is no effect, dopamine, dobutamine should be prescribed. Glucagon (1-10 mg) may be effective. In severe cases, implantation of an artificial pacemaker may be necessary. Bronchospasm is eliminated by the introduction of intravenous β2-adrenergic agonists. Metoprolol is practically not excreted from the body by hemodialysis.

Storage conditions of the drug Egilok

At a temperature of 15-25 °C.

List of pharmacies where you can buy Egilok:

Saint Petersburg

International name

Metoprolol (Metoprolol)

Group affiliation

Selective beta1-blocker

Dosage form

Tablets, long-acting tablets, long-acting enteric coated tablets, long-acting tablets

pharmachologic effect

Cardioselective beta1-blocker. It does not have a membrane-stabilizing effect and does not have an internal CMA. It has hypotensive, antiangial and antiarrhythmic effects.

By blocking beta1-adrenergic receptors of the heart in low doses, it reduces the formation of cAMP from ATP stimulated by catecholamines, reduces intracellular Ca2+ current, has a negative chrono-, dromo-, batmo- and inotropic effect (slows heart rate, inhibits conductivity and excitability, reduces myocardial contractility).

OPSS at the beginning of the use of beta-blockers (in the first 24 hours after oral administration) increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors and the elimination of stimulation of beta2-adrenergic receptors), which after 1-3 days returns to the original, and decreases with long-term administration.

The hypotensive effect is due to a decrease in the IOC and renin synthesis, inhibition of the activity of the renin-angiotensin system (it is more important in patients with initial renin hypersecretion) and the central nervous system, restoration of the sensitivity of baroreceptors of the aortic arch (there is no increase in their activity in response to a decrease in blood pressure) and, as a result, a decrease in peripheral sympathetic influences. Reduces high blood pressure at rest, during physical exertion and stress. The hypotensive effect develops quickly (systolic blood pressure decreases after 15 minutes, maximum - after 2 hours) and lasts for 6 hours, diastolic blood pressure changes more slowly: a stable decrease is observed after several weeks of regular intake.

The antianginal effect is determined by a decrease in myocardial oxygen demand as a result of a decrease in heart rate (lengthening of diastole and improvement in myocardial perfusion) and contractility, as well as a decrease in myocardial sensitivity to the effects of sympathetic innervation. Reduces the number and severity of angina attacks and increases exercise tolerance. By increasing the end-diastolic pressure in the left ventricle and increasing the stretching of the muscle fibers of the ventricles, it can increase the need for oxygen, especially in patients with CHF.

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity sympathetic nervous system, increased levels of cAMP, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and a slowdown in AV conduction (mainly in the antegrade and, to a lesser extent, in the retrograde directions through the AV node) and along additional pathways.

With supraventricular tachycardia, atrial fibrillation, sinus tachycardia with functional diseases heart and thyrotoxicosis slows the heart rate or may even lead to the restoration of sinus rhythm.

Prevents the development of migraine.

Unlike non-selective beta-blockers, when administered in medium therapeutic doses, it has a less pronounced effect on organs containing beta2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism; the severity of the atherogenic action does not differ from the action of propranolol. With long-term use, it reduces the concentration of cholesterol in the blood. When used in large doses(more than 100 mg / day) has a blocking effect on both subtypes of beta-adrenergic receptors.

With intravenous infusion of metoprolol tartrate for 10 minutes or more maximum action develops after 20 minutes, the decrease in heart rate at doses of 5 and 10 mg is 10 and 15%, respectively.

Indications

IHD, exertional angina, unstable angina, myocardial infarction (acute phase, as well as secondary prevention).

Arterial hypertension, hypertensive crisis.

CHF (compensated) in combination with diuretics, ACE inhibitors and cardiac glycosides.

Rhythm disturbances (including with general anesthesia) - sinus tachycardia, ventricular and supraventricular arrhythmias (including supraventricular tachycardia, atrial fibrillation, atrial flutter, atrial tachycardia, tachyarrhythmias caused by digitalis, catecholamines, ventricular extrasystoles, arrhythmias against the background of prolapse of the congenital mitral valve), congenital mitral valve syndrome .

thyrotoxicosis ( complex therapy), withdrawal syndrome, migraine (prevention), tremor (essential, senile), anxiety (auxiliary treatment), akathisia on the background of antipsychotics.

Contraindications

Hypersensitivity, cardiogenic shock, AV block II-III stage, SA block, SSSU, sinus bradycardia (HR less than 50/min), acute HF or decompensated CHF, Prinzmetal's angina, arterial hypotension, acute myocardial infarction (P-Q more than 0.24 s or systolic BP less than 100 mm Hg); lactation period, concomitant use of MAO inhibitors or simultaneous intravenous administration of verapamil. C with caution. Diabetes mellitus, metabolic acidosis, bronchial asthma, COPD (pulmonary emphysema, chronic obstructive bronchitis), liver failure, chronic renal failure, myasthenia gravis, pheochromocytoma, thyrotoxicosis, depression (including history), psoriasis, obliterating peripheral vascular disease ("intermittent" claudication, Raynaud's syndrome), pregnancy, childhood (efficacy and safety have not been determined ), elderly age.

Side effects

From the nervous system: increased fatigue, weakness, headache, slowing down the rate of mental and motor reactions. Rare: paresthesias in the extremities (in patients with "intermittent" claudication and Raynaud's syndrome), tremor, convulsions, depression, anxiety, decreased attention, drowsiness, insomnia, "nightmares" dreams, confusion or momentary loss memory, hallucinations, asthenia, myasthenia gravis.

From the sensory organs: rarely - decreased vision, decreased secretion of lacrimal fluid, dryness and soreness of the eyes, conjunctivitis, tinnitus, hearing loss.

From the CCC: sinus bradycardia, decreased blood pressure, orthostatic hypotension (dizziness, sometimes loss of consciousness). Rarely - a decrease in myocardial contractility, development (aggravation) of CHF (edema, swelling of the feet and / or lower legs, shortness of breath), cardiac arrhythmias, angiospasm manifestation (increased peripheral circulatory disorders, cooling lower extremities, Raynaud's syndrome), myocardial conduction disturbance, cardialgia. Very rarely - aggravation of pre-existing AV conduction disorders.

On the part of the digestive system: nausea, vomiting, abdominal pain, dry mouth, constipation or diarrhea, in some cases - impaired liver function (dark urine, yellowness of the sclera or skin, cholestasis), changes in taste.

From the side skin: skin rash (exacerbation of psoriasis), psoriasis-like skin reactions, skin flushing, exanthema, photodermatosis, increased sweating, reversible alopecia.

From the respiratory system: nasal congestion, bronchospasm when administered in high doses (loss of selectivity and / or in predisposed patients), shortness of breath.

From the side endocrine system: hyperglycemia (in patients with non-insulin-dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), hypothyroid state.

Allergic reactions: urticaria, pruritus, rash.

Laboratory indicators: thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia, increased activity of "liver" enzymes, hyperbilirubinemia.

Effect on the fetus: intrauterine delay growth, hypoglycemia, bradycardia.

Other: pain in the back or joints, weight gain, decreased libido and / or potency, with a sharp cessation of treatment - "withdrawal" syndrome (increased angina attacks, increased blood pressure).

Application and dosage

Inside, with a meal or immediately after a meal, the tablets can be divided in half, but not chewed and washed down with liquid, for dosage forms prolonged action - swallow whole, do not crush, do not break (except for metoprolol succinate and tartrate), do not chew.

With arterial hypertension average dose- 100-150 mg / day in 1-2 doses, if necessary - 200 mg / day.

With angina - 50 mg 2-3 times a day.

With hyperkinetic cardiac syndrome (including thyrotoxicosis) - 50 mg 1-2 times a day.

With tachyarrhythmia - 50 mg 2-3 times a day, if necessary - 200-300 mg / day.

Secondary prevention of myocardial infarction - 200 mg / day.

Prevention of migraine - 100-200 mg / day in 2-4 doses.

For the relief of paroxysmal supraventricular tachycardia, it is administered parenterally, in a hospital setting. Enter slowly, a dose of 2-5 mg (1-2 mg / min). If there is no effect, the administration can be repeated after 5 minutes. Increasing the dose above 15 mg usually does not lead to a greater severity of action. After stopping the attack of arrhythmia, patients are transferred to oral administration at a dose of 50 mg 4 times a day, with the first dose being taken 15 minutes after the cessation of intravenous administration.

IN acute stage myocardial infarction, immediately after hospitalization of the patient (with constant monitoring of hemodynamics: ECG, heart rate, AV conduction, blood pressure), a bolus of 5 mg should be administered intravenously, repeated every 2 minutes until a total dose of 15 mg is reached. With good tolerance after 15 minutes - inside, 25-50 mg every 6 hours, for 2 days. In patients who have not tolerated the full intravenous dose, oral administration should be initiated starting with half the dose. Maintenance therapy continues at doses of 200 mg / day (for 2 doses), for 3 months-3 years.

Renal failure does not require dose adjustment. In liver failure, it is advisable to prescribe other beta-blockers that are not metabolized in the liver.

special instructions

Monitoring of patients taking beta-blockers includes monitoring heart rate and blood pressure (at the beginning of admission - daily, then 1 time in 3-4 months), blood glucose concentration in diabetic patients (1 time in 4-5 months). The patient should be taught how to calculate heart rate and instruct about the need for a medical consultation if the heart rate is less than 50/min.

It is possible to increase the severity of allergic reactions (against the background of aggravated allergic history) and the lack of effect from the introduction usual doses epinephrine.

In elderly patients, it is recommended to monitor kidney function (1 time in 4-5 months). May exacerbate symptoms of peripheral arterial circulatory disorders. Patients with cardiac arrhythmias whose systolic blood pressure is less than 100 mm Hg should be administered intravenously only if special precautions are observed (there is a risk of further reduction in blood pressure). Cancellation of the drug is carried out gradually, reducing the dose within 10 days.

With arterial hypertension, the effect occurs after 2-5 days, a stable effect is noted after 1-2 months.

With angina pectoris, the selected dose of the drug should provide heart rate at rest in the range of 55-60 beats / min, with exercise - no more than 110 beats / min. In "smokers" the effectiveness of beta-blockers is lower.

At combination therapy with clonidine, the latter should be discontinued a few days after the abolition of metoprolol, in order to avoid a hypertensive crisis. At a dose above 200 mg / day, cardioselectivity decreases.

Metoprolol may mask some clinical manifestations thyrotoxicosis (eg tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated, as it can exacerbate symptoms.

In diabetes, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentration to normal levels.

If it is necessary to prescribe to patients with bronchial asthma, beta2-agonists are used as concomitant therapy; with pheochromocytoma - alpha-blockers.

If it is necessary to perform a surgical intervention, it is necessary to warn the anesthesiologist about the therapy being carried out (the choice of drugs for general anesthesia with a minimal negative inotropic effect), drug withdrawal is not recommended.

Reciprocal activation of n.vagus can be eliminated by intravenous atropine (1-2 mg).

Drugs that reduce catecholamine stores (for example, reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant surveillance doctor to check for excessive lowering of blood pressure or bradycardia.

In the case of the appearance in elderly patients of increasing bradycardia (less than 50 / min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe violations liver and kidney function, it is necessary to reduce the dose or stop treatment. It is recommended to stop therapy with the appearance of skin rashes and the development of depression caused by taking beta-blockers.

Cancellation of the drug is carried out gradually, reducing the dose within 10 days. With a sharp cessation of treatment, a "withdrawal" syndrome may occur (increased angina attacks, increased blood pressure). Special attention when discontinuing the drug, it should be given to patients with angina pectoris.

Patients using contact lenses should take into account that against the background of treatment with beta-blockers, a decrease in the production of lacrimal fluid is possible.

During pregnancy, it is prescribed only for strict indications (due to possible development neonatal bradycardia, hypotension, hypoglycemia, and respiratory paralysis). Treatment must be interrupted 48-72 hours before delivery. In cases where this is not possible, it is necessary to ensure strict monitoring of newborns within 48-72 hours after delivery.

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require an increased concentration of attention and speed of psychomotor reactions.

Interaction

Allergens used for immunotherapy or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving metoprolol. Iodine-containing radiopaque drugs for intravenous administration increase the risk of developing anaphylactic reactions.

Phenytoin when administered intravenously, drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressive effect and the likelihood of lowering blood pressure.

Changes the effectiveness of insulin and oral hypoglycemic drugs, masks the symptoms of developing hypoglycemia (tachycardia, increased blood pressure).

Reduces the clearance of lidocaine and xanthines (except diphylline) and increases their plasma concentration, especially in patients with initially increased clearance of theophylline under the influence of smoking.

The hypotensive effect is weakened by NSAIDs (Na + retention and blockade of Pg synthesis by the kidneys), GCS and estrogens (Na + retention).

Cardiac glycosides, methyldopa, reserpine and guanfacine, BMCC (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV blockade, cardiac arrest and heart failure. Nifedipine can lead to a significant decrease in blood pressure.

Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs can lead to an excessive decrease in blood pressure.

Prolongs the action of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins.

Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedative and hypnotic drugs increase CNS depression.

Not recommended simultaneous application with MAO inhibitors due to a significant increase in the hypotensive effect, a break in treatment between taking MAO inhibitors and metoprolol should be at least 14 days.

Non-hydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders.

Reviews about the drug Egilok: 1

I take egilok 1, 2 tons in the morning - there is dizziness (50 mg)

Write your review

Do you use Egilok as an analogue or vice versa?