Bisangil

General characteristics. Structure:

Active agents: the bisoprolola fumarates 2,50 mg and a hydrochlorothiazide of 6,25 mg.

Excipients (kernel): lactoses monohydrate (sugar milk) - 62,0 mg, cellulose microcrystallic - 18,0 mg, croscarmellose sodium - 2,0 mg, starch corn - 4,75 mg; povidone (polyvinylpirrolidone) - 3,5 mg, magnesium stearate - 1,0 mg.

Excipients (cover): a gipromelloza - 1.65 mg, a macrogoal of 4000 - 0,45 mg, titanium dioxide - 0,9 mg. Each tablet of 5,0 mg +6,25 mg contains active agents: the bisoprolola fumarates 5,0 mg and a hydrochlorothiazide of 6,25 mg

Excipients (kernel): lactoses monohydrate (sugar milk) - 130,25 mg, cellulose microcrystallic - 36,0 mg, croscarmellose sodium - 4,0 mg, starch corn - 9,5 mg, povidone (polyvinylpirrolidone) - 7,0 mg, magnesium stearate - 2,0 mg.

Excipients (cover): a gipromelloza - 3,3 mg, a macrogoal of 4000 - 0,9 mg, titanium dioxide - 1,8 mg.

Pharmacological properties:

Pharmacodynamics. Bisoprolol - the selection beta1-adrenoblocker without internal sympathomimetic activity Has anti-hypertensive, antiarrhytmic and anti-anginal effect. Blocking heart beta1-adrenoceptors in low doses, reduces stimulated catechol mines education cyclic an adenozinmonofos-veil (tsAMF) from adenosinetriphosphate (ATP), reduces intracellular current of calcium ions, renders negative hrono-, dromo-, batmo-and inotropic action (urezhat the heart rate (HR), oppresses cordial conductivity, reduces excitability and contractility of a myocardium). At increase in a dose blocks beta2-adrenoceptors.
The general peripheric vascular resistance at the beginning of use of beta adrenoblockers, in the first 24 h increases (as a result of reciprocal increase of activity of alpha adrenoceptors and elimination of stimulation of beta2-adrenoceptors), in 1-3 days is returned to initial, and at long appointment decreases. The anti-hypertensive effect is connected with reduction of minute volume of blood, suppression of sympathetic stimulation of peripheral vessels, decrease of the activity system renin-angiotensin-aldosteronovoy by inhibition of beta adrenoceptors of the juxtaglomerular device of kidneys (that leads to reduction of secretion of a renin), recovery of sensitivity of baroreceptors of an aortic arch (there is no strengthening of their activity in response to a lowering of arterial pressure) and influence on the central nervous system At arterial hypertension the effect develops in 2-5 days, stable action - in 1-2 months of therapy.
The hydrochlorothiazide is thiazide diuretic, breaks a reabsorption of ions of sodium, chlorine, potassium, magnesium in distal department of nephron, removal of calcium, uric acid detains. Increase in renal excretion of these ions is followed by increase in amount of urine (due to osmotic binding of water). The hydrochlorothiazide reduces blood plasma volume, increases activity of a renin in a blood plasma and secretion of Aldosteronum At reception in high doses the hydrochlorothiazide increases excretion of bicarbonates, at long reception reduces calcium excretion. Anti-hypertensive action develops due to reduction of the volume of the circulating blood (VCB), change of reactivity of a vascular wall, decrease in pressor influence of vasoconstrictive amines (adrenaline, noradrenaline) and strengthening of depressor influence on a ganglion does not exert impact on the normal arterial pressure (AP). The diuretic effect is noted in 1-2 h, reaches a maximum in 4 h and proceeds 6-12 h. Anti-hypertensive action comes in 3-4 days, but achievement of optimum therapeutic effect requires 3-4 weeks.

Pharmacokinetics. Bisoprolol is almost completely soaked up in digestive tract, meal does not influence absorption. Effect "(primary passing" through a liver it is insignificant that results in high bioavailability (about 90%).
Bisoprolol is metabolized on an oxidizing way without the subsequent conjugation. All metabolites have strong polarity and the Main metabolites found in a blood plasma and urine are removed by kidneys do not show pharmacological activity. The data obtained as a result of experiments with microsomes of a liver of the person of in vitro show what бисопролол is metabolized first of all by means of CYP3A4 isoenzyme (about 95%), and the isoenzyme of CYP2D6 is only of little importance. Communication with proteins of a blood plasma about 30%. Distribution volume - 3,5 l/kg the General clearance - about 15 l/h. The maximum concentration in a blood plasma is defined in 2-3 hours. Permeability through a blood-brain barrier and a placental barrier - low.
Plasma elimination half-life of blood (10-12 hours) provides efficiency within 24 hours after reception of a single daily dose.
Bisoprolol is brought from an organism in two ways, 50% of a dose are metabolized in a liver with formation of inactive metabolites. About 98% are removed by kidneys, 50% are brought out of them in not changed look; less than 2% - through intestines (with bile).
As removal takes place in kidneys and in a liver equally, with an abnormal liver function or with a renal failure of dose adjustment it is not required to patients. The pharmacokinetics of a bisoprolol is linear and does not depend on age

Hydrochlorothiazide.
After intake absorption and bioavailability of a hydrochlorothiazide makes about 70%. Communication with proteins of a blood plasma - 60-80%. At intake of 12,5 mg of a hydrochlorothiazide the maximum plasma concentration is reached in 1,5-4 hours and makes 70 ng/ml, and at intake of 25 mg of a hydrochlorothiazide maksimal-Nye plasma concentration is reached in 2 - 5 h and makes 142 ng/ml.
In the therapeutic range of doses the average size of the area under a curve "<concentration - time" (AUC) increases in direct ratio to increase in a dose, at purpose of 1 times a day cumulation is insignificant. The Elimination half-life (T1/2) - 5-6 h gets through a gematoplatsentarny barrier and into breast milk. The hydrochlorothiazide is slightly metabolized in a liver. The hydrochlorothiazide is removed almost completely (more than 95%) by kidneys in not changed look. 50-70% of the dose accepted inside are removed within 24 hours.

Indications to use:

Arterial hypertension easy and moderate severity.

Route of administration and doses:

 Bisangil is recommended to accept in the morning (during meal). Tablets should be swallowed entirely, without chewing, washing down with a small amount of liquid, 1 time a day. The dose of drug should be selected individually. An initial dose of drug Bisangil - 1 tablet of 2,5 mg / 6,5 mg (бисопролол 2,5 mg / a hydrochlorothiazide of 6,25 mg) 1 time a day. If the anti-hypertensive effect is insufficient a dose increase (in 2 weeks) - 1 tablet of 5 mg / 6,25 mg (бисопролол 5 mg / a hydrochlorothiazide of 6,25 mg) 1 time in days.
To patients with abnormal liver functions, and also to patients of advanced age of correction of the mode of dosing it is not required. At patients with renal failures (KK more than 30 ml/min.) the maximum daily dose of a bisoprolol should not prevshat 10 mg.

Features of use:

During therapy by drug Bisangil is necessary control of ChSS and the ABP (in an initiation of treatment - daily, then - 1 time in 3-4 months), concentration of glucose in blood at patients with a diabetes mellitus (1 time in 4-5 months). At elderly patients it is recommended to control function of kidneys (1 times in 4-5 months). It is necessary to train the patient in a technique of calculation of ChSS.
During therapy by drug Bisangil it is also necessary to control indicators of an acid-base state and content of electrolytes (potassium, sodium, calcium).
More frequent control of content of potassium at patients of group of high risk is necessary
At patients it is necessary to be careful with disturbances of peripheric circulation at purpose of drug Bisangil
At a thyrotoxicosis drug Bisangil (due to the maintenance of a bisoprolol in it) can mask clinical signs of a disease (for example, tachycardia).
Patients with a pheochromocytoma should not appoint drug Bisangil until treatment is appointed alpha adrenoblockers. At the same time it is necessary to control the ABP At patients with the easy course of bronchial asthma or a chronic obstructive pulmonary disease treatment begin with the minimum dose.
Bisangil at development of the depression caused by beta adrenoblocker reception is recommended to stop therapy by drug (due to the maintenance of a bisoprolol in it).
At patients of advanced age treatment by drug Bisangil should be begun with the dosage form of drug containing a low dose of a bisoprolol (2,5 mg). At the same time regular control of a condition of patients is necessary.
It is not necessary to stop sharply therapy, in particular, at patients with coronary heart disease. The dose needs to be reduced gradually within two weeks. If necessary it is necessary to begin performing the corresponding anti-anginal therapy at the same time. The special attention is required in cases of carrying out surgical intervention under the general anesthesia at the patients accepting a beta - adrenoblockers Such patients should cancel drug Bisangil in 48 hours prior to surgical intervention, to warn the surgeon-anesthesiologist that the patient accepts drug as means for the general anesthesia it is necessary to choose drug with the minimum negative inotropic effect. Against the background of therapy by beta adrenoblockers the aggravation of a course of psoriasis is possible. Patients with this disease Bisangil should appoint drug with care.
At instructions in the anamnesis on anaphylactic reactions, irrespective of the reason of their emergence, especially when performing the desensibilizing therapy, treatment by drug Bisangil (due to the maintenance of a bisoprolol in it) can increase risk of emergence of allergic reactions and promote development of resistance to treatment by Epinephrinum (adrenaline) in usual doses to the Patients using contact lenses it is necessary to be careful at drug use Bisangil as beta adrenoblockers can reduce products of the lacrimal liquid. At patients with a hyperuricemia the risk of development of an aggravation of a course of gout is increased. In this case the drug dose Bisangil should be selected individually under control of concentration of uric acid in blood serum Before a research of function of epithelial bodies treatment by drug Bisangil needs to be stopped as against the background of his reception there can be a tranzitorny hypercalcemia. Athletes should be informed that Bisangil contains drug бисопролол. which can yield false positive results when carrying out a drug test.

Influence on ability to driving of motor transport and to control of mechanisms
Bisangil it is necessary to apply with care at control of vehicles and mechanisms in connection with a possibility of development of dizziness.

Side effects:

Frequency of the side reactions given below was defined according to the following (classification of World Health Organization): very often - not less than 10%; often - not less than 1%, but less than 10%; infrequently - not less than 0.1%), but less than 1%; seldom - not less than 0.01%, but less than 0.1%; very seldom - less than 0.01%>, including separate messages.

From heart and vessels: very often - urezheny ChSS (bradycardia, especially at patients with chronic heart failure); the heart consciousness, is frequent - the expressed decrease in the ABP (especially at patients with chronic heart failure), manifestation of a vasomotor spasm (strengthening of disturbances of peripheric circulation, a cryesthesia in extremities (paresthesia); infrequently - disturbance of AV of conductivity (up to development of total cross block and a cardiac standstill), arrhythmias, orthostatic hypotension, aggravation of a course of chronic heart failure with development of peripheral hypostases (puffiness of anklebones, feet; asthma), stethalgia.
From a nervous system: often - dizziness, a headache, an adynamy, increased fatigue, sleep disorders, a depression, concern; seldom - confusion of consciousness or short-term loss of memory, dreadful dreams, hallucinations, a myasthenia, a tremor, myotonia. Usually these phenomena have easy temper and pass, as a rule, within 1-2 weeks, after an initiation of treatment.
From sense bodys: seldom - a vision disorder, reduction of a slezootdeleniye (it is necessary to consider when carrying contact lenses), a sonitus, decrease in hearing, ear pain; very seldom - dryness and morbidity of eyes, conjunctivitis, taste disturbances.
From respiratory system: infrequently - a bronchospasm at patients with bronchial asthma or obstructive respiratory diseases; seldom - allergic rhinitis; nose congestion.
Co of the party of the alimentary system: often - nausea, vomiting, diarrhea, a lock, dryness of a mucous membrane of an oral cavity, an abdominal pain; seldom - hepatitis, increase in activity of enzymes of a liver (ALT, nuclear heating plant), increase in concentration of bilirubin, taste change.
From a musculoskeletal system: infrequently - an arthralgia, a dorsodynia.
From urinogenital system: very seldom - disturbance of a potentiality, weakening of a libido.
Laboratory indicators: seldom - increase in concentration of triglycerides in blood; in some cases - thrombocytopenia, an agranulocytosis, a leukopenia.
Allergic reactions: seldom - a skin itch, rash, a small tortoiseshell.
From integuments: seldom - sweating strengthening, a dermahemia, a dieback, psoriazopodobny skin reactions; very seldom - the alopecia, beta adrenoblockers can aggravate the course of psoriasis.
Others: withdrawal (increase of attacks of stenocardia, increase in the ABP).

Hydrochlorothiazide
Disturbance of water and electrolytic balance: hypopotassemia, hypomagnesiemia, hypercalcemia and gipokhloremichesky alkalosis: dryness of a mucous membrane of an oral cavity, feeling of thirst, irregular heart rhythm, changes in mood or mentality, spasms and muscle pains, nausea, vomiting, unusual fatigue or weakness. The Gipokhloremichesky alkalosis can cause hepatic encephalopathy or a hepatic coma. Hyponatremia: confusion of consciousness, convulsion, lethargy, delay of process of thinking, increased fatigue, excitability, muscular spasms.
Metabolic disturbances: a hyperglycemia, a glucosuria, hyperuricemias with development of an attack of gout.
Treatment of a tiazidama can break tolerance to glucose, and the latentnoprotekayushchy diabetes mellitus can demonstrate. At use of high doses concentration of lipids in blood serum can increase.
From the alimentary system: cholecystitis or pancreatitis, cholestatic jaundice, diarrhea, sialadenitis, lock, anorexia.
From heart and vessels: arrhythmias, orthostatic hypotension, vasculitis.
From a nervous system: dizziness, temporarily indistinct sight, headache, paresthesias.
From bodies of a hemopoiesis: very seldom - a leukopenia, an agranulocytosis, thrombocytopenia, hemolitic anemia, aplastic anemia.
Allergic reactions: a small tortoiseshell, a purpura, a necrotic vasculitis, Stephens-Johnson's syndrome, a respiratory distress syndrome (including a pneumonitis and not cardiogenic hypostasis of a lung), photosensitivity, anaphylactic reactions up to shock.
Others: decrease in a potentiality, disturbance of renal function, intersticial nephrite.

Interaction with other medicines:

Combinations which use is contraindicated
In case of shock or the arterial hypotension caused by reception of a floktafenin, beta adrenoblockers cause decrease in compensatory cardiovascular reactions.
Bisoprolol should not be applied along with sultopridy as at the same time there is a high risk of developing of ventricular arrhythmias, including the pirouette type
MAO inhibitors of A type should not be accepted along with bisoprololy as there is a danger of development of hypertensive crisis. Not recommended combinations
Antiarrhytmic means of the I class (for example, quinidine, Disopyramidum. lidocaine, Phenytoinum; флекаинид, пропафенон) at simultaneous use with bisopropoly can reduce AV conductivity and sokratitelny ability of heart
Blockers of "slow" calcium channels (BMKK) like verapamil and to a lesser extent, diltiazem, at simultaneous use with bisopropoly can lead to decrease in sokratitelny ability of a myocardium and disturbance of AV of conductivity. In particular, intravenous administration of verapamil to the patients accepting beta adrenoblockers can lead to the blockade expressed to arterial hypotension and AV.
Antihypertensives of the central action (such as clonidine, Methyldopum, моксонидин, рилменидин) can lead to an urezheniye of ChSS and decrease in cordial emission, and also to a vazodilatation following - stvy decrease in the central sympathetic tone. Sharp cancellation of antihypertensives of the central action, especially before cancellation of beta adrenoblockers can increase risk of development of "ricochet" arterial hypertension. The combinations demanding care
Antiarrhytmic means of the III class (for example, Amiodaronum) can strengthen disturbance of AV of conductivity.
Effect of beta adrenoblockers for topical administration (for example, eye drops for treatment of glaucoma) can strengthen system effects of a bisoprolol (decrease in the ABP. urezheny ChSS) Parasimpatomimetiki at simultaneous use with bisopropoly can strengthen disturbance of AV of conductivity and increase risk of development of bradycardia.
Bisangil with beta-adrenergic agonists (for example, изопреналин, Dobutaminum) can lead simultaneous use of drug to decrease in effect of both drugs.
The combination of a bisoprolol with adreny and the bags influencing on beta and alpha adrenoceptors (for example, Norepinephrinum, Epinephrinum), can strengthen to a vazokonstriktornye effects of these means arising with participation of alpha adrenoceptors, leading to increase in the ABP. To the Podobnye of interaction are more probable at use of non-selective beta adrenoblockers.
Meflokhin at simultaneous use with bisopropoly can increase risk of development of bradycardia
The allergens used for an immunotherapy or extracts of allergens for skin tests increase risk of emergence of heavy system allergic reactions or an anaphylaxis at the patients receiving бисопролол.
The iodocontaining X-ray contrast diagnostic intravenous agents increase risk of development anafilakti-chesky reactions.
Phenytoinum at intravenous administration, means for inhalation anesthesia (derivatives of hydrocarbons) increase expressiveness of cardiodepressive action and probability of decrease in the ABP. Efficiency of insulin and hypoglycemic means for intake can change at treatment bisopropoly (masks symptoms of the developing hypoglycemia: tachycardia, increase in the ABP) the Clearance of lidocaine and xanthines (except theophylline) can decrease in connection with possible increase in their concentration in a blood plasma, especially at patients with initially increased clearance of theophylline under the influence of smoking
Anti-hypertensive effect non-steroidal anti-inflammatory drugs (NPVP) (a delay of ions of sodium and blockade of synthesis of prostaglandins kidneys) weaken, glucocorticosteroids and estrogen (a delay of ions of sodium).
Cardiac glycosides, Methyldopum, Reserpinum and гуанфацин. blockers of "slow" calcium channels (verapamil, diltiazem), Amiodaronum and other antiarrhytmic means increase risk of development or aggravation of bradycardia, AV of blockade, a cardiac standstill and cordial недостаточ to Nosta.
Antiarrhytmic means which can cause tachycardia like "pirouette" (the class IA, for example, quinidine, гидрохидин. Disopyramidum and class III, for example, Amiodaronum, дофетилид, ибутилид) and соталол: the hypopotassemia can provoke developing of tachycardia like "pirouette"
Other arhythmic means which can cause tachycardia on the pirouette type (for example, астемизол, erythromycin for intravenous administration, галофантрин, pentamidine. спарфлоксацин, терфенадин, Vincaminum) the hypopotassemia can provoke development of tachycardia like "pirouette".
The ABP Diuretiki, a clonidine, sympatholytics can lead nifedipine to considerable decrease, гидралазин and other antihypertensives can lead to excessive decrease in the ABP. Action of not depolarizing muscle relaxants and anticoagulating effect of coumarins during treatment bisoprololy can be extended. Three cyclic and tetracyclic antidepressants, antipsychotic means (neuroleptics), ethanol, sedative and hypnagogues strengthen oppression of the central nervous system simultaneous use with MAO inhibitors owing to considerable strengthening of anti-hypertensive action is not recommended. Having rummaged in treatment between reception of MAO inhibitors and a bisoprolola
has to make not less than 14 days.
Negidrisovanny alkaloids of an ergot increase risk of development of disturbances of peripheric circulation.
Ergotamine increases risk of development of disturbance of peripheric circulation.
Sulfasalazinum increases concentration of a bisoprolol in a blood plasma Rifampicin the Guide рохл about a mouth and azide shortens an elimination half-life of a bisoprolol
With thiazide diuretics such medicines as ethanol, barbiturates and drugs, can exponentiate risk of development of orthostatic hypotension.
Gipogpikemichesky means (for intake and insulin) - dose adjustment of hypoglycemic means can be required. Other antihypertensives - the additive effect Colestyraminum and колестипол - in the presence of the anion-exchange pitches absorption of a hydrochlorothiazide is broken. Colestyraminum and колестипол in a single dose connect a hydrochlorothiazide and reduce its absorption in digestive tract by 85% and 43%, respectively.
Corticosteroids, AKTG (adrenocorticotropic hormone) or glycyrrhizic acid (contains in a glycyrrhiza root) - the expressed decrease in content of electrolytes, in particular, risk of a hypopotassemia
Pressor amines (for example, Epinephrinum, Norepinephrinum) - decrease in expressiveness of the response to reception of pressor amines. Muscle relaxants of not depolarizing action type (for example, tubocurarine) - strengthening of effect of muscle relaxants.
Lithium - diuretics reduce renal clearance of lithium and increase risk of development of toxic effect of lithium; simultaneous use is not recommended.
Non-steroidal anti-inflammatory drugs (NPVP) (including inhibitors of cyclooxygenase-2 (TsOG-2)) - the diuretic, natriuretic and anti-hypertensive effect of diuretics can reduce.
At some patients with a renal failure (for example, the elderly patients or patients with dehydration including accepting diuretics), NPVP receiving therapy. including TsOG-2 inhibitors, treatment by antagonists of receptors of angiotensin II or APF inhibitors can cause further deterioration in function of kidneys, including development of an acute renal failure. These effects are reversible Simultaneous use of these drugs has to be carried out with care at patients with a renal failure.
Due to the influence on calcium metabolism their reception can distort results of a research of function of epithelial bodies.

Contraindications:

- hypersensitivity to a bisoprolol and other components of drug;
- hypersensitivity to a hydrochlorothiazide and other derivatives of sulfonamide;
- severe forms of bronchial asthma and chronic obstructive pulmonary disease;
- the acute heart failure or chronic heart failure  in    a decompensation stage  demanding  performing inotropic therapy;
- cardiogenic shock;
- sick sinus syndrome (including sinuatrial blockade);
- an atrioventricular block And yes the III degrees without artificial pacemaker,
- heavy bradycardia (ChSS less than 50 beats/min.),
- a pheochromocytoma (without simultaneous use alpha адрено - blockers);
- unmanageable diabetes mellitus,
- late stages of disturbance of peripheric circulation (including Reynaud's syndrome);
- heavy arterial gipoteneiya (systolic ABP less than 100 mm
hg);
- refractory hypopotassemia, hyponatremia, hypercalcemia;
- metabolic acidosis;
- acute renal failure;
- chronic renal failure (clearance of creatinine (CC) menee30ml/mines), anury;
- heavy abnormal liver functions, including coma and prekoma;
- simultaneous use with floktafeniny, sultopridy;
- a concomitant use of inhibitors of a monoaminooxidase (MAO) (except for MAO inhibitors of V type),
- age up to 18 years (efficiency and safety are not established);
- lactose intolerance, deficit of lactase or glyukozo-galaktozny malabsorption;
- pregnancy,
- lactation period.

With care it is necessary to apply at heart failure, an atrioventricular block of the I degree, stenocardia of Printsmeta-la, disturbances of peripheric circulation, coronary heart disease, liver failure, renal failure (Kkbolee30ml/mines); hyperthyroidism, pheochromocytoma (the nafena of treatment by alpha adrenoblockers), water and electrolytic disturbances (a hyponatremia, a hypopotassemia, a hypercalcemia), a depression (including in the anamnesis), a myasthenia, gout, psoriasis, and also at patients of advanced age, a hyperuricemia, a diabetes mellitus with considerable fluctuations of concentration of glucose in blood, a rigid diet, a hypovolemia, bronchial asthma, a bronchospasm (in the anamnesis), performing the desensibilizing therapy. Use at pregnancy and in the period of a lactation drug Use Bisangil contraindicated at pregnancy is unknown Now whether it is removed бисопролол with breast milk. Diuretics are removed from group of tiazid with breast milk and therefore feeding by a breast during treatment by drug Bisangil is not recommended. If use of drug is necessary in the period of a lactation, breastfeeding needs to be cancelled.

Overdose:

The most frequent symptoms of overdose by beta adrenoblockers: the expressed decrease in the ABP, bradycardia, an atrioventricular block, a bronchospasm, an acute heart failure and a hypoglycemia.
Hydrochlorthiazidum
Clinical manifestations of acute or chronic overdose by a hydrochlorothiazide are caused by considerable loss of liquid or electrolytes.
The most frequent symptoms of overdose by a hydrochlorothiazide: dizziness, nausea, drowsiness, a hypovolemia, the expressed decrease in the ABP, a hypopotassemia.

Treatment:
In case of overdose, first of all, it is necessary to stop administration of drug, to wash out a stomach, to appoint the adsorbing means and to begin to carry out the supporting symptomatic therapy. At the expressed bradycardia: intravenous administration of atropine. Temporary statement of an artificial pacemaker can sometimes be required.
At the expressed decrease in the ABP intravenous administration of plasma substituting solutions
At an atrioventricular block (II and III degrees): patients have to be under constant observation, purpose of Epinephrinum, in case of need - statement of an artificial pacemaker is possible.
At an aggravation of a course of chronic heart failure: intravenous administration of diuretics, drugs with a positive inotropic effect, and also vazodilatator
At a bronchospasm: purpose of bronchodilators, beta2-simpatomi-metikov and/or Aminophyllinum.
At a hypoglycemia: intravenous purpose of solution of a dextrose (glucose).

Storage conditions:

To store in the dry, protected from light place at a temperature not above 25 °C.

Issue conditions:

According to the recipe

Packaging:

Tablets, film coated 2,5 mg + 6,25 mg and 5 mg + 6,25 mg.
On 10, 30 tablets in a blister strip packaging from a film of the polyvinyl chloride and printing aluminum foil varnished. On 10, 20, 30, 40, 50 or 100 tablets in a container polymeric for medicines
One container or 1, 2, 3, 4, 5 or 10 blister strip packagings together with the application instruction place in a pack from a cardboard.