Corvitolum

Corvitolum – medicine with antiarrhytmic, anti-anginal and hypotensive action.

Form of release and structure

Corvitolum is released in the form of tablets: ploskotsilindrichesky, white, round, with a facet and risky on the one hand (in blisters on 10 pieces, on 3, 5 or 10 blisters in a cardboard pack).

Is a part of 1 tablet:

• Active ingredient: a metoprolola tartrate – 50 mg (Corvitolum 50) or 100 mg (Corvitolum 100);
• Auxiliary components: monohydrate of lactose – 110,5/221 mg, K30 povidone – 3,5/7 mg, croscarmellose sodium – 8/16 mg, magnesium stearate – 2/4 mg, talc – 2,5/5 mg, colloid silicon dioxide – 1/2 mg.

Indications to use

• Arterial hypertension, including hyperkinetic type (along with other anti-hypertensive drugs or as monotherapy);
• Disturbances of a heart rhythm, including ventricular premature ventricular contraction and supraventricular tachycardia;
• Coronary heart disease (for prevention of attacks of stenocardia, secondary prevention of a myocardial infarction);
• Tachycardia;
• Attacks of migraine (prevention).

Contraindications

• Cardiogenic shock;
• Sinuatrial blockade;
• AV blockade of II and III degrees;
• The expressed bradycardia (at heart rate less than 50 beats per minute);
• Sick sinus syndrome;
• Dekompensirovanny heart failure;
• Disturbances of peripheric circulation (at a heavy current);
• Printsmetal's stenocardia;
• Arterial hypotension (at use for secondary prevention of a myocardial infarction – systolic pressure is less than 100 mm hg);
• Acute myocardial infarction (at the heart rate less than 45 beats per minute, PQ interval – it is more than 0,25 seconds, systolic pressure – it is less than 100 mm hg);
• Simultaneous use with monoamine oxidase inhibitors or verapamil (at intravenous administration);
• Lactation period;
• Age up to 18 years (safety and efficiency of performing therapy at this group of patients are not established);
• Hypersensitivity to drug components, and also to other beta adrenoblockers.

Patients need to apply Corvitolum with care with a diabetes mellitus, a metabolic acidosis, bronchial asthma, a chronic obstructive pulmonary disease (emphysema of lungs, chronic obstructive bronchitis), obliterating diseases of peripheral vessels (the alternating lameness, Reynaud's syndrome), a chronic renal and/or liver failure, a myasthenia, a pheochromocytoma, AV blockade of the I degree, a thyrotoxicosis, a depression (including in the anamnesis), psoriasis, and also to patients of advanced age.

Pregnant women can accept Corvitolum only according to strict indications, considering a ratio of advantage and risk (because of development in a fruit of arterial hypotension, bradycardia and a hypoglycemia). At the same time it is necessary to make careful observation, in particular behind fetation. Up to 2-3 days after delivery strict observation of a condition of the newborn is necessary.

Route of administration and dosage

Corvitolum should be accepted inside, after food. Tablets need to be swallowed, without chewing and to wash down with a small amount of liquid. In need of them it is possible to divide in half.

At frequency rate of use of Corvitolum once a day, it it is necessary to accept in the morning, 2 times a day – in morning and evening.

The mode of dosing is defined by indications:

• Arterial hypertension, stenocardia: 100 mg a day in 1 or 2 receptions. Increase in a daily dose to maximum – 200 mg is in case of need possible;
• The functional cardiac disturbances which are followed by tachycardia: 50-100 mg a day in 1-2 receptions. Increase in a daily dose to maximum – 200 mg in 2 receptions is in case of need possible;
• Attacks of migraine (prevention): 100 mg a day in 1 or 2 receptions. After achievement of therapeutic effect the dose under control of the doctor needs to be lowered.

Correction of the mode of dosing for elderly patients with functional disturbances of kidneys, and also in need of carrying out a hemodialysis is not required.

At functional disturbances of a liver the dose of Corvitolum should be reduced depending on a clinical state.

The course of use of drug in time is not limited, its duration is defined by features of disease.

Side effects

During use of Corvitolum the following side effects can develop:

• Central nervous system: weakness, fatigue, delay of speed of motor and mental reactions, a headache, dizziness, paresthesias in extremities (at patients with Reynaud's syndrome and the alternating lameness), a depression, concern, muscular weakness, decrease in attention, drowsiness, "dreadful" dreams, sleeplessness, an asthenic syndrome, short-term disturbance of memory or confusion of consciousness;
• Cardiovascular system: heartbeat, a sinus bradycardia, the expressed lowering of arterial pressure, orthostatic hypotension (in the form of dizziness, sometimes losses of consciousness); seldom – arrhythmias, decrease in contractility of a myocardium, temporary aggravation of symptoms of chronic heart failure (in the form of hypostases, puffiness of the lower part of shins and/or feet, an asthma), manifestation of a vasomotor spasm (in the form of strengthening of disturbances of peripheric circulation, Reynaud's syndrome, a cold snap of the lower extremities), a cardialgia, disturbances of conductivity of a myocardium;
• System of a hemopoiesis: seldom – thrombocytopenia (hemorrhages and unusual bleedings), a leukopenia, an agranulocytosis;
• Alimentary system: dryness in a mouth, nausea, an abdominal pain, vomiting, diarrhea, a lock, increase in activity of liver enzymes, taste change; extremely seldom – a hyperbilirubinemia;
• Endocrine system: a hypoglycemia (at the patients receiving insulin); seldom – a hypothyroid state, a hyperglycemia (at a non-insulin-dependent diabetes mellitus);
• Respiratory system: a nose congestion, an asthma, difficulty of an exhalation (because of a bronchospasm);
• Sense bodys: seldom – decrease in secretion of the lacrimal liquid and sight, morbidity and a xerophthalmus, a sonitus, conjunctivitis, rhinitis;
• Allergic reactions: skin itch, small tortoiseshell, rash;
• Dermatological reactions: dermahemia, reversible alopecia, aggravation of a course of psoriasis, psoriazopodobny skin reactions, photodermatosis, sweating strengthening, dieback;
• Others: joint pain or to back; in isolated cases – decrease in a potentiality and/or libido, insignificant increase in weight.

Special instructions

During use of Corvitolum it is necessary regularly (1 time in 4-5 months) to control the heart rate and arterial pressure, and also content of glucose in blood at patients with a diabetes mellitus. In case of need the dose of insulin or the hypoglycemic means accepted inside a sick diabetes mellitus needs to be picked up individually.

Elderly patients are regularly recommended to control functions of a liver, the patient with a heavy renal failure – functions of kidneys.

At reduction of heart rate to less than 50 beats per minute it is necessary to consult with the doctor.

It is necessary to consider that cardioselectivity decreases at reception of a dose more than 200 mg a day.

Reception of Corvitolum at heart failure can be begun only after achievement of a stage of compensation.

During therapy perhaps:

• Strengthening of expressiveness of reactions of hypersensitivity (at the burdened allergological anamnesis) and lack of effect at introduction of usual doses of adrenaline (Epinephrinum);
• Development of a photosensitization (it is recommended to wear the corresponding clothes);
• Reduction of products of the lacrimal liquid (it is necessary to consider the patient using contact lenses);
• Strengthening of signs of disturbances of peripheric arterial circulation.

Cancellation of Corvitolum needs to be carried out gradually, reducing a daily dose for 10 days. At the sharp termination of treatment development of the withdrawal which is shown in the form of strengthening of attacks of stenocardia and increase in arterial pressure is possible (the special attention is required by the patient with stenocardia).

At an angina of exertion the dose of Corvitolum is selected so that therapy at rest provided heart rate in borders of 55-60 beats per minute, at loading – to 110 beats per minute.

Drug can mask some symptoms of a thyrotoxicosis (for example, tachycardia). Sharp cancellation of therapy by the patient with a thyrotoxicosis is contraindicated as it can strengthen symptomatology.

Reception of Corvitolum at a diabetes mellitus can mask the tachycardia caused by a hypoglycemia.

In need of purpose of drug the patient with a pheochromocytoma as the accompanying treatment is appointed by alpha adrenoblockers; with bronchial asthma – _{beta2-adrenostimulyator}.

Before carrying out surgical intervention of the anesthesiologist it is necessary to warn about the carried-out treatment (for the general anesthesia it is necessary to choose drugs with the smallest negative inotropic effect), cancellation of Corvitolum at the same time is not recommended.

At a concomitant use with a clonidine, it can be cancelled only in several days after the termination of reception of Corvitolum.

The drugs lowering stocks of catecholamines (for example, Reserpinum), can strengthen effect of beta adrenoblockers therefore the patients accepting such combinations of drugs need constant medical observation regarding detection of bradycardia and excessive reduction of arterial pressure.

Correction of the mode of dosing of Corvitolum (sometimes its cancellation) is required only at emergence in elderly patients of the accruing bradycardia (to 50 beats per minute), ventricular arrhythmias, the expressed lowering of arterial pressure (systolic pressure is lower than 100 mm of mercury.), bronchospasm, AV blockade, heavy functional disturbances of a liver.

Special control of a state is required to the patients accepting Corvitolum with a depression. At development of the depression connected with administration of drug, therapy is recommended to be interrupted.

During use of Corvitolum it is recommended to refuse control of motor transport and performance of potentially dangerous types of the works demanding the increased concentration of attention and bystry psychomotor reactions.

Medicinal interaction

At combined use of Corvitolum with some drugs the following undesirable effects can develop:

• Monoamine oxidase inhibitors: significant strengthening of hypotensive action (the break between administrations of drugs has to make not less than 14 days);
• Nifedipine: significant lowering of arterial pressure;
• Verapamil (intravenous administration): development of a cardiac standstill is possible;
• Means for an inhalation anesthesia (derivatives of hydrocarbons): increase in risk of development of arterial hypotension and oppression of function of a myocardium;
• Ethanol: strengthening of the oppressing impact on the central nervous system and increase in risk of the expressed lowering of arterial pressure;
• Beta адреностимуляторы, cocaine, theophylline, estrogen, indometacin and other non-steroidal anti-inflammatory drugs: easing of hypotensive effect;
• Anesthetics: summation of cardiodepressive effect;
• Ergot alkaloids: increase in risk of disturbances of peripheric circulation;
• Barbiturates, rifampicin (inductors of microsomal enzymes of a liver): strengthening of metabolism of a metoprolol, decrease in its concentration in a blood plasma and effect;
• Insulin: increase in risk of development of a hypoglycemia, strengthening of its expressiveness, masking of some signs of a hypoglycemia (including tachycardia, perspiration, increase in arterial pressure);
• The hypoglycemic means accepted inside: decrease in their effect;
• Hypotensive drugs, diuretics, nitroglycerine, blockers of slow calcium channels: sharp lowering of arterial pressure (extra care needs to be observed at a combination to Prazozinum);
• Verapamil, diltiazem, Reserpinum, antiarrhytmic drugs (Amiodaronum), alpha Methyldopum, a clonidine, гуанфацин, means for the general anesthesia and cardiac glycosides: oppression of AV conductivity and urezheniye of heart rate;
• Clonidine (at cancellation): risk of emergence of a withdrawal (the clonidine should be cancelled in several days);
• Oral contraceptives, Cimetidinum, fenotiazina (inhibitors of microsomal enzymes of a liver): increase in concentration of a metoprolol in a blood plasma;
• Lidocaine, xanthines (except Diphyllinum): decrease in its clearance;
• The allergens applied to an immunotherapy or the extracts of allergens used for conducting skin tests: increase in risk of development of an anaphylaxis or system allergic reactions;
• Iodinated radiopaque substances (intravenous administration): increase in risk of development of anaphylactic reactions;
• Lidocaine: increase in its concentration in a blood plasma;
• The anti-depolarizing muscle relaxants: strengthening and prolongation of their action;
• Coumarins: lengthening of anticoagulating effect.

Terms and storage conditions

To store in the place, unavailable to children, at a temperature up to 30 °C.

Period of validity – 3 years.