Egilok tablets 25mg, No. 60

arterial hypertension (in monotherapy or (if necessary) in combination with other antihypertensive drugs);

ischemic heart disease: myocardial infarction (secondary prevention - complex therapy), prevention of angina attacks;

heart rhythm disturbances (supraventricular tachycardia, ventricular premature beats);

functional disorders of cardiac activity, accompanied by tachycardia;

hyperthyroidism (complex therapy);

prevention of migraine attacks.

Inside, EgilokЃ tablets can be taken with food or with or without food. If necessary, the tablet can be broken in half.

The dose should be adjusted gradually and individually to avoid excessive bradycardia. The maximum daily dose is 200 mg.

Recommended doses

Arterial hypertension. For mild or moderate arterial hypertension, the initial dose is 25-50 mg twice a day (morning and evening). If necessary, the daily dose can be gradually increased to 100-200 mg / day or another antihypertensive agent can be added.

Angina pectoris. The initial dose is 25-50 mg two to three times a day. Depending on the effect, this dose can be gradually increased to 200 mg per day or another antianginal drug can be added.

Supportive care after myocardial infarction. The usual daily dose is 100-200 mg / day, divided into two doses (morning and evening).

Heart rhythm disturbances. The starting dose is 25 to 50 mg two or three times a day. If necessary, the daily dose can be gradually increased to 200 mg / day or another antiarrhythmic agent can be added.

Hyperthyroidism. The usual daily dose is 150-200 mg per day for 3-4 doses.

Functional disorders of the heart, accompanied by a feeling of palpitations. The usual daily dose is 50 mg 2 times a day (morning and evening); if necessary, it can be increased to 200 mg in two divided doses.

Prevention of migraine attacks. The usual daily dose is 100 mg / day in two divided doses (morning and evening); if necessary, it can be increased to 200 mg / day in 2 divided doses.

Special patient groups

In case of impaired renal function, a change in the dosage regimen is not required.

With cirrhosis of the liver, a dose change is usually not required due to the low binding of metoprolol to blood plasma proteins (5-10%). In severe hepatic impairment (for example, after portocaval bypass surgery), it may be necessary to reduce the dose of EgilokЃ.

In elderly patients, dose adjustment is not required.

active substance: metoprolol tartrate

hypersensitivity to metoprolol or any other component of the drug, as well as other beta-blockers;

atrioventricular (AV) block II or III degree;

sinoatrial blockade;

sinus bradycardia (heart rate less than 50 beats / min);

sick sinus syndrome;

cardiogenic shock;

severe peripheral circulatory disorders;

heart failure in the stage of decompensation;

age up to 18 years (due to the lack of sufficient clinical data);

simultaneous intravenous administration of verapamil;

severe form of bronchial asthma;

pheochromocytoma without the simultaneous use of alpha-blockers.

Due to the lack of clinical data, EgilokЃ is contraindicated in acute myocardial infarction, accompanied by a heart rate below 45 beats / min, with a PQ interval of more than 240 ms and a systolic blood pressure below 100 mm Hg. Art.

With care: diabetes mellitus; metabolic acidosis; bronchial asthma; COPD; renal / hepatic impairment; myasthenia gravis; pheochromocytoma (with simultaneous use with alpha-blockers); thyrotoxicosis; AV blockade of the 1st degree; depression (including a history); psoriasis; obliterating peripheral vascular disease (intermittent claudication, Raynaud's syndrome); pregnancy; lactation period; elderly age; patients with a burdened allergic history (a decrease in response is possible with the use of adrenaline).

pharmachologic effect

Cardioselective beta1-blocker without intrinsic sympathomimetic activity. It has hypotensive, antianginal and antiarrhythmic effects. Reduces the automatism of the sinus node, reduces heart rate, slows down AV conduction, reduces myocardial contractility and excitability, decreases cardiac output, and reduces myocardial oxygen demand. Suppresses the stimulating effect of catecholamines on the heart during physical and psycho-emotional stress.

It causes a hypotensive effect, which stabilizes by the end of the 2nd week of course use. With exertional angina, metoprolol reduces the frequency and severity of attacks. Normalizes heart rate with supraventricular tachycardia and atrial fibrillation. In myocardial infarction, it helps to limit the zone of ischemia of the heart muscle and reduces the risk of developing fatal arrhythmias, reduces the possibility of recurrence of myocardial infarction. When used in moderate therapeutic doses, it has a less pronounced effect on the smooth muscles of the bronchi and peripheral arteries than non-selective beta-blockers.

Indications of the active substances of the drug

Arterial hypertension, prevention of angina attacks, cardiac arrhythmias (supraventricular tachycardia, extrasystole), secondary prevention after myocardial infarction, hyperkinetic cardiac syndrome (including hyperthyroidism, NCD). Prevention of migraine attacks.

Dosage regimen

When taken orally, the average dose is 100 mg / day in 1-2 doses. If necessary, the daily dose is gradually increased to 200 mg. With the on / in the introduction, a single dose - 2-5 mg; in the absence of effect, repeated administration is possible after 5 minutes.

Maximum doses: for oral administration, the daily dose is 400 mg, for intravenous administration, a single dose is 15-20 mg.

Side effect

From the side of the cardiovascular system: bradycardia, arterial hypotension, abnormalities of AV conduction, the appearance of symptoms of heart failure are possible.

From the digestive system: at the beginning of therapy, dry mouth, nausea, vomiting, diarrhea, constipation are possible; in some cases - liver dysfunction.

From the side of the central nervous system and peripheral nervous system: at the beginning of therapy, weakness, fatigue, dizziness, headache, muscle cramps, feeling of cold and paresthesia in the extremities are possible; possible decrease in the secretion of lacrimal fluid, conjunctivitis, rhinitis, depression, sleep disturbances, nightmares.

From the hematopoietic system: in some cases - thrombocytopenia.

From the endocrine system: hypoglycemic conditions in patients with diabetes mellitus.

On the part of the respiratory system: in predisposed patients, symptoms of bronchial obstruction may appear.

Allergic reactions: skin rash, itching.

Contraindications for use

AV block II and III degree, sinoatrial block, bradycardia (heart rate less than 50 beats / min), SSSU, arterial hypotension, chronic heart failure stage IIB-III, acute heart failure, cardiogenic shock, metabolic acidosis, severe peripheral circulatory disorders, hypersensitivity to metoprolol. Use during pregnancy and lactation Use during pregnancy is possible only if the intended benefit to the mother outweighs the potential risk to the fetus. Metoprolol crosses the placental barrier. Due to the possible development of bradycardia, arterial hypotension, hypoglycemia and respiratory arrest in a newborn, metoprolol should be canceled 48-72 hours before the planned delivery date.After delivery, it is necessary to ensure strict monitoring of the condition of the newborn for 48-72 hours.

Metoprolol in small amounts is excreted in breast milk. Application during lactation is not recommended.

Application for violations of liver function

Use with caution in patients with severe liver dysfunction.

Application for impaired renal function

Use with caution in patients with severe renal impairment.

special instructions

Use with caution in patients with chronic obstructive respiratory diseases, diabetes mellitus (especially with labile course), Raynaud's disease and obliterating peripheral arterial diseases, pheochromocytoma (should be used in combination with alpha-blockers), severe renal and liver dysfunction.

Against the background of treatment with metoprolol, it is possible to reduce the production of tear fluid, which is important for patients using contact lenses.

Completion of a long course of treatment with metoprolol should be carried out gradually (at least within 10 days) under the supervision of a physician.

The simultaneous use of metoprolol with MAO inhibitors is not recommended.

When combined therapy with clonidine, the latter should be discontinued a few days after discontinuation of metoprolol, in order to avoid a hypertensive crisis. With simultaneous use with hypoglycemic agents, correction of their dosage regimen is required.

A few days before anesthesia, it is necessary to stop taking metoprolol or choose an anesthesia drug with a minimal negative inotropic effect.

Influence on the ability to drive vehicles and use mechanisms

In patients whose activities require increased attention, the question of using metoprolol on an outpatient basis should be resolved only after assessing the patient's individual response.

Drug interactions

With simultaneous use with antihypertensive drugs, diuretics, antiarrhythmic drugs, nitrates, there is a risk of severe arterial hypotension, bradycardia, AV blockade.

With simultaneous use with barbiturates, the metabolism of metoprolol is accelerated, which leads to a decrease in its effectiveness.

With simultaneous use with hypoglycemic agents, it is possible to enhance the action of hypoglycemic agents.

With simultaneous use with NSAIDs, it is possible to reduce the hypotensive effect of metoprolol.

With simultaneous use with opioid analgesics, the cardiodepressant effect is mutually enhanced.

With simultaneous use with peripheral muscle relaxants, neuromuscular blockade may increase.

With simultaneous use with agents for inhalation anesthesia, the risk of inhibition of myocardial function and the development of arterial hypotension increases.

With simultaneous use with oral contraceptives, hydralazine, ranitidine, cimetidine, the concentration of metoprolol in the blood plasma increases.

With simultaneous use with amiodarone, arterial hypotension, bradycardia, ventricular fibrillation, asystole are possible.

With simultaneous use with verapamil, the Cmax in the blood plasma and the AUC of metoprolol increase. The minute and stroke volume of the heart, pulse rate, arterial hypotension decrease. Perhaps the development of heart failure, dyspnea and sinus blockade.

With intravenous administration of verapamil while taking metoprolol, there is a threat of cardiac arrest.

With simultaneous use, it is possible to increase the bradycardia caused by digitalis glycosides.

With simultaneous use with dextropropoxyphene, the bioavailability of metoprolol increases.

With simultaneous use with diazepam, a decrease in clearance and an increase in AUC of diazepam are possible, which can lead to an increase in its effects and a decrease in the speed of psychomotor reactions.

With simultaneous use with diltiazem, the concentration of metoprolol in the blood plasma increases due to the inhibition of its metabolism under the influence of diltiazem. The effect on the activity of the heart is additively inhibited due to the slowing down of impulse conduction through the AV node caused by diltiazem. There is a risk of developing severe bradycardia, a significant decrease in stroke and minute volume.