Corvitol is a drug with antiarrhythmic, hypotensive, antianginal action.
Release form and composition
Korvitol is produced in the form of tablets: white, flat-cylindrical, round, with a one-sided risk and a facet (10 pieces in blisters, 3, 5, 10 blisters in a cardboard box).
The composition of 1 tablet includes:
- Active ingredient: metoprolol tartrate - 50 mg (Corvitol 50) or 100 mg (Corvitol 100);
- Auxiliary components (respectively): lactose monohydrate - 110.5 / 221 mg; Povidone K30 - 3.5 / 7 mg; croscarmellose sodium - 8/16 mg; magnesium stearate - 2/4 mg; talc - 2.5 / 5 mg; colloidal silicon dioxide - 1/2 mg.
Indications for use
- Arterial hypertension, including hyperkinetic type (as monotherapy or simultaneously with other antihypertensive drugs);
- Cardiac arrhythmias (ventricular premature beats, supraventricular tachycardia);
- Prevention of migraine attacks;
- Ischemic heart disease: secondary prevention of myocardial infarction, prevention of strokes.
- Heart failure in the decompensation stage;
- Sinoatrial blockade;
- Cardiogenic shock;
- AV block II and III degree;
- Severe bradycardia (with a heart rate of less than 50 beats per minute);
- Sick sinus syndrome;
- Severe peripheral circulatory disorders;
- Printsmetal angina;
- Acute myocardial infarction (with a PQ interval of more than 0.25 seconds, heart rate less than 45 beats per minute, systolic pressure less than 100 mm Hg);
- Hypotension (when used in the secondary prevention of myocardial infarction - systolic pressure less than 100 mm Hg);
- Simultaneous administration of monoamine oxidase inhibitors (MAO) or simultaneous intravenous administration of verapamil;
- Lactation period;
- Age up to 18 years (the safety and effectiveness of Corvitol for this age group of patients have not been established);
- Hypersensitivity to the components of the drug and other beta-blockers.
Corvitol should be used with caution in elderly patients, as well as in the following conditions / diseases:
- Metabolic acidosis;
- Chronic obstructive pulmonary disease (chronic obstructive bronchitis, pulmonary emphysema);
- Bronchial asthma;
- Myasthenia gravis;
- Obliterating peripheral vascular diseases (Raynaud's syndrome, intermittent claudication);
- Chronic renal and / or liver failure;
- AV block I degree;
- Depression (including in the anamnesis);
Dosing and Administration
Corvitol is taken orally after a meal. Tablets need to be swallowed, not chewed and squeezed liquid in a small amount. If necessary, tablets can be divided in half.
When taking the drug 1 time a day, Corvitol should be taken in the morning, with a double intake in the morning and evening. The course of therapy is not limited in time and is determined by the characteristics of the course of the disease.
In the treatment of arterial hypertension and angina, Corvitol is prescribed 100 mg once a day, or 50 mg twice a day. If necessary, the dose can be increased to the maximum - 2 times a day, 100 mg.
With functional disorders of cardiac activity accompanied by tachycardia, Corvitol should be taken in an initial daily dose of 50-100 mg in 1-2 doses.
As a prophylactic agent for migraine attacks, the drug is prescribed 100 mg once a day, or 50 mg twice a day. After improvement under the supervision of a physician, the dose can be reduced.
Elderly patients with functional disorders of the kidneys, as well as in cases of the need for hemodialysis, the dose should not be changed.
With functional disorders of the liver, depending on the clinical condition, the dose of Corvitol should be reduced.
During therapy may develop disorders of some body systems:
- Cardiovascular system: orthostatic hypotension (dizziness, loss of consciousness), palpitations, sinus bradycardia, marked reduction in blood pressure; rarely - a temporary worsening of signs of chronic heart failure (shortness of breath, swelling, swelling of the lower legs and / or feet), arrhythmias, reduction in myocardial contractility, manifestation of angiospasm (cooling of the lower extremities, increased disturbance of peripheral circulation, Raynaud's syndrome), cardialgia, violation of myocardial conductivity ;
- Central nervous system: weakness, fatigue, dizziness, paresthesias in the extremities (in patients with intermittent claudication and Raynaud's syndrome), headache, decreased attention, slowing down the speed of mental and motor reactions, anxiety, depression, insomnia, drowsiness, nightmares, asthenic syndrome short-term memory impairment or confusion, muscle weakness;
- The digestive system: increased activity of liver enzymes, vomiting, nausea, dry mouth, constipation, abdominal pain, diarrhea, change in taste; in some cases, hyperbilirubinemia;
- Respiratory system: nasal congestion, shortness of breath, difficulty in exhalation (bronchospasm in the appointment of the drug in high doses - loss of selectivity and / or in predisposed patients);
- Endocrine system: hypoglycemia (in patients receiving insulin); rarely, hypothyroid state, hyperglycemia (in patients with non-insulin-dependent diabetes mellitus);
- Hematopoietic system: rarely - agranulocytosis, thrombocytopenia (unusual hemorrhages and hemorrhages), leukopenia;
- Sense organs: rarely - tinnitus, decreased secretion of tear fluid, reduced vision, conjunctivitis, soreness and dryness of the eyes, rhinitis;
- Allergic reactions: pruritus, urticaria, rash;
- Dermatological reactions: increased sweating, psoriasis-like skin reactions, exacerbation of the course of psoriasis, skin hyperemia, photodermatosis, exanthema, reversible alopecia;
- Other: pain in the joints or back; in some cases - a slight increase in body weight, decrease in potency and / or libido.
During the period of therapy, one should regularly monitor heart rate and blood pressure, blood glucose in patients with diabetes mellitus (1 time in 4-5 months). If necessary, an oral dose of hypoglycemic agents or insulin should be prescribed individually for patients with diabetes mellitus.
With a heart rate of less than 50 beats per minute, you should consult with your doctor.
Cardioselectivity decreases when taking a daily dose above 200 mg.
Treatment with Corvitol for heart failure can only begin after reaching the stage of compensation.
Withdrawal of the drug should be carried out gradually, reducing the dose within 10 days. With a sharp cessation of therapy may cause withdrawal (increased blood pressure, increased angina attacks). Special attention should be paid to patients with stenocardia.
Metoprolol may mask some of the clinical manifestations of thyrotoxicosis (for example, tachycardia). In patients with thyrotoxicosis, abruptly cancel the drug is contraindicated, as this may increase the symptoms.
When taking Corvitol may increase the symptoms of disorders of the peripheral arterial circulation.
Patients using contact lenses should take into account that the production of tear fluid may decrease during beta-adrenergic blocking therapy.
When applying Corvitol with angina, the dose should provide the heart rate under load - up to 110 beats per minute, at rest - in the range of 55-60 beats per minute.
During therapy, it is possible to increase the severity of hypersensitivity reactions (with an aggravated allergic history) and the absence of the effect of administering ordinary doses of epinephrine (epinephrine).
Taking Corvitol in diabetes mellitus may mask tachycardia caused by hypoglycemia.
If Corvitol is prescribed to patients with pheochromocytoma, alpha-blockers are used as concomitant therapy; with asthma - beta2-adrenostimulyatory.
In cases where surgery is necessary, the anesthesiologist should be warned about the treatment being carried out (for general anesthesia, means with minimal negative inotropic effects should be chosen), the drug is not recommended to be discontinued.
Strengthening the action of beta-blockers can drugs that reduce the supply of catecholamines (eg, reserpine), so patients taking such combinations of drugs should be under constant medical supervision for the timely detection of bradycardia and excessive blood pressure reduction.
In elderly patients, it is recommended to regularly monitor liver function.
Patients with severe renal insufficiency should monitor renal function.
When taking Corvitol with clonidine at the same time, the latter should be canceled only a few days after stopping Corvitol.
Correction of the dosing regimen (sometimes drug withdrawal) may be required only if advanced bradycardia develops in elderly patients (less than 50 beats per minute), ventricular arrhythmias, marked reduction in blood pressure (systolic pressure below 100 mm Hg), bronchospasm, AV - blockade, severe functional disorders of the liver.
Requires special monitoring of patients with depression. With the development of depression caused by beta-blockers, it is recommended to interrupt therapy.
Appropriate clothing should be worn during treatment, as Corvitol can cause photosensitivity.
At the time of therapy, it is necessary to refrain from driving vehicles and practicing potentially hazardous activities that require psychomotor speed and high concentration of attention from patients.
With the simultaneous use of Corvitol with certain drugs, undesirable effects may occur:
- Monoamine oxidase inhibitors - a significant increase in the hypotensive effect (combination of drugs is not recommended, the interval between taking MAO and Corvitol inhibitors should be at least 14 days);
- Means for inhalation anesthesia (derivatives of hydrocarbons) - an increase in the risk of arterial hypotension and inhibition of myocardial function;
- Verapamil (intravenous) - possible cardiac arrest;
- Nifedipine - a significant decrease in blood pressure;
- Ethanol - increased inhibitory effects on the central nervous system and an increase in the risk of a pronounced decrease in blood pressure;
- Theophylline, beta-adrenostimulyatory, estrogen (sodium retention), cocaine, indomethacin and other nonsteroidal anti-inflammatory drugs (sodium retention and blocking the synthesis of prostaglandin by the kidneys) - weakening the hypotensive effect of Corvitol;
- Means for anesthesia - the summation of the cardiodepressive effect;
- Ergot alkaloids - an increased risk of peripheral circulation disorders;
- Insulin - an increased risk of hypoglycemia, increased severity of its symptoms and lengthening, masking some of the symptoms of hypoglycemia (sweating, tachycardia, high blood pressure);
- Oral hypoglycemic agents - may decrease their effect;
- Verapamil, alpha-methyldop, diltiazem, reserpine, antiarrhythmic drugs (amiodarone), guanfacine, clonidine, general anesthesia and cardiac glycosides - a decrease in heart rate and inhibition of AV conduction;
- Antihypertensives, diuretics, nitroglycerin, or slow calcium channel blockers - a sharp decrease in blood pressure is possible, special care should be taken when combined with prazosin;
- Allergens or allergen extracts for skin tests used for immunotherapy - increases the risk of anaphylaxis or systemic allergic reactions;
- Inductors of liver microsomal enzymes (barbiturates, rifampicin) - increased metabolism of metoprolol, a decrease in the concentration of metoprolol in the blood plasma and a decrease in its effect;
- Lidocaine - the clearance decreases and its concentration in the blood plasma increases;
- Inhibitors of liver microsomal enzymes (oral contraceptives, cimetidine, phenothiazines) - an increase in plasma concentration of metoprolol;
- Antidepolarizing muscle relaxants - their effect is enhanced and prolonged;
- Iodine-containing radiopaque substances for intravenous administration - the risk of anaphylactic reactions increases;
- Coumarins - its anti-coagulant effect is lengthened.
If clonidine and metoprolol are taken at the same time, then if you cancel Corvitol, clonidine must be canceled after a few days (due to the risk of withdrawal syndrome).
Terms and conditions of storage
Keep out of reach of children at temperature up to 30 ° C.
Shelf life - 3 years.