Unbeatable

Nebival is a medicine with pronounced hypotensive activity.

Indications It was not

It is used for therapy in people with primary hypertension.

In addition, it can be used in combination therapy in elderly people with heart failure, when standard therapeutic methods do not give the desired result.

[1], [2], [3], [4], [5], [6]

Release form

The release of the medication is realized in tablets packed in blister cells with 10 pieces each. Inside the box there are 2 such cells.

Pharmacodynamics

The active element of Nebival is the substance nebivolol (a combination of 2 enantiomers - L- and D-nebivolol). The drug has an antihypertensive effect, developed with the help of 2 main therapeutic mechanisms - competitive selective blocking of the activity of β1-adrenergic receptors (element D-nebivolol), as well as metabolic linkage with L-arginine / NO (element L-nebivolol).

After using drugs, the values of heart rate are reduced (without reference to the level of blood pressure and intensity of the load), a decrease in blood pressure and systemic resistance of peripheral vessels (this is due to a decrease in the tone of the smooth muscle inside the layer of the vascular membrane).

The use of the drug in combination with other means for the treatment of heart failure leads to an increase in life expectancy and a decrease in the need for hospitalization due to diseases associated with the CAS.

[7], [8], [9], [10], [11], [12], [13]

Pharmacokinetics

After ingestion, nebivolol is well absorbed inside the small intestine. The degree of intensity and rate of absorption of drugs are not tied to the reception of food.

The active element of the drug participates in metabolic processes inside the liver, forming at the same time active metabolic products. The half-life of the component may differ significantly in different patients and range from 10 to 30-50 hours.

Approximately 40% of the active substance is excreted through the kidneys, and about 50% - with feces.

[14], [15], [16], [17], [18], [19], [20], [21]

Dosing and administration

Use Nebival should be inside, without binding to the reception of food. If necessary, it is allowed to divide the tablet into halves. The daily portion of medicines is usually consumed for 1 dose. To get the maximum medication, you should take the medicine at the same time of day. Duration of treatment and dosage sizes are selected by the attending doctor.

People with elevated blood pressure indicators usually use a 1-hour drug pill per day. If the optimal control of blood pressure values can not be achieved after 4 weeks from the start of treatment, it is necessary to additionally prescribe an antihypertensive drug from another category or a diuretic (eg, hydrochlorothiazide in a dose of 12.5-25 mg per day).

People with CHF are often prescribed to consume 12.5 mg of medication per day. If good drug tolerance is noted, the dose can be increased at 2-week intervals until a daily dose of 10 mg of the substance is obtained.

Before starting to use Nebival, people who use other medicines should already have an optimal dose of these medicines (the last dosage adjustment of such drugs should be done no earlier than 14 days before starting the use of nebivolol).

For a day allowed to consume a maximum of 10 mg of drug substance.

If you need to cancel the medicine, it is recommended to lower its dosage gradually (except for situations when the patient's condition worsens due to taking the drug).

People with disorders of kidney activity per day can take no more than 5 mg of a therapeutic drug.

[29]

Use It was not during pregnancy

Since nebivolol is able to negatively affect the development of the fetus, it is forbidden to use the medication during pregnancy. Before starting treatment, women who are in reproductive age should be excluded from the possibility of pregnancy.

During the planning of conception, you must abandon the reception of Nebival and pick up an analogue that will be more safe for the fetus.

When using lactation, the drug is only allowed if you refuse breastfeeding.

Contraindications

The main contraindications:

• use in people with intolerance regarding nebivolol hydrochloride;
• hypolactasia (also persons with lactase deficiency), galactosemia and glucose-galactose absorption in the intestine;
• pronounced forms of disorders in the liver and kidneys;
• acute stage of heart failure, as well as heart failure, against which decompensation episodes are marked (in these situations, drugs with positive inotropic influence need to be administered);
• decreased blood pressure and cardiogenic shock;
• the expressed degree of a bradycardia, SSSU, AV-blockade of 2-3 degrees;
• untreated pheochromocytoma, asthma (also in history), metabolic acidosis and a tendency to bronchospasm;
• disorders of peripheral blood circulation in the severe stage.

It is necessary to stop the use of nebivolol hydrochloride at least 24 hours before the scheduled surgical procedure, at which general anesthesia is used.

With caution, the drug is prescribed for moderate forms of peripheral circulatory disorders, AB-blockade of the 1st degree, diabetes mellitus, spontaneous angina, obstructive forms of pulmonary pathologies of a chronic nature, and also for psoriasis (also in anamnesis).

Along with this, caution is required when using drugs in people with depression or myasthenia gravis, as well as people over 75 years of age.

It is necessary to abandon the management of life-threatening mechanisms and from driving a car for the duration of treatment using Nebival.

[22], [23], [24], [25], [26], [27],

Side effects It was not

After using the drug, a variety of side effects may develop, caused by the activity of nebivolol hydrochloride:

• disturbances in the CCC and circulatory system: heart rhythm disorder, severe lowering of blood pressure, deterioration in people with impaired peripheral circulation, heart failure of an acute nature, and in addition AV blockade, pain in the heart and peripheral puffiness;
• problems with the function of the NA: headaches, syncope, increased fatigue, paresthesia, dizziness, nightmares, depression, and also weakening of visual acuity. Along with this, there was a single occurrence of hallucinations, psychiatric disorders and Raynaud's disease;
• digestive disorders: nausea, stool, bloating and dyspepsia;
• signs of allergy: itching, erythema, Quincke edema, bronchial spasms, urticaria, anaphylaxis and exacerbation of existing psoriasis;
• Other: cyanosis in the limbs, impotence and dry keratoconjunctivitis.

[28]

Overdose

Use of the drug in excessively large portions can cause bradycardia or bronchial spasms, as well as a decrease in the values of blood pressure and the development of heart failure in the acute stage or collapse.

When poisoning with a large dose of drugs, it is necessary to perform gastric lavage and give the affected enterosorbents. In addition, laxatives may be prescribed to reduce the absorption of nebivolol. In case of an overdose, it is required to track the values on the ECG, blood pressure level, blood glucose values and monitor the general condition of the patient.

In severe forms of intoxication, intensive care procedures are performed.

In the case of bradycardia, it is necessary to administer atropine to the patient.

If there is a marked decrease in blood pressure, the patient should be administered plasma substitutes to increase the total volume of circulating blood, and in addition catecholamines.

When blocking the activity of β-adrenergic receptors, it is required to use isoprenaline hydrochloride or dobutamine in the selected dosages.

If the above measures were ineffective, you need to inject the patient with glucagon in a dose of 50-100 μg / kg.

In severe forms of impairment, artificial pulmonary ventilation and the use of a pacemaker may be necessary.

[30], [31]

Interactions with other drugs

You can not combine the drug with sultopride or floktaphenin.

It is forbidden to combine Nebival with antiarrhythmic drugs from the first category, calcium antagonists (eg, dihydropyridine or verapamil), and in addition to antihypertensive medications that exert a central influence. This is due to the increased likelihood of the occurrence of AV blockade or heart failure in the acute stage.

It is necessary to use with care the medication together with amiodarone, and also with volatile halogenated type analgesics.

Nebivolol is able to mask signs of hypoglycemia, which is why it should be used carefully in combination with insulin and antidiabetic drugs for ingestion.

Amifostin and baclofen with antidepressants and antipsychotics when combined with a drug potentiate its antihypertensive effect.

When combined with sympathomimetics, the medicamental effect of the drug is weakened.

Substances that slow down the activity of the CYP2 D6 enzyme (including quinidine with paroxetine, thioridazine and dextromethorphan with fluoxetine), increase the values of unchanged nebivolol within the plasma.

[32], [33], [34], [35]

Storage conditions

Nebival should be kept at temperature values not exceeding a mark of 30 ° C.

[36], [37], [38]

Shelf life

Nebivale can be used within 24 months from the date of release of the drug.

[39], [40], [41], [42]

Use in children

Nebivall is prohibited from prescribing to pediatrics.

Analogues

Analogues of the drug are medicines Nebilet and Nebivolol.

[43], [44], [45], [46], [47], [48], [49], [50]

Reviews

Nebival basically gets positive feedback from both patients and doctors. With the constant use of drugs with the appointment of a doctor, he demonstrates high efficiency with ischemia or high blood pressure.

It should be taken into account that the drug should be used with extreme caution - avoiding non-compliance with the prescribed regimen, because this can weaken its therapeutic effectiveness. It should also be remembered that poisoning with medication can lead to very serious consequences, up to the death of the patient. Because of this, it is extremely important to follow the instructions prescribed by the specialist in everything.

At the same time, it should be noted that combined therapy is often used (especially in the elderly) with several different drugs. In these cases, the patient's state of health should be carefully monitored in order to avoid the negative consequences associated with the interaction of these drugs.

Of the advantages of the medicine, it is also noted that it is quite affordable.