Nebilet table. Nebilet: analogues and detailed instructions for use

The heart rate decreases after taking this medicine. So, let's take a closer look at the instructions for using the drug Nebilet, reviews of it from cardiologists and patients, prices and analogues.

Features of the drug

In international medical practice, the drug has the generic name Nebivolol. The term Nebival is also used as a synonym.

Compound

The drug Nebilet in 2 tablets contains 5.45 mg of micronized Nebivolol hydrochloride (this number corresponds to the content of 5 mg of nebivolol). To add flavor and for other medical purposes, the following additional substances are also used in the drug:

• lactose;
• hypromellose;
• cellulose;
• corn starch and some others.

Dosage forms

The drug is produced in the form of round white tablets, in the middle of which there is a cross-shaped notch to allow the pill to be separated. The box contains 1-2 or 4 blisters, each of which consists of 7 or 14 tablets.

As for the cost, it can vary significantly depending on the manufacturer. For example, Nebilet No. 28 in Moscow pharmacies costs an average of 1,010 rubles, and the same drug with the postscript Sandoz No. 14 costs 254 rubles.

Pharmacological action and pharmacodynamics

• It is a cardioselective β1-blocker that has hypotensive, antiarrhythmic, and antianginal effects.
• Helps lower blood pressure both under stress or intense physical activity, and at rest.
• Due to its selective form of action, the drug selectively blocks postsynaptic β1-adrenergic receptors. Due to this, such receptors become inaccessible to catecholamines.
• Modulation of endothelial nitric oxide release also occurs. This action leads to dilation of blood vessels.
• In addition, the activity of the renin-angiotensin-aldosterone system decreases, thereby causing a hypertensive effect. After 1-2 weeks of continuous use, the patient should feel positive dynamics. The greatest effect in lowering blood pressure can usually be achieved after 1-2 months.
• The drug helps reduce the myocardial need for oxygen, reduces both the frequency and quality.
• As for the antiarrhythmic properties, in the process of taking this beta1-blocker, the pathological automatism of the “motor” is suppressed, and AV conduction is also slowed down.

Pharmacokinetics

• Suction. Both enantiomers are rapidly absorbed after taking the tablet orally, regardless of food intake, since it does not affect absorption. Bioavailability is about 12% in those who boast an accelerated metabolism; in those patients who have a “slow” metabolism, the bioavailability is almost complete.
• Distribution. These enantiomers are mostly associated with albumin.
• Metabolism The active substance of the drug occurs through alicyclic and aromatic hydroxylation.
• Removal residues occur through the kidneys and intestines.

Excreted by the kidneys (38%) and through the intestines (48%).

Indications for use of Nebilet

The drug is used in the treatment of patients with the following ailments of the cardiovascular system:

• arterial hypertension;
• , seizures;
• , as part of combi-therapy together with ACE inhibitors and other drugs.

For pregnant women, the drug can be indicated only if the benefits of taking the drug outweigh the potential harm or risk of such harm to the health of the fetus, since it may also develop hypertension. If therapy is nevertheless prescribed, the doctor must carefully monitor the uteroplacental blood flow and the growth of the unborn child. Stop taking the drug 2-3 days before giving birth.

During lactation, taking the drug is undesirable, or the child is not allowed to drink such milk.

Now let's look at the instructions for the drug Nebilet.

Instructions

As for the dosage, doctors usually prescribe the patient to take Nebilet once a day (regardless of meals). It is highly advisable to use the drug at the same time every day. Each Nebilet tablet is taken orally with water.

Depending on the type of disease, the dosage may vary:

• For the treatment of arterial hypertension and coronary heart disease, 0.5-1 tablet per day is prescribed.
• In the combination treatment of CHF, taking tablets begins with a minimum dose (1.25 mg), with a gradual increase once every week or two under the constant supervision of a doctor.
• If the patient has renal failure, as well as those whose age is more than 65 years, they are prescribed to take 0.5 tablets with a gradual increase to a maximum of 2 tablets per day.
• For ischemic heart disease, the dosage of the drug is similar to the treatment of arterial hypertension and is 0.5-1 tablet per day.

The attending physician should monitor the patient for 2 hours after the first dose of the medicine, as well as in case of increasing the dosage.

The maximum permissible daily dose of the drug is 10 mg.

Contraindications

Like any drug, Nebilet has contraindications, namely:

• CHF at the stage of decompensation;
• systolic blood pressure is less than 90 mm Hg. column;
• and other SSSU;
• AV block of the second and third degrees;
• severe illnesses and liver dysfunction;
• past bronchospasm/bronchial asthma;
• bradycardia;
• serious ;
• impotence, myasthenia;
• metabolic acidosis;
• pheochromocytoma;
• prolonged depressive state.

In addition to this, there are also “non-painful” factors, such as:

• lactose intolerance;
• age less than 18 years;
• high sensitivity to the substances contained in the drug.

This drug should be used with extreme caution in people with:

• renal failure;
• allergies and psoriasis;
• First degree AV block;
• diabetes mellitus;
• hyperfunction of the thyroid gland,
• chronic obstructive pulmonary disease.

Also, special attention should be paid when taking the medicine if the patient has already reached the age of 75.

Side effects

For a better understanding, possible side effects were presented in table form:

special instructions

If an overdose of a β-blocker occurs, the patient may experience symptoms.

Name:

Nebilet

Pharmacological
action:

Cardioselective beta1-blocker. It has hypotensive, antianginal and antiarrhythmic effects.
Reduces high blood pressure at rest, during physical exertion and stress.
Competitively and selectively blocks postsynaptic β1-adrenergic receptors, making them inaccessible to catecholamines, modulates the release of endothelial vasodilating factor nitric oxide (NO).
Nebivolol is a racemate of two enantiomers: SRRR-nebivolol (D-nebivolol) and RSSS-nebivolol (L-nebivolol), combining two pharmacological actions:
- D-nebivolol is a competitive and highly selective β1-adrenergic receptor blocker;
- L-nebivolol has a mild vasodilatory effect by modulating the release of vasodilating factor (NO) from the vascular endothelium.

The hypotensive effect is also due to a decrease in the activity of the renin-angiotensin-aldosterone system (RAAS) (does not directly correlate with changes in renin activity in the blood plasma).
Sustained hypotensive effect develops after 1-2 weeks regular use of the drug, and in some cases - after 4 weeks, a stable effect is observed after 1-2 months.
By reducing myocardial oxygen demand (reducing heart rate and reducing preload and afterload), it reduces the number and severity of angina attacks and increases exercise tolerance.
The antiarrhythmic effect is due to the suppression of pathological automatism of the heart (including in the pathological focus) and slowdown of AV conduction.

Pharmacokinetics
Suction
After oral administration, both enantiomers are rapidly absorbed.
Food intake does not affect absorption, so nebivolol can be taken regardless of meals.
The bioavailability of nebivolol after oral administration averages 12% in rapid metabolizers (first pass effect through the liver) and is almost complete in slow metabolizers.
Distribution
In blood plasma, both enantiomers are predominantly associated with albumin. Plasma protein binding for D-nebivolol is 98.1%, and for L-nebivolol - 97.9%.

Metabolism
Metabolized by acyclic and aromatic hydroxylation and partial N-dealkylation.
The resulting hydroxy and amino derivatives are conjugated with glucuronic acid and are excreted in the form of O- and N-glucuronides.
Removal
Excreted by the kidneys (38%) and through the intestines (48%).
In persons with “fast” metabolism T1/2 of hydroxymetabolites - 24 hours, enantiomers of nebivolol - 10 hours; in persons with “slow” metabolism: hydroxymetabolites - 48 hours, nebivolol enantiomers - 30-50 hours.
Excretion of unchanged nebivolol in urine is less than 0.5% of the amount of the drug taken orally.

Indications for
application:

The drug is used in the treatment of patients with the following disorders of the cardiovascular system:
- arterial hypertension;
- coronary heart disease, angina pectoris;
- the drug is also used in complex therapy of chronic heart failure.

Mode of application:

Essential hypertension. The dose is 1 tablet (5 mg nebivolol) per day; You should always take it at the same time, possibly during meals.
The antihypertensive effect appears after 1–2 weeks of treatment; in some cases, the optimal effect is achieved only within 4 weeks.
Nebilet can be prescribed both as monotherapy and with other antihypertensive drugs.
To date, additional hypotensive effects have only been observed when used in combination with 12.5–25 mg hydrochlorothiazide.
Chronic heart failure.
Treatment with Nebilet should begin with a gradual increase in dose until an individual optimal maintenance dose is achieved.
The drug is prescribed in the absence of episodes of decompensation of chronic heart failure over the past 6 weeks.
Doses of other drugs (diuretics, digoxin, ACE inhibitors, angiotensin II receptor antagonists) used in the patient should be adjusted over the 2 weeks preceding the start of Nebilet therapy.
The initial titration of the dose should be carried out according to the following scheme, adhering to 1-2 week intervals before each dose increase and focusing on its tolerability by the patient: 1.25 mg of nebivolol is initially prescribed, then the dose can be increased to 5 mg, and then to 10 mg 1 time per day.

The maximum recommended dose is 10 mg nebivolol once a day.
At the beginning of treatment and with each dose increase, the patient should be under medical supervision for at least 2 hours to ensure that the clinical condition remains stable (especially with regard to blood pressure, heart rate, myocardial conduction disturbances, and an increase in the severity of symptoms of heart failure).
If necessary, the dose already achieved can be gradually reduced again or returned to it again. If the severity of symptoms of heart failure or intolerance to the drug increases during its titration phase, it is recommended to first reduce the dose of nebivolol or, if necessary, immediately discontinue it (with the appearance of severe hypotension, an increase in the severity of symptoms of heart failure with acute pulmonary edema, with the appearance of cardiogenic shock, symptomatic bradycardia or AV block).
As a rule, treatment of chronic heart failure with nebivolol is long-term. Treatment with nebivolol should not be stopped suddenly, as this may increase the severity of heart failure symptoms.
If discontinuation of the drug is necessary, the dose should be reduced in stages, reducing it by half per week.

Patients with renal failure: The recommended starting dose is 2.5 mg/day.
If necessary, the daily dose can be increased to 5 mg.
Patients with liver failure: experience with the drug in such patients is limited, therefore nebivolol is contraindicated.
Patients over 65 years of age: for this group of patients the initial dose is 2.5 mg per day, and if necessary it can be increased to 5 mg.
Due to insufficient experience with the use of the drug in patients over the age of 75 years, its use requires caution and careful monitoring.

Side effects:

When taking the drug, patients experienced the following side effects:
- from the gastrointestinal tract: nausea, vomiting, stool disorders, flatulence, dry mouth;
- from the peripheral and central nervous system: headaches, dizziness, paresthesia, depression, fatigue, increased fatigue, impaired concentration. Disturbance in sleep and wakefulness, nightmares, hallucinations;
-from the cardiovascular system: arrhythmias, bradycardia, atrioventricular block, hypotension, swelling of the face and limbs, Raynaud's syndrome, shortness of breath, pain in the heart, heart failure.
Allergic reactions: urticaria, itching, allergic rhinitis.
Other side effects: visual impairment, photodermatosis, bronchospasm, hyperhidrosis.

The drug is characterized by a withdrawal syndrome upon abrupt cessation of use, therefore it is recommended to stop drug therapy gradually.
Patients who wear contact lenses should be aware that taking Nebilet may cause dry eye syndrome.
When taking the drug, the reaction rate may decrease; this must be taken into account when prescribing the drug to patients whose work is associated with potentially unsafe mechanisms.

Contraindications:

Acute heart failure;
- chronic heart failure in the stage of decompensation (requiring intravenous administration of drugs with inotropic effects);
- severe arterial hypotension (systolic blood pressure less than 90 mm Hg);
- SSSU, including sinoatrial block;
- AV block II and III degrees (without artificial pacemaker);
- bradycardia (heart rate less than 60 beats/min);
- cardiogenic shock;
- pheochromocytoma (without simultaneous use of alpha-blockers);
- metabolic acidosis;
- severe liver dysfunction;
- history of bronchospasm and bronchial asthma;
- severe obliterating diseases of peripheral vessels (intermittent claudication, Raynaud's syndrome);
- myasthenia;
- depression;
- lactose intolerance, lactase deficiency and glucose/galactose malabsorption syndrome;
- children and adolescents under 18 years of age (efficacy and safety have not been studied);
- hypersensitivity to nebivolol or one of the components of the drug.

Should be used with caution drug for renal failure, diabetes mellitus, hyperfunction of the thyroid gland, a history of allergic diseases, psoriasis, chronic obstructive pulmonary disease, AV blockade of the first degree, Prinzmetal's angina, as well as for patients over 75 years of age.

The withdrawal of beta-blockers should be carried out gradually over 10 days (up to 2 weeks in patients with coronary artery disease).
Monitoring blood pressure and heart rate at the beginning of taking the drug should be daily.
In elderly patients, monitoring of kidney function is necessary (once every 4-5 months).
For exertional angina, the dose of the drug should ensure that the heart rate at rest is within the range of 55-60 beats/min, and during exercise - no more than 110 beats/min.
Beta blockers may cause bradycardia: the dose should be reduced if the heart rate is less than 50-55 beats/min.
When deciding on the use of Nebilet® in patients with psoriasis, one should carefully weigh the expected benefits of using the drug and the possible risk of exacerbation of psoriasis.
Patients who use contact lenses should take into account that the use of beta-blockers may reduce the production of tear fluid.

When performing surgical interventions, the anesthesiologist should be warned that the patient is taking beta-blockers.
Nebivolol does not affect plasma glucose concentrations in patients with diabetes mellitus. Nevertheless, care should be taken when treatment of these patients, since Nebilet may mask certain symptoms of hypoglycemia (for example, tachycardia) caused by the use of oral hypoglycemic agents and insulin. Monitoring the concentration of glucose in the blood plasma should be carried out once every 4-5 months (in patients with diabetes mellitus).
With hyperthyroidism, beta-blockers can mask tachycardia.
Beta blockers should be used with caution in patients with chronic obstructive pulmonary disease, as bronchospasm may increase.
Beta blockers may increase sensitivity to allergens and the severity of anaphylactic reactions.

Impact on the ability to drive vehicles and operate machinery
The effect of the drug Nebilet on the ability to drive vehicles and operate machinery has not been specifically studied.
Pharmacodynamic studies of nebivolol have shown that Nebilet does not affect psychomotor function.
During treatment with Nebilet (if side effects occur), caution should be exercised when driving vehicles and when engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Interaction
other medicinal
by other means:

Pharmacodynamic interaction
With the simultaneous use of beta-blockers with blockers of slow calcium channels (verapamil and diltiazem), the negative effect on myocardial contractility and AV conductivity increases.
IV administration of verapamil is contraindicated while using nebivolol.
When nebivolol is used simultaneously with antihypertensive drugs, nitroglycerin or slow calcium channel blockers, severe arterial hypotension may develop (special caution is required when combined with prazosin).

With the simultaneous use of nebivolol with class I antiarrhythmic drugs and amiodarone, the negative inotropic effect may be enhanced and the time of excitation through the atria may be prolonged.
With simultaneous use of nebivolol with cardiac glycosides, there was no increase in the effect on slowing down AV conduction.
The simultaneous use of nebivolol and drugs for general anesthesia may suppress reflex tachycardia and increase the risk of developing arterial hypotension.
There is no clinically significant interaction between nebivolol and NSAIDs.
Concomitant use of nebivolol with tricyclic antidepressants, barbiturates and phenothiazine derivatives may enhance the hypotensive effect of nebivolol.

Pharmacokinetic interaction
With the simultaneous use of nebivolol with drugs that inhibit serotonin reuptake, or other drugs that are biotransformed with the participation of the CYP2D6 isoenzyme, the concentration of nebivolol in the blood plasma increases, the metabolism of nebivolol slows down, which can lead to the risk of bradycardia.
When used concomitantly with digoxin, nebivolol does not affect the pharmacokinetic parameters of digoxin.
With simultaneous use of nebivolol with cimetidine, the concentration of nebivolol in the blood plasma increases.
The simultaneous use of nebivolol and ranitidine does not affect the pharmacokinetic parameters of nebivolol.

With simultaneous use of nebivolol with nicardipine, the concentrations of active substances in the blood plasma increase slightly, but this does not have clinical significance.
Concomitant use of nebivolol and ethanol, furosemide or hydrochlorothiazide does not affect the pharmacokinetics of nebivolol.
No clinically significant interaction between nebivolol and warfarin has been established.
When nebivolol is used concomitantly with insulin and oral hypoglycemic agents, the symptoms of hypoglycemia (tachycardia) may be masked.

Pregnancy:

During pregnancy, Nebilet is prescribed only for vital indications, when the benefit to the mother outweighs the possible risk to the fetus or newborn (due to the possible development of bradycardia, arterial hypotension, and hypoglycemia in the fetus and newborn).
If treatment with Nebilet is necessary, uteroplacental blood flow and fetal growth should be monitored.
Treatment must be interrupted 48-72 hours before delivery.
In cases where this is not possible, it is necessary to establish strict monitoring of newborns for 48-72 hours after delivery.
Nebivolol is excreted in breast milk.
If it is necessary to take Nebilet® during lactation, breastfeeding should be stopped.

Overdose:

Symptoms: marked decrease in blood pressure, nausea, vomiting, cyanosis, sinus bradycardia, AV block, bronchospasm, loss of consciousness, cardiogenic shock, coma, cardiac arrest.
Treatment: gastric lavage, taking activated carbon. In case of a pronounced decrease in blood pressure, it is necessary to place the patient in a horizontal position with raised legs, and, if necessary, administer intravenous fluids and vasopressors. For bradycardia, 0.5-2 mg of atropine should be administered intravenously; if there is no positive effect, a transvenous or intracardiac pacemaker may be installed. In case of AV blockade (II-III stage), intravenous administration of beta-adrenergic stimulants is recommended; if they are ineffective, the issue of installing an artificial pacemaker should be considered. In case of heart failure, treatment begins with the administration of cardiac glycosides and diuretics; if there is no effect, it is advisable to administer dopamine, dobutamine or vasodilators. For bronchospasm, IV β2-adrenergic receptor stimulators are used. For ventricular estracystole - lidocaine (class IA antiarrhythmic drugs cannot be administered).

A healthy person often does not understand how great a gift he has been given from above. After all, he can live every day exactly the way he wants, regardless of weather conditions, atmospheric pressure and other factors. But people suffering from certain diseases look at the world differently. For them, the coming morning is sometimes real happiness. This is especially true for those who have heart problems and hypertension. Many people underestimate the seriousness of high blood pressure, but doctors around the world say that it is progressive hypertension that causes diseases of various organs. In the future, human carelessness can lead to stroke and sudden death in a dream. Today, a large number of drugs have been developed that very effectively combat arrhythmia, high blood pressure and other problems of the cardiovascular system. One of the most common remedies in Russia is “Nebilet”. Reviews from cardiologists about it are overwhelmingly positive. Therefore, it is often prescribed to patients in different clinics. However, this medicine should not be considered a panacea; it has a lot of side effects and contraindications. Therefore, you need to be very careful about the independent use of Nebilet. Indications for treatment with the drug should only be identified by a cardiologist. He will be able to compare the need to take pills with the diagnosis. Today we will tell you what Nebilet is, how long to take it and which groups of patients really need this drug.

a brief description of

From the reviews of cardiologists about Nebilet, you can form a general idea about this product. It belongs to a large group of beta-blockers. Such drugs have been used for a very long time, and several generations of them have already been released today. "Nebilet" are the latest generation tablets that combine effectiveness and maximum safety for the patient.

The drug quickly lowers blood pressure, dilates blood vessels, eliminates oxygen starvation and normalizes heart rate. Also, from the reviews of cardiologists about Nebilet, it becomes clear that the drug significantly reduces the risk of death from stroke and coronary disease. It is also often prescribed to avoid recurrent heart attacks. The product can be used as personal therapy or in combination with other medications prescribed by a doctor.

Release form, active and excipients

The manufacturer of Nebilet is the Belgian company Berlin-Chemie AG/Menarini Group. It has been supplying the drug to Russia for several years. In pharmacies, the product is sold only in tablet form, so if you are offered to purchase the medicine in the form of drops, keep in mind that this is an obvious fake. It can cost you not only your health, but also your life.

The instructions for Nebilet indicate that the tablets are produced in blisters of seven, fourteen, twenty-eight and fifty-six pieces. Each tablet is painted white and has a convex shape on both sides. It has a notch on one side, making it easy to divide.

Often, cardiologists, when prescribing this drug to a patient, say such a mysterious phrase as “Nebilet”, 5 mg." However, at the pharmacy, visitors learn that each tablet of the drug contains almost five and a half milligrams of the active substance. It is nebivolol, which provides lowering blood pressure. For those who are confused by the dosage indicated on the packaging of Nebilet tablets, we will tell you that the main active ingredient of the drug in the tablet is in connection with the hydrochloride. Once in the body, nebivolol is released, and in its pure form its dosage is exactly five milligrams Therefore, pharmacists decided to indicate the amount of pure active substance on the medicine packaging.

Among the auxiliary components of the drug are the following:

• polysorbate;
• corn starch;
• microcrystalline cellulose and other similar substances.

Cardiologists in reviews of Nebilet write that the drug is very quickly absorbed into the body, so you don’t have to wait more than ten minutes for its effect. All patients note that relief occurs within minutes after taking one tablet.

“Nebilet” and “Nebilet Plus”: similarities and differences

Often patients who are prescribed this drug are interested in whether they can purchase “Nebilet Plus” instead, which is also very common. Doctors usually warn against such a replacement, because, despite the similarity of the drugs, they also have significant differences.

"Nebilet Plus" has two active components instead of one, and the second has a pronounced diuretic effect. This helps to quickly lower blood pressure, but at the same time, such a side effect can aggravate the patient’s condition with certain cardiovascular diseases. Therefore, the drug that we are describing today differs significantly in its therapeutic effect from Nebilet Plus, and they are in no way interchangeable.

Therapeutic effect of the drug

Nebilet is prescribed by cardiologists for people suffering from diseases of the cardiovascular system and for the treatment of hypertension. It has proven to be very effective in complex therapy, so doctors often combine it with other drugs, which ultimately enhances the effect of Nebilet. However, experimenting with various means on your own is strictly prohibited.

It is believed that this drug in its group has the maximum therapeutic effect:

• Reduced blood pressure. It is noteworthy that the medicine helps to normalize blood pressure in various physical and mental conditions of a person. You can take Nebilet tablets (the price will be indicated by us in one of the sections of the article) when you are resting, doing physical labor, or are in a stressful situation. In any case, the desired result will be achieved quickly. Sometimes, when taking the drug for the first time, a temporary increase in pressure is observed, but after a maximum of five days the patient’s condition returns to normal. And after one to two months of regular use, the patient observes a lasting effect.
• Reducing the oxygen demand of the heart muscle and increasing the efficiency of its contractions. People suffering from coronary heart disease, heart failure or arrhythmia know that their “engine” works under constant conditions of oxygen deficiency. When taking Nebilet and analogues, the heart muscle requires less oxygen, and the organ begins to function more efficiently. In this case, patients tolerate stress and physical activity more easily, and the frequency of angina attacks decreases. In addition to the already listed therapeutic effect, the drug actively protects heart cells from toxins and the effects of adverse environmental factors. As a result, the organ is maintained in working condition for quite a long time.
• Relief of arrhythmia attacks.

Despite the abundance of adrenergic blockers in pharmacies, cardiologists in most cases prescribe Nebilet. They believe that taking it has minimal side effects. Therefore, patients are not at risk of impaired carbohydrate metabolism, impotence and other consequences.

Who is indicated for taking the drug?

Keep in mind that Nebilet cannot be taken without a doctor's prescription. Only he can decide how treatable your disease is with this remedy. It is usually prescribed due to the following problems:

• High blood pressure. Often the medicine is successfully combined with other similar drugs.
• Cardiac ischemia.
• Heart failure of varying degrees of severity (the drug has shown itself well in the treatment of people over seventy years of age).

Patients taking Nebilet claim that their quality of life has improved and the risk of hospitalization has significantly decreased. Cardiologists also add that patients who use this particular drug for treatment live longer than those who ignore doctor’s orders.

Nebilet tablets: instructions for use

If the doctor does not prescribe a specific dose of the drug, then you must adhere to the regimen specified in the instructions. The drug is taken once a day. It is important that this happens at the same time. Some patients set a reminder on their phone so they don't miss their appointment. Each tablet should be taken with a glass of clean water.

The dosage regimen we described is general, but for some diseases you need to follow different instructions:

• Hypertension and coronary heart disease. You should start taking the drug with half and then gradually increase the dose to one tablet. If the desired effect is not achieved, then you can take two Nebilet tablets at a time. However, do not forget that regardless of the dosage, you must drink the medicine once a day. If you suffer only from hypertension in the absence of heart problems, then you can quite effectively combine the drug with a diuretic. In this case, the medicine will act faster and have a more stable effect.
• Chronic heart failure. Nebilet is started to be taken only when the patient has not experienced exacerbations leading to hospitalization for a long time (at least six months). Cardiologists recommend starting treatment with a quarter and only then slowly reaching the optimal dosage. As soon as you feel an improvement in your condition, you have found the required dosage. Now be prepared that you will have to take the drug for several years. When taking a quarter tablet for the first time, you should wait approximately two weeks before increasing your dosage.

It is recommended that after starting treatment with Nebilet you are under 24-hour medical supervision for five days. The specialist will record all changes in the body, and if side effects or other alarming symptoms appear, he will immediately take action. Each increase in dosage should also be carried out under the strict supervision of the attending physician.

Keep in mind that you cannot stop taking the drug immediately. The patient should withdraw from its influence gradually, reducing the dosage to one-fourth of the tablet.

Effect of the drug on the course of pregnancy

Taking Nebilet during pregnancy can lead to a number of complications:

• intrauterine growth retardation;
• miscarriage;
• premature contractions.

Doctors try to avoid prescribing this drug to pregnant women. In rare cases, when the life of the expectant mother is at risk and without Nebilet she may die, the doctor may prescribe this remedy. However, a woman should be under the supervision of specialists at all times and stop taking pills three days before giving birth and three days after it. The newborn should also be under close medical supervision, because the drug can cause many complications.

During breastfeeding, stop taking the medicine, otherwise the baby should be immediately switched to artificial formula.

Combination of the drug with alcohol

Nebilet and alcohol are incompatible. This should be clearly understood by all patients. When taking alcoholic beverages in parallel with pills, intoxication occurs much faster, and its consequences often last for several days. Therefore, refrain from such drinks during treatment.

"Nebilet": side effects

Despite its safety, the drug can cause a lot of side effects, about which patients should be warned. For example, the central nervous system may respond with fainting, depression, insomnia, and fatigue.

Patients may also experience dry mouth, nausea (even vomiting) and bloating after taking the drug. Sometimes patients complain of heart pain, arrhythmia and low blood pressure. In the rarest cases, severe skin rash, itching and even swelling have been observed. Side effects include such manifestations as:

• dry eyes;
• sweating;
• blurred vision;
• regular swelling;
• hallucinations.

If you notice any side effects while taking Nebilet, consult your doctor immediately. He will do some lab tests to see if you should continue taking this drug.

Analogues and synonyms

Almost every drug has a number of similar drugs. Pharmacists divide them into synonyms and analogues. The former have identical active substances, but the latter have a similar therapeutic effect when using other active ingredients.

Among the synonyms of “Nebilet” are “Binelol”, “Nevotens” and “Nebikor”. In general, there are about ten such drugs.

Analogs of Nebilet are very numerous; thirty-three drugs with similar effects are known on the drug market. These include such well-known names as:

• "Egilok";
• "Coronal"
• "Concor";
• "Cerdol";
• "Biprol."

If Nebilet does not suit you for certain parameters, then the cardiologist has the right to prescribe a synonym or analogue of this drug. Perhaps another remedy will be more useful to you.

Cost of the drug

Unfortunately, Nebilet tablets are not the lowest priced. Therefore, the drug is not available to every patient. Often its cost reaches almost six hundred rubles per package. At the same time, reviews often write that with each increase in prices for medicines, Nebilet becomes more expensive by almost a hundred rubles immediately.

Patients consider this fact to be a significant disadvantage of this drug.

Chronic heart failure, ischemic heart disease.

Nebilet's abstract notes its ability to persistently dilate blood vessels, which, in combination with a pronounced hypotensive effect, allowed it to win the trust of doctors and patients.

The drug is original, the name indicated in the international register is . It should be noted that this medicine is not a panacea; it has a number of limitations in use and side effects. Below we will describe how to take Nebilet correctly and for how long, instructions for use and some other important nuances.

By its chemical nature, the drug is a cardioselective beta-1 adrenergic blocker. The drug perfectly stabilizes blood pressure, not only in a relaxed state, but also during stress, emotional and stress.

Nebilet tablets 5 mg

It reduces the frequency of angina episodes, normalizes rhythm, and due to its ability to modulate the release of nitric oxide, dilates blood vessels. A stable effect on hypertension begins to be observed after a week, sometimes two, of regular treatment. The maximum reduction and normalization of indicators occurs after a couple of months.

The instructions for use accompanying the medicine Nebilet indicate the following indications:

• secondary hypertension;
• chronic heart failure;
• as a preventative against angina pectoris in coronary artery disease.

Compound

The drug Nebilet contains nebivolol hydrochloride in the amount of 5.45 mg per tablet. This is the active substance.

Each tablet contains starch, magnesium stearate, lactose, sodium carboxymethylcellulose, polysorbate 80, MCC and some other components.

The description of Nebilet for buyers is as follows: it is available in blisters, the number of tablets in each is 7 or 14. There are 1, 2, 4 plates in a box. The tablet is almost white, with a faint yellowish tint, convex on both sides. For ease of dividing into two or four parts, it has a notch.

Medicine Nebilet: instructions, price and symptoms of overdose

So, how to take Nebilet? It is enough to take the medicine once a day, preferably at the same time. Intake does not depend on food intake: you can take a tablet before or after a meal.

Often, the optimal dose for patients with hypertension and coronary artery disease is half or a whole tablet, that is, 2.5 or 5 mg per day.

The drug interacts well with antihypertensive tablets of other groups, so it is allowed to be combined, but only after receiving medical advice.

In the case of CHF, the regimen for taking this medication varies. With this pathology, the course begins with taking a quarter of a tablet per day, over two weeks the dose is increased to half. Treatment is carried out under the close supervision of a therapist and cardiologist.

For people suffering from kidney failure, as well as for people over 65 years of age, the scheme is the same. They start taking it with 1.25 mg for hypertension, CHF, and coronary artery disease. The price of Nebilet depends on the packaging: 14 pcs. – around 550 rubles, 28 pcs. – about 950 rubles.

Taking Nebilet 5 mg not according to the instructions may lead to an overdose of the active ingredient. In this case, the following symptoms will manifest themselves:

• a sharp drop in pressure;
• bluish skin tone;
• nausea;
• vomit;
• weak pulse.

More rarely, the following conditions may occur:

• cardiogenic shock;
• bronchospasm;
• loss of consciousness;
• heart failure;
• coma;
• development of AV block.

In case of an overdose, you should urgently call an ambulance, as the person may need resuscitation, intensive care measures, or the administration of drugs that are not in a regular home first aid kit. Before the specialists arrive, if the patient is conscious, you can rinse the stomach and give several tablets of activated carbon.

Side effects

Even when used correctly, the product may in some cases have undesirable effects. They are divided by frequency of occurrence.

The instructions for use accompanying the drug Nebilet indicate a 1-10% chance of the following side effects:

• dizziness;
• excessive fatigue;
• headache;
• paresthesia;
• diarrhea;
• constipation.

More rare manifestations, with a frequency of less than 1% recorded in control groups, include the following:

• rash, itchy skin;
• flatulence;
• vomit;
• nausea;
• bradycardia;
• dry eyes;
• depressive states;
• disturbing dreams;
• orthostatic hypotension;
• swelling of different localization;
• heart failure;
• Raynaud's syndrome;
• drowsiness;
• decreased concentration;
• heart failure;
• cardialgia;
• increased sweating;
• bronchospasm;
• rhinitis;
• insomnia;
• photodermatosis;
• AV block.

Drug interactions

Depression of the heart and the risk of lowering blood pressure will be caused by simultaneous use of Nebilet with any anesthetics.

Barbiturates and Rifampicin can reduce, and Cimetidine, on the contrary, increase the concentration of the drug in plasma.

This medicine should be used with particular caution in combination with any slow calcium channel blockers, Nitroglycerin, Reserpine, Guanfacine, antiarrhythmic drugs, alpha-methyldopa.

Their interaction can induce severe hypotension. Clonidine enhances the “withdrawal” syndrome, and cardiac glycosides lead to the summation of the dromo- and chronotropic effect. Diabetics should be aware that the use of this drug can “mute” the symptoms of hypoglycemia.

When treating with any drugs in parallel with Nebilet therapy, you must be careful and inform your doctor.

Pregnancy and lactation

This remedy is prescribed to women in a delicate situation extremely rarely and only in cases where the beneficial effects for the mother significantly outweigh the possible risks for her unborn child.

Feto-placental blood flow should be monitored and constantly monitored. In addition, the doctor regularly monitors the development of the fetus.

Possible consequences for the baby include a weak pulse, its insufficient frequency, low blood pressure and plasma glucose concentration.

Doctors consider it necessary to stop using the medicine 2-3 days before the expected birth. If this is not possible, the baby is closely monitored by doctors for three postpartum days in case there is a need to take emergency measures.

The active component passes into mother's milk, so you cannot breastfeed your baby while taking the medicine.

Contraindications

Despite its effectiveness and relative safety, this product also has strict contraindications.

The instructions for use accompanying the drugs Nebilet 5 mg and Nebilet plus prohibit their use for the following concomitant pathologies:

• bradycardia below 60 heart beats per minute;
• bronchospasm;
• asthma;
• severe liver dysfunction;
• cardiogenic shock;
• age under 18 years;
• pheochromocytoma;
• sick sinus syndrome;
• sinoatrial block;
• acute heart failure;
• depressive states;
• CHF at the stage of decompensation of the process, when parenteral administration of drugs that increase the intensity of contraction of the heart muscles is necessary;
• hypersensitivity to the components of the product;
• AV block (degree 2, 3);
• arterial hypotension;
• lactose malabsorption;
• lactase deficiency.

COPD (chronic bronchial obstruction) is a relative contraindication, so before you start taking the drug, you need to talk to your doctor about the advisability of this measure.

Local disturbances of blood flow in the legs and intermittent claudication also place a taboo on Nebilet, but despite this, in some special cases, cardiologists prescribe this medicine to such patients and are very successful.

Video on the topic

You can learn how to take Nebilet tablets for high blood pressure from this video:

In conclusion, we can say that taking Nebilet tablets according to the instructions and exclusively as prescribed by a qualified specialist will minimize possible risks and unwanted effects. Used according to a correctly selected scheme by a competent doctor, it will control blood pressure well and will slow down the development of pathological changes in the heart muscle and blood vessels.

The drug Nebilet has antianginal, hypotensive effects, as well as a dose-dependent anti-ischemic effect. The use of this drug gradually reduces the size of myocardial infarction.

Pharmacological action and pharmacokinetics

The mechanism of action of the drug on the body consists of two properties:

• Firstly, Nebilet has a mild vasodilator effect,
• Secondly, a competitive and selective adrenergic receptor blocker.

The use of the medicine leads to a decrease in heart rate and a decrease in blood pressure (blood pressure).

The hypotensive effect of Nebilet persists with long-term treatment; the effectiveness of therapy does not depend on the gender and age of the patient and left ventricular ejection parameters.

Taking the drug as an adjuvant drug to the standard treatment complex in patients with chronic heart failure significantly improves the prognosis in terms of the frequency of hospitalization due to cardiovascular diseases.

A decrease in the number of cases of sudden death due to similar problems among patients using Nebilet has also been recorded.

The use of the medicine affects the body as follows:

• is able to lower blood pressure both at rest and during intense physical activity, in stressful and depressive situations,
• selectively and competitively blocks adrenergic receptors,
• the hypotensive effect develops after 3-6 days, stability of the patient’s condition is noted after 1-2 months,
• the number and severity of angina attacks when taking Nebilet is significantly reduced,
• exercise tolerance increases,
• the medicine has an antiarrhythmic effect.

After direct oral administration, the drug is relatively quickly absorbed from the gastrointestinal tract; food intake does not have a particular effect on absorption). Bioavailability is observed in 12% of patients with accelerated metabolism, complete bioavailability is observed in all patients with slow metabolism. Excreted by the intestines (with feces) - 48%, by the kidneys (with urine) - 38%.

Video

You can see the appearance of the drug in the video:

Indications for use

This drug is actively used in the treatment of patients with disorders of the cardiovascular system, such as:

• severe arterial hypertension,
• angina pectoris,

This drug is also widely used in combination for the treatment of chronic heart failure.

Contraindications for use

• in the presence of the disease "acute heart failure",
• those suffering from a chronic form of heart failure in the stage of decompensation (this stage requires intravenous administration of drugs that have an inotropic effect),
• with severe arterial hypotension (with systolic pressure below 90),
• with bradycardia, in which the heart rate is not more than 60 beats per minute,
• with cardiogenic shock,
• with metabolic acidosis,
• with severe liver dysfunction,
• with a history of bronchial asthma and bronchospasms,
• who have been diagnosed with Raynaud's syndrome,
• for myasthenia gravis and depressive states,
• with lactase deficiency and lactose intolerance.

Use the medicine with caution when:

• renal failure,
• hyperfunction of the thyroid gland,
• diabetes mellitus,
• psoriasis,
• Prinzmetal's angina,
• aged over 70 years.

Side effects

When using the medicine, the following reactions are possible:

• state of depression,
• headache,
• paresthesia,
• nightmares, hallucinations,
• visual impairment,
• bradycardia,
• atrioventricular block,
• dyspnea,
• severe intermittent claudication,
• diarrhea, constipation,
• dyspepsia,
• flatulence,
• vomit,
• erythematous rashes,
• swelling,
• hyperhidrosis (increased sweating),
• impotence,
• excessive fatigue, etc.

Drug interactions

1. When the drug Nebilet interacts with narcotic drugs, its cardiodepressive effect is significantly enhanced.
2. Medicines that depress the central nervous system (CNS), including antidepressants, barbiturates, phenothiazide derivatives, significantly enhance the hypotensive effect of Nebilet's substance - nebivolol.
3. Parallel use of the drug with calcium channel blockers, with antihypertensive substances, antiarrhythmic drugs, with nitroglycerin and methyldopa, there is a high risk of developing hypotension (low blood pressure), bradycardia (decreased heart rate). It is also not recommended to combine the drugs Nebilet and Prazorin.
4. The drug Clonidine develops Nebilet withdrawal syndrome.
5. Use together with ergot alkaloids increases the risk of disruption of the peripheral circulatory system.
6. Nebilet reduces the effectiveness of oral antidiabetic agents, but increases the hypoglycemic effect of insulins.
7. NSAIDs (non-steroidal anti-inflammatory drugs) can reduce the hypotensive effect of Nebilet.
8. Nicardipine and Cimetidine, when taken together with the drug in question, increase the concentration of nebivolol in the blood plasma.

You should also know that smoking reduces the effectiveness of the medicine.

Overdose

When using the medicine above the norm specified in the instructions, patients may experience the following reactions:

• vomiting and nausea (in 10% of patients),
• arterial hypotension (in 5.5% of patients),
• heart rhythm disturbances (in 2.5% of patients),
• loss of consciousness and cardiac arrest (in 0.2% of patients).

If there are signs of an overdose, the patient must urgently rinse the stomach and take enterosorbents. In case of a strong and sharp decrease in pressure, the development of heart failure or bradycardia, the administration of adrenomimetics by injection is indicated. In case of extrasystole, administration of lidocaine is indicated, and in case of convulsions, urgent intravenous administration of a dose of diazepam is indicated.

Dosage and method of administration

Tablets are taken orally, once a day and at the same time (recommended to achieve effect). You need to take the tablets with plenty of liquid (preferably water, at least 150 grams).

Nebilet is taken both in monotherapy and in combination with other medications that reduce blood pressure.

Treatment of patients with this drug should begin with a gradual increase in dose to the maximum optimal.

The treatment regimen is prescribed by the doctor, but at the beginning of therapy (about 2-3 hours), the patient remains under the careful supervision of the doctor, who monitors the patient’s condition and regulates the dosage of the drug.

The tablet can be divided, for which it is placed on a flat and hard surface with the notch facing up. Use both index fingers to press down on the tablet.

Storage conditions and periods

The storage conditions for the drug are similar to most drugs - a dry and warm place, temperature from 10 to 28 degrees, but the shelf life is extended and is 3 years.