Niperten tablets: instructions for use, price, reviews, analogues

Compound

Depending on the release form, the chemical composition of one Niperten tablet (INN Bisoprolol) may contain 2.5 mg. 5 mg. or 10 mg. active medicinal compound bisoprolol fumarate .
Povidone , magnesium stearate , carboxymethyl starch , as well as MCC and colloidal silicon dioxide (anhydrous) are included in Niperthene as excipients.

The film shell of Niperthene tablets contains titanium dioxide, macrogol and talc.

Pharmacodynamics and pharmacokinetics

At its core, Niperten is a beta1-adrenergic blocker , which is a selective compound; it does not possess membrane-stabilizing properties without its own sympathomimetic activity . This medicine helps reduce the level of renin in the blood and also reduces the myocardium's need for oxygen .

The drug has a pronounced antiarrhythmic, hypotensive and antianginal effect on the body. Due to its distinctive properties, Niperten can influence the intensity of calcium ion current at the intracellular level, and also blocks beta1-adrenergic receptors formed in small doses in the heart , thereby slowing down the process of formation of cAMP (cyclic adenosine monophosphate) from ATP .

The antiarrhythmic effect of Niperten is due to the ability of the drug to increase the amount of cyclic adenosine monophosphate , as well as eliminate arrhythmogenic factors such as tachycardia , hypertension , and increased activity of the nervous system . Under the influence of Niperthene, the myocardial for oxygen becomes less and, as a result, the contractility of the main cardiac muscle decreases, due to which the antianginal effect of the drug .

The medicinal compound achieves a hypotensive effect by reducing blood volume (in 1 minute), restoring sensitivity (the result of an effect on the central nervous system and lowering blood pressure ), as well as by stimulating peripheral blood vessels . Under the influence of active α-adrenergic receptors , as well as with a decrease in stimulation of β2-adrenergic receptors , TPVR (total peripheral vascular resistance) increases

However, after 3 days the indicators return to normal, and with long-term therapeutic treatment they decrease. It has been noted that, in comparison with similar drugs, Niperten has a less pronounced effect on carbohydrate metabolism , as well as on organs containing β2-adrenergic receptors , such as the bronchi, pancreas, peripheral arteries, and uterus.

The drug compound is absorbed by 80-90%. About half the dose of the drug is metabolized by the liver within 12 hours. Subsequently, the kidneys remove about 98% of the active compound from the body.

Contraindications

It is not recommended to use the drug if:

collapse;
hypersensitivity to beta-blockers and other components of the drug;
pulmonary edema;
sinoatrial blockade;
bradycardia;
cardiomegaly;
sinus node weakness;
Prinzmetal's angina;
bronchial asthma;
peripheral circulation disorders ;
pheochromocytoma;
AV block II–III degree.

Niperten is contraindicated in patients under 18 years of age. In addition, patients with diabetes mellitus , as well as renal failure , thyrotoxicosis , psoriasis , myasthenia gravis , as well as elderly people should be especially careful about the dosage and regimen of taking the drug.

Niperten®

The effectiveness and tolerability of bisoprolol may be affected by concomitant use of other medications. This interaction can also occur when two drugs are taken within a short period of time. It is necessary to inform your doctor if you are taking other medications, even if you are taking them without a doctor’s prescription (i.e., over-the-counter medications).

Combinations not recommended

Treatment of chronic heart failure

Class I antiarrhythmic drugs (for example, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and myocardial contractility.

All indications for use of the drug Niperten®

Centrally acting antihypertensives (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and cardiac output, as well as vasodilation due to a decrease in central sympathetic tone.

Abrupt withdrawal, especially before discontinuation of beta-blockers, may increase the risk of developing rebound hypertension.

Combinations requiring special caution

Treatment of arterial hypertension and angina pectoris

All indications for use of the drug Niperten®

BMCC, dihydropyridine derivatives (for example, nifedipine, felodipine, amlodipine), when used simultaneously with bisoprolol, may increase the risk of developing arterial hypotension. In patients with CHF, the risk of subsequent deterioration in cardiac contractility cannot be excluded.

Class III antiarrhythmic drugs (eg, amiodarone) may worsen AV conduction disturbances.

The effect of topical β-blockers (for example, eye drops for the treatment of glaucoma) may enhance the systemic effects of bisoprolol (lowering blood pressure, lowering heart rate).

Parasympathomimetics, when used simultaneously with bisoprolol, may enhance AV conduction disturbances and increase the risk of developing bradycardia.

The hypoglycemic effect of insulin or oral hypoglycemic agents may be enhanced. Signs of hypoglycemia, in particular tachycardia, may be masked or suppressed. Such interactions are more likely when using non-selective beta-blockers.

General anesthesia agents may increase the risk of cardiodepressive effects, leading to arterial hypotension (see section "Special Instructions").

Cardiac glycosides, when used simultaneously with bisoprolol, can lead to an increase in impulse conduction time and, thus, to the development of bradycardia.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect of bisoprolol.

The simultaneous use of Niperten® with β-adrenergic agonists (for example, isoprenaline, dobutamine) may lead to a decrease in the effect of both drugs.

The use of bisoprolol with adrenergic agonists that affect α- and β-adrenergic receptors (for example, norepinephrine, epinephrine) may enhance the vasoconstrictor effects of these drugs that occur with the participation of α-adrenergic receptors, leading to an increase in blood pressure. Such interactions are more likely when using non-selective beta-blockers.

Antihypertensive drugs, as well as other drugs with a possible antihypertensive effect (for example, tricyclic antidepressants, barbiturates, phenothiazines), may enhance the antihypertensive effect of bisoprolol.

Mefloquine, when used simultaneously with bisoprolol, may increase the risk of bradycardia.

Monoamine oxidase (MAO) inhibitors (except MAO B inhibitors) may enhance the antihypertensive effect of beta-blockers. Concomitant use may also lead to the development of a hypertensive crisis.

Side effects

The use of the drug causes such side effects as:

weakness, increased fatigue and dizziness;
sleep disorders;
headaches and memory impairment;
hallucinations and depression;
myasthenia gravis;
convulsions;
decreased vision;
conjunctivitis;
arrhythmia;
Raynaud's syndrome;
bradycardia;
chest pain;
vomiting and nausea;
constipation or diarrhea;
change in taste;
difficulty breathing;
hyperglycemia in diabetes;
hypoglycemia;
hypothyroid condition;
skin rashes;
alopecia;
leukopenia;
thrombocytopenia;
arthralgia;
decreased potency;
backache.

Interaction

To avoid complications or side effects when treating with Niperten, you should avoid:

allergens that are used in immunotherapy ;
iodine-containing radiopaque agents for intravenous administration of drugs;
phenytoin, inhalation anesthesia ;
antihypertensive drugs;
antidepressants , sedatives and hypnotics ;
non-hydrogenated ergot alkaloids;
ergotamine;
antiarrhythmic drugs.

An active drug changes the effectiveness of insulin , and also increases the concentration of xanthines and the clearance of lidocaine .

NIPERTENE

Interaction

The effectiveness and tolerability of bisoprolol may be affected by concomitant use of other medications.
This interaction can also occur when two drugs are taken within a short period of time. It is necessary to inform your doctor if you are taking other medications, even if you are taking them without a doctor’s prescription (i.e., over-the-counter medications). Combinations not recommended

Treatment of chronic heart failure

All indications for use of the drug Niperten®

Blockers of “slow” calcium channels (SCBC) such as verapamil and, to a lesser extent, diltiazem, when used simultaneously with bisoprolol, can lead to a decrease in myocardial contractility and impaired AV conduction. In particular, intravenous administration of verapamil to patients taking beta-blockers can lead to severe arterial hypotension and AV block. Centrally acting antihypertensives (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and cardiac output, as well as vasodilation due to a decrease in central sympathetic tone. Abrupt withdrawal, especially before discontinuation of beta-blockers, may increase the risk of developing rebound hypertension.

Combinations requiring special caution

Treatment of arterial hypertension and angina pectoris

All indications for use of the drug Niperten®

Class III antiarrhythmic drugs (eg, amiodarone) may worsen AV conduction disturbances.

The effect of topical β-blockers (for example, eye drops for the treatment of glaucoma) may enhance the systemic effects of bisoprolol (lowering blood pressure, lowering heart rate).

Parasympathomimetics, when used simultaneously with bisoprolol, may enhance AV conduction disturbances and increase the risk of developing bradycardia.

General anesthesia agents may increase the risk of cardiodepressive effects, leading to arterial hypotension (see section "Special Instructions").

Cardiac glycosides, when used simultaneously with bisoprolol, can lead to an increase in impulse conduction time and, thus, to the development of bradycardia.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect of bisoprolol.

The simultaneous use of Niperten® with β-adrenergic agonists (for example, isoprenaline, dobutamine) may lead to a decrease in the effect of both drugs. The use of bisoprolol with adrenergic agonists that affect α- and β-adrenergic receptors (for example, norepinephrine, epinephrine) may enhance the vasoconstrictor effects of these drugs that occur with the participation of α-adrenergic receptors, leading to an increase in blood pressure. Such interactions are more likely when using non-selective β-blockers.

Mefloquine, when used simultaneously with bisoprolol, may increase the risk of bradycardia.

Monoamine oxidase (MAO) inhibitors (except MAO B inhibitors) may enhance the antihypertensive effect of beta-blockers. Concomitant use may also lead to the development of a hypertensive crisis.

special instructions

The condition of patients undergoing treatment with Niperten must be constantly monitored by medical personnel. For elderly patients, it is recommended to conduct kidney function tests at least once every 5 months. Doctors are advised to teach patients how to count their heart (HR) so that they can self-monitor their condition if necessary.

Before starting direct treatment, patients with a bronchopulmonary history are recommended to undergo a comprehensive examination of the respiratory tract . During treatment, the secretion of tear fluid may decrease; this should be taken into account by patients using contact lenses.

Niperten, 30 pcs., 5 mg, film-coated tablets

You should not interrupt treatment with Niperten® abruptly and do not change the recommended dose without first consulting your doctor, because this may lead to a temporary deterioration in heart function. Treatment should not be interrupted suddenly, especially in patients with coronary artery disease. If discontinuation of treatment is necessary, the dose should be reduced gradually.

When using clonidine simultaneously, its use can be discontinued only a few days after discontinuation of the drug Niperten®.

At the initial stages of treatment with Niperten®, patients require constant monitoring.

Monitoring the condition of patients taking the drug Niperten® should include measuring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), conducting an ECG, determining the concentration of glucose in the blood in patients with diabetes mellitus (once every 4–5 months). In elderly patients, it is recommended to monitor renal function (once every 4–5 months).

The patient should be taught how to calculate heart rate and instructed to consult a doctor if the heart rate is less than 60 beats/min.

Niperten® should be used with caution in the following cases:

- diabetes mellitus with significant fluctuations in plasma glucose concentration: symptoms of a pronounced decrease in glucose concentration (hypoglycemia) such as tachycardia, palpitations or increased sweating may be masked;

- strict diet;

— carrying out desensitizing therapy;

— AV block of the first degree;

- Prinzmetal's angina;

- mild to moderate peripheral arterial circulation disorders (increased symptoms may occur at the beginning of therapy);

- psoriasis (including history).

If increasing bradycardia (heart rate less than 60 beats/min), a pronounced decrease in blood pressure (sBP below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe liver and/or kidney dysfunction is detected in elderly patients, it is necessary to reduce the dose of the drug or stop treatment.

It is recommended to discontinue therapy if depression caused by taking β-blockers develops.

Respiratory system

Before starting therapy, it is recommended to conduct a study of external respiratory function in patients with a burdened bronchopulmonary history.

For bronchial asthma or COPD, simultaneous use of bronchodilators is indicated. In patients with bronchial asthma, there may be an increase in airway resistance, which requires a higher dose of β2-adrenergic agonists.

In smokers, the effectiveness of β-blockers is lower.

Allergic reactions

β-blockers, including Niperten®, may increase sensitivity to allergens and the severity of anaphylactic reactions due to weakening of adrenergic compensatory regulation under the influence of β-blockers. Therapy with epinephrine (adrenaline) does not always give the expected therapeutic effect.

General anesthesia

When performing general anesthesia, the risk of β-adrenergic receptor blockade should be taken into account. If it is necessary to discontinue Niperten® therapy before surgery, this should be done gradually and completed 48 hours before general anesthesia. The anesthesiologist should be warned that the patient is taking the drug Niperten®.

Pheochromocytoma

In patients with an adrenal tumor (pheochromocytoma), the drug Niperten® can only be used against the background of simultaneous use of α-blockers.

Hyperthyroidism

When treated with Niperten®, symptoms of hyperthyroidism (hyperthyroidism) may be masked.

Patients using contact lenses should take into account that during treatment there may be a decrease in the production of tear fluid.

Impact on the ability to perform potentially hazardous activities that require special attention and quick reactions (for example, driving vehicles, working with moving mechanisms).

The drug Niperten® does not affect the ability to drive vehicles, according to the results of a study in patients with coronary artery disease. However, due to individual reactions, the ability to drive vehicles or operate technically complex mechanisms may be impaired. Particular attention should be paid to this at the beginning of treatment, after changing the dose, and also when consuming alcohol at the same time.

Niperten's analogs

Level 4 ATC code matches:
Biol

Metocard

Metozok

Nebilet

Nebilong

Betaxolol

Bisogamma

Aritel

Cordinorm

Vasocardin

Corvitol

Bidop

Bisoprolol

Nebivolol

Biprol

Bisoprol

Concor Cor

Lokren

Concor

Betaloc ZOK

The main analogues of Niperten include such drugs as:

Aritel;
Bisocard;
Biol;
Bidop;
Concor;
Bisoprolol;
Corbis;
Tirez;
Coronal.

Niperten price, where to buy

The cost of the drug depends primarily on its nominal volume and the number of tablets in the package. The average price of Niperten (5 mg) of 30 tablets per package does not exceed 150 rubles, and 100 tablets - 350 rubles.

Online pharmacies in RussiaRussia
Online pharmacies in KazakhstanKazakhstan

ZdravCity

Niperten tablets p.p.o.
5 mg 30 pcs. Krka-Rus LLC 122 rub. order
Niperten tablets p.p.o. 2.5 mg 30 pcs. Krka-Rus LLC
99 RUR order
Niperten tablets p.p.o. 2.5 mg 100 pcs. Krka-Rus LLC
206 rub. order
Niperten tablets p.p.o. 10 mg 30 pcs. Krka-Rus LLC
172 RUR order
Niperten tablets p.p.o. 5 mg 100 pcs. Krka-Rus LLC
RUB 252 order

Pharmacy Dialogue

Niperten (tab.p.pl/vol. 10mg No. 100) KRKA-RUS
452 rub. order
Niperten (tablet p/o cap. 10 mg No. 30) KRKA-RUS
RUB 195 order
Niperten (tab.p.pl/vol. 2.5 mg No. 30) KRKA-RUS
108 RUR order
Niperten (tab.p.pl/vol. 5mg No. 30) KRKA-RUS
138 RUR order
Niperten-Combi tablets 5mg+5mg No. 30KRKA-RUS
RUB 308 order

Buy Niperten tablets p.o 2.5 mg No. 100 in pharmacies

Instructions for use Niperten tab p.o 2.5 mg No. 100

Dosage forms tablets 2.5 mg

Synonyms Aritel Aritel Cor Bidop Bidop Cor Biol Biprol Bisogamma Bisoprolol Concor Concor Cor Cordinorm Coronal Group Beta1-adrenergic blockers (cardioselective) International nonproprietary name Bisoprolol Composition Active substance: Bisoprolol. Manufacturers Krka-Rus LLC (Russia) Pharmacological action Pharmacological action - hypotensive, antianginal, antiarrhythmic. Selectively blocks beta1-adrenergic receptors and has no internal sympathomimetic or membrane-stabilizing activity. Inhibits all functions of the heart: reduces heart rate, minute volume, etc. Reduces the tone of the sympathetic department of the vasomotor center, cardiac output, renin secretion, peripheral vascular resistance (with long-term use), SBP and DBP. Increases the effective refractory period of the sinus and AV nodes, slows down conduction along the AV connection. Has virtually no effect on lipid metabolism. Metabolized during the “first pass” through the liver. The maximum concentration is reached after 2-4 hours. It is excreted by the kidneys, with feces. Secreted into breast milk. Side effects From the nervous system and sensory organs: dizziness, insomnia, asthenia, hypoesthesia, depression, drowsiness, anxiety, paresthesia (a feeling of coldness in the extremities), hallucinations, disturbances in thinking, concentration, orientation in time and space, balance, emotional lability , tinnitus, conjunctivitis, visual disturbances, decreased secretion of tear fluid, convulsions. From the cardiovascular system and blood (hematopoiesis, hemostasis): bradycardia, arrhythmia, palpitations, AV block, hypotension, heart failure, impaired microcirculation in the myocardium and extremities, intermittent claudication, vasculitis, agranulocytosis, thrombocytopenia, thrombocytopenic purpura. From the gastrointestinal tract: diarrhea, nausea, vomiting, dry mouth, dyspeptic symptoms, constipation, ischemic colitis, mesenteric artery thrombosis. From the respiratory system: cough, shortness of breath, broncho- and laryngospasm, pharyngitis, rhinitis, sinusitis, respiratory tract infections, respiratory distress syndrome. From the genitourinary system: peripheral edema, decreased libido, impotence, Peyronie's disease, cystitis, renal colic. From the skin: rash, acne, eczema-like reactions, prurigo, redness of the skin, hyperhidrosis, dermatitis, alopecia. On the metabolic side: increased concentrations of liver enzymes (AST, ALT), hyperglycemia or increased glucose tolerance, hyperuricemia, changes in potassium concentration in the blood. Other: pain, weight gain. Indications for use Arterial hypertension, angina pectoris, post-infarction period, chronic heart failure (moderate, stable without exacerbation over the last 6 weeks). Contraindications Hypersensitivity, sinus bradycardia (less than 45-50 beats/min), sick sinus syndrome, sinoatrial and AV block II-III degree, cardiogenic shock, acute and refractory to treatment severe heart failure, acute myocardial infarction, arterial hypotension (sBP) below 90 mmHg), severe obstructive respiratory failure, pregnancy, breastfeeding. Restrictions on use: Chronic obstructive pulmonary diseases, severe bronchial asthma, variant angina (Prinzmetal), tendency to bradycardia, AV blockade of the first degree, peripheral circulatory disorders (including Raynaud's syndrome), diabetes mellitus, hypoglycemia, thyrotoxicosis, psoriasis , impaired liver and kidney function, acidosis, childhood (safety and effectiveness of use in children have not been determined). Overdose Symptoms: bradycardia, arrhythmia, hypotension, heart failure (difficulty breathing, acrocyanosis, edema), hypoglycemia, and in severe cases, collapse. Treatment: gastric lavage and administration of adsorbents, symptomatic therapy: atropine, beta-adrenergic agonists (isoprenaline), sedatives (diazepam, lorazepam) and cardiotonic (dobutamine, dopamine, epinephrine, norepinephrine) drugs, cardiac glycosides, diuretics, glucagon, etc. heart block - transvenous stimulation, connection of an artificial pacemaker. Interaction The likelihood of disturbances in the automaticity, conduction and contractility of the heart increases (mutually) against the background of amiodarone, diltiazem, verapamil, quinidine drugs, cardiac glycosides, reserpine, alpha-methyldopa. Co-administration of dihydropyridine calcium antagonists, especially in patients with latent heart failure, increases the risk of hypotension and cardiac decompensation. Efficacy is reduced by xanthines and sympathomimetics, rifampicin reduces the half-life, ergotamine derivatives potentiate peripheral circulatory disorders. Incompatible with MAO inhibitors. Special instructions The possibility of masking the symptoms of hypoglycemia and thyrotoxicosis during treatment should be taken into account. In case of severe liver dysfunction or acute renal failure, the dose must be reduced. Bisoprolol reduces compensatory cardiovascular reactions in response to the use of general anesthetics and iodinated contrast agents. It is necessary to discontinue the drug 48 hours before anesthesia or select an anesthetic with the least negative inotropic effect. Treatment should be stopped gradually over a period of about 2 weeks (withdrawal syndrome is possible). Use with caution while working for vehicle drivers and people whose profession involves increased concentration. It is necessary to avoid the consumption of alcoholic beverages during treatment (risk of orthostatic hypotension). It is possible that test results may change during laboratory tests. Storage conditions List B. At a temperature not exceeding 30 °C.