The tablets should be taken once a day with a small amount of liquid in the morning before, during or after breakfast. The tablets should not be chewed or powdered. Arterial hypertension and stable angina pectoris. In all cases, the regimen and dose are selected by the doctor for each patient individually, in particular, taking into account the heart rate and the patient's condition. The usual starting dose is 5 mg once a day. If necessary, the dose can be increased to 10 mg once a day. In the treatment of arterial hypertension and stable angina pectoris, the maximum recommended dose is 20 mg of the drug once a day. Chronic heart failure. The standard treatment regimen for CHF includes the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists (in case of intolerance to ACE inhibitors), beta-blockers, diuretics, and, optionally, cardiac glycosides. The beginning of CHF treatment with a drug requires a special titration phase and regular medical supervision. A precondition for drug treatment is stable chronic heart failure without signs of exacerbation. Treatment of CHF with the drug begins in accordance with the following titration scheme. In this case, individual adaptation may be required depending on how well the patient tolerates the prescribed dose, i.e., the dose can be increased only if the previous dose was well tolerated. To ensure an appropriate titration process at the initial stages of treatment, it is recommended to use bisoprolol in dosage form: 2.5 mg tablets. The recommended starting dose is 1.25 mg once a day. Depending on individual tolerance, the dose should be gradually increased to 2.5 mg, 3.75 mg, 5 mg, 7.5 mg and 10 mg once a day. Each subsequent dose increase should be carried out at least two weeks later. If an increase in the dose of the drug is poorly tolerated by the patient, a dose reduction is possible. The maximum recommended dose for CHF is 10 mg of the drug once a day. During titration, regular monitoring of blood pressure, heart rate and the severity of CHF symptoms is recommended. Aggravation of the symptoms of CHF is possible from the first day of using the drug. If the patient does not tolerate the maximum recommended dose of the drug, a gradual dose reduction is possible. During the titration phase or after it, a temporary worsening of the course of CHF, arterial hypotension or bradycardia may occur. In this case, it is recommended, first of all, to adjust the doses of concomitant therapy drugs. You may also need to temporarily reduce the dose of the drug or cancel it. After stabilization of the patient's condition, the dose should be titrated again, or treatment should be continued. Drug treatment is usually a long-term therapy. Special patient groups. Impaired kidney or liver function. Mild to moderate hepatic or renal impairment usually does not require dose adjustment. In severe renal impairment (CC less than 20 ml / min.) And in patients with severe liver disease, the maximum daily dose is 10 mg. Increasing the dose in such patients should be done with extreme caution. Elderly patients. No dose adjustment is required. Children. Since there is not enough data on the use of the drug in children, it is not recommended to prescribe the drug to children under 18 years of age. To date, there is insufficient data on the use of the drug in patients with CHF in combination with type 1 diabetes mellitus, severe renal and / or liver dysfunction, restrictive cardiomyopathy, congenital heart disease or heart valve disease with severe hemodynamic disorders. Also, until now, there has not been sufficient data on patients with CHF with myocardial infarction during the last 3 months.

Hypersensitivity to bisoprolol or to any of the excipients; acute heart failure, chronic heart failure in the stage of decompensation, requiring inotropic therapy; cardiogenic shock; atrioventricular (AV) blockade of II and III degrees, without a pacemaker; sick sinus syndrome; sinoatrial blockade, pronounced bradycardia (heart rate less than 60 beats / min); severe arterial hypotension (systolic blood pressure less than 100 mm Hg); severe forms of bronchial asthma or chronic obstructive pulmonary disease; severe disorders of peripheral arterial circulation or Raynaud's syndrome; pheochromocytoma (without the simultaneous use of alpha-blockers); metabolic acidosis; age up to 18 years (insufficient data on efficacy and safety in this age group).

Central nervous system. Often: dizziness, headache; rarely: loss of consciousness. General violations. Often: asthenia (in patients with CHF), increased fatigue; infrequently: asthenia (in patients with arterial hypertension or angina pectoris). Mental disorders. Uncommon: depression, insomnia; rarely: hallucinations, nightmares. On the part of the organ of vision. Rarely: reduced lacrimation (should be considered when wearing contact lenses); very rare: conjunctivitis. From the organ of hearing. Rarely: hearing impairment. On the part of the cardiovascular system. Very often: bradycardia (in patients with CHF); often: aggravation of symptoms of the course of CHF (in patients with CHF), a feeling of coldness or numbness in the extremities, a marked decrease in blood pressure, especially in patients with CHF; infrequently: violation of AV conduction, bradycardia (in patients with arterial hypertension or angina pectoris), aggravation of symptoms of CHF (in patients with arterial hypertension or angina pectoris), orthostatic hypotension. From the respiratory system. Uncommon: bronchospasm in patients with bronchial asthma or a history of airway obstruction; rarely: allergic rhinitis. From the digestive tract. Often: nausea, vomiting, diarrhea, constipation; rarely: hepatitis. From the musculoskeletal system. Uncommon: muscle weakness, muscle cramps. On the part of the skin. Rarely: hypersensitivity reactions, such as itching, rash, flushing of the skin; very rare: alopecia. Beta-blockers can aggravate psoriasis symptoms or cause a psoriasis-like rash. From the reproductive system. Rarely: violations of potency. Laboratory indicators. Rarely: an increase in the concentration of triglycerides and the activity of "hepatic" transaminases in the blood (aspartate aminotransferase (ACT), alanine aminotransferase (ALT)). In patients with arterial hypertension or angina pectoris, these symptoms often appear at the beginning of the course of treatment. Usually these phenomena are mild and usually disappear within 1-2 weeks after starting treatment.

The efficacy and tolerance of bisoprolol may be affected by the simultaneous administration of other drugs. This interaction can also occur when two drugs are taken over a short period of time. The doctor must be informed about taking other drugs, even if they are taken without a doctor's prescription (i.e. over-the-counter drugs). Combinations not recommended. Class I antiarrhythmics (for example, quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone), when used simultaneously with bisoprolol, can reduce AV conduction and cardiac contractility. Blockers of "slow" calcium channels (BMCC) such as verapamil and, to a lesser extent, diltiazem, when used simultaneously with bisoprolol, can lead to a decrease in myocardial contractility and a violation of 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 a decrease in cardiac output, as well as to vasodilation due to a decrease in central sympathetic tone. Abrupt withdrawal, especially before the withdrawal of beta-blockers can increase the risk of developing "rebound" arterial hypertension. Combinations requiring special care. BMCC derivatives of dihydropyridine (for example, nifedipine, felodipine, amlodipine), when used simultaneously with bisoprolol, may increase the risk of arterial hypotension. In patients with CHF, the risk of subsequent deterioration of the contractile function of the heart cannot be excluded. Class III antiarrhythmics (eg, amiodarone) can increase AV conduction disturbances. The action of beta-blockers for topical use (for example, eye drops for the treatment of glaucoma) can enhance the systemic effects of bisoprolol (lowering blood pressure, lowering heart rate). Parasympathomimetics, when used simultaneously with bisoprolol, can enhance AV conduction disturbance and increase the risk of bradycardia. The hypoglycemic effect of insulin or oral hypoglycemic agents may be enhanced. Signs of hypoglycemia - in particular tachycardia - can be masked or suppressed. Such interactions are more likely with the use of non-selective beta-blockers. General anesthetic agents can increase the risk of cardiodepressive effects, leading to hypotension. Cardiac glycosides, when used simultaneously with bisoprolol, can lead to an increase in the duration of the impulse, and thus to the development of bradycardia. Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the hypotensive effect of bisoprolol. The simultaneous use of the drug with beta-adrenergic agonists (for example, isoprenaline, dobutamine) can lead to a decrease in the effect of both drugs. The combination of bisoprolol with adrenergic agonists that affect beta and alpha adrenergic receptors (for example, norepinephrine, epinephrine) can enhance the vasoconstrictor effects of these drugs, which occur with the participation of alpha adrenergic receptors, leading to an increase in blood pressure. Such interactions are more likely with the use of non-selective beta-blockers. Antihypertensive drugs, as well as other drugs with a possible antihypertensive effect (for example, three cyclic antidepressants, barbiturates, phenothiazines) can enhance the hypotensive effect of bisoprolol. Mefloquine, when used simultaneously with bisoprolol, may increase the risk of developing bradycardia. MAO inhibitors (with the exception of MAO B inhibitors) can enhance the hypotensive effect of beta-blockers. Simultaneous use can also lead to the development of a hypertensive crisis.

Symptoms The most common symptoms of overdose: AV block, severe bradycardia, marked decrease in blood pressure, bronchospasm, acute heart failure and hypoglycemia. The sensitivity to a single dose of a high dose of bisoprolol varies greatly among individual patients and, probably, patients with CHF are highly sensitive. Treatment. If an overdose occurs, first of all, it is necessary to stop taking the drug and begin supportive symptomatic therapy. With severe bradycardia: intravenous administration of atropine. If the effect is insufficient, a drug with a positive chronotropic effect can be introduced with caution. Sometimes a temporary pacemaker may be required. With a pronounced decrease in blood pressure: intravenous administration of plasma-substituting solutions and vasopressor drugs. For AV block: patients should be monitored continuously and treated with beta-agonists such as epinephrine. If necessary, setting up an artificial pacemaker. With an exacerbation of CHF: intravenous administration of diuretics, drugs with a positive inotropic effect, as well as vasodilators. With bronchospasm: the appointment of bronchodilators, including beta2-adrenergic agonists and / or aminophylline. With hypoglycemia: intravenous dextrose (glucose).