Coronal is an antihypertensive, antiarrhythmic and antianginal drug, a selective beta1-blocker.
It has a hypotensive effect (reduces pressure), also reduces the pain in the left chest and restores the heart rhythm. Also, the action of Coronal is aimed at obstructing the entry of calcium ions into the heart muscle, which leads to a decrease in the inflow of signals causing excitation and inhibition in the myocardium.
Thus, there is a decrease in the frequency of heart beats.
Clinical and pharmacological group
Pharmacy sales terms
It is released on prescription.
How much is a Coronal? The average price in pharmacies is 120 rubles.
Release form and composition
Coronal is available in oral tablet form. The tablets are covered with a protective film sheath, convex on both sides and packed in blisters of 10 pieces (3-5 blisters in a carton box).
Active ingredient - bisoprolol fumarate:
- 1 light yellow tablet - 5 mg;
- 1 tablet of light pink color - 10 mg.
Auxiliary components: corn starch, microcrystalline cellulose, sodium lauryl sulfate, magnesium stearate, colloidal silicon dioxide.
The composition of the film shell: macrogol 400, hypromellose, titanium dioxide (E171).
Additionally as part of the shell:
- 5 mg tablets: iron dye oxide yellow (E172);
- Tablets of 10 mg: iron dye oxide red (E172).
Coronal has a hypotensive, antianginal, antiarrhythmic effect. Small doses of the drug help block heart beta-blockers, reduce intracellular calcium current, inhibit conductivity, excitability, decrease heart rate and myocardial contractility.
On the first day after Coronal use, an increase in total peripheral resistance occurs. After two or three days, it decreases to the initial level, continuing to decrease with prolonged therapy. Due to the hypotensive effect of the drug, the minute volume of blood is reduced, the activity of the reninangiotensin system is inhibited, the normal sensitivity of baroreceptors located on the aortic arch is restored. The coronal also has a direct effect on the central nervous system.
In patients with arterial hypertension, a decrease in pressure is observed after 2-5 days after the start of Coronal use. After 1-2 months, a stable hypotensive effect occurs. Angina after taking Coronal is reduced due to improved muscular cardiac perfusion, diastole lengthening, reduced oxygen consumption by the cardiac muscle.
Indications for use
Coronal (10 mg) is prescribed to patients diagnosed with persistent arterial hypertension, ischemia and stable angina.
Also, tablets are prescribed for other cardiac pathologies:
- double valve prolapse;
- supraventricular tachyarrhythmia, if combined with an accelerated sinus rhythm;
- violation of the heart rhythm supraventricular or ventricular localization;
- atrial fibrillation formed on the background of thyroid hormone intoxication.
Coronal tablets with a dosage of 5 mg are prescribed as a secondary prophylaxis of myocardial infarction, as well as in cases when minor cardiac pathologies have been identified.
Before starting drug therapy, the attached instructions should be studied in detail. Coronal tablets are contraindicated in the presence of the following conditions:
- Atrioventricular block (AV block) of II and III degree (without artificial pacemaker);
- Sick sinus syndrome (SSS);
- Cardiomegaly (without signs of heart failure);
- Severe bradycardia;
- Raynaud's disease;
- Acute heart failure;
- Chronic heart failure (CHF) in the stage of decompensation;
- Shock (including cardiogenic);
- Sinoatrial blockade;
- The simultaneous use of phloctafenin and sultopride;
- Breastfeeding period;
- Age up to 18 years (safety and efficacy not established);
- Hypotension (upper blood pressure (BP) below 100 mm Hg (Hg), especially in myocardial infarction);
- Late stages of impaired peripheral circulation;
- Bronchial asthma and chronic obstructive pulmonary disease (COPD) in history;
- Combined use of monoamine oxidase inhibitors (MAO) (except for type B MAO inhibitors);
- Hypersensitivity to the components of the tool or other beta-blockers.
During the period of Coronal therapy, strict medical supervision is necessary for the following diseases and conditions:
- Printsmetal angina;
- AV block I degree;
- Restrictive cardiomyopathy;
- Severe allergic reactions in history;
- Desensitizing immunotherapy with allergens and allergen extracts;
- Compliance with a strict diet;
- Renal failure (creatinine clearance (CK) less than 20 ml / min);
- CHF with myocardial infarction in the last 3 months;
- Congenital heart defects or valvular defects with marked hemodynamic disturbances;
- Depression (including history);
- Metabolic acidosis;
- Liver failure;
- Pheochromocytoma (with concomitant use of alpha-blockers);
- Diabetes in the stage of decompensation;
- Elderly age.
Use during pregnancy and lactation
In pregnancy, Coronal is prescribed only under strict indications if the intended benefit to the mother outweighs the potential risk to the fetus. 72 hours before delivery, taking the drug Coronal must be discontinued due to the possible development of fetal / newborn bradycardia, arterial hypotension, hypoglycemia and respiratory depression.
If taking Coronal is necessary during lactation, breastfeeding should be stopped.
When taking bisoprolol during pregnancy, fetal growth is possible intrauterine growth retardation, hypoglycemia, bradycardia.
Dosage and method of use
The instructions for use indicated: Coronal tablets should be taken orally, in the morning on an empty stomach, without chewing, with a small amount of liquid.
- In hypertension and coronary heart disease (prevention of attacks of stable angina), the initial dose is 2.5-5 mg 1 time / day. If necessary, increase the dose to 10 mg 1 time / day. The maximum daily dose is 20 mg.
In patients with impaired renal function with CC <20 ml / min or with severe impaired liver function, the maximum daily dose is 10 mg.
Dose adjustment in elderly patients is not required.
Coronal under certain circumstances can cause a number of side effects:
- From the side of view - conjunctivitis, dry and sore eyes, blurred vision, reduced secretion of tear fluid;
- Gastrointestinal tract - vomiting, abdominal pain, diarrhea, constipation, change in taste, dryness of the oral mucosa, etc .;
- On the part of the endocrine system - hyper- or hypoglycemia, hypothyroid state;
- Respiratory system - nasal congestion and difficulty breathing;
- Nervous system effects - weakness, dizziness, headache, increased fatigue, depression, anxiety, hallucinations, short-term memory loss, tremor;
- Hematopoiesis - leukopenia, agranulocytosis;
- Cardiovascular system - sinus bradycardia, arrhythmia, exacerbation of chronic heart failure, chest pain, manifestation of angiospasm, lowering blood pressure, orthostatic hypotension, weakening of myocardial contractility or a violation of its conductivity.
A number of allergic, dermatological and other reactions are also possible.
With a significant dose overdose arrhythmia, ventricular premature beats, severe bradycardia, AV-blockade, arterial hypotension, acute heart failure, acrocyanosis, difficulty in breathing, bronchospasm, dizziness, fainting, convulsions are possible.
If you experience these symptoms, wash the stomach and take the adsorbents. Symptomatic therapy is also indicated. With AV blockade, 1-2 mg of atropine, epinephrine intravenously or the introduction of a temporary pacemaker. For ventricular premature beats, it is indicated to inject lidocaine intravenously. With reduced pressure it is worth taking the position of Trendelenburg. If symptoms of pulmonary edema are absent, plasma-substituting solutions are injected intravenously, with the ineffectiveness of the agent, epinephrine, dopamine, dobutamine are injected. Signs of heart failure require the use of cardiac glycosides, diuretics, glucagon. When convulsions diazepam is injected, with bronchospasm - beta-2-adrenostimulyatory.
Before you start using the drug, read the specific instructions:
- Before starting therapy, it is recommended to conduct a study of the function of external respiration in patients with a burdened bronchopulmonary history.
- When taking Coronal, an electrocardiogram should be performed regularly, heart rate and blood pressure should be monitored (at the beginning of the therapy - daily, later - once every 3-4 months), the level of glucose in the blood of diabetic patients should be determined (1 time in 4 5 months). Elderly patients should be monitored for renal function (1 every 4–5 months).
- In smokers, Coronal efficacy decreases.
- It should be borne in mind that in some patients with stenocardia (approximately in 20% of cases) beta-blockers may be ineffective, which is associated with severe coronary atherosclerosis with a low ischemia threshold (heart rate less than 100 beats per minute) and an increased end-diastolic volume of the left ventricle, disrupting subendocardial blood flow.
- When using Coronal in patients with pheochromocytoma, there is a risk of paradoxical arterial hypertension (if an effective alpha adrenoblockade has not been achieved in advance).
- Patients who use contact lenses need to consider that it is possible to reduce the production of tear fluid during therapy.
- Patients with thyrotoxicosis cannot be abruptly discontinued, as this may increase the symptoms of the disease.
- With simultaneous use of Coronal with clonidine, the latter can be stopped only a few days after the end of therapy.
- In case of diabetes mellitus, bisoprolol may mask tachycardia caused by hypoglycemia.
- With an allergic history, it is possible to increase the severity of hypersensitivity reactions and the lack of effect from the usual doses of epinephrine.
- With the development of depression therapy is recommended to interrupt.
- Before performing a planned surgical treatment, Coronal should be canceled 48 hours before the start of general anesthesia. If the patient has taken the drug before the operation, a medicine with minimal negative inotropic effect is selected for general anesthesia.
- Lowering stocks of catecholamine drugs (including reserpine) can enhance the action of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision for the timely detection of bradycardia or marked lowering of blood pressure.
- Before conducting a study of the content of catecholamines, vanillimindal acid, normetanephrine, and titers of antinuclear antibodies in the urine and blood, the preparation should be canceled.
- To avoid the development of myocardial infarction and severe arrhythmias, it is impossible to abruptly interrupt the treatment. Cancellation should be carried out gradually, reducing the dose for 14 days or more (every 3-4 days, reduce the dose by 25%).
- With the emergence in patients of advanced age of increasing bradycardia (less than 50 beats per minute), AV blockade, marked lowering of blood pressure (systolic pressure below 100 mm Hg), it is necessary to reduce the daily dose or discontinue therapy.
During the period of therapy, care should be taken when driving vehicles and machinery, as well as when performing other potentially dangerous types of work that require increased concentration and psychomotor reactions.
When using the drug, you must consider the interaction with other drugs:
- In combination with rifampicin T1 / 2 bisoprolol is shortened.
- Combination with iodine-containing radiopaque agents increases the risk of anaphylactic reactions.
- When combined with bisoprolol allergens for immunotherapy or allergen extracts for skin tests, severe systemic allergic reactions are possible.
- Coronal alters the effectiveness of insulin and oral hypoglycemic drugs.
- In combination with phenytoin for IV administration, means for inhalation general anesthesia (hydrocarbon derivatives) increases the cardiodepressant effect and the risk of BP reduction is high.
- NSAIDs, GCS and estrogens weaken the anti-hypertensive effect of Coronal.
- The drug reduces the clearance of lidocaine and xanthines (except diphillin) and increases their concentration in plasma, which is more typical for smokers.
- In combination with nifedipine, a significant decrease in blood pressure is possible.
- Coronal in combination with cardiac glycosides, methyldopa, reserpine and guanfacine, blockers of slow calcium channels, amiodarone and other antiarrhythmic agents increases the risk of bradycardia, AV-blockade, cardiac arrest and heart failure.
- In combination with taking diuretics, clonidine, sympatholytics, hydralazine and other antihypertensives. Coronal causes an excessive decrease in blood pressure.
- It is not recommended to combine Coronal with MAO inhibitors, the interval between doses should be 14 days.
- Coronal lengthens the action of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins.
- In combination with non-hydrated ergot alkaloids, ergotamine, the risk of peripheral circulatory disorders is increased.
- Sulfasalazine increases plasma concentrations of bisoprolol.
- When taken together with beta-blockers for local use, there is a risk of an additive effect with the development of hypotension and / or significant bradycardia.
- During therapy with quinidine drugs in combination with the Coronal there is a risk of disorders in automatism, conduction and contractility of the heart increases (mutually).
- The antihypertensive effect of Coronal is reduced by the use of adrenaline and norepinephrine.
- In case of shock or arterial hypotension caused by floctafenin, when used together, it is possible to reduce compensatory cardiovascular reactions.
- With the simultaneous use of tricyclic and tetracyclic antidepressants, neuroleptics, ethanol, sedatives and hypnotic drugs increase the depression of the central nervous system, can provoke cardiac rhythm disturbances, bradycardia and orthostatic hypotension.
- With simultaneous use with baclofen or amifostine, there is also an increased antihypertensive effect.
We picked up some reviews of people taking Coronal:
- Olga The second time the coronal is discharged for the treatment of ventricular e / systolia. The first time I didn’t drink, or rather I tried once the floor of the pill - it was very bad.The second time I tried, I didn’t "get the water off."
- Dmitriy. Well reduces the pulse rate. The pressure is almost not affected. That is, it helps with low pressure tachycardia.
- Natalia. In my old age began problems with high blood pressure. A cardiologist prescribed this drug as an option in my case. 2-3 days of reception and he acted! The drug acts by reducing the heart rate, so it is dangerous to take it alone without a doctor's prescription! I recommend to start with the minimum dosage and, if necessary, increase it to the level as prescribed by the doctor. To throw sharply also can not in any case, gradually reduce the dosage for about a week. The price is very affordable, but only a doctor should prescribe! The medicine came up to me and it helped a lot!
- Ilya. In my opinion, this medicine is best suited for the treatment, reduction of arterial hypertension. First, excellent absorption, and this is often one of the most important factors, because buying a medicine, we want it to start acting immediately. Secondly, in contrast to similar drugs, a good percentage of elimination, which cannot but distinguish this medicine for the better. Of all such drugs, coronal is perhaps the most optimal solution for acquiring and receiving.
Analogues of the drug Coronal are:
- Aritel Cor;
- Concor Cor;
Before using analogues consult your doctor.
Storage conditions and shelf life
Tablets should be kept away from children in a dry cool place, avoiding direct sunlight on the package.
The shelf life of the drug is 3 years from the date of manufacture, indicated on the package. At the end of the shelf life of Coronal tablets must be disposed of.