"Concor" or "Kapoten": what is the difference and which is better

Almost every person who has heart problems or suffers from high blood pressure is familiar with the drug Concor, because it is usually the first thing doctors prescribe.

This high-quality drug, the active ingredient of which is bisoprolol, has proven itself, therefore it is often used in complex treatment together with other medications.

In the instructions for the drug Concor, compatibility with other medications is described especially carefully, since there is a whole list of drugs with which it is strictly forbidden to use it. We will talk about them in detail in our article.

Pharmacological characteristics

The drug, which belongs to the group of beta-blockers, is successfully used to treat a whole range of diseases of the cardiovascular system. Its main active ingredient, bisoprolol, blocks the effect of adrenaline and other catecholamines, as well as stimulating nerve impulses of the central nervous system, on the heart muscle.

Concor tablets

The drug has a gentle effect, but the effect is not observed instantly, but only after an appropriate course of treatment.

As a result of intake, the frequency and strength of heart contractions decreases, due to which the need of the heart muscle for oxygen is reduced, in addition, the heart rhythm is normalized.

Unlike some analogue drugs, bisoprolol acts selectively only on the heart muscle, with virtually no effect on other internal organs - bronchi, pancreas, due to which the likelihood of side effects is noticeably reduced.

The drug is prescribed in the presence of the following pathologies:

• high blood pressure;
• cardiac ischemia;
• angina pectoris;
• stage of compensation for chronic heart failure.

People who regularly use this drug as a course reduce the likelihood of a heart attack and other consequences of hypertension.

The medicine is taken 1 tablet per day in long courses, the effect appears at least 2 weeks after the start of treatment. You should not stop taking it abruptly; you must gradually reduce the dose, otherwise a hypertensive crisis may occur.

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Beta-1 blockers are great for lowering blood pressure and improving the functioning of the cardiovascular system in general. A good drug in this segment is Concor.

The medicine helps stabilize blood pressure, and also has antiarrhythmic and antianginal effects (eliminates symptoms of coronary heart disease).

The medication is available in the form of tablets for oral use. There are tablets with 2.5 mg, 5 mg and 10 mg of the active ingredient. The price of the medicine in the pharmacy is about 150-400 rubles for a package of 30 tablets (the cost depends on the amount of active ingredient in the tablet).

How does the drug work?

Arterial hypertension is the most common pathology of the cardiovascular system. Unfortunately, it is impossible to cure the disease, but it is quite possible to stabilize the patient’s condition.

For this purpose, medications with a pronounced hypotensive effect are used. Beta-1 blockers are widely used. One of the most effective drugs in this segment is Concor.

Doctors are often asked the question, does Concor lower blood pressure or not? Of course, it reduces, because the medication has a pronounced hypotensive effect. Patients also have a question: Does Concor reduce blood pressure or just pulse? The drug has a pronounced antiarrhythmic, antianginal and hypotensive effect, so when taking the tablets, both blood pressure and pulse are stabilized.

Let's consider the principle of action of the medication. So, it includes:

1. The active components are bisoprolol hemifumarate and bisoprolol fumarate (ratio 2:1).
2. Excipients: crospovidone, magnesium stearate, microcrystalline cellulose, silicon dioxide, calcium hydrogen phosphate, corn starch.
3. The composition of the shell is hypromellose, yellow iron oxide, dimethicone, macrogol 400, titanium dioxide.

The active components reduce the activity of the sympathoadrenal system by blocking beta-1 adrenergic receptors of the heart. The substance has a hypotensive effect by reducing cardiac output and inhibiting the secretion of rhinin. In addition, the active components affect the baroreceptors of the carotid sinus and aorta.

The advantage of the drug is the fact that its active components have low affinity for beta-2 receptors of the smooth muscle structure of the bronchi, blood vessels and endocrine system. Due to this, when using the medicine, it is possible to avoid effects on glucose metabolism, bronchi and peripheral arteries. Long-term use of Concor helps reduce increased peripheral vascular resistance.

In patients with coronary artery disease and chronic heart failure, the active components help reduce the number of heart contractions. The substances also reduce the stroke volume of the heart, myocardial oxygen demand and ejection fraction.

Absorption of active components from the intestines – 90%. Bioavailability indicator – 90%. Food has no effect on absorption. The highest concentration of the active component in the blood plasma is observed after 3 hours. Plasma protein binding is about 30%. Derivatives are excreted by the kidneys. The half-life is about 12 hours.

In patients over 75 years of age, no changes in the pharmacokinetics of the drug were observed, so the tablets can be easily taken by elderly hypertensive patients.

Instructions for use of the drug

It was already noted above that Concor lowers blood pressure, so a beta-blocker should be taken by patients suffering from arterial hypertension. Moreover, the medicine can be combined with other antihypertensive pills. Indications for use include coronary heart disease and chronic heart failure.

How to take Concor with high blood pressure? It should be noted right away that adults and elderly patients need to take it once, preferably in the morning. The tablets cannot be chewed - they must be swallowed whole with a small amount of water.

The starting dosage is 5 mg (half tablet 10 mg, whole tablet 5 mg, 2 tablets 2.5 mg). If this dose is ineffective, then it can be increased by 2 times. The maximum daily dosage is 20 mg. When treating chronic heart failure, you should take 5-10 mg.

How long can you take the pills? The instructions for use do not stipulate the duration of therapy. The treatment regimen and duration are selected on a strictly individual basis by the attending physician.

Persons with arterial hypertension accompanied by diabetes mellitus should take Concor with caution.

Contraindications and side effects

Taking Concor tablets when treating arterial hypertension is not possible in all cases. The beta blocker has a number of contraindications for use. Let's look at them in more detail:

• Acute course of heart failure.
• Decompensated form of chronic heart failure.
• Hypotension (low blood pressure).
• Minor age.
• Hypersensitivity to the components of the drug.
• Bronchial asthma, chronic obstructive pulmonary disease.
• Bradycardia.
• Sinoatrial block.
• Metabolic acidosis.
• Severe changes in arterial peripheral circulation.
• Pheochromocytoma.

Pregnant and lactating women are prescribed Concor only if the positive effects of taking the pills outweigh the risk to the child. The side effects of the tablets are discussed in the summary table provided below.

Organ or system.

Description.

In case of overdose, heart failure, severe bradycardia, hypoglycemia, and bronchospasm are observed. It is worth noting that the drug Concor has a withdrawal syndrome. After abrupt cessation of therapy, blood pressure may increase, a rapid pulse may occur, and even a hypertensive crisis may develop.

To avoid this, the drug should be discontinued gradually, that is, the daily dose should be gradually reduced.

Reviews and analogues

Reviews about the drug Concor are mixed. Some patients claim that the drug helped them normalize blood pressure and improve their overall well-being. Patients attribute its relatively low cost to the advantages of the drug.

There are also a lot of negative comments. People complain that in the first days of treatment they had a severe headache, general weakness, and muscle cramps. Some hypertensive patients complain that even a week after the start of therapy, blood pressure did not normalize.

Probably, such reviews are due to the fact that in case of decompensated arterial hypertension, one antihypertensive medication will not help - such patients are prescribed 2 medications or combined pills at the same time to lower blood pressure.

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Alternatives to Concor include:

• Verapamil (50-80 rubles). Hypertensive patients often wonder whether Verapamil or Concor is better? Doctors say that Concor helps stabilize blood pressure faster and is much better tolerated by patients.
• Bisogamma (100-180 rubles).
• Lokren (1000-1200 rubles).
• Egilok (120-200 rubles).

Reviews from cardiologists

Concor is one of the best beta-1 blockers. It is widely used in cardiological practice due to its low price, moderate tolerability and rapid effect.

In my opinion, the medication is perfect for hypertension of 1-2 degrees of severity. The product cannot raise blood pressure under any circumstances. An undoubted advantage is the fact that the drug can be used after myocardial infarction and in hypertensive patients in whom hypertension is accompanied by coronary artery disease, chronic heart failure or atrial fibrillation.

Among the disadvantages of Concor, I would include the fact that it often causes bradycardia, and in the initial stages of treatment, 80% of patients experience severe headaches and asthenic syndrome (increased fatigue, weakness, decreased performance).

I would also include withdrawal syndrome as a negative aspect. If therapy is stopped abruptly, blood pressure will rise again. More unpleasant consequences may also develop, including a hypertensive crisis.

To summarize, we can say that Concor is an excellent antihypertensive drug, but it is not without its drawbacks. It is well suited for patients who require long-term treatment (over 2-3 months). If you take tablets in a reasonable proportion (5-15 mg), you can significantly improve your overall well-being and stabilize your blood pressure.

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Compatibility with drugs with similar effects

You should be careful with various centrally acting antihypertensive drugs, such as Reserpine, Guanfacine, Moxonidine and Methyldop.

Their combination can lead to a sharp disturbance in heart rhythm and a further rise in pressure.

Pay attention to other medications that directly or indirectly reduce blood pressure, for example, antispasmodics, diuretics, barbiturates; they can also enhance the effect of the drug and lead to an attack of hypotension.

However, in some cases, the attending physician may prescribe drugs with an antihypertensive effect together with Concor if he believes that it alone will be ineffective, as a rule, this is one of the following drugs:

• Amlodipine , which is used for high blood pressure. However, the answer to the question of whether Concor and Amlodipine can be taken will be negative if there is heart failure;
• Indapamide has a diuretic and vasodilating effect, used for hypertension, with a minimum of side effects. Concor and Indapamide have good compatibility;
• Noliprel is another potent drug that can lower blood pressure;
• Cardiomanil is an aspirin-based drug that was previously often used to treat hypertension. Is it possible to take Concor and Cardiomagnyl together? Based on recent studies, its effectiveness and safety are questionable and, as a rule, it is not currently prescribed.

Amlodipine tablets

Concor and Kapoten (or Prestarium) have good compatibility, but their simultaneous use is usually prescribed for very high pressure. Prestarium and Capoten tablets belong to the same group of drugs - ACE inhibitors. It should be noted that the first is a newer drug and exhibits greater activity and is better tolerated by patients.

As you can see, Concor is combined with other analogue drugs that have a similar effect. However, their joint use must be discussed with your doctor so that the effect of an overdose does not occur and the pressure does not drop below normal levels.

Sometimes the drug is prescribed along with sedatives. So Concor and Phenazepam have good compatibility, but you should still consult a doctor before using them. Is it possible to take Lozap and Concor at the same time? This combination is prescribed only in cases where the degree of arterial hypertension is so high that treatment with one drug is ineffective.

When using antihypertensive drugs simultaneously, for example, if Concor and Enalapril are taken together, symptoms such as weakness, headache, dizziness, and constant fatigue may appear; you should immediately inform your doctor about this; most likely, he will cancel one of the drugs.

How long can you be treated with the drug?

The product is intended for long-term treatment. When determining how much Concor can be taken for hypertension, the following is taken into account:

• effectiveness of hypertension control;
• change in heart rate;
• other effects of the drug.

With good tolerance and adequate blood pressure control, Concor can be taken for as long as required, sometimes for life. For heart failure, Concor is prescribed in the form of courses; in these cases, the duration of taking Concor will be several weeks or months.

Incompatible drugs

There is a large list of medications that absolutely cannot be taken together, so an experienced doctor will definitely ask the patient and find out what he is being treated with before prescribing this drug. Most incompatible drugs affect the heart muscle.

Thus, you should not use Concor if you are using antiarrhythmic drugs, since as a result of their combined action, the heart rate may sharply decrease, and the pressure due to a decrease in cardiac output will decrease sharply.

This group includes sodium channel blockers - Lidocaine, Diphenine, Quinidine, Proparphenone, Novocainamide, etc.

The next group of unacceptable drugs are potassium channel blockers (for example, Amiodarone), which in combination with Concor tablets can lead to very serious negative consequences, including atrioventricular block.

Diltiazem tablets

Also, you should not take calcium channel blockers, which can lead to a decrease in heart rate and a decrease in the contractility of the heart muscle. In this group, the most popular today are Diltiazem, Verapamil, Nifedipine, etc.

No less dangerous is taking cardiac glycosides, which are usually used by people with heart failure; when used simultaneously, conduction is impaired, which can provoke atrioventricular block.

It is dangerous to prescribe Concor in combination with various adrenergic agonists that stimulate alpha and beta receptors; in this case, peripheral pressure may increase.

Concor should absolutely not be taken together with MAO inhibitors used as antidepressants: Nialamide, Befol, Phenelzine, Metralindole and their analogues.

If you are already taking them, you should stop taking them and wait at least 2 weeks before you start using Concor.

Your doctor should tell you all the medications you use, since even those applied topically may increase the effect of taking them together, such as beta-blocker eye drops for glaucoma.

Side effects of Concor and Prestarium

Possible side effects of Concor tablets:

• dizziness;
• loss of consciousness;
• fatigue;
• weakness;
• asthenia;
• insomnia;
• nightmares;
• conjunctivitis.

The medicine, even after a single dose, can cause bradycardia in patients with CHF.

Frequent phenomena after taking pills are considered to be:

Inappropriate reactions of the body can manifest themselves in the form of:

• chronic renal failure;
• impotence;
• acute liver failure.

Drugs that reduce effectiveness

When taking medications, it should be taken into account that drugs of the opposite direction weaken its effect. First of all, these include beta-agonists dobutamine or isoprenaline.

Below is a whole list of drugs that negatively affect the effectiveness of taking Concor, including:

• female sex hormones estrogens;
• glucocorticosteroids (Hydrocortisone, Prednisolone, Dexamethasone, etc.);
• anti-inflammatory non-steroidal drugs (Acetylsalicylic acid, Analgin, Paracetamol, etc.).

It is not necessary to stop taking them when treating hypertension, however, it should be taken into account that the effect will be lower and the doctor’s attention should be focused on this; in some cases, he may increase the dosage.

Special instructions for treatment

Caution should be exercised in patients who have:

• bronchial asthma;
• anaphylaxis;
• diabetes;
• obliterating or endarteritis;
• 1st degree atrioventricular block.

Carrying out anesthesia may require discontinuation of the drug several days before surgery, so you must inform the anesthesiologist about taking Concor.

During treatment, it is necessary to gradually increase the dose, until it becomes necessary to titrate it. You should not abruptly stop taking the medication; discontinuation of Concor should be gradual.

Medicines to be taken with caution

There are special instructions for people with diabetes.

If they use insulin and hypoglycemic medications in tablets, they must take into account that bispoprolol, the main active ingredient of Concor, potentiates their effect.

An additional danger of co-administration is that Concor reduces the manifestations of tachycardia, which in diabetics is a signal of a decrease in blood sugar levels, due to which the patient may miss a dangerous symptom and a hypoglycemic coma may develop.

How to replace Concor

The active ingredient of the drug is bisoprolol. Medicines with this trade name are produced by many domestic and foreign pharmaceutical companies. Medicines with similar composition:

• Dorez,
• Bicard,
• Bisogamma,
• Corbis,
• Bisostad,
• Cordinorm,
• Coronal,
• Bisomore,
• Niperten,
• Aritel,
• Bidop,
• Biol,
• Biprolol,
• Tirez.

Video on the topic

Instructions for use of the drug:

As you can see, the list of medications that are not recommended to be taken together with Concor is very extensive. Some combinations simply reduce the effectiveness of taking the drug, and some can lead to very unpleasant consequences. That is why this drug should only be prescribed by a doctor, having previously discussed with the patient all the medications he is currently using. Tell your doctor not only about certified drugs from the pharmacy chain, but also about dietary supplements and herbs, if you take them.

The information on the MyMedNews.ru website is for reference and general information, collected from publicly available sources and cannot serve as a basis for making a decision on the use of medications in the course of treatment.

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Action of Prestaium

The medicine for hypertension contains the active component of perindopril, arginine. The drug is an inhibitor of the substance that carries out the transition of angiotensin I to angiotensin II. The drug reduces the production of aldosterone.

The therapeutic effect is due to the presence of the metabolite perindoprilate. The medicine is absorbed from the gastrointestinal tract into organs and tissues after 1 hour. Eating reduces the absorption of the medication.

The drug is recommended to be taken in the morning before meals once a day.

Perindoprilat binds to blood proteins in small amounts. The medication is removed from the body by the kidneys. After 3-5 hours, ½ of the free fraction is excreted.

Dangerous combinations of heart medications

Cardiovascular diseases are the most common among the world's population, so a fairly large percentage of people take “heart” medications, and this, as a rule, is not one medicine, but several.
In this case, the question arises about their safe combination. In this article we will talk about dangerous combinations of “heart” drugs. The term “heart medications” is quite general and non-specific.

Medicines for the treatment of arterial hypertension, angina pectoris, myocardial infarction, cardiomyopathies, cardiac arrhythmias and conduction disorders, and many others fit this description.

To bring some clarity, it is necessary to make a reservation that the article will discuss the most widely used medications that affect the functioning of the heart, and their possible combinations with each other.

The following groups of drugs will be considered:

Note: all drugs are written by international nonproprietary name (INN).

I. Beta blockers:

1. non-selective: propranolol, carvedilol, oxprenolol, pindolol, nadolol. 2. selective: atenolol, metoprolol, bisoprolol, nebivolol, talinolol.

II . Calcium channel blockers (calcium antagonists):

1. non-dihydropyridine: verapamil, diltiazem; 2. dihydropyridine: nifedipine, amlodipine, S-amlodipine, lercanidipine.

III. ACE inhibitors: captopril, perindopril, enalapril, ramipril, zofenapril, fosinopril, lisinopril.

IV. Angiotensin II receptor blockers : losartan, valsartan, candesartan, ibresartan, telmisartan.

V. Diuretics:

1. thiazide: hydrochlorothiazide, chlorthalidone.2. thiazide-like: indapamide.3. loop diuretics: furosemide, torsemide.

4. potassium-sparing diuretics: spironolactone, eplerenone.

Note: the classification shows the most famous representatives of drugs. If you do not find your drug here, then you can find out which group it belongs to by looking at the instructions for it (find the line “pharmacotherapeutic group”), or in reference books on drugs (Vidal, RLS, reference book by M.D. Mashkovsky) .

Recommendations for the treatment of arterial hypertension from 2013, developed by the European Society of Hypertension and the European Society of Cardiology, established the following irrational (i.e. dangerous) combinations of “heart” drugs:

1. beta-blockers + non-dihydropyridine calcium channel blockers (verapamil, diltiazem). This combination is a BIG ERROR on the part of the doctor, since drugs of both groups cause a decrease in heart rate.

When prescribed together, their total effect on heart rate is so pronounced that life-threatening conditions can occur (even heart rhythm disturbances).

If, by coincidence, the patient can only be prescribed a combination of beta-blockers with calcium channel blockers, then from the group of the latter, preference is given to dihydropyridine drugs (nifedipine, amlodipine, lercanidipine).

Note: A combination of beta blockers and non-dihydropyridine calcium antagonists is sometimes used to control ventricular rate in persistent atrial fibrillation. BUT! Only in this case!

2. ACE inhibitor + potassium-sparing diuretic. Potassium-sparing diuretics include spironolactone and eplerenone. Like all diuretics, a group of potassium-sparing drugs removes excess fluid from the body while maintaining potassium in the blood. ACE inhibitors also contribute to the accumulation of potassium in the body.

When combining drugs from both groups, a dangerous condition for the heart can occur - hyperkalemia - which can cause cardiac arrest in diastole. If your doctor has prescribed you a drug from any of these groups, you need to periodically check your potassium level (during dose selection, once a week, when the optimal dose of the drug is selected - once a month).

The normal level of potassium in blood plasma for adults is 3.5-5.1 mmol/l.

3. Beta-blocker and centrally acting drugs. The latter group includes methyldopa, clonidine, moxonidine, and rilmenidine. These groups have similar mechanisms of action, clinical effects, and - most importantly - side effects. Due to mutual enhancement of undesirable effects, these two groups are not used together.

4. ACE inhibitor and angiotensin-II receptor blocker. Previously, this combination of drugs was possible, but since 2013 it has been established that the combination of these two groups has a negative effect on the kidneys, causing renal failure in a relatively short time.

The same Recommendations talk about possible, but less studied combinations of drugs. It is possible that someday these combinations will move into the group of rational or dangerous. Such combinations include the following:

1. ACE inhibitor + beta blocker; 2. Angiotensin-II receptor blocker + beta-blocker; 3. Dihydropyridine calcium antagonists + beta-blockers.

The following combinations of drugs are rational and as safe as possible:

1. Diuretic (thiazide) + angiotensin-II receptor blocker; 2. Diuretic (thiazide) + calcium antagonist;3. Diuretic (thiazide) + ACE inhibitor;4. Angiotensin II receptor blocker + calcium antagonist;

5. ACE inhibitor + calcium antagonist.

These are, perhaps, all the features of the most common combinations of “heart” drugs. Of course, in each individual case, in relation to a particular drug, there are characteristics unique to it. But the basic rules in prescribing several “heart” medications are the above.

therapist A.V. Kosova

Source: https://azbyka.ru/zdorovie/opasnye-sochetaniya-serdechnyx-lekarstvennyx-preparatov

Doctors' opinion

Morshanovsky S. O., cardiologist

An effective drug compared to similar products: Bisoprolol, Biol, Biprol. Available in a convenient dosage of 5-10 mg, tablets can be divided in half. It has a disadvantage: it reduces potency in men. I prescribe the medicine only according to indications.

Lapshin N.I., cardiologist

I recommend a medication based on perindopril arginine for the treatment of angina pectoris and heart rate control. Patients tolerate the medication well. The patient uses an angiotensin enzyme inhibitor tablet once a day. No side effects were found.