Toricard-5

Nebivolol HCl

Essential HTN. Stable mild & moderate chronic heart failure in addition to standard therapies in elderly patients.

HTN Adult 1 tab daily, preferably at the same time of the day. 5 mg in combination w/ hydrochlorothiazide 12.5-25 mg. Elderly >65 yr & renal insufficiency Initially 2.5 mg daily, may be increased to 5 mg daily. Chronic heart failure Initial uptitration at 1-2 wkly intervals: 1.25 mg, increased to 2.5 mg once daily, then to 5 mg once daily & then 10 mg once daily. Max: 10 mg once daily.

May be taken with or without food: Tab may be broken in half-line if required.

Hypersensitivity. Liver insufficiency or impairment. Acute heart failure, cardiogenic shock or episodes of heart failure decomposition requiring IV inotropic therapy; sick sinus syndrome, including SA block; 2nd & 3rd degree heart block (w/o pacemaker); history of bronchospasm & bronchial asthma; untreated pheochromocytoma; metabolic acidosis; bradycardia (heart rate <60 bpm prior to start of therapy); hypotension (systolic BP <90 mmHg); severe peripheral circulatory disturbances.

Discontinue use at least 24 hr in prep for surgery. Patients w/ untreated CHF. Discontinue use gradually in patients w/ ischaemic heart disease. May induce bradycardia; reduce dose if pulse rate drops <50-55 bpm. Peripheral circulatory disorders (Raynaud's disease or syndrome, intermittent claudication), 1st degree heart block, Prinzmetal's angina, diabetic patients, hyperthyroidism, COPD, patients w/ history of psoriasis. May mask hypoglycemic symptoms. Certain anaesth that may cause myocardial depression. Concomitant use w/ verapamil, diltiazem & centrally acting antihypertensive drugs is not recommended. Galactose intolerance, Lapp-lactase deficiency or glucose-galactose malabsorption. May affect ability to drive & use machines. Pregnancy & lactation. Childn & adolescents.

Headache, dizziness, paraesthesia; dyspnea; constipation, nausea, diarrhea; tiredness, oedema.

May potentiate effect on AV conduction time & increase -ve inotropic effect w/ class I anti-arrhythmics (quinidine, hydroquinidine, cibenzoline, flecainide, disopyramide, lidocaine, mexiletine, propafenone). -ve influence on contractility & AV conduction w/ Ca-channel antagonists of verapamil/diltiazem type. Decrease in central sympathetic tonus (reduction of heart rate & cardiac output, vasodilation) w/ centrally-acting hypertensives (clonidine, guanfacine, monoxidine, methyldopa, rilmenidine). May potentiate effect on AV conduction w/ amiodarone. May attenuate reflex tachycardia & increase risk of hypotension w/ anaesth (volatile halogenated). May mark certain symptoms of hypoglycemia (palpitations, tachycardia) w/ insulin & oral antidiabetic drugs. Increased fall in BP w/ baclofen & amisfostine. May increase AV conduction time w/ digitalis glycosides. May increase risk of hypotension & further deterioration of ventricular pump fraction w/ Ca antagonists of dihydropyridine type (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nitrendipine). Enhanced hypotensive effect (additive effect) w/ antipsychotics & antidepressants (tricyclics, barbiturates & phenothiazines). May counteract effect w/ sympathomimetic agents. Increased plasma levels associated w/ increased risk of excessive bradycardia & adverse events w/ CYP2D6 isoenzyme inhibitors eg, paroxetine, fluoxetine, thioridazine & quinidine. Increased plasma levels w/ cimetidine.

Beta-Blockers

C07AB12 - nebivolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

Rx