What can replace the drug atenolol. Pharmacological action of Atenolol

Atenolol (Atenolol Nycomed, Astrapharm, Actavis) – modern medicinal product, belonging to the group of β-blockers. This drug is on the list of essential drugs for high blood pressure(hypertension), heart disease, heart rhythm disturbances (arrhythmia, tachycardia). Active active substance drug - a compound with a similar name, atenolol. Below is more detailed information about the medicine Atenolol - instructions for use, indications and contraindications for use, possible side effects after administration.

The pills block β-receptors of stress hormones (such as adrenaline) in the body, thereby suppressing undesirable effect stress reactions on organs. Blood pressure drops, heart rate slows, risk decreases serious violations heart rate. Atenolol is one of the cardioselective β-blockers. This means that its maximum effect depends on beta receptors in the heart.

Brief summary and description of the medicine:

manufacturer: Pliva Hrvatska d.o.o., Croatia. The largest supplier of medicines produced in Croatia in Russia and Ukraine is the Belupo company;
name in Latin: Atenololum;
from Latin name INN, RLS: atenolol (Atenolol) also occurred.

active ingredient – atenolol;
auxiliary components - starch, pre-gelatinized starch, lactose monohydrate, silicon dioxide, magnesium stearate.

Release forms

Pharmaceutical form of release: tablets. The most common packaging in our country is Atenolol 50 mg 50 tablets. Other packages also available:

Tablet, mg	Number of tablets
25	30
25	50
25	100
50	30
50	50
50	100
100	30
100	50
100	100

Instructions for use of Atenolol

The exact dosage is determined by the doctor individually. Unless otherwise indicated, it is recommended to use the tablets in accordance with the following dosage:

treatment of high blood pressure (hypertension), angina pectoris, heart rhythm disturbances: 50 mg of Atenolol should be taken once a day or 100 mg in 1 or 2 daily doses;
treatment functional disorders cardiovascular system: take the drug 25 mg once a day.

Dosage in patients with impaired renal function:

with reduced kidney function, Atenolol Nycomed (Astrapharm, Actavis) is used in lower doses; The exact dosage is determined by the doctor depending on the degree of renal failure.

Atenolol tablets are swallowed whole, washed down with water (200-250 ml) before meals. The duration of treatment is determined by the doctor.

Indications for use

In accordance with the instructions for use of the drug Atenolol Nycomed, indications for use include the following diseases:

functional disorders of the cardiovascular system (a condition with increased cardiac function and decreased vascular resistance, dysregulation of high blood pressure);
coronary artery disease (stable and unstable angina);
high blood pressure ( arterial hypertension);
heart rhythm disturbances with an increase in heart rate.

According to the instructions, Atenolol Nikamed (Astrapharm, Actavis) is intended for the treatment of adults and adolescents.

Contraindications

When using the drug Atenolol, in addition to the indications for use, contraindications should also be taken into account. Health problems for which the medicine should not be used are no less important factors than the indications for use of Atenolol (instructions for use, for what blood pressure and heart disease it should be taken).

Contraindications:

hypersensitivity to the drug (and other beta-blockers) or to any of the other ingredients of the drug;
severe heart failure;
state of shock (poor blood circulation);
some disorders of the formation and control of excitement in the heart (atrioventricular block II and III degree, atrial wall block, so-called. sick sinus syndrome);
the patient's heart rate before treatment with Atenolol is less than 50/minute (bradycardia);
markedly low blood pressure (hypotension with systolic pressure below 90 mm Hg. Art.);
acidification of the blood (acidosis);
susceptibility to bronchial spasms (eg, bronchial asthma);
late stages of limb perfusion disorders.

Side effects

Although the drug is generally well tolerated, it is pharmaceuticals, which can cause side effects (also possible in case of overdose).

Common (affects less than 1 in 10 people):

slow heartbeat when taking the drug;
cold hands and feet;
diarrhea;
feeling tired;
elevated liver enzymes in laboratory tests.

Less common (affects less than 1 in 100 people):

sleep disturbance.

Rare (affects less than 1 in 1000 people):

heart block (may cause dizziness, abnormal heartbeat, fatigue, weakness);
worsening heart failure;
lack of sensation or cramps in the fingers, accompanied by a feeling of warmth and pain (Raynaud's phenomenon);
mood changes;
nightmares;
changes in personality (psychosis), hallucinations;
headache;
dizziness, fainting (especially when changing body position);
tingling in the hands;
impotence;
dry mouth;
dry mucous membranes of the eyes;
visual disturbances (blurred vision);
hair loss;
skin rash;
relapse of psoriasis;
decreased platelet count;
purple spots on the skin;
jaundice (with yellowing of the skin and whites of the eyes);
bronchospasm (in patients with asthma).

Very rare (affects less than 1 in 10,000 people):

changes in your blood – your doctor may do blood tests to see if these changes occur while you are taking Atenolol.

Unknowns (cannot be estimated from available data):

lupus syndrome (a disease in which the immune system produces antibodies that attack the skin and joints).

Treatment with Atenolol

Atenolol is a β-adrenergic blocker with a predominant effect on β-1 receptors. It does not have membrane stabilizing effects or intrinsic sympathomimetic activity.

The mechanism of the antihypertensive effect of the drug has not been established. However, cardiologists point to the possibility of exposure to the following factors:

the ability to competitively antagonize catecholamine-induced tachycardia at β-receptors in the heart, thereby reducing cardiac output;
inhibition of renin release from the kidneys;
inhibition of vasomotor centers.

The mechanism of the antianginal effect of Atenolol is also not defined. An important factor there may be a decrease in myocardial oxygen demand due to blockade of the catecholamine-induced increase in heart rate, systolic blood pressure, speed and degree of contraction of the heart muscle.

Approximately 50% of the oral dose of the drug is absorbed from the digestive tract, the remaining amount is excreted in the feces. 6–16% of the drug binds to plasma proteins. Maximum plasma concentrations are achieved within 2–4 hours. The average peak plasma concentration of Atenolol is approximately 300 and 700 mg/ml after administration of 50 mg and 100 mg, respectively. The plasma half-life is approximately 6–7 hours. The drug is widely distributed into extravascular tissues, but only small amounts are present in the central nervous system.

After 72 hours, the drug is completely eliminated.

Attenolol during pregnancy and lactation

During pregnancy and breastfeeding, there are special instructions for the use of the drug Atenolol.

Pregnancy

Atenolol passes through the placenta and reaches almost the same concentration in cord blood as in maternal blood. There are no research data on the use of the drug during the first 3 months of pregnancy, so the possibility of harm to the fetus should not be ruled out. Remedy for increased medical supervision can be used to treat hypertension in the 3rd trimester of pregnancy. The use of Atenolol in pregnant women with treatment of mild or moderate hypertension has been associated with intrauterine growth restriction. Treatment should be discontinued 24–48 hours before the estimated date of delivery due to the risk of hypotension, bradycardia, respiratory depression, hypoglycemia (neonatal asphyxia) in newborns.

Important! When using Atenolol in women who are pregnant or trying to become pregnant, the expected benefits and potential risks should be taken into account, especially in the 1st and 2nd trimester of pregnancy.

Breast-feeding

Active substances accumulate significantly in breast milk, reaching concentrations that are several times higher than serum concentration mother. Newborns whose mothers took atenolol at birth or during breastfeeding are at increased risk of developing hypoglycemia and bradycardia. The drug for breastfeeding should be prescribed only after careful consideration of the benefits and risks of treatment.

Since use in children is not supported by sufficient clinical data, Atenolol should not be given to children.

Drug interactions of Atenolol

Taking Atenolol and other medications at the same time may interfere with each other's effectiveness. Therefore, you should tell your doctor about all medications you take, both prescription and over-the-counter. Do not take any medications at the same time as Atenolol without consulting your doctor.

Interactions with drugs:

Medicines to lower blood pressure, increase urine output (diuretics), dilate blood vessels, some medications for treatment mental illness(tricyclic antidepressants, phenothiazines), barbiturates enhance the effect of the drug on blood pressure.
Medicines used to treat heart rhythm disorders (antiarrhythmic drugs) increase the suppressive effect of Atenolol on the heartbeat.
Using medicine with therapeutic agents, such as Verapamil, Diltiazem (blockers calcium channels), as well as some substances used for heart rhythm disorders (for example, disopyramide), leads to a decrease in blood pressure (hypotension), a significant decrease in heart rate (bradycardia), and other cardiac disorders.
Calcium antagonists such as Nifedipine (used to treat high blood pressure) when taken simultaneously with Atenolol, lead to a significant decrease in blood pressure, and in some cases even to heart failure.
Substances such as reserpine, clonidine (used to treat high blood pressure) and α-methyldopa - helps with hypertension, significantly reduces heart rate - slows conduction in the heart area.
Suddenly stopping clonidine (used to treat high blood pressure) if simultaneous use Atenolol may cause excessive increases in blood pressure. A few days before eliminating Clonidine, you should stop taking Atenolol, and then gradually withdraw from the medication.
When taking Atenolol with drugs that lower blood sugar (insulin and oral antidiabetic agents), the effect is enhanced due to the fact that the symptoms of low blood sugar (tremor, increased heart rate) can be masked by the action of Atenolol.
Medicine used with norepinephrine and epinephrine may cause a severe increase in blood pressure; medications with anti-inflammatory effects (Indomethacin) may weaken the effect of Atenolol on blood pressure.

Alcohol compatibility

When combined with alcohol, the drug may adversely affect reaction and concentration abilities.

Storage conditions

Keep the medicine out of the reach of children. Do not use after the expiration date stated on the blister and carton (EXP). The expiration date refers to last day the specified month.

Store the drug in its original packaging to protect it from light and moisture.

Important! Do not dispose of any medicines in sewage or household waste. Ask your pharmacist to discard medications you no longer use. These measures help protect the environment.

Terms of sale

The medicine is available by prescription.

Interaction

Atenolol, like other β-blockers, should be taken with caution when treating concomitant diseases:

The medicine may increase the number and duration of angina attacks in patients with this disease. This is a selective β-1 blocker, so its use always requires the utmost caution.
Because of negative impact on conduction, caution is needed in patients with 1st degree AV block.
The drug can affect tachycardia during hypoglycemia (diabetic patients with fluctuations in sugar levels).
The medicine may mask the symptoms of thyrotoxicosis.
Due to its pharmacological action, the drug reduces the heart rate. If you experience symptoms that may be related to a slow heart rate, your dose may need to be reduced.
The drug should not be abruptly withdrawn in patients with ischemia.
The drug may increase susceptibility to allergens and cause severe anaphylactic reactions in patients with a history of anaphylactic reactions to these allergens.
Caution is needed for patients with psoriasis (risk of exacerbation).
For depression, treatment is carried out under strict medical supervision!
Patients with myasthenia gravis may experience worsening symptoms of the disease.

Atenolol's analogs

The drug can be replaced with analogues with the same effect. Replacing Atenolol with analogues should be supervised by a doctor!

Medicines with effects similar to Atenolol:

Metoprolol();
Concor;

There are contraindications. Before starting use, consult your doctor.

Commercial names abroad (abroad) - Ancoren, Antipressan, Atcardil, Ateblocor, Atehexal, Atel, Aten, Atenblock, Aterol, Atestad, Atpark, Betacard, Biduten, Blocotenol, Blotex, Cadpres, Clinaten, Duratenol, Estekor, Falitonsin, Hexa -Blok, Hypoten, Loten, Myocord, Normiten, Nortan, Nosbal, Noten, Plenacor, Prenormine, Prinorm, Ranlol, Selinol, Telvodin, Teno, Tenoblock, Tenocor, Tevanolol, Tredol, Unibloc, Vascoten, Velorin, Zumablok.

All drugs used in cardiology.

You can ask a question or leave a review about the medicine (please, do not forget to indicate the name of the drug in the text of the message).

Preparations containing Atenolol (Atenolol, ATC code C07AB03):

Common forms of release (more than 100 offers in Moscow pharmacies)
Name	Release form	Packaging, pcs.	Manufacturer country	Price in Moscow, r	Offers in Moscow
Atenolol	tablets 50mg	20,28,30,50	Different	6- (average 45) -61	304↘
Atenolol	tablets 100mg	14; 28; 30; 50	Different	7- (average 38) -59	159↘
Atenolol Belupo	tablets 25mg	30	Croatia, Belupo	18- (average 29) -40	373↗
Atenolol Belupo	tablets 50mg	30	Croatia, Belupo	6- (average 45) -61	304↗
Atenolol Belupo	tablets 100mg	14 and 28	Croatia, Belupo	25- (average 37↘) -55	198↘
Atenolol Nycomed	tablets 50mg	30	Denmark, Nycomed	20- (average 44) -48	276↘
Atenolol Nycomed	tablets 100mg	30	Denmark, Nycomed	43- (average 55) -61	336↗
Rarely encountered and discontinued release forms (less than 100 offerings in Moscow pharmacies)
Name	Release form	Packaging, pcs.	Manufacturer country	Price in Moscow, r	Offers in Moscow
	tablets 50mg	28	English, Zeneca	No	No
Tenormin - original	tablets 100mg	28	English, Zeneca	No	No
Atenolol	tablets 25mg	28	India, Ipka	26-27	2
Atenolol FPO	tablets 50mg	30	Russia, Obolenskoye	12-13	6
Atenolol-Agio	tablets 100mg	30	India, Ajio	18-29	2
Atenolol-Agio	tablets 50mg	30	India, Ajio	12-13	2
Atenolol-Acri	tablets 50mg	30	Russia, Akrikhin	17- (average 23) -48	5↘
Atenolol-Acri	tablets 100mg	30	Russia, Akrikhin	27- (average 28) -31	12↘
Atenolol-Teva	tablets 25mg	30	Germany, Merkle	15-29	25↗
Atenolol Teva	tablets 100mg	30	Israel, Teva	No	No
Atenolol-UBF	tablets 100mg	30	Russia, UralBioPharm	16-26	4↗
Atenolol-AKOS	tablets 50mg	30	Russia, Kurgan	No	No
Atenolol-AKOS	tablets 100mg	30	Russia, Kurgan	No	No
Atenolol Ratiopharm 25	tablets 25mg	30	Germany, Ratiopharm	No	No
Atenolol Ratiopharm 50	tablets 50mg	30	Germany, Ratiopharm	No	No
Atenolol Ratiopharm 100	tablets 100mg	30	Germany, Ratiopharm	No	No
Vero-Atenolol	tablets 50mg	30	Russia, Veropharm	No	No
Vero-Atenolol	tablets 100mg	30	Russia, Veropharm	No	No
Betacard-50	tablets 50mg	100	India, Torrent	No	No
Vazkoten	tablets 100mg	20	Cyprus, Medokemi	No	No

Atenolol - official instructions for use. The drug is a prescription, the information is intended only for healthcare professionals!

Clinical and pharmacological group:

Beta1 blocker

pharmachologic effect

It has antianginal, hypotensive and antiarrhythmic effects. It does not have membrane stabilizing or internal sympathomimetic activity. Reduces catecholamine stimulation of the formation of cAMP and ATP, reduces the intracellular current of calcium ions.

In the first 24 hours after oral administration, against the background of a decrease in cardiac output, a reactive increase in peripheral vascular resistance is observed, the severity of which gradually decreases within 1-3 days.

The hypotensive effect is associated with a decrease in cardiac output, a decrease in the activity of the renin-angiotensin system, barocceptor sensitivity and an effect on the central nervous system. The hypotensive effect is manifested by a decrease in systolic and diastolic blood pressure, a decrease in stroke and minute volumes. In average therapeutic doses it has no effect on the tone of peripheral arteries. The hypotensive effect lasts 24 hours, and with regular use it stabilizes by the end of 2 weeks of treatment.

The antianginal effect is determined by a decrease in myocardial oxygen demand as a result of a decrease in heart rate (prolongation of diastole and improvement of myocardial perfusion) and contractility, as well as a decrease in the sensitivity of the myocardium to the effects of sympathetic innervation. Reduces heart rate at rest and during physical activity. By increasing the tension of the ventricular muscle fibers and end-diastolic pressure in the left ventricle, it can increase myocardial oxygen demand, especially in patients with chronic heart failure.

The antiarrhythmic effect is manifested by the suppression of sinus tachycardia and is associated with the elimination of arrhythmogenic sympathetic influences on the conduction system of the heart, inhibition of heterogeneous automatism, a decrease in the speed of propagation of excitation through the sinoauricular node and an extension of the refractory period. It inhibits the conduction of impulses in the antegrade and, to a lesser extent, in the retrograde directions through the AV node and along additional pathways.

Increases the survival rate of patients who have had myocardial infarction (reduces the frequency of ventricular arrhythmias and angina attacks). Slightly reduces the vital capacity of the lungs, practically does not weaken the bronchodilatory effect of isoproterenol. At therapeutic concentrations it does not affect β2-adrenergic receptors; in contrast to non-selective beta-blockers, it has a less pronounced effect on the smooth muscles of the bronchi and peripheral arteries and on lipid metabolism. When taken more than 100 mg per day, it may have a beta2-adrenergic blocking effect.

The negative chronotropic effect appears 1 hour after administration, reaches a maximum after 2-4 hours and lasts up to 24 hours.

Pharmacokinetics

After oral administration, the drug is quickly absorbed from the gastrointestinal tract - approximately 50% of the dose taken orally. Solubility in fats is poor, bioavailability is 40-50%, Tmax in blood plasma after oral administration is 2-4 hours.

It penetrates poorly through the blood-brain barrier and passes in small quantities through the placental barrier and into breast milk. Binding to blood plasma proteins is 6-16%. Practically not metabolized in the liver.

T1/2 - 6-9 hours (increases in elderly patients). Excreted by the kidneys glomerular filtration(85-100% unchanged).

Impaired renal function is accompanied by prolongation of T1/2 and cumulation: with clearance below 35 mg/min/1.73 m2, T1/2 is 16-27 hours, with clearance below 15 mg/min - more than 27 hours (dosage reduction is necessary).

Excreted during hemodialysis.

Indications for use of the drug ATENOLOL

arterial hypertension;
prevention of angina attacks, with the exception of Prinzmetal angina;
heart rhythm disturbances: sinus tachycardia, prevention of supraventricular tachyarrhythmias, ventricular extrasystole, ventricular tachycardia.

Dosage regimen

The drug is taken orally before meals, without chewing, with a small amount of liquid.

Arterial hypertension.

Treatment begins with taking 50 mg of Atenolol once a day. To achieve a stable antihypertensive effect, 1-2 weeks of administration are required. If the hypotensive effect is insufficient, the dose of the drug is increased to 100 mg per dose. Further increase in dose is not recommended, because it is not accompanied by an increase in clinical effect.

Angina pectoris.

The initial dose is 50 mg per day. If the optimal therapeutic effect is not achieved within a week, the dose is increased to 100 mg per day. Sometimes it is possible to increase the dose to 200 mg 1 time per day. Elderly patients and patients with impaired renal function require dose adjustment depending on QC. In patients with renal failure with CC values above 35 ml/min/1.73 m2 (normal values are 100-150 ml/min/1.73 m2), significant accumulation of atenolol does not occur.

For patients on hemodialysis, Atenolol is prescribed 50 mg per day immediately after each dialysis in inpatient conditions under close medical supervision, as there is a risk of developing arterial hypotension. In elderly patients, the initial single dose is 25 mg (can be increased under the control of blood pressure and heart rate). Increasing the daily dose above 100 mg is not recommended, because the therapeutic effect is not enhanced, and the likelihood side effects increases. Maximum daily dose is 200 mg. In case of planned withdrawal, the dose is reduced by 1/4 of the dose every 3-4 days.

Side effect

Most side effects associated with the use of Atenolol are mild and transient.

The most common side effects are mainly related to the pharmacological action of the drug and are expressed as follows:

From the cardiovascular system: the appearance of symptoms of heart failure, impaired AV conduction, bradycardia, marked decrease in blood pressure, palpitations.

From the central nervous system: dizziness, sleep disturbance, decreased ability to concentrate, drowsiness, depression, hallucinations, lethargy, feeling tired, headache, weakness, headache, insomnia, nightmares, anxiety, confusion or short-term memory loss, weakened reaction abilities, parasthesia in the limbs (in patients with intermittent claudication and Raynaud's syndrome), muscle weakness, convulsions.

From the gastrointestinal tract: dry mouth, nausea, vomiting, diarrhea, abdominal pain, constipation.

From the outside respiratory system: dyspnea, apnea, bronchospasm.

Hematological reactions: thrombocytopenic purpura, anemia (aplastic), thrombosis.

From the outside endocrine system: gynecomastia, decreased potency, decreased libido, hyperglycemia (in patients with non-insulin-dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), hypothyroid state.

Metabolic reactions: hyperlipidemia.

Skin reactions: urticaria, dermatitis, itching, photosensitivity, increased sweating, skin hyperemia, exacerbation of psoriasis.

Sense organs: blurred vision, decreased secretion of tear fluid, dry and sore eyes, conjunctivitis, vasculitis, chest pain.

Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia.

Laboratory indicators: agranulocytosis, leukopenia, changes in the activity of liver enzymes and bilirubin levels.

Other: withdrawal syndrome (increased angina attacks, increased blood pressure), reversible alopecia, back pain, arthralgia. The frequency of side effects increases with increasing dosage of the drug.

Contraindications to the use of the drug ATENOLOL

hypersensitivity to the drug;
cardiogenic shock;
AV block II or III degree;
severe bradycardia;
sick sinus syndrome;
sinoauricular block;
acute heart failure;
chronic heart failure (in the stage of decompensation);
cardiomegaly without signs of heart failure; Prinzmetal's angina;
arterial hypotension (if used for myocardial infarction, systolic blood pressure less than 100 mmHg);
bronchial asthma;
lactation period;
simultaneous use of MAO inhibitors;
age under 18 years (efficacy and safety have not been determined).

With caution - diabetes mellitus, metabolic acidosis, hypoglycemia, history of allergic reactions, chronic obstructive pulmonary diseases (including emphysema), AV block of the first degree, chronic heart failure, obliterating diseases of peripheral vessels ("intermittent" claudication, Raynaud's syndrome), pheochromocytoma, chronic renal failure, liver failure, myasthenia gravis, thyrotoxicosis, depression (including a history), psoriasis, pregnancy, old age.

Use of the drug ATENOLOL during pregnancy and breastfeeding

Pregnant women should be prescribed Atenolol only in cases where the benefit to the mother outweighs the potential risk to the fetus. Atenolol is released from breast milk, therefore during the feeding period it should be taken only at exceptional cases with great care.

Use for liver dysfunction

With caution - liver failure.

Use for renal impairment

In patients with renal failure with creatinine clearance values above 35 ml/min/1.73 m2 (normal values are 100-150 ml/min/1.73 m2), significant accumulation of atenolol does not occur.

For dosages for patients with renal failure, see the table in the "dosage regimen" section.

For patients on hemodialysis, atenolol is prescribed 50 mg per day immediately after each dialysis in a hospital setting under close medical supervision, since there is a risk of developing arterial hypotension.

special instructions

Monitoring of patients taking atenolol should include monitoring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), blood glucose levels 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 about the need medical consultation at heart rate less than 50/min.

In thyrotoxicosis, atenolol may mask certain Clinical signs hyperthyroidism (for example, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it can increase symptoms.

Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentrations to normal levels.

In patients with coronary disease heart disease (CHD), abrupt withdrawal of beta-blockers may cause an increase in the frequency or severity of anginal attacks, therefore, discontinuation of atenolol in patients with ischemic heart disease should be carried out gradually.

Particular attention also requires the selection of doses in patients with cardiac decompensation. Compared with non-selective beta-blockers, cardioselective beta-blockers have less effect on pulmonary function, however, in obstructive diseases respiratory tract Atenolol should only be prescribed if absolute readings. If it is necessary to prescribe them, in some cases the use of β2-adrenergic agonists can be recommended.

Patients with bronchospastic diseases can be prescribed cardioselective adrenergic blockers in case of intolerance and/or ineffectiveness of other antihypertensive drugs, but the dosage should be strictly monitored. An overdose is dangerous due to the development of bronchospasm.

Particular attention is required in cases where it is required surgical intervention under anesthesia in patients taking Atenolol. The drug should be stopped 48 hours before surgery. As an anesthetic, you should choose a drug with as little negative inotropic effect as possible.

When using Atenolol and clonidine simultaneously, Atenolol should be stopped several days before clonidine in order to avoid withdrawal symptoms from the latter.

It is possible that the severity of the hypersensitivity reaction may increase and the absence of effect from usual doses of epinephrine against the background of a burdened allergic history.

Drugs that reduce catecholamine reserves (for example, reserpine) may enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect arterial hypotension or bradycardia. In the case of severe bradycardia (less than 50 beats/min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias in elderly patients, severe violations liver and kidney function, it is necessary to reduce the dose or discontinue treatment.

If intravenous administration of verapamil is necessary, this should be done at least 48 hours after taking Atenolol.

When using Atenolol, it is possible to reduce the production of tear fluid, which is important for patients who use contact lenses.

Treatment should not be abruptly interrupted due to the risk of developing severe arrhythmias and myocardial infarction. Cancellation is carried out gradually, reducing the dose over 2 weeks or more (reduce the dose by 25% in 3-4 days).

The drug should be discontinued before testing the content of catecholamines, normetanephrine and vanillylmandelic acid in the blood and urine; antinuclear antibody titers.

Beta blockers are less effective in smokers.

Impact on the ability to drive and operate machinery.

During the treatment period, it is necessary to refrain from driving vehicles and potentially engaging in activities dangerous species activities requiring increased concentration attention and speed of psychomotor reactions.

Overdose

Symptoms: bradycardia, AV block of II and III degrees, marked decrease in blood pressure, increasing symptoms of heart failure, bronchospasm, hypoglycemia, dizziness, fainting, arrhythmias, ventricular extrasystole, cyanosis of fingernails or palms, convulsions.

Treatment: gastric lavage and administration of adsorbents. If bronchospasm occurs, inhalation or intravenous administration of the beta2-adrenergic agonist salbutamol is indicated. In case of impaired AV conduction, bradycardia, intravenous administration of 1-2 mg of atropine, epinephrine or placement of a temporary pacemaker. At ventricular extrasystole- lidocaine (class IA drugs should not be used), in case of arterial hypotension - the patient should be in the Trendelenburg position. If there are no signs of pulmonary edema, intravenous plasma-substituting solutions are used; if ineffective, the administration of epinephrine, dopamine, or dobutamine. For heart failure - cardiac glycosides, diuretics, glucagon, for convulsions - intravenous diazepam. Dialysis is possible.

Drug interactions

With the simultaneous use of Atenolol and insulin (or oral hypoglycemic agents), their hypoglycemic effect may be enhanced.

Concomitant use of atenolol with antihypertensive drugs of other groups leads to an increased hypotensive effect. When taking atenolol with verapamil (or diltiazem), a mutual enhancement of the cardiodepressive effect occurs.

The hypotensive effect is weakened by estrogens (sodium retention).

When co-administered with cardiac glycosides, the risk of developing bradycardia and AV conduction disorders increases.

When administered simultaneously with reserpine, methyldopa, clonidine, verapamil, severe bradycardia may occur.

For patients taking atenolol and clonidine simultaneously, clonidine should be discontinued only after several days have passed after stopping treatment with atenolol.

Simultaneous intravenous administration of verapamil and diltiazem can provoke cardiac arrest, nifedipine can lead to a significant decrease in blood pressure.

When taking atenolol simultaneously with derivatives of ergotamine, xanthine, and NSAIDs, the effectiveness of atenolol is reduced.

Concomitant use with lidocaine may reduce its elimination and increase the risk toxic effect lidocaine.

The combined use of atenolol with phenothiazine derivatives helps to increase the concentration of each drug in the blood serum.

Phenytoin for intravenous administration, means for general anesthesia increases the severity of the cardiodepressive effect.

When taken simultaneously with aminophylline (aminophylline) and theophylline, mutual suppression of the therapeutic effect is possible.

Allergens used for immunotherapy or allergen extracts used in skin testing increase the risk of severe systemic allergic reactions or anaphylaxis.

Means for inhalation anesthesia(hydrocarbon derivatives) increase the risk of suppression of myocardial function and the development of arterial hypotension.

Amiodarone increases the risk of bradycardia and inhibits AV conduction.

Cimetidine increases plasma concentrations (inhibits metabolism).

Prolongs the effect of non-polarizing muscle relaxants and the anticoagulant effect of coumarins.

Tri- and tetracyclic antidepressants, antipsychotics, sedatives, hypnotics and ethanol increase CNS depression.

Conditions for dispensing from pharmacies

On prescription.

Storage conditions and periods

List B. When room temperature 15-25° C out of the reach of children!

Shelf life: 5 years (indicated on the package). Do not use after the date indicated on the package

A selective β1-adrenergic receptor blocker without BCA, which does not have membrane stabilizing activity. Due to its cardioselectivity and hydrophilicity, atenolol is much less likely to induce the development of bronchospasm and impaired peripheral circulation, sleep disturbance or emotional sphere. Cardioselectivity when used in high doses is lost.
Reduces heart rate, cardiac output, systolic and diastolic blood pressure at rest and during exercise, has an antiarrhythmic effect by eliminating adrenergic effects on the heart, and reduces myocardial oxygen demand. Used as a hypotensive and antianginal agent. At long-term use the antihypertensive activity of atenolol is not reduced.
After oral administration, it is quickly but not completely absorbed into the digestive tract. 50-60% of the dose taken orally is absorbed, the remaining amount of atenolol is excreted unchanged in the feces. The β-adrenergic blocking effect of atenolol occurs within 1 hour after a single oral dose. Maximum effect develops after 2-4 hours. The half-life is 6-9 hours, however, the pharmacological effects of atenolol persist for a longer time (about 24 hours). In renal failure, the half-life is significantly prolonged. Less than 5% of atenolol is bound to plasma proteins, the volume of distribution is 0.7 l/kg body weight. Most of the atenolol that enters the systemic circulation (85%) is excreted unchanged in the urine. With long-term use, the pharmacokinetics of atenolol remains virtually unchanged. Penetrates the placental barrier and enters breast milk. Atenolol practically does not penetrate the BBB.

Indications for use of the drug Atenolol

Hypertension (arterial hypertension), hyperkinetic cardiac syndrome, hypertrophic idiopathic subaortic stenosis, heart rhythm disturbances (supraventricular tachycardia, atrial fibrillation and flutter, supraventricular and ventricular extrasystoles, tachyarrhythmia caused by myocardial infarction), angina pectoris (for the prevention of attacks), prevention of myocardial infarction and sudden coronary death.

Use of the drug Atenolol

For hypertension (arterial hypertension) it is prescribed orally at an initial dose of 50 mg once a day. Used as monotherapy or in combination with other antihypertensive drugs. The maximum therapeutic effect usually develops after 1-2 weeks of treatment. If necessary, the dose can be increased to 100 mg 1 time per day; further increase in dose does not increase the effectiveness of treatment.
For angina pectoris, a dose of 50-100 mg is prescribed once a day; in some cases, to achieve optimal effect it is necessary to use atenolol at a dose of 200 mg once a day.
Atenolol should be withdrawn gradually.
Elderly patients and those with kidney disease may require a reduction in the dose of atenolol. With a creatinine clearance of 15-35 ml/min, the half-life of atenolol is 16-27 hours, and the maximum daily dose is 50 mg; with creatinine clearance less than 15 ml/min, the half-life is more than 27 hours, and the maximum daily dose is 25 mg.
Patients on hemodialysis should be prescribed 25 or 50 mg of atenolol after each procedure (only in a hospital due to the possibility of a sharp decrease in blood pressure).

Contraindications to the use of the drug Atenolol

Sinus bradycardia, AV block II-III degree, cardiogenic shock, severe circulatory failure.

Side effects of the drug Atenolol

Most side effects are mild and temporary. The most likely are bradycardia, a feeling of coldness in the extremities, paresthesia, pain in lower limbs, nausea, increased concentrations of liver enzymes and/or bilirubin in the blood serum, dizziness, headache, orthostatic hypotension, collapse, increased fatigue, weakness, drowsiness, general malaise, depression, hallucinations, psychosis, diarrhea, nausea, dyspnea, psoriasiform rash or exacerbation of psoriasis, purpura, reversible alopecia, thrombocytopenia and visual disturbances. Atenolol, like other β-adrenergic receptor blockers, can promote the formation of antinuclear antibodies and the development of lupus syndrome.

Special instructions for the use of the drug Atenolol

Persons with coronary artery disease who have taken atenolol should be warned about the danger of abrupt withdrawal. In patients with angina pectoris, withdrawal syndrome is observed when β-adrenergic blockers are abruptly discontinued varying degrees severity (from increased frequency and intensity of angina attacks to myocardial infarction and heart rhythm disturbances).
The relative β1-selectivity of atenolol allows it to be used with caution in patients with bronchospastic diseases resistant to other antihypertensive drugs. Atenolol should be prescribed in minimally effective doses.
Atenolol should be prescribed with caution to patients with diabetes mellitus, since β-adrenergic receptor blockers can mask the manifestations of hypoglycemia and potentiate the hypoglycemic effect of antidiabetic agents; β-adrenergic blockers may mask the severity of some clinical manifestations hyperthyroidism (for example, eliminate tachycardia). Abrupt withdrawal of β-adrenergic receptor blockers can provoke the development of a thyrotoxic crisis, therefore, if it is necessary to discontinue β-adrenergic receptor blockers in such patients, careful medical supervision is required.
Atenolol crosses the placental barrier and may have pathological influence for the fruit Prescribing atenolol starting from the second trimester of pregnancy can lead to the birth of premature babies. Atenolol is excreted in breast milk, so children may experience severe bradycardia. Caution should be exercised when prescribing atenolol during breastfeeding. Premature babies and children with kidney damage are more likely to develop side effects.
The safety and effectiveness of atenolol in pediatric practice have not been established.

Drug interactions Atenolol

With the simultaneous use of atenolol with reserpine, methyldopa, clonidine, guanfacine and verapamil, severe arterial hypotension and bradycardia may develop. With simultaneous treatment with clonidine, it can be discontinued only a few days after stopping taking atenolol. Atenolol potentiates the hypoglycemic effect of oral antidiabetic agents and insulin. A few days before anesthesia with the use of drugs that have a cardiodepressive effect, it is necessary to stop taking atenolol; If it is impossible to discontinue atenolol, narcotic drugs with minimal negative inotropic effect should be used.

Overdose of the drug Atenolol, symptoms and treatment

An overdose of atenolol has been described in patients who took a single dose of about 5 g. Early manifestations of an overdose are drowsiness, respiratory failure, wheezing, bradycardia. Congestive heart failure, arterial hypotension, bronchospasm and hypoglycemia may develop. Perform gastric lavage and prescribe Activated carbon glucagon is injected orally. Atenolol can be removed from the systemic circulation by hemodialysis. For bradycardia or AV block, atropine or isoproterenol is administered; in case of ineffectiveness drug treatment transesophageal pacing is performed. For congestive heart failure, digitalization is performed and diuretics are prescribed.

List of pharmacies where you can buy Atenolol:

Saint Petersburg

Hypertension is a common disease requiring drug therapy. Only a doctor can correctly prescribe a treatment regimen after studying clinical picture diseases, obtaining test results. IN Lately“Atenolol” has become widespread, the instructions for use of which tell you at what pressure the medication can be taken. The drug belongs to beta-blockers and is a potent remedy against high blood pressure.

Description of the medication

"Atenolol" is available in tablet form. It is taken orally. Main active component is atenolol. The tablet may contain one of the following dosages:

25 mg;
50 mg;
100 mg.

The package contains 30 or 60 tablets and instructions.

Atenolol is available in the form of tablets with a dosage of 25, 50 or 100 mg of active ingredient

Operating principle

The drug blocks specific adrenergic receptors located in the heart muscle or blood vessels.

As a result, Atenolol has the following therapeutic effects:

Antianginal. The heart rate decreases, as a result of which the myocardium needs less nutritional compounds contained in oxygen.
Antihypertensive. By reducing the effect of adrenaline and other catecholamines on the arteries and heart muscle, blood pressure (BP) decreases.
Antiarrhythmic. Heartbeat is normalized by reducing the excitability of myocardial cells and stabilizing the membranes of neurocytes.

Indications for use

Blood pressure tablets with atenolol are also used in other cases:

Arrhythmia.
Sinus tachycardia with increased heart rate.
Angina pectoris.
Ventricular extrasystole.

As a rule, atenolol helps to cope with high blood pressure and may have a number of undesirable effects

A more detailed list of indications is contained in the instructions for the drug. It is used to prevent myocardial infarction and increased heart rate of supraventricular origin. The decision to prescribe medication can be made by a cardiologist or therapist.

Contraindications

"Atenolol" is not prescribed for the following pathological conditions:

Heart failure with decompensation.
Blockade of the atrioventricular node.
A strong decrease in blood pressure, especially after myocardial infarction.
Cardiomegaly without symptoms of myocardial failure.
Bronchial asthma at an advanced stage.
Bradycardia.
Patients under 18 years of age.
Pregnancy and breastfeeding.
Intolerance to one of the components.

Before prescribing, the specialist must make sure that the patient has no contraindications to taking the medication.

Taking the drug by expectant mothers early stages pregnancy can cause fetal growth retardation

Mode of application

Tablets are taken before meals, washed down sufficient quantity water. It is not recommended to chew them. Depending on the pathological process per day, 25 to 100 mg of the active substance is prescribed. In the first week of treatment, 25 to 50 mg of medication per day is prescribed. The dosage can then be increased to 70–100 mg at the discretion of the physician.

The dosage and duration of therapy in each individual case is determined by the doctor after diagnosis. The medication acts within 24 hours. Blood pressure levels stabilize at 2 weeks of therapy.

Negative consequences

Atenolol is a drug with a strong therapeutic effect. Therefore in medical practice The following side effects are common:

dizziness;
weak response to environmental factors;
insomnia or increased sleepiness;
depression;
feeling of anxiety;
headache;
bradycardia;
orthostatic hypotension;
disruption of the gastrointestinal tract;

The instructions accompanying the packaging indicate the following possible Negative consequences: dizziness, weakness, apathy

nausea;
pain in the epigastric region;
dry mouth;
visual impairment;
spasm of the larynx;
nasal congestion;
skin hyperemia;
alopecia;
excessive sweating;
rash;
disruption of the thyroid and pancreas.

The medicine also changes laboratory parameters. If one of the listed symptoms is detected, you should stop taking the medication immediately.

Features of therapy

Before starting treatment, you should study some features of the medication:

Compatibility with other medications.

The dose of the drug is determined by the attending physician strictly individually, depending on the disease

Contraindicated for use simultaneously with alcoholic drinks. After taking the medication, you should not drink alcohol for 12 hours. Possible negative consequences from the cardiovascular system.
Analogs have similar therapeutic effects. The most common substitute is "". But only a doctor can decide on the advisability of replacing the drug.
When side effects the doctor may decide to replace the drug with an analogue.
The reaction rate slows down, so it is not recommended to perform work that requires increased concentration and quick reaction during the therapy period.

Atenolol is available only with a doctor's prescription. In the first trimester of pregnancy, the drug can cause fetal growth retardation. Only short-term use is permissible in the last trimester, when the likelihood of harming the baby is minimal. Treatment in this case should be carried out under the supervision of a therapist and gynecologist.

Overdose

If the dosage is not observed, negative consequences develop such as:

bronchospasm;
decrease in blood pressure;
dizziness;
heart rate disturbance;
heart failure.

"Bisoprolol." Can be used during pregnancy, but is contraindicated during lactation. Has a faster therapeutic effect. After 1–3 hours the patient feels better. Stabilization of the condition occurs after a month of therapy.
" ". Blood pressure levels decrease after 3–4 hours. For a sustainable therapeutic effect, 1–2 months of taking the medication are necessary.
"Aprilin." The therapeutic effect occurs within 1–2 hours. The result is noticeable in 2 weeks.

A qualified specialist can choose the right analogue.

"Atenolol" for blood pressure: reviews

There is more about the drug on the Internet positive feedback than negative ones. The therapeutic effect is noted not only by patients, but also by doctors.

Yuri Ivanovich, 55 years old: “I was worried about pain in my heart. The doctor prescribed a dosage of 50. The pain no longer bothered me, my blood pressure improved.”

Ivan, 45 years old: “I’m suffering high blood pressure. The doctor prescribed Atenolol. After the blood pressure levels normalized, I decided to stop taking the drug, but after a couple of days the pressure increased again. Probably, the drug needs to be taken constantly.”

The article describes the drug Atenolol, its instructions for use, release forms, pharmacological properties drug, indications for use, composition, possible side effect on the human body and other aspects of this drug.

Atenolol is a well-known drug used to treat heart disease and high blood pressure.

Pharmacological properties of the drug Atenolol

Atenolol belongs to the group of selective β-blockers that block receptors sensitive to adrenaline. The drug performs the function of blocking nerve impulses in the heart muscle, which in turn reduces the frequency and power of heart contractions.

Atenolol lowers the upper and lower blood pressure values, its antihypertensive effect lasts a day after administration. The result becomes permanently stable with regular use of the medicine after 2 weeks.

Antianginal action. The frequency of contraction of the heart muscle decreases, and accordingly its need for oxygen saturation decreases. But the need to saturate the myocardium with oxygen increases due to increased diastolic pressure and load on the smooth muscle ventricles.

Antiarrhythmic effect. The work of the heart muscle is stabilized, tachycardia is eliminated. Atenolol affects the conductivity of impulses in the direction of its decrease and reduces myocardial contractions. Because of this, the number of arrhythmia attacks becomes less.

Composition and release form

The composition of the medicinal product includes the active substance - atenolol 50 mg or 100 mg, additional substances necessary for the preparation of the medicinal product - basic magnesium carbonate, corn starch, potato starch, magnesium stearate, steatite.

Atenolol is produced in the form of tablets in blisters according to 10 and 20 pcs. cardboard packaging can hold 30 or 50 tablets.

What doctors say about hypertension

Doctor of Medical Sciences, Professor Emelyanov G.V.:

I have been treating hypertension for many years. According to statistics, in 89% of cases, hypertension results in a heart attack or stroke and death. Currently, approximately two thirds of patients die within the first 5 years of disease progression.

The next fact is that it is possible and necessary to reduce blood pressure, but this does not cure the disease itself. The only medicine that is officially recommended by the Ministry of Health for the treatment of hypertension and is also used by cardiologists in their work is. The drug acts on the cause of the disease, making it possible to completely get rid of hypertension. In addition, within the framework of the federal program, every resident of the Russian Federation can receive it FOR FREE.

Indications for use of Atenolol

Atenolol is used to treat heart diseases and various pathologies:

Ischemic disease, angina pectoris, myocardial infarction.
Hypertonic disease.
Arrhythmias of various types.
Hereditary idiopathic tremor, tremor in abstinence syndrome.
Vegetovascular dystonia of various types.
Reduction of muscles at the mitral valve.
Atrial flutter.

Important! According to Decree No. 56742, until June 17, every diabetic can receive a unique medicine! Blood sugar is permanently reduced to 4.7 mmol/l. Save yourself and your loved ones from diabetes!

Contraindications

The drug Atenolol is NOT prescribed:

Bradycardia (slow heart rate less than 60 beats per minute).
Cardiogenic shock ( a sharp decline ability of the myocardium to contract).
Bronchial asthma.
Chronic heart failure.
Individual intolerance to individual components of the drug.
Variant angina.
Atrioventricular block 2 and 3 degrees, sinoatrial block.
Significant increase in the heart, its mass and size.
Changes acid-base balance body.
In case of taking a group of monoamine oxidase inhibitors.
Children under 18 years of age.

Requires special precautions when taking the drug in case of disorders of neuromuscular conduction, diabetes mellitus, reduced level glucose in the blood, psoriasis, spasm of the small arteries of the arms, liver and kidney dysfunction, in cases depressive disorders and older people.

Alcohol compatibility

During pregnancy and lactation

Atenolol is not prescribed to pregnant women, because the active substance penetrates the placenta and can harm the health of the child, can cause developmental delays, premature birth or fetal death. In the first two trimesters, taking the drug is strictly contraindicated.

If it is necessary to use the drug in the third trimester of pregnancy, the woman should be under regular medical supervision. Taking the drug in the third trimester is possible only if the expected benefit to the mother is many times greater than the possible harm to the child.

During breastfeeding, when taking Atenolol, you need to transfer the child to artificial feeding during the course of treatment.

Indications for use

Atenolol tablets are taken orally with a glass of a small amount water. It is not recommended to crush the tablet and take it before meals. People who smoke have less effect from the drug.

During treatment, the patient must regularly monitor blood pressure and pulse levels, blood glucose levels, and check the kidneys. In case of deviation from the norm, you should consult a doctor.

If it is necessary to undergo surgery using anesthesia, you must stop taking Atenolol 48 hours before the operation.

If depression appears, use of the drug is discontinued. Spontaneous discontinuation of Atenonol is not recommended. This can provoke severe arrhythmia and myocardial infarction. The appointment is canceled in stages under the supervision of a doctor. The dose of Atenolol is reduced by 25% every 3-4 days for two weeks.

Abrupt cessation of use may be accompanied by the following symptoms:

Attacks of angina.
Increased heart rate.
The occurrence of arrhythmia.
The appearance of hypertension, etc.

Video

Atenolol dosage

The dosage of Atenolol is selected by a specialist taking into account the degree of the patient’s disease, depending on the indications for which treatment is necessary, taking into account existing pathologies and individual intolerance.

Maximum daily dose is 200 mg in one or more doses of the drug during treatment, as maintenance therapy, maximum dosage is 25 mg per day.

Angina pectoris– initial dosage – 50 mg of the drug once a day. The course of treatment lasts 1-2 weeks. If the desired effect is not achieved after a week of taking Atenolol, the dosage is increased to 100 mg of the drug per day. Subsequent dose increases are not recommended. This can cause significant side effects of the drug.
Arterial hypertension– starting dose: 50 mg per day. Later, the dose is increased to 100 mg at a time to obtain the expected therapeutic effect.
Kidney failure– the daily dose is set at 50 mg, can be increased to 100 mg per day. Patients on hemodialysis are prescribed 25-50 mg of Atenolol under the supervision of a doctor.
Cardiac ischemia– daily dose is 50 mg.

In older people, if adverse reactions to Atenolol occur, such as bronchial spasm, heart pain, or renal failure, the dosage of the drug should be reduced or discontinued completely.

Overdose

In case of exceeding maximum dose medical product Atenolol may cause the following reactions: decreased heart contractions, decreased blood pressure, difficulty breathing, dizziness, arrhythmia, seizures.

To provide assistance in case of an overdose, it is necessary to urgently rinse the stomach, induce vomiting, give the patient absorbent drugs. In case of spasms, the bronchus is injected bronchodilators intravenously or by inhalation. In cases of premature muscle contractions, it is used lidocaine, with a decrease in blood pressure and the absence of pulmonary edema, they are administered plasma replacement solutions. IN extreme cases carry out dialysis.

Side effects of the drug Atenolol

The bulk of the side effects of Atenolol are manifested in mild form and goes away within two to three weeks. In case of overdose side effect substances are enhanced.

Atenolol has similar side effects:

Cordially vascular system. Bradycardia, arrhythmia, hypotension, decreased number of heartbeats, heart pain, etc.
Nervous system: loss of concentration, memory complications, slow reactions, headaches, lightheadedness, asomnia or lethargy, anxiety, fear, depression, seizures.
Digestive system. Abdominal pain, nausea, vomiting, diarrhea, changes in taste buds, liver dysfunction.
Hormonal system. Increased blood glucose levels in insulin-independent people and vice versa. Decreased libido, potency.
Respiratory system. Spasms of the bronchi, larynx, breathing problems, difficulty breathing, possible respiratory arrest.
Organs of vision. Poor visual acuity, pain, eye infections.
Allergic reactions. Skin rashes of various types, itching and burning of the skin, increased sweating, psoriasis.
Other reactions. Pain in the back muscles and joints.

The drug Atenolol has a pronounced withdrawal syndrome, so it is necessary to follow a step-by-step plan for stopping taking the drug.

Interaction with other drugs

Atenolol may have certain effects on the human body when taken in parallel with other drugs, namely:

Increases the effect of insulin on the concentration of glucose in the blood towards its decrease; increases the effect of diuretics, nitrates and other antihypertensive drugs.
Combined use with Diltiazem, Phenytoin has a depressant effect on the heart and can cause it to stop when administered intravenously.
With Methyldop, Reserpine, etc., the chance of bradycardia and impaired conduction of impulses increases.
The effect of Atenolol is reduced in combination with the use of estrogens, glucocorticosteroids, and non-steroidal anti-inflammatory drugs.
Atenolol increases the toxicity of lidocaine by reducing excretion from the body.
Mutual enhancement of Atenolol and Phenothiazine, mutual inhibition with Theophyllin and Euphyllin.
Risk of dangerous allergic reactions when used simultaneously with various allergens that are taken for skin testing.
Strengthens sedative effect sleeping pills, sedatives and antidepressants.