Betaloc ZOK, 100 mg, delayed-release, film-coated tablets, 30 pcs.

pharmachologic effect

Manufacturer: Astra Zeneca, Sweden
Release form: extended-release tablets

Active ingredient: Metoprolol

Synonyms: Egilok Retard, Metoprolol Retard, Metoprolol KRKA

Betaloc ZOK is a selective beta-1 adrenergic blocker, that is, it blocks mainly beta-1 adrenergic receptors, reducing cardiac output, slowing the rhythm, facilitating myocardial stimulation during physical and mental stress, preventing reflex tachycardia. The drug inhibits the activity of the renin-angiotensin system, restores the sensitivity of baroreceptors, which, together with a decrease in cardiac output, causes a rapid hypotensive effect.

By reducing the frequency and strength of myocardial contractions, as well as its need for oxygen, Betaloc ZOK has an antianginal (anti-ischemic) effect.

The drug slows down the sinus rhythm and the rate of propagation of excitation through the atrioventricular node, inhibits the automaticity of the heart, lengthens the refractory period, and reduces the force of heart contractions. Thanks to these effects, the drug has an antiarrhythmic effect.

Since in therapeutic doses the drug does not affect beta-2 adrenergic receptors, bronchospasm, decreased sugar and constriction of peripheral vessels do not occur.

Betaloc lowers blood pressure, but is not a diuretic.

Betaloc ZOK, 100 mg, delayed-release, film-coated tablets, 30 pcs.

Metoprolol is a CYP2D6 substrate, and therefore drugs that inhibit CYP2D6 (quinidine, terbinafine, paroxetine, fluoxetine, sertraline, celecoxib, propafenone and diphenhydramine) may affect the plasma concentrations of metoprolol.

The combined use of Betalok® ZOK with the following drugs should be avoided.

Derivatives of barbituric acid.

Barbiturates (study conducted with pentobarbital) increase the metabolism of metoprolol due to enzyme induction.

Propaphenone.

When propafenone was prescribed to four patients treated with metoprolol, an increase in plasma concentrations of metoprolol was observed by 2-5 times, while two patients experienced side effects characteristic of metoprolol. This interaction was confirmed in a study of data from 8 volunteers. The interaction is likely due to the inhibition by propafenone, like quinidine, of the metabolism of metoprolol through the cytochrome P450 2D6 system. Taking into account the fact that propafenone has the properties of a beta-blocker, the joint administration of metoprolol and propafenone does not seem appropriate.

Verapamil.

The combination of β-blockers (atenolol, propranolol and pindolol) and verapamil can cause bradycardia and lead to a decrease in blood pressure. Verapamil and β-blockers have complementary inhibitory effects on AV conduction and sinus node function.

The combination of Betaloc® ZOK with the following drugs may require dose adjustment.

Amiodarone.

The combined use of amiodarone and metoprolol can lead to severe sinus bradycardia. Taking into account the extremely long T1/2 of amiodarone (50 days), the possible interaction should be considered long after discontinuation of amiodarone.

Class I antiarrhythmic drugs.

Class I antiarrhythmics and β-blockers may result in additive negative inotropic effects, which can lead to serious hemodynamic side effects in patients with impaired left ventricular function. This combination should also be avoided in patients with sick sinus syndrome and impaired AV conduction. The interaction is described using disopyramide as an example.

NSAIDs.

NSAIDs weaken the antihypertensive effect of β-blockers. This interaction has been documented for indomethacin. It is likely that the described interaction will not be observed with sulindac. Negative interactions have been noted in studies with diclofenac.

Diphenhydramine.

Diphenhydramine reduces the clearance of metoprolol to α-hydroxymetoprolol by 2.5 times. At the same time, an increase in the effect of metoprolol is observed.

Diltiazem.

Diltiazem and β-blockers mutually enhance the inhibitory effect on AV conduction and sinus node function. When metoprolol was combined with diltiazem, cases of severe bradycardia were observed.

Epinephrine (adrenaline).

Ten cases of severe hypertension and bradycardia have been reported in patients taking non-selective beta-blockers (including pindolol and propranolol) and receiving epinephrine (adrenaline). The interaction was also observed in the group of healthy volunteers. It is assumed that similar reactions can be observed when epinephrine is used together with local anesthetics if it accidentally enters the vascular bed. It is assumed that this risk is much lower with the use of cardioselective beta-blockers.

Phenylpropanolamine.

Phenylpropanolamine (norephedrine) in a single dose of 50 mg can cause an increase in blood pressure to pathological values ​​in healthy volunteers. Propranolol mainly prevents the increase in blood pressure caused by phenylpropanolamine. However, β-blockers may cause paradoxical hypertension reactions in patients receiving high doses of phenylpropanolamine. Several cases of hypertensive crisis have been reported while taking phenylpropanolamine.

Quinidine.

Quinidine inhibits the metabolism of metoprolol in a special group of patients with rapid hydroxylation (in Sweden, approximately 90% of the population), causing mainly a significant increase in plasma concentrations of metoprolol and increased β-blockade. It is believed that a similar interaction is typical for other β-blockers, the metabolism of which involves cytochrome P450 2D6.

Clonidine.

Hypertensive reactions during abrupt withdrawal of clonidine may be exacerbated by concomitant use of beta-blockers. When used together, if clonidine is discontinued, discontinuation of beta-blockers should begin several days before discontinuation of clonidine.

Rifampicin.

Rifampicin may increase the metabolism of metoprolol, reducing plasma concentrations of metoprolol.

Patients concomitantly taking metoprolol and other beta-blockers (eye drops) or MAO inhibitors should be closely monitored. When taking β-blockers, inhalational anesthetics enhance the cardiodepressive effect. While taking β-blockers, patients receiving oral hypoglycemic agents may require dose adjustment of the latter.

Plasma concentrations of metoprolol may increase when taking cimetidine or hydralazine.

Cardiac glycosides, when used in combination with beta-blockers, can increase AV conduction time and cause bradycardia.

Betaloc ZOK - instructions for use

The medicine should be taken every morning, swallowed whole and washed down, regardless of meals. You can split the tablet in half, but do not chew or suck it.

Doses are selected individually, depending on the disease, ranging from 12.5 to 200 mg per day. Often combined with other antihypertensive or antianginal drugs.

Before using the drug, you should carefully read the instructions for use of Betaloc ZOK for contraindications and drug interactions.

Analogues of Betalok ZOK

The main analogues and substitutes for Betaloc ZOK are its synonyms and other adrenergic blockers, which can be divided into groups:

1. Non-selective beta-blockers - Anaprilin, Sotahexal.
2. Selective beta1-blockers - Metoprolol, Nebilet, Atenolol.
3. Alpha and beta blockers – Carvedilol.

Analogs of Betalok ZOK with prices are presented in the table.

Betalok or Betalok ZOK – which is better, the difference

Manufacturer: Astra Zeneca, Sweden
Release form: tablets and solution for internal use

Active ingredient: Metoprolol

Synonyms: Egilok, Metoprolol Teva, Metoprolol KRKA, Serdol, Metocard

The Betalok analogue differs from Betalok ZOK in the technology of tablets and the release of the active substance from them. Betaloc ZOK is available in the form of tablets with prolonged release, that is, the active substance gradually, in small portions, penetrates the bloodstream and has a uniform effect throughout the day.

Simple Betaloc is produced in the form of regular 100 mg tablets. Therefore, it is taken twice a day for the same indications, only the daily dose is divided into two doses.

Betalok ZOK or Concor – which is better?

Manufacturer: Merck, Germany
Release form: film-coated tablets

Active ingredient: Bisoprolol

Synonyms: Biprol, Biol, Bisogamma, Coronal, Niperten

An analogue of Betaloc ZOK, the drug Concor also selectively blocks beta-1 adrenergic receptors, providing hypotensive, antianginal and antiarrhythmic effects.

The medication slowly and gradually reduces blood pressure, the maximum effect occurs after two weeks.

Concor is used to treat hypertension, stable angina and chronic heart failure.

Therapeutic doses vary from 2.5 to 10 mg and are selected individually. When replacing, it should be taken into account that Concor 5 mg will be an approximate analogue of Betaloc ZOK 100 mg, but you should not change the dose yourself; be sure to consult your doctor.

For chronic heart failure, the dose is taken starting from 1.25 mg, gradually increasing to 5 or 10 mg per day.

Patient reviews are positive when using both drugs.

Let's sum it up

The most common and cheapest analogue of Betaloc is Metoprolol - a drug with this name is produced by different manufacturers, so choosing a suitable product will not be difficult. Bisoprolol is no less popular, but its cost is much higher than that of metoprolol.

Table of Betalok analogues

All analogues of Betalok and Betalok ZOK belong to the category of beta-blockers - drugs that have a positive effect on the activity of the cardiovascular system, reduce the risk of heart attack and other serious complications. However, they have significant differences in the mechanism of action, the list of side effects and contraindications.

The appropriate drug must be selected depending on the clinical course of the disease, the severity of symptoms and the characteristics of the patient’s body. The cost of the medicine in this case plays a secondary role, since the wrong choice can lead to unpleasant health consequences. Before taking Betaloc, Betaloc ZOK and their substitutes, you should definitely consult your doctor.

Betaloc ZOK or Metoprolol – which is better?

Manufacturer: Vertex, Ozone, Pranafarm, Russia / Hemofarm, Serbia
Release form: tablets

Active ingredient: Metoprolol

Synonyms: Egilok, Metoprolol Teva, Metoprolol KRKA, Serdol, Metocard

Metoprolol is the active substance of Betaloc ZOK and all its synonyms, as well as its international non-proprietary name. In addition, there are many domestic drugs whose trade name is the same as the generic one.

The analog Metoprolol has the same properties - antihypertensive, antianginal and antiarrhythmic effects. According to doctors, the effectiveness of domestic analogues is no lower than that of imported drugs.

Betaloc ZOK or Bisoprolol - which is better, comparison

Manufacturer: Rapharma, Izvarino, Atoll, Russia
Release form: film-coated tablets

Active ingredient: Bisoprolol

Synonyms: Concor, Biprol, Biol, Bisogamma, Coronal, Niperten

You can replace Betaloc ZOK with Bisoprolol, which also selectively blocks beta-1 adrenergic receptors, reduces the volume and force of cardiac output, reduces myocardial oxygen demand, and reduces heart rate.

Analogue Bisoprolol is the active component and international non-proprietary name of many drugs that have antianginal, antiarrhythmic and anti-ischemic properties. The half-life of Bisoprolol allows you to take the medicine once a day.

Reviews from cardiologists indicate the high effectiveness of the drug, regardless of the manufacturer and trade name, in the treatment of chronic heart failure, as well as stable angina and hypertension.

Overdose of the drug Betaloc zok

Symptoms: severe arterial hypotension, sinus bradycardia, AV block, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, disturbances of consciousness up to coma, nausea, vomiting, cyanosis of the extremities. Concomitant use of alcohol, antihypertensive drugs, quinidine or barbiturates may worsen the patient's condition. The first symptoms develop 20 minutes to 2 hours after an overdose. Treatment: gastric lavage, taking activated carbon. In cases of severe arterial hypotension, bradycardia, or the threat of developing heart failure, administration of a β1-adrenergic receptor agonist (for example, prenalterol) intravenously at intervals of 2–5 minutes or as an infusion is indicated until a therapeutic effect is achieved. In the absence of a selective β1-adrenergic receptor agonist, it can be replaced by intravenous dopamine or atropine sulfate to block the vagus nerve. If a therapeutic effect cannot be achieved, other sympathomimetics (dobutamine or norepinephrine) can be used. Administration of glucagon at a dose of 1–10 mg is indicated. It may be necessary to use a pacemaker. To relieve bronchospasm, a β2-adrenergic receptor agonist is administered intravenously. It should be borne in mind that the doses of antidotes that are necessary to eliminate the symptoms of an overdose of a β-adrenergic receptor blocker are much higher than therapeutic doses, since β-adrenergic receptors are bound by their blockers.

Egilok or Betalok ZOK – which is better, what’s the difference

Manufacturer: Egis, Hungary
Release form: tablets

Active ingredient: Metoprolol

Synonyms: Metoprolol Teva, Metoprolol KRKA, Serdol, Metocard

A substitute for Betalok ZOK, the drug Egilok is produced in the form of regular and retard forms. Egilok Retard is a complete synonym for Betalok ZOK, since it is also a prolonged release form of the active substance.

Egilok is taken twice a day, Egilok retard is taken once. The drug has the same effect as Betaloc ZOK; it is used for hypertension, arrhythmia, angina pectoris, and for maintenance after myocardial infarction.

The use of Egilok's analogue reduces the risk of mortality in patients after a heart attack.

Indications and contraindications

Indications for the use of Betaloc include supraventricular tachycardia, ischemia of the heart muscle, tachycardia and pain syndrome during myocardial infarction. The use of the drug reduces the severity of symptoms, prevents the risk of necrosis and limits the area of ​​tissue damage.

Contraindications to the use of the drug include severe cardiac disorders (sick sinus syndrome, decompensated heart failure, etc.), arterial hypotension, and circulatory disorders in peripheral vessels.

Nebilet

Manufacturer: Berlin Hemi, Germany
Release form: tablets

Active ingredient: Nebivolol

Synonyms: Binelol, Bivotenz, Nebivolol Sandoz

The Nebilet analogue is the same selective beta-1 adrenergic blocker as Betaloc ZOK. It has hypotensive, anti-ischemic and antiarthmic effects.

The analogue Nebilet is used for hypertension and angina pectoris in doses of 2.5-5 mg once a day. If we compare doses, the analogue of Betaloc ZOK 25 mg is Nebilet 2.5 mg.

Analogues and substitutes

Betaloc is difficult to classify as an inexpensive drug, so many patients are interested in cheap substitutes and analogues of the drug. Modern pharmacology offers many drugs that have similar effects, but the list of contraindications and features of their effects may be different.

Egilok

Egilok is a drug that is most often prescribed to patients as a substitute for Betalok and Betalok ZOK. Its active substance is metoprolol tartrate, that is, the therapeutic effect is similar to Betaloc. Egilok is prescribed for disorders of cardiovascular activity (arrhythmia, extrasystole), arterial hypertension, migraines, coronary artery disease, and sometimes for dysfunction of the thyroid gland. The list of additional components of drugs differs slightly, so people with an increased tendency to allergic reactions need to carefully choose the drug.

Bisoprolol

The main active ingredient of the drug is Bisoprolol, which is considered a classic beta-blocker and has been used to treat cardiovascular disorders for more than 40 years. It has an antiarrhythmic and antihypertensive effect, reduces the severity of cardiovascular disorders and prevents the risk of heart attack.

All Betalok analogues are potent drugs and are therefore sold in pharmacies with a prescription.

Despite the similar list of indications, the mechanism of action of metoprolol and bisoprolol is different. Betaloc has a wider list of indications and is less likely to cause unwanted reactions in the body.

The most common side effect when using Betaloc is increased fatigue and decreased performance, and Bisoprolol most often causes bradycardia and decreased blood pressure.

Metoprolol

The drug is a complete analogue of Betaloc, since its mechanism of action is based on metoprolol tartrate. The list of indications, contraindications and side effects for the drugs is also the same, but when purchasing Metoprolol you should pay attention to additional components, the content of the active substance and the manufacturer. The drug is produced by different companies, both Russian and foreign - the former are cheaper, and the latter are considered safer and of higher quality.

Concor

The main active ingredient of the popular product Concor is bisoprolol fumarate. They belong to the same pharmacological group and are used for the treatment and prevention of cardiac disorders, but there are significant differences in the characteristics of their effects.

If Bisoprolol is considered the “gold” standard in the treatment of heart diseases, then Metoprolol, according to patient reviews, is better tolerated by the body.

Concor has a long-lasting therapeutic effect that lasts for 12 hours. The duration of action of Betalok is 4 hours, so the dose must be repeated 2 or 3 times a day.

The side effects of the drugs also differ, which must be taken into account in the presence of concomitant diseases.

1. Concor
   can cause serious mental disorders, hearing and vision impairment - a particularly common reaction is a decrease in lacrimation, which should be taken into account by people who wear contact lenses;
2. Metoprolol
   does not affect the organs of vision and hearing, but quite often provokes allergic reactions, which are manifested by rash, itching and hives.

When choosing a drug, you should also take into account the fact that Concor is considered a potent drug, while Bisprolol has a gentle effect on the body.

Implicor

Implicor is a combination drug of French origin, and it contains two components - metoprolol and ivabradine. The latter refers to substances that can slow down the heart rate and regulate heart rate. Implicor is a new pharmacological agent, but has already earned positive reviews as an effective drug. Thanks to the content of two components, it has a quick effect and relieves symptoms of cardiovascular disorders.

At the same time, Implicor has a fairly wide list of contraindications and side effects, so it must be used with extreme caution. Betaloc and Betaloc ZOK have a gentler effect on the body, cause side effects less often, and their cost is much lower, but if there are appropriate medical indications, it is better to give preference to Implicor.

Logimax

A Swedish combination drug that includes the calcium antagonist felodipine and the beta blocker metoprolol. They complement each other’s effects, due to which the product has a pronounced prolonged effect. It is enough to take Logimax once a day, which distinguishes it from Betaloc, which requires two or three doses.

The disadvantage of this product is that, like all combination drugs containing several components, it has a fairly wide list of contraindications and side effects. In addition, Betaloc and Betaloc ZOK are considered the drugs of choice for cardiac disorders, and Logimax is used primarily to reduce arterial hypertension.