Adults

2 tablets

1 time daily

regardless of the meal

Adults

4 tablets

1 time daily

regardless of the meal

Adults

2 tablets

2 times daily

regardless of the meal

Adults

4 tablets

2 times daily

regardless of the meal

Adults

1/2 tablet

2 times daily

with the meal

Adults

4 tablets

2 times daily

with the meal

How does the active ingredient of the medicine work?

The active ingredient lowers blood pressure. To achieve this, it blocks the binding sites of messenger substances, so-called beta-receptors, in the body. Furthermore, the drug has a cardiac effect: it reduces the number of beats (frequency) and the oxygen demand of the heart - excessive cardiac work is reduced.

What speaks against an application?

Always:
- Hypersensitivity to the ingredients
- Worsened heart failure without physical exertion (decompensated heart failure)
- Very severe heart failure (heart failure NYHA IV)
- Chronic obstructive pulmonary disease (chronic respiratory disease with narrowing of the airways)
- Bronchospasm
- Bronchial asthma
- Liver disease
- AV block (disorder of conduction from the atria of the heart to the ventricle), 2nd and 3rd degree
- Severe reduction in pulse rate
- Sick sinus syndrome (disorder in the origin of the heartbeat)
- Sinoatrial block (disordered origin of the heartbeat in the heart atrium)
- Shock (cardiogenic shock)
- Low blood pressure
- Prinzmetal's angina (special form of angina pectoris)
- Pheochromocytoma (adrenaline-producing tumor)
- Shift of the acid-base balance in the blood to the acidic side (acidosis)
- Peripheral circulatory disorders (e.g. arms, legs) that are already very advanced

Under certain circumstances - talk to your doctor or pharmacist about this:
- AV block (disorder of conduction from the atria of the heart to the ventricle), 1st degree
- Raynaud's syndrome
- Impaired kidney function
- Impaired liver function
- Diabetes mellitus (sugar disease)
- Prolonged strict fasting
- Hyperthyroidism
- Psoriasis
- Tendency to severe hypersensitivity reactions, also a current desensitization therapy
- Upcoming surgery

Which age group should be considered?
- Children and adolescents under 18 years: The medicine must not be used.
- Elderly patients: Treatment should be well coordinated with your doctor and carefully monitored, e.g. through close controls. The desired effects and unwanted side effects of the medicine may be increased or decreased in this group.

What about pregnancy and lactation?
- Pregnancy: Consult your doctor. Various considerations play a role in whether and how the medicine can be used during pregnancy.
- Lactation: According to current knowledge, use is not recommended. Weaning may need to be considered.

If the medicine has been prescribed to you despite a contraindication, talk to your doctor or pharmacist. The therapeutic benefit may be higher than the risk associated with its use in the presence of a contraindication.

Which undesirable effects can occur?

- Gastrointestinal complaints, such as:
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Abdominal pain
- Weight gain
- Headaches
- Dizziness
- Fatigue
- Sleep disorders
- Nightmares
- Hallucinations
- Delirium (confusion)
- Depression
- Paresthesia
- Visual disturbances
- Impaired tear fluid production (important for contact lens wearers)
- Eye irritation
- Hypersensitivity reactions of the skin, such as:
- Skin rash
- Inflammatory skin reactions
- Hives
- Itching
- Worsening of existing psoriasis
- Low blood pressure
- Orthostatic hypotension (circulatory disorders due to low blood pressure)
- Transient loss of consciousness, lasting only a few seconds to minutes
- Reduced pulse rate
- AV block (disordered heartbeat during conduction from the atrium to the ventricle)
- Peripheral circulatory disorder (e.g. arms, legs)
- Worsening of existing circulatory disorder in the legs (intermittent claudication)
- Worsening of Raynaud's syndrome
- Bronchial asthma
- Attacks of shortness of breath
- Water retention (edema)
- Decreased water excretion
- Increase in blood sugar, in patients with diabetes mellitus
- Hypoglycemia
- Increase in blood lipid levels (cholesterol)
- Muscle pain in arms and legs
- Erectile dysfunction
- General weakness
- Fluid overload in the blood
- Bronchitis
- Pneumonia due to infection
- Urinary tract infection
- Anemia
- Weakness of the heart muscle (heart failure)
- Paroxysmal pain in the heart region (angina pectoris)
- High blood pressure
- Fluid accumulation in the lungs (pulmonary edema)
- Kidney failure
- Impaired kidney function
- Near-syncope
- Sweating (hyperhidrosis) due to medication

If you notice a discomfort or change during treatment, contact your doctor or pharmacist.

The information provided here primarily considers side effects that occur in at least one out of 1,000 treated patients.

What should you consider?
- The ability to react can be impaired even with proper use, especially in higher doses or in combination with alcohol. Pay particular attention to this if you participate in road traffic or operate machinery (even in the household) with which you can injure yourself.
- Problems or complaints can arise from sudden discontinuation. Therefore, treatment should be stopped slowly, i.e., by gradually tapering off the dose. It is best to consult your doctor or pharmacist about this.
- This medicine contains substances that may be classified as doping agents under certain circumstances. Ask your doctor or pharmacist about this.
- Caution in case of allergy to beta-blockers!
- Caution in case of lactose intolerance. If you need to follow a diabetic diet, you should consider the sugar content.
- Caution in case of sucrose intolerance. If you need to follow a diabetic diet, you should consider the sugar content.
- There may be medicines with which interactions occur. Therefore, before starting treatment with a new medicine, you should generally inform your doctor or pharmacist about any other medicines you are already using. This also applies to medicines that you buy yourself, only use occasionally, or whose use dates back some time.
- Alcohol consumption should be avoided as much as possible during long-term treatment. Occasional alcohol consumption in small amounts is allowed, but not together with the medication.
- Grapefruit and grapefruit preparations should be completely avoided during treatment with the medication.