Bisostad 5

HTN; stable chronic angina; stable chronic heart failure w/ reduced systolic left ventricular function in addition to ACE inhibitors & diuretics, & optionally cardiac glycosides.

HTN & chronic stable angina pectoris Adult Initially 5 mg daily. Usual dose: 10 mg once daily. Max dose: 20 mg daily. Patient w/ severe renal impairment (CrCl <20 mL/min) Max dose: 10 mg once daily. Stable chronic heart failure Adult Titration phase: Initially 1.25 mg once daily for 1 wk. If well tolerated, increase to 2.5 mg once daily for a further wk; then 3.75 mg once daily for a further wk; then 5 mg once daily for the following 4 wk; then 7.5 mg once daily for the following 4 wk. Maintenance phase: 10 mg once daily. Max dose: 10 mg once daily.

Should be taken with food: Take in the morning. Swallow w/ liqd. Do not chew.

Chronic heart failure: Hypersensitivity. Patients w/ acute heart failure or during episodes of heart failure decompensation requiring IV inotropic therapy; cardiogenic shock; 2nd or 3rd degree AV block (w/o pacemaker); sick sinus syndrome; SA block; symptomatic bradycardia; symptomatic hypotension; severe bronchial asthma or severe COPD; late stages of peripheral arterial occlusive disease & Raynaud's syndrome; untreated phaeochromocytoma; metabolic acidosis.

Do not abruptly stop therapy, especially in patients w/ ischemic heart disease. Caution in bronchospasm (bronchial asthma, obstructive airways diseases); DM w/ large fluctuations in blood glucose values; strict fasting; ongoing desensitisation therapy; 1st degree AV block; Prinzmetal's angina; peripheral arterial occlusive disease; general anaesth. Administer in patients w/ psoriasis or w/ history of psoriasis only after carefully balancing benefits against risks. Do not administer in patients w/ phaeochromocytoma until after α-receptor blockade. Symptoms of thyrotoxicosis may be masked during treatment. May impair ability to drive a vehicle or operate machinery. Not recommended during pregnancy unless clearly necessary. Breastfeeding is not recommended during treatment. Not recommended for childn. HTN or angina pectoris: Caution in patients w/ HTN or angina pectoris & accompanying heart failure. Chronic heart failure: Initiate treatment w/ special titration phase. Treatment initiation necessitates regular monitoring. No therapeutic experience in patients w/ IDDM (type I); severely impaired renal or hepatic function; restrictive cardiomyopathy; congenital heart disease; haemodynamically significant organic valvular disease; MI w/in 3 mth.

Dizziness, headache; feeling of coldness or numbness in the extremities, hypotension especially in patient w/ heart failure; GI complaints eg, nausea, vomiting, diarrhoea, constipation; fatigue. Chronic heart failure: Bradycardia. Worsening of pre-existing heart failure; asthenia.

Potentiated effect on AV conduction time & increased -ve inotropic effect w/ class I antiarrhythmics (eg, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone). -ve influence on contractility & AV conduction w/ Ca antagonists of the verapamil type (& of the diltiazem type, to a lesser extent). Worsened heart failure w/ centrally acting antihypertensives (eg, clonidine, methyldopa, moxonidine, rilmenidine). Increased risk of hypotension & further deterioration of ventricular pump function w/ Ca antagonists of the dihydropyridine type (eg, felodipine, amlodipine). Potentiated effect on AV conduction time w/ class III antiarrhythmics (eg, amiodarone). Additive systemic effects w/ topical β-blockers (eg, eye drops for glaucoma treatment). Increased AV conduction time & risk of bradycardia w/ parasympathomimetics. Increased blood-sugar-lowering effect of insulin & oral antidiabetics. Attenuated reflex tachycardia & increased risk of hypotension w/ anaesth. Reduced heart rate & increased AV conduction time w/ digitalis glycosides. Reduced hypotensive effect w/ NSAIDs. Combination of β-sympathomimetics (eg, isoprenaline, dobutamine) w/ bisoprolol may reduce the effect of both agents. Combination of sympathomimetics that activate both β- & α-adrenoceptors (eg, noradrenaline, adrenaline) w/ bisoprolol may unmask the α-adrenoceptor-mediated vasoconstrictor effects of these agents leading to increased BP & exacerbated intermittent claudication. Increased risk of hypotension w/ antihypertensives & other drugs w/ BP-lowering potential (eg, TCAs, barbiturates, phenothiazines). Increased risk of bradycardia w/ mefloquine. Enhanced hypotensive effect & risk for hypertensive crisis w/ MAOIs (except MAO-B inhibitors). Slight reduction of t_1/2 w/ rifampicin. Exacerbation of peripheral circulatory disturbances w/ ergotamine derivatives.

Beta-Blockers

C07AB07 - bisoprolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

P₁S₁S₃