Biscore 2.5/Biscore 5 Special Precautions

Bisoprolol must be used with caution in patients with: hypertension or angina pectoris and accompanying heart failure, diabetes mellitus showing large fluctuations in blood glucose values. Symptoms of hypoglycemia can be masked, strict fasting, on-going desensitization therapy, AV block of first degree, Prinzmental's angina; Cases of coronary vasospasm have been observed. Despite its high beta₁-selectivity, angina attacks cannot be completely excluded when Bisoprolol is administered to patients with Prinzmental's angina, peripheral arterial occlusive disease; Intensification of complaints may occur especially when starting therapy, general anesthesia.
In patients undergoing the general anesthesia beta-blockade reduces the incidence of arrhythmias and myocardial ischemia during induction and intubation, and the post-operative period. It is currently recommended that maintenance beta-blockade be continued peri-operatively.
The anesthetist must be aware of beta-blockade because of the potential for interactions with other drugs, resulting in bradyarrhythmias, attenuation of the reflex tachycardia and the decreased reflex ability to compensate for blood loss. If it is thought necessary to withdraw beta-blocker therapy before surgery, this should be done gradually and completed about 48 hours before anesthesia.
Although cardioselective (beta₁) beta-blockers may have less effect on lung function than nonselective beta-blockers, as with all beta-blockers, these should be avoided in patients with obstructive airways diseases, unless there are compelling clinical reasons for their use. Where such reasons exist, Bisoprolol may be used with caution. In bronchial asthma or other chronic obstructive lung diseases, which may cause symptoms, bronchodilating therapy should be given concomitantly. Occasionally an increase of the airway resistance may occur in patients with asthma, therefore the dose of beta₂-stimulants may have to be increased.
As with other beta-blockers, Bisoprolol may increase both the sensitivity towards allergens and the severity of anaphylactic reactions. Adrenaline treatment does not always give the expected therapeutic effect.
Patients with psoriasis or with a history of psoriasis should only be given beta-blockers (e.g. Bisoprolol) after carefully balancing the benefits against the risks.
In patients with phaeochromocytoma Bisoprolol must not be administered until after alpha-receptor blockade. Under treatment with Bisoprolol the symptoms of a thyreotoxicosis may be masked.
The cessation of therapy with Bisoprolol should not be done abruptly unless clearly indicated.