Bisosten Special Precautions

Beta blockers should not be given to patients with bronchospasm or asthma or to those with a history of obstructive airway disease. This contraindication generally applies even to those beta blockers considered to be cardioselective. However, cardioselective beta blockers may be used with extreme caution when there is no alternative treatment. Other contraindications include metabolic acidosis, cardiogenic shock, hypotension, severe peripheral arterial disease, sinus bradycardia, and second- or third-degree AV block; caution should be observed in first-degree block. Although beta blockers are used in the management of heart failure, they should not be given to patients with uncontrolled heart failure and treatment should be begun with great care, starting with a low dose and cautiously titrating upwards. Patients with pheochromocytoma should not be given beta blockers without alpha-adrenoceptor blocking therapy as well.
Beta blockers may mask the symptoms of hyperthyroidism and of hypoglycemia. They may unmask myasthenia gravis. Psoriasis may be aggravated. Beta blockers may increase the number of attacks of chest pain in patients with Prinzmetal's angina; this occurs especially with non­-cardioselective beta blockers, which should be avoided. Beta blockers increase sensitivity to allergens and also the severity of anaphylactoid reactions; patients with a history of anaphylaxis to an antigen may be more reactive to repeated challenge with the antigen while taking beta blockers.
Use in Pregnancy: Bisoprolol should not be used during pregnancy unless clearly necessary. If treatment with bisoprolol is considered necessary, the uteroplacental blood flow and the fetal growth should be monitored. In case of harmful effects on pregnancy or the fetus alternative treatment should be considered. The newborn infant must be closely monitored. Symptoms of hypoglycemia and bradycardia are generally to be expected within the first 3 days.
Use in Lactation: It is not known whether this drug is excreted in human milk. Therefore, breastfeeding is not recommended during administration of bisoprolol.