Concore Drug Interactions

Combinations not recommended: Treatment of stable chronic heart failure: Class-I antiarrhythmic drugs (e.g. quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone): Effect on atrio-ventricular conduction time may be potentiated and negative inotropic effect increased.
All indications: Calcium antagonists of the verapamil type and to a lesser extent of the diltiazem type: Negative effect on contractility and atrio-ventricular conduction. Intravenous administration of verapamil in patients on beta-blocker treatment may lead to profound hypotension and atrio-ventricular block.
Centrally-acting antihypertensive drugs (such as clonidine, methyldopa, moxonidine, rilmenidine): Concomitant use of centrally-acting antihypertensive drugs may further decrease the central sympathetic tonus and may thus lead to reduction of heart rate and cardiac output and to vasodilatation. Abrupt withdrawal, particularly if prior to beta-blocker discontinuation, may increase the risk of 'rebound hypertension'.
Combinations to be used with caution: Treatment of hypertension or coronary heart disease (angina pectoris): Class-I antiarrhythmic drugs (e.g. quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone): Effect on atrio-ventricular conduction time may be potentiated and negative inotropic effect increased.
All indications: Calcium antagonists of the dihydropyridine type (e.g. felodipine and amlodipine): Concomitant use may increase the risk of hypotension. An increase in the risk of a further deterioration of the ventricular pump function in patients with heart failure cannot be excluded.
Class-III antiarrhythmic drugs (e.g. amiodarone): Effect on atrio-ventricular conduction time may be potentiated.
Topical beta-blockers (e.g. eye drops for glaucoma treatment) may add to the systemic effects of bisoprolol (Concore).
Parasympathomimetic drugs: Concomitant use may increase atrio-ventricular conduction time and the risk of bradycardia.
The blood sugar lowering effect of insulin or oral anti-diabetic drugs may be increased. Blockade of beta-adrenoceptors may mask symptoms of hypoglycemia - especially accelerated heart rate (tachycardia).
Anesthetic agents: Attenuation of the reflex tachycardia and increase of the risk of hypotension (for further information on general anesthesia see Precautions).
Cardiac glycosides (digitalis): Increase of atrio-ventricular conduction time, reduction in heart rate.
Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the hypotensive effect of bisoprolol (Concore).
Beta-sympathomimetics (e.g. isoprenaline, dobutamine) used in combination with bisoprolol (Concore) may reduce the effect of both agents.
A combination of bisoprolol (Concore) with sympathomimetics that activate both beta- and alpha-adrenoceptors (e.g. norepinephrine, epinephrine) may unmask the alpha-adrenoceptor-mediated vasoconstrictor effects of these agents leading to blood pressure increase and exacerbated intermittent claudication. Such interactions are considered to be more likely with nonselective beta-blockers.
Concomitant use with antihypertensive agents as well as with other drugs with blood pressure lowering potential (e.g. tricyclic antidepressants, barbiturates, phenothiazines) may increase the risk of hypotension.
Combinations to be considered: Mefloquine may increase the risk of decelerating the heart rate (bradycardia), if used in combination with bisoprolol (Concore).
Monoamine oxidase inhibitors (except MAO-B inhibitors) may enhance the hypotensive effect of the beta-blockers. Concomitant use may also be a risk for hypertensive crisis.
Rifampicin: Slight reduction of the half-life of bisoprolol (Concore) possible due to the induction of hepatic drug-metabolizing enzymes. Normally no dosage adjustment is necessary.
Ergotamine derivatives: Exacerbation of peripheral circulatory disturbances.