Concore Special Precautions

Bisoprolol (Concore) must be used with caution in: diabetes mellitus with extremely fluctuating blood glucose levels: symptoms of markedly reduced blood glucose (hypoglycemia) such as tachycardia, palpitations or sweating can be masked; strict fasting; ongoing desensitization therapy; mild disturbances of atrioventricular conduction (first degree AV block); Prinzmetal'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 Prinzmetal's angina. Utmost caution must be exercised; peripheral arterial occlusive disease. Aggravation of symptoms may occur especially when starting therapy.
Beta-blockers, including bisoprolol (Concore), may increase the sensitivity to allergens and the severity of anaphylactic reactions because the adrenergic counter-regulation under beta-blockade may be alleviated. Treatment with epinephrine may not always yield the expected therapeutic effect.
Patients with psoriasis or with a history of psoriasis should only be given beta-blockers (e.g. bisoprolol) after a careful balancing of benefits against risks.
Under treatment with bisoprolol (Concore), symptoms of a thyroid hyperfunction (thyrotoxicosis) may be masked.
In patients with a tumor of the adrenal gland (pheochromocytoma), bisoprolol (Concore) must not be administered until after alpha-receptor blockade.
In patients undergoing general anesthesia, the anesthetist must be aware of beta-blockade. If it is thought necessary to withdraw bisoprolol (Concore) before surgery, this should be done gradually and completed about 48 hours prior to anesthesia.
Although cardioselective (beta₁) beta-blockers may have less effect on lung function than non-selective 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 (Concore) may be used with caution. In bronchial asthma or other chronic obstructive pulmonary diseases, which may cause symptoms, concomitant bronchodilating therapy is recommended. Occasionally, an increase of the airway resistance may occur in patients with asthma, therefore the dose of beta₂-stimulants may have to be increased.
There is no therapeutic experience of bisoprolol treatment in heart failure in patients with the following diseases and conditions: insulin dependent type 1 diabetes mellitus; severely impaired renal function; severely impaired hepatic function; restrictive cardiomyopathy; congenital heart disease; hemodynamically significant organic valvular disease; myocardial infarction within the last 3 months.
Effects on the ability to drive and use machines: In a study with patients suffering from coronary heart disease, bisoprolol did not affect the driving performance of the patients. However, depending on the individual patient's response to treatment, the ability to drive a vehicle or to use machines may be impaired. This needs to be considered particularly at the start of treatment, upon change of medication, or in conjunction with alcohol.