RiteMED Bisoprolol

HTN. CHD (angina pectoris). Stable chronic heart failure w/ reduced systolic left ventricular function.

HTN or angina pectoris Adult 5 mg once daily, may be increased to 10 mg once daily. Max: 20 mg once daily. Severe renal (CrCl <20 mL/min) & hepatic impairment Max: Not to exceed 10 mg daily. Stable chronic heart failure Titration phase: Initially 1.25 mg once daily, increased to 2.5 mg, 3.75 mg, 5 mg, 7.5 mg, & 10 mg once daily in intervals of ≥2 wk. Max: 10 mg once daily.

May be taken with or without food: Take in the morning. Swallow w/ some liquid & do not chew.

Hypersensitivity. Acute heart failure or during episodes of heart failure decompensation requiring IV inotropic therapy; cardiogenic shock; 2nd or 3rd degree AV block; sick sinus syndrome; SA block; symptomatic bradycardia; symptomatic hypotension; severe bronchial asthma or severe COPD; severe forms of peripheral arterial occlusive disease or Raynaud's syndrome; untreated phaeochromocytoma; metabolic acidosis.

Do not abruptly stop therapy especially in patients w/ ischaemic heart disease. Not to be administered until after α-receptor blockade in patients w/ phaeochromocytoma. Caution in bronchospasm (bronchial asthma, obstructive airways diseases), DM showing large fluctuations in blood glucose values, strict fasting, ongoing desensitisation therapy, 1st degree AV block, Prinzmetal's angina, peripheral arterial occlusive disease; psoriasis. May mask symptoms of thyrotoxicosis. Increase of airway resistance may occur in patients w/ asthma. Gradually w/draw therapy 48 hr before anaesth. May cause +ve reaction in anti-doping tests. May impair ability to drive a vehicle or use machines. Not recommended during pregnancy & lactation. Not recommended in childn. Stable chronic heart failure: Patients should be stable (w/o acute failure) when treatment is initiated. Treatment of stable chronic heart failure has to be initiated w/ special titration phase. No therapeutic experience of treatment in heart failure in patients w/ IDDM, severe renal & hepatic impairment, restrictive cardiomyopathy, congenital heart disease, haemodynamically significant organic valvular disease, MI w/in 3 mth. Regularly monitor in initiation & cessation of treatment. Hepatic or renal impairment.

Bradycardia (in patients w/ chronic heart failure). Dizziness, headache; worsening of preexisting heart failure (in patients w/ chronic heart failure); feeling of coldness or numbness in extremities, hypotension; GI complaints eg, nausea, vomiting, diarrhoea, constipation; asthenia (in patients w/ chronic heart failure), fatigue.

May potentiate effect on AV conduction time & increase -ve inotropic effect w/ class I antiarrhythmics. -ve effect on contractility & AV conduction w/ Ca antagonists of verapamil type & to lesser extent of diltiazem type. May lead to profound hypotension & AV block w/ IV verapamil. May lead to reduction of heart rate & cardiac output & to vasodilation w/ centrally-acting antihypertensives. May increase risk of hypotension & further deterioration of ventricular pump function w/ Ca antagonists of dihydropyridine type in heart failure patients. May potentiate effect on AV conduction time w/ class III antiarrhythmics. May increase AV conduction time & risk of bradycardia w/ parasympathomimetics. Topical β-blockers (eg, eye drops for glaucoma) may add to systemic effects of bisoprolol. Increased blood sugar lowering effect of insulin & oral antidiabetics. Attenuated reflex tachycardia & increased risk of hypotension w/ anaesth. Increased AV conduction time & reduced heart rate w/ digitalis glycosides. Hypotensive effect may be reduced w/ NSAIDs. Effect of both β-sympathomimetics & bisoprolol may be reduced when used in combination. May lead to increased BP w/ sympathomimetics that activate both β- & α-adrenoceptors. May increase risk of hypotension w/ antihypertensives & other medicinal products w/ BP-lowering potential. Increased risk of bradycardia w/ mefloquine. Enhanced hypotensive effect & risk of hypertensive crisis w/ MAOIs (except MAO-B inhibitors).

Beta-Blockers

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

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