Bisoprolol is indicated for the treatment of stable chronic heart failure with reduced systolic left ventricular function in addition to ACE inhibitors diuretics and optionally cardiac glycosides. Treatment of chronic, stable angina pectoris. Treatment of essential hypertension.
Anti adrenergic agent (Beta blockers), Beta-adrenoceptor blocking drugs, Beta-blockers
Bisoprolol blocks the action of the sympathetic nervous system on the heart by blocking the heart’s β1-adrenergic receptors. Bisoprolol reduces the rate & force of contraction of the heart, thus lowers blood pressure.
Dosage & Administration
The dose of Bisoprolol must be individualized to the needs of the patient. The usual starting dose is Bisoprolol 5 mg once daily. In some patients, Bisoprolol 2.5 mg may be an appropriate starting dose. If the antihypertensive effect of Bisoprolol 5 mg is inadequate, the dose may be increased to 10 mg and then, if necessary, to 20 mg once daily.
The effect and tolerability of medicines can be influenced by simultaneous intake of other medication. Such interactions can also occur if a short time has elapsed since the use of the other medication.
Bisoprolol is contraindicated in patients with cardiogenic shock, overt cardiac failure, second or third degree AV block, and marked sinus bradycardia.
Fatigue, dizziness, headache, disturbances of the gut such as nausea, vomiting, diarrhoea, constipation or abdominal pain, cold or numb extremities, e.g. hands and feet, muscle weakness or cramps, slower than normal heart beat (bradycardia), worsening of heart failure, sleep disturbance, depression, breathing difficulties due to a narrowing of the airways (bronchospasm) in people with asthma or COPD.
Pregnancy & Lactation
Pregnancy: Bisoprolol should not be used during pregnancy unless clearly necessary. If treatment with Bisoprolol is considered necessary, the uteroplacental blood flow and the foetal growth should be monitored. In case of harmful effects on pregnancy or the foetus, alternative treatment should be considered. The newborn infant must be closely monitored. Symptoms of hypoglycaemia and bradycardia are generally to be expected within the first 3 days.
Lactation: It is not known whether this drug is excreted in human milk. Therefore, breast-feeding is not recommended during administration of Bisoprolol.
Bisoprolol Fumarate must be used with caution in:
Bronchospasm (bronchial asthma, obstructive airways diseases)
Diabetes Mellitus with large fluctuations in blood glucose values; symptoms of hypoglycemia can be masked
Ongoing desensitization therapy
First degree AV block
Peripheral arterial occlusive disease (intensification of complaints might happen especially during the start of therapy)
The most common signs expected with overdosage of a beta blocker are bradycardia, hypotension, congestive heart failure, bronchospasm, and hypoglycemia. Only a few cases of overdose with Bisoprolol have been reported. Bradycardia and/or hypotension were noted. Sympathomimetic agents were given in some cases, and all patients recovered. In general, if overdose occurs, Bisoprolol therapy should be stopped and supportive and symptomatic treatment should be provided.
Use in Special Population
Pediatric Patients: There is no pediatric experience with Bisoprolol.
Geriatric Patients: It is not necessary to adjust the dose in the elderly, unless there is also significant renal or hepatic dysfunction.
Renal impairment: Reduce dose if eGFR less than 20 ml/ minute/ 1.73 m2 (max. 10 mg daily).
Hepatic impairment: Maximum 10 mg daily in severe impairment (hepatitis or cirrhosis).
Keep out of the reach of children. Protect from light and moisture, keep in a cool and dry place.