Bisostad 5

Bisoprolol fumarate

HTN; stable chronic angina; stable chronic heart failure w/ reduced systolic left ventricular function in addition to ACE inhibitors & diuretics, & optionally cardiac glycosides.

HTN & chronic stable angina pectoris Adult Initially 5 mg daily. Usual dose: 10 mg once daily. Max: 20 mg daily. Patient w/ renal impairment Max: 10 mg once daily. Stable chronic heart failure Adult Titration phase: Initially 1.25 mg once daily for 1 wk. If well tolerated increase to 2.5 mg once daily for a further wk; then 3.75 mg once daily for a further wk; 5 mg once daily for the 4 following wk; 7.5 mg once daily for the 4 following wk; then 10 mg once daily for the maintenance therapy. Max: 10 mg once daily.

May be taken with or without food.

Hypersensitivity. Chronic heart failure patients w/ acute heart failure or during episodes of heart failure decompensation requiring IV inotropic therapy; cardiogenic shock; 2nd or 3rd degree AV block (w/o pacemaker); sick sinus syndrome; SA block; symptomatic bradycardia; symptomatic hypotension; severe bronchial asthma or severe COPD; late stages of peripheral arterial occlusive disease & Raynaud's syndrome; untreated phaeochromocytoma; metabolic acidosis.

Do not abruptly stop therapy in patients w/ ischemic heart disease. Caution in bronchospasm (bronchial asthma, obstructive airways diseases); DM w/ large fluctuations in blood glucose values; strict fasting; ongoing desensitisation therapy; 1st degree AV block; Prinzmetal's angina; peripheral arterial occlusive disease; general anaesth. Patients w/ psoriasis or history of psoriasis. Do not administer in patients w/ phaeochromocytoma until after α-receptor blockade. Symptoms of thyrotoxicosis may be masked. May impair ability to drive a vehicle or to operate machinery. Patients w/ renal or hepatic impairment. Pregnancy & lactation. Not recommended for childn. Chronic heart failure: Treatment has to be initiated w/ special titration phase. Treatment initiation necessitates regular monitoring. Patients w/ insulin-dependent DM; severely impaired renal or hepatic function; restrictive cardiomyopathy; congenital heart disease; haemodynamically significant organic valvular disease; MI w/in 3 mth. HTN or angina pectoris: Patients w/ HTN or angina pectoris & accompanying heart failure.

Dizziness, headache; feeling of coldness or numbness in the extremities; hypotension especially in patient w/ heart failure; GI complaints eg, nausea, vomiting, diarrhoea, constipation; fatigue. Chronic heart failure: Bradycardia; worsening of pre-existing heart failure; asthenia.

Potentiated effect on AV conduction time & increased negative inotropic effect w/ class I antiarrhythmics (eg, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone). Negative influence on contractility & AV conduction w/ Ca antagonists of the verapamil type. Worsened heart failure w/ centrally acting antihypertensive drugs eg, clonidine, methyldopa, moxonodine, rilmenidine. Increased risk of hypotension & further deterioration of the ventricular pump function in patients w/ heart failure w/ Ca antagonists of the dihydropyridine type eg, felodipine & amlodipine. Potentiated effect on AV conduction time w/ class III antiarrhythmics (eg, amiodarone). Possible additive systemic effect w/ topical β-blockers. Increased AV conduction time & risk of bradycardia w/ parasympathomimetics. Increased effect of insulin & oral antidiabetics; blockade of β-adrenoreceptors may mask hypoglycaemia symptoms. Attenuation of reflex tachycardia & increased risk of hypotension w/ anaesth. Reduced heart rate & increased AV conduction time w/ digitalis glycosides. Reduced hypotensive effect w/ NSAIDs. Combination of β-sympathomimetics (eg, isoprenaline, dobutamine) w/ bisoprolol may reduce effect of both agents. Combination of sympathomimetics that activate both β- & α-adrenoceptors (eg, noradrenaline, adrenaline) w/ bisoprolol may unmask the α-adrenoceptor-mediated vasoconstrictor effects of these agents leading to BP increase & exacerbated intermittent claudication. Increased risk of hypotension w/ antihypertensives & other drugs w/ BP-lowering potential (eg, TCAs, barbiturates, phenothiazines). Increased risk of bradycardia w/ mefloquine. Enhanced hypotensive effect & risk for hypertensive crisis w/ MAOIs except MAO-B inhibitors. Slight reduction of t_½ w/ rifampicin. Exacerbation of peripheral circulatory disturbances w/ ergotamine derivatives.

Beta-Blockers

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

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