Lodoz Special Precautions

Bisoprolol: Never interrupt treatment suddenly in case of ischemic heart disease. Use with care in cases of 1st-degree AV block. Since bisoprolol is a highly selective β₁-adrenoreceptor blocker, it may be prescribed with care in patients with a history of chronic obstructive bronchopathy or a family history of asthma. However, an increase in airways resistance may be observed in certain patients and this may be regarded as a signal to discontinue therapy. This bronchospasm generally subsides on administration of a standard bronchodilator eg, salbutamol.
Bisoprolol has a low affinity for β₂-receptors and therefore, does not cause hypoglycemia. However, caution is required in diabetics because bisoprolol may mask the symptoms of hypoglycemia (tachycardia in particular).
Beta-blockers may trigger or aggravate symptoms connected with arterial insufficiency in patients with peripheral vascular disorders. Caution is required in these patients.
In patients susceptible to a severe anaphylactic reaction, whatever its origin or during desensitizing treatments, β-blockers may lead to an aggravation of the reaction and to resistance to its treatment with adrenaline in the usual doses.
Hydrochlorothiazide: It has been observed in clinical studies that the low dose of hydrochlorothiazide present in Lodoz leads to a smaller increase in serum uric acid than that usually described after higher doses. Caution is necessary, however, in patients predisposed to gout or hyperuricemia.
The use of Lodoz with a particularly low thiazide content (6.25 mg) reduces the risk of any appreciable electrolyte imbalance. However, checks of the water and electrolyte balance must be carried out at regular intervals in all patients treated with diuretics. Thiazides can induce hypokalemia and therefore, serum potassium must be monitored, particularly in the elderly, in patients on digitalis medication, on a low-potassium diet or with gastrointestinal anomalies.
Concomitant administration with insulin or oral antidiabetics may potentiate or prolong or else attenuate their effect. Regular monitoring of blood glucose levels is therefore necessary.
Bisoprolol and Hydrochlorothiazide: Before any surgical intervention, the anesthetist must be informed of treatment with Lodoz. In patients with severe ischemic heart disease, the risks and the advantages of continuing treatment must be evaluated. Caution is required when using volatile anesthetics, associated with a risk of increased hypotension. Hydrochlorothiazide may increase the response to certain curare products.
Use in pregnancy: There are no adequate and well-controlled studies with Lodoz in pregnant women. It should be used during pregnancy only if the potential benefit justifies the risk to the fetus.
Use in lactation: Use during the lactation period is contraindicated since hydrochlorothiazide can inhibit milk production. If use during this period is essential, breastfeeding should be avoided.