Vasoten Special Precautions

The following section describes when Vasoten must be used with special caution: diabetes mellitus with extremely fluctuating blood glucose levels: symptoms of markedly reduced blood glucose (hypoglycaemia) such as tachycardia, palpitations or sweating can be masked, strict fasting, ongoing desensitisation therapy, mild disturbances of atrioventricular conduction (first degree AV block), disturbed blood flow in the coronary vessels due to vasospasms (Prinzmetal's angina), peripheral arterial occlusive disease (intensification of complaints may occur especially when starting therapy), patients with a personal or family history of psoriasis.
Respiratory system: Beta-blockers should generally be avoided in patients with a history of asthma or chronic obstructive airway disease. However, if there is no alternative, a cardio-selective beta-blocker such as Vasoten may be used with extreme caution under specialist supervision. In some asthmatic patients, some increase in airway resistance may occur, and this may be regarded as a signal to discontinue therapy. Bronchospasm can usually be reversed by commonly used bronchodilators such as salbutamol. As a warning to patients, both the label and patient information leaflet for Vasoten advise patients not to take Vasoten, but to talk to their doctor if they have ever suffered from wheezing or asthma.
Allergic reactions: Beta-blockers, including Vasoten, may increase the sensitivity to allergens and the severity of anaphylactic reactions because the adrenergic counterregulation under beta-blockade may be alleviated. Treatment with adrenaline may not always give the expected therapeutic effect.
General anaesthesia: In patients undergoing general anaesthesia the anaesthetist must be aware of beta-blockade. If it is thought necessary to withdraw Vasoten before surgery, this should be done gradually and completed about 48 hours prior to anaesthesia.
Phaeochromocytoma: In patients with a tumour of the adrenal gland (phaeochromocytoma) Vasoten may only be administered after previous alpha-receptor blockade.
Thyrotoxicosis: Under treatment with Vasoten the symptoms of a thyroid hyperfunction (thyrotoxicosis) may be masked.
Bisoprolol should be used with care in patients with a prolonged PR conduction interval, poor cardiac reserve and peripheral circulatory disease such as Raynaud's phenomena, since aggravation of these disorders may occur. Treatment should not be discontinued abruptly. As with other beta-blockers, gradual dosage reduction over 1-2 weeks is recommended, particularly in patients with ischaemic heart disease. If necessary, replacement therapy should be initiated at the same time to prevent exacerbation of angina pectoris.
In the event of a precipitous drop in pulse rate and/or blood pressure, treatment with Vasoten should be discontinued.
Bisoprolol should be used with caution in patients with metabolic acidosis.
Due to their negative effect on conduction time, beta-blockers should only be given with caution to patients with first degree heart block.
Caution should be exercised when using anaesthetic agents with Vasoten. The anaesthetist should be informed if the patient is taking Vasoten, and anaesthetic agents causing myocardial depression, such as cyclopropane or trichloroethylene, are best avoided. In cases of severe ischaemic heart disease, the risk/benefit of continuing treatment should be carefully evaluated. If withdrawal of Vasoten is desired, this should be completed at least 24 hours prior to anaesthesia. Continuation of beta-blockade reduces the risk of arrhythmias during induction and intubation, but may result in attenuation of reflex tachycardia and increase the risk of hypotension. The patient may be protected against vagal reactions by intravenous administration of atropine.