Diopolol Special Precautions

Bisoprolol must be used with caution in: Heart failure (the treatment of stable chronic heart failure with bisoprolol has to be initiated with a special titration phase). Bronchospasm (bronchial asthma, obstructive airways diseases). Concomitant treatment with inhalation anaesthetics. Diabetes mellitus with large fluctuations in blood glucose values; symptoms of hypoglycaemia can be masked. Strict fasting. Ongoing desensitisation therapy. AV block of first degree. Prinzmetal's angina. Peripheral arterial occlusive disease (intensification of complaints may occur particularly during the start of therapy).
In bronchial asthma or other chronic obstructive lung diseases, which may cause symptoms, bronchodilating therapy should be given concomitantly. Occasionally an increase of the airway resistance may occur in patients with asthma, therefore the dose of β2-stimulants may have to be increased.
As with other β-blockers, bisoprolol may increase both the sensitivity towards allergens and the severity of anaphylactic reactions. Adrenaline treatment does not always give the expected therapeutic effect.
Patients with psoriasis or with a history of psoriasis should only be given β-blockers (e.g. bisoprolol) alter carefully balancing the benefits against the risks.
In patients with phaeochromocytoma bisoprolol must not be administered until after alpha-receptor blockade.
Under treatment with bisoprolol the symptoms of a thyrotoxicosis may be masked.
In patients with ischaemic heart disease, treatment should not be withdrawn abruptly.
Combination with calcium antagonists, clonidine or monoamine oxidase inhibitors (except MAO-B inhibitors) is not recommended.
Effects on ability to drive and operate machine: Patients should know how they react to Bisoprolol before they drive or use machines because occasionally, dizziness or fatigue may occur.
Pregnancy: There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Nursing mothers: It is not known whether this drug is excreted in human milk. Therefore, breastfeeding is not recommended during administration of bisoprolol.