Bisoprolol

Bisoprolol fumarate

Cardiovascular drugs

Cardiovascular medicines – beta-adrenergic blocking medicines

2.5, 5, 10 mg tablets

Each coated tablet contains bisoprolol fumarate 2.5, 5 and 10 mg.

Bisoprolol is a selective cardiac β1-adrenergic blocking agent used to treat hypertension. It is considered a rich drug with a long half-life that can be taken once a day to reduce the need for multiple doses of antihypertensive medications. Bisoprolol is generally well tolerated which may be due to β1-adrenergic receptor selectivity so is a useful alternative to non-selective β-blocking medications such as carvedilol and labetalol in the treatment of hypertension. This drug may be used alone or in combination with other medicines to control hypertension, and due to its receptor selectivity, bisoprolol can be effective in patients with chronic obstructive pulmonary disease (COPD).

By reducing cardiac output, reducing sympathetic outflow from the CNS, or suppressing renin release, it leads to a decrease in blood pressure.

Bisoprolol belongs to the category of beta-blocker medicines, which is used in cardiovascular diseases.

By inhibiting beta receptors, bisoprolol helps to regulate the heart rate and reduce the pressure on the heart.

Bisoprolol also helps to reduce chest pain in angina sufferers.

Hypertension: It is used as monotherapy or in combination with other blood pressure medications. Bisoprolol is one of the preferred treatments to start in patients with heart failure, post-myocardial stroke, ischemic heart disease and diabetes. It can be used as the first treatment for uncomplicated hypertension, although thiazide diuretics are preferred.

Control: CHF control of moderate to severe heart failure (NYHA class II or III) of ischemic or cardiomyopathic origin with cardiac glycosides, diuretics and ACE inhibitors.

It has been shown that bisoprolol, carvedilol and slow-release metoprolol succinate are effective in reducing the risk of death in patients with heart failure. However, this evidence should not be used as an indicator for the effectiveness of the beta-adrenergic blockers class.

General instructions for the patient:

Take bisoprolol exactly as prescribed by your doctor. Generally, this drug is prescribed once a day, though the dosage varies according to the reason for the prescription. If bisoprolol is prescribed for the treatment of heart failure, the treatment normally starts with a small amount (1.25 mg) and is gradually increased over the course of a week. Subsequently, the amount of consumption increases until it reaches the required level. Accordingly, the doctor may gradually increase the dosage of the medicine. Therefore, follow the instructions and recommendations of your doctor carefully and discuss your questions with the doctor or pharmacist.

This drug is produced in the form of oral tablets in different doses (1.25-2.5-10 mg). Therefore, every time before taking a new purchased drug, make sure that the dose of the drug corresponds to the dose prescribed by the doctor.

You can take Bisoprolol with or without food. However, try to take it every day at a certain time so that you can achieve the desired therapeutic effects sooner with regular consumption.

The best time to take this medicine is in the morning with a glass of water.

If you miss a dose, take it as soon as you remember. If you forget to take the medicine for a whole day, do not take the missed dose and take the next doses according to the previous routine. Do not double the amount of medicine in one session.

Before starting to take bisoprolol, pay attention to these points:

Be sure to inform your doctor if you are pregnant or breastfeeding.

If you have asthma or any breathing failures, inform your doctor.

If you have a history of liver or kidney disorders, inform your doctor.

If you have a history of low blood pressure, inform your doctor.

In case of diabetes, skin disorders such as psoriasis and muscle disorder myasthenia gravis, be sure to inform the doctor.

Be sure to tell your doctor if you have arrhythmia (an uneven heartbeat) or if you experience a drop in heart rate.

If you have a history of chest pain caused by spasm of the heart vessels Prinzmetal angina (vasospastic angina or variant angina) be sure to inform your doctor.

Provide your doctor or pharmacist with a detailed list of medications (even non-prescription medications and herbal supplements) so that necessary measures can be taken in case of an interaction with bisoprolol.

If you have a history of allergy to this drug or similar drugs, inform your doctor.

Category X interactions to avoid:

Rivastigmine

Beta 2 agonists, epinephrine (nasal, oral inhalation, systemic), theophylline derivatives

Amphetamines, barbiturates, Brigatinib, Bromperidol, severe and moderate CYP3A4 inducers, Deferasirox, dexmethylphenidate, enzalutamide, antihypertensive herbs, methylphenidate, non-steroidal anti-inflammatory drugs, rifamycin derivatives, tocilizumab, yohimbine

Alpha 1 blockers, alpha 2 agonists, phenothiazine and atypical antipsychotics (second generation), bradycardia drugs, Bromperidol, bupivacaine, cardiac glycosides, cholinergic agonists, disopyramide, duloxetine, ergot derivatives, Faxinidazole, fingolimod, antihypertension medicines, Ivabradine, Lacosamide, products containing levodopa, lidocaine (systemic and topical), mepivacaine, methacholine, nitroprusside, Siponimod, sulfonylureas.

Acetylcholinesterase inhibitors, alpha 2 agonists, antimalarial aminoquinolines, amiodarone, phenothiazine antipsychotics, barbiturates, brimonidine (topical), non-dihydropyridine calcium channel blockers, diazoxide, dipyridamole, disopyramide, dronedarone, antihypertensive herbs, lormetazepam , midodrine, nicorandil, nifedipine, Obinutuzumab, pentoxifylline, phosphodiesterase 5 inhibitors, propafenone, quinagolide, regorafenib, rivastigmine, Ruxolitinib

Has not been stated.

Possible occurrence of CHF, do not use in obvious CHF. It can be used with caution in patients with compensated heart failure (for example, people who are controlled with cardiac glycosides or diuretics). In case of symptoms of heart failure, adequate treatment and careful monitoring is necessary. If the failure continues, stop the treatment and if possible, stop the drug gradually.

Sudden discontinuation is not recommended due to exacerbation of symptoms, occurrence of MI, or occurrence of ventricular arrhythmias in CAD patients. During 1-2 weeks, the medicine should gradually be stopped and the patients must be carefully monitored. In case of withdrawal symptoms (exacerbation of angina or hypotension), increase the dose or start the treatment again.

Occurrence or exacerbation of symptoms of arterial disorder can occur.

In general, it should not be prescribed in patients suffering from spasm of pulmonary ducts. In case of non-response or intolerance of other medications, bisoprolol can be prescribed with caution. The lowest effective dose (2.5 mg daily at the beginning of treatment) is prescribed and a bronchodilator is available.

Use with caution in patients undergoing major surgery with general anesthesia.

It reduces the symptoms of hypoglycemia (such as tachycardia).

Hyperthyroid symptoms (such as tachycardia) are hidden by bisoprolol. Patients with thyrotoxicosis should be carefully monitored if hyperthyroidism suddenly stops or thyroid storm occurs.

Increased reaction to allergens can occur during the use of beta blockers. These patients do not respond to normal doses of epinephrine.

Safety and effectiveness in children have not been proven.

Medicines should not be stopped suddenly without a doctor’s prescription.

In case of symptoms of congestive heart failure, severe bradycardia and difficulty in breathing, inform the doctor immediately.

The patient should inform the anesthetist or dentist of taking bisoprolol before the surgery.

Diabetic patients should be taught that this drug can mask symptoms of hypoglycemia such as increased heart rate.

Avoid activities that require full alertness (such as driving).

Patients with sinus bradycardia, heart block greater than first degree, cardiogenic shock or marked heart failure.

Hypersensitivity to bisoprolol fumarate or other components of the formulation or sulfonamides

All medicines have possible unwanted side effects along with the therapeutic effect, although not all of these side effects can be seen in the same person. However, if any of them occurred, consult your doctor.

Relatively common side effects (1-10%):

Cardiovascular: chest pain, angioedema

Central nervous system: fatigue, hypoesthesia (tactile disorder)

Gastrointestinal: diarrhea, vomiting

Hepatic: increased serum level of alanine aminotransferase, increased serum level of aspartate aminotransferase

Respiratory: upper respiratory tract infection, shortness of breath

Other complications (uncertain percentage):

Cardiovascular: Cardiac arrhythmia, heart failure, lameness, coldness of the extremities, edema, hot flashes, vasculitis caused by hypersensitivity, hypotension, postural hypotension, palpitations.

Central nervous system: anxiety, depression, dizziness, drowsiness, headache, hyperesthesia (increased sensitivity in the sense of touch), insomnia, lack of concentration, boredom, memory impairment, limb numbness, restlessness, feeling of pressure in the eyes, muscle jumps, a vivid and memorable dream

Skin: acne vulgaris, hair loss, increased perspiration, eczema, itching, skin burning and irritation, skin rash

Endocrine and metabolism: Loss of libido, gout, hyperglycemia (increase in blood sugar), increase in serum phosphate, increase in serum potassium, increase in serum triglyceride, increase in uric acid, increase in weight.

Gastrointestinal: Abdominal pain, constipation, taste disturbance, indigestion, epigastric pain, stomach pain, gastritis, nausea, peptic ulcer, xerostomia (dry mouth).

Genitourinary: Bladder inflammation, sexual dysfunction

Hematology and oncology: Decrease in the number of white blood cells, positive ANA titer, purpura, thrombocytopenia

Neurological, musculoskeletal: back pain, muscle cramps, muscle pain, neck pain, tremors

Ocular: abnormal tears, eye pain, visual impairment

Ear: ear pain, tinnitus

Renal: increased BUN, increased serum creatinine, Hyperuria, renal colic

Respiratory: asthma, bronchitis, bronchospasm, cough, dyspnea (shortness of breath during exercise), pharyngitis, rhinitis, sinusitis

Dizziness, drowsiness, fatigue and light-headedness are common side effects of this medicine. Thus, when you get up, do it slowly and avoid sudden movements. If you feel dizzy when standing up, lie down for a few minutes to return to normal conditions, then sit for a few minutes and get up when you feel that the dizziness is gone. This complication usually appears in the 1-2 weeks and gradually diminishes. Though if it continues, consult your doctor. If you feel dizzy and sleepy, avoid driving and working with dangerous tools.

If you feel nausea and vomiting, diarrhea or constipation, you can reduce this discomfort by consuming enough simple foods and liquids.

-In case of headache, drink enough fluids and consult your pharmacist to choose the right painkiller. If your headache continues or becomes severe, be sure to inform your doctor.

Talk to your doctor if you feel numbness or coldness in your fingertips, sleep disturbance or heart rate drop.

During the treatment with bisoprolol, it is necessary to remain under the supervision of a doctor so that the required examinations and tests can be performed regularly and periodically and the treatment and recovery process can be checked.

If you plan to have any surgery or receive dental services, be sure to inform your doctor about taking bisoprolol since it can affect the effect of some anesthetic drugs.

– Simultaneous use of this drug with alcoholic products can lead to severe drop in blood pressure and dizziness. Therefore, during the treatment with bisoprolol, it is not appropriate and not recommended to consume alcoholic products.

– Before buying any medicine or supplement, provide the pharmacist with a complete list of all the medications you are taking to make sure that the new medicine is suitable for you. Some drugs, including painkillers and anti-inflammatory and cold medicines, interfere with bisoprolol.

-The doctor will probably suggest to change your diet and lifestyle.

Following the doctor’s advices is a part of your treatment.

Treatment with bisoprolol is long-term. Therefore, continue taking the medicine as long as the doctor considers it appropriate. Stopping treatment suddenly can cause problems for you. As a result, refraining to take the medication should be done under the doctor’s supervision and with a gradual reduction in the drug intake.

-If you have diabetes, taking bisoprolol can mask the symptoms of hypoglycemia, so you should get the necessary advice from your doctor.

If you are taking hydrochlorothiazide at the same time as bisoprolol, it is recommended to consult a dermatologist in case of spots or any changes on the surface of your skin. Plus, use appropriate sunscreen creams.

Keep the medicine at a temperature below 30 degrees centigrade and in the original packaging. Keep the medicine out of the reach of children. Avoid using expired medicines.

Each box contains 3 blisters containing 30 tablets and a drug information brochure.