Bisostad 2.5

Rx

Indications

• Hypertension.
• Angina.
• Treatment of stable chrome heart failure with reduced systolic left ventricular function in addition to ACE inhibitor, and diuretics, and optionally cardiac glycosides.

Dosage

• Hypertension and angina for adults:
  The usual starting dose is 2.5 – 5 mg once daily. If the antihypertensive effect of 5 mg is inadequate, the dose may be increased to 10 mg and then, if necessary, to 20 mg once daily.
• Chrome heart failure (CHF) for adults:
  Standard treatment of CHF: Patients should be stable (without acute failure) when bisoprolol treatment is initiated. The treatment with bisoprolol is to be started with a gradual up titration according to the following steps:
  1.25 mg (Use of suitable dosage forms when using doses of 1.25 mg) once daily for 1 week, if well tolerated increase to
  2.5 mg once daily for a further week, if well tolerated increase to
  3.75 mg once daily for a further week, if well tolerated increase to
  5 mg once daily for the 4 following weeks, if well tolerated increase to
  7.5 mg once daily for the 4 following weeks, if well tolerated increase to
  10 mg once daily for the maintenance therapy
  The maximum recommended dose is 10 mg once daily.
• Renal or hepatic impairment:
  Titration of the dose in these populations should therefore be made with additional caution.

Usage

• Administered orally, should be taken in the morning and can be taken with food.

• Known hypersensitivity to any of the active substance or excipients.
• Acute heart failure or during episodes of heart failure decompensation requiring i.v. inotropic therapy.
• Cardiogenic shock.
• AV block of second or third degree (without a pacemaker).
• Sick sinus syndrome.
• Sinoatrial bloc.
• Bradycardia with less than 60 beats/min before starting therapy.
• Hypotension (systolic blood pressure less than 100 mm/Hg).
• Severe bronchial asthma or severe chronic obstructive pulmonary disease.
• Late stages of peripheral arterial occlusive disease and Raynaud’s syndrome.
• Untreated phaeochromocytoma.
• Metabolic acidosis.

• Dizziness, vertigo, headache, paresthesia, hypoaesthesia, somnolence, anxiety, restlessness, decreased concentration/memory.
• Dry mouth.
• Bradycardia, palpitations and other rhythm disturbances, cold extremities, claudication, hypotension, chest pain, congestive heart failure, dyspnea on exertion.
• Vivid dreams, insomnia, depression.
• Gastric/epigastric/abdominal pain, gastritis, dyspepsia, nausea, vomiting, diarrhea, constipation
• Muscle/joint pain, back/neck pain, muscle cramps, twitching/tremor
• Rash, eczema, skin irritation, pruritus, flushing, sweating, alopecia, angioedema, exfoliative dermatitis, cutaneous vasculitis.
• Visual disturbances, ocular pain/pressure, abnormal lacrimation, tinnitus, earache, taste abnormalities.
• Gout.
• Asthma/bronchospasm, bronchitis, coughing, dyspnea, pharyngitis, rhinitis, sinusitis.
• Decreased libido/impotence, cystitis, renal colic.
• Purpura.
• Fatigue, asthenia, chest pain, malaise, edema, weight gain.

• Beta – blockade may result in further depression of myocardial contractility and precipitate more severe failure.
• At the first signs or symptoms of heart failure, discontinuation of bisoprolol should be considered.
• Do not abrupt cessation of therapy with beta – blockers in patients with coronary artery disease and hyperthyroidism.
• Beta – blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease.
• Use with caution in patients with bronchospastic disease who do not respond to, or who cannot tolerate other antihypertensive treatment.
• Beta – blockers may mask some of the manifestations of hypoglycemia, particularly tachycardia in patients subject to spontaneous hypoglycemia or diabetic patients receiving insulin or oral hypoglycemic agents.
• Particular care should be taken when anesthetic, agents which depress myocardial function, are used.
• Bisoprolol is not recommended for pregnancy and breastfeeding.
• Patients should be aware of how they react to drug before driving or operating machinery (especially when starting treatment, dosage adjustment, alcohol drinking).