BMA Concise Guide to Medicine & Drugs

Bisoprolol

Brand names Cardicor, Emcor

Used in the following combined preparations None

QUICK REFERENCE

Drug group Beta blocker

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Bisoprolol is a cardioselective beta blocker. It is used in the treatment of angina and, usually in combination with an ACE inhibitor and a diuretic, for treating heart failure. It is also used to treat high blood pressure, but is not usually used to initiate treatment. Bisoprolol is less likely than non-cardioselective beta blockers, to provoke breathing difficulties but, nevertheless, it is not usually given to patients with asthma. It may also slow the body’s response to low blood sugar, if you are a diabetic on insulin.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Once daily.

Adult dosage range Heart failure 1.25mg per day (Initial dose), increasing to 10mg. Hypertension and angina 5–20mg.

Onset of effect 2 hours. Full antihypertensive effect seen after two weeks.

Duration of action 24 hours.

Diet advice None.

Storage Keep in original container in a dry cool place, out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 12 hours, take a single dose now. If more than 12 hours have passed, skip the missed dose and take the next dose at the scheduled time.

Stopping the drug Do not stop taking the drug without consulting your doctor; abrupt cessation may lead to worsening of the underlying condition. The drug should be withdrawn gradually.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if breathing difficulties, collapse, or loss of consciousness occur.

POSSIBLE ADVERSE EFFECTS

Bisoprolol’s adverse effects are common to most beta blockers; they are usually temporary and tend to diminish with long-term use. Dizziness, lethargy, fatigue, and cold hands and feet are common. If dizziness is severe or you experience any of these other adverse effects, you should report them to your doctor. Nausea and vomiting are less common but should also be reported to your doctor. Rarely, bisoprolol may cause nightmares, vivid dreams, a rash, or dry eyes. If any of these occur, you should stop taking the drug and consult your doctor. If you experience fainting, palpitations, breathlessness, or wheezing, you should stop taking the drug and seek immediate medical attention.

INTERACTIONS

Other antihypertensives may enhance bisoprolol’s blood-pressure-lowering effect and some may worsen heart failure.

Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the blood-pressure-lowering effect of bisoprolol.

Insulin and oral antidiabetics Bisoprolol may increase the blood-sugar-lowering effect of these drugs and may also mask symptoms of low blood sugar.

Calcium channel blockers These may cause low blood pressure, a slow heartbeat, and heart failure if taken with bisoprolol.

Cardiac glycosides (e.g. digoxin) These may increase the heart-slowing effect of bisoprolol.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have, or have had, asthma.

· You have heart problems.

· You have liver or kidney problems.

· You have diabetes.

· You have psoriasis.

· You have phaeochromocytoma.

· You are taking other medicines.

Pregnancy Not normally prescribed. May affect the developing baby. Discuss with your doctor.

Breast-feeding The drug passes into breast milk but the small amount present is unlikely to affect your baby. Discuss with your doctor.

Infants and children Not recommended.

Over 60 No special problems.

Driving and hazardous work Avoid such activities until you have learned how bisoprolol affects you because the drug can cause fatigue and dizziness.

Alcohol Avoid excessive intake. Alcohol may increase the blood-pressure-lowering effect of bisoprolol.

Surgery and general anaesthetics Occasionally, bisoprolol may need to be stopped before you have a general anaesthetic, but only do this after discussion with your doctor or dentist.

PROLONGED USE

No special problems.