Formulary
Bisoprolol fumarate: Indications, Dosing, Side Effects and Interactions
Bisoprolol fumarate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Bisoprolol fumarate: Indications, Dosing, Side Effects and Interactions
Bisoprolol fumarate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension,Angina**
- **Adult** (By Mouth): Initially 5 mg once daily, usual maintenance 10 mg once daily; increased if necessary up to 20 mg once daily.
**Adjunct in heart failure**
- **Adult** (By Mouth): Initially 1.25 mg once daily for 1 week, dose to be taken in the morning, then increased if tolerated to 2.5 mg once daily for 1 week, then increased if tolerated to 3.75 mg once daily for 1 week, then increased if tolerated to 5 mg once daily for 4 weeks, then increased if tolerated to 7.5 mg once daily for 4 weeks, then increased if tolerated to 10 mg once daily.
Cautions
For all beta-adrenoceptor blockers (systemic) Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: in combination with verapamil or diltiazem (risk of heart block) with bradycardia (heart rate less than 50 beats per minute), or second- or third-degree AV block (contra-indicated; risk of complete heart block, asystole) in diabetes mellitus patients with frequent hypoglycaemic episodes (risk of suppressing hypoglycaemic symptoms) if prescribed a non-selective beta-blocker (including topical beta-blockers) in a history of asthma requiring treatment (contra-indicated in asthma; risk of increased bronchospasm) Cautions For bisoprolol fumarate Ensure heart failure not worsening before increasing dose
Contraindications
For all beta-adrenoceptor blockers (systemic) Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal's angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure Contra-indications, further information Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken. Contra-indications For bisoprolol fumarate Acute or decompensated heart failure requiring intravenous inotropes; sino-atrial block
Side effects
For all beta-adrenoceptor blockers (systemic) Common or very common Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; rash (reversible on discontinuation); Raynaud's phenomenon; sleep disorders; syncope; visual impairment; vomiting Uncommon Alopecia; atrioventricular block; bronchospasm Rare or very rare Hallucination; psoriasis exacerbated Side-effects, further information With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. Overdose Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. For details on the management of poisoning, see Beta-blockers, under Emergency treatment of poisoning . Side-effects For bisoprolol fumarate Common or very common Constipation Uncommon Muscle cramps; muscle weakness; postural hypotension Rare or very rare Allergic rhinitis; auditory disorder; conjunctivitis; flushing; hepatitis; hypersensitivity; pruritus
Interactions
**Other interactions (9):**
- Combinations not recommended Class I antiarrhythmic drugs (e.g.
- Centrally acting antihypertensive drugs such as clonidine and others (e.g.
- Combinations to be used with caution Calcium antagonists of the dihydropyridine type such as felodipine and amlodipine: Concomitant use may increase the risk of hypotension, and an increase in the...
- Class-III antiarrhythmic drugs (e.g.
- Topical beta-blockers (e.g.
- Insulin and oral antidiabetic drugs: Increase of blood sugar lowering effect.
Pregnancy
For all beta-adrenoceptor blockers (systemic) Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension.
Breast feeding
For all beta-adrenoceptor blockers (systemic) With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants.
Hepatic impairment
Manufacturer advises caution. Dose adjustments When used for Angina or Hypertension: Manufacturer advises consider maximum dose of 10 mg once daily in severe impairment-consult product literature. When used for Heart failure: Manufacturer advises caution when titrating dose (no information available).
Renal impairment
Dose adjustments When used for Angina or Hypertension: Max. 10 mg daily if creatinine clearance less than 20 mL/minute. M See Prescribing in renal impairment . When used for Heart failure: Use with caution when titrating dose (no information available). M
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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