Bisoprolol

Indications

Bisoprolol is used for: Hypertension, Angina pectoris, Congestive heart failure

Adult Dose

The usual starting dose is 5 mg once daily. In some patients, 2.5 mg may be an appropriate starting dose. 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. For heart failure: Initially 1.25 mg once daily (in the morning) for 1 week then, if well tolerated, increased to 2.5 mg once daily for 1 week, then 3.75 mg once daily for 1 week, then 5 mg once daily for 4 weeks, then 7.5 mg once daily for 4 weeks, then 10 mg once daily; max. 10 mg daily. Hepatic impairment: Severe: Initially, 2.5 mg/day. Max: 10 mg/day. Elderly: Hypertension 2.5-20 mg PO qDay Heart Failure 1.25 mg PO qDay; not to exceed 10 mg/day

Child Dose

Renal Dose

Renal impairment: CrCl (ml/min) <40 Initial: 2.5 mg/day.

Administration

May be taken with or without food.

Contra Indications

Patients with cardiogenic shock, overt cardiac failure, second or third degree AV block and marked sinus bradycardia.

Precautions

Impaired Renal or Hepatic Function. Lactation: excretion in milk unknown; use caution

Pregnancy-Lactation

Pregnancy Category: C Lactation: excretion in milk unknown; use caution

Interactions

May potentiate AV conduction time and may increase negative inotropic effect w/ class I antiarrhythmic drugs (e.g. quinidine, disopyramide, propafenone). Concomitant catecholamine-depleting drugs (e.g. reserpine, guanethidine) may produce excessive sympathetic activity. May exacerbate rebound HTN upon discontinuance of clonidine treatment. Increased risk of bradycardia w/ digitalis glycosides. Reduced hypotensive effect w/ NSAIDs.

Adverse Effects

Side effects of Bisoprolol : 1-10% Dizziness (10%), Dyssomnia (8%-10%), Bradyarrhythmia (9%), Upper respiratory infection (5%), Diarrhea (4%), Rhinitis (4%), Arthralgia (3%), Cough (3%), Dyspnea (2%), Nausea (2%), Pharyngitis (2%), Sinusitis (2%), Vomiting (2%) <1% Cold extremities, Hypotension, Depression, Dyspepsia, Bronchospasm Frequency Not Defined Aggravate CHF, Decrease HDL, Hypertriglyceridemia, Mask symptoms of hypoglycemia, Decreased exercise tolerance, Raynaud's phenomenon, May increase triglyceride levels and insulin resistance

Mechanism of Action

Bisoprolol selectively and competitively blocks beta1-receptors but has little or no effect on beta2-receptors except at high doses.