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Applies only to hypertension or angina pectoris: Bisoprolol must be used with caution in patients with hypertension or angina pectoris and accompanying heart failure.
Applies only to chronic heart failure: The initiation of treatment with bisoprolol necessitates regular monitoring.
There is no therapeutic experience of bisoprolol treatment of heart failure in patients with the following diseases and conditions: insulin dependent diabetes mellitus (type I); severely impaired renal function; severely impaired hepatic function; restrictive cardiomyopathy; congenital heart disease; haemodynamically significant organic valvular disease; myocardial infarction within 3 months.
Applies to all indications: Bisoprolol must be used with caution in: bronchospasm (bronchial asthma, obstructive airways diseases); diabetes mellitus with large fluctuations in blood glucose values (symptoms of hypoglycaemia (e.g. tachycardia, palpitations or sweating) can be masked); strict fasting; ongoing desensitisation therapy; first degree AV block; Prinzmetal's angina; peripheral arterial occlusive disease (intensification of complaints might happen especially during the start of therapy); general anaesthesia.
In bronchial asthma or other chronic obstructive lung diseases, which may cause symptoms, bronchodilating therapy is recommended to be given concomitantly. Occasionally an increase of the airway resistance may occur in patients with asthma, therefore the dose of beta2-stimulants may have to be increased.
As with other beta-blockers, bisoprolol may increase both the sensitivity towards allergens and the severity of anaphylactic reactions.
Adrenaline treatment does not always give the expected therapeutic effect.
In patients undergoing general anaesthesia, beta-blockade reduces the incidence of arrhythmias and myocardial ischemia during induction and intubation, and the post-operative period. It is currently recommended that maintenance beta-blockade be continued peri-operatively. The anaesthetist must be aware of beta-blockade because of the potential for interactions with other drugs, resulting in bradyarrhythmias, attenuation of the reflex tachycardia and the decreased reflex ability to compensate for blood loss. If it is thought necessary to withdraw beta-blocker therapy before surgery, this should be done gradually and completed about 48 hours before anaesthesia.
Patients with psoriasis or with a history of psoriasis should only be given beta-blockers (e.g. bisoprolol) after carefully balancing the benefits against the risks.
In patients with phaeochromocytoma, bisoprolol must not be administered until after alpha-receptor blockade.
Under treatment with bisoprolol, the symptoms of thyrotoxicosis may be masked.
Effects on ability to drive and use machines: In a study with coronary heart disease patients, bisoprolol did not impair driving performance. However, due to individual variations in reactions to the drug, the ability to drive a vehicle or to operate machinery may be impaired. This should be considered particularly at start of treatment and upon change of medication as well as in conjunction with alcohol.
