Concor Dosage/Direction for Use

Treatment of Hypertension or Angina Pectoris: 1 tab (Concor 5 mg) daily in the morning before or after breakfast. In milder forms of disease, Concor 5 mg daily may be sufficient. Most patients will be controlled by 10 mg daily only in few cases a dosage of 20 mg daily is required.
Treatment of Stable Chronic Heart Failure: The patients should have stable chronic heart failure without acute failure during the past 6 weeks and a mainly unchanged basic therapy during the past 2 weeks. They should be treated at optimal dose with an ACE inhibitor (or other vasodilator in case of intolerance to ACE inhibitor) and a diuretic, and optionally cardiac glycosides, prior to the administration of bisoprolol.
It is recommended that the treating physician should be experienced in the management of chronic heart failure.
Warning: The treatment of stable chronic heart failure with bisoprolol has to be initiated with a titration phase as follows: The treatment with bisoprolol is to be started with a gradual up-titration according to the following steps: 1.25 mg once daily for 1 week. If well tolerated, increase to 2.5 mg up to 3.75 mg for a further week. If well tolerated, increase to 5 mg up to 7.5 mg once daily for the following weeks. If well tolerated, increase to 10 mg once daily for the maintenance therapy.
After initiation of treatment with 1.25 mg, the patients should be observed over a period of approximately 4 hrs (especially as regards to blood pressure, heart rate, conduction disturbances, signs of worsening heart failure).
The maximum recommended dose is 10 mg once daily.
Occurrence of adverse events may prevent all patients being treated with the maximum recommended dose. If necessary, the dose reached can also be decreased step by step. The treatment may be interrupted if necessary and reintroduced as appropriate. During the titration phase, in case of worsening heart failure or intolerance, it is recommended first to reduce the dose of bisoprolol, or to stop immediately if necessary (in case of severe hypotension, worsening heart failure with acute pulmonary edema, cardiogenic shock, symptomatic bradycardia or atrioventrivular block).
Duration of Therapy For All Indications: Treatment of stable chronic heart failure with bisoprolol is generally a long-term treatment. The treatment with bisoprolol is not recommended to be stopped abruptly since this might lead to a transitory worsening of heart failure. If discontinuation is necessary, the dose should be gradually decreased divided into halves weekly.
Special Populations: Renal or Liver Impairment: Treatment of Hypertension or Angina Pectoris: For patients with final stage of renal impairment or severe disturbances in liver function, the maximum dosage is 10 mg daily.
Treatment of Stable Chronic Heart Failure: There is no information regarding pharmacokinetics of bisoprolol in patients with chronic heart failure, and with impaired liver or renal function. Uptitration of the dose in these populations should therefore be made with additional caution.
Elderly: No dosage adjustment is required.
Children: There is no pediatric experience with bisoprolol, therefore its use cannot be recommended for children.
Administration: Bisoprolol tablets should be taken in the morning and can be taken with food. The tablets should be swallowed with liquid and should not be chewed.