Concor Overdosage

Symptoms: The most common signs expected with overdosage of a β-blocker are bradycardia, hypotension, bronchospasm, acute cardiac insufficiency and hypoglycaemia. To date, a few cases of overdose (maximum: 2000 mg) with bisoprolol have been reported in patients suffering from hypertension, and/or coronary heart disease showing bradycardia and/or hypotension; all patients recovered. There is a wide interindividual variation in sensitivity to 1 single high dose of bisoprolol and patients with heart failure are probably very sensitive. Therefore, it is mandatory to initiate the treatment of these patients with a gradual up-titration according to the scheme given (see Dosage & Administration).
Treatment: In general, if overdosage occurs, bisoprolol treatment should be stopped, and supportive and symptomatic treatment should be provided. Limited data suggest that bisoprolol is hardly dialysable. Based on the expected pharmacologic actions and recommendations for other β-blockers, the following general measures should be considered when clinically warranted.
Bradycardia: Administer IV atropine. If response is inadequate, isoprenaline or another agent with positive chronotropic properties may be given cautiously. Under some circumstances, transvenous pacemaker insertion may be necessary.
Hypotension: IV fluids and vasopressors should be administered. IV glucagon may be useful.
Atrioventricular Block (2nd- or 3rd-Degree): Patients should be carefully monitored and treated with isoprenaline infusion or transvenous cardiac pacemaker insertion.
Acute Worsening of Heart Failure: Administer IV diuretics, inotropic agents, vasodilating agents.
Bronchospasm: Administer bronchodilator therapy eg, isoprenaline, β₂-sympathomimetic drugs and/or aminophylline.
Hypoglycaemia: Administer IV glucose.
Limited data suggest that bisoprolol is hardly dialyzable.