Bistapro Special Precautions

Applies only to CHF: The treatment of stable chronic heart failure with bisoprolol has to be initiated with a special titration phase.
Applies to all indications: Especially in patients with ischaemic heart disease the cessation of therapy with bisoprolol must not be done abruptly unless clearly indicated, because this may lead to transitional worsening of heart condition.
Applies only to CHF: The initiation and cessation of treatment of stable chronic heart failure with bisoprolol necessitates regular monitoring.
There is no therapeutic experience of bisoprolol treatment in 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 showing large fluctuations in blood glucose values. Symptoms of hypoglycaemia can be masked; strict fasting; ongoing desensitisation therapy. As with other beta-blockers, bisoprolol may increase both the sensitivity towards allergens and the severity of anaphylactic reactions. Epinephrine treatment may not always yield the expected therapeutic effect; first degree AV block; Prinzmetal's angina; peripheral arterial occlusive disease. Aggravation of symptoms may occur especially when starting therapy.
Patients with psoriasis or with a history of psoriasis should only be given beta-blockers (e.g. bisoprolol) after a careful balancing of benefits against risks.
The symptoms of thyrotoxicosis may be masked under treatment with bisoprolol.
In patients with phaeochromocytoma bisoprolol must not be administered until after alpha-receptor blockade.
In patients undergoing general anaesthesia, the anaesthetist must be aware of beta-blockade. If it is thought necessary to withdraw beta-blocker therapy before surgery, this should be done gradually and completed about 48 hours before anaesthesia.
In bronchial asthma or other chronic obstructive pulmonary diseases, which may cause symptoms, concomitant bronchodilating therapy is recommended. Occasionally an increase of the airway resistance may occur in patients with asthma, therefore the dose of beta2-stimulants may have to be increased.
Athletes must be aware that this medicine may cause a positive reaction to 'anti-doping' tests.
Effects on ability to drive and use machines: Depending on the individual patients' response to treatment the ability to drive a vehicle or to use machines may be impaired. This needs to be considered particularly at start of treatment, upon change of medication, or in conjunction with alcohol.