Concore Overdosage

Symptoms: The most common signs expected with overdose of a beta-blocker are slow heart rate (bradycardia), marked drop in blood pressure (hypotension), bronchospasm, acute cardiac insufficiency and hypoglycemia.
There is a wide inter-individual variation in sensitivity to one single high dose of bisoprolol and patients with heart failure are probably very sensitive.
Management: In general, if overdose occurs, discontinuation of bisoprolol treatment and supportive and symptomatic treatment is recommended.
Based on the expected pharmacologic actions and recommendations for other beta-blockers, the following general measures may be considered when clinically warranted.
Bradycardia: Administer intravenous atropine. If the 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: Intravenous fluids and vasopressors should be administered. Intravenous glucagon may be useful.
AV block (second or third degree): Patients should be carefully monitored and treated with isoprenaline infusion or temporary pacing.
Acute worsening of heart failure: Administer i.v. diuretics, inotropic agents, vasodilating agents.
Bronchospasm: Administer bronchodilator therapy such as isoprenaline, beta₂-sympathomimetic drugs and/or aminophylline.
Hypoglycemia: Administer i.v. glucose.
Limited data suggest that bisoprolol is hardly dialyzable.