Epibloc Dosage/Direction for Use

Hypertension/Angina pectoris: Adults: The dosage should be individually adjusted, in particular according to the pulse rate and therapeutic success. It is recommended to start with 5 mg per day. The usual dose is 10 mg once daily with a maximum recommended dose of 20 mg once daily.
Elderly: It is recommended to start with the lowest possibe dose.
Renal or hepatic impairment: In patients with liver or kidney function disorders of mild to moderate severity, no dosage adjustment is normally required. In patients with severe renal impairment (creatinine clearance <20 mL/min) and in patients with severe liver function disorders it is recommended that a daily dose of 10 mg is not exceeded.
Experience with the use of bisoprolol in renal dialysis patients is limited. However, there is no evidence that the dosage regime needs to be altered.
Stable chronic heart failure: Standard treatment of CHF consists of an ACE inhibitor (or an angiotensin receptor blocker in case of intolerance of ACE inhibitors), a beta-blocking agent, diuretics, and when appropriate cardiac glycosides. Patients should be stable (without acute failure) when bisoprolol treatment is initiated. It is recommended that the treating physician should be experienced in the management of chronic heart failure.
Titration phase: The treatment of stable chronic heart failure with bisoprolol requires a titration phase.
The treatment with bisoprolol is to be started with a gradual uptitration 1.25 mg once daily for 1 week, if well tolerated increase to a maximum, recommended dose of 10 mg once daily.
Close monitoring of vital signs (heart rate, blood pressure) and symptoms of worsening heart failure is recommended during titration phase.
Duration of treatment: Treatment of stable chronic heart failure with bisoprolol is generally long-term treatment. The treatment with bisoprolol must not be stopped abruptly since this might lead to a transitory worsening condition. Especially in patients with ischaemic heart disease, treatment must not be discontinued suddenly. Gradual reduction of the daily dose is recommended.
Bisoprolol should be taken in the morning and can be taken with food. They should be swallowed with liquid and should not be chewed.
Pediatric population: There is no experience with bisoprolol in children and adolescents, therefore its use cannot be recommended.