NIKP-Bisoprolol

2.5 mg: Stable chronic heart failure. 5 mg: HTN. Chronic stable angina pectoris. Stable chronic heart failure w/ reduced systolic left ventricular function in addition to ACE inhibitors, diuretics, & cardiac glycosides.

Stable chronic heart failure Adult Initially 1.25 mg once daily for 1 wk, gradually increased to 2.5 mg once daily for further wk, then 3.75 mg once daily for further wk, then 5 mg once daily for the following 4 wk, then 7.5 mg once daily for the following 4 wk. Maintenance & max recommended dose: 10 mg once daily. 5 mg: HTN & chronic angina pectoris Adult Individualized dose. Initially 5 mg once daily. Usual dose: 10 mg once daily. Max recommended dose: 20 mg daily. Severe renal (CrCl <20 mL/min) & hepatic impairment Max: 10 mg once daily. May divide dosage into halves.

May be taken with or without food.

Hypersensitivity. Acute heart failure or during episodes of heart failure decompensation requiring IV inotropic therapy; cardiogenic shock; 2^nd or 3^rd degree AV block; sick sinus syndrome; SA block; symptomatic bradycardia & hypotension; severe bronchial asthma; severe forms of peripheral arterial occlusive disease or Raynaud's syndrome; untreated phaeochromocytoma; metabolic acidosis.

Not to administer in patients w/ phaeochromocytoma until after α-receptor blockade. Gradually w/draw therapy before surgery (completed about 48 hr before anaesth). Avoid use in patients w/ obstructive airway diseases. Worsening of heart condition especially in patients w/ ischaemic heart disease upon abrupt cessation of therapy. Coronary vasospasm. Increased airway resistance in patients w/ asthma. May mask symptoms of hypoglycaemia (eg, tachycardia, palpitations, sweating); thyrotoxicosis. May increase sensitivity towards allergens & of anaphylactic reactions. Patients w/ insulin dependent type 1 DM; restrictive cardiomyopathy; congenital heart disease; haemodynamically significant organic valvular disease; MI w/in 3 mth; bronchospasm (bronchial asthma, obstructive airways diseases); DM w/ large fluctuating blood glucose values; strict fasting; ongoing desensitisation therapy; 1st degree AV block; Prinzmetal's angina; peripheral arterial occlusive disease (aggravation of symptoms might occur especially when starting therapy); psoriasis or history of psoriasis. Patients undergoing general anaesth. Regularly monitor initiation & cessation of treatment in patients w/ chronic heart failure. Not recommended to use in combination w/ Ca antagonists (of verapamil or diltiazem type), class-I antiarrhythmics, & centrally acting antihypertensives. May impair ability to drive & use machines. Severe renal & hepatic function impairment. Pregnancy. Not recommended to breastfeed during treatment. Not recommended in paed. 5 mg: Patients w/ HTN or angina pectoris & accompanying heart failure.

Dizziness, headache; feeling of coldness or numbness in the extremities, hypotension especially in patients w/ heart failure; nausea, vomiting, diarrhoea, constipation; fatigue. Patient w/ chronic heart failure: Bradycardia. Worsening of pre-existing heart failure; asthenia.

Increased risk of hypotension w/ antihypertensives & drugs w/ BP-lowering potential eg, TCAs, barbiturates, phenothiazines. Profound hypotension & AV block w/ Ca antagonists of verapamil & diltiazem type. Increased risk of hypotension & further deterioration of ventricular pump w/ Ca antagonists of dihydropyridine type eg, nifedipine, amlodipine, felodipine. Decreased central sympathetic tonus leading to reduced heart rate, cardiac output, & vasodilation w/ centrally acting antihypertensives eg, clonidine, methyldopa, moxonidine, rilmenidine. Potentiated effect on AV conduction time & increased -ve inotropic effect w/ class-I antiarrhythmics (eg, disopyramide, quinidine, lidocaine, phenytoin; flecainide, propafenone); class-III antiarrhythmics (eg, amiodarone). Increased AV conduction time & risk of bradycardia w/ parasympathomimetics. Increased hypoglycemic effects & may mask symptoms of hypoglycaemia w/ insulin & oral antidiabetics. Increased BP & exacerbated intermittent claudication w/ sympathomimetics that activate both β- & α-adrenoceptors eg, noradrenaline, adrenaline. Added systemic effects w/ topical β-blockers (eg, eye drops for glaucoma treatment). Attenuation of reflex tachycardia & increased risk of hypotension w/ anaesthetics. Reduced heart rate & increased AV conduction time w/ digitalis glycosides. Reduced hypotensive effect w/ NSAIDs. Reduced effect w/ sympathomimetics eg, β-sympathomimetics (eg, isoprenaline, dobutamine). Enhanced hypotensive effect & risk for hypertensive crisis w/ MAOIs except MAO-B inhibitors. Increased risk of bradycardia w/ mefloquine.

Beta-Blockers

C07AB07 - bisoprolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

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