Isolol

Indications

Bisoprolol is used to treat high blood pressure and angina (chest pain caused by poor blood flow to the heart). It is also used together with other medicines to treat stable long-term heart failure, and doctors may use it to control a fast heart rate in atrial fibrillation.

How It Works

Bisoprolol is a cardioselective beta-blocker, which means it acts mainly on the heart. It blocks the effect of adrenaline on the heart, so the heart beats more slowly and with less effort. This lowers blood pressure and reduces the heart's need for oxygen.

Dosage and Administration

• High blood pressure and angina: usually 5 mg once a day; some people start at 2.5 mg. The doctor may increase it to 10 mg once a day. The maximum is 20 mg a day.
• Heart failure: started at a low dose of 1.25 mg once a day and increased slowly by the doctor over several weeks, up to a maximum of 10 mg once a day.
• Children: not recommended.

Take in the morning, with or without food, swallowed whole with water. Do not stop suddenly; the dose must be reduced gradually as the doctor advises.

Interactions

Verapamil and Diltiazem can slow the heart too much. Heart rhythm medicines such as Flecainide and Amiodarone, Digoxin and other blood pressure medicines add to its effects. If you also take Clonidine, do not stop Clonidine on your own. It can hide the warning signs of low blood sugar in people taking Insulin or diabetes tablets. Painkillers such as Ibuprofen can reduce its effect. Mefloquine and Fingolimod can slow the heart further.

Contraindications

• Heart failure that has suddenly worsened and needs hospital treatment, or shock caused by heart problems.
• Second or third degree heart block or sick sinus syndrome without a pacemaker.
• A very slow heart rate or very low blood pressure.
• Severe asthma or severe chronic lung disease.
• Severe circulation problems in the hands or legs (including severe Raynaud's).
• Untreated phaeochromocytoma, metabolic acidosis, or allergy to bisoprolol.

Side Effects

Common: tiredness, dizziness, headache, cold hands and feet, nausea, diarrhoea or constipation, and a slow pulse. In heart failure, symptoms may get a little worse when the dose is first increased.

Get urgent medical help if you have a very slow pulse, fainting, wheezing or difficulty breathing, worsening breathlessness or ankle swelling, or signs of allergy such as swelling of the face or throat.

Pregnancy and Lactation

Use in pregnancy only if the doctor decides it is clearly needed; the baby's growth may need checking, and the newborn should be watched for a slow heartbeat and low blood sugar. It is not known whether it passes into breast milk, so it is usually not recommended while breastfeeding; ask your doctor.

Precautions and Warnings

Never stop suddenly, as this can worsen angina or heart failure. Use with care in diabetes, mild asthma or lung disease, psoriasis, thyroid disease, first degree heart block and Prinzmetal's angina. In severe kidney or liver disease the dose should not usually go above 10 mg a day. Tell the doctor or dentist that you take it before any operation. Dizziness may affect driving.

Overdose

An overdose can cause a very slow heartbeat, very low blood pressure, dizziness, breathing difficulty, worsening heart failure and low blood sugar. Seek emergency medical help straight away.

Therapeutic Class

Cardioselective beta-adrenergic blocker (beta-blocker).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.