ANCOR PLUS 2.5MG + 6.25MG

Description

Indications
Ancor Plus tablet is prescribed for the management and treatment of hypertension.
Take the medicine as directed by a registered healthcare professional.

Pharmacology
The combination of Bisoprolol Fumarate and Hydrochlorothiazide has been used individually and together in treating high blood pressure. The antihypertensive effects of these two agents are complementary, with Hydrochlorothiazide 6.25 mg enhancing the effect of Bisoprolol Fumarate. Notably, the incidence of hypokalemia is lower with the combination of Bisoprolol Fumarate and Hydrochlorothiazide 6.25 mg compared to Hydrochlorothiazide 25 mg alone.
Bisoprolol Fumarate is a β1-selective (cardioselective) adrenoceptor blocking agent that does not exhibit significant membrane stabilizing or intrinsic sympathomimetic activity at the recommended therapeutic doses. Hydrochlorothiazide, a benzothiadiazine diuretic, works by altering renal tubular processes to increase the excretion of sodium and chloride, which helps control blood pressure.

Dosage & Administration
Bisoprolol is effective in treating hypertension with once-daily doses ranging from 2.5 mg to 40 mg, while Hydrochlorothiazide is effective within the range of 12.5 mg to 50 mg. In clinical studies with Bisoprolol and Hydrochlorothiazide combination therapy, doses ranging from 2.5 mg to 20 mg of Bisoprolol and 6.25 mg to 25 mg of Hydrochlorothiazide showed an increase in antihypertensive effect as the doses were adjusted.

• Initial Therapy: For starting treatment, the combination can be taken as one tablet of 2.5/6.25 mg once daily. The dosage may be increased gradually in 14-day intervals to the maximum recommended dose of 20/12.5 mg once daily.
• Replacement Therapy: This combination can replace individual components once titrated to appropriate doses.
• Therapy Guided by Clinical Effect: If blood pressure is not well controlled with 2.5-20 mg Bisoprolol daily, this combination may be considered. Patients who experience significant potassium loss with 50 mg Hydrochlorothiazide daily may achieve similar blood pressure control without the electrolyte disturbances by switching to this combination.
  Take the medicine as directed by a registered healthcare professional.

Interaction
Ancor Plus may enhance the effects of other antihypertensive medications. It should not be used with other beta-blockers. Close monitoring is necessary for patients on catecholamine-depleting drugs, such as reserpine or guanethidine, as the additional beta-blocking effect of Bisoprolol Fumarate may cause an excessive reduction in sympathetic activity.
In patients receiving clonidine, Ancor Plus should be discontinued several days before discontinuing clonidine. Caution is advised when using Ancor Plus alongside myocardial depressants or AV conduction inhibitors like calcium antagonists (especially verapamil and diltiazem) or antiarrhythmic drugs like disopyramide, as they can worsen bradycardia. The combined use of digitalis glycosides and beta-blockers may increase the risk of bradycardia due to their effect on atrioventricular conduction and heart rate.

Contraindications
Ancor Plus should not be used in patients with cardiogenic shock, overt heart failure, second- or third-degree AV block, marked sinus bradycardia, anuria, or hypersensitivity to either component or other sulfonamide-derived drugs.

Side Effects
Ancor Plus is generally well tolerated, with most side effects being mild and transient. Possible side effects include:

• Fatigue
• Dizziness
• Headache
• Bradycardia
• Arrhythmias
• Peripheral ischemia
• Chest pain
• Palpitations
• Cold extremities
• Claudication
• Orthostatic hypotension
• Gastrointestinal issues such as nausea, constipation, diarrhea, dyspepsia, rhinitis, pharyngitis

Pregnancy & Lactation

• Use in Pregnancy: Category C. There are no well-controlled studies in pregnant women, so this medication should only be used if the potential benefit justifies the risk to the fetus.
• Use in Nursing Mothers: Bisoprolol Fumarate, whether used alone or in combination with Hydrochlorothiazide, has not been studied in nursing mothers. Thiazides are excreted in breast milk, and small amounts of Bisoprolol Fumarate have been detected in lactating rats. Due to potential risks to nursing infants, a decision must be made whether to discontinue breastfeeding or the medication, depending on the importance of the drug for the mother.

Precautions & Warnings

• Hyperuricemia and Gout: Thiazide diuretics like Hydrochlorothiazide can precipitate hyperuricemia or acute gout in some patients.
• Fluid and Electrolyte Imbalance: Watch for symptoms such as mouth dryness, thirst, weakness, drowsiness, muscle cramps, fatigue, hypotension, tachycardia, and gastrointestinal issues. Hypokalemia may occur.
• Withdrawal: If Ancor Plus therapy needs to be discontinued, it should be done gradually over approximately two weeks, with close observation.

Overdose Effects
Overdose symptoms may include bradycardia, hypotension, lethargy, and, in severe cases, delirium, coma, respiratory arrest, congestive heart failure, bronchospasm, or hypoglycemia. Overdose with thiazide diuretics is rare, but may lead to acute fluid and electrolyte loss. Symptoms may include tachycardia, hypotension, shock, weakness, confusion, dizziness, cramps, and gastrointestinal distress.

Therapeutic Class
Combined antihypertensive preparations.

Storage Conditions
Store below 30°C, away from light and moisture. Keep out of reach of children.