Ancor Plus 5 mg+6.25 mg

Indications
Ancor Plus tablet is used for the treatment of Hypertension.
Take the medication as prescribed by a registered physician.

Pharmacology
Bisoprolol Fumarate and Hydrochlorothiazide are effective, both individually and in combination, for managing hypertension. The combined antihypertensive effect of these agents is additive. Hydrochlorothiazide 6.25 mg significantly enhances the effect of Bisoprolol Fumarate. The risk of hypokalemia with the Bisoprolol Fumarate and Hydrochlorothiazide 6.25 mg combination is notably lower compared to Hydrochlorothiazide 25 mg alone.
Bisoprolol Fumarate is a β1-selective (cardioselective) adrenoceptor blocking agent. It does not exhibit significant membrane-stabilizing or intrinsic sympathomimetic properties within its therapeutic dose range. Hydrochlorothiazide, a benzothiadiazine diuretic, influences renal tubular electrolyte reabsorption, resulting in an increase in the excretion of sodium and chloride in roughly equivalent amounts.

Dosage & Administration
Bisoprolol is effective for hypertension in once-daily doses of 2.5 to 40 mg, while Hydrochlorothiazide is effective in doses ranging from 12.5 to 50 mg. Clinical trials using the Bisoprolol/Hydrochlorothiazide combination showed that the antihypertensive effects increased with higher doses of either component.

• Initial Therapy: Start with the lowest combination dose of 2.5/6.25 mg once daily. Adjust the dose every 14 days as necessary, with a maximum recommended dose of 20/12.5 mg once daily.
• Replacement Therapy: The combination may replace individually titrated doses of Bisoprolol and Hydrochlorothiazide.
• Therapy Guided by Clinical Effect: If a patient’s blood pressure is not controlled with 2.5-20 mg of Bisoprolol daily, they may benefit from the combination. For patients controlled with 50 mg of Hydrochlorothiazide but experiencing significant potassium loss, switching to this combination may help achieve similar blood pressure control without electrolyte imbalance.
  Take the medication as prescribed by a registered physician.

Interaction
Ancor Plus may enhance the effects of other antihypertensive agents used concurrently. It should not be combined with other beta-blockers. Patients on catecholamine-depleting drugs like reserpine or guanethidine should be monitored closely, as the combined beta-blocking effect of Bisoprolol Fumarate can excessively reduce sympathetic activity.
When discontinuing therapy with clonidine, it is recommended to stop Ancor Plus several days before discontinuing clonidine. Use Ancor Plus cautiously with myocardial depressants or AV conduction inhibitors, such as certain calcium antagonists (e.g., verapamil, diltiazem) or antiarrhythmic agents (e.g., disopyramide). Both digitalis and beta-blockers slow AV conduction and reduce heart rate, which may increase the risk of bradycardia.

Contraindications
Ancor Plus is contraindicated in patients with cardiogenic shock, overt cardiac failure, second or third-degree AV block, significant sinus bradycardia, anuria, or hypersensitivity to either component or sulfonamide-derived drugs.

Side Effects
This medication is generally well-tolerated, and most side effects are mild and temporary. Potential side effects include fatigue, dizziness, headache, bradycardia, arrhythmia, peripheral ischemia, chest pain, palpitations, rhythm disturbances, cold extremities, claudication, orthostatic hypotension, diarrhea, constipation, nausea, dyspepsia, rhinitis, and pharyngitis.

Pregnancy & Lactation

• Use in Pregnancy: Category C. There are no adequate studies in pregnant women. Ancor Plus should only be used during pregnancy if the benefits outweigh the risks to the fetus.
• Use in Nursing Mothers: Bisoprolol Fumarate, alone or in combination with Hydrochlorothiazide, has not been studied in breastfeeding mothers. Thiazides are excreted in human breast milk, and small amounts of Bisoprolol Fumarate have been detected in the milk of lactating rats. Because of the potential for serious adverse reactions in infants, a decision should be made whether to discontinue breastfeeding or the medication, depending on the importance of the drug to the mother.

Precautions & Warnings
Patients receiving thiazide diuretics may experience hyperuricemia or acute gout. Symptoms of fluid and electrolyte imbalance, including dry mouth, thirst, weakness, drowsiness, muscle cramps, hypotension, tachycardia, and gastrointestinal disturbances like nausea and vomiting, should be monitored. Hypokalemia is a potential risk. Discontinuation of Ancor Plus therapy should be gradual over approximately 2 weeks, with careful observation.

Overdose Effects
There is limited data on overdose with Ancor Plus. Common symptoms of beta-blocker overdose include bradycardia, hypotension, and lethargy. Severe overdoses can lead to delirium, coma, convulsions, respiratory arrest, congestive heart failure, bronchospasm, and hypoglycemia. Overdose with thiazide diuretics is rare, but it can cause significant fluid and electrolyte loss, leading to symptoms such as tachycardia, hypotension, shock, confusion, muscle weakness, cramps, nausea, and renal issues (polyuria, oliguria, or anuria).

Therapeutic Class
Combined antihypertensive preparations

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