Bislol Plus 2.5 mg+6.25 mg

Description

Indications Bislol Plus tablets are prescribed for the management of hypertension (high blood pressure).

Pharmacology Bislol Plus is a combination of Bisoprolol Fumarate and Hydrochlorothiazide, both of which are used to treat hypertension. Their combined effect provides enhanced blood pressure reduction. Hydrochlorothiazide at a dose of 6.25 mg significantly augments the antihypertensive effect of Bisoprolol Fumarate while also reducing the likelihood of hypokalemia compared to Hydrochlorothiazide 25 mg alone. Bisoprolol Fumarate is a selective beta-1 adrenergic receptor blocker that does not exhibit significant membrane-stabilizing or intrinsic sympathomimetic activity within therapeutic doses. Hydrochlorothiazide belongs to the benzothiadiazine diuretic class and works by modifying electrolyte reabsorption mechanisms in the renal tubules, leading to increased excretion of sodium and chloride.

Dosage & Administration Bisoprolol is effective for hypertension treatment when taken once daily in doses ranging from 2.5 mg to 40 mg, while Hydrochlorothiazide is effective at doses between 12.5 mg and 50 mg. Clinical studies using Bisoprolol doses of 2.5 to 20 mg and Hydrochlorothiazide doses of 6.25 to 25 mg have demonstrated a dose-dependent increase in antihypertensive efficacy.

• Initial Therapy: Treatment may begin with the lowest available dose, typically 2.5 mg Bisoprolol/6.25 mg Hydrochlorothiazide once daily. Dose adjustments should be made at 14-day intervals, up to a maximum recommended dose of 20 mg Bisoprolol/12.5 mg Hydrochlorothiazide daily.
• Replacement Therapy: Patients already stabilized on individual components may be switched to the fixed-dose combination.
• Therapy Based on Clinical Response: Patients not achieving adequate blood pressure control with Bisoprolol alone (2.5–20 mg daily) may benefit from the combination. Additionally, patients who experience significant potassium loss with Hydrochlorothiazide 50 mg alone may achieve better electrolyte balance with this combination therapy.

Drug Interactions Bislol Plus may enhance the effects of other antihypertensive medications when used together. It should not be used with other beta-blockers. Patients taking catecholamine-depleting drugs (such as reserpine or guanethidine) require close monitoring, as Bisoprolol Fumarate may cause excessive suppression of sympathetic activity. In patients using clonidine, it is recommended to discontinue Bislol Plus a few days before stopping clonidine. This medication should be used cautiously with myocardial depressants or AV conduction inhibitors, including calcium channel blockers of the phenylalkylamine (verapamil) and benzothiazepine (diltiazem) classes, as well as antiarrhythmic agents like disopyramide. Concomitant use with digitalis glycosides and beta-blockers may increase the risk of bradycardia.

Contraindications Bislol Plus is contraindicated in patients with:

• Cardiogenic shock
• Overt heart failure
• Second- or third-degree atrioventricular (AV) block
• Marked sinus bradycardia
• Anuria
• Hypersensitivity to Bisoprolol Fumarate, Hydrochlorothiazide, or sulfonamide-derived drugs

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

• Fatigue, dizziness, headache
• Bradycardia, arrhythmia, palpitations, chest pain, peripheral ischemia, orthostatic hypotension
• Cold extremities, claudication
• Gastrointestinal disturbances such as nausea, constipation, diarrhea, and dyspepsia
• Respiratory symptoms including rhinitis and pharyngitis

Pregnancy & Lactation

• Use in Pregnancy: Classified as Pregnancy Category C. There are no well-controlled studies in pregnant women. The medication should be used during pregnancy only if the potential benefits outweigh the risks to the fetus.
• Use in Nursing Mothers: The excretion of Bisoprolol Fumarate in human breast milk has not been studied, but Hydrochlorothiazide is known to be present in breast milk. Due to the potential for serious adverse effects in nursing infants, a decision should be made whether to discontinue breastfeeding or to discontinue the drug, based on its necessity for the mother.

Precautions & Warnings

• Thiazide diuretics may lead to hyperuricemia or trigger acute gout in susceptible individuals.
• Electrolyte imbalance symptoms, including dry mouth, excessive thirst, weakness, lethargy, drowsiness, restlessness, muscle cramps, fatigue, hypotension, reduced urine output, rapid heartbeat, nausea, and vomiting, should be monitored.
• Hypokalemia may occur.
• Discontinuation of therapy should be done gradually over two weeks under medical supervision.

Overdose Effects Data on Bislol Plus overdose is limited. Common overdose symptoms related to beta-blockers include bradycardia, hypotension, and lethargy. In severe cases, delirium, coma, convulsions, respiratory arrest, heart failure, bronchospasm, and hypoglycemia may occur. Thiazide diuretic overdose is rare but can result in acute dehydration and electrolyte imbalance. Symptoms may include:

• Cardiovascular: Hypotension, shock, tachycardia
• Neuromuscular: Weakness, confusion, dizziness, cramps, fatigue, altered consciousness
• Gastrointestinal: Nausea, vomiting, excessive thirst
• Renal: Polyuria, oliguria, or anuria
• Laboratory findings: Hypokalemia, hyponatremia, hypochloremia, alkalosis, elevated blood urea nitrogen (BUN), especially in patients with renal impairment

Therapeutic Class Combination antihypertensive agents

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