Bislol Plus 2.5 mg+6.25 mg

Description

Indications

Bislol Plus Tablet is indicated for the treatment of Hypertension.
Use the medicine as per the advice of a registered healthcare professional.

Pharmacology

Bisoprolol Fumarate and Hydrochlorothiazide are both used individually and in combination for managing hypertension. These agents work together to enhance the antihypertensive effect, with Hydrochlorothiazide 6.25 mg significantly amplifying the effect of Bisoprolol Fumarate. The risk of hypokalemia is notably 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, which has minimal membrane stabilizing or intrinsic sympathomimetic activities within its therapeutic dose range. Hydrochlorothiazide, a benzothiadiazine diuretic, acts on renal tubular mechanisms to increase the excretion of sodium and chloride ions in nearly equal amounts.

Dosage & Administration

Bisoprolol is effective for treating hypertension at daily doses ranging from 2.5 to 40 mg, while Hydrochlorothiazide is effective at doses between 12.5 and 50 mg. Clinical trials of the Bisoprolol/Hydrochlorothiazide combination therapy (using Bisoprolol doses from 2.5 to 20 mg and Hydrochlorothiazide doses from 6.25 to 25 mg) have shown that antihypertensive effects improve with increased doses of either component.

Initial Therapy:

Treatment can begin with the lowest dose combination, one 2.5/6.25 mg tablet once daily. Titration may occur at 14-day intervals, gradually increasing the dose up to the maximum recommended dose of 20/12.5 mg once daily, as needed.

Replacement Therapy:

The combination therapy may replace the individually titrated components if appropriate.

Therapy Guided by Clinical Effect:

For patients whose blood pressure is not adequately controlled with 2.5-20 mg of Bisoprolol daily, switching to this combination therapy may be beneficial. Patients who are well-controlled on 50 mg of Hydrochlorothiazide daily, but experience significant potassium loss, may achieve similar blood pressure control without the electrolyte disturbance when switched to this combination.

Use the medicine as per the advice of a registered healthcare professional.

Interactions

Bislol Plus may enhance the effects of other antihypertensive medications when used together. However, it should not be combined with other beta-blockers. Caution is advised for patients receiving catecholamine-depleting drugs (such as reserpine or guanethidine), as the additional beta-blocking effect of Bisoprolol Fumarate can excessively reduce sympathetic activity.

In patients using clonidine, it is recommended to stop Bislol Plus a few days before discontinuing clonidine therapy. Caution should also be exercised when using myocardial depressants or AV conduction inhibitors, such as specific calcium antagonists (verapamil or diltiazem) or antiarrhythmic agents like disopyramide. When used together, both digitalis glycosides and beta-blockers can slow atrioventricular conduction and reduce heart rate, increasing the risk of bradycardia.

Contraindications

This medication should not be used in patients with:

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

Side Effects

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

• Fatigue
• Dizziness
• Headache
• Bradycardia
• Arrhythmia
• Chest pain
• Palpitations
• Cold extremities
• Claudication
• Orthostatic hypotension
• Diarrhea, constipation, nausea
• Dyspepsia
• Rhinitis, pharyngitis, etc.

Pregnancy & Lactation

Use during Pregnancy:
Category C – There are no well-controlled studies in pregnant women. This medication should only be used during pregnancy if the potential benefit justifies the risk to the fetus.

Use during Lactation:
The effects of Bisoprolol Fumarate and Hydrochlorothiazide during lactation have not been studied in nursing mothers. Thiazides are excreted in human breast milk. Bisoprolol Fumarate has been detected in the milk of lactating rats. Due to the potential for serious adverse reactions in nursing infants, a decision should be made to either discontinue breastfeeding or the medication, depending on its importance to the mother.

Precautions & Warnings

Thiazide diuretics can potentially cause hyperuricemia or trigger acute gout in certain patients. Signs and symptoms of fluid and electrolyte imbalance include:

• Dry mouth
• Thirst
• Weakness
• Lethargy
• Drowsiness
• Restlessness
• Muscle cramps or fatigue
• Hypotension
• Oliguria
• Tachycardia
• Gastrointestinal disturbances (nausea, vomiting)

Hypokalemia may also occur. If Bislol Plus therapy is to be discontinued, it should be tapered gradually over about 2 weeks. Patients should be carefully monitored.

Overdose Effects

Overdose data for Bislol Plus is limited, but typical symptoms of beta-blocker overdose include bradycardia and hypotension, with lethargy being common. In severe cases, delirium, coma, convulsions, and respiratory arrest may occur.

With thiazide diuretics, acute intoxication is rare, but fluid and electrolyte loss is a prominent feature. Symptoms may include:

• Cardiovascular (tachycardia, hypotension, shock)
• Neuromuscular (weakness, confusion, dizziness, cramps, fatigue)
• Gastrointestinal (nausea, vomiting, thirst)
• Renal (polyuria, oliguria, or anuria)
• Laboratory findings (hypokalemia, hyponatremia, hypochloremia, alkalosis, elevated BUN)

Therapeutic Class

Combined antihypertensive preparations

Storage Conditions

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