Bislol Plus 2.5 mg+6.25 mg

Description

Indications
Bislol Plus is prescribed for the management of hypertension.

Pharmacology
Bislol Plus contains Bisoprolol Fumarate and Hydrochlorothiazide, both of which are effective in controlling high blood pressure. When used together, these components have an additive antihypertensive effect, with Hydrochlorothiazide 6.25 mg enhancing the efficacy of Bisoprolol Fumarate. Additionally, this combination reduces the likelihood of hypokalemia compared to higher doses of Hydrochlorothiazide alone.

Bisoprolol Fumarate is a selective β1-adrenergic receptor blocker (cardioselective) that lacks significant membrane-stabilizing or intrinsic sympathomimetic activities at therapeutic doses. Hydrochlorothiazide, a thiazide diuretic, works by modifying electrolyte reabsorption in the renal tubules, promoting the excretion of sodium and chloride in approximately equal amounts.

Dosage & Administration

• Initial Therapy: The recommended starting dose is one tablet (2.5 mg Bisoprolol / 6.25 mg Hydrochlorothiazide) taken once daily. Dosage adjustments may be made at 14-day intervals as needed, up to a maximum dose of 20 mg / 12.5 mg per day.
• Replacement Therapy: Patients already receiving the individual components separately may switch to the fixed-dose combination for convenience.
• Adjustments Based on Clinical Response:
  • If blood pressure is not sufficiently controlled with Bisoprolol alone (2.5-20 mg daily), switching to the combination may be considered.
  • Patients taking Hydrochlorothiazide 50 mg who experience excessive potassium loss may achieve similar blood pressure control with this combination while minimizing electrolyte disturbances.

Tablets should be taken with or without food, preferably at the same time each day.

Drug Interactions

• Other Antihypertensive Agents: The effects of Bislol Plus may be enhanced when used with other blood pressure-lowering medications.
• Beta-Blockers: Should not be used in combination with other beta-blocking drugs.
• Catecholamine-Depleting Drugs (e.g., Reserpine, Guanethidine): May lead to excessive reduction in sympathetic activity; close monitoring is required.
• Clonidine: If discontinuing clonidine, Bislol Plus should be stopped several days in advance.
• Calcium Channel Blockers (e.g., Verapamil, Diltiazem), Antiarrhythmic Drugs: May enhance myocardial depression and AV conduction inhibition.
• Digitalis Glycosides: Concurrent use may increase the risk of bradycardia.

Contraindications
Bislol Plus 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, Hydrochlorothiazide, or other sulfonamide-derived drugs

Side Effects
Most side effects are mild and transient. Possible adverse effects include:

• Fatigue, dizziness, headache
• Bradycardia, arrhythmia, peripheral ischemia
• Chest pain, palpitations, cold extremities
• Orthostatic hypotension
• Gastrointestinal disturbances (nausea, diarrhea, constipation, dyspepsia)
• Respiratory issues (rhinitis, pharyngitis)

Use in Pregnancy & Lactation

• Pregnancy (Category C): There are no well-controlled studies in pregnant women. Bislol Plus should only be used if the potential benefits outweigh the risks.
• Breastfeeding: Hydrochlorothiazide is known to be excreted in breast milk, and small amounts of Bisoprolol have been found in animal studies. Due to the risk of adverse effects in infants, discontinuation of either breastfeeding or the medication should be considered based on clinical necessity.

Precautions & Warnings

• Thiazide diuretics may precipitate hyperuricemia or acute gout in susceptible individuals.
• Patients should monitor for signs of fluid and electrolyte imbalances, including dry mouth, thirst, muscle cramps, lethargy, drowsiness, and gastrointestinal disturbances.
• Hypokalemia may occur, and potassium levels should be monitored regularly.
• Discontinuation should be gradual over two weeks to avoid withdrawal effects.

Overdose Effects

• Beta-Blocker Overdose: Symptoms may include bradycardia, hypotension, lethargy, delirium, convulsions, respiratory depression, congestive heart failure, bronchospasm, and hypoglycemia.
• Thiazide Diuretic Overdose: Acute toxicity is rare but may lead to dehydration and electrolyte imbalances. Symptoms include cardiovascular effects (tachycardia, shock), neuromuscular issues (weakness, dizziness, confusion), renal disturbances (polyuria or oliguria), and metabolic imbalances (hypokalemia, hyponatremia).

Therapeutic Class
Combination antihypertensive preparations

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