Bislol Plus 5 mg+6.25 mg

Description

Indications
Bislol Plus tablet is indicated for the management and treatment of hypertension.
It is important to use this medication only under the guidance of a registered healthcare professional.

Pharmacology
Bislol Plus combines two active ingredients: Bisoprolol Fumarate and Hydrochlorothiazide, both of which are used separately or in combination to treat hypertension. The antihypertensive effects of these agents work synergistically, meaning their effects add up. The 6.25 mg dose of Hydrochlorothiazide significantly enhances the blood pressure-lowering effects of Bisoprolol Fumarate. Additionally, the incidence of hypokalemia (low potassium levels) with the Bisoprolol Fumarate and Hydrochlorothiazide 6.25 mg combination is notably lower than when Hydrochlorothiazide is used alone at higher doses.

• Bisoprolol Fumarate is a β1-selective (cardioselective) beta-blocker, which primarily targets the heart with minimal effects on other organs. It does not exhibit membrane stabilizing or intrinsic sympathomimetic activities at its therapeutic doses.
• Hydrochlorothiazide is a thiazide diuretic. It works by influencing renal tubular mechanisms to enhance the excretion of sodium and chloride, helping to lower blood pressure.

Dosage & Administration
The typical dosage range for Bisoprolol is 2.5 to 40 mg once daily, while Hydrochlorothiazide is effective in doses ranging from 12.5 to 50 mg. Clinical trials have shown that the antihypertensive effects of this combination increase with higher doses of either ingredient.

• Initial Therapy: Start with one tablet containing 2.5 mg Bisoprolol and 6.25 mg Hydrochlorothiazide once daily. Dose titration (at intervals of 14 days) can be carried out, adjusting up to a maximum of 20 mg Bisoprolol and 12.5 mg Hydrochlorothiazide once daily, depending on individual response.
• Replacement Therapy: The combination of Bisoprolol and Hydrochlorothiazide may replace the individual use of these medications if they were previously titrated separately.
• Therapy Guided by Clinical Effect: If a patient’s blood pressure is not well controlled with Bisoprolol alone (2.5 to 20 mg daily), this combination may be considered. If the patient is already using 50 mg of Hydrochlorothiazide daily and experiences significant potassium loss, the combination can provide similar blood pressure control without causing electrolyte imbalances.

Always follow the instructions of a registered healthcare professional when using this medication.

Interactions

• Bislol Plus may enhance the effects of other antihypertensive agents taken alongside it.
• It should not be combined with other beta-blockers.
• If a patient is receiving catecholamine-depleting drugs like reserpine or guanethidine, close monitoring is advised due to the potential for excessive sympathetic activity suppression caused by Bisoprolol Fumarate.
• When used with clonidine, discontinue Bislol Plus several days before stopping clonidine to avoid a rebound hypertensive effect.
• Caution is required when using this combination with myocardial depressants or inhibitors of AV conduction, such as certain calcium antagonists (verapamil, diltiazem), or antiarrhythmic drugs (disopyramide), as both beta-blockers and digitalis glycosides slow AV conduction and lower heart rate. This can increase the risk of bradycardia (slow heart rate).

Contraindications
Bislol Plus is contraindicated in patients with:

• Cardiogenic shock
• Overt heart failure
• Second or third-degree AV block
• Marked sinus bradycardia
• Anuria (absence of urine production)
• Hypersensitivity to any component of this product or other sulfonamide-derived drugs

Side Effects
Bislol Plus is generally well-tolerated. Most side effects are mild and transient. Possible side effects include:

• Fatigue
• Dizziness
• Headache
• Bradycardia (slow heart rate)
• Arrhythmia (irregular heartbeats)
• Peripheral ischemia (reduced blood flow to limbs)
• Chest pain
• Palpitations
• Cold extremities
• Claudication (pain in the legs due to inadequate blood flow)
• Orthostatic hypotension (low blood pressure upon standing)
• Diarrhea, constipation, nausea, dyspepsia (indigestion)
• Rhinitis (inflammation of the nose)
• Pharyngitis (inflammation of the throat)

Pregnancy & Lactation

• Pregnancy: Category C. There are no well-controlled studies in pregnant women. Bisoprolol Fumarate and Hydrochlorothiazide should only be used during pregnancy if the potential benefit justifies the possible risk to the fetus.
• Lactation: There are no studies on the use of Bisoprolol Fumarate with Hydrochlorothiazide in nursing mothers. Thiazides are excreted in human breast milk, and small amounts of Bisoprolol Fumarate have been detected in the milk of lactating rats. Due to the potential risks to nursing infants, a decision should be made whether to discontinue breastfeeding or stop the medication, considering the importance of the drug to the mother.

Precautions & Warnings

• Thiazide diuretics like Hydrochlorothiazide can cause hyperuricemia (high uric acid levels) or trigger acute gout in some patients.
• Watch for signs of fluid and electrolyte imbalances, such as dry mouth, thirst, weakness, fatigue, restlessness, muscle cramps, hypotension (low blood pressure), and gastrointestinal issues like nausea and vomiting. Hypokalemia (low potassium) may also develop.
• If discontinuing Bislol Plus, it should be done gradually over 2 weeks, with close monitoring.

Overdose Effects
Overdose data for Bislol Plus are limited. Symptoms of overdose with Bisoprolol Fumarate typically include bradycardia and hypotension, often accompanied by lethargy. Severe overdoses can result in delirium, coma, seizures, and respiratory arrest.
With Hydrochlorothiazide, acute intoxication is rare but may lead to significant fluid and electrolyte loss. Symptoms of overdose include:

• Cardiovascular: Tachycardia (fast heart rate), hypotension, shock
• Neuromuscular: Weakness, confusion, dizziness, cramps, fatigue
• Gastrointestinal: Nausea, vomiting, extreme thirst
• Renal: Polyuria (excessive urination), oliguria (low urine output), or anuria
• Laboratory findings: Hypokalemia, hyponatremia (low sodium), hypochloremia, alkalosis, and elevated BUN (blood urea nitrogen)

Therapeutic Class
Combined antihypertensive preparations

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