Bisoprolol Fumarate Tablets is an angiotensin II receptor blocker (ARB) used in the therapy of hypertension, Angina Pectoris, and Congestive Heart Failure. It is manufactured and sold in India as Concor,Corbis,Bisotab.
Bisoprolol Fumarate uses in the treatment of many conditions including Blood Pressure management, Angina Pectoris and Congestive heart failure. Bisoprolol is a potent highly beta1-selective-adrenoceptor blocking agent, lacking intrinsic sympathomimetic and relevant membrane stabilising activity. As with other Beta1blocking agents, the method of acting in hypertension is unclear. However, it is known that Bisoprolol reduces plasma renin activity markedly.
With regards to its antianginal mechanism, Bisoprolol by inhibiting the cardiac beta receptors inhibits the response given to sympathetic activation. That results in the decrease of heart rate and contractility this way decreasing the oxygen demand of the cardiac muscle.
Bisoprolol Fumarate is indicated for the treatment of
• Coronary heart disease (Angina pectoris)
• Congestive heart failure (CHF)
Dose and Method of Administration
The dosage and administration of Bisoprolol in the treatment of hypertension and chronic stable angina pectoris, Stable chronic heart failure including those in special population varies based on the disease and patient condition including special populations.
Method of Administration: Bisoprolol tablets are meant for oral use. Bisoprolol tablets should be taken in the morning and can be taken with food. They should be swallowed with liquid and should not be chewed.
Bisoprolol is contra-indicated in patients with:
• Hypersensitivity to the active substance or to any of the excipients
• Acute heart failure or during episodes of heart failure decompensation requiring i.v. inotropic therapy
• Cardiogenic shock
• Second or third degree AV block (without a pacemaker)
• Sick sinus syndrome
• Sinoatrial block
• Symptomatic bradycardia
• Symptomatic hypotension
• Severe bronchial asthma or severe chronic obstructive pulmonary disease
• Severe forms of peripheral arterial occlusive disease or severe forms of Raynaud's syndrome
• Untreated phaeochromocytoma
• Metabolic acidosis
Warning and Precautions
Bisoprolol is indicated in multiple conditions. In General Bisoprolol must be used with caution in:
• chronic obstructive lung diseases, which may cause symptoms, bronchodilating therapy is recommended to be given concomitantly. Occasionally an increase of the airway resistance may occur in patients with asthma, therefore the dose of beta2-stimulants may have to be increased
• Diabetes mellitus with large fluctuations in blood glucose values; symptoms of hypoglycaemia (e.g. tachycardia, palpitations or sweating) can be masked
• Strict fasting
• Ongoing desensitisation therapy. As with other beta-blockers, bisoprolol may increase both the sensitivity towards allergens and the severity of anaphylactic reactions. Epinephrine treatment may not always yield the expected therapeutic effect.
• First degree AV block
• Prinzmetal's angina
• Peripheral arterial occlusive disease. Aggravation of symptoms may occur especially when starting therapy.
• General anaesthesia
Bisoprolol may have drug interactions with the following drugs
• Calcium antagonists of the dihydropyridine type such as felodipine and amlodipine
• Class-III antiarrhythmic medicinal product (e.g. amiodarone)
• Parasympathomimetic medicinal products
• Topical beta-blocking agents
• Insulin and oral antidiabetic medicinal products
• Anaesthetic agents
• Digitalis glycosides
• Non-steroidal anti-inflammatory medicinal products (NSAIDs)
• β-Sympathomimetic agents (e.g. isoprenaline, dobutamine)
• Sympathomimetics that activate both β- and α-adrenoceptors (e.g. norepinephrine, epinephrine),etc
Side effects/ Overdose
The most common signs expected with overdose of a beta-blocker such as bisoprolol are bradycardia, hypotension, bronchospasm, acute cardiac insufficiency and hypoglycaemia. There is limited experience with overdose of bisoprolol, only a few cases of overdose with bisoprolol have been reported.