Bisoprolol and Hydrochlorothiazide

Betablocking Agent · Beta-blocker/Thiazide diuretic

Indications

Angina. Hypertension.

Dosage

Angina/Hypertension: Adults: Dosage to be individualized. Usually 1 tab once daily. Max: Bisoprolol 20 mg & hydrochlorothiazide 12.5 mg. Children: Not recommended.

Adverse Effects

Cardiovascular effects including bradycardia, postural hypotension. Rarely, heart failure, increased AV block, cardiac arrhythmias. Raynaud's, phenomenon cold extremities, sexual dysfunction. GI, sleep and CNS disturbances. Dyspnoea rarely, bronchospasm. Skin reactions, withdraw if unexplained dry eyes or rash. Fatigue, paraesthesia, peripheral neuropathy, arthralgia, myopathy, altered blood sugar, haematology and lipid levels.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: 2nd or 3rd degree AV block (without pacemaker), severe bradycardia, sick sinus syndrome, uncontrolled heart failure, cardiogenic shock, severe peripheral arterial disease, hypotension, metabolic acidosis, untreated pheochromocytoma, severe asthma or COPD. Precautions: 1st degree AV block. Heart failure (avoid if uncontrolled). Peripheral arterial circulatory disorders (avoid if severe), Prinzmetal's angina, Myasthaenia gravis. Ischaemic heart disease, withdraw gradually. History of bronchospasm. Diabetes, hyperthyroidism, renal or hepatic impairment, psoriasis. Elderly. Consider withdrawal before elective surgery. Anaphylaxis risk due to increased sensitivity to allergens. Always withdraw gradually over period of 1-2 weeks.

Interactions

Ca++ antagonists. Antihypertensives including centrally acting agents (e.g. clonidine), antiarrhythmics, antipsychotics. TCADs, MAOIs, fluvoxamine, barbiturates, cardiac glycosides, sympathomimetics, cimetidine, hydralazine, rifampicin, insulin/oral hypoglycaemics, NSAIDs, ergot derivatives, erythromycin, anaesthetics, diuretics.

Pharmacokinetics

BISOPROLOL: Onset of action: 1-2 hrs. Absorption: Rapid and almost complete. Metabolism: Extensively hepatic; significant first-pass effect (approx. 20%). Bioavailability: Approx. 80%. Half-life elimination: Normal renal function: 9-12 hrs. CrCl <40mL/min: 27-36 hrs. Hepatic cirrhosis: 8-22 hrs. Time to peak: 2-4 hrs. Excretion: Urine (>50%). Faeces (<2%). HYDROCHLOROTHIAZIDE: Onset of action: Diuresis: Infants: 2-6 hrs. Adults: Approx. 2 hrs. Peak effect: 4-6 hrs. Duration: Infants: 8 hrs. Adults: 6-12 hrs. Absorption: Well absorbed, absorption is decreased in patients with CHF. Metabolism: Not metabolized. Bioavailability: 65%-75%. Half-life elimination: Approx. 6-15 hrs. Time to peak: Approx. 1-5 hrs. Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.