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The B1 adrenergic receptor blocker, or beta-blocker, bisoprolol was approved in 1992 by the United States Food and Drug Administration (FDA) for use in treating high blood pressure. In 2011 it is used to treat a wide variety of other conditions, including angina, stage fright, reduced blood flow to the head, and to prevent post-traumatic stress disorder. Despite their relatively innocuous safety profile, some of the side effects of bisoprolol can be serious, including the exacerbation or precipitation of attacks of low blood sugar, asthma, and bradycardia. People at risk for these conditions as well as those with liver or kidney disease or who are taking certain medications, should take a lower initial bisoprolol dose. Due to a genetic resistance to the action of beta-blockers, an active dose of a diuretic should be co-administered to black patients who are using medications like bisoprolol.
When using this beta-blocker to treat high blood pressure in adults under the age of 65, an initial bisoprolol dose of 5 mg should be administered orally once per day. A maintenance dose between 5 mg and 20 mg may be given once daily if required. The same regimen with no maintenance dose can be used in the prevention angina pectoris attacks, to treat premature ventricular depolarizations, or to control supraventricular tachycardia. Depending on the patient's response, the bisoprolol dose may be increased to 10 mg after three days, and then to 20 mg in another three days.
In adult patients with congestive heart failure, an initial dose of 1.25 mg should be taken orally once daily, with or without food. If this dose is well tolerated after 48 hours, it can be increased by 1.25 mg. Evaluation of dosage increases should be conducted every seven days, with increases not exceeding a daily bisoprolol dose of 5 mg.
The dosage recommendations for patients with moderate to severe kidney sufficiency — defined as having CrCl levels of less than 40 ml/min — should be given an initial dose of 2.5 mg once daily, with a maintenance dose between 2.5 mg and 20 mg once daily. Patients suffering from lowered hepatic function should follow the same dosage recommendations. Caution should also be used when determining the appropriate bisoprolol dose to give patients with a history of asthma, bronchospastic disease, heart failure, peripheral vascular disease or diabetes, particularly in dosages greater than 20 mg per day.
Discontinuation of this medication should be performed gradually and under close medical supervision. There have been several instances of the exacerbation of angina as well as sudden heart attacks and ventricular arrhythmias after the sudden cessation of treatment. These risks are even more pronounced in patients with coronary artery disease.
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