Bislor
Generic Name
Bisoprolol Fumarate
Manufacturer
Healthcare Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| bislor 20 mg tablet | ৳ 15.00 | ৳ 150.00 |
Description
Overview of the medicine
Bislor 20 mg Tablet contains Bisoprolol Fumarate, a cardioselective beta-1 adrenergic blocking agent. It is primarily used to treat high blood pressure, angina (chest pain due to heart disease), and chronic stable heart failure.
Uses & Indications
Dosage
Adults
Hypertension/Angina: Initially 5 mg once daily, maximum 20 mg once daily. Chronic heart failure: Initially 1.25 mg once daily for 1 week, gradually titrate up to a maximum of 10 mg once daily, guided by patient tolerance.
Elderly
No specific dose adjustment is usually required, but caution should be exercised, especially with renal/hepatic impairment.
Renal_impairment
In severe renal impairment (creatinine clearance <20 mL/min), the maximum dose is 10 mg once daily. No adjustment needed for mild to moderate impairment.
How to Take
Take orally, once daily in the morning, with or without food. Swallow the tablet whole with some liquid. Do not chew or crush.
Mechanism of Action
Bisoprolol selectively blocks beta-1 adrenergic receptors, primarily in the heart. This action reduces heart rate, myocardial contractility, and cardiac output, leading to decreased blood pressure and myocardial oxygen demand.
Pharmacokinetics
Onset
Within 2-4 hours for blood pressure reduction.
Excretion
Approximately 50% excreted unchanged in urine, and the remaining 50% as inactive metabolites.
Half life
Approximately 10-12 hours, allowing for once-daily dosing.
Absorption
Well absorbed orally, with a bioavailability of approximately 90%. Peak plasma concentrations occur within 2-4 hours.
Metabolism
About 50% metabolized in the liver to inactive metabolites by CYP2D6. The remaining 50% is excreted unchanged.
Side Effects
Contraindications
- Acute heart failure or during episodes of decompensation of heart failure requiring intravenous inotropic therapy
- Cardiogenic shock
- Second or third degree AV block (without a pacemaker)
- Sick sinus syndrome
- Sinoatrial block
- Bradycardia (heart rate <50 beats/minute before treatment)
- Severe asthma or severe chronic obstructive pulmonary disease
- Severe forms of peripheral arterial occlusive disease or Raynaud's syndrome
- Phaeochromocytoma (untreated)
- Metabolic acidosis
- Hypersensitivity to bisoprolol or any of the excipients
Drug Interactions
Clonidine
Risk of rebound hypertension upon abrupt withdrawal of clonidine if beta-blocker is not withdrawn several days prior.
Insulin and oral antidiabetics
Beta-blockers may mask symptoms of hypoglycemia (e.g., tachycardia).
MAO inhibitors (except MAO-B inhibitors)
Increased hypotensive effect, risk of hypertensive crisis.
NSAIDs (Non-steroidal anti-inflammatory drugs)
May reduce the antihypertensive effect of bisoprolol.
Antiarrhythmics (e.g., disopyramide, amiodarone)
Additive negative inotropic effects and prolongation of AV conduction time.
Calcium channel blockers (e.g., verapamil, diltiazem)
Increased risk of bradycardia, AV block, and severe hypotension. Close monitoring is essential.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include bradycardia, hypotension, bronchospasm, acute cardiac insufficiency, and hypoglycemia. Management involves supportive and symptomatic treatment. Atropine for bradycardia, glucagon, IV fluids, vasopressors, and bronchodilators may be used.
Pregnancy & Lactation
Pregnancy: Use only if clearly indicated and the potential benefits outweigh the risks. May cause fetal bradycardia, hypoglycemia, and respiratory depression. Lactation: Not recommended during breastfeeding as bisoprolol is excreted in breast milk.
Side Effects
Contraindications
- Acute heart failure or during episodes of decompensation of heart failure requiring intravenous inotropic therapy
- Cardiogenic shock
- Second or third degree AV block (without a pacemaker)
- Sick sinus syndrome
- Sinoatrial block
- Bradycardia (heart rate <50 beats/minute before treatment)
- Severe asthma or severe chronic obstructive pulmonary disease
- Severe forms of peripheral arterial occlusive disease or Raynaud's syndrome
- Phaeochromocytoma (untreated)
- Metabolic acidosis
- Hypersensitivity to bisoprolol or any of the excipients
Drug Interactions
Clonidine
Risk of rebound hypertension upon abrupt withdrawal of clonidine if beta-blocker is not withdrawn several days prior.
Insulin and oral antidiabetics
Beta-blockers may mask symptoms of hypoglycemia (e.g., tachycardia).
MAO inhibitors (except MAO-B inhibitors)
Increased hypotensive effect, risk of hypertensive crisis.
NSAIDs (Non-steroidal anti-inflammatory drugs)
May reduce the antihypertensive effect of bisoprolol.
Antiarrhythmics (e.g., disopyramide, amiodarone)
Additive negative inotropic effects and prolongation of AV conduction time.
Calcium channel blockers (e.g., verapamil, diltiazem)
Increased risk of bradycardia, AV block, and severe hypotension. Close monitoring is essential.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include bradycardia, hypotension, bronchospasm, acute cardiac insufficiency, and hypoglycemia. Management involves supportive and symptomatic treatment. Atropine for bradycardia, glucagon, IV fluids, vasopressors, and bronchodilators may be used.
Pregnancy & Lactation
Pregnancy: Use only if clearly indicated and the potential benefits outweigh the risks. May cause fetal bradycardia, hypoglycemia, and respiratory depression. Lactation: Not recommended during breastfeeding as bisoprolol is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture.
Availability
Pharmacies, Hospitals
Approval Status
Approved by relevant authorities (e.g., FDA, DGDA)
Patent Status
Off-patent globally, brand trademarked
WHO Essential Medicine
YesClinical Trials
Bisoprolol's efficacy in heart failure has been demonstrated in major clinical trials such as CIBIS-II and MERIT-HF.
Lab Monitoring
- Blood pressure monitoring
- Heart rate monitoring
- Renal function (e.g., creatinine, BUN) periodically
- Liver function tests (ALT, AST) in long-term therapy or if symptoms occur
- Blood glucose in diabetic patients
Doctor Notes
- Careful titration is crucial, especially in patients with chronic heart failure, starting with low doses.
- Monitor blood pressure and heart rate closely during initiation and dose adjustments.
- Educate patients on the importance of not discontinuing the medication abruptly.
- Assess for potential drug interactions, especially with other cardiovascular medications.
Patient Guidelines
- Do not stop taking Bislor abruptly without consulting your doctor, as this may worsen your condition.
- Inform your doctor about all medications you are taking, including over-the-counter drugs, supplements, and herbal remedies.
- Monitor your blood pressure and heart rate regularly as advised by your doctor.
- Report any new or worsening symptoms, especially shortness of breath, swelling of ankles, or unusual weight gain, to your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Bislor may cause dizziness, fatigue, or lightheadedness, especially at the start of treatment or when changing dosage. Exercise caution when driving or operating machinery until you know how the medicine affects you.
Lifestyle Advice
- Maintain a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity as recommended by your doctor.
- Limit alcohol intake and avoid smoking.
- Manage stress through relaxation techniques or hobbies.
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