Cardifort Plus
Generic Name
Bisoprolol Fumarate + Amlodipine Besylate
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| cardifort plus 5 mg tablet | ৳ 6.00 | ৳ 60.00 |
Description
Overview of the medicine
Cardifort Plus 5 mg tablet is a combination medication containing Bisoprolol Fumarate and Amlodipine Besylate. It is primarily used for the management of hypertension (high blood pressure) and chronic stable angina pectoris. Bisoprolol is a beta-blocker that reduces heart rate and blood pressure, while Amlodipine is a calcium channel blocker that relaxes blood vessels.
Uses & Indications
Dosage
Adults
One Cardifort Plus 5/5 tablet (Bisoprolol 5mg + Amlodipine 5mg) once daily, or as directed by physician. Dosage should be individualized.
Elderly
No specific dose adjustment is generally required, but caution should be exercised. Start with a lower dose if necessary and titrate carefully.
Renal_impairment
Mild to moderate renal impairment: No dose adjustment usually needed. Severe renal impairment: Use with caution, consider lower starting doses. Monitor renal function closely.
How to Take
Take the tablet orally with water, usually once daily, with or without food. It is recommended to take it at the same time each day.
Mechanism of Action
Bisoprolol is a highly selective beta1-adrenergic receptor blocker. It reduces heart rate and cardiac output, thereby lowering blood pressure. Amlodipine is a dihydropyridine calcium channel blocker. It inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, leading to vasodilation and reduced peripheral vascular resistance.
Pharmacokinetics
Onset
Bisoprolol: ~2 hours (antihypertensive effect). Amlodipine: ~6-12 hours (antihypertensive effect).
Excretion
Bisoprolol: ~50% renally excreted unchanged, remainder as inactive metabolites. Amlodipine: Primarily excreted in urine as inactive metabolites (60%).
Half life
Bisoprolol: 10-12 hours. Amlodipine: 30-50 hours.
Absorption
Bisoprolol: Well absorbed (bioavailability ~90%). Amlodipine: Well absorbed orally (bioavailability ~60-65%). Peak plasma concentrations are reached in 2-4 hours for bisoprolol and 6-12 hours for amlodipine.
Metabolism
Bisoprolol: ~50% hepatic metabolism via CYP2D6. Amlodipine: Extensive hepatic metabolism via CYP3A4.
Side Effects
Contraindications
- Hypersensitivity to bisoprolol, amlodipine, or any component of the formulation
- Acute heart failure or decompensated heart failure requiring intravenous inotropic therapy
- Cardiogenic shock
- Sick sinus syndrome (unless a pacemaker is in situ)
- Second or third-degree AV block (unless a pacemaker is in situ)
- Severe bradycardia (heart rate <50 bpm)
- Severe hypotension
- Severe bronchial asthma or severe chronic obstructive pulmonary disease
- Severe peripheral arterial occlusive disease or Raynaud's syndrome
Drug Interactions
NSAIDs
May reduce the antihypertensive effect of both bisoprolol and amlodipine.
Digitalis glycosides
Increased risk of bradycardia with bisoprolol.
Other antihypertensives
Additive hypotensive effects. Concurrent use requires caution and dose adjustment.
Calcium antagonists (e.g., verapamil, diltiazem)
Increased risk of bradycardia and AV block with bisoprolol. Increased risk of hypotension with amlodipine.
CYP3A4 inhibitors (e.g., ketoconazole, ritonavir)
May increase amlodipine plasma concentrations, leading to increased risk of side effects.
CYP3A4 inducers (e.g., rifampicin, St. John's Wort)
May decrease amlodipine plasma concentrations, reducing efficacy.
Class I antiarrhythmics (e.g., disopyramide, quinidine)
May potentiate the negative inotropic effect of bisoprolol and increase AV conduction time.
Storage
Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, bradycardia, heart failure, and bronchospasm. Management involves supportive therapy, including gastric lavage, activated charcoal, and intravenous fluids. For bradycardia, atropine or isoproterenol may be administered. Glucagon may be useful for severe cardiac depression. Vasopressors may be needed for hypotension.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Bisoprolol and amlodipine are excreted in breast milk. Caution should be exercised when administered to a nursing mother; consider discontinuing the drug or breastfeeding based on the importance of the drug to the mother.
Side Effects
Contraindications
- Hypersensitivity to bisoprolol, amlodipine, or any component of the formulation
- Acute heart failure or decompensated heart failure requiring intravenous inotropic therapy
- Cardiogenic shock
- Sick sinus syndrome (unless a pacemaker is in situ)
- Second or third-degree AV block (unless a pacemaker is in situ)
- Severe bradycardia (heart rate <50 bpm)
- Severe hypotension
- Severe bronchial asthma or severe chronic obstructive pulmonary disease
- Severe peripheral arterial occlusive disease or Raynaud's syndrome
Drug Interactions
NSAIDs
May reduce the antihypertensive effect of both bisoprolol and amlodipine.
Digitalis glycosides
Increased risk of bradycardia with bisoprolol.
Other antihypertensives
Additive hypotensive effects. Concurrent use requires caution and dose adjustment.
Calcium antagonists (e.g., verapamil, diltiazem)
Increased risk of bradycardia and AV block with bisoprolol. Increased risk of hypotension with amlodipine.
CYP3A4 inhibitors (e.g., ketoconazole, ritonavir)
May increase amlodipine plasma concentrations, leading to increased risk of side effects.
CYP3A4 inducers (e.g., rifampicin, St. John's Wort)
May decrease amlodipine plasma concentrations, reducing efficacy.
Class I antiarrhythmics (e.g., disopyramide, quinidine)
May potentiate the negative inotropic effect of bisoprolol and increase AV conduction time.
Storage
Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, bradycardia, heart failure, and bronchospasm. Management involves supportive therapy, including gastric lavage, activated charcoal, and intravenous fluids. For bradycardia, atropine or isoproterenol may be administered. Glucagon may be useful for severe cardiac depression. Vasopressors may be needed for hypotension.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Bisoprolol and amlodipine are excreted in breast milk. Caution should be exercised when administered to a nursing mother; consider discontinuing the drug or breastfeeding based on the importance of the drug to the mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture. Refer to the specific product packaging for exact details.
Availability
Available in pharmacies nationwide
Approval Status
Approved by DGDA (Bangladesh)
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of bisoprolol and amlodipine combinations in managing hypertension and angina, showing superior blood pressure control and tolerability compared to monotherapy in many cases.
Lab Monitoring
- Blood pressure monitoring
- Heart rate monitoring
- Renal function tests (e.g., serum creatinine, BUN) periodically
- Liver function tests (e.g., ALT, AST) periodically
- Electrolyte levels (e.g., potassium)
Doctor Notes
- Emphasize gradual withdrawal of bisoprolol to prevent rebound effects.
- Monitor for signs of bradycardia and hypotension, especially in elderly patients or those with pre-existing cardiac conditions.
- Advise patients about potential ankle edema associated with amlodipine, and differentiate it from systemic fluid retention.
- Consider dosage adjustment in severe hepatic impairment for amlodipine.
Patient Guidelines
- Take this medicine regularly as prescribed by your doctor, even if you feel well.
- Do not stop taking this medicine abruptly without consulting your doctor.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
- Report any unusual side effects, especially swelling in the ankles or persistent dizziness, to your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
This medicine may cause dizziness, fatigue, or blurred vision, especially at the start of treatment or when changing doses. Patients should be cautioned about driving or operating machinery until they know how they react to the medication.
Lifestyle Advice
- Adopt a healthy lifestyle including a balanced diet low in salt and fat.
- Engage in regular physical activity as advised by your doctor.
- Maintain a healthy weight.
- Avoid smoking and limit alcohol consumption.
- Manage stress effectively.
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