Cardobis Plus
Generic Name
Bisoprolol Fumarate + Hydrochlorothiazide
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| cardobis plus 5 mg tablet | ৳ 11.00 | ৳ 110.00 |
| cardobis plus 25 mg tablet | ৳ 7.00 | ৳ 70.00 |
Description
Overview of the medicine
Cardobis Plus is a combination medicine containing Bisoprolol Fumarate, a beta-blocker, and Hydrochlorothiazide, a thiazide diuretic. It is used to treat essential hypertension (high blood pressure). Bisoprolol reduces heart rate and contractility, while hydrochlorothiazide promotes the excretion of sodium and water from the body, thereby reducing blood volume and blood pressure.
Uses & Indications
Dosage
Adults
Usually 1 tablet once daily. Dosage may be adjusted by a physician based on blood pressure response.
Elderly
No specific dose adjustment is typically required, but caution is advised due to potential age-related organ function decline.
Renal_impairment
Use with caution in patients with renal impairment; dosage adjustment may be necessary for severe impairment.
How to Take
Take orally, once daily, preferably in the morning. It can be taken with or without food. Swallow the tablet whole with water; do not crush or chew.
Mechanism of Action
Bisoprolol selectively blocks beta-1 adrenergic receptors, reducing heart rate and cardiac output. Hydrochlorothiazide acts on the distal convoluted tubules to inhibit sodium and chloride reabsorption, leading to increased excretion of water, sodium, and chloride. This combined action effectively lowers blood pressure.
Pharmacokinetics
Onset
Bisoprolol: 2-4 hours; Hydrochlorothiazide: 2 hours.
Excretion
Bisoprolol: ~50% renal excretion (unchanged), ~50% metabolites in urine; Hydrochlorothiazide: Primarily renal excretion (unchanged).
Half life
Bisoprolol: 10-12 hours; Hydrochlorothiazide: 5-15 hours.
Absorption
Bisoprolol is almost completely absorbed from the GI tract (bioavailability ~90%). Hydrochlorothiazide is absorbed to varying degrees (bioavailability 65-75%).
Metabolism
Bisoprolol: ~50% metabolized in the liver (CYP2D6); Hydrochlorothiazide: Not metabolized.
Side Effects
Contraindications
- Acute heart failure, cardiogenic shock, second or third-degree AV block (without pacemaker), sick sinus syndrome, severe bradycardia (less than 50 beats/min), severe asthma, severe chronic obstructive pulmonary disease, severe peripheral arterial occlusive disease, Raynaud's syndrome, untreated pheochromocytoma, metabolic acidosis, anuria, hypersensitivity to bisoprolol, hydrochlorothiazide or other sulfonamide-derived drugs.
Drug Interactions
Lithium
Renal clearance of lithium may be reduced, increasing lithium toxicity.
Digitalis glycosides
Increased risk of bradycardia and AV block.
Other antihypertensives
Potentiated hypotensive effect.
NSAIDs (e.g., Ibuprofen)
May reduce the antihypertensive effect of hydrochlorothiazide.
Insulin/Oral antidiabetics
May mask symptoms of hypoglycemia; dosage adjustment may be needed.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, bradycardia, bronchospasm, acute cardiac failure, and severe electrolyte disturbance. Treatment is symptomatic and supportive; includes gastric lavage, activated charcoal, IV fluids, vasopressors, and atropine for bradycardia.
Pregnancy & Lactation
Pregnancy Category C/D (Hydrochlorothiazide). Not recommended during pregnancy unless clearly necessary, as it may cause fetal or neonatal adverse effects. Both bisoprolol and hydrochlorothiazide are excreted in breast milk; therefore, it is not recommended during lactation.
Side Effects
Contraindications
- Acute heart failure, cardiogenic shock, second or third-degree AV block (without pacemaker), sick sinus syndrome, severe bradycardia (less than 50 beats/min), severe asthma, severe chronic obstructive pulmonary disease, severe peripheral arterial occlusive disease, Raynaud's syndrome, untreated pheochromocytoma, metabolic acidosis, anuria, hypersensitivity to bisoprolol, hydrochlorothiazide or other sulfonamide-derived drugs.
Drug Interactions
Lithium
Renal clearance of lithium may be reduced, increasing lithium toxicity.
Digitalis glycosides
Increased risk of bradycardia and AV block.
Other antihypertensives
Potentiated hypotensive effect.
NSAIDs (e.g., Ibuprofen)
May reduce the antihypertensive effect of hydrochlorothiazide.
Insulin/Oral antidiabetics
May mask symptoms of hypoglycemia; dosage adjustment may be needed.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, bradycardia, bronchospasm, acute cardiac failure, and severe electrolyte disturbance. Treatment is symptomatic and supportive; includes gastric lavage, activated charcoal, IV fluids, vasopressors, and atropine for bradycardia.
Pregnancy & Lactation
Pregnancy Category C/D (Hydrochlorothiazide). Not recommended during pregnancy unless clearly necessary, as it may cause fetal or neonatal adverse effects. Both bisoprolol and hydrochlorothiazide are excreted in breast milk; therefore, it is not recommended during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months
Availability
Available in pharmacies across Bangladesh
Approval Status
Approved by DGDA, Bangladesh
Patent Status
Off-patent (Generic available)
Clinical Trials
Extensive clinical trials have established the efficacy and safety of bisoprolol and hydrochlorothiazide combinations for hypertension management.
Lab Monitoring
- Blood pressure monitoring
- Heart rate monitoring
- Serum electrolytes (potassium, sodium)
- Renal function tests (creatinine, BUN)
- Blood glucose levels
Doctor Notes
- Regularly monitor blood pressure, heart rate, renal function, and serum electrolytes. Advise patients not to discontinue abruptly. Educate patients about lifestyle modifications.
- Consider alternative therapies if adequate blood pressure control is not achieved or if severe side effects occur.
Patient Guidelines
- Take this medicine regularly as prescribed by your doctor, even if you feel well.
- Do not stop taking the medicine suddenly without consulting your doctor.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
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 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 or fatigue, especially at the beginning of treatment. If affected, avoid driving or operating machinery.
Lifestyle Advice
- Maintain a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity.
- Avoid smoking and limit alcohol consumption.
- Monitor your blood pressure regularly at home.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.