Dipicard 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 |
|---|---|---|
| dipicard plus 5 mg tablet | ৳ 6.00 | N/A |
Description
Overview of the medicine
Dipicard Plus 5 mg tablet is a combination medication containing Bisoprolol Fumarate and Hydrochlorothiazide. It is primarily used to treat essential hypertension (high blood pressure) by lowering blood pressure through two complementary mechanisms: a beta-blocker and a diuretic. Bisoprolol helps to slow the heart rate and relax blood vessels, while Hydrochlorothiazide helps the body get rid of excess salt and water.
Uses & Indications
Dosage
Adults
Usually one tablet once daily. Dosage may be adjusted by the physician based on individual patient response and tolerability. Maximum dose depends on the individual components.
Elderly
No specific dose adjustment is required in elderly patients with normal renal function. Initiate with lower doses and titrate carefully.
Renal_impairment
Use with caution in patients with renal impairment. Dose adjustment may be necessary if creatinine clearance is <30 mL/min.
How to Take
Take orally once daily, preferably in the morning, with or without food. Swallow the tablet whole with water; do not crush, chew, or break it.
Mechanism of Action
Bisoprolol is a cardioselective beta-1 adrenergic blocking agent. It reduces heart rate, myocardial contractility, and cardiac output, leading to a decrease in blood pressure. Hydrochlorothiazide is a thiazide diuretic that acts on the distal convoluted tubules of the kidney to inhibit sodium and chloride reabsorption, leading to increased excretion of water, sodium, and chloride. This reduces plasma volume and peripheral vascular resistance, contributing to its antihypertensive effect.
Pharmacokinetics
Onset
Bisoprolol: 2-4 hours. Hydrochlorothiazide: 2 hours.
Excretion
Bisoprolol: ~50% renal (unchanged), ~50% metabolites. Hydrochlorothiazide: Primarily renal (unchanged).
Half life
Bisoprolol: 9-12 hours. Hydrochlorothiazide: 5.6-14.8 hours.
Absorption
Bisoprolol: Well absorbed (90% bioavailability), peak in 2-4 hours. Hydrochlorothiazide: Readily absorbed (65-75% bioavailability), peak in 1-2.5 hours.
Metabolism
Bisoprolol: ~50% hepatic metabolism. Hydrochlorothiazide: Not metabolized.
Side Effects
Contraindications
- Acute heart failure or decompensated heart failure requiring intravenous inotropic therapy
- Cardiogenic shock
- Second or third degree AV block without a pacemaker
- Sick sinus syndrome without a pacemaker
- Severe bradycardia (heart rate < 60 bpm)
- Severe asthma or severe chronic obstructive pulmonary disease
- Severe peripheral arterial occlusive disease or Raynaud's syndrome
- Untreated phaeochromocytoma
- Metabolic acidosis
- Severe renal impairment (creatinine clearance < 30 mL/min) or anuria
- Hypersensitivity to Bisoprolol, Hydrochlorothiazide, other sulfonamide-derived drugs, or any excipients
Drug Interactions
Lithium
Renal clearance of lithium is reduced by thiazides, increasing the risk of lithium toxicity. Avoid concomitant use or monitor lithium levels closely.
Digitalis glycosides
Increased risk of digitalis toxicity with hypokalemia (due to HCTZ).
Corticosteroids, ACTH
May enhance electrolyte depletion, particularly hypokalemia (due to HCTZ).
Other antihypertensive agents
Additive hypotensive effect. Monitor blood pressure closely.
Insulin and oral antidiabetics
Beta-blockers may mask symptoms of hypoglycemia and alter glucose metabolism. Hydrochlorothiazide may increase blood glucose. Adjust antidiabetic dosage.
Alcohol, barbiturates, narcotics
May potentiate orthostatic hypotension.
Muscle relaxants (non-depolarizing)
Thiazides may potentiate the effect of muscle relaxants.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
May reduce the antihypertensive effect of Bisoprolol and Hydrochlorothiazide. Monitor blood pressure.
Calcium channel blockers (e.g., verapamil, diltiazem)
Increased risk of bradycardia, AV block, and heart failure. Monitor carefully.
Class I antiarrhythmics (e.g., disopyramide, quinidine)
May potentiate cardiac depressant effects. Increased risk of severe bradycardia or cardiac arrest.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include severe bradycardia, hypotension, bronchospasm, acute cardiac insufficiency, and hypoglycemia (Bisoprolol). For Hydrochlorothiazide, symptoms may include electrolyte depletion (hypokalemia, hypochloremia, hyponatremia) and dehydration resulting from excessive diuresis. Treatment is largely symptomatic and supportive. Gastric lavage and activated charcoal may be considered if recent ingestion. Closely monitor vital signs and electrolyte balance. Intravenous fluids, vasopressors, atropine (for bradycardia), glucagon (for severe hypoglycemia/bradycardia), and bronchodilators may be administered as needed.
Pregnancy & Lactation
Pregnancy: Category C. Bisoprolol and Hydrochlorothiazide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. May cause fetal/neonatal bradycardia, hypoglycemia, and reduced placental perfusion. Lactation: Both components are excreted in breast milk. Due to potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
Side Effects
Contraindications
- Acute heart failure or decompensated heart failure requiring intravenous inotropic therapy
- Cardiogenic shock
- Second or third degree AV block without a pacemaker
- Sick sinus syndrome without a pacemaker
- Severe bradycardia (heart rate < 60 bpm)
- Severe asthma or severe chronic obstructive pulmonary disease
- Severe peripheral arterial occlusive disease or Raynaud's syndrome
- Untreated phaeochromocytoma
- Metabolic acidosis
- Severe renal impairment (creatinine clearance < 30 mL/min) or anuria
- Hypersensitivity to Bisoprolol, Hydrochlorothiazide, other sulfonamide-derived drugs, or any excipients
Drug Interactions
Lithium
Renal clearance of lithium is reduced by thiazides, increasing the risk of lithium toxicity. Avoid concomitant use or monitor lithium levels closely.
Digitalis glycosides
Increased risk of digitalis toxicity with hypokalemia (due to HCTZ).
Corticosteroids, ACTH
May enhance electrolyte depletion, particularly hypokalemia (due to HCTZ).
Other antihypertensive agents
Additive hypotensive effect. Monitor blood pressure closely.
Insulin and oral antidiabetics
Beta-blockers may mask symptoms of hypoglycemia and alter glucose metabolism. Hydrochlorothiazide may increase blood glucose. Adjust antidiabetic dosage.
Alcohol, barbiturates, narcotics
May potentiate orthostatic hypotension.
Muscle relaxants (non-depolarizing)
Thiazides may potentiate the effect of muscle relaxants.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
May reduce the antihypertensive effect of Bisoprolol and Hydrochlorothiazide. Monitor blood pressure.
Calcium channel blockers (e.g., verapamil, diltiazem)
Increased risk of bradycardia, AV block, and heart failure. Monitor carefully.
Class I antiarrhythmics (e.g., disopyramide, quinidine)
May potentiate cardiac depressant effects. Increased risk of severe bradycardia or cardiac arrest.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include severe bradycardia, hypotension, bronchospasm, acute cardiac insufficiency, and hypoglycemia (Bisoprolol). For Hydrochlorothiazide, symptoms may include electrolyte depletion (hypokalemia, hypochloremia, hyponatremia) and dehydration resulting from excessive diuresis. Treatment is largely symptomatic and supportive. Gastric lavage and activated charcoal may be considered if recent ingestion. Closely monitor vital signs and electrolyte balance. Intravenous fluids, vasopressors, atropine (for bradycardia), glucagon (for severe hypoglycemia/bradycardia), and bronchodilators may be administered as needed.
Pregnancy & Lactation
Pregnancy: Category C. Bisoprolol and Hydrochlorothiazide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. May cause fetal/neonatal bradycardia, hypoglycemia, and reduced placental perfusion. Lactation: Both components are excreted in breast milk. Due to potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months
Availability
Pharmacies, Hospitals
Approval Status
Approved by DGDA
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Numerous clinical trials have established the efficacy and safety of Bisoprolol and Hydrochlorothiazide, both individually and in combination, for the management of hypertension. Studies demonstrate superior blood pressure lowering and good tolerability compared to monotherapy for many patients.
Lab Monitoring
- Blood pressure
- Heart rate
- Serum electrolytes (especially potassium, sodium, magnesium, calcium)
- Renal function (BUN, creatinine)
- Blood glucose
- Liver function tests
Doctor Notes
- Monitor patient's heart rate, blood pressure, and electrolytes regularly.
- Educate patients on the importance of adherence and gradual withdrawal if necessary.
- Caution in patients with a history of bronchospasm, diabetes, or severe renal/hepatic impairment.
- Consider lifestyle modifications as an adjunct to pharmacotherapy.
Patient Guidelines
- Take your medication regularly as prescribed, even if you feel well.
- Do not stop taking this medicine suddenly without consulting your doctor, as it may worsen your condition.
- Report any unusual side effects, especially dizziness, lightheadedness, or very slow heart rate.
- Avoid standing up too quickly from a sitting or lying position to prevent dizziness.
- 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. 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 or fatigue, especially at the beginning of treatment or when changing doses. If affected, avoid driving or operating machinery.
Lifestyle Advice
- Adopt a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity as advised by your doctor.
- Maintain a healthy weight.
- Limit alcohol consumption.
- Quit smoking.
- Manage stress effectively.
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