SOPRAL PLUS
BISOPROLOL AND HYDROCHLOROTHIAZIDE · by BRYON
Composition
Tab5/6.25 mg: Bisoprolol (as fumarate) 5 nig, hy-drochlorothiazide 6.25 mg. Tab10/6.25 mg: Bisoprolol (as fumarate) 10 mg, hydrochlorothiazide 6.25 mg. Tab5/12.5 mg: Bisoprolol (as fumarate)
Indications & Dosage
Hypertension, Angina: Adults: 1 tab once daily, max; Bisoprolol 20 mg and hydrochlorothiazide 12.5 mg. Children: Not recommended.
Contraindications
Acute or decompensated heart failure requiring intravenous inotropes, sino-atrial block, 2nd or 3rd degree AV block (without pacemaker), severe bradycardia, uncontrolled heart failure, cardiogenic shock, severe peripheral arterial disease, hypotension, metabolic acidosis, untreated pheochromocytoma, severe asthma or COPD.
Precautions
AV block, heart failure (avoid if un-controlled), peripheral arterial circulatory disorders (avoid if severe), Prinzmetals angina, myasthenia gravis, Ischaemic heart disease, withdraw gradually, history of bronchospasm, diabetes, hyperthyroidism, renal or hepatic impairment, psoriasis, elderly, consider withdrawal before elective surgery, anaphylaxis risk due to increased sensitivity to allergens, Always withdraw gradually over period of 1-2 weeks IV administration requires cardiac and blood pressure monitoring. Dose adjustment in renal impairment: with oral use max 50mg daily if eGFR15-35 ml/minute/1.73m2; max 25mg daily or 50 mg on alternate days if eGFR less than 15 ml/minute/1.73m2.With intravenous use max 10 mg on alternate days if eGFR15-35 ml/minute/1.73m2; max.10 mg every 4 days if eGFR less than 15 ml/minute/1.73m2.
Interactions
Ca+ + antagonists, antihypertensives including centrally acting agents (e.g. clonidine), antiarrhythmics, antipsychotics, TCADs, MAOIs, fluvoxamine, barbiturates, cardiac glycosides, sympathomimetics, cimetidine, hydralazine, rifampicin, insulin/oral hypoglycaemics, NSAIDs, ergot derivatives, erythromycin, anaesthetics, diuretics.
Pregnancy
Avoid, risk cannot be ruled out.
Lactation
Contraindicated or not recommended.
Side Effects
Cardiovascular effects including bradycardia, postural hypotension, increased AV block, cardiac arrhythmias, Raynauds phenomenon, cold extremities, sexual dysfunction, GI upset, sleep and CNS disturbances, skin reactions, fatigue, paraesthesia, peripheral neuropathy, arthralgia, myopathy, altered blood sugar haematology and lipid levels. Withdraw if unexplained dry eyes or rash. Rarely, heart failure, dyspnea, bronchospasm