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Bisoprolol fumarate, RXList:"Cardiac Failure: In general, beta-blocking agents should be avoided in patients with overt congestive failure. However, in some patients with compensated cardiac failure, it may be necessary to utilize these agents. In such situations, they must be used cautiously. Patients Without a History of Cardiac Failure: Continued depression of the myocardium with beta-blockers can, in some patients, precipitate cardiac failure. At the first signs or symptoms of heart failure, discontinuation of bisoprolol fumarate should be considered. In some cases bisoprolol fumarate therapy can be continued while heart failure is treated with other drugs. Abrupt Cessation of Therapy: Exacerbations of angina pectoris and, in some instances, myocardial infarction or ventricular arrhythmia, have been observed in patients with coronary artery disease following abrupt cessation of therapy with beta-blockers. Such patients should, therefore, be cautioned against interruption or discontinuation of therapy without the physician's advice. Even in patients without overt coronary artery disease, it may be advisable to taper therapy with bisoprolol fumarate over approximately 1 week with the patient under careful observation. If withdrawal symptoms occur, beta-blocking agent therapy should be reinstituted, at least temporarily."
http://www.rxlist.com/cgi/generic/bishctz_wcp.htm

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Bisoprolol fumarate, Nurses's PDR Resource Center:"Special Concerns: Use with caution in clients with peripheral vascular disease, impaired renal or hepatic function, and progressive liver disease and in clients also receiving myocardial depressants or inhibitors of AV conduction such as verapamil, diltiazem, and disopyramide. Elderly clients may be more sensitive to the effects of this drug product. Safety and effectiveness have not been determined in children. Side Effects: See individual drugs. Most commonly, dizziness and fatigue. At higher doses, bisoprolol inhibits beta-2-adrenergic receptors located in bronchial and vascular muscle."
http://www.nursespdr.com/members/database/archives/bisoprololfumarateandhydrochlorothiazide.html

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Bisoprolol fumarate, Mosby, Inc.,:"Bisoprolol fumarate; HCTZ have been used individually and in combination for the treatment of hypertension. The antihypertensive effects of these agents are additive; HCTZ 6.25 mg significantly increases the antihypertensive effect of bisoprolol fumarate. The incidence of hypokalemia with the bisoprolol fumarate; HCTZ 6.25 mg combination (B/H) is significantly lower than with HCTZ 25 mg. In clinical trials of bisoprolol fumarate; HCTZ, mean changes in serum potassium for patients treated with bisoprolol fumarate; HCTZ 2.5/6.25 mg. 5/6.25 mg or 10/6.25 mg or placebo were less than ± 0.1 mEq/L. Mean changes in serum potassium for patients treated with any dose of bisoprolol in combination with HCTZ 25 mg ranged from -0.1 to -0.3 mEq/L. Bisoprolol fumarate is a beta1-selective (cardioselective) adrenoceptor blocking agent without significant membrane stabilizing or intrinsic sympathomimetic activities in its therapeutic dose range. At higher doses (³ 20 mg) bisoprolol fumarate also inhibits beta2-adrenoreceptors located in bronchial and vascular musculature. To retain relative selectivity, it is important to use the lowest effective dose. Hydrochlorothiazide is a benzothiadiazine diuretic. Thiazides affect renal tubular mechanisms of electrolyte reabsorption and increase excretion of sodium and chloride in approximately equivalent amounts. Natriuresis causes a secondary loss of potassium."
http://www.mosbysdrugconsult.com/genrxfree/Top_200_2000/Drugs/E3167.htm

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Bisoprolol fumarate, WholeHealthMD:"How It Works: Bisoprolol slows the rate and force of contraction of the heart by blocking certain nerve impulses, thus reducing blood pressure. Range and Frequency: Starting dose is 5 mg once a day, or 2.5 mg once a day for those with kidney or liver problems. If necessary, it may be increased gradually to 20 mg once a day. Maximum dose is 20 mg per day."
http://www.wholehealthmd.com/refshelf/drugs_view/1,1524,65,00.html

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Bisoprolol fumarate, The Village:" Controlling blood pressure is very important for people with diabetes in order to reduce the risk of some long-term complications. There are a number of ways you can do this - keeping blood glucose levels acceptable, taking regular exercise, controlling your weight, eating a healthy, balanced diet, not exceeding the recommended daily intake of alcohol and not smoking. However, you may also have to use drug treatment and over the next few issues we'll be looking at various drugs, beginning with beta-blockers. Why are they used: Beta-adrenoceptor blocking drugs (or beta-blockers) are prescribed for the management of high blood pressure (hypertension). They may also be used to treat angina, an irregular heart beat (arrhythmia), possible reduction in the recurrence rate of a heart attack and heart failure (when the heart does not pump as well as it should). In addition, they can be used for conditions unrelated to the heart such as thyrotoxicosis (the disorder resulting from excessive production of thyroid hormones), phaeochromocytoma (a rare tumour of the inner part of the adrenal gland), anxiety, migraine and glaucoma. How do they work? Beta blockers affect the body's response to specific nerve impulses. This then decreases the rate and force of the heart's contractions, which lowers blood pressure and reduces the amount of oxygen the heart needs."
http://www.thediabetesvillage.com/Q&As%20&%20Articles/Your%20Health%20-Treatments/Your%20Health%20-%20beta%20blockers.html

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Bisoprolol fumarate, Health-Center.com:" Are There Drug Interactions?: Remember, always follow your physician's recommendations on how to take your medication. Even if you are taking one of the following substances, continue taking your medication as prescribed and consult your physician. Also, if you are taking any herbal remedies, vitamins, and/or over-the-counter medications, be sure to tell your physician. The following drugs interacts with Ziac and other beta-adrenergic blocking agents and thiazide diuretics (combos) to produce either increased or decreased effects of the drug intself. For instance, there is an increased anti-diabetic effect when taken in combination with diabetic medications."
http://www2.health-center.com/pharmacy/1159/antihyper/ziac.htm

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Bisoprolol fumarate, American Heart Association, Inc.:" Many medications, known as antihypertensives, are available to lower high blood pressure. Some, called diuretics, rid the body of excess fluids and salt (sodium). Others, called beta blockers, reduce the heart rate and the heart's output of blood. Another class of antihypertensives is called sympathetic nerve inhibitors. Sympathetic nerves go from the brain to all parts of the body, including the arteries. They can cause the arteries to constrict, raising blood pressure. This class of drugs reduces blood pressure by inhibiting these nerves from constricting blood vessels. Yet another group of drugs is the vasodilators. These can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen)."
http://www.americanheart.org/presenter.jhtml?identifier=2141

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Bisoprolol fumarate, NetDoctor.co.uk:" When bisoprolol is taken with other medicines that decrease blood pressure there may be a risk of a large drop in blood pressure, particularly with the first dose. Alcohol may enhance the blood pressure lowering effect of this medicine, which may result in dizziness or fainting. In people with diabetes, bisoprolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. Individuals should monitor their blood sugar, as bisoprolol can also mask the signs of hypoglycaemia. When taken with digoxin or diltiazem there may be an increased risk of slow heart rate. When taken with verapamil the risk of slow heart rate and heart block may be increased. When taken with nifedepine and possibly other calcium channel blockers, the risk of a large fall in blood pressure and heart failure may be increased. The increase in blood pressure that occurs when clonidine is withdrawn may be worsened if bisoprolol is being taken with clonidine. The bisoprolol should be stopped several days before slowly withdrawing the clonidine. Non-steroidal anti-inflammatory drugs (NSAIDs) such as indometacin may reduce the blood pressure lowering effects of bisoprolol. Care should be taken when adrenaline is given with bisoprolol as this combination may cause severe high blood pressure and slow heart rate."
http://www.netdoctor.co.uk/medicines/showpreparation.asp?id=3948

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Bisoprolol fumarate, MEDLINEplus:"Before taking bisoprolol, tell your doctor and pharmacist if you are allergic to bisoprolol or any other drugs. Tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially clonidine; medications for migraine headaches, asthma, allergies, colds, or pain; other medications for heart disease or high blood pressure; reserpine; rifampin (Rifadin); and vitamins. Tell your doctor if you have or have ever had asthma or other lung disease; heart, liver, or kidney disease; diabetes; severe allergies; circulation problems; or thyroid problems. Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking bisoprolol, call your doctor. If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking bisoprolol. You should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you. Remember that alcohol can add to the drowsiness caused by this drug."
http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a693024.html

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