Dosing: Adult

Hypertension: Oral: 2.5-5 mg once daily; may be increased to 10 mg and then up to 20 mg once daily, if necessary; usual dose range (JNC 7): 2.5-10 mg once daily

HF (unlabeled use): Initial: 1.25 mg once daily; maximum recommended dose: 10 mg once daily. Note: Increase dose gradually and monitor for signs and symptoms of CHF.

Dosing: Geriatric

Oral: Initial: 2.5 mg/day; may be increased by 2.5-5 mg/day; maximum recommended dose: 20 mg/day

Dosing: Renal Impairment

Clcr <40 mL/minute: Oral: Initial: 2.5 mg/day; increase cautiously

Not dialyzable

Dosage Forms: U.S.

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, oral, as fumarate: 5 mg, 10 mg

Zebeta®: 5 mg [scored]

Zebeta®: 10 mg

Generic Equivalent Available: U.S.

Yes

Administration

May be administered without regard to meals.

Use

Treatment of hypertension, alone or in combination with other agents

Use - Unlabeled/Investigational

Chronic stable angina, supraventricular arrhythmias, PVCs, heart failure (HF)

Adverse Reactions Significant

1% to 10%:

Cardiovascular: Chest pain (1% to 2%)

Central nervous system: Fatigue (dose related; 6% to 8%), insomnia (2% to 3%), hypoesthesia (1% to 2%)

Gastrointestinal: Diarrhea (dose related; 3% to 4%), nausea (2%), vomiting (1% to 2%)

Neuromuscular & skeletal: Arthralgia, asthenia (dose related; ≤2%)

Respiratory: Upper respiratory infection (5%), rhinitis (3% to 4%), sinusitis (dose related; 2%), dyspnea (1% to 2%)

<1% (Limited to important or life-threatening): Abdominal pain, acne, alopecia, angioedema, anxiety, arrhythmia, asthma, back/neck pain, bradycardia (dose related), bronchitis, bronchospasm, BUN/creatinine increased, claudication, cold extremities, confusion (especially in the elderly), congestive heart failure, constipation, coughing, cutaneous vasculitis, cystitis, depression, dermatitis, dizziness, dyspepsia, dyspnea on exertion, eczema, edema, flushing, gastritis, gout, hallucinations, headache, hearing decreased, hyper-/hypoesthesia, hyperglycemia, hyperkalemia, hyperphosphatemia, hypertriglyceridemia, hypotension, impotence, lacrimation (abnormal), leukopenia, libido decreased, malaise, memory loss, muscle cramps, muscle/joint pain, nervousness, ocular pain/pressure, orthostatic hypotension, palpitations, paresthesia, peptic ulcer, Peyronie's disease, pharyngitis, polyuria, positive ANA titers, pruritus, psoriasis, psoriasiform eruption, purpura, rash, renal colic, restlessness, rhythm disturbances, sleep disturbances, somnolence, syncope, taste abnormality, thrombocytopenia, tinnitus, transaminases increased, tremor, twitching, uric acid increased, vasculitis, vertigo, visual disturbances, weight gain, xerostomia

Contraindications

Cardiogenic shock; overt cardiac failure; marked sinus bradycardia; heart block greater than first-degree (except in patients with a functioning artificial pacemaker)

Warnings/Precautions

Concerns related to adverse events:

• Anaphylactic reactions: Use caution with history of severe anaphylaxis to allergens; patients taking beta-blockers may become more sensitive to repeated challenges. Treatment of anaphylaxis (eg, epinephrine) in patients taking beta-blockers may be ineffective or promote undesirable effects.

Disease-related concerns:

• Bronchospastic disease: In general, patients with bronchospastic disease should not receive beta-blockers; for patients with bronchospastic disease who do not respond to or cannot tolerate other therapies, initial low doses of beta1-selective bisoprolol may be employed and used cautiously with close monitoring. Ensure patient has an inhaled beta2-agonist immediately available. At doses ≥20 mg/day, slight asymptomatic increases in airway resistance and decreases in forced expiratory volume (FEV1) has been observed.

• Conduction abnormality: Consider pre-existing conditions such as sick sinus syndrome before initiating.

• Diabetes: Use with caution in patients with diabetes mellitus; may potentiate hypoglycemia and/or mask signs and symptoms.

• Heart failure (HF): Use with caution in patients with compensated heart failure and monitor for a worsening of the condition. Patients should be stabilized on heart failure regimen prior to initiation of beta-blocker. Beta-blocker therapy should be initiated at very low doses with gradual and very careful titration. Adjustment of other medications (ACE inhibitors and/or diuretics) may be required

• Hepatic impairment: Use with caution in patients with hepatic impairment; dosage adjustment required with severe impairment.

• Myasthenia gravis: Use with caution in patients with myasthenia gravis.

• Peripheral vascular disease (PVD) and Raynaud's disease: Can precipitate or aggravate symptoms of arterial insufficiency in patients with PVD and Raynaud's disease. Use with caution and monitor for progression of arterial obstruction.

• Pheochromocytoma (untreated): Adequate alpha-blockade is required prior to use of any beta-blocker

• Psoriasis: Beta-blocker use has been associated with induction or exacerbation of psoriasis, but cause and effect have not been firmly established.

• Psychiatric disease: Use with caution in patients with a history of psychiatric illness; may cause or exacerbate CNS depression.

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment required with Clcr <40 mL/minute.

• Thyrotoxicosis: Beta-blockade may mask signs of hyperthyroidism (eg, tachycardia). Abrupt discontinuation of beta-blockade may exacerbate symptoms of hyperthyroidism and may also induce thyroid storm.

Concurrent drug therapy issues:

• Anesthetic agents: Use with caution in patients receiving anesthetic agents which decrease myocardial function (eg, ether, cyclopropane, and trichloroethylene).

• Calcium channel blockers: Use with caution in patients on concurrent verapamil or diltiazem; bradycardia or heart block may occur.

Other warnings/precautions:

• Abrupt withdrawal: Beta-blocker therapy should not be withdrawn abruptly (particularly in patients with CAD), but gradually tapered to avoid acute tachycardia, hypertension, and/or ischemia

Bisoprolol/ Hydrochlorothiazide Brands

Bisoprolol/ Hydrochlorothiazide More info

Bisoprolol is effective at doses of 2.5 mg to 40 mg OD while hydrochlorothiazide at doses of 12.5 mg to 50 mg OD