Bisoprolol fumarate and hydrochlorothiazide for hypertension management

This medication combines bisoprolol fumarate, a cardioselective beta1-blocker, with hydrochlorothiazide, a thiazide diuretic, to effectively lower high blood pressure. It is supplied as oral tablets with varying strengths for once-daily administration.

By using two complementary antihypertensive agents, this combination addresses multiple mechanisms involved in hypertension control.

Bisoprolol fumarate and hydrochlorothiazide tablets are prescribed for the management of hypertension in adults, aiming at lowering elevated blood pressure to reduce cardiovascular risk.

Bisoprolol fumarate; Hydrochlorothiazide

Bisoprolol selectively blocks beta1-adrenergic receptors in the heart which reduces heart rate and cardiac output, and inhibits renin release from the kidneys, contributing to lower blood pressure. Hydrochlorothiazide acts as a diuretic by increasing sodium and chloride excretion through the kidneys, promoting fluid loss which decreases blood volume and vascular resistance. Their antihypertensive effects are additive when combined.

The tablets contain bisoprolol fumarate 2.5 mg, 5 mg, or 10 mg combined with hydrochlorothiazide 6.25 mg per tablet for oral use once daily. Peak blood levels of bisoprolol occur around 3 hours post-dose, and hydrochlorothiazide peaks at approximately 2.5 hours. The half-life of bisoprolol ranges from 7 to 15 hours, and hydrochlorothiazide from 4 to 10 hours. No food effect on absorption has been observed.

Dosing should start with the lowest effective dose to maintain beta1-selectivity and minimize side effects, especially in patients with pulmonary concerns.

• Cardiogenic shock
• Overt cardiac failure (decompensated)
• Second or third degree atrioventricular block
• Marked sinus bradycardia
• Anuria
• Hypersensitivity to bisoprolol, hydrochlorothiazide, or sulfonamide derived drugs

• Do not use in patients with cardiogenic shock, overt cardiac failure, second or third degree AV block, marked sinus bradycardia, anuria, or hypersensitivity to any components or sulfonamide-derived drugs.
• Beta-blockers should generally be avoided in overt congestive heart failure but may be used cautiously in compensated cases.
• Discontinuation should be tapered over about one week to reduce risk of exacerbating angina, myocardial infarction, or arrhythmias.
• Caution in patients with peripheral vascular disease due to risk of arterial insufficiency.
• Patients with bronchospastic pulmonary disease should generally avoid beta-blockers; however, this combination may be cautiously used at the lowest dose if other antihypertensives are not tolerated, and a beta2 agonist should be available.
• Beta-blockers may mask hypoglycemia symptoms and increase risk of severe hypoglycemia, especially in diabetics or fasting patients. Blood glucose monitoring is advised.
• May mask symptoms of hyperthyroidism; abrupt withdrawal can worsen thyroid symptoms.
• Use caution in renal impairment; clearance of bisoprolol may be reduced, increasing half-life significantly.
• Use caution with impaired hepatic function; thiazides may precipitate hepatic coma due to fluid/electrolyte imbalance.
• Hydrochlorothiazide can cause rare acute angle-closure glaucoma; urgent discontinuation is required if symptoms occur.

Common side effects relate to beta-blocker and diuretic effects such as fatigue, dizziness, slow heart rate, and electrolyte imbalance. Serious but less common effects may include heart failure worsening, hypokalemia, bronchospasm, or acute glaucoma.

Concurrent use with sulfonylureas may increase risk of severe hypoglycemia. Careful monitoring of blood glucose is recommended. Additional interactions or dose adjustments should be managed by healthcare providers.

No specific storage instructions provided in the label.