Bisoren Plus 2.5mg +6.25mg Tablet 1 Strip

✔️ Overdose Information

Beta-blocker overdose symptoms:

• Slow heart rate, low blood pressure, fatigue, confusion, seizures, breathing difficulty, heart failure, and low blood sugar.

Thiazide overdose symptoms:

• Fluid and electrolyte loss, dizziness, weakness, nausea, changes in urine output, and electrolyte abnormalities like low potassium, sodium, or chloride.

✔️ Dosage & Administration

• Bisoprolol is typically effective at daily doses of 2.5–40 mg.
• Hydrochlorothiazide works well at daily doses of 12.5–50 mg.
  In combination therapy, Bisoren Plus is available with 2.5–20 mg of Bisoprolol and 6.25–25 mg of Hydrochlorothiazide.
• Initial Dose: Start with one tablet of 2.5 mg/6.25 mg once daily.
• Titration: Dosage can be adjusted every 14 days, up to a maximum of 20 mg/12.5 mg once daily, as needed.
• Replacement Therapy: Can replace individual drugs if the patient is already stabilized on them.
• Clinical Use: Suitable for patients who are not achieving control with Bisoprolol alone or those experiencing potassium loss with high-dose Hydrochlorothiazide.

✔️ Side Effects

Most patients tolerate Bisoren Plus well, but side effects may include:

• Tiredness, dizziness, slow heart rate (bradycardia), irregular heartbeat
• Chest pain, cold hands and feet, low blood pressure (especially when standing)
• Digestive issues (nausea, constipation, diarrhea, indigestion)
• Respiratory symptoms (runny nose, sore throat)

✔️ Drug Interactions

• It may enhance the effects of other blood pressure-lowering medications.
• Avoid combining with other beta-blockers.
• Use caution with catecholamine-depleting agents (e.g., reserpine, guanethidine) due to the risk of excessive sympathetic suppression.
• If also on clonidine, stop Bisoren Plus a few days before discontinuing clonidine.
• Take care when used with cardiac depressants like verapamil, diltiazem, disopyramide, or digoxin, as they may increase the risk of slow heart rate (bradycardia) or heart block.

✔️ Do not use in patients with:

• Cardiogenic shock
• Decompensated heart failure
• Second or third-degree AV block
• Severe bradycardia
• Anuria (no urine output)
• Allergy to any component of the drug or to sulfonamides

✔️ Use in Pregnancy and Lactation

Pregnancy: Category C. It should only be used if the benefit outweighs the risk.

Breastfeeding: Not recommended. Thiazides pass into breast milk, and bisoprolol may be present in small amounts. A decision should be made whether to stop breastfeeding or discontinue the medication.

✔️ Precautions & Warnings

• Thiazides can cause hyperuricemia or gout.
• Watch for signs of fluid or electrolyte imbalance: dry mouth, thirst, weakness, drowsiness, cramps, low blood pressure, or gastrointestinal upset.
• Low potassium (hypokalemia) may occur.
• Discontinue the medication gradually over 2 weeks to avoid adverse reactions.
• Monitor patients closely during withdrawal.

✔️ Storage Condition

Store below 30°C, away from moisture and light. Keep out of reach of children.