Bisoprolol Hemifumarate + Hydrochlorothiazide

Bisoprolol Hemifumarate + Hydrochlorothiazide is a beta-blocker and thiazide diuretic antihypertensive combination medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Treatment of hypertension (high blood pressure) in adults when combination therapy with bisoprolol and hydrochlorothiazide is clinically appropriate.
• It may be used when blood pressure is not adequately controlled with one component alone, or as directed by a doctor based on the patient’s condition.

The dose and strength should be individualized by the prescribing doctor according to blood pressure response, pulse rate, kidney function, other medicines, and tolerability. It is usually taken once daily, preferably at the same time each day. Do not stop suddenly unless a doctor advises, because abrupt withdrawal of a beta-blocker may worsen heart symptoms in some patients.

• Common side effects may include dizziness, tiredness, headache, slow pulse, light-headedness, cold hands or feet, nausea, stomach upset, and increased urination.
• Hydrochlorothiazide may cause low potassium or sodium, increased uric acid, increased blood sugar, dehydration, or muscle cramps.
• Serious effects needing urgent medical advice include fainting, very slow heartbeat, severe shortness of breath or wheezing, chest pain, severe weakness, confusion, irregular heartbeat, signs of severe dehydration, allergic swelling or rash, eye pain or sudden vision changes, and symptoms of severe electrolyte imbalance.

Use with caution in people with asthma or chronic obstructive lung disease, diabetes, thyroid disease, gout, kidney or liver impairment, electrolyte imbalance, peripheral circulation problems, psoriasis, a history of severe allergy, or heart conduction problems. Blood pressure, pulse, kidney function, blood glucose, uric acid, and electrolytes may need monitoring. Use this medicine only under the guidance of a registered doctor or pharmacist.

• Other blood pressure-lowering medicines, nitrates, alcohol, or sedatives may increase dizziness or low blood pressure.
• Verapamil, diltiazem, digoxin, amiodarone, and some other heart rhythm medicines may increase the risk of slow pulse or heart block.
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, or naproxen may reduce blood pressure control and may affect kidney function.
• Insulin and oral diabetes medicines: beta-blockers may mask warning signs of low blood sugar, such as fast heartbeat.
• Lithium levels may rise with thiazide diuretics and cause toxicity.
• Corticosteroids, laxative overuse, amphotericin B, or other medicines that lower potassium may increase the risk of electrolyte imbalance.
• Cholestyramine or colestipol may reduce absorption of hydrochlorothiazide if taken at the same time.

• Known hypersensitivity to bisoprolol, hydrochlorothiazide, thiazides, sulfonamide-derived medicines, or any component of the product.
• Anuria (inability to pass urine).
• Cardiogenic shock, acute decompensated heart failure, or severe untreated heart failure.
• Severe bradycardia, second- or third-degree heart block, or sick sinus syndrome unless a functioning pacemaker is present.
• Severe hypotension.
• Severe bronchospastic disease where beta-blocker use is not appropriate, unless specifically judged necessary by a specialist.

This combination is generally not preferred during pregnancy unless a doctor decides the benefit outweighs the risk. Beta-blockers may affect fetal growth or cause newborn slow heartbeat or low blood sugar, and thiazide diuretics are not usually used for routine pregnancy-related swelling. During breastfeeding, use only on medical advice; hydrochlorothiazide can pass into breast milk and higher doses may reduce milk production, while information on bisoprolol in breastfeeding is limited.

Store at room temperature, protected from moisture, heat, and direct sunlight. Keep tablets in the original packaging and out of the reach of children. Do not use after the expiry date.