Bisoprolol

INDICATION SCOPE: the retrieved SPC (Bisoprolol 1.25 mg Orodispersible Tablets) §4.2 covers ONLY stable chronic heart failure — no hypertension or angina regimen appears in the retrieved text; source those separately. Standard CHF treatment consists of an ACE inhibitor (or ARB if ACE-intolerant), a beta-blocker, diuretics and, when appropriate, cardiac glycosides; patients should be stable (without acute failure) when bisoprolol is initiated and the treating physician should be experienced in managing chronic heart failure. Transient worsening of heart failure, hypotension or bradycardia may occur during titration and thereafter — close monitoring of vital signs (heart rate, blood pressure) and symptoms of worsening heart failure is recommended during the titration phase; symptoms may occur within the first day. TREATMENT MODIFICATION: if the maximum recommended dose is not well tolerated, gradual dose reduction may be considered; in transient worsening of heart failure, hypotension or bradycardia, reconsider the dose of concomitant medication and, if needed, temporarily lower the bisoprolol dose or consider discontinuation, reintroducing/uptitrating when the patient is stable again. If discontinuation is considered, decrease the dose gradually — abrupt withdrawal may lead to acute deterioration. Treatment is generally long-term. ELDERLY: no dosage adjustment required. PAEDIATRIC: there is no paediatric experience with bisoprolol, therefore its use cannot be recommended in paediatric patients. CROSS-CHECK (US labelling, openFDA — bisoprolol fumarate tablets, for hypertension, NOT the UK SPC): usual starting dose 5 mg once daily (2.5 mg may be appropriate in some patients), increasing to 10 mg and then if necessary 20 mg once daily; initial daily dose 2.5 mg in hepatic impairment (hepatitis or cirrhosis) or creatinine clearance <40 mL/min; not dialysable, so drug replacement is not necessary in dialysis patients.