Bisoprolol fumarate
Trade name: Zebeta
Class:
Beta-adrenoceptor blocking drugs Pregnancy: (Category C)
Action:
§ Blocks adrenergic receptors of the sympathetic nervous system in
the heart and juxtaglomerular apparatus (kidney), thus decreasing the
excitability of the heart.
§ Decreasing cardiac output and oxygen consumption, decreasing the
release of rennin from the kidney, and lowering blood pressure.
Uses:
§ Management of hypertension,
§ used alone or with other antihypertensive agents Dose
Hypertension and
angina, usually 10 mg once daily (5
mg may be adequate in some patients); max. 20 mg daily
Adjunct in stable
moderate to severe heart failure,
initially 1.25 mg
once daily (in the morning) for 1 week then, if well tolerated, increased to
2.5 mg once daily for 1 week, then 3.75 mg
once daily
for 1 week, then 5 mg once daily for 4 weeks, then 7.5 mg once
daily for 4 weeks, then 10 mg once daily; max. 10 mg daily Contraindications:
• Sinus bradycardia, second- or third-degree heart block,
cardiogenic shock, CHF.
• Use cautiously with renal failure, diabetes or thyrotoxicosis
(bisoprolol can mask the usual cardiac signs of hypoglycemia and
thyrotoxicosis), lactation.
Side effects:
• CNS: Dizziness, paresthesias,
sleep disturbances, hallucinations, disorientation, memory loss, slurred speech
.
• GI: Gastric pain, flatulence,
constipation, diarrhea, nausea, vomiting, anorexia, ischemic colitis, ,
retroperitoneal fibrosis, hepatomegaly, acute pancreatitis.
• CV: Bradycardia, CHF, cardiac
arrhythmias, sinoatrial or AV nodal block, tachycardia, peripheral vascular
insufficiency, claudicating, CVA, pulmonary edema, hypotension
• Respiratory: Bronchospasm,
dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis.
• GU: Impotence, decreased libido, Peyronie's disease,
dysuria, nocturia, frequent urination.
• Musculoskeletal: Joint pain,
arthralgia, muscle cramp
• EENT: Eye irritation, dry eyes,
conjunctivitis, blurred vision
• Other: Decreased exercise
tolerance, development of antinuclear antibodies, hyperglycemia or
hypoglycemia, elevated serum transaminase, alkaline phosphatase, and LDH Nursing
considerations:
• Do not discontinue drug abruptly after chronic therapy
(hypersensitivity to catecholamine may have developed, causing exacerbation of
angina, MI, and ventricular arrhythmias).
• Taper drug gradually over 2 wk with monitoring.
• Consult with physician about withdrawing drug if patient is to
undergo surgery (withdrawal is controversial).
