Indications

Bislol Plus tablet is indicated for the treatment of hypertension (high blood pressure).

Pharmacology

Bislol Plus is a combination of two antihypertensive agents: Bisoprolol Fumarate and Hydrochlorothiazide. Their effects are additive, with the combination providing a significant blood pressure reduction.

• Bisoprolol Fumarate: This is a β1​-selective (cardioselective) adrenoceptor blocking agent. It reduces blood pressure without having significant membrane-stabilizing or intrinsic sympathomimetic activities.
• Hydrochlorothiazide: This is a benzothiadiazine diuretic. It affects the kidneys' ability to reabsorb electrolytes, leading to increased excretion of sodium and chloride, which helps to lower blood pressure. The combination with a low dose of hydrochlorothiazide (6.25 mg) results in a significantly lower incidence of hypokalemia (low potassium levels) compared to a higher dose of hydrochlorothiazide alone (25 mg).

Dosage & Administration

• Initial Therapy: The starting dose is one 2.5/6.25 mg tablet once daily. The dose can be adjusted at 14-day intervals, up to a maximum of one 20/12.5 mg tablet once daily.
• Replacement Therapy: The combination can be used to replace the individual components once their doses have been titrated.
• Therapy Guided by Clinical Effect: Patients with inadequate blood pressure control on 2.5-20 mg of Bisoprolol daily, or those who experience significant potassium loss on 50 mg of Hydrochlorothiazide daily, may benefit from switching to Bislol Plus.

Interaction

• Other antihypertensive agents: Bislol Plus may potentiate the effects of other blood pressure medications.
• Other beta-blockers: Bislol Plus should not be combined with other beta-blocking agents.
• Catecholamine-depleting drugs (e.g., reserpine): Patients taking these drugs should be closely monitored as the combination with Bisoprolol can cause an excessive reduction of sympathetic activity.
• Clonidine: If clonidine therapy is being discontinued, Bislol Plus should be stopped several days beforehand.
• Calcium antagonists (e.g., verapamil, diltiazem) and antiarrhythmic agents (e.g., disopyramide): Bislol Plus should be used with caution as these combinations can lead to a severe drop in heart rate and heart failure.
• Digitalis glycosides: Concomitant use with beta-blockers can increase the risk of a slow heart rate (bradycardia).

Contraindications

Bislol Plus is contraindicated in patients with cardiogenic shock, overt cardiac failure, second or third-degree AV block, marked sinus bradycardia, anuria, and hypersensitivity to either component or to other sulfonamide-derived drugs.

Side Effects

The medication is generally well-tolerated. Most side effects are mild and temporary. Possible side effects include fatigue, dizziness, headache, slow heart rate (bradycardia), arrhythmia, chest pain, palpitations, cold extremities, and digestive issues like diarrhea, constipation, and nausea.

Pregnancy & Lactation

This is a Pregnancy Category C drug. It should only be used during pregnancy if the potential benefit outweighs the risk to the fetus. Hydrochlorothiazide is excreted in human breast milk, and small amounts of bisoprolol have been detected in the milk of lactating rats. Due to the potential for serious side effects in nursing infants, a decision must be made to either stop nursing or discontinue the drug, considering its importance to the mother.

Precautions & Warnings

• Fluid and electrolyte imbalance: Patients should be monitored for signs of imbalance, which may include dry mouth, thirst, muscle cramps, and weakness. Hypokalemia (low potassium) may develop.
• Withdrawal: If therapy needs to be stopped, it should be done gradually over a period of about 2 weeks.
• Hyperuricemia: Thiazide diuretics may cause an increase in uric acid, potentially leading to gout.

Overdose Effects

Overdose data for Bislol Plus is limited.

• Beta-blocker overdose: The most common signs are a slow heart rate (bradycardia) and low blood pressure (hypotension). Severe overdoses can lead to delirium, coma, and respiratory arrest.
• Thiazide diuretic overdose: The main features are fluid and electrolyte loss, which can cause symptoms such as a rapid heart rate (tachycardia), low blood pressure (hypotension), and confusion.

Therapeutic Class

Bislol Plus is a combined antihypertensive preparation.

Storage Conditions

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