💊 Bisoprolol (Bisoprolol Fumarate And Hydrochlorothiazide)
This medicine contains two active ingredients, bisoprolol fumarate and hydrochlorothiazide, and is used to treat high blood pressure. It is taken by mouth once daily, and your doctor determines the right dose for you.
In Arabic: بيسوبرولول (مع هيدروكلوروثيازيد)
✅ What it is used for
- Management of hypertension (high blood pressure)
🧪 Active ingredient
Bisoprolol: a beta-1 selective (cardioselective) adrenergic blocker that helps lower blood pressure. Hydrochlorothiazide: a thiazide diuretic that increases renal excretion of sodium and chloride. Their blood pressure-lowering effects are additive.
🌿 Benefits
- Lowers blood pressure with once-daily dosing
- Combining two agents increases the antihypertensive effect
- The low hydrochlorothiazide dose (6.25 mg) is associated with less potassium loss than the 25 mg dose
📝 How to use
- Taken by mouth once daily.
- The dose is set by your doctor or pharmacist based on your condition; do not adjust it yourself.
- It can be taken with or without food.
- Do not stop suddenly without medical advice; stopping should be gradual under your doctor's supervision.
💊 Dosage forms
- Tablets 2.5 mg/6.25 mg
- Tablets 5 mg/6.25 mg
- Tablets 10 mg/6.25 mg
⚠️ Common side effects
- Fatigue
- Dizziness
- Headache
- Diarrhea
- Cough
- Chest pain
- Muscle pain and cramps
- Insomnia or sleepiness
- Nausea and dyspepsia
- Peripheral edema
🚨 Serious — seek medical help
- Marked slow heart rate or heart rhythm disturbances
- Signs of heart failure (shortness of breath, swelling)
- Bronchospasm (wheezing, difficulty breathing)
- Low blood potassium (hypokalemia)
- Pancreatitis (possible with thiazides)
- Severe skin rash
- Worsening angina after abrupt cessation
⛔ Do not use if
- Cardiogenic shock
- Overt cardiac failure
- Second- or third-degree AV block
- Marked sinus bradycardia
- Anuria
- Hypersensitivity to either component or to other sulfonamide-derived drugs
❗ Warnings & precautions
- Beta-blockers should generally be avoided in overt congestive heart failure.
- Abrupt cessation may worsen angina or cause myocardial infarction or ventricular arrhythmia; taper gradually.
- Beta-blockers can aggravate symptoms of arterial insufficiency in peripheral vascular disease.
- Patients with bronchospastic disease should generally not receive beta-blockers; if used, use caution and the lowest possible dose.
- Use caution when dosing in hepatic or renal impairment.
- Thiazide diuretics may cause fluid and electrolyte disturbances (e.g., low potassium).
- Tell your doctor before any surgery.
🔄 Drug interactions
- Tell your doctor or pharmacist about all medicines you take, as some may affect how this drug works or its safety.
- The label text provided does not include detailed information on specific drug interactions.
🤰 Pregnancy
There are no adequate, well-controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit justifies the risk to the fetus, as decided by the doctor.
🍼 Breastfeeding
Thiazides are excreted in human breast milk, and small amounts of bisoprolol have been detected in the milk of lactating rats. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother.
🧒 Children
Safety and effectiveness in pediatric patients have not been established.
👴 Older adults
No overall differences in effectiveness or safety were observed between elderly and younger patients, and dose adjustment on the basis of age alone is not usually necessary unless there is significant renal or hepatic dysfunction. Greater sensitivity in some older individuals cannot be ruled out.
🌡️ Storage
Store at 20° to 25°C (excursions permitted to 15° to 30°C) in a tight, light-resistant container.
⏰ Missed dose
The label text provided does not give specific instructions for a missed dose. Ask your doctor or pharmacist, and do not double the dose on your own.
🆘 Overdose
Symptoms may include slow heart rate, low blood pressure and lethargy, and in severe cases delirium, coma, convulsions and respiratory arrest, plus fluid and electrolyte loss. Stop the medicine and seek emergency medical help immediately. Treatment is symptomatic and supportive; there is no specific antidote.
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Mechanism of action
Bisoprolol is a beta-1 selective adrenoceptor blocker without significant membrane stabilizing or intrinsic sympathomimetic activity in its therapeutic range; at higher doses (≥20 mg) it also inhibits beta-2 adrenoreceptors. Hydrochlorothiazide is a benzothiadiazine diuretic that affects renal tubular electrolyte reabsorption, increasing sodium and chloride excretion, with secondary potassium loss.
Labeled dosing
Per the label: initiate with the lowest dose (one 2.5 mg/6.25 mg tablet once daily), titrating at 14-day intervals up to the maximum recommended dose of 20 mg/12.5 mg (two 10 mg/6.25 mg tablets) once daily, as appropriate. The combination may replace the titrated individual components. Withdrawal should be gradual over about 2 weeks. The dose is set by the doctor or pharmacist.
- The combination may be used when BP is not controlled on bisoprolol 2.5–20 mg, or in patients controlled on hydrochlorothiazide 50 mg who have significant potassium loss.
- Use caution in dosing/titrating in hepatic or renal impairment; no drug replacement is needed in dialysis as neither component appears dialyzable.
- Dosage adjustment for age is not usually necessary unless renal or hepatic dysfunction is present.
- There is no pediatric experience.
- Overdose management: for bradycardia, IV atropine; if inadequate, isoproterenol or another agent with positive chronotropic properties, plus supportive care and correction of fluid and electrolyte imbalance.
🎓 Key points for students
- Bisoprolol: beta-1 selective blocker; selectivity is relative and diminishes at doses ≥20 mg.
- Hydrochlorothiazide: thiazide diuretic causing natriuresis with secondary potassium loss.
- The antihypertensive effects are additive, and hydrochlorothiazide 6.25 mg lowers hypokalemia risk compared with 25 mg.
- Dose-dependent effects of bisoprolol include bradycardia, diarrhea, asthenia and fatigue; for hydrochlorothiazide, primarily hypokalemia.
- Abrupt beta-blocker withdrawal can exacerbate angina; taper over about 2 weeks.
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What is this medicine used for?
It is used to treat high blood pressure.
Can I stop it suddenly if I feel better?
No. Stopping suddenly may worsen angina or cause heart problems. Ask your doctor to taper it gradually.
Can I take it with food?
Yes, it can be taken with or without food; absorption is not affected by food.
What are the common side effects?
Fatigue, dizziness, headache, diarrhea, cough and muscle pain; most are mild and transient.
Is it safe in pregnancy?
There are no adequate studies in pregnant women; it should be used only if the benefit justifies the risk to the fetus, as decided by your doctor.
⚕️ For education only — not a substitute for advice from your doctor or pharmacist. Do not start or stop any medicine without advice. Source: official FDA drug label via openFDA (2026-09), simplified. Updated: 2026-11-10.