Effects on the ability to drive vehicles or use machines
Concomitant use of Conolol with the following drugs is not recommended :-
- Central acting antihypertensive drugs (such as methyldopa and clonidine) may reduce heart rate and cardiac output
and may lead to vasodilation.
Each f/c tablet contains : Bisoprolol fumarate 2.5mg, 5mg or 10mg.
- Calcium antagonist (such as verapamil and diltiazem) and class I anti-arrhythmic agents may reduce the
Conolol (Bisoprolol) is a cardio selective beta-1 adrenergic blocking agent used to treat high blood pressure. It is
considered a potent drug with long half-life that can be used once daily to reduce the need for multiple doses of
antihypertensive drugs. Conolol decreases heart rate, decreases contractility and need for oxygen and hence dialates blood vessels leading to reduced blood pressure. Conolol also reduces the output of renin in the kidneys, which
normally increases blood pressure. Due to its receptor selectivity ( low affinity to beta 2 receptors of the smooth muscles of the bronchi ), it can be useful in patients with chronic obstructive pulmonary disease COPD.
contractility of heart muscle and delay AV impulse conduction. Concomitant use of Conolol with the following
drugs is to be taken with caution:-
- Calcium antagonist (such as amlodipine) may increase the risk of hypotension.
Class III antiarrhythmic drugs such as Amiodarone, and parasympathomimetic medicines because they may
increase the inhibitory effect on AV impulse conduction.
- Topical beta blockers such as eye drops for glaucoma treatment.
- Treatment of hypertension.
nsulin or oral anti-hyperglycemic leads to potentiating their effect. - Anaesthetic Agents may lead to hypotension.
- Treatment of stable chronic angina.
- Treatment of stable chronic heart failure in addition to other drugs such as ACE inhibitors ,diuretics and cardiac
- Cardiac glycosides (digitalis) lead to reduction in heart rate.
- NSAIDs may reduce the effect of Bisoprolol.
- Beta Sympathomimetics such as isoprenaline, and dobutamine lead to the reduction of the effect of both drugs.
DOSAGE & ADMINISTRATION :
- Sympathomimetics that activate beta & alfa receptors (adrenaline and noradrenaline) lead to increase in blood
The tablet should be taken in the morning before, after or with breakfast.
Treatment of hypertension and stable chronic angina :
Antihypertensive drugs and other drugs (such as tricyclic antidepressants, barbiturate, phenothiazines) and MAOI (except MAO-B inhibitors) may increase the risk of hypotension.
The usual starting dose is 5mg once daily ,if necessary and after being closely monitored, the dose may increased to
- Mefloquine increases the risk of bradycardia.
10mg once daily. The maximum daily recommended dose is 20mg.
SIDE EFFECTS :
- Patients with severe renal impairment (Cr.Cl< 20ml/min) or severe liver impairment the dose shouldn’t exceed 10mg
Conolol is mostly well tolerate:
- In elderly patients it is recommended to start with the lowest possible dose.
Treatment of stable chronic heart failure :
The treatment should not be initiated unless the patient has not any heart failure during the past 6 weeks and the basic MAO
The common and very common adverse effects: Dizziness ,headache , and fatigue (Temporary side effects that
appears for the first to the second week after the start of treatment and applies to hypertensive and angina pectoris patients) , bradycardia in patients with chronic heart failure, worsening of preexisting heart failure, feeling of
coldness and numbness of extremities, arthralgia, insomnia, nausea, vomitting ,diarrhea , cough, pharyngitis, rhinitis,
therapy hasn't change for the past 2 weeks.
sinusitis, peripheral edema.
- The dose is starting with 1.25 mg once daily (in the morning) for 1 week then, if well tolerated, increased to 2.5mg
once daily for 1 week, then 3.75mg once daily for 1 week, then 5mg once daily for 4 weeks, then 7.5mg once daily
Uncommon adverse effects : Asthenia, orthostatic hypotension, bronchospasms in patients with bronchial asthma or
for 4 weeks, then 10mg once daily.
- The maximum recommended dose is 10 mg once daily.
history of obstructive airway disease., AV-conduction disturbances, , Sleep disorders , muscles cramps and weakness.
Rare adverse effects : hypersensitivity reactions such as itching, flush, rash, Potency disorders, and very rare After initiation of treatment with 1.25 mg the vital signs of patient should be observed over a period of 4 hours.
- Patients with severe renal and hepatic impairment the uptitration should be made with additional caution.
alopecia, conjunctivitis. OVER DOSAGE :
- If deterioration of heart failure intolerance occur during titration gradual reduction of the dose is recommended or in the presence of compelling reasons immediately discontinuation the treatment should be gradually.
The most frequent signs are bradycardia, markedly dropped in blood pressure, bronchospasm, acute heart failure ,
AV block and hypoglycemia. Patients should be taken to the nearest health center so they can get monitored closely
RESTRICTIONS ON USE : Contraindication
and treated by the physician.
The treatment of overdose is supportive and symptomatic treatment such as giving the patient intravenous atropine or
isoprenaline cautiously in case of bradycardia and i.v. Diuretics, inotropic agents and vasodilating agents, in case of
- Must not be used in patients with acute heart failure or during deterioration of heart failure required i.v therapy. - It is contraindicated in patients with cardiogenic shock ,sinoatrial block ,symptomatic bradycardia , symptomatic
acute worsening of heart failure yet if there is Bronchospasm the patient should be given bronchodilator therapy. If
hypotension and second or third degree of AV block and sick sinus syndrome (bradycardia and tachycardia
hypotension is manifested the patient should be given I.V fluids and vasopressors.
Must not be used in severe bronchial asthma ,severe chronic obstructive pulmonary disease ,severe form of
peripheral arterial occlusive disease or Raynaud's syndrome ( a syndrome effect the blood vessels)
STORAGE INSTRUCTIONS :
Store below 30oC, in a dry place.
- Must be avoided in patients with untreated phaeochromocytoma and metabolic acidosis. - It is contraindicated when there is hypersensitivity to bisoprolol.
Conolol tablet 2.5mg : pack of different sizes. Conolol tablet 5mg : pack of different sizes. Conolol tablet 10mg : pack of different sizes.
- Must be used with caution by diabetes mellitus and ongoing through strict fasting because it masks the signs and
symptoms of hypoglycemia, it also masks the signs of thyrotoxicosis.
- Must use in caution with patients with first degree AV block ,Prinzmetal's angina , peripheral arterial occlusive
- In bronchial asthma or other chronic obstructive pulmonary disease concomitant bronchodilation therapy is recommended.
- Conolol may increase the sensitivity to allergens and severity of anaphylactic reactions.
- Conolol's withdraw should be done gradually before the surgery and completed about 48 hours prior anesthesia. - Conolol must not be used until after alpha-receptor blockade in patients with phaeochromocytoma. - Abrupt withdrawal of clonidine ,especially if Conolol was discontinued prior the withdrawal, lead to an increase risk of rebound hypertension.
- Patients should avoid contact lenses because Conolol leads to a reduction of lacrimal fluid secretion. - Conolol shouldn’t be stopped abruptly. The dosage should be diminished gradually.
Use in Pregnancy & Lactation
Conolol is not recommended during pregnancy unless its benefits outweigh the risk and is contraindicated during lactation .