Bisoprolol + Hydrochlorothiazide Pharmacology

Bisoprolol + Hydrochlorothiazide

About Bisoprolol + Hydrochlorothiazide
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Mechanism of Action of Bisoprolol + Hydrochlorothiazide
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Pharmacokinets of Bisoprolol + Hydrochlorothiazide
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Onset of Action for Bisoprolol + Hydrochlorothiazide
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Duration of Action for Bisoprolol + Hydrochlorothiazide
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Half Life of Bisoprolol + Hydrochlorothiazide
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Side Effects of Bisoprolol + Hydrochlorothiazide
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Contra-indications of Bisoprolol + Hydrochlorothiazide
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Special Precautions while taking Bisoprolol + Hydrochlorothiazide
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Pregnancy Related Information
Contraindicated; since Hydrochlorothiazide is contraindicated in pregnancy, the combination generic cannot be used in pregnancy
Old Age Related Information
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Breast Feeding Related Information
Contraindicated; since Hydrochlorothiazide is contraindicated in lactation, the combination generic cannot be used in breast feeding.
Children Related Information
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Indications for Bisoprolol + Hydrochlorothiazide
It is the combination of beta blocker Bisoprolol and diuretic Hydrochlorothiazide.
Hypertention
Interactions for Bisoprolol + Hydrochlorothiazide
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Typical Dosage for Bisoprolol + Hydrochlorothiazide
1 tablet / day
Schedule of Bisoprolol + Hydrochlorothiazide
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Storage Requirements for Bisoprolol + Hydrochlorothiazide
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Effects of Missed Dosage of Bisoprolol + Hydrochlorothiazide
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Effects of Overdose of Bisoprolol + Hydrochlorothiazide
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Bisoprolol

About Bisoprolol
Beta1-selective adrenergic blocker, Antihypertensive.
Mechanism of Action of Bisoprolol
Bisoprolol is a cardio selective beta-1 adrenergic antagonist.It has negative chronotropic and negative inotropic effects on heart. It decreases oxygen consumption; cardiac work and aortic pressure. It decreases central sympathetic out flow and also decreases nor adrenaline and renin releases. The drug decreases BP in hypertensive individuals.
Pharmacokinets of Bisoprolol
Absorption: well absorbed orally, Distribution: Widely distributed. Metabolism: Metabolized in liver. Excretion: Excreted mainly through urine & a small portion is excreted through faeces.
Onset of Action for Bisoprolol
1 to 4hours
Duration of Action for Bisoprolol
24hours
Half Life of Bisoprolol
9 to12hours
Side Effects of Bisoprolol
1.Heart failure
2.Heart block
3.Nightmares
4.Gastrointestinal problems
5.Nausea
6.Tiredness
7.Sinus bradycardia
8.Depression
9.Rash
10.Hypotension
11Dizziness
12.Depression
13.Fatigue
14.Vomiting
15.Diarrhoea
16.Constipation
17.Headache
18.Bronhospasm
19.Sleep disturbances
20.Cold extremities
21.Rhinitis
22.Sinusitis
23.Edema
24.Impotence
25.Coughing
26.Myalgia
27.Arthralgia
Contra-indications of Bisoprolol
1.Hypersensitivity to the drug
2.Second or third degree heart block
3.Congestive heart failure
4.Cardiogenic shock
5.Sinus Bradycardia
6.Chronic obstructive pulmonary diseases
7.Bronchial asthma
9.Peripheral arteriolar disorders
10.Renal impairment.
Special Precautions while taking Bisoprolol
1.Left ventricular failure
2.Hepatic impairment
3.The drug should be gradually withdraw with caution
4.Respiratory disorders
5.Diabetes mellitus
6.General Anaesthesia
7.Thyrotoxicosis
8.Use with caution along with class-1 antiarrrythmic drugs & other anti hypertensive drugs.
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Contraindicated
Indications for Bisoprolol
1.Hypertension
2.Coronary artery diseases
Interactions for Bisoprolol
Alcohol, Anxiolytics and Hypnotics, Cimetidine, Diuretics: Enhanced hypotensive effect.
Analgesics: NSAIDs antagonise hypotensive effect.
Antidiabetics: Enhanced hypoglycaemic effect.
Calcium channel blockers: Increase risk of bradycardia and AV block with diltiazem, severe hypotension and heart failure with verapamil, nifedipine.
Cardiac glycosides: Increased AV Block and brandycardia.
Cholinergics: Effects antagonised by bisoprolol.
Corticosteroids: Antagonism of hypotensive effect.
Sympathomimetics: Severe hypertension with adrenaline and noradrenaline.
Typical Dosage for Bisoprolol
2.5mg to 10mg 0nce daily depending upon the patient`s response
Maximum dose: 20mg/day
Schedule of Bisoprolol
H
Storage Requirements for Bisoprolol
Store at room temperature in a well closed container. Keep out of reach of children
Effects of Missed Dosage of Bisoprolol
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Bisoprolol
Treatment is supportive and symptomatic. After ingestion empty the stomach by induced emesis or gastric lavage. Administer activated charcoal to reduce absorption. . Treat Bradycardia with atropine. If required administer isoproterinol with caution; in heart block. Treat hypotension with glucagons and vasopressors like epinephrine. Treat cardiac failure with diuretics and cardiac glycosides. Treat Bronhospasm with isoproterinol and aminophylline. Treat hypoglycemia with glucose

Hydrochlorothiazide

About Hydrochlorothiazide
Thiazide derivatibve, Diuretic.
Mechanism of Action of Hydrochlorothiazide
It is thiazide diuretic which exerts its action by acting at site-3(central dilating segment of early distal tubule). It binds to Na+Cl- symporter and inhibits Na+Cl- symport at the luminal membrane. It has additional carbonic anhydrase inhibitory actions in proximal tubules. It increases natriuresis, kaliuresis and diuresis. It decreases Ca2+ excretion and increases Mg2+excretion. It also has minor carbonic anhydrase inhibitory action. It also causes direct arteriolar vasodilatation and decreases total peripheral resistance. The antihypertensive actions of the drug may be attributable to depletion of sodium and subsequent reduction in plasma volume and a decrease in peripheral resistance. Decrease in peripheral resistance is due to either the loss of sodium from the arteriolar wall or a direct action on the vascular bed. It is an effective drug in edema associated with congestive heart failure.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure

Pharmacokinets of Hydrochlorothiazide
Absorption: It is absorbed after oral administration.
Metabolism: It is not metabolized in the body.
Excretion: Excreted unchanged in urine.

Onset of Action for Hydrochlorothiazide
1 to 3 hours
Duration of Action for Hydrochlorothiazide
12 to 16 hours
Half Life of Hydrochlorothiazide
5 to 15 hours
Side Effects of Hydrochlorothiazide
1. Dizziness
2. Blurred vision
3. Confusion
4. Tingling fingers
5. Dry mouth
6. Nausea
7. Diarrhoea
8. Constipation
9. Vomiting
10. Weakness
11. Hypokalaemia
12. Hyponatraemia
13. Hyperuricaemia
14. Elevated levels of glucose, calcium and lipids
15. Gastro intestinal disturbances
16. Polyuria
17. Electrolyte imbalance
18. Jaundice
19. Rashes
20. Photosensitivity
21. Fever
22. Itching
23. Myalgia
24. Muscle cramps
25. Arthralgia
26. Blood dyscrasias
27. Ototoxicity

Contra-indications of Hydrochlorothiazide
1. Hyper uricaemia
2. Hyper calcaemia
3. Renal impairment
4. Hepatic impairment
5. Anuria
6. Hypersensitivity to the drug
7. Hyper sensitivity to sulfonamides
8. Fluid and electrolyte imbalance

Special Precautions while taking Hydrochlorothiazide
1. Gout
2. Diabetes mellitus
3. Renal impairment
4. Hepatic impairment
5. Monitor and correct Fluid and electrolyte imbalance
6. Hyper parathyroidism
7. Cirrhosis

Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
May be used
Indications for Hydrochlorothiazide
1. Hypertension
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Diabetes insipidus
5. Idiopathic hypercalciurea.
6. Vertigo
Interactions for Hydrochlorothiazide
Cholestyramine & Colestipol: decrease absorption of hydrochlorothiazide.
Diazoxide: Additive action - may cause hyperglycemia, hyperuricaemia and hypotension.
Digitalis: Diuretics induced hypokalaemia may precipitate digitalis toxicity.
Lithium: Hydrochlorothiazide potentiates therapeutic and toxic effects by increasing its renal excretion.
Frusemide: Synergy leading to profound diuresis and greater than predicted electrolyte loss.
Non-depolarizing muscle relaxants: Diuretics induced hypokalaemia enhances efficacy.
Sulfonylureas: Efficacy decreased due to hydrochlorothiazide induced glucose intolerance.
Chlorpropamide: Hypokalaemia.
Propantheline: Bioavailability of hydrochlorothiazide increased.
Metoclopramide: Bioavailability of hydrochlorothiazide decreased.
NSAIDs: Natriuretic effect of hydrochlorothiazide decreased.
Typical Dosage for Hydrochlorothiazide
Adults:
Hypertension: 25mg once daily or in divided doses. Increased to 50mg if required; depending up on the patient`s response.
Children: 1mg/kg single daily dose.
Oedema:
Adults:
Starts with 25 to 50mg. Increased the dose until desired response is obtained.
Maximum dose: 200mg/day
Maintenance dosage: 25 to 100mg daily or on alternate days.
Children: 1mg/kg single daily dose or 1 to 3mg/kg/day in two divided doses



Schedule of Hydrochlorothiazide
G
Storage Requirements for Hydrochlorothiazide
Store at room temperature in a well closed container and protected from light.
Effects of Missed Dosage of Hydrochlorothiazide
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Continue the regular schedule.Do not double the dose.
Effects of Overdose of Hydrochlorothiazide
Treatment is supportive and symptomatic. Remove drug from the body by induced emesis and gastric lavage. Monitor and assist respiratory, cardiovascular, and renal function as indicated. Monitor and support fluid and electrolyte balance.

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