Medicase - Tenobis Plus 2.5 - 14 Tablets - 2.5mg+6.25mg

Tenobis Plus 2.52.5mg+6.25mg

Type:14 Tablets

Generic Name:Bisoprolol + Hydrochlorothiazide

Manufacturer:Drug International Ltd.

Price:৳84.70

Indication

Hypertension, Congestive heart failure, HTN, Angina pectoris

Administration

May be taken with or without food.

Adult Dose

Adult: PO Initial: 2.5 mg/6.25 mg tablet once daily. Increase based on clinical response in 2 weeks, Maximum: bisoprolol 20 mg/hydrochlorothiazide 12.5 mg once daily. Elderly: Dosage adjustment for geriatric patients usually not necessary

Renal Dose

Renal Impairment Use caution in dosing/titrating patients with renal dysfunction Cumulative effects of thiazides may develop with impaired renal function CrCl <40mL/min: half-life of bisoprolol fumarate is increased up to threefold

Contraindication

Low cardiac output and uncompensated cardiac failure; sinus bradycardia, 1st ° heart block, cardiogenic shock, bronchospasm; severe haemorrhage. Pregnancy.

Mode of Action

Bisoprolol fumarate/hydrochlorothiazide is a fixed-combination tablet that combines a Beta adrenergic receptor blocker, bisoprolol fumarate, and a thiazide diuretic, hydrochlorothiazide. Bisoprolol fumarate, a cardioselective inhibitor of beta(1)-adrenoceptor, has no significant intrinsic sympathomimetic activity or membrane stabilizing activity in its therapeutic dosage; exhibits beta(2)-adrenoceptors inhibition and negative chronotropic effect. Hydrochlorothiazide is a thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excretion of Na+ and water, also K+ and H+ ions.

Precaution

Bronchospastic disease, hyperthyroidism, peripheral vascular disease, undergoing anaesthesia. Monitor blood glucose regularly. May mask symptoms of hypoglycaemia. Elderly. Gradual withdrawal is advised. Lactation: excreted in breast milk, use caution

Side Effect

1-10% Bisoprolol fumarate Arthralgia (3%), asthenia (2%), cough (3%), diarrhea (4%), dizziness (10%), dry mouth (1%), dyspnea (2%), fatigue (8%), headache (11%), hypoaesthesia (2%), insomnia (3%), nausea (2%), peripheral edema (4%), pharyngitis (2%), rhinitis (4%), sinusitis (2%), upper respiratory infection (5%), vomiting (2% ) Hydrochlorothiazide Anorexia,Epigastric distress,Hypokalemia,Hypotension,Orthostatic hypotension,Phototoxicity Frequency Not Defined Bisoprolol fumarate Aggravate CHF, cold extremeties, decrease HDL, depression, hypotension, increase bronchospasm, increase triglycerides, mask symptoms of hypoglycemia, muscle & joint pain Hydrochlorothiazide Agranulocytosis, anaphylaxis, anemia, Confusion, erythema multiforme skin reactions including Stevens-Johnson syndrome Exfoliative dermatitis including toxic epidermal necrolysis, Hypomagnesemia, hyponatremia, hypochloremia, dizziness, fatigue, headache, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, hypercholesterolemia, muscle weakness or cramps, nausea, purpura, rash, vertigo, vomiting Potentially Fatal: AV block, bradycardia. Rare but may occur in patients with preexisting cardiac disease. Includes severe bronchospasm, hypoglycaemia, hypotension, orthostatic hypotension, bradyarrhythmias. 'Rebound phenomenon' leading to unstable angina or MI on sudden withdrawal.

Pregnancy Category Note

Pregnancy Category: C Lactation: excreted in breast milk, use caution

Interaction

Bisoprolol : May potentiate AV conduction time and may increase negative inotropic effect w/ class I antiarrhythmic drugs (e.g. quinidine, disopyramide, propafenone). Concomitant catecholamine-depleting drugs (e.g. reserpine, guanethidine) may produce excessive sympathetic activity. May exacerbate rebound HTN upon discontinuance of clonidine treatment. Increased risk of bradycardia w/ digitalis glycosides. Reduced hypotensive effect w/ NSAIDs. Hydrochlorothiazide: Increases toxicity of lithium. May potentiate orthostatic hypotension w/ barbiturates and narcotics. Enhanced neuromuscular blocking action of competitive neuromuscular blockers (e.g. atracurium). Increased hypokalaemic effect w/ corticosteroids, corticotropin, ?2 agonists (e.g. salbutamol). Additive effect w/ other antihypertensives. Potentiation of orthostatic hypotension w/ barbiturates or opioids. Reduced antihypertensive effect by drugs that cause fluid retention (e.g. corticosteroids, NSAIDs, carbenoxolone). Enhanced nephrotoxicity of NSAIDs. Reduced therapeutic effect of antidiabetics.