Home Drug Guide Bisoprolol Fumarate

Drug Guide

Generic Name

Bisoprolol Fumarate

Brand Names Zebeta

Classification

Therapeutic: Cardiovascular agent, antihypertensive, beta-blocker

Pharmacological: Beta-1 selective adrenergic receptor blocker

FDA Approved Indications

Hypertension
Angina pectoris

Mechanism of Action

Bisoprolol selectively blocks beta-1 adrenergic receptors in the heart, decreasing heart rate, cardiac output, and blood pressure, thereby reducing myocardial oxygen demand.

Dosage and Administration

Adult: Typically 5 mg once daily, adjustable up to 20 mg based on response.

Pediatric: Not indicated for pediatric use.

Geriatric: Start at lower dose, titrate cautiously due to potential increased sensitivity.

Renal Impairment: Adjust dosage based on severity; close monitoring advised.

Hepatic Impairment: Use with caution; no specific dosage adjustment established.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; bioavailability approximately 90%.

Metabolism: Minimal hepatic metabolism.

Excretion: Renal excretion of unchanged drug and metabolites.

Half Life: Approximately 10-12 hours.

Contraindications

Absolute: Sinus bradycardia, second- or third-degree AV block, cardiogenic shock, overt cardiac failure.
Precautions: Asthma, COPD, peripheral vascular disease, diabetes mellitus, thyrotoxicosis, and patients on other antihypertensive therapy.

Precautions

Use with caution in patients with respiratory conditions due to risk of bronchospasm; monitor blood glucose in diabetics.

Adverse Reactions - Common

Fatigue (Common)
Dizziness (Common)
Bradycardia (Common)

Adverse Reactions - Serious

Severe bradycardia or heart block (Rare)
Worsening heart failure (Rare)
Bronchospasm in susceptible individuals (Rare)

Drug-Drug Interactions

Other antihypertensives, calcium channel blockers, antiarrhythmic agents, insulin and antidiabetics (may mask hypoglycemia)

Drug-Food Interactions

Alcohol may enhance hypotensive effects.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, and respiratory status regularly. Assess for signs of heart failure.

Diagnoses:

Risk for decreased cardiac output
Risk for falls related to hypotension and dizziness.

Implementation: Administer sunrise; monitor HR and BP; caution with abrupt discontinuation.

Evaluation: Assess whether blood pressure and heart rate are controlled and adjust therapy accordingly.

Patient/Family Teaching

Take medication exactly as prescribed.
Notify healthcare provider if symptoms of bradycardia, dizziness, or shortness of breath occur.
Do not discontinue abruptly.
Limit alcohol intake.
Monitor blood glucose if diabetic.

Special Considerations

Black Box Warnings:

Abrupt discontinuation can exacerbate angina and increase risk of myocardial infarction.

Genetic Factors: Consider pharmacogenetic variability in beta-blocker response.

Lab Test Interference: May mask hypoglycemia symptoms in diabetics.

Overdose Management

Signs/Symptoms: Severe bradycardia, hypotension, heart failure, bronchospasm, hypoglycemia.

Treatment: Administer activated charcoal if recent ingestion; vasopressors and atropine for bradycardia; glucagon may be used in overdose with beta-blockers.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under recommended storage conditions.