Bisoprolol must not be used under certain circumstances. This is the case, for example, if there is hypersensitivity to the active substance. Other contraindications include:
- A severe or inadequately treated form of myocardial insufficiency.
- Pumping failure of the heart (cardiogenic shock).
- Excitation conduction disorders in the area of the heart.
- Diseases of the lungs such as severe bronchial asthma or severe chronic obstructive pulmonary disease.
- Low blood pressure
- Untreated tumor of the adrenal glands
- Late stage of window shopper’s disease or Raynaud’s syndrome.
- Metabolic acidosis (acidosis)
Special caution should also be exercised in patients with diabetes mellitus, psoriasis, impaired liver or kidney function, Prinzmetal angina, slow cardiac arrhythmias (bradycardia), hyperthyroidism, and impaired conduction of excitation from the atria to the ventricle. Similarly, patients currently undergoing desensitization should take bisoprolol only after a careful risk-benefit assessment.
Bisoprolol in Pregnancy
During pregnancy, bisoprolol should be used only if the physician considers the treatment absolutely necessary. This is because, to date, there is no firm evidence on how bisoprolol works during pregnancy. However, there are indications that the active ingredient reduces the blood supply to the placenta, which can lead to growth disorders in the child. Bisoprolol should also not be taken during breastfeeding, as it has been observed in animal studies that the active substance passes into breast milk. If treatment is necessary, breastfeeding should be stopped beforehand. Children should not be treated with bisoprolol because insufficient experience has been gained in this area.
Enhancement of the antihypertensive effect
If bisoprolol is taken concomitantly with certain other medications, serious drug interactions may occur. Under no circumstances should the beta-blocker be used together with floctafenine, amiodarone, or sultopride, as this may cause severe cardiac arrhythmias. The patient must also be carefully monitored when taking calcium channel blockers of the verapamil or diltiazem type and other antiarrhythmic agents. The simultaneous use of other antihypertensive agents, diuretics, calcium channel blockers of the nifedipine type, vasodilators, sleeping pills, anesthetics, antihistamines, antirheumatic drugs, neuroleptics, or tricyclic antidepressants may increase the antihypertensive effect of bisoprolol. This effect may also occur with antacid agents such as ranitidine or cimetidine.
Other interactions with bisoprolol
In contrast, the antihypertensive effect of bisoprolol is attenuated by taking MAO inhibitors and products containing epinephrine or norepinephrine. The same applies to the intake of the antibiotic rifampicin. If bisoprolol is used simultaneously with specific blood pressure medications such as guanfacine, guanethidine, clonidine, alpha-methyldopa, or reserpine, there may be a sharp decrease in heart rate as well as a delay in the conduction to the heart. Taking certain migraine medications (ergotamine derivatives), on the other hand, may increase circulatory disturbances in the periphery. The simultaneous use of bisoprolol and insulin or other agents that lower blood glucose may intensify or mask hypoglycemia. Regular blood glucose monitoring is therefore particularly important for diabetics. If the active substance digoxin is taken at the same time as bisoprolol to strengthen the heart, the excretion of digoxin may be slowed down. Therefore, the amount of digoxin in the blood must be monitored regularly by a physician.
Bisoprolol: Additional Notes
- Drinking alcohol may increase the antihypertensive effect of bisoprolol.
- During heavy physical exertion or strict fasting, hypoglycemia may occur if bisoprolol is taken at the same time.
- Treatment may increase sensitivity to allergens. As a result, severe hypersensitivity reactions may occur during desensitization.
- In patients with renal dysfunction, renal function should be checked regularly during treatment.
- Especially at the beginning of treatment, when the dose is increased, or when switching preparations, bisoprolol may adversely affect the ability to react. This can – especially in combination with alcohol – lead to complications in road traffic or when operating machinery.
- Problems may occur with contact lens wearers, as bisoprolol can negatively affect the formation of tear fluid.
