Zebeta

Generic name:

Bisoprolol fumarate

Drug class:

Cardioselective beta-1 adrenergic receptor blocker (beta-blocker)

Dosage form:

Tablets: 2.5 mg, 5 mg, 10 mg

Root of administration:

Oral

Dose:

Hypertension and angina: initial 2.5–5 mg once daily; maintenance 5–10 mg once daily; maximum 20 mg/day. Chronic heart failure: initial 1.25 mg once daily; titrate to target 10 mg once daily based on tolerability. Adjust dose in elderly or renal/hepatic impairment.

Mechanism of action:

Selective inhibition of beta-1 adrenergic receptors in cardiac tissue reduces heart rate, myocardial contractility, and cardiac output, leading to decreased blood pressure and reduced myocardial oxygen demand.

Drug usage cases:

• Essential hypertension
• Chronic stable angina pectoris
• Chronic heart failure (NYHA class II–IV)
• Adjunctive therapy post–myocardial infarction
• Supraventricular and ventricular arrhythmias (off-label)
• Migraine prophylaxis (off-label)
• Performance anxiety (off-label)
• Thyrotoxicosis (off-label)
• Hypertrophic obstructive cardiomyopathy (off-label)

Drug contra indications:

• Severe bradycardia (heart rate <45 bpm)
• Second- or third-degree atrioventricular block without pacemaker
• Sick sinus syndrome
• Cardiogenic shock
• Unstable or decompensated heart failure
• Severe hypotension (systolic <90 mmHg)
• Severe peripheral arterial disease with critical limb ischemia
• Asthma or severe chronic obstructive pulmonary disease with active bronchospasm
• Hypersensitivity to bisoprolol or any formulation component

Side effects:

• Bradycardia
• Hypotension
• Fatigue
• Dizziness
• Headache
• Nausea
• Diarrhea or constipation
• Cold extremities
• Impotence or decreased libido
• Sleep disturbances (insomnia, vivid dreams)
• Depression or mood changes
• Exacerbation of heart failure
• Atrioventricular block
• Bronchospasm (rare)
• Hypoglycemia unawareness in diabetic patients

Warnings:

• Abrupt withdrawal may precipitate angina, myocardial infarction, or arrhythmias; taper gradually over 1–2 weeks
• May mask signs of hypoglycemia in diabetic patients; use with caution
• Use cautiously in peripheral vascular disease; may worsen symptoms
• Adjust dose in renal or hepatic impairment
• Monitor blood pressure and heart rate regularly
• Use with caution in asthma/COPD; monitor for bronchospasm
• May mask symptoms of hyperthyroidism
• Potential interactions with other antihypertensives leading to additive hypotension
• Monitor mood for signs of depression

Use during pregnancy or breastfeeding:

Use during pregnancy only if potential benefits justify potential fetal risk. May cause fetal bradycardia, intrauterine growth retardation, neonatal hypoglycemia or hypotension. Excreted in breast milk; use with caution in nursing mothers. Monitor infants for bradycardia, hypoglycemia, and respiratory distress.