What Factors Affect a Sufficient Bisoprolol Dose?

Bisoprolol hydrochlorothiazide tablets, for the treatment of mild to moderate hypertension.

Drug Name: Bisoprolol hydrochlorothiazide tablets
Alias: Nozd Lodoz (Noszou)
Foreign name: Bisoprolol Fumarate and Hydrochlorothiazide Tablets
Whether prescription drugs: prescription
Main indications: Mild to moderate hypertension
Dosage: See below
Adverse reactions: See below

Main medication contraindications: See below
Dosage form: tablet
Athletes use with caution: Use with caution
Approval Number: 2.5mg / 6.25mg: H200603635mg / 6.25mg: H20060364
Drug Name: Bisoprolol hydrochlorothiazide tablets
Drug type: prescription
Special medicine: Doping

Bisoprolol hydrochlorothiazide tablets ingredients

This product is a compound preparation. Its components are: bisoprolol fumarate 2.5mg or 5mg; hydrochlorothiazide 6.25mg.
Bisoprolol fumarate: 1- [4-[[2- (1-methylethoxy) ethoxy] methyl] phenoxy] -3-[(1-methylethyl) amino] 2-propanol, (E) -2-butadienoic acid (2: 1)
Molecular formula: C ₁₈ H ₃₁ NO ₄ · 1 / 2C ₄ H ₄ O ₄
Molecular weight: 766.97

Hydrochlorothiazide: 6-chloro-3, 4-diaza-2H-1, 2, 4-phenylpropiathiazine-7-sulfamide-1, 1-dioxide.
Molecular formula: C ₇ H ₇ ClN ₃ O ₄ S ₂
Molecular weight: 297.74

Bisoprolol hydrochlorothiazide tablet properties

This product is light yellow (specification 2.5mg) and pink (specification 5mg) biconvex film-coated tablets. One side is engraved with "2.5" or "5". It is white after removing the film.

Indications for bisoprolol hydrochlorothiazide tablets

Mild to moderate hypertension ^[1] .

Bisoprolol Hydrochlorothiazide Tablets Specifications

2.5mg / 6.25mg (each tablet contains 2.5mg bisoprolol fumarate and 6.25mg hydrochlorothiazide);
5mg / 6.25mg (each tablet contains 5mg bisoprolol fumarate and 6.25mg hydrochlorothiazide).

Bisoprolol hydrochlorothiazide tablets usage dosage

Initial dose: 2.5mg / 6.25mg, once a day, one tablet at a time.
If the treatment effect is not good, you can increase the dose to 5mg / 6.25mg once a day, one tablet at a time.
This product should be taken in the morning and can be taken with food. This film-coated tablet should be swallowed at the same time with a small amount of liquid, and should not be chewed.
Patients with mild to moderate liver failure or mild to moderate renal failure (creatinine clearance greater than 30 ml / min) do not need to change the dose.

Adverse effects of bisoprolol hydrochlorothiazide tablets

Common (1%, <10%)
Circulatory system: cold or numb limbs.
Central nervous system: fatigue, extreme exertion, dizziness, headache.
Gastrointestinal tract: nausea, vomiting, diarrhea, constipation.
· Metabolism: elevated triglycerides and cholesterol, glycemicemia, urine glucose, hyperuricemia, water-electrolyte balance (especially hypokalemia and hyponatremia, and hypochloremia and calcium), metabolic The above-mentioned positive symptoms of acidosis appear in the early stage of treatment, to a lesser extent, and usually disappear within 1-2 weeks after the start of treatment.
Rare (0.1%, <1%)
Whole body: muscle weakness or cramps.
Circulatory system: bradycardia, atrioventricular block, increased heart failure, orthostatic hypotension.
Central nervous system: sleep disorders, depression.
· Respiratory tract: Bronchial spasm in patients with asthma or patients with a history of obstructive hives. · Kidney: Reversibly increased serum inosine and urea.
Gastrointestinal tract: loss of appetite, abdominal pain, increased amylase.
Rare (0.01%, <0.1%)
Central nervous system: dreams, hallucinations.
· Skin: Allergic reactions (pruritus, while flushing, rash, photosensitivity, purpura, rubella)
· Liver: Increased liver enzymes (ALAT, ASAT), hepatitis, jaundice.
· Urogenital system: impotence.
ENT: Hearing impairment, allergic rhinitis.
Eyes: dry eyes (considering whether the patient is wearing contact lenses), visual disturbances.
Blood: Fewer white blood cells, thrombocytopenia.
Very rare: (0.001%)
· Eyes: Conjunctivitis · Circulatory system: Chest pain · Skin: -blockers can cause or worsen psoriasis or cause psoriasis-like rashes, alopecia and lupus erythematosus.
Blood: agranulocytosis.
Gastrointestinal tract: pancreatitis

Bisoprolol hydrochlorothiazide tablets contraindications

Related to bisoprolol:
This product is disabled under the following conditions:
1. Severe asthma and severe chronic obstructive pulmonary disease;
2. Heart failure that cannot be controlled by clinical treatment;
3. Cardiogenic shock;
4. Sick sinus node syndrome (including sinoatrial block);
5. Second or third degree AV block without pacemaker;
6. Significant bradycardia (heart rate below 50 beats / min);
7. Variant angina (simple and single treatment);
8. Severe Raynaud's disease and severe peripheral circulation disorders;
9, hypotension, etc .;
10. Compare those with allergy to sorol.
11. Use in combination with flovinine (see "Drug Interactions" for details).
12. In combination with sutopril (see "Drug Interactions" for details).
Related to Hydrochlorothiazide:
This product is disabled under the following conditions:
1. Those who are allergic to sulfa drugs.
2. Severe renal failure (creatinine clearance 30ml / min).
3. Severe liver failure.
4. Lactation.
This product is generally not recommended for use with lithium salts and non-antiarrhythmic drugs that increase polymorphic ventricular tachycardia (see "Drug Interactions" for details).

Precautions for bisoprolol hydrochlorothiazide tablets

caveat:
Related to bisoprolol :
Patients with angina pectoris should not abruptly discontinue treatment, as this may lead to severe arrhythmias, myocardial infarction or sudden death.
Related to Hydrochlorothiazide:
For patients with liver failure, thiazide diuretics and related substances may cause related hepatic encephalopathy. In this case, diuretics must be discontinued immediately.
Things to watch out for during use:
Related to bisoprolol:
1. Suspension of treatment cannot be abruptly stopped, especially for patients with congestive heart disease.
The dose must be gradually reduced (preferably within 1-2 weeks); if necessary, alternative therapies can be used to avoid exacerbation of angina.
2. Asthma and chronic obstructive pulmonary disease Because -blockers are only used for the treatment of mild asthma and chronic obstructive pulmonary disease, and the treatment should start with a lower dose of selective ₁ -blockers, so It is recommended that patients with asthma and chronic obstructive pulmonary disease be mild, and those with moderate hypertension should undergo a lung function test before receiving this product. The treatment will affect the low dose to start.
If the above diseases occur during the treatment of this product, ₂ -blockers such as bronchodilators can be used.
3. Patients with heart failure who are controlled after heart failure treatment. If needed, bisoprolol should be started with very low doses of selective 1-receptor blockers. Therefore, mild to moderate asthma and COPD Patients with hypertension should start with very low doses and gradually increase the dose under strict medical examination when receiving this product.
4 Bradycardia If the patient's resting heart rate is reduced to 50-55 beats per minute, and accompanied by bradycardia-related symptoms, the dosage must be reduced.
5. Atrioventricular block Since -blockers have a negative conduction effect, patients with first-degree atrioventricular block should be used with caution.
6. Beta-blockers of variant angina pectoris can increase the number and duration of attacks in patients with variant angina pectoris. If vasodilators are administered in combination, a small amount of cardiac selective -blockers can be used as an adjuvant combination.
7. Peripheral circulatory disorders are for patients with peripheral circulatory disorders (Raynaud's disease or syndrome, arteritis, or chronic arterial occlusion of the lower limbs). Beta-blockers may worsen the condition. In these cases, -blockers should be used with caution.
8. Eosinophils Patients with eosinophils should not use this product before treatment with alpha-blockers.
Patient blood pressure must be closely monitored.
9. Patients with diabetes should inform patients that they may be at risk for hypoglycemia, and allow patients to increase their self-monitoring of blood glucose at the beginning of treatment. Beta-blockers may mask the signs of hypoglycemia (especially tachycardia, palpitations, and sweating).
10 Psoriasis has been reported to indicate that beta-blockers can aggravate psoriasis symptoms, and bisoprolol should not be used unless necessary.
11. Allergic reactions Patients who are prone to severe allergic reactions (for whatever reason), especially when taking iodine-containing contrast agents or flofenine (see "Drug Interactions"), or during desensitization treatment. Beta-blockers may exacerbate allergic reactions and reduce the effectiveness of conventional doses of epinephrine therapy.
12. General anesthesia beta-blockers are likely to reduce reflex tachycardia and increase the risk of hypotension. The risk of arrhythmias, myocardial ischemia, and transient hypertension is reduced if treatment with beta-blockers is continued. If the patient is taking beta-blockers for treatment. The anesthesiologist should be informed.
If the use of this product must be discontinued, 48 hours after withdrawal is sufficient to restore sensitivity to catecholamines.
Beta-blocker therapy cannot be discontinued in the following situations:
Considering the risks associated with abrupt discontinuation of treatment, patients with ischemic heart disease should continue treatment until surgery is performed.
· In an emergency or must continue treatment, in order to prevent the advantage of vagus, the patient must be given a sufficient amount of atropine in advance. If necessary, repeated administration should be used. Anesthesia with the smallest myocardial sedation effect should be used for anesthesia and blood volume should be supplemented.
The risk of allergic reactions must be considered.
13. Hyperthyroid beta-blockers are likely to mask cardiovascular symptoms of hyperthyroidism.
14. Athletes Athletes should be aware that the active ingredients contained in this product may cause a positive response during doping testing.
Related to Hydrochlorothiazide:
Body fluid and electrolyte balance Serum sodium concentration should be measured before starting treatment, and it should be measured regularly after treatment is started. Usually any diuretic treatment can cause hyponatremia, occasionally with severe consequences.
The decline in serum sodium concentration may begin to be asymptomatic, so regular measurement of serum sodium concentration is necessary, and it should be increased for dangerous populations such as elderly patients and patients with liver cirrhosis (see "Adverse Reactions" and "Drug Overdose" for details). Measurement frequency.
2. The main risk of serum potassium concentrations of thiazide diuretics and related compounds is hypokalemia of potassium depletion.
Certain specific populations, such as elderly patients and / or malnourished patients and / or patients using multiple drugs, patients with liver cirrhosis with edema and ascites, patients with coronary heart disease, and patients with heart failure must prevent hypokalemia (serum Potassium concentration <3.5mmol / L), hypokalemia will increase the cardiotoxicity and arrhythmia caused by digitalis.
No matter the cause is congenital or iatrogenic, this product is at risk for patients with prolonged QT interval. Hypokalemia (and bradycardia) can cause severe arrhythmias, especially polymorphic ventricles, which may be fatal. Sexual tachycardia.
In all cases, the number of determinations of serum potassium should be increased, and the first measurement of serum potassium should be started within one week after starting treatment.
3 The serum calcium concentration of thiazide diuretics and related compounds may reduce the excretion of urine calcium, resulting in a slight and temporary increase in serum calcium concentration. Obvious hypercalcemia may be related to occult hyperthyroidism. Treatment of this product should be discontinued before testing for parathyroid function.
4 Controlling blood glucose levels is extremely important in patients with diabetes, especially when hypokalemia occurs.
5. Patients with uric acid and hyperuricemia are more likely to develop gout: the dose should be adjusted according to the serum uric acid concentration.
6. Renal function and diuretic thiazide diuretics are completely effective in patients with normal renal function or only slight changes in renal function (adult serum creatinine concentration below 25 mg / L, ie 220 mol / L).
Serum creatinine concentration in elderly patients must be adjusted based on the patient's age, weight, and sex. Using the Cockroft formula:
Clcr = (140-age) × weight / 0.814 × serum creatinine concentration
Age in years, body weight in Kg, serum creatinine concentration in mol / L
This formula applies to older men, and older women must multiply the above calculation by 0.85 to correct.
Secondary hypovolemia caused by water and sodium loss caused by diuretic therapy can lead to a decrease in glomerular filtration rate, which may cause an increase in serum uric acid and creatinine concentrations.
This short-term functional renal failure is not important for patients with normal renal function, but it will aggravate existing renal failure.
7. It is recommended to reduce the dosage of this product when used in combination with other antihypertensive drugs, at least in the early stage of administration.
8. Athletes Athletes should be aware that the active ingredients contained in this product may cause a positive response during doping testing.
[Impact on driving cars and operating machines]
There is a danger of hypotension and dizziness when using this product, so it may affect driving cars and operating machines.

Bisoprolol hydrochlorothiazide tablets for pregnant and lactating women

Pregnant women should not use this product because it contains thiazide diuretics.
Related to bisoprolol:
Animal tests have found no teratogenic effects of bisoprolol.
To date, placebo-controlled prospective studies using some beta-blockers have shown that they do not cause neonatal deformities. Pregnant women receiving beta-blockers may have beta-blockers in their newborns that last for a few days after birth and may cause bradycardia, respiratory distress, or hypoglycemia. Pregnant women should use bisoprolol It usually does not have clinical effects, but because heart failure can occur. Pregnant women should be hospitalized in the intensive care unit. The use of plasma volume expanders (as they can cause acute pulmonary edema) should be avoided.
Related to chlorothiazide:
Diuretics can cause fetal placental ischemia and may cause fetal hypoplasia. Rarely reported severe neonatal thrombocytopenia.
Breastfeeding women and bisoprolol:
Whether bisoprolol is excreted by milk is unclear.
The risk of hypoglycemia and bradycardia in breast-feeding infants treated with bisoprolol has not been evaluated.
Related to Hydrochlorothiazide:
Thiazine diuretics can be excreted through milk, so breastfeeding is prohibited during the application of this product (see "Contraindications").
Thiazine diuretics may have the following effects:
Reduced or even suppressed milk secretion;
· Adverse biological effects (hypokalemia);
· Red blood cell dissolution (in the case of insufficient G-6-PD) and allergy to sulfa drugs.

Bisoprolol hydrochlorothiazide tablets for children

There is no data on children's medication, so children are not recommended to use this product.

Bisoprolol hydrochlorothiazide tablets for elderly

Elderly patients must be scrutinized for contraindications. Treatment must be started at low doses and monitored closely.

Bisoprolol hydrochlorothiazide tablets drug interactions

Drug interactions with bisoprolol:
1. Contraindications:
Flofenin Flofenin may cause shock and hypotension. When combined with -blockers, -blockers may reduce the cardiovascular compensation response.
Sutopril increases the risk of ventricular arrhythmias, especially polymorphic ventricular tachycardia.
2. Not recommended for concomitant use:
Amiodarone produces contraction, autonomy, and conduction disorders due to its inhibition of the sympathetic nerve compensation mechanism.
3 Concomitant medications to pay close attention to:
Volatile halogenated anesthetic -blockers can reduce the cardiovascular compensation response (the use of -agonists can eliminate -adrenergic suppression during surgery).
Sudden interruptions in the treatment of beta-blockers must usually be avoided. Patients should be aware of the anesthesiologist if they are being treated with beta-blockers.
· Calcium antagonists (benzidil, diltiazem, verapamil)
Causes autonomic dysfunction (excessive bradycardia, sinus arrest), sinus and atrioventricular conduction disorders, and heart failure (synergistic effects).
This combination drug can only be used under strict clinical and ECG monitoring, especially for elderly patients and early treatment.
· Antiarrhythmic drugs (Propazone and Class I.a drugs such as quinidine, quinidine and propidium)
Contractility, naturalness, and conduction disorders (decreased sympathetic nerve compensation mechanism).
Clinical and ECG monitoring should be performed.
· Insulin and sulfonylureas all beta-blockers may mask some symptoms of hypoglycemia, especially palpitations and tachycardia.
Remind patients and urge them to strengthen their blood glucose self-tests, especially at the beginning of treatment.
Lidocaine (Penolol, Metoprolol and Nadorol should also be used with caution)
Increased serum lidocaine concentration may be accompanied by severe neurological and cardiac adverse effects (because this product reduces liver metabolism of lidocaine).
The dose of lidocaine should be adjusted. Perform clinical and electrocardiographic monitoring during beta-blocker therapy and after discontinuation of therapy, and monitor serum lidocaine concentrations as much as possible.
· Iodine-containing contrast agents Iodine-containing contrast agents may cause shock or hypotension, and beta-blockers may reduce the cardiovascular compensation response.
Where possible, treatment of beta-blockers should be discontinued before radiological examinations. If treatment cannot be discontinued, the doctor must have appropriate resuscitation methods.
· Cholinesterase inhibitors are at risk for excessive bradycardia (synergistic bradycardia).
Routine clinical monitoring should be performed when combined.
4 Concomitant medications to note:
· Non-steroidal anti-inflammatory drugs (NSAIDs)
Decreased antihypertensive effect (NSAID can inhibit vasodilating prostaglandins, and NSAID-pyrazolone derivatives can cause sodium and sodium retention)
· Calcium antagonists: dihydropyridines (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nirendipine)
Potential or uncontrolled patients with heart failure can cause hypotension and heart failure. Sexual force effect).
In addition, beta-blockers can cause a decrease in hemodynamics by reducing reflex sympathetic responses.
· Mefloquine is at risk for bradycardia (synergistic bradycardia)
Drug interactions with hydrochlorothiazide:
1. Not recommended for concomitant use:
Lithium is the same as ingesting sodium-free foods (this will reduce the excretion of urinary lithium), and it will increase the serum lithium concentration with signs of excess lithium. If combined administration is necessary, the serum lithium concentration should be strictly monitored and the dosage administered.
Non-arrhythmic drugs that cause polymorphic ventricular tachycardia (astemizole, benzprodil, erythromycin, halotritraline, pentamidine, sparfloxacin, terfenadine, and Vincristine) (for sutopril, "contraindications associated with bisoprolol")
Polymorphic ventricular tachycardia (hypokalemia, bradycardia, and pre-existing QT interval prolongation are all predisposing factors)
When hypokalemia occurs, treatments that do not cause polymorphic tachycardia should be used.
2. Concomitant medications to pay close attention to:
Systemic non-steroidal anti-inflammatory drugs (NSAIDs). Patients with high-dose salicylate dehydration can cause acute renal failure (NSAIDs can inhibit vasodilatory prostaglandins and cause a decrease in glomerular filtration), which should be given to patients. Rehydration; and monitor their renal function early in the treatment.
Potassium excretion agent amphotericin B (intravenous administration), glucocorticoids and mineralocorticoids (systemic action), teicotaxin, and stimulant laxatives: can increase the risk of hypokalemia (synergistic effects).
Serum potassium concentrations should be monitored and corrected if necessary: special attention should be paid to whether patients are using digitalis. Non-irritating laxatives should be used.
Digitalis glucoside hypokalemia can increase the toxicity of digitalis glycosides.
Serum potassium levels should be monitored and ECG monitored if necessary.
· Potassium-preserving diuretics (amilolide, potassium canamate, spironolactone, ampicillin)
Reasonable combination therapy is beneficial to some patients, but it does not rule out the possibility of hypokalemia. Hyperkalemia may also occur in patients with impaired renal function and diabetes.
Serum potassium levels should be monitored, and electrocardiograms should be monitored and treatment options reconsidered if necessary.
Angiotensin-converting enzyme (ACE) inhibitors. Patients who already have sodium depletion (especially renal arterial stenosis) may be at risk of sudden hypotension and / or acute renal failure in the initial phase of treatment with ACE inhibitors.
If previous diuretic therapy has caused sodium depletion in patients with high blood pressure, diuretics must be discontinued 3 days before ACE inhibitor treatment and consideration should be given to re-using potassium-releasing diuretics, or slowly increasing after reducing the initial dose of ACE inhibitor Administered dose.
Patients with congestive heart failure start treatment with very low doses of ACE inhibitors after reducing the dose of potassium-releasing diuretics as much as possible.
In all of these cases, the patient's renal function must be monitored during the first few weeks of treatment with ACE inhibitors (detection of serum creatinine concentration).
· Antiarrhythmic drugs that cause polymorphic ventricular tachycardia: Class I.a antiarrhythmic drugs (quinidine, quinidine and propidamine), amiodarone, benzyl bromide, and sotalol Polymorphic ventricular tachycardia (hypokalemia, bradycardia, and pre-existing QT interval prolongation are all predisposing factors).
Prevent hypokalemia and correct hypokalemia if necessary: monitor QT interval.
If polymorphic ventricular tachycardia occurs, do not take antiarrhythmic drugs (implant a pacemaker to stimulate the heart).
· The use of diuretics for metformin, more specifically the use of diuretics can cause functional kidney damage, which in turn leads to metformin-induced lactic acidemia.
Metformin is prohibited when the serum creatinine concentration of male patients exceeds 15 mg / L (135 mol) / L and female patients exceed 12 mg / L (110 mol / L).
· Iodine-containing contrast agents Patients who are dehydrated due to diuretics have an increased risk of acute renal failure when using high-dose iodine-containing contrast agents. 2. Hydrate the patient before using iodine-containing contrast agents. Concomitant medications to note:
· Reduced calcium excretion due to urinary calcium may cause hypercalcemia.
· Cyclosporine has the risk of increasing serum creatinine concentration even in the absence of body fluid or sodium loss, while not affecting the circulating level of cyclosporine.
Interactions with bisoprolol and hydrochlorothiazide:
1. Concomitant medications to pay close attention to:
Baclofen increases its anti-hypertensive effect: blood pressure should be monitored and the dose of antihypertensive drugs adjusted if necessary.
2. Concomitant medications to note:
· Tricyclic antidepressants and psychotropic agents increase their anti-hypertensive blood pressure effects and may cause orthostatic hypotension (synergy).
Systemic effects of steroids and corticotropin to reduce anti-diarrheal blood pressure (corticosteroids can cause water and sodium retention).

Bisoprolol hydrochlorothiazide tablets overdose

If the patient has bradycardia or abnormally decreased blood pressure, the following drugs must be given intravenously:
Atropine, 1 to 2 mg bolus;
· Subsequent bolus of 1 mg of pancreatic glucagon, 10 mg / hour intravenous drip if necessary;
· If necessary afterwards, or slow intravenous infusion of isoproterenol 15 to 85 g (repeated operation, but the total dose should not exceed 300 g), or intravenous infusion of dobutamine 2.5 to 10 g / kg / hour.
Mothers use beta-blockers if their newborns experience cardiac metabolic disorders:
· Intravenous glucagon 0.3mg / kg;
Hospitalization in an intensive care unit;
· Isoproterenol or dobutamine: usually higher doses and longer treatment periods should be monitored.

Bisoprolol Hydrochlorothiazide Tablets Pharmacology and Toxicology

Pharmacology:
This product is a compound preparation of -blocker ( ₁ selective) and thiazide diuretics.
Clinical experiments have proven that the two active ingredients in the compound have an additive effect. The lowest dose (2.5 mg + 6.25 mg) has been effective for mild to moderate hypertension.
Hypokalemia caused by hydrochlorothiazide and adverse reactions such as bradycardia, weakness, and headache caused by bisoprolol are dose-related. The two active substances are used in combination at a quarter or a half (2.5 mg + 6.25 mg) of a single therapeutic dose, respectively, in order to reduce these adverse reactions.
Bisoprolol is a potent, selective ₁ -adrenergic receptor blocker without intrinsic sympathomimetic activity and any significant membrane stabilization effects.
Although bisoprolol can significantly reduce the concentration of propeller renin and slow the heart rate, like other ₁ -adrenergic receptor blockers, its mode of action for treating iliac blood pressure is unclear.
Hydrochlorothiazide is a thiazide diuretic and has antihypertensive effects. Its mechanism of action is to block Na ⁺ reabsorption by blocking the active transport of Na ⁺ from the renal tubules to the blood.
toxicology:
Like other beta-blockers, high-dose bisoprolol in maternal studies (feeding and weight loss), embryos and / or fetuses (increased number of late abortions, weight loss in offspring, physical development before the end of lactation) (Slow) have toxic effects. However, neither bisoprolol nor hydrochlorothiazide had any teratogenic effects. The two active ingredients were administered at the same time without toxicity accumulation.

Pharmacokinetics of bisoprolol hydrochlorothiazide tablets

Bisoprolol < br Absorption: The peak time (T _max ) of bisoprolol is 1 to 4 hours. Its bioavailability is high (88%), it is not affected by eating, and first-pass metabolism of the liver rarely occurs. When the dose is in the range of 5 40mg, its pharmacokinetics is linear.
Distribution: The plasma protein binding rate of bisoprolol is 30%, and the distribution volume is very high (about 3L / Kg).
Metabolism: 40% of bisoprolol is metabolized by the liver and its metabolites are inactive.
Clearance: The plasma clearance half-life is 11 hours. The liver and kidney clearance rates are almost the same, and half of the administered dose of the original drug and metabolites were found in the urine. The total clearance is 15L / h.
Hydrochlorothiazide < br Absorption: Hydrochlorothiazide has a bioavailability of 60% to 80%, with individual differences. The peak time (T _max ) is 1.5 to 5 hours, with an average of about 4 hours.
Distribution: about 40% bound to plasma proteins.
Clearance: Hydrochlorothiazide is not metabolized, and almost all is excreted in the original form through glomerular filtration and active secretion of the renal tubules. The elimination half-life is approximately 8 hours. In patients with renal failure and heart failure, hydrochlorothiazide's renal clearance is decreased and the clearance half-life is prolonged. In addition to decreased renal clearance and prolonged clearance half-life, elderly patients are also accompanied by an increase in peak plasma concentration ( _Cmax ).

Bisoprolol Hydrochlorothiazide Tablets Storage

Store below 25 ° C.

Bisoprolol Hydrochlorothiazide Tablets Packaging

Aluminum-plastic packaging.
10 tablets / box; 30 tablets / box.

Validity of bisoprolol hydrochlorothiazide tablets

36 months.

Bisoprolol Hydrochlorothiazide Tablets

Import Drug Registration Standard JX20020098

Pregnancy grading of bisoprolol hydrochlorothiazide tablets

FDA pregnancy classification: C; D-as used in the middle and late pregnancy.