bisoprolol fumarate

(bis oh' pro lole)
Zebeta Pregnancy Category C
Drug classes

Beta-selective adrenergic blocking agent Antihypertensive
Therapeutic actions

Blocks beta-adrenergic receptors of the sympathetic nervous system in the heart and juxtaglomerular apparatus (kidney), thus decreasing the excitability of the heart, decreasing cardiac output and oxygen consumption, decreasing the release of renin from the kidney, and lowering blood pressure.
Indications

• • •

Management of hypertension, used alone or with other antihypertensive agents Contraindicated with sinus bradycardia, second- or third-degree heart block, cardiogenic shock, CHF. Use cautiously with renal failure, diabetes or thyrotoxicosis (bisoprolol can mask the usual cardiac signs of hypoglycemia and thyrotoxicosis), pregnancy, lactation, and in those with bronchospastic disease.

Contraindications and cautions

Available forms

Tablets—5, 10 mg
Dosages ADULTS

Initially, 5 mg PO daily, alone or added to diuretic therapy; 2.5 mg may be appropriate; up to 20 mg PO daily has been used.
PEDIATRIC PATIENTS

Safety and efficacy not established.
PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT

Initially, 2.5 mg PO; adjust, and use extreme caution.
Pharmacokinetics
Route Oral Onset 30–60 min Peak 2 hr Duration 12–15 hr

Metabolism: Hepatic; T1/2: 9–12 hr Distribution: Crosses placenta; may enter breast milk Excretion: Urine
Adverse effects

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Allergic reactions: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm, respiratory distress CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech CV: Bradycardia, CHF, cardiac arrhythmias, sinoatrial or AV nodal block, tachycardia, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension Dermatologic: Rash, pruritus, sweating, dry skin EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis GU: Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequent urination Musculoskeletal: Joint pain, arthralgia, muscle cramp Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis (less likely than with propranolol) Other: Decreased exercise tolerance, development of antinuclear antibodies, hyperglycemia or hypoglycemia, elevated serum transaminase, alkaline phosphatase, and LDH

Interactions

Drug-drug • Increased effects with verapamil, anticholinergics • Increased risk of orthostatic hypotension with prazosin • Possible increased BP-lowering effects with aspirin, bismuth subsalicylate, magnesium salicylate, sulfinpyrazone, hormonal contraceptives • Decreased antihypertensive effects with NSAIDs • Possible increased hypoglycemic effect of insulin Drug-lab test • Possible false results with glucose or insulin tolerance tests
Nursing considerations CLINICAL ALERT!

Name confusion has occurred between Zebeta (bisoprolol) and DiaBeta (glyburide); use caution.
Assessment

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History: Sinus bradycardia, cardiac arrhythmias, cardiogenic shock, CHF, renal failure, diabetes or thyrotoxicosis, pregnancy, lactation Physical: Baseline weight, skin condition, neurologic status, P, BP, ECG, R, kidney and liver function tests, blood and urine glucose

Interventions

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Do not discontinue drug abruptly after long-term therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring. Consult with physician about withdrawing drug if patient is to undergo surgery (withdrawal is controversial). Do not stop taking this drug unless instructed to do so by a health care provider. Avoid over-the-counter medications. Avoid driving or dangerous activities if dizziness, weakness occur. These side effects may occur: Dizziness, light-headedness, loss of appetite, nightmares, depression, sexual impotence. Report difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, depression, rash, fever, sore throat.

Teaching points

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Adverse effects in Italic are most common; those in Bold are life-threatening.

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