BisoprololBisoprolol Fumarate

About Bisoprolol

Bisoprolol blocks beta-1 receptors, mainly in the heart, slowing the heart rate and lowering blood pressure; at higher doses it also blocks beta-2 receptors. Its US label covers high blood pressure only; MedlinePlus notes it is sometimes used for heart failure, a decision for the prescriber. The usual start is 5 mg once a day, or 2.5 mg for some people, such as those with bronchospastic lung disease or kidney or liver impairment; the maximum is 20 mg.

Tiredness, headache, dizziness, weakness, diarrhea and trouble sleeping are common. It is not used in cardiogenic shock, overt heart failure, second or third degree heart block or a markedly slow heart rate. In some people with coronary artery disease, stopping a beta blocker suddenly has worsened angina or led to a heart attack or dangerous heart rhythm, so the label advises tapering over about a week. It can worsen heart failure, poor circulation and bronchospasm, and can hide the fast heartbeat of low blood sugar or an overactive thyroid. There is no boxed warning.

The combination with hydrochlorothiazide (Ziac and generics) adds a small diuretic dose, and its label allows it as a first treatment at the lowest strength. It is not used if you cannot pass urine or are allergic to sulfonamide-derived drugs; eye pain or a sudden drop in vision needs prompt care; and hydrochlorothiazide is linked to non-melanoma skin cancer, so the label advises sun protection and regular skin checks.

Taking Bisoprolol

How to take it

Once a day at about the same time, with or without food. Do not stop it without your prescriber’s advice; the label advises reducing it over about a week. Know how it affects you before driving.

If you miss a dose

Take it as soon as you remember, unless the next dose is almost due; then skip the missed dose and continue as usual. Do not take a double dose.

Storage

At room temperature in a tightly closed, light-resistant container, protected from moisture and out of reach of children.

Interactions to know about

Do not combine it with another beta blocker. Verapamil, diltiazem, disopyramide and digoxin can slow the heart further. If clonidine is to be stopped, the label suggests stopping bisoprolol several days before. With the combination, lithium is generally avoided and anti-inflammatory painkillers can weaken its effect. People with a history of severe allergic reactions may respond less to the usual dose of epinephrine.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Bisoprolol differs from pharmacy to pharmacy

The 5 and 10 mg tablets and the combination have many generic makers, so a cash quote mostly reflects each pharmacy’s dispensing fee and markup, and a ninety-day fill carries one fee instead of three.

The 2.5 mg tablet has fewer makers, so a pharmacy may need to order it and quotes differ more. A prescription naming Ziac without allowing substitution is priced as a brand.

Ways to pay less for Bisoprolol without insurance

• If the prescription names Ziac, ask the prescriber to allow generic substitution.
• Ask for a ninety-day supply once your dose is stable, and whether bisoprolol is on the pharmacy’s flat-price generic list.
• If you take 2.5 mg and the pharmacy does not stock it, ask the prescriber whether half of a scored 5 mg tablet is acceptable.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Bisoprolol

1. 1.Is this plain bisoprolol or the combination, and which strength?
2. 2.What should I do if my pulse is slow or I feel faint?
3. 3.How should the dose be reduced if I ever stop?
4. 4.Does it interact with my heart, blood pressure or diabetes medicines?
5. 5.Should I tell my surgeon I take it before an operation?

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