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BISOPROLOL FUMARATE
Indications
see under Dose
Cautions
see under Propranolol Hydrochloride;
ensure heart failure not worsening before increasing
dose
Contra-indications
see under Propranolol Hydro-
chloride; also acute or decompensated heart failure
requiring intravenous inotropes;
sino-atrial block
Hepatic impairment
max.
10 mg daily in severe
impairment
Renal impairment
reduce dose if eGFR less than
20 mL/minute/1.73 m
2
(max.
10 mg daily)
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see under Propranolol Hydrochloride;
also
less commonly
depression, muscle weakness, and
cramp;
rarely
hypertriglyceridaemia,
syncope,
and
hearing impairment;
very rarely
conjunctivitis
Dose
. Hypertension and angina,
usually 10 mg once daily
(5 mg may be adequate in some patients); max. 20 mg
daily
. Adjunct in heart failure (section 2.5.5),
initially
1.25 mg once daily (in the morning) for 1 week then, if
well tolerated,
increased to 2.5 mg once daily for 1
week, then 3.75 mg once daily for 1 week, then 5 mg
once daily for 4 weeks,
then 7.5 mg once daily for 4
weeks,
then 10 mg once daily; max.
10 mg daily
Bisoprolol Fumarate
(Non-proprietary) A
Tablets
,
bisoprolol fumarate 5 mg,
net price 28-tab
pack = £1.08;
10 mg,
28-tab pack = £1.14.
Label:
8
Cardicor
c
(Merck Serono) A
Tablets
,
f/c,
bisoprolol fumarate 1.25 mg (white),
net
price 28-tab pack = £4.90; 2.5 mg (scored, white), 28-
tab pack = £3.40;
3.75 mg (scored,
off-white),
28-tab
pack = £4.90; 5 mg (scored, light yellow), 28-tab pack
= £5.90; 7.5 mg (scored, yellow), 28-tab pack = £5.90;
10 mg (scored, orange), 28-tab pack = £5.90. Label: 8
Emcor
c
(Merck Serono) A
LS Tablets
,
yellow,
f/c,
scored,
bisoprolol fumarate
5 mg,
net price 28-tab pack = £11.30.
Label:
8
Tablets
,
orange,
f/c,
scored,
bisoprolol fumarate
10 mg,
net price 28-tab pack = £12.68.
Label:
8
CARVEDILOL
Indications
hypertension; angina; adjunct to diuretics,
digoxin, or ACE inhibitors in symptomatic chronic
heart failure
Cautions
see under Propranolol Hydrochloride;
monitor renal function during dose titration in
patients with heart failure who also have renal
impairment,
low blood pressure,
ischaemic heart
disease,
or diffuse vascular disease
Contra-indications
see under Propranolol Hydro-
chloride; acute or decompensated heart failure
requiring intravenous inotropes
Hepatic impairment
avoid
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
postural hypotension,
dizziness,
head-
ache,
fatigue,
gastro-intestinal disturbances,
brady-
cardia; occasionally diminished peripheral circulation,
peripheral oedema and painful extremities,
dry
mouth,
dry eyes,
eye irritation or disturbed vision,
impotence, disturbances of micturition, influenza-like
symptoms;
rarely angina,
AV block,
exacerbation of
intermittent claudication or Raynaud’s phenomenon;
allergic skin reactions, exacerbation of psoriasis, nasal
stuffiness,
wheezing,
depressed mood,
sleep distur-
bances,
paraesthesia,
heart failure,
changes in liver
enzymes,
thrombocytopenia,
leucopenia also
reported
Dose
. Hypertension,
initially 12.5 mg once daily,
increased
after 2 days to usual dose of 25 mg once daily;
if
necessary may be further increased at intervals of at
least 2 weeks to max. 50 mg daily in single or divided
doses;
ELDERLY
initial dose of 12.5 mg daily may
provide satisfactory control
. Angina, initially 12.5 mg twice daily, increased after 2
days to 25 mg twice daily
. Adjunct in heart failure (section 2.5.5) initially
3.125 mg twice daily (with food), dose increased at
intervals of at least 2 weeks to 6.25 mg twice daily,
then to 12.5 mg twice daily, then to 25 mg twice daily;
increase to highest dose tolerated,
max.
25 mg twice
daily in patients with severe heart failure or body-
weight less than 85 kg and 50 mg twice daily in
patients over 85 kg
Carvedilol
(Non-proprietary) A
Tablets
,
carvedilol 3.125 mg, net price 28-tab pack =
£1.10;
6.25 mg,
28-tab pack = £1.25;
12.5 mg,
28-tab
pack = £1.37;
25 mg,
28-tab pack = £1.84.
Label:
8
Eucardic
c
(Roche) A
Tablets
,
scored,
carvedilol 3.125 mg (pink),
net price
28-tab pack = £7.13;
6.25 mg (yellow), 28-tab pack =
£7.92;
12.5 mg (peach),
28-tab pack = £8.81;
25 mg,
28-tab pack = £11.00.
Label:
8
CELIPROLOL HYDROCHLORIDE
Indications
mild to moderate hypertension
Cautions
see under Propranolol Hydrochloride
Contra-indications
see under Propranolol Hydro-
chloride
Renal impairment
reduce dose by half if eGFR 15–
40 mL/minute/1.73 m
2
;
avoid if eGFR less than
15 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
headache,
dizziness,
fatigue,
nausea and
somnolence;
also bradycardia,
bronchospasm;
depression and pneumonitis reported rarely
Dose
. 200 mg once daily in the morning,
increased to
400 mg once daily if necessary
Celiprolol
(Non-proprietary) A
Tablets
, celiprolol hydrochloride 200 mg, net price 28-
tab pack = £4.53;
400 mg,
28-tab pack = £24.24.
Label:
8,
22
Celectol
c
(Winthrop) A
Tablets
,
f/c,
scored,
celiprolol hydrochloride 200 mg
(yellow), net price 28-tab pack = £19.83;
400 mg,
28-
tab pack = £39.65.
Label:
8,
22
BNF 61
2.4 Beta-adrenoceptor blocking drugs
101
2
Cardiovascular system