Prescription Drug Information: Bisoprolol Fumarate and Hydrochlorothiazide (Page 4 of 6)

Bisoprolol Fumarate

In rats, bisoprolol fumarate was not teratogenic at doses up to 150 mg/kg/day, which were 375 and 77 times the MRHD on the basis of body weight and body surface area, respectively. Bisoprolol fumarate was fetotoxic (increased late resorptions) at 50 mg/kg/day and maternotoxic (decreased food intake and body weight gain) at 150 mg/kg/day. The fetotoxicity in rats occurred at 125 times the MRHD on a body weight basis and 26 times the MRHD on the basis of body surface area. The maternotoxicity occurred at 375 times the MRHD on a body weight basis and 77 times the MRHD on the basis of body surface area. In rabbits, bisoprolol fumarate was not teratogenic at doses up to 12.5 mg/kg/day, which is 31 and 12 times the MRHD based on body weight and body surface area, respectively, but was embryolethal (increased early resorptions) at 12.5 mg/kg/day.

Hydrochlorothiazide

Hydrochlorothiazide was orally administered to pregnant mice and rats during respective periods of major organogenesis at doses up to 3000 and 1000 mg/kg/day, respectively. At these doses, which are multiples of the MRHD equal to 12,000 for mice and 4000 for rats, based on body weight, and equal to 1129 for mice and 824 for rats, based on body surface area, there was no evidence of harm to the fetus. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Nonteratogenic Effects

Thiazides cross the placental barrier and appear in the cord blood. The use of thiazides in pregnant women requires that the anticipated benefit be weighed against possible hazards to the fetus. These hazards include fetal or neonatal jaundice, pancreatitis, thrombocytopenia, and possibly other adverse reactions that have occurred in the adult.

Nursing Mothers

Bisoprolol fumarate alone or in combination with HCTZ has not been studied in nursing mothers. Thiazides are excreted in human breast milk. Small amounts of bisoprolol fumarate (<2% of the dose) have been detected in the milk of lactating rats. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and effectiveness of bisoprolol fumarate and hydrochlorothiazide tablets in pediatric patients have not been established.

Geriatric Use

In clinical trials, at least 270 patients treated with bisoprolol fumarate plus HCTZ were 60 years of age or older. HCTZ added significantly to the antihypertensive effect of bisoprolol in elderly hypertensive patients. No overall differences in effectiveness or safety were observed between these patients and younger patients. Other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

ADVERSE REACTIONS

Bisoprolol Fumarate and Hydrochlorothiazide Tablets

Bisoprolol fumarate/HCTZ 6.25 mg is well tolerated in most patients. Most adverse effects (AEs) have been mild and transient. In more than 65,000 patients treated worldwide with bisoprolol fumarate, occurrences of bronchospasm have been rare. Discontinuation rates for AEs were similar for bisoprolol fumarate/HCTZ 6.25 mg and placebo-treated patients.

In the United States, 252 patients received bisoprolol fumarate (2.5, 5, 10, or 40 mg)/HCTZ 6.25 mg and 144 patients received placebo in two controlled trials. In Study 1, bisoprolol fumarate 5/HCTZ 6.25 mg was administered for 4 weeks. In Study 2, bisoprolol fumarate 2.5, 10, or 40/HCTZ 6.25 mg was administered for 12 weeks. All adverse experiences, whether drug related or not, and drug related adverse experiences in patients treated with bisoprolol fumarate 2.5-10/HCTZ 6.25 mg, reported during comparable, 4-week treatment periods by at least 2% of bisoprolol fumarate/HCTZ 6.25 mg-treated patients (plus additional selected adverse experiences) are presented in the following table:

% of Patients with Adverse Experiencesa

Body System/ Adverse Experience

All Adverse Experiences

Drug Related Adverse Experiences

Placebo b

B2.5-40/H6.25b

Placebo b

B2.5-10/H6.25b

(n=144)

(n=252)

(n=144)

(n=221)

%

%

%

%

Cardiovascular

bradycardia

0.7

1.1

0.7

0.9

arrhythmia

1.4

0.4

0.0

0.0

peripheral ischemia

0.9

0.7

0.9

0.4

chest pain

0.7

1.8

0.7

0.9

Respiratory

bronchospasm

0.0

0.0

0.0

0.0

cough

1.0

2.2

0.7

1.5

rhinitis

2.0

0.7

0.7

0.9

URI

2.3

2.1

0.0

0.0

Body as a Whole

asthenia

0.0

0.0

0.0

0.0

fatigue

2.7

4.6

1.7

3.0

peripheral edema

0.7

1.1

0.7

0.9

Central Nervous System

dizziness

1.8

5.1

1.8

3.2

headache

4.7

4.5

2.7

0.4

Musculoskeletal

muscle cramps

0.7

1.2

0.7

1.1

myalgia

1.4

2.4

0.0

0.0

Psychiatric

insomnia

2.4

1.1

2.0

1.2

somnolence

0.7

1.1

0.7

0.9

loss of libido

1.2

0.4

1.2

0.4

impotence

0.7

1.1

0.7

1.1

Gastrointestinal

diarrhea

1.4

4.3

1.2

1.1

nausea

0.9

1.1

0.9

0.9

dyspepsia

0.7

1.2

0.7

0.9

a Averages adjusted to combine across studies.

b Combined across studies.


Other adverse experiences that have been reported with the individual components are listed below.

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