Cardinor Plus 2.5/6.25 - tablet Bisoprolol + Hydrochlorothiazide - 2.5mg+6.25mg 10 Tablet(s) / Strip Labaid Pharmaceuticals Ltd. Introduction: Cardinor Plus 2.5/6.25 is a medicine used to treat hypertension (high blood pressure). Cardinor Plus 2.5/6.25 is a combination of two medicines that helps to control blood pressure when a single medication is not effective. It helps to reduce chances of any future heart attack and stroke. Cardinor Plus 2.5/6.25 is taken with or without food preferably in the morning to avoid frequent urination at night. Keep taking it for as long as advised by your doctor. Even if you feel well, do not stop this medicine on your own because high blood pressure often has no symptoms. If you... Uses of Cardinor Plus 2.5/6.25: Hypertension (high blood pressure) Side effects of Cardinor Plus 2.5/6.25: NauseaConstipationFatigueHeadacheDiarrheaDizzinessCold extremitiesSlow heart rateIncreased blood uric acidDecreased potassium level in bloodGlucose intoleranceAltered blood lipid levelDecreased magnesium level in bloodIncreased calcium level in blood How to use Cardinor Plus 2.5/6.25: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Cardinor Plus 2.5/6.25 may be taken with or without food, but it is better to take it at a fixed time. How Cardinor Plus 2.5/6.25 works: Cardinor Plus 2.5/6.25 is a combination of two blood-pressure lowering medicines: Bisoprolol and Hydrochlorothiazide. Bisoprolol is a beta blocker. It works specifically on the heart to improve its efficiency of pumping blood throughout the body. Hydrochlorothiazide is a diuretic which lowers blood pressure by removing extra water from the body. Over time it also relaxes blood vessels and improves blood flow. Indication: Hypertension, Congestive heart failure, HTN, Angina pectoris Administration: May be taken with or without food. Adult Dose: Adult: PO Initial: 2.5 mg/6.25 mg tablet once daily. Increase based on clinical response in 2 weeks, Maximum: bisoprolol 20 mg/hydrochlorothiazide 12.5 mg once daily. Elderly: Dosage adjustment for geriatric patients usually not necessary Renal Dose: Renal Impairment Use caution in dosing/titrating patients with renal dysfunction Cumulative effects of thiazides may develop with impaired renal function CrCl <40mL/min: half-life of bisoprolol fumarate is increased up to threefold Contraindication: Low cardiac output and uncompensated cardiac failure; sinus bradycardia, 1st ° heart block, cardiogenic shock, bronchospasm; severe haemorrhage. Pregnancy. Mode of Action: Bisoprolol fumarate/hydrochlorothiazide is a fixed-combination tablet that combines a Beta adrenergic receptor blocker, bisoprolol fumarate, and a thiazide diuretic, hydrochlorothiazide. Bisoprolol fumarate, a cardioselective inhibitor of beta(1)-adrenoceptor, has no significant intrinsic sympathomimetic activity or membrane stabilizing activity in its therapeutic dosage; exhibits beta(2)-adrenoceptors inhibition and negative chronotropic effect. Hydrochlorothiazide is a thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excretion of Na+ and water, also K+ and H+ ions. Precaution: Bronchospastic disease, hyperthyroidism, peripheral vascular disease, undergoing anaesthesia. Monitor blood glucose regularly. May mask symptoms of hypoglycaemia. Elderly. Gradual withdrawal is advised. Lactation: excreted in breast milk, use caution Side Effect: 1-10% Bisoprolol fumarate Arthralgia (3%), asthenia (2%), cough (3%), diarrhea (4%), dizziness (10%), dry mouth (1%), dyspnea (2%), fatigue (8%), headache (11%), hypoaesthesia (2%), insomnia (3%), nausea (2%), peripheral edema (4%), pharyngitis (2%), rhinitis (4%), sinusitis (2%), upper respiratory infection (5%), vomiting (2% ) Hydrochlorothiazide Anorexia,Epigastric distress,Hypokalemia,Hypotension,Orthostatic hypotension,Phototoxicity Frequency Not Defined Bisoprolol fumarate Aggravate CHF, cold extremeties, decrease HDL, depression, hypotension, increase bronchospasm, increase triglycerides, mask symptoms of hypoglycemia, muscle & joint pain Hydrochlorothiazide Agranulocytosis, anaphylaxis, anemia, Confusion, erythema multiforme skin reactions including Stevens-Johnson syndrome Exfoliative dermatitis including toxic epidermal necrolysis, Hypomagnesemia, hyponatremia, hypochloremia, dizziness, fatigue, headache, hypercalcemia, hyperuricemia, hyperglycemia,... Pregnancy Category Note: Pregnancy Category: C Lactation: excreted in breast milk, use caution Interaction: Bisoprolol : May potentiate AV conduction time and may increase negative inotropic effect w/ class I antiarrhythmic drugs (e.g. quinidine, disopyramide, propafenone). Concomitant catecholamine-depleting drugs (e.g. reserpine, guanethidine) may produce excessive sympathetic activity. May exacerbate rebound HTN upon discontinuance of clonidine treatment. Increased risk of bradycardia w/ digitalis glycosides. Reduced hypotensive effect w/ NSAIDs. Hydrochlorothiazide: Increases toxicity of lithium. May potentiate orthostatic hypotension w/ barbiturates and narcotics. Enhanced neuromuscular blocking action of competitive neuromuscular blockers (e.g. atracurium). Increased hypokalaemic effect w/ corticosteroids, corticotropin, ?2 agonists (e.g. salbutamol). Additive effect w/ other antihypertensives. Potentiation of orthostatic hypotension w/ barbiturates or opioids....