Bisopro Plus 2.5/6.25 Tablet

Combination of a cardioselective beta-blocker and a thiazide diuretic for high blood pressure when a single medicine is not enough (or to replace separate tablets).

Adults: one tablet once daily in the morning — bisoprolol 2.5 mg + HCTZ 6.25 mg, increased if needed to 5/6.25 mg or 10/6.25 mg (maximum bisoprolol 20 mg + HCTZ 12.5 mg per day in some products).

• Swallow with water, with or without food.
• Do not stop suddenly (bisoprolol) — reduce gradually over 1–2 weeks.
• Not recommended in severe kidney impairment (eGFR < 30).

• Uncontrolled heart failure, cardiogenic shock
• Heart block (2nd/3rd degree), sick sinus syndrome, slow heart rate (< 50/min)
• Severe asthma or COPD
• Severe peripheral arterial disease, Raynaud's
• Untreated phaeochromocytoma, metabolic acidosis
• Anuria, severe kidney or liver impairment
• Low potassium or sodium, high calcium (resistant), symptomatic gout
• Allergy to bisoprolol, thiazides or sulphonamides

Common: tiredness, dizziness, headache, cold hands and feet, slow heartbeat, stomach upset, raised uric acid and blood sugar, low potassium.

Less common: sleep disturbance, low mood, muscle cramps, low blood pressure on standing, sun sensitivity, erectile difficulty.

Rare but serious: heart block, bronchospasm, worsening heart failure, pancreatitis, acute myopia/angle-closure glaucoma (sudden eye pain), severe skin reactions; non-melanoma skin cancer risk with long-term HCTZ.

• Check potassium, sodium, kidney function, sugar and uric acid periodically.
• Diabetes: may mask hypoglycaemia.
• Use sun protection and check skin regularly.
• Tell the anaesthetist before surgery.

Not recommended in pregnancy or while breastfeeding.

• Verapamil, diltiazem (heart block) — avoid
• Clonidine (rebound if stopped)
• Lithium (toxicity)
• NSAIDs (reduced effect, kidney injury)
• Digoxin, amiodarone, sotalol (slow pulse; risk with low potassium)
• Insulin and diabetes tablets (hidden hypoglycaemia, raised sugar)
• Corticosteroids, laxatives (low potassium)

Slow heartbeat, low blood pressure, bronchospasm, dehydration, electrolyte loss. Emergency care.

Store below 30°C.