A 67 year old patient who has DM and HTN is starting Bisprolol Fumarate (5mg) once daily.
His daily drugs include:
Glimipiride 1mg
Cilaril Plus (Cilazapril 5mg & Hydrochlorothiazide 12.5mg)
Dutasteride .5mg
Tamsulosin Hydrochloride .4mg
Levothyroxine Sodium 125 ug
He takes those drugs once a day.
Should any of the drug doses be altered now that he is going to start taking Bisprolol?
From the medications that have been advised to this patient, it seems that this old man is a known case of BPH apart from DM and HTN. The patient is already on a combintion of diuretic and ACEI, so adding a cardioselective Beta blocker in addition may require some dose reduction to prevent any episode of hypotension. If the patients glucose level are controlled so far on the current dose of Glimipride, it doesnt require a dose reduction, but what is important is to inform the patient about the fact that beta blockers tend to mask all the symptoms of hypoglycemia apart from sewating. So the patient should be monitroing his glucose level frequently during the initial phase of the treatment.
Agree with Pallavi Kawatra above, since there appears to be several medications given to the patient to control BPH.The patient is also taking an ACEI apart from a diuretic. Also, Bisoprolol may interact with some drugs including levothyroxine (although the interaction is negligible), but the patient should be monitored for any abrupt fall in blood sugar, as suggested. What is important is that diabetic patients taking levothyroxine should be monitored when a Beta-blocker is introduced. The patient seems to have symptoms of hypothyroidism as the medication schedules points to, and if so, beta blockers can affect thyroid function tests.
I agree that blood glucose should be monitored in this patient. More importantly I suggest to analyze the pharmacokinetics of the ACEI as the patient experiences uncontrolled hypertension rather than adding bisoprolol to the drug regimen in the presence of disease factors
The patient is elderly so unless there is a specific need to introduce a beta blocker he should probably not be prescribed that class. If the patient needs a beta blocker (e.g. post-MI), then the best option is to start the beta blocker with a low dose and gradually titrate upwards while monitoring both blood pressure and blood glucose and adjust treatment as necessary. If the objective is to control blood pressure to target then adding a calcium channel blocker e.g. amlodipine (metabolically neutral) may be the best option in this case. Again both BP and blood glucose need to be monitored.
Bisoprolol is used for blood pressure, angina and heart failure. The maximum dose for hypertension and angina is 20 mg while for heart failure is 10 mg. The starting dose for hypertension and angina is 5 mg while for heart failure is 1.25 mg which is increased gradually. First week 1.25 mg, second week 2.50 mg, third week 3.75 mg, fourth week 5 mg, second month 7.5 mg, third week 10 mg.
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