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What you need to know before you take Bisoprolol

Do not take Bisoprolol: Do not take Bisoprolol if one of the following conditions applies to you: • allergic (hypersensitivity) to bisoprolol or to any of the other ingredients of this medicine (listed in section 6) • severe asthma. • severe blood circulation problems in your limbs (such as Raynaud’s syndrome), which may cause your fingers and toes to tingle or turn pale or blue. • untreated pheochromocytoma, which is a rare tumour of the adrenal gland. • metabolic acidosis, which is a condition when there is too much acid in the blood. Do not take Bisoprolol if you have one of the following heart problems: • acute heart failure. • worsening heart failure requiring injection of medicines into a vein that increase the force of contraction of the heart. • slow heart rate • low blood pressure • Certain heart conditions causing a very slow heart rate or irregular heartbeat. • Cardiogenic shock, which is an acute serious heart condition causing low blood pressure and circulatory failure. Warnings and precautions If you have any of the following conditions tell your doctor before taking Bisoprolol; he or she may want to take special care (for example give additional treatment or perform more frequent checks): • diabetes • strict fasting • certain heart diseases such as disturbances in heart rhythm, or severe chest pain at rest (Prinzmetal’s angina) • kidney or liver problems • less severe blood circulation problems in your limbs • chronic lung disease or less severe asthma • history of a scaly skin rash (psoriasis) • tumour of the adrenal gland (pheochromocytoma) • thyroid disorder. In addition, tell your doctor if you are going to have: • Desensitization therapy (for example for the prevention of hay fever), because Bisoprolol may make it more likely that you experience an allergic reaction, or such reaction may be more severe. • Anaesthesia (for example for surgery) because Bisoprolol may influence how your body reacts in that situation. If you have chronic lung disease or less severe asthma please inform your doctor immediately if you start to experience new difficulties in breathing, coughing, wheezing after exercise, etc. when using Bisoprolol. Children and adolescents Bisoprolol is not recommended for use in children or adolescents. Other medicines and Bisoprolol Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. Do not take the following medicines with Bisoprolol without special advice from your doctor: • certain medicines used to treat irregular or abnormal heartbeat (Class I antiarrhythmic medicines such as quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone) • certain medicines used to treat high blood pressure, angina pectoris or irregular heartbeat (calcium antagonists such as verapamil and diltiazem) • certain medicines used to treat high blood pressure such as clonidine, methyldopa, moxonidine, rilmenidine. However, do not stop taking these medicines without checking with your doctor first. Check with your doctor before taking the following medicines with Bisoprolol because your doctor may need to check your condition more frequently: • certain medicines used to treat high blood pressure or angina pectoris (dihydropyridine-type calcium antagonists such as felodipine and amlodipine) • certain medicines used to treat irregular or abnormal heartbeat (Class III antiarrhythmic medicines such as amiodarone) • beta-blockers applied locally (such as timolol eye drops for glaucoma treatment) • certain medicines used to treat for example Alzheimer’s disease or glaucoma (parasympathomimetics such as tacrine or carbachol) or medicines that are used to treat acute heart problems (sympathomimetics such as isoprenaline and dobutamine) • antidiabetic medicines including insulin • anaesthetic agents (for example during surgery) • digitalis, used to treat heart failure • non-steroidal anti-inflammatory medicines (NSAIDs) used to treat arthritis, pain or inflammation (for example ibuprofen or diclofenac) • any medicine that can lower blood pressure as a desired or undesired effect, such as antihypertensives, certain medicines for depression (tricyclic antidepressants such as imipramine or amitriptyline), certain medicines used to treat epilepsy or during anaesthesia (barbiturates such as phenobarbital), or certain medicines to treat mental illness characterized by a loss of contact with reality (phenothiazines such as levomepromazine) • mefloquine, used for prevention or treatment of malaria • depression treatment medicines called monoamine oxidase inhibitors (except MAO-B inhibitors) such as moclobemide. Pregnancy and breast-feeding If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Pregnancy There is a risk that the use of Bisoprolol during pregnancy may harm the baby. If you are pregnant or planning to become pregnant, tell your doctor. He or she will decide whether you can take Bisoprolol during pregnancy. Breast-feeding It is not known whether bisoprolol passes into human breast milk. Therefore, breast-feeding is not recommended during therapy with Bisoprolol. Driving and using machines Your ability to drive or use machinery may be affected depending on how well you tolerate the medicine. Please be especially cautious at the start of treatment, when the dose is increased or the medication is changed, as well as in combination with alcohol.