Bipranix

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Fatigue
- Dizziness
- Headache
- Disturbances of the gut such as nausea, vomiting, diarrhoea, constipation or abdominal pain
- Cold or numb extremities, eg hands and feet
- Muscle weakness or cramps
- Slower than normal heart beat (bradycardia)
- Worsening of heart failure
- Sleep disturbance
- Depression
- Breathing difficulties due to a narrowing of the airways (bronchospasm) in people with asthma or COPD
- A drop in blood pressure that occurs when moving from a lying or sitting position to sitting or standing, which causes dizziness and lightheadedness (postural hypotension - if you experience this you should lie down until the symptoms pass)
- Nightmares
- Hallucinations
- Skin rashes
- Impotence
- Dry eyes
- Inflammation of the liver
- Worsening of psoriasis

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

In people with diabetes, bisoprolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. People with diabetes should monitor their blood sugar, as bisoprolol can also mask the signs of hypoglycaemia.

If bisoprolol is taken in combination with calcium channel blockers such as verapamil, nifedipine or diltiazem, there may be an increased risk of slow heart rate, low blood pressure and heart failure. Verapamil and diltiazem are not recommended for use in combination with bisoprolol.

If bisoprolol is taken in combination with clonidine to lower blood pressure, there is a risk of a rebound increase in blood pressure if the clonidine is stopped. To avoid this, the bisoprolol should be stopped several days before slowly stopping the clonidine.

There may be an increased risk of a slow heart rate if bisoprolol is taken with the following medicines:

- digoxin
- medicines for irregular heart beats (antiarrhythmics), such as amiodarone, disopyramide, flecainide or quinidine.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin may reduce the blood pressure lowering effects of bisoprolol.

If bisoprolol is taken in combination with ergotamine or dihydroergotamine there may be an increased risk of blood circulation problems in the extremities (cold hands and feet).

Bisoprolol has an additive effect with other medicines that decrease blood pressure, particularly medicines used to treat high blood pressure (antihypertensives). Other medicines that decrease blood pressure include the following:

- alpha-blockers such as prazosin
- ACE inhibitors such as captopril
- calcium-channel blockers such as nifedipine
- clonidine
- diuretics, eg furosemide, bendroflumethiazide
- nitrates, eg glyceryl trinitrate
- certain antidepressants, eg amitriptyline, phenelzine
- certain antipsychotics
- alprostadil
- baclofen
- benzodiazepines, eg temazepam
- barbiturates, eg amobarbital.

The antibiotic rifampicin may decrease the blood level of bisoprolol.

Other medicines containing the same active ingredient

Emcor

Cardicor

Vivacor

Bisoprolol tablets and oral solution are also available without a brand name, ie as the generic medicine.

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