Cardinor Plus 2.5/6.25

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 stop taking it, your condition may get worse. Keeping active with regular exercise, reducing your weight and eating a healthy diet will also help control your blood pressure. Follow your doctor’s advice while taking this medicine. Nausea, constipation, diarrhea, and fatigue are some common side effects of this medicine. Consult your doctor If any of these bother you, or get worse, or Do not go away. Drink plenty of fluids while taking medicine to overcome muscle weakness, dry mouth and extreme thirst. Dizziness or headache may occur due to low blood pressure but this gets better with time. Before taking it, let your doctor know if you have any liver or kidney problems. Pregnant or breastfeeding women should also consult their doctor for advice before taking this medicine. You also need to tell your doctor what other medicines you are taking especially those used to treat high blood pressure or heart conditions. You should have your blood pressure, kidney function, blood sugar level and the levels of salts such as potassium or magnesium checked regularly to make sure that this medicine is working properly.

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Uses of Cardinor Plus 2.5/6.25
Hypertension (high blood pressure)
Side effects of Cardinor Plus 2.5/6.25
Common
Nausea
Constipation
Fatigue
Headache
Diarrhea
Dizziness
Cold extremities
Slow heart rate
Increased blood uric acid
Decreased potassium level in blood
Glucose intolerance
Altered blood lipid level
Decreased magnesium level in blood
Increased 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.
Quick Tips
It is a combination of two blood pressure lowering medications used for the treatment of high blood pressure.
It can be taken with or without food.
Do not stop taking Cardinor Plus 2.5/6.25 suddenly as it can cause your blood pressure to rise suddenly thereby increasing the risk of heart attack and stroke.
It may cause dizziness. If this happens to you, get up slowly when rising from a sitting or lying position.
It can hide symptoms of low blood sugar if you’re diabetic. Monitor your blood sugar levels regularly.
Cardinor Plus 2.5/6.25 may cause dehydration. Drink plenty of fluids and Inform your doctor if you develop extreme thirst, muscle weakness or very dry mouth.
Brief Description
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

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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, hyperlipidemia, hypercholesterolemia, muscle weakness or cramps, nausea, purpura, rash, vertigo, vomiting Potentially Fatal: AV block, bradycardia. Rare but may occur in patients with preexisting cardiac disease. Includes severe bronchospasm, hypoglycaemia, hypotension, orthostatic hypotension, bradyarrhythmias. 'Rebound phenomenon' leading to unstable angina or MI on sudden withdrawal. _ 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. Reduced antihypertensive effect by drugs that cause fluid retention (e.g. corticosteroids, NSAIDs, carbenoxolone). Enhanced nephrotoxicity of NSAIDs. Reduced therapeutic effect of antidiabetics. _