Emcor (Bisoprolol)

How does it work?

Emcor tablets and Emcor LS tablets contain the active ingredient bisoprolol, which is a type of medicine called a beta-blocker. (NB. Bisoprolol is also available without a brand name, ie as the generic medicine.)

Beta-blockers work by blocking beta receptors that are found in various parts of the body. Blocking beta receptors prevents the action of two chemicals, called noradrenaline and adrenaline, which are produced naturally by the body. These are often referred to as the 'fight or flight' chemicals, because they are responsible for the body's reaction to stressful situations.

Beta receptors are found in the heart. When they are blocked by bisoprolol, this reduces the effect of adrenaline and noradrenaline on the heart. As a result, the heart beats more slowly and with less force. This reduces the pressure at which the blood is pumped out of the heart and around the body, which in turn reduces the blood pressure. This means that bisoprolol can be used to treat high blood pressure.

When the heart beats slower and with less force, this also reduces the energy used by the heart to pump blood around the body. This reduces the heart's need for oxygen, which means bisoprolol can also be used in the management of angina.

Angina is chest pain that occurs because the heart does not get enough oxygen to meet demand, such as when doing exercise. Bisoprolol reduces the workload of the heart and so decreases its demand for oxygen. This helps to prevent attacks of angina.

What is it used for?

  • Angina pectoris.
  • High blood pressure (hypertension).

Warning!

  • This medicine may cause fatigue and dizziness. You should take care when performing potentially hazardous activites, such as driving or operating machinery, until you know how this medicine affects you and are sure you can perform such activities safely.
  • Alcohol may enhance the blood pressure lowering effect of this medicine, which might make you feel dizzy or faint.
  • You should not stop taking this medicine suddenly, particularly if you have ischaemic heart disease (inadequate flow of blood to the heart, eg angina). When treatment with this medicine is stopped it should be done gradually, following the instructions given by your doctor.
  • This medicine may mask some of the warning symptoms of low blood sugar, such as increased heart rate, tremor and nausea. People with diabetes should carefully monitor their blood sugar while taking this medicine.

Use with caution in

  • Decreased kidney function.
  • Decreased liver function.
  • Heart failure.
  • Slowed conduction of electrical messages between the chambers of the heart (1st degree heart block).
  • A severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
  • Problems with blood circulation in the arteries of the extremities (peripheral arterial disease such as Raynaud's syndrome or intermittant claudication).
  • Asthma.
  • Chronic obstructive pulmonary disease (COPD).
  • Diabetes.
  • Strict fasting.
  • History of psoriasis.
  • People with a history of allergies (beta-blockers may increase sensitivity to allergens and result in more serious allergic reactions; they may also reduce the response to adrenaline used to treat anaphylactic shock).
  • People having desensitisation therapy for allergies.
  • Overactive thyroid gland (hyperthyroidism).

Not to be used in

  • Acute or uncontrolled heart failure.
  • Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
  • Serious defect in the heart's electrical message pathways (2nd or 3rd degree heart block), unless an artificial pacemaker is fitted.
  • A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
  • Failure of the electrical impulse that causes the heart to beat to leave the pacemaker of the heart, resulting in decreased heart function (sino-atrial heart block).
  • Slow heart rate of less than 60 beats per minute (bradycardia).
  • Low blood pressure (hypotension).
  • Severe problems with blood circulation in the arteries of the extremities (peripheral arterial disease such as Raynaud's syndrome or intermittant claudication).
  • Severe asthma.
  • Severe chronic obstructive pulmonary disease (COPD).
  • Untreated tumour of the adrenal gland (phaeochromocytoma).
  • Increased acid levels in the blood (metabolic acidosis).
  • There is insufficient information regarding the safety and efficacy of this medicine in children. It is not recommended for children.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine may be harmful to a developing baby. It should not be used during pregnancy unless considered essential by your doctor. Seek medical advice from your doctor.
  • It is not known whether this medicine passes into breast milk. Breastfeeding is not recommended while taking this medicine. Seek medical advice from your doctor.

Label warnings

  • Do not stop taking this medication except on your doctor's advice.

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. Just because a side effect is stated here 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

Cardicor Vivacor

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