Bipinor 5 Tablet contains Nebivolol Hydrochlorideequivalent to 5 mg of Nebivolol.It is manufactured by ACI Limited in Bangladesh.  

Indications: Bipinor is indicated for:

• Treatment of essential hypertension (high blood pressure).  
• Treatment of stable mild and moderate chronic heart failure in addition to standard therapies in elderly patients over 70 years.  

Pharmacology:Nebivolol is a beta-adrenergic receptor blocking agent. It works by: 

• Selectively blocking beta1-receptors in the heart, leading to a slower heart rate and reduced force of contraction.  
• Having a vasodilating effect due to its interaction with the endothelium and nitric oxide release, which helps to lower blood pressure.  

Dosage and Administration:

• Hypertension:The usual starting dose for adults is 5 mg once daily, preferably at the same time each day.The dose may be increased if needed at intervals of 2 weeks, up to a maximum of 40 mg once daily.  
• Elderly (over 65 years): The recommended starting dose is 2.5 mg daily, which may be increased to 5 mg daily if needed.
• Renal Impairment: The recommended starting dose is 2.5 mg daily, which may be increased to 5 mg daily if needed in patients with severe renal impairment (Creatinine clearance < 30 ml/min).
• Hepatic Impairment: The recommended starting dose is 2.5 mg once daily in patients with moderate hepatic impairment, to be titrated slowly if needed. Nebivolol is contraindicated in severe hepatic impairment.  
• Chronic Heart Failure: The initial uptitration should be done according to a specific stepwise approach at 1-2 week intervals based on patient tolerability, starting from 1.25 mg daily and increasing to 2.5 mg, 5 mg, and then a maximum of 10 mg once daily.

Bipinor tablets can be taken with or without food.  

Contraindications: Bipinor is contraindicated in patients with:

• Severe bradycardia (heart rate < 50 bpm).
• Heart block greater than first degree.
• Cardiogenic shock.
• Decompensated cardiac failure.
• Sick sinus syndrome (unless a permanent pacemaker is in place).  
• Severe hepatic impairment (Child-Pugh>B).  
• Hypersensitivity to nebivolol or any component of the product.
• Metabolic acidosis.
• Bronchial asthma or a history of bronchospasm.
• Untreated pheochromocytoma.
• Pregnancy and lactation.

Precautions:

• Patients with coronary artery disease should be advised against abrupt discontinuation of therapy.
• Caution should be exercised in patients with circulatory disorders, first-degree heartblock, during anesthesia, in diabetes, hyperthyroidism, chronic obstructive pulmonary disorders, and allergen sensitivity.  
• It may mask signs and symptoms of hypoglycemia and hyperthyroidism.  
• Use with caution in patients with well-compensated heart failure and myasthenia gravis.

Side Effects: The most common side effects are:

• Headache
• Nausea
• Bradycardia (slow heart rate) Other possible side effects include fatigue, dizziness, diarrhea, and constipation.  

Drug Interactions: Nebivolol can interact with:

• Verapamil and diltiazem-type calcium channel blockers.  
• Class I antiarrhythmic drugs (e.g., quinidine, disopyramide).
• Amiodarone.
• CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, propafenone).  
• Other beta-blockers.
• Digitalis glycosides.
• Centrally-acting antihypertensives.
• Anesthetics.
• Antipsychotics, antidepressants, and NSAIDs.

Storage: Store between 20-25°C. Protect from light. Keep out of reach of children.

Important Note: This information is for general knowledge and informational purposes only and does not substitute professional medical advice. Always consult your doctor or pharmacist for specific instructions and guidance regarding your medication. They can assess your individual medical condition and provide the most appropriate advice.