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Sid asked...

I have stopped taking concor 5mg suddenly

I have stopped taking concor 5mg suddenly and taken terminol 25mg but it started chest pain and sleeping diorders so can I start taking concor again.

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The answer

Hello Sid

Thank you for contacting Health at Hand.

Concor 5mg tablets contain the active ingredient Bisoprolol 5mg tablets. We could not find any medications named Terminol but do you mean Tenormin?

Tenormin contain the active ingredient Atenolol and they are available in different strengths including 25mg.

Both Atenolol and Bisoprolol belong to the group of medications called beta blockers. What are Beta blockers?

Beta blockers are a group of medicines that are used to treat at least 9 different conditions These include;

  • High blood pressure (Hypertension)
  • Angina
  • Abnormal heart beats or rhythms (Arrhythmias) including atrial fibrillation
  • Heart attack
  • Heart Failure
  • Overactive thyroid
  • Glaucoma
  • Migraine
  • Anxiety

Many beta-blockers are now available and these include acebutalol, atenolol, bisoprolol, carvedilol, celiprolol, labetalol, metoprolol, nadolol, nebivolol, oxprenolol, pindolol, sotalol, propranolol and timolol.

Overall they are equally effective but there are some differences between them. Some are work more on the heart whilst others have greater effect blood vessels. Some are water soluble and some are lipid soluble so the side effects can differ. Some have a short duration of action compared to others. These differences mean that your doctor will select the one that is best for your needs.

How do they work?

They work by blocking the beta receptors found mainly in the heart , brain and blood vessels.

What is the difference between Atenolol and Bisoprolol?

Atenolol is cardioselective and water-soluble medicine. This means that it acts mainly on the heart and is less likely to cause central side effects such as sleep disturbances and nightmares.

It is normally the first choice for the treatment of angina and hypertension.

To treat hypertension it is normally taken as 25mg or 50mg tablets once daily.

To treat angina or arrhythmias it is normally taken as 50 to 100mg tablets daily.

It is also used to prevent migraine and within the first 12 hours of a heart attack.

Bisoprolol is highly cardioselective this means it action is even more selective on the heart.

Bisoprolol is also more lipid-soluble than atenolol, and therefore has more potential to cause nightmares and sleep disturbances.

Bisoprolol is used to treat hypertension, angina and long-term moderate to severe heart failure in addition to ACE inhibitor therapy and diuretics.

To treat hypertension or angina it is normally taken as 5-10mg tablets once a day.

To treat heart failure it is taken at a low dose of 1.25mg to begin with then gradually increased weekly according to the patient’s needs. If it is tolerated it can be taken as a maximum dose of 10mg daily.

How much atenolol will give the same response as bisoprolol 5mg?

It is generally thought that bisoprolol 5mg is bioequivalent to atenolol 50mg so if you are taking atenolol 50mg once daily then your doctor will switch you to bisoprolol 5mg once.

However, the dose of bisoprolol differs for different people so the dose you need will have to be carefully monitored by your cardiologist.

With each dose change your doctor will need to check your blood pressure, pulse and weight after each step because you may have breathlessness, your heart may slow down to a undesirable level or have some swelling. These effects are often transient and are more apparent when you first start taking Bisprolol. If they persist your doctor will have to select another treatment.

Your cardiologist will also have to consider other conditions before staring or changing the dose of bisoprolol you may have such as diabetes mellitus, interstitial pulmonary disease, irreversible chronic obstructive pulmonary disease (COPD). In this case bisoprolol may be best choice as it is cardioselective.

Atenolol and Bisoprolol should never be stopped suddenly unless it is done so according to the instruction of your cardiologist or doctor.

In summary...

In view of the fact that you are having chest pain we suggest you consult your cardiologist or your GP urgently to decide what your next steps should be.

You may find the following web links useful;

http://www.nhs.uk/Conditions/Beta-blockers/Pages/Introduction.aspx

http://patient.info/health/beta-blockers

http://www.netdoctor.co.uk/medicines/heart-and-blood/a26554/bisoprolol-uses-and-action/

If you have further questions please do not hesitate to contact us.

Kind regards

Answered by the Health at Hand nurses