Are the risks of an abrupt cessation exaggerated?
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If a patient is on bisoprolol fumarate for severe COPD but has a protracted problem with pleural effusion then is it safe or appropriate to abruptly cease administration of the medication or must the dosage always be gradually titrated downward? Are the risks of an abrupt cessation exaggerated? What alternative medication could be considered bearing in mind the patient's ongoing pleural effusion?
Posted Tue, 11 Mar 2014 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 1 hour later
Brief Answer: please see details Detailed Answer: Dear Sir 1. Bisoprolol is a medication not meant to be used in COPD. Likelihood is that it is being given for CCF. 2. There are many causes of pleural effusion in such scenario. Some of them could be worsening of CHF, pulmonary thrombo-embolism, acute infective exacerbation of COPD & unrelated infection or tumor of lungs. Bisoprolol is to be withdrawn if the cause is worsening of CHF or acute exacerbation of COPD with remarkable reactive component. In both these scenarios an alternative is not to be given. 3. The sudden withdrawal of bisoprolol may have its share of problems like precipitation of angina, tachycardia or high blood pressure. However, the treating physician would weigh the problems of sudden withdrawal against harms of continuous administration and decide. Hope this provides some insight into the issue. Feel free to discuss further. Sincerely Sukhvinder