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Are The Risks Of An Abrupt Cessation Exaggerated?

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Posted on Tue, 11 Mar 2014
Question: 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?
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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 Bisoprolol is to be withdrawn if the cause is worsening of CHF or acute exacerbation of COPD with remarkable reactive component.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
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Above answer was peer-reviewed by : Dr. Prasad
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Dr. Sukhvinder Singh

Cardiologist

Practicing since :1998

Answered : 1306 Questions

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Are The Risks Of An Abrupt Cessation Exaggerated?

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 Bisoprolol is to be withdrawn if the cause is worsening of CHF or acute exacerbation of COPD with remarkable reactive component.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