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Bopindolol: Uses, Dosage, Side Effects & Warnings | DrugsAtlas

Authoritative Clinical Reference

DRUG NAME: Bopindolol

Therapeutic Class: Antihypertensive

Subclass: Non-selective Beta-blocker with Intrinsic Sympathomimetic Activity (ISA)

Specialty: Cardiology

Schedule (India): Schedule H

Route(s): Oral

Formulations Available in India:
• Tablets: 2 mg, 4 mg

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Indication	Starting Dose	Titration	Maintenance Dose	Maximum Dose	Clinical Notes
Essential Hypertension	2 mg once daily	Increase to 4 mg once daily after 1–2 weeks if blood pressure control inadequate	2–4 mg once daily	4 mg once daily	ISA reduces likelihood of bradycardia and cold extremities; administer at same time daily
Stable Angina Pectoris	2 mg once daily	Increase to 4 mg once daily based on symptom control and tolerability	2–4 mg once daily	4 mg once daily	Not preferred for post-myocardial infarction beta-blockade due to ISA; use primarily for symptom relief

Secondary Indications — Adults (Off-label, if any)

Not applicable — No established off-label indications in Indian clinical practice

PAEDIATRIC DOSING (Specialist Only)

Primary Indications:
• NOT APPROVED for use in children in India
• Safety and efficacy data insufficient in paediatric population
• No paediatric-specific formulations available

Secondary Indications — Paediatrics (Off-label, if any):
• NOT RECOMMENDED in routine paediatric practice
• May be considered only under paediatric cardiologist supervision in exceptional circumstances
• No established Indian practice consensus

RENAL ADJUSTMENT

Renal Function	Recommendation
Mild impairment (eGFR 60–89 mL/min)	No dose adjustment required
Moderate impairment (eGFR 30–59 mL/min)	No dose adjustment required
Severe impairment (eGFR <30 mL/min)	Start at 2 mg once daily; titrate cautiously; monitor heart rate and blood pressure closely
Haemodialysis	Limited data; use with caution; no supplemental dose typically required

HEPATIC ADJUSTMENT

Child-Pugh Class	Recommendation
Class A (Mild)	No dose adjustment required; monitor clinical response
Class B (Moderate)	Start at 2 mg once daily; titrate cautiously based on response
Class C (Severe)	Use with caution; start at 2 mg once daily; monitor closely for excessive bradycardia and hypotension

CONTRAINDICATIONS

• Severe sinus bradycardia (<50 beats per minute)
• Second-degree or third-degree atrioventricular block (without pacemaker)
• Sick sinus syndrome (without pacemaker)
• Decompensated heart failure
• Cardiogenic shock
• Bronchial asthma or severe chronic obstructive pulmonary disease
• Known hypersensitivity to bopindolol or other beta-blockers
• Untreated pheochromocytoma

CAUTIONS

• Peripheral vascular disease — may worsen claudication symptoms
• Diabetes mellitus — may mask hypoglycaemic symptoms (tachycardia, tremor); sweating preserved
• Thyrotoxicosis — may mask tachycardia; do not withdraw abruptly
• Controlled bronchospastic disease — use only under specialist supervision
• First-degree AV block — monitor for progression
• Psoriasis — potential exacerbation
• Depression history — monitor for mood changes
• Abrupt discontinuation — taper over 1–2 weeks to avoid rebound angina or hypertensive crisis

PREGNANCY

Parameter	Details
Risk summary	Not recommended; limited human data available
Preferred alternatives	Labetalol, methyldopa (as per Indian obstetric practice)
When may be used	Only if no suitable alternative and benefit clearly outweighs risk
Monitoring	Fetal growth (IUGR risk), uterine blood flow; neonatal bradycardia and hypoglycaemia if used in third trimester

LACTATION

Parameter	Details
Compatibility	Unknown; limited data on excretion into breast milk
Preferred alternatives	Labetalol, propranolol (better studied in lactation)
Drug level in milk	Unknown
Infant monitoring	Bradycardia, poor feeding, inadequate weight gain

ELDERLY

• Starting dose: 2 mg once daily
• Titration: Slower titration over 2–4 week intervals recommended
• Special considerations:

Increased sensitivity to beta-blocker effects
Higher risk of orthostatic hypotension
Monitor for excessive bradycardia
Increased fall risk; assess balance
Reduced renal reserve may prolong drug effects

MAJOR DRUG INTERACTIONS

Interacting Drug	Effect	Recommendation
Verapamil, Diltiazem (especially IV)	Severe bradycardia, AV block, myocardial depression	Avoid combination; if essential, use with extreme caution and monitoring
Class I antiarrhythmics (disopyramide, flecainide, quinidine)	Additive negative inotropy, proarrhythmic risk	Avoid concurrent use
Non-selective MAO inhibitors	Risk of severe hypotension	Avoid combination
Clonidine (abrupt withdrawal)	Rebound hypertensive crisis when clonidine stopped during beta-blocker therapy	Discontinue bopindolol first; taper clonidine gradually

MODERATE DRUG INTERACTIONS

Interacting Drug	Effect	Recommendation
Insulin, sulfonylureas	Masking of hypoglycaemic symptoms (tachycardia, tremor)	Monitor blood glucose closely; counsel patient
Digoxin	Additive bradycardia and AV conduction delay	Monitor heart rate and ECG
NSAIDs	Attenuation of antihypertensive effect	Monitor blood pressure; consider alternatives
Anaesthetic agents	Enhanced hypotensive effect	Inform anaesthetist; may need dose adjustment
Antihypertensives (ACEi, ARBs, diuretics)	Additive hypotension	Monitor blood pressure

COMMON ADVERSE EFFECTS

• Fatigue
• Dizziness
• Headache
• Cold extremities (less common due to ISA)
• Mild bradycardia
• Gastrointestinal disturbances (nausea, diarrhoea)
• Sleep disturbances

SERIOUS ADVERSE EFFECTS

• Severe bradycardia or high-grade AV block — may require pacemaker support
• Bronchospasm — especially in undiagnosed reactive airway disease
• Heart failure exacerbation or precipitation
• Severe hypotension
• Withdrawal syndrome (rebound hypertension, angina exacerbation) — if stopped abruptly
• Hypoglycaemia masking in diabetics

MONITORING REQUIREMENTS

Phase	Parameters
Baseline	Blood pressure, heart rate, ECG (if cardiac history), blood glucose (in diabetics), renal function
After initiation/dose change	Heart rate and blood pressure at 1–2 weeks
Long-term	Periodic blood pressure and pulse; blood glucose in diabetics; clinical assessment for signs of heart failure; monitor weight

BRANDS AVAILABLE IN INDIA

• Bopbloc
• Bopenol
• Laugal

Note: Limited market availability; typically available as monotherapy tablets only

PRICE RANGE (INR)

Formulation	Approximate Price
Tablet 2 mg	₹4–7 per tablet
Tablet 4 mg	₹6–10 per tablet

• Not included in NLEM; not under NPPA price control
• Limited availability in government supply chains

CLINICAL PEARLS

• ISA property reduces resting bradycardia risk — useful in patients with borderline low heart rate who require beta-blockade
• Not suitable for post-myocardial infarction secondary prevention — ISA attenuates mortality benefit demonstrated with non-ISA beta-blockers
• ISA does not confer protection against bronchospasm — avoid in uncontrolled asthma regardless of ISA status
• Always taper gradually when discontinuing; do not stop abruptly even when switching to another beta-blocker
• Less metabolic effects on lipids compared to non-ISA beta-blockers
• Consider in patients who develop significant bradycardia or cold extremities with other beta-blockers

Clinical Responsibility

This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

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