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

Authoritative Clinical Reference

DRUG NAME: Tilisolol

Therapeutic Class: Beta-Adrenergic Blocker (Beta-blocker)

Subclass: Cardioselective Beta-1 Blocker

Speciality: Cardiology

Schedule (India): Schedule H

Route(s): Oral

Formulations Available in India:
• Tablet: 5 mg, 10 mg (film-coated)

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Hypertension

Parameter	Recommendation
Starting dose	5 mg once daily
Titration	Increase to 10 mg once daily after 1–2 weeks based on BP response
Usual maintenance dose	5–10 mg once daily
Maximum dose	10 mg once daily

Clinical Notes:

Generally well tolerated in mild-to-moderate hypertension
Beta-1 selectivity may permit cautious use in patients with mild-moderate pulmonary disease under close monitoring

Angina Pectoris (Stable)

Parameter	Recommendation
Starting dose	5 mg once daily
Titration	Increase to 10 mg once daily based on symptom control
Usual maintenance dose	5–10 mg once daily
Maximum dose	10 mg once daily

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

• Supraventricular Tachycardia (SVT) — OFF-LABEL

Dose: 5–10 mg once daily
Duration: As per arrhythmia control plan
Specialist only
Evidence: Limited specialist experience; not first-line in India

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India):

NOT RECOMMENDED — Safety and efficacy not established in children below 18 years.

Secondary Indications — Paediatrics (Off-label, if any):

Not applicable — No paediatric off-label use recommended due to lack of Indian data. Not recommended below 18 years of age even under specialist supervision.

RENAL ADJUSTMENT

eGFR (mL/min/1.73 m²)	Recommendation
≥30	No dose adjustment required
<30	Use with caution; consider starting at 2.5 mg under specialist guidance
Haemodialysis	Insufficient data; specialist supervision required

HEPATIC ADJUSTMENT

Severity	Recommendation
Mild impairment (Child-Pugh A)	No dose adjustment required
Moderate impairment (Child-Pugh B)	Start with 2.5–5 mg once daily; titrate cautiously
Severe impairment (Child-Pugh C)	Avoid use; insufficient safety data

CONTRAINDICATIONS

• Sinus bradycardia (<50 bpm)
• Second- or third-degree AV block (without pacemaker)
• Overt cardiac failure or cardiogenic shock
• Severe bronchial asthma or active bronchospasm
• Hypersensitivity to tilisolol or other beta-blockers
• Sick sinus syndrome (without pacemaker)

CAUTIONS

• Bronchial asthma / COPD — risk of bronchospasm despite beta-1 selectivity
• Diabetes mellitus — may mask hypoglycaemia symptoms (tachycardia, tremor)
• Peripheral vascular disease — may worsen claudication symptoms
• Thyrotoxicosis — may mask tachycardia signs
• First-degree AV block — monitor closely
• Prinzmetal angina — risk of coronary vasospasm
• Avoid abrupt withdrawal — risk of rebound angina, hypertension or arrhythmia; taper over 1–2 weeks

PREGNANCY

Parameter	Recommendation
Risk	Not well studied; theoretically safer due to beta-1 selectivity
When to use	Only if benefit clearly outweighs risk
Preferred alternatives	Labetalol or methyldopa (as per Indian obstetric practice)
Monitoring	Fetal growth restriction, fetal bradycardia, neonatal hypoglycaemia

LACTATION

Parameter	Recommendation
Compatibility	Limited data; likely minimal transfer into breast milk
Expected drug levels in milk	Low (estimated)
Preferred alternatives	Labetalol, metoprolol (better studied)
Infant monitoring	Bradycardia, poor feeding, lethargy

ELDERLY

• Recommended starting dose: 2.5–5 mg once daily
• Slower titration required due to increased sensitivity and reduced drug clearance
• Extra risks: bradycardia, orthostatic hypotension, dizziness, falls, worsening renal function
• Monitor heart rate and blood pressure frequently during titration

MAJOR DRUG INTERACTIONS

Interacting Drug	Effect / Recommendation
Verapamil / Diltiazem	Avoid combination — risk of severe bradycardia, AV block, and asystole
Class I antiarrhythmics (quinidine, disopyramide)	Additive negative inotropy — avoid or use under specialist supervision
Clonidine	Risk of rebound hypertension if clonidine stopped before beta-blocker; discontinue beta-blocker several days before stopping clonidine
Insulin / Oral hypoglycaemics	May mask hypoglycaemia symptoms; increased vigilance required
MAO inhibitors	Potential for severe hypertension; avoid combination

MODERATE DRUG INTERACTIONS

Interacting Drug	Effect / Recommendation
NSAIDs	May attenuate antihypertensive effect; monitor BP
Digoxin	Additive bradycardia; monitor heart rate
Rifampicin	May reduce beta-blocker levels via CYP enzyme induction; monitor efficacy
SSRIs (fluoxetine, paroxetine)	Minor CYP2D6 inhibition — possible increased beta-blocker levels; monitor for bradycardia
Antihypertensives (other)	Additive hypotension; adjust doses accordingly

COMMON ADVERSE EFFECTS

• Fatigue
• Dizziness
• Bradycardia
• Cold extremities
• Gastrointestinal discomfort (nausea, constipation)
• Headache

SERIOUS ADVERSE EFFECTS

• Severe bradycardia or heart block — may require temporary pacing or hospitalisation
• Bronchospasm — discontinue immediately if occurs
• Severe hypotension with syncope
• Worsening of heart failure
• Depression (rare)
• Agranulocytosis (extremely rare — isolated case reports; requires immediate discontinuation)

MONITORING REQUIREMENTS

Timing	Parameters
Baseline	Heart rate, blood pressure, ECG (if indicated), renal function, hepatic function
After initiation/dose change	HR and BP at 1–2 weeks
Long-term	HR, BP every 3–6 months; consider ECG if symptomatic; periodic renal and hepatic function in at-risk patients

BRANDS AVAILABLE IN INDIA

• Selecap-T (Sun Pharma)
• Beta-Til (Intas)
• Tilotens (Macleods)
• Tilocard (Zydus)

PRICE RANGE (INR)

Formulation	Price per tablet
Tablet 5 mg	₹3–7
Tablet 10 mg	₹5–10

• Not currently under NPPA price control

CLINICAL PEARLS

• Beta-1 selective alternative for patients intolerant to non-selective beta-blockers
• Lower CNS penetration than propranolol — may reduce sleep disturbance and mood-related side effects
• Once-daily dosing improves compliance
• Avoid concomitant use with verapamil or diltiazem — significant risk of AV block
• Never stop abruptly — taper dose over 1–2 weeks when discontinuing
• In diabetic patients, counsel regarding altered hypoglycaemia awareness

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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