Bisoprolol × Glibenclamide

Beta-blockers can mask the adrenergic warning signs of hypoglycaemia: fast pulse, palpitations, sweating (bisoprolol and glibenclamide SmPCs). The bisoprolol SmPC warns that with sulfonylureas, glibenclamide among them, the risk of severe hypoglycaemia may rise. Glibenclamide is long-acting and so causes severe hypoglycaemia more often than short-acting sulfonylureas, and in older people hypoglycaemia is harder to recognise (glibenclamide SmPC).

Sudden confusion, weakness, ataxia without preceding tachycardia or sweating. Older patients: risk of severe hypoglycaemia without warning symptoms.

The combination can be used with caution (bisoprolol SmPC). Advise the patient with diabetes to monitor blood glucose carefully (bisoprolol SmPC) and explain in advance that on a beta-blocker the fast pulse, palpitations and sweating of hypoglycaemia may weaken or disappear (bisoprolol and glibenclamide SmPCs). In older people the starting and maintenance glibenclamide doses are chosen conservatively, because hypoglycaemia is more frequent and harder to notice. The patient always carries at least 20 g of glucose or sugar to treat hypoglycaemia at once (glibenclamide SmPC). The US Food and Drug Administration (FDA) also requires warning patients on oral antidiabetic drugs that bisoprolol may mask signs of hypoglycaemia, particularly a fast pulse (bisoprolol FDA label).