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P10 Initiation of bisoprolol in paediatric patients – experience from a specialist paediatric cardiac centre
  1. Andrea Bueno Gomez1,
  2. Mary Healy1,
  3. Grazia Delle Donne2,
  4. Sian Bentley1,
  5. Sukeshi Makhecha1,
  6. Piers Daubeney1,
  7. Nitha Naqvi1,
  8. Jan Till1,
  9. Leonie Wong1
  1. 1Royal Brompton and Harefield Hospitals
  2. 2Leeds Teaching Hospitals NHS Trust


Aim Given the lack of published dosing information to guide the use of bisoprolol in our paediatric cardiology patients, we assessed the safety and tolerability of initiation and maintenance doses of bisoprolol in a cohort of children with congenital structural heart disease, cardiomyopathy, or structural normal heart, to treat heart failure, arrhythmias or hypertension, and prevention of arrhythmias in channelopathies.

Method A retrospective review of hospital records of all children who received bisoprolol between May 2014 and August 2019 in a tertiary paediatric referral centre. Patients were identified via pharmacy records and clinical informatic systems were used to identify the indication, dose at initiation (mg/kg), up-titration dose, and any documented side effects.

Results 157 children (mean 11.6 years; range 2 months – 17.8 years) were identified. 56 children (36%) had a cardiomyopathy, 23 (15%) had structural heart disease and 78 (50%) were receiving bisoprolol with a structural normal heart for the prevention or treatment of arrhythmias. 149 children had a weight documented. The starting dose of bisoprolol ranged from 0.02 mg/kg/day to 0.19 mg/kg/day (mean 0.06 mg/kg/day); independent of the indication. The dose was up titrated in 90 (57%) of children. The weight was documented in 77 of these patients and up-titrated doses in these patients ranged from 0.02 mg/kg/day to 0.4 mg/kg/day (mean 0.14 mg/kg/day). A total of 24 (15%) of children had documented adverse events attributed to bisoprolol. Fatigue or dizziness were the most common reported adverse events, with 67% of the total events. In total, 5 children (3%) stopped bisoprolol due to adverse events; 4 due to fatigue or dizziness and 1 because of wheeze in a known asthmatic. HR was documented before and after initiation of bisoprolol in 89 patients (57%). The mean change was a decrease of 8 beats per minute (bpm) and all were within normal limits. Systolic blood pressure (BP) was documented before and after initiation of bisoprolol in 61 patients (39%). The mean change was a reduction of 4.2 millimeters of mercury (mmHg) and all were within normal limits.

Conclusion Our experience shows that initiating bisoprolol in paediatric cardiology patients with a cardiomyopathy, structural heart disease and normal structural heart, to treat arrhythmias, heart failure, outflow tract obstruction and systemic hypertension at a dose of 0.06 mg/kg once a day, up to a maintenance dose of 0.14 mg/kg/day was safe. However, this is limited by the sample size and retrospective nature of the study. Further studies are needed to be able to comment on the efficacy in this cohort of patients.

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