ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Antihypertensive Pregnancy: C — may cause neonatal bradycardia, hypoglycaemia, and growth restriction; use only if benefit outweighs risk

Bisoprolol

Brand names: Cardicor, Emcor

Adult dose

Dose: Heart failure: 1.25mg OD (start) titrate to max 10mg OD. HTN/angina: 5–10mg OD
Route: Oral
Frequency: Once daily
Max: 20mg/day
Heart failure (CIBIS-II): start 1.25mg, double every 2 weeks if tolerated. Target dose 10mg OD. HTN/angina: 5mg OD start, usual 5–10mg OD.

Dose adjustments

Renal

Max 10mg/day if GFR <20 ml/min/1.73m².

Hepatic

Max 10mg/day in hepatic impairment.

Clinical pearls

  • Bisoprolol is highly cardioselective (β₁) — lower risk of bronchospasm than propranolol, but still avoid in severe asthma.
  • In heart failure with reduced ejection fraction (HFrEF): titrate up slowly over weeks. Temporary worsening of HF can occur early — this is expected and not a reason to stop.
  • Do NOT abruptly discontinue in ischaemic heart disease — rebound tachycardia and angina risk. Taper over 2 weeks.
  • Preferred beta-blocker for HFrEF: bisoprolol, carvedilol, and metoprolol succinate are the only three with survival benefit (Class I evidence).

Contraindications

  • Acute decompensated heart failure requiring IV inotropes
  • Cardiogenic shock
  • Second or third degree AV block (without pacemaker)
  • Sick sinus syndrome
  • Severe symptomatic bradycardia (HR <50 bpm)
  • Severe asthma or COPD (relative — use with extreme caution)

Side effects

  • Bradycardia (most common — dose-dependent)
  • Fatigue and lethargy
  • Cold extremities
  • Bronchospasm (risk in asthma/COPD)
  • Hypotension, dizziness
  • Sexual dysfunction
  • Masking of hypoglycaemia symptoms in diabetes

Interactions

  • Verapamil / diltiazem: risk of severe bradycardia and AV block — avoid combination
  • Clonidine: rebound hypertension on clonidine withdrawal — stop beta-blocker first
  • Digoxin: additive bradycardia
  • NSAIDs: reduced antihypertensive effect
  • Adrenaline: severe hypertension then bradycardia (blocked beta-adrenergic response)

Monitoring

  • Resting HR (target 55–65 bpm in HF titration)
  • BP
  • signs of HF decompensation
  • FEV₁ if asthmatic

Reference: NICE NG106 Chronic HF; CIBIS-II Trial Lancet 1999; NICE BNF 84. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Drugs
Same class
Pathways
Same specialty