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Antihypertensive Pregnancy: Should not be used during pregnancy unless clearly necessary; beta-blockers reduce placental perfusion (growth retardation, intrauterine death, abortion, early labour) and may cause hypoglycaemia/bradycardia in the fetus and newborn. Breast-feeding not recommended (eMC §4.6).

Bisoprolol

Brand names: Cardicor, Emcor

Used in: Atrial Fibrillation Acute Coronary Syndrome & Chest Pain Heart Failure Hypertension

Bisoprolol is a cardioselective beta-blocker used in chronic heart failure, angina, hypertension and rate control.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1.25 mg once daily initially, uptitrated stepwise to a target maintenance of 10 mg once daily
Route: Oral
Frequency: Once daily (in the morning)
Max: 10 mg once daily
eMC §4.2 (Bisoprolol 1.25 mg Orodispersible Tablets) — for stable chronic heart failure, which requires a titration phase. Patients should be stable (without acute failure) before initiation, under a physician experienced in managing chronic heart failure. Titration: 1.25 mg once daily for 1 week, if well tolerated increase to 2.5 mg once daily for a further week, then 3.75 mg once daily for a further week, then 5 mg once daily for 4 weeks, then 7.5 mg once daily for 4 weeks, then 10 mg once daily for maintenance. Close monitoring of heart rate, blood pressure and symptoms of worsening heart failure during titration. Do not withdraw abruptly (gradual dose decrease). No dose adjustment required in older people; uptitrate with additional caution in hepatic or renal impairment. US labelling (bisoprolol fumarate tablets, hypertension): usual starting dose 5 mg once daily (2.5 mg may be appropriate in some), may increase to 10 mg then 20 mg once daily — different indication/dose.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION The dose of bisoprolol fumarate tablets must be individualized to the needs of the patient. The usual starting dose is 5 mg once daily. In some patients, 2.5 mg may be an appropriate starting dose (see Bronchospastic Disease in WARNINGS ). If the antihypertensive effect of 5 mg is inadequate, the dose may be increased to 10 mg and then, if necessary, to 20 mg once daily. Patients with Renal or Hepatic Impairment In patients with hepatic impairment (hepatitis or cirrhosis) or renal dysfunction (creatinine clearance less than 40 mL/min), the initial daily dose should be 2.5 mg and caution should be used in dose-titration. Since limited data suggest that bisoprolol …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-06-26. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

  • Acute heart failure or decompensation requiring i.v. inotropic therapy
  • Cardiogenic shock
  • Second or third degree AV block; sick sinus syndrome; sinoatrial block
  • Symptomatic bradycardia or symptomatic hypotension
  • Severe bronchial asthma
  • Severe peripheral arterial occlusive disease or severe Raynaud's syndrome
  • Untreated phaeochromocytoma; metabolic acidosis
  • Hypersensitivity to bisoprolol or any excipient

Side effects

  • Bradycardia (very common); worsening of heart failure (common)
  • Dizziness, headache (common)
  • Feeling of coldness/numbness in the extremities, hypotension (common); gastrointestinal complaints — nausea, vomiting, diarrhoea, constipation (common)
  • Asthenia, fatigue (common)
  • AV-conduction disturbances, bronchospasm in patients with asthma/obstructive airways disease (uncommon)

Interactions

  • Calcium antagonists of the verapamil or diltiazem type — generally not recommended
  • Class I antiarrhythmic drugs — generally not recommended
  • Centrally acting antihypertensive drugs — generally not recommended

Clinical monograph

How it works

It selectively blocks β1-adrenoceptors, reducing heart rate, contractility and AV-node conduction and lowering myocardial oxygen demand. In heart failure, slow up-titration improves prognosis.

Prescribing in practice

  • In heart failure, start low and up-titrate slowly only when the patient is stable and euvolaemic — do not start during decompensation.
  • Do not stop abruptly in ischaemic heart disease; taper to avoid rebound.
  • Use caution in asthma — cardioselectivity is relative and is lost at higher doses.
  • It can mask the warning signs of hypoglycaemia in diabetes.

Monitoring

Monitor heart rate, blood pressure and heart-failure symptoms during titration.

Counselling the patient

  • Do not stop suddenly without advice.
  • Some tiredness, cold hands or a slower pulse can occur, especially early on.
  • Report worsening breathlessness, swelling, or a very slow pulse with dizziness.

Evidence & guidelines

Prognostic benefit in HFrEF is well established (e.g. CIBIS-II); recommended within guideline-directed therapy in NICE NG106.

Reference: NICE NG106 Chronic HF; CIBIS-II Trial Lancet 1999; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

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