Cardioselective beta-blocker 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 fetal/neonatal hypoglycaemia and bradycardia. Breastfeeding not recommended.

Bisoprolol fumarate

Brand names: Cardicor, Emcor

Bisoprolol fumarate is a highly cardioselective beta-blocker used for hypertension, angina and, importantly, stable chronic heart failure with reduced ejection fraction.

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 (starting/titration dose for chronic heart failure)

Route: Oral

Frequency: Once daily, in the morning; can be taken with food

Max: 10 mg once daily

SPC posology is for stable chronic heart failure (adjunct to ACE inhibitor/ARB, diuretic and, when appropriate, cardiac glycoside). Requires a titration phase: 1.25 mg once daily for 1 week, then if well tolerated 2.5 mg once daily for 1 week, then 3.75 mg once daily for 1 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. Maximum recommended dose 10 mg once daily. Close monitoring of heart rate, blood pressure and symptoms of worsening heart failure during titration. Do not withdraw abruptly (gradual dose decrease; abrupt withdrawal may cause acute deterioration). Hepatic/renal impairment: uptitrate with additional caution. Older people: no dosage adjustment required. Paediatric population: no paediatric experience; use cannot be recommended in paediatric patients. NB US labelling (openFDA) gives a different hypertension regimen (usual start 5 mg once daily, up to 10 mg then 20 mg once daily; 2.5 mg start in renal/hepatic impairment) — verify indication vs UK SPC.

Dose adjustments

Renal

No specific dose given; there is no PK information in chronic heart failure patients with impaired renal function — uptitrate with additional caution. (US labelling suggests 2.5 mg initial daily dose if creatinine clearance <40 mL/min.)

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.

Contraindications

Acute heart failure or heart failure decompensation requiring i.v. inotropic therapy
Cardiogenic shock
Second or third degree AV block
Sick sinus syndrome
Sinoatrial block
Symptomatic bradycardia
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)
Gastrointestinal complaints — nausea, vomiting, diarrhoea, constipation (common)
Feeling of coldness or numbness in the extremities, hypotension (common)
Asthenia, fatigue (common)

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
Sulfonylureas — beta-blockers may increase risk of severe hypoglycaemia and mask hypoglycaemia symptoms
General anaesthetics — potential for interactions (bradyarrhythmias, attenuated reflex tachycardia); inform anaesthetist of beta-blockade

Clinical monograph

How it works

It selectively blocks beta-1 adrenoceptors, slowing heart rate and reducing contractility and renin release, which lowers cardiac workload and, in heart failure, counteracts chronic sympathetic overactivity.

Prescribing in practice

In heart failure it must be started at a low dose only when the patient is stable and titrated up slowly, as too-rapid uptitration can transiently worsen failure.
Do not withdraw abruptly because of the risk of rebound ischaemia and arrhythmia; taper instead.
Use caution in asthma, marked bradycardia or high-grade heart block, and it may mask hypoglycaemic warning signs.

Monitoring

Monitor heart rate, blood pressure and, in heart failure, clinical status for fluid retention during gradual dose titration.

Counselling the patient

Do not stop the medicine suddenly without advice.
Expect that any temporary worsening during heart failure dose increases usually settles; report persistent breathlessness or swelling.
Report a very slow pulse, fainting or wheeze.

Evidence & guidelines

Bisoprolol improves survival in chronic heart failure with reduced ejection fraction, as shown in the CIBIS-II trial, and is recommended by NICE for heart failure and for hypertension and angina.

Reference: NICE NG106; NG136; NG196; ESC; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways