Beta-Blocker (Selective) 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

Bisoprolol is a cardioselective beta-blocker used in the management of hypertension, angina, and chronic stable heart failure, and for rate control in certain arrhythmias.

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) — same SPC as the general bisoprolol entry; this is the general-medicine-context listing. 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.

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 beta-1 adrenoceptors, reducing heart rate, myocardial contractility and conduction, which lowers cardiac workload and, in heart failure, counters chronic sympathetic overactivity.

Prescribing in practice

Do not stop it abruptly, as sudden withdrawal can precipitate rebound tachycardia, worsening angina or myocardial infarction; taper the dose when discontinuing.
It is contraindicated in marked bradycardia, second- or third-degree heart block, sick sinus syndrome, decompensated heart failure and severe hypotension.
In heart failure it must be initiated at a low dose in a stable patient and titrated slowly upward, and used with caution in asthma and with rate-limiting calcium-channel blockers.

Monitoring

Monitor heart rate, blood pressure and, in heart failure, symptoms and clinical status during initiation and dose titration.

Counselling the patient

Take it regularly and never stop suddenly without medical advice.
Report a very slow pulse, dizziness, fainting or worsening breathlessness.
Be aware it may mask some warning signs of low blood sugar in diabetes.

Evidence & guidelines

Beta-blockers including bisoprolol have strong evidence for prognostic benefit in chronic heart failure with reduced ejection fraction and are recommended in NICE guidance.

Reference: NICE NG106 (Chronic Heart Failure); 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways