Selective beta-1 blocker Pregnancy: Use only if essential. Fetal bradycardia and IUGR risk.

Bisoprolol (Heart Failure in Elderly)

Brand names: Cardicor, Emcor

Adult dose

Dose: Start 1.25 mg once daily; double every 2 weeks to target 10 mg/day

Route: Oral

Frequency: Once daily

Max: 10 mg/day

Heart failure with reduced ejection fraction: start 1.25 mg OD in stable HF (not in acute decompensation). Double dose every 2 weeks if tolerated: 1.25 → 2.5 → 5 → 10 mg. Target 10 mg OD. Reduce titration pace in elderly. Hypertension/angina: 2.5–10 mg once daily.

Paediatric dose

Route: Not applicable

Frequency: See cardiology entry

Max: See cardiology entry

See cardiology drugs entry for paediatric dosing context.

Dose adjustments

Renal

Max 10 mg/day; use cautiously at lower doses if eGFR <20.

Hepatic

Max 10 mg/day; slow titration in hepatic impairment.

Clinical pearls

Never start in acute decompensated HF — wait until euvolaemic and stable
Titrate slowly in elderly — orthostatic hypotension and falls risk
If patient develops acute illness (e.g., pneumonia) causing decompensation, do not abruptly stop — halve dose
MERIT-HF: metoprolol CR/XL; CIBIS-II: bisoprolol — both demonstrate mortality benefit in HFrEF

Contraindications

Acute decompensated heart failure
Significant bradycardia
Severe asthma
Second/third degree AV block

Side effects

Bradycardia and hypotension
Fatigue
Cold extremities
Dizziness (particularly on standing — orthostatic hypotension in elderly)
Bronchospasm (selective — less than non-selective, but still possible)

Interactions

Verapamil/diltiazem — severe bradycardia and heart block (avoid combination)
Clonidine — rebound hypertension if bisoprolol stopped first
Antidiabetics — may mask hypoglycaemic tachycardia

Monitoring

BP and HR
Functional status (NYHA class)
Fluid status
Echocardiogram (annual or as indicated)

Reference: BNFc; BNF; NICE NG106 Heart Failure; ESC HF Guidelines 2021. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways