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Bisoprolol ๐
Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure
๐ About
Always check the BNF link here for updated guidance.
- Beta-blocker: blocks ฮฒ-adrenergic receptors in the heart, vessels, lungs, pancreas, and liver.
- Atenolol (for comparison) is more lipid-soluble, with potentially greater CNS side effects.
- Bisoprolol is relatively cardio-selective, particularly useful in heart failure and AF.
๐ฏ Indications
- ๐ฉธ Hypertension โ reduces cardiac output, blocks peripheral receptors, lowers plasma renin activity.
- โค๏ธ Angina โ reduces myocardial oxygen demand. โ ๏ธ Avoid combining with verapamil (risk of heart failure).
- ๐ซ Heart failure โ one of the few ฮฒ-blockers (with carvedilol) proven to reduce mortality. Nebivolol may be used in patients >70 with mildโmoderate HF.
- ๐ Atrial fibrillation (rate control) โ bisoprolol is the preferred oral ฮฒ-blocker for continuous AF.
โ Contraindications
- Bradycardia (<60 bpm) or systolic BP <100 mmHg.
- Asthma / bronchospasm.
- 2nd or 3rd-degree heart block.
- Uncontrolled / decompensated / acute severe heart failure.
- Severe hypotension.
- Phaeochromocytoma (unless combined with an ฮฑ-blocker).
- Sick sinus syndrome.
- Significant peripheral vascular disease.
- Concomitant verapamil use (risk of heart block).
- โ ๏ธ Use caution in diabetes (masks hypoglycaemia and worsens metabolic control).
โ ๏ธ Side Effects
- Fatigue, lethargy, cold peripheries ๐ฅถ.
- Bradycardia, hypotension, worsening heart failure.
- Conduction problems (heart block, arrhythmias).
- Impotence, reduced exercise tolerance.
- Worsening psoriasis and diabetic control.
๐ Dosing Bisoprolol (Oral)
- ๐ด Elderly starting dose: 2.5 mg once daily (OD). In frail elderly, start with 1.25 mg OD.
- ๐ Heart failure: 1.25 mg OD โ titrate slowly up to 10 mg OD (max).
- ๐ฉธ Hypertension / Ischaemic heart disease: 2.5โ10 mg daily (usually OD, sometimes BD if needed).
- โค๏ธ Angina: 2.5โ10 mg daily (OD, occasionally split).
- ๐ Atrial fibrillation (rate control): 2.5โ10 mg OD. Start 1.25 mg OD in elderly or frail patients.
โ ๏ธ Dose range: Always confirm with the BNF or datasheet before prescribing.
๐ References
- Bisoprolol โ BNF
- European Society of Cardiology (ESC) Guidelines โ Heart Failure & AF.
- Oxford Handbook of Clinical Medicine.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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