Makindo Medical Notes

📖 About

Always check the BNF link here for updated guidance.

• Beta-blocker: blocks β-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.

🎯 Indications

• 🩸 Hypertension → reduces cardiac output, blocks peripheral receptors, lowers plasma renin activity.
• ❤️ Angina → reduces myocardial oxygen demand. ⚠️ Avoid combining with verapamil (risk of heart failure).
• 🫀 Heart failure → one of the few β-blockers (with carvedilol) proven to reduce mortality. Nebivolol may be used in patients >70 with mild–moderate HF.
• 💓 Atrial fibrillation (rate control) → bisoprolol is the preferred oral β-blocker for continuous AF.

⛔ 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 α-blocker).
• Sick sinus syndrome.
• Significant peripheral vascular disease.
• Concomitant verapamil use (risk of heart block).
• ⚠️ Use caution in diabetes (masks hypoglycaemia and worsens metabolic control).

⚠️ Side Effects

• Fatigue, lethargy, cold peripheries 🥶.
• Bradycardia, hypotension, worsening heart failure.
• Conduction problems (heart block, arrhythmias).
• Impotence, reduced exercise tolerance.
• Worsening psoriasis and diabetic control.

💊 Dosing Bisoprolol (Oral)

• 👴 Elderly starting dose: 2.5 mg once daily (OD). In frail elderly, start with 1.25 mg OD.
• 📈 Heart failure: 1.25 mg OD → titrate slowly up to 10 mg OD (max).
• 🩸 Hypertension / Ischaemic heart disease: 2.5–10 mg daily (usually OD, sometimes BD if needed).
• ❤️ Angina: 2.5–10 mg daily (OD, occasionally split).
• 💓 Atrial fibrillation (rate control): 2.5–10 mg OD. Start 1.25 mg OD in elderly or frail patients.

⚠️ Dose range: Always confirm with the BNF or datasheet before prescribing.

📚 References

• Bisoprolol – BNF
• European Society of Cardiology (ESC) Guidelines – Heart Failure & AF.
• Oxford Handbook of Clinical Medicine.