Bisoprolol (Oral)

Bisoprolol, brand name Zebeta, is an oral medication with a beta-blocking action which lowers the blood pressure and heart rate of patients suffering from hypertension.

Overview

Bisoprolol is used in the treatment of hypertension, or high blood pressure. Hypertension is caused by a variety of factors such as obesity, genetics, excessive alcohol consumption and smoking. Other risk factors include a diet rich in salty foods, medications such as NSAIDs (among these are ibuprofen and aspirin), and the use of certain illicit drugs like cocaine. Hypertension can cause serious medical events including heart attack, stroke, and organ failure. Often elevated blood pressure is aggravated by chemicals such as epinephrine (also known as adrenaline) and norepinephrine, that bind to beta receptors on nerves.

Bisoprolol belongs to a class of medications called beta blockers, called such because their purpose is to block the binding of epinephrine and norepinephrine to these beta receptors. This keeps the blood vessels dilated and consequently reduces blood pressure and lowers the heart rate. It is important to note that Bisoprolol may also cause the negative consequence of stimulating muscles around air passages, which causes the passages to contract and restricts breathing. This is a common side effect of Bisoprolol.

Type of Drug

  • Cardioselective beta blocker

Conditions Treated

  • Hypertension

Side Effects

Bisoprolol can cause numerous side effects of varying severity. There are some adverse responses that are very serious, and medical attention should be sought immediately if these occur:

  • Body aches and pains
  • Pain in chest
  • Discomfort in chest
  • Chills
  • Cough
  • Difficulty breathing, labored breathing
  • Congestion in ear
  • Fever
  • Headache
  • Lightheadedness, dizziness, or fainting
  • Voice Loss
  • Congestion of the nasal passages
  • Tenderness or pain surrounding eyes and cheekbones
  • Shortness of breath
  • Sneezing
  • Sore throat
  • Stuffy or runny nose
  • Tightness in chest
  • Unusual tiredness or weakness
  • Wheezing

Symptoms of Bisoprolol overdose include:

  • Anxiety
  • Blurred vision
  • Cold sweats
  • Coma
  • Confusion
  • Cool, pale skin
  • Decreased urine output
  • Depression
  • Dilated neck veins
  • Dizziness, faintness, or lightheadedness when standing up after lying or sitting
  • Extreme fatigue
  • Fast heartbeat
  • Increased hunger
  • Irregular breathing
  • Nausea
  • Nervousness
  • Nightmares
  • Noisy breathing
  • Seizures
  • Shakiness
  • Slurred speech
  • Sweating
  • Swelling of face, fingers, feet, or lower legs

There are also side effects of Bisoprolol that are not as serious and do not warrant immediate medical attention. They often disappear as the patient's body becomes accustomed to the medication. Caregivers can also inform their patients on how to avoid these effects. If these effects become an annoyance, the patient should contact their healthcare provider.

Less serious side effects of Bisoprolol are:

  • Abnormal or decreased touch sensation
  • Diarrhea
  • Difficulty in moving
  • Lack or loss of strength
  • Muscle pain or stiffness
  • Pain in joints
  • Sleeplessness
  • Trouble sleeping, inability to sleep
  • Vomiting

Dosage

Bisoprolol is prescribed at an initial dose of 5 mg per day orally. If the bisoprolol does not achieve the desired results, the dose may be upped to 10 mg per day. The maximum dose of Bisoprolol is 20 mg.

Dosage should be tailored to the patient. A starting dose of 2.5 mg per day may be more beneficial to some patients.

Clinical trials observed that blood pressure lowering effects began one week after the start of Bisoprol treatment and that little change in blood pressure was seen afterward.

Renal-Related Dose Adjustment

CrCl less than 40 mL/minute
Initial dose of 2.5 mg per day, with dose titration, use caution

Liver-Related Dose Adjustments

Initial dose should be 2.5 mg per day, caution should be used with dose iration

Cessation of Therapy with Bisoprolol

To cease bisoprolol treatment, dosage should be tapered to 0 mg over one week. Abrupt discontinuation is not recommended.

Upon the occurrence of withdrawal symptoms, therapy may be temporarily reinstituted.

Drug Interactions

The following list includes some (not all) major drug interactions.

Major Drug Interactions

  • Aminophylline
  • Aminophylline / amobarbital / ephedrine
  • Aminophylline / ephedrine / guaifenesin / phenobarbital
  • Aminophylline / ephedrine / phenobarbital / potassium iodide
  • Aminophylline / guaifenesin
  • Atazanavir
  • Aazanavir / cobicistat
  • Diltiazem
  • Diltiazem / enalapril
  • Disopyramide
  • Dolasetron
  • Dyphylline
  • Dyphylline / ephedrine / guaifenesin / phenobarbital
  • Dyphylline / guaifenesin
  • Ephedrine / guaifenesin / theophylline
  • Ephedrine / hydroxyzine / theophylline
  • Ephedrine / phenobarbital / potassium iodide / theophylline
  • ephedrine / phenobarbital / theophylline
  • Fingolimod
  • Guaifenesin / oxtriphylline
  • Guaifenesin / theophylline
  • Methacholine
  • Mixed grass pollens allergen extract
  • Oxtriphylline
  • Potassium iodide / theophylline
  • Ragweed pollen allergen extract
  • Ritodrine
  • Saquinavir
  • Theophylline
  • Timothy grass pollen allergen extract
  • Tizanidine
  • Trandolapril / verapamil
  • Verapamil

Moderate Interactions

  • Acetaminophen
  • Acetohexamide
  • Acetylcarbromal
  • Albuterol
  • Albuterol / ipratropium
  • Aldesleukin
  • Alectinib
  • Alfentanil
  • Alfuzosin
  • Aliskiren
  • Alprazolam
  • Aluminum hydroxide
  • Amifostine
  • Amiloride
  • Amiodarone
  • Amitriptyline
  • Amlodipine
  • Ammonium chloride
  • Amobarbital / secobarbital
  • Amoxapine
  • Amyl nitrite / sodium nitrite / sodium thiosulfate
  • Amylase / cellulase / hyoscyamine / lipase / phenyltoloxamine / protease
  • Anhydrous calcium iodide
  • Antivenin (black widow spider)
  • Antivenin (crotalidae) polyvalent
  • Antivenin (micrurus fulvius)
  • Apomorphine
  • Apraclonidine ophthalmic
  • Arbutamine
  • Arformoterol
  • Aripiprazole
  • Articaine / epinephrine
  • Asenapine
  • Aspirin
  • Atenolol / chlorthalidone
  • Atracurium
  • Atropine
  • Avanafil
  • Azilsartan medoxomil / chlorthalidone
  • Baclofenl
  • Belladonna
  • Belladonna
  • Benazepril / hydrochlorothiazide
  • Bendroflumethiazide
  • Bendroflumethiazide / nadolol
  • Bendroflumethiazide / rauwolfia serpentina
  • Benzoic acid / hyoscyamine / methenamine / methylene blue / phenyl salicylate
  • Benzthiazide
  • Benztropine
  • Bepridil
  • Betamethasone
  • Betaxolol ophthalmic
  • Biperiden
  • Bisoprolol / hydrochlorothiazide
  • Bitolterol
  • Brexpiprazole
  • Brigatinib
  • Brimonidine ophthalmic
  • Brimonidine topical
  • Brimonidine / brinzolamide ophthalmic
  • Brimonidine / timolol ophthalmic
  • Bromfenac
  • Bromocriptine
  • Bromodiphenhydramine / codeine
  • Brompheniramine
  • Budesonide
  • Budesonide / formoterol
  • Bumetanide
  • Bupivacaine
  • Buprenorphine
  • Buprenorphine / naloxone
  • Bupropion
  • Bupropion / naltrexone
  • Buspirone
  • Butabarbital
  • Butabarbital / hyoscyamine / phenazopyridine
  • Butorphanol
  • Cabergoline
  • Calcium acetate
  • Calcium carbonate
  • Calcium citrate
  • Calcium glubionate
  • Calcium gluconate
  • Calcium glycerophosphate / calcium lactate
  • Calcium lactate
  • Calcium phosphate, tribasic
  • Calcium / ferrous fumarate / vitamin d
  • Calcium / folic acid / ginger / pyridoxine
  • Calcium / vitamin d
  • Canagliflozin
  • Canagliflozin / metformin
  • Candesartan / hydrochlorothiazide
  • Captopril / hydrochlorothiazide
  • Carbetapentane / carbinoxamine / phenylephrine
  • Carbetapentane / chlorpheniramine / ephedrine / phenylephrine
  • Carbetapentane / chlorpheniramine / phenylephrine
  • Carbetapentane / dexchlorpheniramine / phenylephrine
  • Carbetapentane / diphenhydramine
  • Carbetapentane / diphenhydramine / phenylephrine
  • Carbetapentane / guaifenesin / phenylephrine
  • Carbetapentane / phenylephrine
  • Carbetapentane / phenylephrine / phenylpropanolamine / potassium guaiacolsulfonate
  • Carbetapentane / phenylephrine / potassium guaiacolsulfonate
  • Carbetapentane / phenylephrine / pyrilamine
  • Carbidopa / entacapone / levodopa
  • Carbidopa / levodopa
  • Carbinoxamine / dextromethorphan / phenylephrine
  • Carbinoxamine / hydrocodone / phenylephrine
  • Carbinoxamine / methscopolamine / pseudoephedrine
  • Carbinoxamine / phenylephrine
  • Cariprazine
  • Carisoprodol
  • Carteolol ophthalmic
  • Ceftriaxone / lidocaine
  • Cellulase / hyoscyamine / pancrelipase / phenyltoloxamine
  • Ceritinib
  • Cevimeline
  • Chlophedianol / chlorpheniramine / phenylephrine
  • Chlophedianol / dexbrompheniramine / phenylephrine
  • Chlophedianol / guaifenesin / phenylephrine
  • Chlophedianol / phenylephrine / pyrilamine
  • Chlophedianol / phenylephrine / thonzylamine
  • Chlophedianol / phenylephrine / triprolidine
  • Chloral hydrate
  • Chlorcyclizine / codeine
  • Chlorcyclizine / codeine / phenylephrine
  • Chlorcyclizine / codeine / pseudoephedrine
  • Chlorcyclizine / phenylephrine
  • Chlordiazepoxide
  • Chlordiazepoxide / clidinium
  • Chlordiazepoxide / methscopolamine
  • Chlormezanone
  • Chlorothiazide
  • Chlorothiazide / methyldopa
  • Chlorothiazide / reserpine
  • Chlorphenesin
  • Chlorpheniramine / codeine
  • Chlorpheniramine / codeine / phenylephrine
  • Chlorpheniramine / codeine / phenylephrine / phenylpropanolamine
  • Chlorpheniramine / codeine / phenylephrine / potassium iodide
  • Chlorpheniramine / codeine / pseudoephedrine
  • Chlorpheniramine / dextromethorphan / guaifenesin / methscopolamine / phenylephrine
  • Chlorpheniramine / dextromethorphan / guaifenesin / phenylephrine
  • Chlorpheniramine / dextromethorphan / methscopolamine
  • Chlorpheniramine / dextromethorphan / phenylephrine
  • Chlorpheniramine / dihydrocodeine / phenylephrine
  • Chlorpheniramine / dihydrocodeine / phenylephrine / phenylpropanolamine
  • Chlorpheniramine / dihydrocodeine / pseudoephedrine
  • Chlorpheniramine / ephedrine / guaifenesin
  • Chlorpheniramine / epinephrine
  • Chlorpheniramine / guaifenesin / methscopolamine / phenylephrine
  • Chlorpheniramine / guaifenesin / phenylephrine
  • Chlorpheniramine / hydrocodone / phenylephrine
  • Chlorpheniramine / ibuprofen / pseudoephedrine
  • Chlorpheniramine / methscopolamine
  • Chlorpheniramine / methscopolamine / phenylephrine
  • Chlorpheniramine / methscopolamine / phenylephrine / pseudoephedrine
  • Chlorpheniramine / methscopolamine / phenylpropanolamine
  • Chlorpheniramine / methscopolamine / pseudoephedrine
  • Chlorpheniramine / phenylephrine
  • Chlorpheniramine / phenylephrine / phenylpropanolamine
  • Chlorpheniramine / phenylephrine / phenylpropanolamine / phenyltoloxamine
  • Chlorpheniramine / phenylephrine / phenylpropanolamine / pyrilamine
  • Chlorpheniramine / phenylephrine / phenyltoloxamine
  • Chlorpheniramine / phenylephrine / pyrilamine
  • Chlorpromazine
  • Chlorpropamide
  • Chlorthalidone
  • Chlorthalidone / clonidine
  • Chlorthalidone / reserpine
  • Chlorzoxazone
  • Cimetidine
  • Cisatracurium
  • Clevidipine
  • Clidinium
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clonidine
  • Clorazepate
  • Clozapine
  • Codeine
  • Conjugated estrogens / meprobamate
  • Corticorelin
  • Corticotropin
  • Cortisone
  • Cosyntropin
  • Crizotinib
  • Cyclobenzaprine
  • Cyclopentolate / phenylephrine ophthalmic
  • Dapagliflozin
  • Dapagliflozin / metformin
  • Dapagliflozin / saxagliptin
  • Deflazacort
  • Deserpidine / hydrochlorothiazide
  • Deserpidine / methyclothiazide
  • Desipramine
  • Dexamethasone
  • Dexamethasone / lidocaine
  • Dexbrompheniramine
  • Dexmedetomidine
  • Dextrometho
  • Diatrizoate / iodipamide
  • Diazepam
  • Diclofenac
  • Diclofenac / misoprostol
  • Dicyclomine
  • Digitoxin
  • Digoxin
  • Dihydrocodeine / guaifenesin
  • Dihydrocodeine / guaifenesin / phenylephrine
  • Dihydrocodeine / guaifenesin / pseudoephedrine
  • Dihydrocodeine / phenylephrine
  • Dihydrocodeine / phenylephrine / pyrilamine
  • Dihydroergotamine
  • Diphenhydramine
  • Dobutamine
  • Donepezil
  • Donepezil / memantine
  • Dopamine
  • Dorzolamide / timolol ophthalmic
  • Doxacurium
  • Doxazosin
  • Doxepin
  • Doxepin topical
  • Doxylamine / phenylephrine
  • Dronedarone
  • Droperidol / fentanyl
  • Empagliflozin
  • Emtricitabine / lopinavir / ritonavir / tenofovir
  • Enalapril / felodipine
  • Enalapril / hydrochlorothiazide
  • Ephedrine
  • Ephedrine / guaifenesin
  • Ephedrine / potassium iodide
  • Epinephrine
  • Epinephrine / etidocaine
  • Epinephrine / lidocaine
  • Epinephrine / prilocaine
  • Epoprostenol
  • Eprosartan / hydrochlorothiazide
  • Ergonovine
  • Ergotamine
  • Esomeprazole / naproxen
  • Estazolam
  • Ethacrynic acid
  • Ethanol
  • Ethchlorvynol
  • Ethiodized oil
  • Etodolac
  • Famotidine / ibuprofen
  • Felodipine
  • Fenoldopam
  • Fenoprofen
  • Fentanyl
  • Fentanyl / ropivacaine
  • Flecainide
  • Fludrocortisone
  • Fluorescein
  • Fluoxetine / olanzapine
  • Fluphenazine
  • Flurazepam
  • Flurbiprofen
  • Fluticasone / salmeterol
  • Fluticasone / umeclidinium / vilanterol
  • Fluticasone / vilanterol
  • Formoterol
  • Formoterol / glycopyrrolate
  • Formoterol / mometasone
  • Fosinopril / hydrochlorothiazide
  • Furazolidone
  • Furosemide
  • Gadobenate dimeglumine
  • Gadobutrol
  • Gadodiamide
  • Gadofosveset trisodium
  • Gadopentetate dimeglumine
  • Gadoterate meglumine
  • Gadoteridol
  • Gadoversetamide
  • Gadoxetate disodium
  • Galantamine
  • Glimepiride
  • Glimepiride / pioglitazone
  • Glimepiride / rosiglitazone
  • Glipizide
  • Glipizide / metformin
  • Glyburide
  • Glyburide / metformin
  • Glycopyrrolate
  • Glycopyrrolate / indacaterol
  • Guaifenesin / hydrocodone / pheniramine / phenylephrine / phenylpropanolamine
  • Guaifenesin / hydrocodone / phenylephrine
  • Guaifenesin / hydromorphone
  • Guaifenesin / phenylephrine
  • Guaifenesin / phenylephrine / phenylpropanolamine
  • Guaifenesin / phenylephrine / pyrilamine
  • Guanadrel
  • Guanethidine
  • Guanethidine / hydrochlorothiazide
  • Halazepam
  • Haloperidol
  • Heroin
  • Homatropine / hydrocodone
  • Hydralazine / hydrochlorothiazide
  • Hydralazine / hydrochlorothiazide / reserpine
  • Hydrochlorothiazide
  • Hydrocodone / pheniramine / phenylephrine / phenylpropanolamine / pyrilamine
  • Hydrocodone / phenylephrine
  • Hydrocodone / phenylephrine / pyrilamine
  • Hydrocortisone
  • Hydroflumethiazide
  • Hydroflumethiazide / reserpine
  • Hydromorphone
  • Hydromorphone / ropivacaine
  • Hydroxyzine
  • Hyoscyamine
  • Hyoscyamine / methenamine
  • Hyoscyamine / methenamine / methylene blue / phenyl salicylate
  • Hyoscyamine / methenamine / methylene blue / phenyl salicylate / sodium biphosphate
  • Hyoscyamine / methenamine / methylene blue / sodium biphosphate
  • Hyoscyamine / phenobarbital
  • Hyoscyamine / phenyltoloxamine
  • Ibuprofen
  • Iloperidone
  • Iloprost
  • Imipramine
  • Indacaterol
  • Indapamide
  • Indomethacin
  • Insulin
  • Insulin aspart
  • Insulin aspart protamine
  • Insulin aspart / insulin aspart protamine
  • Insulin aspart / insulin degludec
  • Insulin degludec
  • Insulin degludec / liraglutide
  • Insulin detemir
  • Insulin glargine
  • Insulin glargine / lixisenatide
  • Insulin glulisine
  • Insulin inhalation, rapid acting
  • Insulin isophane
  • Insulin isophane / insulin regular
  • Insulin lispro
  • Insulin lispro protamine
  • Insulin lispro / insulin lispro protamine
  • Insulin regular
  • Insulin zinc
  • Insulin zinc extended
  • Iodamide
  • Iodipamide
  • Iodixanol
  • Iohexol
  • Iopamidol
  • Iopanoic acid
  • Iopromide
  • Iothalamate
  • Ioversol
  • Ioxaglate
  • Ioxilan
  • Ipodate
  • Isocarboxazid
  • Isoetharine
  • Isoniazid / pyrazinamide / rifampin
  • Isoniazid / rifampin
  • Isoproterenol
  • Isoproterenol / phenylephrine
  • Isradipine
  • Ivabradine
  • Ketoprofen
  • Ketorolac
  • Ketorolac / phenylephrine ophthalmic
  • Lacosamide
  • Lactobacillus acidophilus / methscopolamine
  • Lanreotide
  • Lansoprazole / naproxen
  • Lanthanum carbonate
  • Levalbuterol
  • Levobetaxolol ophthalmic
  • Levobunolol ophthalmic
  • Levodopa
  • Licorice
  • Lidocaine
  • Lidocaine / oxytetracycline
  • Lidocaine / potassium chloride
  • Lidocaine / sodium bicarbonate
  • Linezolid
  • Lithium
  • Lopinavir / ritonavir
  • Lorazepam
  • Loxapine
  • Lurasidone
  • Maprotiline
  • Maraviroc
  • Meclofenamate
  • Mefenamic acid
  • Mefloquine
  • Meloxicam
  • Mepenzolate
  • Meperidine
  • Meperidine / promethazine
  • Mephentermine
  • Meprobamate
  • Mesoridazine
  • Metaproterenol
  • Metaraminol
  • Metaxalone
  • Metformin / repaglinide
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methotrimeprazine
  • Methoxyflurane
  • Methscopolamine
  • Methyclothiazide
  • Methyclothiazide / reserpine
  • Methylergonovine
  • Methylprednisolone
  • Methysergide maleate
  • Metipranolol ophthalmic
  • Metocurine
  • Metolazone
  • Metrizamide
  • Mexiletine
  • Midodrine
  • Mirtazapine
  • Mivacurium
  • Molindone
  • Morphine
  • Morphine liposomal
  • Morphine / naltrexone
  • Multivitamin with minerals
  • Multivitamin, prenatal
  • Nabumetone
  • Nalbuphine
  • Naloxone / oxycodone
  • Naloxone / pentazocine
  • Naltrexone / oxycodone
  • Naproxen
  • Naproxen / pseudoephedrine
  • Naproxen / sumatriptan
  • Nateglinide
  • Nebivolol / valsartan
  • Nefazodone
  • Neostigmine
  • Nicardipine
  • Nifedipine
  • Nimodipine
  • Nisoldipine
  • Norepinephrine
  • Nortriptyline
  • Octreotide
  • Olanzapine
  • Olodaterol
  • Opium
  • Orphenadrine
  • Oxaprozin
  • Oxazepam
  • Oxybutynin
  • Oxycodone
  • Paliperidone
  • Pancuronium
  • Paraldehyde
  • Pasireotide
  • Pentazocine
  • Pentoxifylline
  • Perphenazine
  • Phenelzine
  • Phenobarbital
  • Phenoxybenzamine
  • Phenylbutazone
  • Phenylephrine
  • Pilocarpine
  • Pipecuronium
  • Pirbuterol
  • Piroxicam
  • Polythiazide
  • Polythiazide / prazosin
  • Polythiazide / reserpine
  • Prazosin
  • Prednisolone
  • Prednisone
  • Procarbazine
  • Prochlorperazine
  • Procyclidine
  • Promazine
  • Promethazine
  • Propantheline
  • Propiomazine
  • Propoxyphene
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Quinidine
  • Racepinephrine
  • Rapacuronium
  • Rasagiline
  • Rauwolfia serpentina
  • Repaglinide
  • Reserpine
  • Rifampin
  • Riociguat
  • Risperidone
  • Rivastigmine
  • Rocuronium
  • Ropivacaine / sufentanil
  • Sacubitril / valsartan
  • Safinamide
  • Salmeterol
  • Scopolamine
  • Secobarbital
  • Selegiline
  • Selexipag
  • Sildenafil
  • Silodosin
  • Sodium nitrite
  • Sodium nitrite / sodium thiosulfate
  • Sodium oxybate
  • Spironolactone
  • Succinylcholine
  • Sufentanil
  • Sulindac
  • Sunitinib
  • Tacrine
  • Temazepam
  • Terazosin
  • Terbutaline
  • Tetrabenazine
  • Tetrofosmin
  • Thalidomide
  • Thiethylperazine
  • Thioridazine
  • Thiothixene
  • Timolol ophthalmic
  • Tocainide
  • Tolazamide
  • Tolbutamide
  • Tolmetin
  • Tolterodine
  • Torsemide
  • Tranylcypromine
  • Trazodone
  • Treprostinil
  • Triamcinolone
  • Triamterene
  • Triazolam
  • Trichlormethiazide
  • Trifluoperazine
  • Triflupromazine
  • Trihexyphenidyl
  • Trimeprazine
  • Trimipramine
  • Trospium
  • Tubocurarine
  • Tyropanoate
  • Umeclidinium / vilanterol
  • Valsartan
  • Vardenafil
  • Vecuronium
  • Zaleplon
  • Zileu
  • Ziprasinor
  • Ziprasidone
  • Zileutone
  • Zolpidem

Minor Drug Interactions

  • Acetaminophen / aluminum hydroxide / aspirin / caffeine / magnesium hydroxide
  • Acetaminophen / aspirin
  • Acetaminophen / aspirin / caffeine
  • Acetaminophen / aspirin / caffeine / salicylamide
  • Acetaminophen / aspirin / phenylpropanolamine
  • Acetaminophen / caffeine / magnesium salicylate
  • Acetaminophen / caffeine / magnesium salicylate / phenyltoloxamine
  • Acetaminophen / magnesium salicylate
  • Acetaminophen / magnesium salicylate / pamabrom
  • Alginic acid / aluminum hydroxide / magnesium carbonate
  • Alginic acid / aluminum hydroxide / magnesium trisilicate
  • Aluminum carbonate
  • Aluminum hydroxide
  • Aluminum hydroxide / magnesium carbonate
  • Aluminum hydroxide / magnesium hydroxide
  • Aluminum hydroxide / magnesium hydroxide / simethicone
  • Aluminum hydroxide / magnesium trisilicate
  • Aluminum hydroxide / mineral oil
  • Aspirin
  • Aspirin / brompheniramine / dextromethorphan / phenylpropanolamine
  • Aspirin / butalbital
  • Aspirin / butalbital / caffeine
  • Aspirin / caffeine
  • Aspirin / caffeine / salicylamide
  • Aspirin / chlorpheniramine / dextromethorphan
  • Aspirin / chlorpheniramine / dextromethorphan / phenylpropanolamine
  • Aspirin / chlorpheniramine / phenylpropanolamine
  • Aspirin / citric acid / sodium bicarbonate
  • Aspirin / dipyridamole
  • Aspirin / hydrocodone
  • Aspirin / omeprazole
  • Aspirin / phenyltoloxamine
  • Aspirin / pravastatin
  • Aspirin / pseudoephedrine
  • Attapulgite
  • Benzoic acid / methenamine / sodium salicylate
  • Caffeine / magnesium salicylate
  • Cascara sagrada / magnesium hydroxide
  • Choline salicylate
  • Choline salicylate / magnesium salicylate
  • Citric acid / glucono-delta-lactone / magnesium carbonate topical
  • Citric acid / magnesium oxide / sodium picosulfate
  • Diflunisal
  • Dihydroxyaluminum sodium carbonate
  • Garlic
  • Glucagon
  • Kaolin
  • Kaolin / pectin
  • Levothyroxine
  • Liothyronine
  • Liotrix
  • Magaldrate
  • Magaldrate / simethicone
  • Magnesium carbonate
  • Magnesium hydroxide
  • Magnesium hydroxide / mineral oil
  • Magnesium oxide
  • Magnesium salicylate
  • Magnesium salicylate / phenyltoloxamine
  • Salsalate
  • Sodium salicylate
  • Sodium thiosalicylate
  • Sucralfate
  • Sulfinpyrazone
  • Tadalafil
  • Thyroid desiccated
  • Ticagrelor
  • Zolmitriptan

The patient should inform their doctor if they are taking any of these medications, or begin taking them after starting treatment with Bisoprolol.

Additionally, the patient should inform their caregiver if they are diagnosed with any of the conditions on this list.

  • Asthma/Copd
  • Bradyarrhythmia/Av Block
  • Cardiogenic Shock/Hypotension
  • Diabetes
  • Hemodialysis
  • Hypersensitivity
  • Pvd
  • Renal/Liver Disease
  • Cerebrovascular Insufficiency
  • Chf
  • Glaucoma
  • Hyperlipidemia
  • Hyperthyroidism
  • Ischemic Heart Disease
  • Myasthenia Gravis
  • Pheochromocytoma
  • Psoriasis
  • Tachycardia

Warnings

Cardiac Failure

Bisoprolol medications should not be used by most patients with congestive heart failure due to its potential to reduce sympathetic stimulation, which is crucial in facilitating circulatory function in patients with congestive heart failure. Some patients with compensated cardiac failure may be prescribed Bisoprolol if deemed absolutely necessary, such as in the event that the patient cannot tolerate or does not respond to any other form of antihypertensive treatment. Caution must be used when treating these patients with Bisoprolol.

Bisoprolol can also cause heart failure in patients not previously diagnosed with the condition, due to its tendency to cause myocardial depression. The emergence of heart failure in Bisoprolol patients should prompt their caregiver to consider discontinuation of Bisoprolol. However, Bisoprolol may be continued if heart failure is treated successfully with other drugs.

Abrupt Cessation of Bisoprolol Treatment

Patients with coronary artery disease taking Bisoprolol may have suffered conditions such as exacerbation of angina pectoris, myocardial infarction, and ventricular arrhythmia. Caregivers should inform these patients of the dangers of discontinuing therapy without the advice of a medical professional. In cases where the patient does not have coronary artery disease, tapering over one week may be advised. This must be done under the careful supervision of a healthcare professional. Cessation of Bisoprolol can cause withdrawal symptoms. If this occurs, treatment with Bisoprolol should be at least temporarily.

Patients with peripheral vascular disease may have their condition aggravated by Bisoprolol therapy. The drug should be used with caution in these individuals.

It is typically not advised for patients with the Bronchospastic disease to be treated with Bisoprolol. However, in cases where the patient does not respond to or does not tolerate any other hypertension treatment, Bisoprolol should be used with extreme caution. The lowest possible dose (2.5 mg/day) should be used, and the patient should be offered a bronchodilator medication.

Though withdrawal of Bisoprolol is not recommended before major surgery, it should be noted that the drug's effect on the heart's ability to respond to stimuli may increase the risk of surgery and general anesthesia.

Bisoprolol should be used with caution in patients with diabetes and hypoglycemia, as the medication can mask some serious effects of this condition, such as tachycardia. Patients who are diabetic and being treated with insulin and hypoglycemic agents and those that are prone to hypoglycemic agents should be informed of the effect Bisoprolol can have on their conditions. Bisoprolol should be used with caution.

Clinical indicators of hypothyroidism, such as tachycardia, may be masked by Bisoprolol. Abrupt cessation of Bisoprolol may result in exacerbation of hyperthyroidism symptoms and may also cause thyroid storm.

Caution should be used when patients with renal or hepatic impairment are treated with Bisoprolol.

Patients with a history of anaphylactic reactions may experience more reaction to repeated challenge, whether accidental, diagnostic, or therapeutic. Epinephrine treatment for allergic reaction in these patients may not achieve the desired response in the usual doses.

Long-term studies (involving testing of the medication on rats) did not detect any carcinogenic, mutagenesis, or impairment of fertility.

Pregnant women should only be treated with Bisoprolol if the benefit justifies the fetal risk. Additionally, caution should be used when Bisoprolol is given to women who are nursing.

The effectiveness and safety of Bisprolol treatment in pediatric patients has not been established.

Elderly patients have received Bisoprolol treatment for hypertension. The treatment achieved similar response rates and mean diastolic and systolic blood pressure decreases to those of younger patients. The elderly also saw a slightly greater heart rate reduction than the older patients and the reductions tended to increase with greater dosage. Elderly patients tend to receive a higher dosage of Bisoprolol than their younger counterparts. Additionally, there was no variation in reports of safety-related dropouts or adverse experiences between the older and younger groups.

In event of an overdose, seek medical attention immediately.

Contraindications for Bisoprolol include:

  • AV Block (2nd or 3rd Degree)
  • Cardiac Faliure (Overt)
  • Cardiogenic Shock
  • Marked Sinus Bradycardia

Storage

Bisoprolol tablets should be stored in the container they were received in, which should be tightly closed and kept away from excessive heat and moisture. Outdated Bisoprolol tablets should be discarded in the proper fashion.

Summary

Bisoprolol is proven to be effective in the treatment of hypertension. Its beta-blocking action opens the blood vessels in a way that eases blood flow, greatly reducing strain on the heart and thus reducing pulse rate. However, caution must be taken when treating a patient with Bisoprolol, as its effect on the constriction of certain heart valves can aggravate or cause heart failure. As a result, Bisoprolol must be used with caution in patients with heart failure. Effects on respiratory function, such as dyspnea have also been noted with Bisoprolol. It is generally not advised for patients with certain respiratory conditions to take Bisoprolol unless it is deemed absolutely necessary. Even in this situation, only the lowest dose should be used.

Abrupt discontinuation of Bisoprolol can cause serious withdrawal symptoms, so tapering is necessary to stop using Bisoprolol. Women who are pregnant are only prescribed Bisoprolol if the benefit outweighs the risk of fetal harm. Nursing women are also advised to use caution when taking Bisoprolol. Studies have shown that the elderly benefit slightly more from Bisoprolol treatment than younger patients. In general, Bisoprolol is a drug that can have great benefit in the treatment of hypertension, but also great risk.

Resources
Last Reviewed:
December 22, 2017
Last Updated:
April 04, 2018
Content Source: