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Bisoprolol Side Effects

Not all side effects for bisoprolol may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to bisoprolol: oral tablet

In addition to its needed effects, some unwanted effects may be caused by bisoprolol. In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking bisoprolol:

Less common
  • Body aches or pain
  • chest pain
  • chills
  • cough
  • difficult or labored breathing
  • ear congestion
  • fever
  • headache
  • loss of voice
  • nasal congestion
  • pain or tenderness around eyes and cheekbones
  • shortness of breath or troubled breathing
  • sneezing
  • sore throat
  • stuffy or runny nose
  • tightness in chest
  • unusual tiredness or weakness
  • wheezing
  • Chest discomfort
  • lightheadedness, dizziness, or fainting
  • slow or irregular heartbeat

If any of the following symptoms of overdose occur while taking bisoprolol, get emergency help immediately:

Symptoms of overdose
  • Anxiety
  • blurred vision
  • cold sweats
  • coma
  • confusion
  • cool, pale skin
  • decreased urine output
  • depression
  • dilated neck veins
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • 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
  • weight gain

Some of the side effects that can occur with bisoprolol may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common
  • Abnormal or decreased touch sensation
  • diarrhea
  • difficulty in moving
  • lack or loss of strength
  • muscle pain or stiffness
  • pain in joints
  • sleeplessness
  • trouble sleeping
  • unable to sleep
  • vomiting

For Healthcare Professionals

Applies to bisoprolol: oral tablet


Bisoprolol is generally well-tolerated. In one placebo-controlled trial, the withdrawal rate associated with bisoprolol and placebo were 3.3% and 6.8%, respectively.

In a review of heart failure trials, beta-blockers (i.e., carvedilol, metoprolol, bisoprolol) were associated with increased risks of hypotension, dizziness, and bradycardia, but not fatigue compared with placebo. In addition, beta-blocker therapy was associated with fewer overall all-cause withdrawals and less heart failure deterioration than placebo.[Ref]


Cardiovascular side effects include bradycardia, dizziness, and dyspnea. Like other beta-blockers, bisoprolol may decrease myocardial contractility, which may be important in some patients with poor left ventricular systolic function. Unusual side effects include palpitations, mild heart rhythm disturbances, and orthostatic hypotension. Claudication is reported, and may be more likely in patients with peripheral vascular disease.[Ref]

Nervous system

More common nervous system side effects include fatigue (4% to 25%), dizziness (3% to 10%), and headache (2% to 10%). Paresthesias, somnolence, decreased concentration or memory, anxiety, and vertigo have been reported in 1% to 10% of patients. Abnormal dreams have been reported rarely.[Ref]


Wheezing is a rare respiratory system side effect that is associated with beta-blockers. This is due to beta-blockade of bronchial dilation, and may be important in patients with reactive airways disease.[Ref]


Dermatologic problems associated with bisoprolol include rash, acne, eczema, skin irritation, pruritus, flushing, sweating, alopecia, angioedema, and exfoliative dermatitis.[Ref]


Endocrinologic changes are unusual, and include hyperglycemia and hypercholesterolemia. Sporadic reports of elevated serum triglycerides are found. While rare and often clinically insignificant, these problems may be important in patients with or at risk of diabetes or coronary artery disease. Thyroid function tests are unaffected by bisoprolol. This may be relevant if bisoprolol is used to treat the symptoms of hyperthyroidism.[Ref]


The incidence of elevated liver function tests (SGOT and SGPT) of between one and two times normal is approximately 6%, of greater than two times normal is approximately 2%.[Ref]


Genitourinary problems include decreased libido, impotence, Peyronie's disease, cystitis, and renal colic.[Ref]


Psychiatric problems associated with bisoprolol include vivid dreams, hallucinations, and insomnia. Rare cases of catatonia are reported. Depression is reported, as with some other beta-blockers.[Ref]


Hematologic side effects are rare. Purpura, agranulocytosis, and thrombocytopenia are reported.[Ref]


Musculoskeletal side effects have included rare reports of musculoskeletal pain and acute quadriplegic myopathy.[Ref]

Acute quadriplegic myopathy was reported in an anephric patient receiving bisoprolol 2.5 mg daily. Muscle function and strength returned to normal following discontinuation of bisoprolol. Symptoms recurred when the patient was started on carvedilol and resolved within 3 days after discontinuation of carvedilol.[Ref]


Approximately 15% of patients on long-term bisoprolol therapy develop a positive ANA titer. Other immunologic changes are not reported.[Ref]


Other side effects including dry mouth have been reported.[Ref]


Metabolic side effects have included gout. Gout and elevated serum uric acid levels are reported in at least 1% of patients.[Ref]


1. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.

2. Ko DT, Hebert PR, Coffey CS, et al. "Adverse effects of beta-blocker therapy for patients with heart failure: a quantitative overview of randomized trials." Arch Intern Med 164 (2004): 1389-94

3. Hayes PC, Jenkins D, Vavianos P, Dagap K, Johnston A, Ioannides C, Thomas P, Williams R "Single oral dose pharmacokinetics of bisoprolol 10 mg in liver disease." Eur Heart J 8 (1987): 23-9

4. Wheeldon NM, Macdonald TM, Prasad N, Maclean D, Peebles I, Mcdevitt DG "A double-blind comparison of bisoprolol and atenolol in patients with essential hypertension." Q J Med 88 (1995): 565-70

5. Johns TE, Lopez LM "Bisoprolol: is this just another beta-blocker for hypertension or angina?" Ann Pharmacother 29 (1995): 403-14

6. Iranzo AE, Santamaria J "Bisoprolol-induced rapid eye movement sleep behavior disorder." Am J Med 107 (1999): 390-2

7. Salpeter SS, Ormiston T, Salpeter E, Poole P, Cates D "Cardioselective beta-blockers for chronic obstructive pulmonary disease." Cochrane Database Syst Rev 2 (2002): CD0003566

8. Le Jeunne C, Poirier JM, Cheymol G, Ertzbischoff O, Engel F, Hugues FC "Pharmacokinetics of intravenous bisoprolol in obese and non-obese volunteers." Eur J Clin Pharmacol 41 (1991): 171-4

9. Pfannenstiel P, Rummeny E, Baew-Christow T, Bux B, Cordes M, Adam W, Panitz N, Pabst J, Disselhoff G "Pharmacokinetics of bisoprolol and influence on serum thyroid hormones in hyperthyroid patients." J Cardiovasc Pharmacol 8 (1986): s100-5

10. Izzedine H, Launay-Vacher V, Hulot JS, Sternberg D, Deray G "Beta-blocker-induced quadriparesis." Ann Intern Med 141 (2004): W62

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