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Bisoprolol Patient Tips

Medically reviewed on Nov 29, 2017 by C. Fookes, BPharm.

How it works

  • Bisoprolol works on specific receptors located in the heart (called beta1 receptors) to slow the heart rate.
  • The exact way bisoprolol works to lower blood pressure is not known but studies have shown it decreases cardiac output, inhibits renin release from the kidneys, and reduces the activity of the sympathetic nervous system.
  • Bisoprolol belongs to the class of drugs known as beta blockers. It is called a cardioselective beta blocker because at low dosages it only works on beta1 receptors in the heart and has a low affinity for beta2 receptors located in the airways.


  • Bisoprolol causes a reduction in heart rate both at rest and during exercise.
  • Bisoprolol also lowers blood pressure and is used for the treatment of high blood pressure (hypertension).
  • Bisoprolol may be used alone or in addition to other antihypertensives.
  • Bisoprolol is cardioselective (mainly works on receptors in the heart) at low dosages. May be preferred for people with co-existing chronic obstructive pulmonary disorder (COPD) because it is less likely than nonselective beta-blockers to cause bronchoconstriction.
  • Can be taken once daily.
  • Less likely than nonselective beta-blockers to cause fatigue and cold extremities.
  • Generic bisoprolol is available.


If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache, dizziness, diarrhea, dizziness, rhinitis, and fatigue are the most common side effects reported.
  • May also cause a dry mouth, erectile dysfunction, vivid dreams, and insomnia. May increase serum triglycerides in some people.
  • Cardioselectivity of bisoprolol is not absolute, and at dosages higher than 20mg/day bisoprolol also inhibits beta2 receptors, mostly located in the bronchial and vascular musculature. The lowest effective dose should be used to maintain cardioselectivity.
  • Generally not recommended for people with bronchospastic disease; however, it may be used in certain circumstances because bisoprolol is less likely than nonselective beta-blockers to cause bronchospasm.
  • Can mask symptoms of hypoglycemia or hyperthyroidism, so should be used with caution in people with diabetes or thyroid disease.
  • May cause a number of unwanted heart-related effects and aggravate peripheral circulatory disorders (conditions that cause reduced blood flow to the hands or feet).
  • The clearance of bisoprolol from the body may be delayed in renal or liver disease which means the dosage of bisoprolol should be reduced in people with these conditions.
  • May not be suitable for some people including those with heart failure, a significantly slow heartbeat, or reduced peripheral circulation.
  • May interact with some medications including other medications used for the treatment of arrhythmias or angina.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

Bottom Line

Bisoprolol works on heart-specific receptors to lower blood pressure and slow heart rate; however, cardioselectivity may be lost with dosages greater than 20mg/day.


  • May be taken with or without food.
  • Bisoprolol is taken once a day. Try to take tablets at the same time each day.
  • Sudden discontinuation has been associated with an exacerbation of angina, and sometimes myocardial infarction (heart attack) or ventricular arrhythmias. If you need to discontinue bisoprolol, your doctor will advise how to do this slowly over at least a week.
  • If you have diabetes, bisoprolol may mask some of the symptoms of hypoglycemia (low blood sugar).
  • Should always be used as part of a comprehensive cardiovascular risk reduction program which includes diabetes management, smoking cessation, exercise, and other drug therapies. May be used in addition to other blood pressure lowering medicines.
  • Seek medical advice immediately if shortness of breath develops.
  • Seek medical advice if any new numbness, pain, a cold feeling, skin color changes or reduced sensitivity occurs in fingers or toes.
  • Talk to you doctor if you are having any side effects that are interfering with your quality of life, including erectile dysfunction. Do not stop taking bisoprolol suddenly.
  • Your doctor will need to regularly monitor your blood pressure and possibly other markers. Keep your appointments.
  • Bisoprolol may impair your thinking or reaction time and affect your ability to drive. Drinking alcohol may enhance these effects. Do not drive if you think your driving ability is being compromised by bisoprolol.

Response and Effectiveness

  • Peak concentrations reached between two and four hours after an oral dose. May take up to a week before the full effects on blood pressure and heart rate are seen, although some effect is evident within 24 hours.
  • Effects of bisoprolol persist for 24 hours following a single dose. Blood pressure returns to baseline within two weeks of tapering a dose of bisoprolol.
  • The half-life of bisoprolol is increased three-fold in people with kidney disease and a creatinine clearance of less than 40 mL/min.


  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use bisoprolol only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that this information is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This drug information does not endorse drugs, diagnose patients or recommend therapy. It is an informational resource designed as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of this information. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2018 Revision Date: 2017-11-28 22:41:48