[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Beta blockers](https://durgical.com/en/pharmacology/classes/beta-blockers/) › Bisoprolol [Pharmacology](https://durgical.com/en/pharmacology/) · [Beta blockers](https://durgical.com/en/pharmacology/classes/beta-blockers/) # Bisoprolol A highly β1-selective beta blocker. Used for high blood pressure and, started low and raised slowly, for heart failure with reduced ejection fraction. Updated 2026-11-01 - Class: [Beta blockers](https://durgical.com/en/pharmacology/classes/beta-blockers/) - Receptor: β1-adrenergic receptor - ATC code: C07AB07 - WHO Model List of Essential Medicines ◎**β1-adrenergic receptor**Bisoprolol ⓘ The figure shows the turkey β1 receptor with cyanopindolol, another beta blocker in the same binding site where bisoprolol acts; no structure with bisoprolol bound is available. **Target in 3D:** β1-adrenergic receptor. PDB structure 2VT4 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/2VT4) · Drag to rotate · pinch to zoom ## Mechanism of action Bisoprolol blocks β1 receptors with high selectivity. Heart rate, contractility and renin release fall, lowering blood pressure and oxygen demand. In heart failure, long-term blockade protects the heart from chronic sympathetic overdrive, which reduces deaths and hospital stays. At higher exposure it also blocks β2 receptors. - Bisoprolol selectively blocks β1 receptors - Heart rate, contractility and renin release fall - Long-term, the heart is shielded from sympathetic overdrive ## Pharmacokinetics **Absorption** Well absorbed by mouth, with high bioavailability **Elimination** Half by the kidneys unchanged and half as liver metabolites **Half-life** About 9 to 12 hours, longer in kidney failure and in the elderly ## Indications - High blood pressure [Arterial hypertension →](https://durgical.com/en/conditions/arterial-hypertension/) - Heart failure with reduced ejection fraction (WHO list) [Heart failure →](https://durgical.com/en/conditions/heart-failure/) - Angina and rate control in atrial fibrillation (WHO list) [Atrial fibrillation →](https://durgical.com/en/conditions/atrial-fibrillation/) ## Adverse effects ### Common - Fatigue - Bradycardia - Dizziness - Cold extremities ### Serious (rare, important) - Worse heart failure when started at a high level or raised too fast - Severe bradycardia or AV block - Angina or infarction after abrupt withdrawal - Bronchospasm at higher exposure ## Contraindications - Cardiogenic shock - Overt (decompensated) heart failure - Second- or third-degree AV block - Marked sinus bradycardia ## Key interactions **Verapamil, diltiazem or disopyramide** Added depression of the AV node and of contractility **Clonidine** Rebound hypertension if clonidine is stopped first **Rifampicin** Faster clearance and shorter half-life of bisoprolol ## What is monitored - Heart rate and blood pressure - Weight, oedema and breathlessness in heart failure - ECG if bradycardia appears ## Administration and safety - Given by mouth once a day; in heart failure it is started low and raised step by step over weeks - Tapered, never stopped suddenly - Check the name: several «-olol» drugs look alike ## Nursing care - Check pulse and blood pressure before each dose - In heart failure, weigh the patient daily during titration and report rapid weight gain or more breathlessness - Explain that tiredness in the first weeks is common and usually improves ## Pregnancy and breastfeeding Human data are limited; beta blockers can slow fetal growth and cause bradycardia and hypoglycaemia in the newborn, so it is used only when needed. ## Memory aid BISoprolol: Beta-1 Is Selective, and in heart failure it goes up in BIte-Sized steps. ## Test yourself Think of the answer, then tap the question to see it. ## Why is bisoprolol started low and raised slowly in heart failure? Its first effect is to reduce contractility, which can worsen congestion; the long-term benefit appears as the heart adapts. ## Which beta blockers have shown a survival benefit in heart failure with reduced ejection fraction? Bisoprolol, carvedilol and extended-release metoprolol succinate. ## Is bisoprolol started in decompensated heart failure? No. Overt, decompensated failure is a contraindication; it is started once the patient is stable. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/bisoprolol/) ## Related drugs - [Atenolol](https://durgical.com/en/pharmacology/atenolol/) - [Metoprolol](https://durgical.com/en/pharmacology/metoprolol/) - [Carvedilol](https://durgical.com/en/pharmacology/carvedilol/) ## Related conditions - [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/) - [Heart failure](https://durgical.com/en/conditions/heart-failure/) - [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/) [← Back to the class: Beta blockers](https://durgical.com/en/pharmacology/classes/beta-blockers/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - BISOPROLOL FUMARATE tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7556f457-c4d3-49d6-b383-0ade6d489091) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C07AB07) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/?query=bisoprolol) (World Health Organization, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/bisoprolol/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/bisoprolol/