Cardiology · β₁-selective adrenergic blocker
Bisoprolol
Dose
HF: start 1.25 mg OD, double q2 weeks to target 10 mg OD. HTN/angina: 5–10 mg OD (max 20).
Mechanism
Selective β₁ blockade → ↓HR, ↓contractility, ↓renin, ↓myocardial O₂ demand.
Indications
- • HFrEF (prognostic)
- • Ischaemic heart disease/angina
- • Rate control in AF
- • Hypertension
Contraindications
- • Sinus bradycardia <50
- • 2°/3° AV block without pacing
- • Cardiogenic shock
- • Severe asthma
Dose adjustment
CrCl <20 or Child–Pugh C: max 10 mg/day
Use
Prognostic β-blocker in HFrEF; rate control; anti-anginal.
Monitoring
HR (>55), BP, symptoms of HF decompensation, U&E on initiation.
Side effects
- • Bradycardia
- • Fatigue
- • Cold extremities
- • Bronchospasm
- • Erectile dysfunction
- • Mask hypoglycaemia
Pregnancy safety
Avoid — IUGR risk; if essential use labetalol.
Related in WardRound
Always confirm dose against your local formulary / BNF before prescribing.
