Bisoprolol: NHS information and prescribing guide

Bisoprolol is a cardioselective beta-blocker. The NHS prescribes it widely. It comes as bisoprolol fumarate in tablet form.

Doctors use it for several heart and blood vessel conditions.

Licensed uses include:

• Chronic heart failure: NICE (NG106) recommends bisoprolol. It is a first-line beta-blocker for stable heart failure with reduced ejection fraction.
• Hypertension (high blood pressure): Doctors use it if other first-line treatments are not suitable. They may also add it to other therapies.
• Angina: It helps reduce how often and how severe chest pain episodes are.

Sometimes, doctors prescribe bisoprolol off-label. This means it is used for conditions not listed on its licence.

These include fast heart rhythms (tachyarrhythmias), migraine prevention, and palpitations linked to anxiety.

The medicine works by blocking beta-1 adrenergic receptors in the heart. This slows the heart rate and lowers blood pressure. It also reduces how much oxygen the heart muscle needs.

Bisoprolol is cardioselective. This means it affects the lungs less than non-selective beta-blockers. However, patients with breathing conditions still need caution.

Swallow bisoprolol tablets whole with a glass of water. You can take them with or without food. Taking them at the same time each day helps keep a steady level of the medicine in your body.

Key prescribing information:

• Usual starting dose for high blood pressure or angina: 5 mg to 10 mg once daily.
• Heart failure starting dose: 1.25 mg once daily. Increase this dose gradually over at least 2-week intervals.
• Maximum dose: 10 mg once daily for most uses.
• Timing: Most prescribers suggest a morning dose. This helps reduce drowsiness during the day.

For heart failure, the BNF advises a careful dose increase schedule. Start with 1.25 mg for 1 to 2 weeks. Then take 2.5 mg, then 3.75 mg, then 5 mg, then 7.5 mg, and finally 10 mg.

Each step should last at least 2 weeks. Your doctor will check your heart rate, blood pressure, and symptoms at each stage.

If you miss a dose, take it as soon as you remember. Do not take it if it is almost time for your next dose. Never take a double dose to make up for a missed one.

For more details, see our bisoprolol dosage guide.

Bisoprolol can cause side effects, like all medicines. Not everyone gets them. The BNF and NHS medicines information list the most common ones.

Very common (more than 1 in 10 people):

• Tiredness, especially in the first few weeks of treatment.

Common (up to 1 in 10 people):

• Dizziness and feeling light-headed.
• Cold hands and feet.
• Headache.
• Feeling sick or being sick.
• Diarrhoea or constipation.

Uncommon (up to 1 in 100 people):

• Sleep problems and vivid dreams.
• Low mood or depression.
• Slow heartbeat (bradycardia).
• Muscle cramps.
• Breathing problems in people who are prone to them.

For full details on managing these effects, see our page on bisoprolol side effects.

The NHS says most side effects are mild. They usually get better over time. Do not stop taking bisoprolol without talking to your doctor first.

Bisoprolol can interact with other medicines. Always tell your doctor or pharmacist about everything you take. This includes over-the-counter medicines and herbal supplements.

Important interactions include:

• Verapamil and diltiazem (calcium channel blockers): These can cause dangerously slow heart rates. Do not usually use them with bisoprolol.
• Clonidine: Stopping clonidine while taking bisoprolol can cause a dangerous rise in blood pressure. Withdraw clonidine gradually, and only after stopping bisoprolol.
• Other blood-pressure-lowering medicines: The combined effect might lead to very low blood pressure.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen and similar medicines can reduce bisoprolol's blood-pressure-lowering effect.
• Insulin and oral diabetes medicines: Bisoprolol can hide the signs of low blood sugar (hypoglycaemia). These signs include tremor and a fast heartbeat.
• Digoxin: Using these together can increase the risk of a slow heart rate.

The BNF has a full list of interactions. Your pharmacist can check for interactions when you start any new medicine.

Bisoprolol is not right for everyone. Some people should avoid it. Others should only use it under close medical care.

Do not take bisoprolol if you have:

• Uncontrolled heart failure that needs hospital treatment.
• A very slow heart rate (below 50 bpm) before starting treatment.
• Very low blood pressure (systolic below 90 mmHg).
• Severe asthma or severe COPD.
• Untreated phaeochromocytoma.
• Metabolic acidosis.
• Sick sinus syndrome or second- or third-degree heart block (unless you have a pacemaker).

Use with caution if you have:

• Mild to moderate asthma or COPD (NICE says cardioselective beta-blockers can be used carefully).
• Diabetes (bisoprolol might hide low blood sugar symptoms).
• Peripheral vascular disease (Raynaud's phenomenon might get worse).
• Psoriasis (beta-blockers might trigger or worsen flare-ups).
• A history of depression.

Pregnancy and breastfeeding: Only use bisoprolol during pregnancy if the benefits outweigh the risks. It is not advised during breastfeeding. Talk to your doctor about other options.

Bisoprolol is a generic medicine. It is one of the most common beta-blockers prescribed on the NHS. The BNF lists it.

It is also on local formularies across England, Scotland, Wales, and Northern Ireland.

Key points about NHS prescribing:

• It comes in 1.25 mg, 2.5 mg, 3.75 mg, 5 mg, 7.5 mg, and 10 mg tablets.
• The generic form is very cheap. It usually costs the NHS a few pence per tablet.
• You can get it on a standard NHS prescription. This currently has a standard charge in England.
• Patients in Scotland, Wales, and Northern Ireland get free prescriptions.
• Some patients with long-term conditions may get a medical exemption certificate.

Bisoprolol is on the NHS England national medicines optimisation dashboard. It is a recommended beta-blocker for heart failure.

NICE guidance (NG106) names bisoprolol, carvedilol, and nebivolol as first-choice options.

If you have prescription questions, your community pharmacist can always help.