Bisoprolol - EM Doctors

1. About bisoprolol

Bisoprolol is a medicine used to treat high blood pressure (hypertension) and heart failure.

If you have high blood pressure, taking bisoprolol helps prevent future heart disease, heart attacks and strokes.

Bisoprolol is also used to prevent chest pain caused by angina.

It's also used to treat atrial fibrillation and other conditions that cause an irregular heartbeat.

This medicine is only available on prescription. It comes as tablets.

2. Key facts

Bisoprolol slows down your heart rate and makes it easier for your heart to pump blood around your body.
Your very first dose of bisoprolol may make you feel dizzy, so take it at bedtime. After that, if you don't feel dizzy, it's best to take it in the morning.
It's usual to take bisoprolol once a day in the morning.
The main side effects of bisoprolol are feeling dizzy or sick, headaches, cold hands or feet, constipation or diarrhoea - these are usually mild and shortlived.
Bisoprolol is also known by the brand names Cardicor and Congescor.

3. Who can and can't take bisoprolol

Bisoprolol can be taken by adults aged 18 and over.

It isn't suitable for everyone.

To make sure it's safe for you, tell your doctor before starting bisoprolol if you have:

had an allergic reaction to bisoprolol or any other medicine in the past
low blood pressure (hypotension) or a slow heart rate
heart failure that's getting worse, heart disease, or you have recently had a heart attack
severe blood circulation problems in your limbs (such as Raynaud's), which may make your fingers and toes tingle or turn pale or blue
metabolic acidosis - when there's too much acid in your blood
a lung disease or severe asthma

4. How and when to take it

It's usual to take bisoprolol once a day in the morning.

Your doctor may advise you to take your first dose before bedtime as it can make you feel dizzy.

If you don't feel dizzy after having the first dose, take bisoprolol in the morning.

Important

Take bisoprolol even if you feel well, as you'll still be getting the benefits of the medicine.

How much will I take?

Your dose depends on why you need the medicine.

For high blood pressure or angina, you'll usually start on 5mg to 10mg once a day. If this dose isn't working well enough (your blood pressure doesn't go down enough, or your angina keeps happening), your doctor may increase it up to 20mg.
For heart failure, you'll usually start at a low dose of 1.25mg a day and increase gradually up to 10mg a day. The dose is usually increased slowly over a few months.

How to take it

Bisoprolol doesn't usually upset your stomach, so you can take it with or without food.

Swallow the tablets whole with a drink of water. Some brands have a score line to help you break the tablet to make it easier to swallow.

Check the information leaflet for your brand to see if you can do this.

What if I forget to take it?

If you miss a dose of bisoprolol, take it as soon as you remember that day.

If you don't remember until the next day, skip the missed dose.

Do not take a double dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

If you take too much bisoprolol by accident, contact your doctor or nearest hospital straight away.

An overdose of bisoprolol can slow down your heart rate and make it difficult to breathe. It can also cause dizziness and trembling.

The amount of bisoprolol that can lead to an overdose varies from person to person.

Urgent advice: Call your doctor or go to A&E straight away if you take too much bisoprolol

If you need to go to A&E, do not drive yourself - get someone else to drive you, or call for an ambulance.

Take the bisoprolol packet or leaflet inside it, plus any remaining medicine, with you.

5. Side effects

Like all medicines, bisoprolol can cause side effects in some people, but many people have no side effects or only minor ones.

Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people. They're usually mild and shortlived.

Talk to your doctor or pharmacist if the side effects bother you or last more than a few days:

headache
feeling dizzy or weak
cold hands or feet
feeling or being sick (nausea or vomiting) or diarrhoea
constipation

Serious side effects

It happens rarely, but some people have serious side effects when taking bisoprolol.

Call a doctor straight away if you have:

shortness of breath with a cough that gets worse when you exercise (like walking up stairs), swollen ankles or legs, chest pain, an irregular heartbeat - these are signs of heart problems
shortness of breath, wheezing and tightening of the chest - these can be signs of lung problems
yellow skin or the whites of your eyes turn yellow - these can be signs of liver problems

Serious allergic reaction

In rare cases, bisoprolol may cause a serious allergic reaction.

Immediate action required: Call 999 or go to A&E if:

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
you're wheezing
you get tightness in the chest or throat
you have trouble breathing or talking
your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These aren't all the side effects of bisoprolol.

For a full list, see the leaflet inside your medicine packet.

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches usually go away after the first week of taking bisoprolol. Talk to your doctor if the headaches last longer than a week or are severe.
feeling dizzy or weak - if bisoprolol makes you feel dizzy or weak, stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machinery if you're feeling tired. Do not drink alcohol as it'll make you feel worse.
cold hands or feet - put your hands or feet under warm running water, massage them, and wiggle your fingers and toes. Do not smoke or have drinks with caffeine in - these can make your blood vessels narrower and restrict your blood flow. Smoking also makes your skin colder. Try wearing mittens (they're warmer than gloves) and warm socks. Do not wear tight watches or bracelets.
feeling or being sick (nausea or vomiting) or diarrhoea - stick to simple meals and do not eat rich or spicy food. It might help to take your bisoprolol after you have eaten. If you're being sick, try drinking small, frequent sips of water. If you have diarrhoea, drink plenty of water or other fluids. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
constipation - eat more high-fibre foods, such as fresh fruit, vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this doesn't help, talk to your pharmacist or doctor. Watch this short video about how to treat constipation.

7. Pregnancy and breastfeeding

Bisoprolol is not usually recommended in pregnancy or when breastfeeding.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking bisoprolol.

There may be other blood pressure-lowering medicines that are safer for you.

Labetalol is a similar medicine that's often recommended for high blood pressure in pregnancy.

Bisoprolol and breastfeeding

There's not a lot of information about the safety of bisoprolol if you're breastfeeding.

Small amounts of bisoprolol may get into breast milk and this can cause low blood pressure in your baby.

Talk to your doctor, as other medicines for high blood pressure might be better while you're breastfeeding.

Non-urgent advice: Tell your doctor if you're:

trying to get pregnant
pregnant
breastfeeding

8. Cautions with other medicines

There are some medicines that may interfere with the way bisoprolol works.

Tell your doctor if you're taking:

other medicines for high blood pressure - the combination with bisoprolol can sometimes lower your blood pressure too much, which may make you feel dizzy or faint (if this keeps happening to you, tell your doctor - they may change your dose)
other medicines that can lower your blood pressure, such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson's disease medicines, such as co-careldopa and levodopa
non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen - they can stop bisoprolol working as well as it should
steroids, like prednisolone
cough medicines that contain pseudoephedrine or xylometazoline
medicines for diabetes - bisoprolol may make it more difficult to recognise the warning signs of low blood sugar
medicines for allergies, such as ephedrine, noradrenaline or adrenaline
medicines for asthma or chronic obstructive pulmonary disease (COPD)
rifampicin, an antibiotic

Mixing bisoprolol with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with bisoprolol.

Important

For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions

How does bisoprolol work?

How long does bisoprolol take to work?

Bisoprolol starts to work after about 2 hours to reduce high blood pressure, but it can take 2 to 6 weeks to fully take effect.

If you're taking bisoprolol for high blood pressure, you may not feel any different when you take bisoprolol.

This doesn't mean the medicine isn't working and it's important to keep taking it.

If you're taking bisoprolol for angina, it'll probably take a couple of weeks before you feel better.

Until then, you'll still have bouts of chest pain. You may even find the pain gets worse to start with.

Make sure you have your medicine (spray or tablets) for treating angina attacks with you at all times, and use it if you need to.

If you're taking bisoprolol for heart failure, it may take several weeks, even months, before you feel better.

How long will I take it for?

Is it safe to take for a long time?

What will happen if I stop taking it?

Talk to your doctor if you want to stop taking bisoprolol.

Stopping bisoprolol can make your blood pressure rise, and this may increase your risk of heart attack and stroke.

If you're bothered by side effects, your doctor may be able to prescribe a different blood pressure-lowering medicine.

If you stop taking bisoprolol, it'll take 2 to 3 days for it to be completely out of your body.

How does it compare with other heart medicines?

Bisoprolol works as well as other beta blockers for reducing blood pressure, but it's less likely to cause side effects.

That's because bisoprolol works mainly on the heart.

Other beta blockers, such as propranolol, work on the heart, but affect other parts of the body as well.

There are lots of other medicines to lower your blood pressure and treat chest pain or heart failure.

They work in a different way from beta blockers and include:

ACE inhibitors - for example, ramipril and lisinopril
angiotensin receptor blockers - for example, candesartan
calcium channel blockers - for example, amlodipine
diuretics (tablets that make you pee more) - for example, furosemide.

Beta blockers aren't usually the first choice treatment for high blood pressure.

The medicine your doctor prescribes depends on your age and ethnicity.

if you're under 55, you'll usually be offered an ACE inhibitor or an angiotensin receptor blocker
if you're 55 or older, or you're any age and of African Caribbean or black African origin, you'll usually be offered a calcium channel blocker

Sometimes you may have to try other blood pressure-lowering medicines if you get side effects.

Many people need to take a combination of different blood pressure-lowering tablets.

Will I need to stop bisoprolol before surgery?

Tell your doctor that you're taking bisoprolol if you're going to be put to sleep (have a general anaesthetic) for an operation.

Or if you're going to have a major operation, such as a caesarean section, without a general anaesthetic.

Your doctor may advise you to stop taking bisoprolol 48 hours before surgery.

This is because if you have bisoprolol with some anaesthetics, it can lower your blood pressure too much.

Can I drink alcohol with it?

Is there any food or drink I need to avoid?

Will it affect my contraception?

Will it affect my fertility?

Will it affect my sex life?

Do I need to avoid playing sports?

Can I drive or ride a bike?

Can lifestyle changes help?

You can boost the health of your heart by making some key lifestyle changes.

These will also help if you have high blood pressure:

quit smoking - smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke.
cut down on alcohol - drinking too much alcohol raises blood pressure over time. It makes heart failure worse, too. Try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
exercise - regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn't need to be too energetic - walking every day is enough.
eat well - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products, and lean proteins. It's a good idea to cut down on salt, too. Eating too much salt is the biggest cause of high blood pressure - the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
deal with stress - when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse, too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
vaccinations - if you have heart failure, it's recommended that you have a flu jab every year and a pneumonia vaccination (also called the pneumococcal vaccine) every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS.