Bisoprolol

What is bisoprolol?

Bisoprolol is a beta-blocker used to treat high blood pressure, heart failure, angina and some heart rhythm disorders. It regulates the way nerve impulses are dealt with in the body and slows the heart rate to allow it to pump blood around your body with ease. Beta-blockers are also sometimes prescribed to treat symptoms of anxiety, hyperthyroidism and migraine.

How long does bisoprolol take to work?

Bisoprolol starts to take effect within just a few hours of taking it, but to have an optimal effect on your blood pressure it may take a few weeks. High blood pressure often doesn’t have any symptoms, so you’re not likely to feel any different, but this doesn’t mean that the medicine isn’t working. If you’re taking a beta-blocker for angina, the chest pain should start to improve after a couple of weeks and if you’re taking it for heart failure it may take months to see an improvement.

Will I need to keep taking bisoprolol after my blood pressure is lower?

You should keep taking bisoprolol even if your blood pressure has lowered. If you stop taking it, your blood pressure may rise again and you’ll be at risk of experiencing a heart attack or stroke in the future.

Is bisoprolol safe for long term use?

Yes, bisoprolol is safe for long term use and is most beneficial when taken over a long period of time. The medicine will regulate your blood pressure and prevent a heart attack or stroke.

When will bisoprolol start to work?

Bisoprolol will start to work two hours after you start to take it but it usually takes a few weeks to have full effect.

What happens if you don’t treat high blood pressure?

If left untreated, high blood pressure can lead to stroke, heart attack and kidney problems. Bisoprolol helps lower blood pressure by making the heart beat slower and with less force.

Active ingredients

Bisoprolol fumarate is the active ingredient in this medication.

Inactive ingredients

Other ingredients in bisoprolol are cellulose microcrystalline, sodium starch glycolate, povidone K-30, silica colloidal anhydrous, magnesium stearate (E470b), hypromellose E-15 (E464), macrogol 400 (E553), titanium dioxide (E171) and talc.

Please note: inactive ingredients can vary between different doses and brands.

Bisoprolol dosage

You’ll usually start with a low dose of 5 mg or 10 mg. This may be increased to 20 mg if your blood pressure is still high.

How to take bisoprolol?

Bisoprolol is usually taken once a day, in the morning, with or without food. It’s best to stick to the same time each day and if you forget, take the tablet as soon as you remember, skipping the dose if you don’t remember until the next day.

Can bisoprolol pills be split in half or crushed?

You should check the individual instructions. Some brands produce bisoprolol that can be split in half easily but unless otherwise stated you should swallow the tablet whole. Tablets that are not designed to be split can cause issues if you do break them apart – they may not work properly or could cause harm to you. You should avoid crushing bisoprolol unless specifically advised, as it can increase the likelihood of side effects affecting your throat and breathing. If you struggle to take tablets whole, you should speak to your doctor, who can help you find an alternative solution.

Bisoprolol side effects

Common side effects from bisoprolol include:

• Feeling tired or weak
• Dizziness
• Headache
• Cold or numb hands and feet 
• Low blood pressure
• Stomach problems
• Slow heart rate
• Worsening of pre-existing heart failure
• Gastrointestinal upset such as nausea, vomiting, diarrhoea or constipation

Uncommon side effects are:

• Problems sleeping
• Depression
• Worsening of symptoms in those with asthma or obstructive airways disease
• A feeling of weakness in the muscles or cramps
• Heart arrhythmias

Rare or very rare side effects that occur in less than 1 in 1,000 people:

• Allergic reaction
• Problems hearing 
• Dry eyes 
• Runny nose
• Yellowed skin and eyes due to an inflammation in the liver
• Changes in liver enzymes
• A rash or flushed, itchy skin 
• Sexual problems 
• Nightmares 
• Hallucinations
• Feeling faint or fainting
• Conjunctivitis (inflammation of the eye)

Serious side effects include difficulty breathing and worsening of heart failure symptoms. If you experience any of these issues, seek medical help right away.

Contraindications

Bisoprolol can be taken by adults over the age of 18 but there are people who may not be able to take it. Inform your doctor if you:

• Are allergic to bisoprolol or other medicines 
• Have low blood pressure 
• Are experiencing a slow heart rate 
• Have had a recent heart attack
• Have heart disease or heart failure which is getting worse 
• Have circulation problems like Raynaud's phenomenon
• Have metabolic acidosis 
• Have a respiratory condition such as asthma, chronic obstructive pulmonary disease or bronchospasm
• Have cardiogenic shock
• Have a phaeochromocytoma
• Have any heart rhythm disorder such as heart block or sick sinus syndrome
• Have peripheral arterial disease
• Have heart failure
• Have diabetes
• Have impaired kidney function
• Have any liver problems 
• Are fasting or intermittently fasting for any reason
• Have psoriasis

Drug interactions

It’s important to inform your doctor about any other medications you are taking in case they interfere with each other. In particular, the following medicines may stop bisoprolol from working properly:

• Additional medicine for high blood pressure
• Any medications used to treat heart rhythm disorders
• Topical beta-blockers e.g. eye drops
• Certain types of antidepressants 
• Nitrates – a chest pain treatment 
• Baclofen – a muscle relaxant
• Treatment for enlarged prostate 
• Treatment for Parkinson’s disease 
• Anti-inflammatories like ibuprofen 
• Steroids 
• Pseudoephedrine or xylometazoline (present in some cough medicines)
• Diabetes treatment 
• Allergy medication 
• Rifampicin 

Caution should be taken in mixing bisoprolol with herbal remedies as it’s not known how they could interact with the medication. 

Bisoprolol and pregnancy

Bisoprolol is not recommended during pregnancy. You should inform your doctor if you are pregnant or planning to start a family before starting your treatment. Labetalol may be prescribed instead to avoid causing harm to the baby.

Bisoprolol and breastfeeding

It’s not known if bisoprolol is safe to take while breastfeeding. You should speak to your doctor to find a suitable treatment.

Can I drive when taking bisoprolol?

If bisoprolol makes you dizzy, you should avoid driving.

Bisoprolol and alcohol

During the first few days of taking bisoprolol, you should avoid drinking alcohol as it can exacerbate the effects of the medicine, causing you to feel dizzy or lightheaded. If these effects continue, it’s best to avoid alcohol during your treatment.

Does bisoprolol cause constipation?

Constipation is a common side effect of bisoprolol. It’s more likely to affect older adults over the age of 60 but this side effect should pass within a couple of weeks.

Will bisoprolol affect my fertility?

Bisoprolol hasn’t been shown to affect fertility in women or men. In rare cases, it can have an effect on sexual function and cause erectile dysfunction in men.

Will bisoprolol affect my contraception?

Taking bisoprolol won’t have an impact on your contraception. The combined pill is not usually suitable for women with high blood pressure, as it can cause your blood pressure to rise. If you have high blood pressure and you are taking the combined pill, you should speak to your doctor to discuss your contraceptive options.

How to cope with bisoprolol side effects?

You may experience dizziness when you first take bisoprolol. If this happens, sit or lie down until it passes and don’t drive or use heavy machinery until you feel better. For headaches, stay hydrated and take a painkiller like paracetamol if needed. If you feel sick, avoid anything too spicy or rich and take your tablet after eating. If you experience constipation, eat food high in fibre and exercise regularly. Drinking plenty of water is important too and helps you to stay hydrated if you get diarrhoea.

What else can I do to lower my blood pressure?

Aside from medication, your diet and lifestyle have an impact on your blood pressure. Eating a healthy diet, cutting down on salt and saturated fats and exercising regularly are all things that will help to lower your blood pressure.

Bisoprolol vs other beta blockers

Some beta-blockers treat heart conditions but are not effective for treating high blood pressure. Different types are suited to different purposes so it will depend on your condition and symptoms as to which one is best.

Lifestyle changes to reduce your blood pressure

There are changes you can make yourself to improve your lifestyle and overall health and benefit your blood pressure at the same time. Cutting down on salt and fatty foods, eating plenty of vegetables, stopping smoking and exercising regularly are all positive steps you can take to reduce your blood pressure.

Alternatives to bisoprolol

There are other types of medication that can be given to treat high blood pressure and heart problems. These include ACE inhibitors, angiotensin receptor blockers and calcium-channel blockers which help widen the blood vessels.

What type of antihypertensive is bisoprolol?

Antihypertensives are medicines that reduce blood pressure. Bisoprolol is a beta-blocker, which is one type of antihypertensive. Beta-blockers work by blocking adrenaline from binding to the receptors in the muscles and organs, in particular the ones surrounding the blood vessels. This causes the blood vessels to dilate so that blood can flow more freely. Beta-blockers also act on the heart, slowing the heart rate.

Can I eat grapefruit whilst taking bisoprolol?

You don’t need to avoid any types of food or drink while you are taking bisoprolol. Grapefruit should be avoided if you are also taking certain types of calcium channel blocker.

Do I need to avoid sports when taking bisoprolol?

You can still participate in sports or physical activities while taking bisoprolol. Take care not to overexert yourself and rest where necessary. If you are participating in competitions or athletic performance, taking medicines such as bisoprolol may prohibit you from taking part.

Will bisoprolol affect my sex life?

A less common side effect of bisoprolol is trouble getting an erection. If this becomes a problem, speak to your healthcare practitioner. 

Can I take bisoprolol for migraines?

Bisoprolol can be helpful in preventing migraines. It’s likely that your doctor will try you with medication specifically designed for migraines first. Beta-blockers can be a good preventative measure for migraines, but should only be used for this purpose if specifically prescribed for it.

Can I take bisoprolol for anxiety?

Beta-blockers like bisoprolol can sometimes be prescribed for anxiety. During periods of anxiety, the body goes into fight or flight mode which causes adrenaline to spike. Beta-blockers work to block these hormones and regulate the heart which can help to treat the physical symptoms of anxiety. Only take bisoprolol for anxiety under supervision from your doctor. 

Can I take bisoprolol before surgery?

You’ll need to tell your doctor that you are taking bisoprolol if you are scheduled to have surgery. You might need to stop taking it before surgery as it may interact with certain general anaesthetics and cause your blood pressure to drop too low.