A beta-blocker
Bisoprolol
A heart-selective beta-blocker used in heart failure, to control heart rate in atrial fibrillation, and for angina.
What is Bisoprolol?
Bisoprolol is a cardioselective beta-blocker that slows the heart rate and reduces the workload on the heart. It is used in heart failure, to control the heart rate in atrial fibrillation, and to treat angina and high blood pressure.
Education and reference only. This is a plain-language guide to Bisoprolol — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Bisoprolol is a commonly used "cardioselective" beta-blocker — meaning it acts mainly on the heart. It is a foundation treatment for heart failure with a reduced pumping function, is widely used to control the heart rate in atrial fibrillation, and is used for angina and some other heart conditions. It is taken as a once-daily tablet.
How it works
Bisoprolol blocks beta receptors in the heart, reducing the effect of adrenaline-type stress signals. This slows the heart rate, eases the force of each beat and lowers the heart's workload and oxygen demand. In heart failure, gently easing this stress load over time helps the heart muscle recover and improves survival; in atrial fibrillation it brings a fast, irregular rate under control.
Company & origin
Originated / developed by: Merck KGaA (E. Merck), Germany.
Bisoprolol is a beta-blocker developed by the German company E. Merck (Merck KGaA) and first introduced in Germany around 1986. It later reached the United States, where it was approved by the FDA in 1992, and is marketed in the UK as Cardicor and Emcor.
What it treats
Conditions Bisoprolol is used for
Practical use
How to take Bisoprolol
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Usually taken once a day, often in the morning.
- Swallow the tablet with water; it can be taken with or without food.
- It is usually started low and built up gradually, particularly in heart failure.
- If you miss a dose, skip it and carry on as normal — do not take two together.
- Do not stop suddenly; the dose should be reduced gradually to avoid a rebound in heart rate or chest pain.
- Tell your doctor if you have asthma or breathing problems, as beta-blockers can affect this.
Weighing it up
Advantages & disadvantages of Bisoprolol
Advantages
- Proven to improve survival in heart failure with a reduced pumping function.
- Once-daily and largely heart-selective, so generally better tolerated than older beta-blockers.
- Effective for rate control in atrial fibrillation and for angina.
- Cheap, widely used generic.
Disadvantages
- Can cause tiredness, cold hands and feet, and a slow heart rate.
- May worsen asthma or severe airways disease in susceptible people.
- Must not be stopped abruptly because of rebound effects.
- Can mask some warning signs of a low blood sugar in people with diabetes.
Practical use
Good to know
In heart failure it is started low and increased slowly — symptoms can briefly feel worse before they improve, which is expected and not a reason to stop on your own. It must never be stopped abruptly, as this can cause a rebound increase in heart rate and chest pain. A slow pulse, tiredness or cold hands are common.
Who should not take it / use with caution
- People with certain slow or blocked heart rhythms (e.g. some heart block) or very low heart rate/blood pressure, or untreated heart failure that is acutely decompensated.
- Used with caution in asthma (can trigger wheeze); often avoided or used very cautiously.
- Care in people with severe peripheral circulation problems.
Monitoring
- Heart rate and blood pressure
- Symptoms during dose changes in heart failure
- Breathing in anyone with airways disease
Side effects
- Tiredness, cold hands and feet, and a slow pulse.
- Dizziness, especially when starting or increasing.
- Vivid dreams or disturbed sleep; in heart failure, a temporary feeling of being more breathless or swollen while the dose is built up.
Key interactions
- Other heart-rate-lowering medicines (e.g. diltiazem, verapamil, digoxin) can slow the heart too much.
- Care alongside other blood-pressure-lowering medicines.
- Can mask the warning signs of a low blood sugar in people with diabetes.
Available as: Tablets (several strengths).
Answers
Bisoprolol: frequently asked questions
Can I stop bisoprolol suddenly?
No — stopping a beta-blocker abruptly can cause a rebound fast heart rate, raised blood pressure and chest pain, and can be dangerous in heart disease. If it needs to stop, it is reduced gradually under guidance.
Why do I feel more tired or breathless after starting it for heart failure?
When bisoprolol is started or increased for heart failure, symptoms can briefly feel worse before they improve, because the heart is adjusting. This is expected, the dose is built up slowly, and it should not be stopped on your own — tell your team if it is marked or persistent.
Can I take bisoprolol if I have asthma?
Beta-blockers can trigger wheezing and are used with great caution, or avoided, in asthma. Always tell your prescriber about any asthma or breathing condition so the right choice is made.
Does bisoprolol affect diabetes?
It can blunt some of the early warning signs of a low blood sugar (such as a racing heart), so people with diabetes should be aware and monitor as advised. It does not usually change blood-sugar control much.
Is bisoprolol the same as Cardicor?
Yes — bisoprolol is the generic name and Cardicor and Emcor are brand names; all contain the same active ingredient.
The wider class
About Beta-blockers
Bisoprolol belongs to the beta-blockers class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
Browse by body system
Authoritative sources
- BNF: Bisoprolol fumarate.
- electronic Medicines Compendium (SmPC): Bisoprolol.
- NICE CKS: Bisoprolol.
Building a medicines information resource?
We create evidence-led, dose-free drug and formulary references for teams.