Bisoprolol
beta-blocker
Our referenceBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Pharmacologically, Bisoprolol relates to the category “beta-blocker”. Beta-blockers slow and relieve the heart and lower blood pressure. They are never stopped abruptly.
For Bisoprolol in practice: Slows the heart and lowers blood pressure. It is generally taken over the long term, within regular monitoring, and is not stopped on your own initiative.
Under which brands it is found
Bisoprolol is part of about 31 presentations listed in France. It can be found under several brand names and as generics.
- Bisoprolol Accord Healthcare
- Bisoprolol Arrow Lab
- Bisoprolol Biogaran
- Bisoprolol Cristers
- Bisoprolol Eg
- Bisoprolol Evolugen
- Bisoprolol Krka
- Bisoprolol Quiver
- and other presentations
Original brand-name products and generics deliver the same active substance; the choice between them is made with your doctor or pharmacist.
Our product for this treatment
You take Bisoprolol. For people who follow this type of treatment every day, we have designed a dedicated product.
Layer Nutrition Beta-Blockers
Melatonin helps you fall asleep faster. Magnesium and vitamin B6 help you reduce tiredness during the day.
- Contributes to the reduction of time taken to fall asleep (melatonin 1 mg, at bedtime)
- Contributes to the reduction of tiredness (magnesium, vitamin B6)
- Contributes to normal muscle function and to the normal functioning of the nervous system (magnesium)
Melatonin 1 mg · Magnesium 100 mg · B6 1.4 mg
One bottle, one dose per day. Reduced price from the second box, free delivery from two boxes.
How bisoprolol works
Bisoprolol belongs to the beta-blocker family. It acts as a selective antagonist of the heart's beta-1 adrenergic receptors. By blocking these receptors, it slows the heart rate, an effect known as negative chronotropic, and reduces the force of contractions, a negative inotropic effect. The heart then beats more slowly and less forcefully, which lowers its oxygen consumption.
Bisoprolol also acts on the kidney. By blocking the renal beta-1 receptors, it reduces the release of renin, which lessens activation of the renin-angiotensin system and helps lower blood pressure. Its distinctive feature lies in its strong cardioselectivity: it has a low affinity for the beta-2 receptors of the bronchi, the blood vessels and the fat cells, and it has no intrinsic sympathomimetic activity. At high doses, this beta-1 selectivity fades and some of the beta-2 receptors become blocked in turn.
Why it is prescribed
Bisoprolol is prescribed for high blood pressure, for heart failure with reduced ejection fraction, for stable angina and in the care that follows a myocardial infarction. These situations share a common feature: a heart that works too hard, whether against pressure that is too high, with a weakened muscle, or with narrowed coronary arteries. By slowing the rhythm and lowering the pressure, bisoprolol eases this workload.
This relief has direct consequences. In angina, a heart that consumes less oxygen suffers less when exertion raises demand. After an infarction or in heart failure, lastingly slowing the rhythm protects a muscle that is already strained and improves the outlook. It is for these reasons that treatment is established over the long term and adjusted in stages, raising the dose gradually according to tolerance.
How to take it day to day
The tablet is taken in the morning, with or without food, and swallowed with a liquid without being chewed. A single dose per day is enough: the plasma elimination half-life of bisoprolol is about 10 to 11 hours, which keeps the effect steady over twenty-four hours. Its oral bioavailability is high and the peak blood concentration is reached within 2 to 4 hours. Taking the tablet at the same time each day helps keep this regularity.
Bisoprolol must never be stopped abruptly. A sudden interruption can cause a rise in blood pressure and a speeding up of the heart, a rebound phenomenon that exposes the patient to complications. If stopping becomes necessary, it is done gradually and under medical supervision, lowering the dose in steps. Regular intake is part of the treatment just as much as the dose itself.
The effects to know about
In patients with chronic heart failure, bradycardia, meaning a heart that beats too slowly, is a very common effect: it affects at least one person in ten. Common, between one and ten people in a hundred, are dizziness, headaches, a sensation of cold or numbness in the extremities, a drop in pressure, fatigue and digestive disturbances such as nausea, vomiting, diarrhoea or constipation. These symptoms occur mainly at the start of treatment and generally disappear within one to two weeks. They often reflect the body's adaptation to a slower heart rate.
Less often, between one and ten people in a thousand, sleep disturbances appear, along with depressed mood, muscle weakness or cramps, a drop in pressure on standing up, conduction disturbances between the atria and the ventricles, and a tightening of the bronchi in people with asthma. More rarely still, between one and ten people in ten thousand, a rise in blood triglycerides and liver enzymes is observed. One point deserves attention in people with diabetes: blocking the beta receptors can mask the warning signs of hypoglycaemia, in particular the speeding up of the heart that usually alerts the patient.
Sleep and melatonin
Beta-blockers reduce the night-time secretion of melatonin. The mechanism is identified: blocking the beta-1 adrenergic receptors that control the pineal gland slows the night-time production of this hormone. This pharmacological effect contributes to the sleep disturbances reported during treatment. The molecule that protects the heart during the day therefore also weighs on the biological signal that triggers falling asleep.
This effect has been the subject of a randomised controlled trial. In hypertensive patients treated with a beta-blocker, night-time supplementation with 2.5 mg of melatonin for three weeks increased total sleep time by 37 minutes and sleep efficiency by 7.6 percent, with no rebound insomnia on stopping. The deficit induced by the treatment and the corrective intake thus concern the same hormone.
On the plate
Sleep is built from what food provides. Tryptophan, an amino acid supplied by the plate, is the starting point of the pathway that leads to serotonin, then to melatonin, the hormone that regulates the sleep-wake cycle. This chain therefore begins at the table and ends at the signal of falling asleep. When bisoprolol slows the night-time secretion of melatonin, this raw material keeps all its value.
Magnesium plays on another field: it contributes to normal muscle function. It is found in spinach and other green leafy vegetables, in legumes, nuts, seeds and whole grains. A varied diet lays this foundation, but the melatonin called for by disturbed sleep is not restored by the plate alone. This is where a targeted intake, in addition to your treatment and never in its place, makes sense.
Interactions and monitoring
Some combinations call for caution. Combining bisoprolol with calcium channel blockers of the verapamil or diltiazem type is generally not recommended, because together they depress the contractility of the heart and the conduction between the atria and the ventricles. Digitalis drugs such as digoxin also lengthen the conduction time and slow the rhythm. In people with diabetes, combining it with insulin or sulfonylureas can strengthen the fall in blood sugar and increase the risk of severe hypoglycaemia.
Monitoring accompanies the treatment over the long term. It includes blood pressure, heart rate, the electrical activity of the heart by electrocardiogram to detect a conduction block, blood glucose in people with diabetes and kidney function. As regards elimination, bisoprolol follows a balanced dual route: about half is excreted by the kidney unchanged and the other half is metabolised by the liver into inactive products, mainly via the CYP3A4 enzyme with a minor contribution from CYP2D6. This sharing makes its pharmacokinetics little affected by moderate kidney or liver impairment.
Sources
- Bisoprolol - StatPearls
- Pharmacodynamic profile of bisoprolol, a new beta 1-selective adrenoceptor antagonist
- Bisoprolol Fumarate 5 mg film-coated tablets - Summary of Product Characteristics (SmPC)
- Basic pharmacokinetics of bisoprolol, a new highly beta 1-selective adrenoceptor antagonist
- Balanced pharmacokinetics and metabolism of bisoprolol
- Influence of beta-blockers on melatonin release (Stoschitzky et al.)
- Repeated Melatonin Supplementation Improves Sleep in Hypertensive Patients Treated with Beta-Blockers: A Randomized Controlled Trial (Scheer et al.)
- Tryptophan - an overview
- Magnesium - Health Professional Fact Sheet
Related molecules
To explore in the « Heart and blood pressure » family and its neighbours.
See the whole « Heart and blood pressure » family · Back to the atlas
Frequently asked questions
What is bisoprolol used for?
Bisoprolol is a beta blocker. Its patient leaflet lists uses including high blood pressure, certain types of chest pain (angina) and heart failure. For the indication that applies to you, refer to the leaflet and to your doctor.
What are the side effects of bisoprolol?
The patient leaflet lists side effects including tiredness, dizziness, headaches, cold hands and feet, digestive problems and sleep disturbances, especially when starting treatment. If a side effect worries you or persists, talk to your doctor or pharmacist.
Bisoprolol 1.25 mg, 2.5 mg, 5 mg, 10 mg: what is the difference?
These are different strengths of the same active substance. The choice of dose is up to your doctor, based on your situation. Refer to your prescription, the patient leaflet and your doctor or pharmacist.
Should you take bisoprolol in the morning or at night?
The time to take it is set out on your prescription and in the patient leaflet, and it may be adjusted depending on how you tolerate it. To know when to take it in your case, ask your doctor or pharmacist.
What is bisoprolol fumarate?
The fumarate is simply the salt in which the active substance, bisoprolol, is formulated in the tablet. It is indeed the same medicine. The patient leaflet gives the exact composition of your pack.
Can bisoprolol be combined with perindopril or hydrochlorothiazide?
These combinations exist and are sometimes prescribed together, including as a single combined tablet. Only your doctor decides to combine them and adjusts your follow-up. Check with your doctor or pharmacist before making any change.
What are the drug interactions of bisoprolol?
The patient leaflet flags possible interactions, particularly with certain heart medicines (such as calcium channel blockers), anti-inflammatory drugs (NSAIDs) and diabetes treatments. Tell your doctor or pharmacist about all the medicines you take, including over-the-counter ones.
Can you drink alcohol while taking bisoprolol?
The patient leaflet advises caution, as alcohol can add to the drop in blood pressure. For your situation, ask your doctor or pharmacist for advice and follow the patient leaflet.
How do you stop taking bisoprolol?
A beta blocker should not be stopped abruptly on your own, as this can affect the heart. Any stopping or change must be decided and supervised by your doctor. If you miss a dose, follow the instructions in the patient leaflet.
Is Bisoprolol Viatris (the generic) the same medicine?
A generic contains the same active substance, bisoprolol, at the same strength as the reference brand. The inactive ingredients may differ. For any question about your pack, your pharmacist is the right person to ask.
Can bisoprolol disrupt sleep and melatonin?
A study (Stoschitzky et al., 1999) observed that beta blockers reduce the night-time secretion of melatonin, the hormone that accompanies falling asleep. This can help explain the sleep disturbances that are sometimes reported. It is something to keep an eye on and to raise with your doctor if your sleep worsens.
What to consider on the nutrition side with a beta blocker like bisoprolol?
Since research links beta blockers to a decrease in night-time melatonin, melatonin and magnesium are the two angles we document for sleep comfort. Our BB01 reference brings these together, with magnesium as bisglycinate, which is well tolerated. This comes in addition to your treatment, never in its place.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.