Bisoprolol

What Does Bisoprolol Do?

Bisoprolol is a beta blocker that treats hypertension, angina, and heart failure by obstructing the effects of specific hormones (e.g. adrenaline) on the heart and blood vessels, thereby reducing heart rate and blood pressure. It is also used off-label for certain arrhythmias, migraines, and anxiety disorders. 

How Does Bisoprolol Work?

By selectively blocking beta-1 receptors, Bisoprolol eases the heart's workload, leading to decreased heart rate, stroke volume, and cardiac output, resulting in improved cardiac function.

This leads to reduced oxygen demand by the heart muscle and improved overall heart function. The drug also curbs the release of renin from the kidneys, which can decrease peripheral vascular resistance and further lower blood pressure.

Drug Type and Category of Bisoprolol

Bisoprolol is a small molecule drug that belongs to the class of cardioselective beta-adrenergic blocking agents (beta-blockers).

What dosage of Bisoprolol should you be taking?

The dosage of bisoprolol depends on the reason for taking the medication and can vary from person to person.

For high blood pressure or angina:

• Starting dose: 5-10 mg once daily
• If needed, the dose may be increased to 20 mg once daily

For heart failure:

• Starting dose: 1.25 mg once daily
• The dose is usually increased gradually over a few months up to 10 mg once daily

The dose should be individualised based on the patient's response. In some cases, a lower starting dose of 2.5 mg once daily may be appropriate.

Dosage adjustments are needed for patients with kidney dysfunction (CrCl < 40>

What are the side-effects of Bisoprolol?

The most common side effects of bisoprolol include:

• Headaches
• Feeling dizzy or weak
• Cold hands or feet
• Feeling or being sick (nausea or vomiting)
• Diarrhea
• Tiredness or weakness
• Slower heart rate
• Anxiety
• Changes in sex drive or performance
• Changes in mood

Other less common but potentially serious side effects that require immediate medical attention include:

• Shortness of breath with cough, swollen ankles/legs, or irregular heartbeat (signs of heart problems)
• Yellowing of eyes or skin (liver problems)
• Chest pain (heart problems)
• Shortness of breath, wheezing, chest tightening (lung problems)
• Serious allergic reactions with symptoms like swollen lips/tongue, trouble breathing, rash, dizziness, fainting
• Confusion, depression, blurred vision, decreased urine output (overdose symptoms)

Interestingly, Bisoprolol may also mask symptoms of low blood sugar in diabetics and make it harder to control blood sugar levels. Caution is also advised when driving or operating machinery due to potential drowsiness.

Drug Interactions

Bisoprolol has a large number of known drug interactions. There are 483 medications known to interact with bisoprolol, including 26 major interactions, 428 moderate interactions, and 29 minor interactions.

Some of the most common and important interactions include:

• Other blood pressure medications - The combination with bisoprolol can sometimes lower blood pressure too much, causing dizziness or fainting.
• NSAIDs like ibuprofen - They can stop bisoprolol from working as well.
• Steroids like prednisolone
• Diabetes medications - Bisoprolol may make it harder to recognise the warning signs of low blood sugar.
• Allergy medications like ephedrine, norepinephrine or epinephrine
• Asthma or COPD medications
• Antibiotics like rifampicin

Bisoprolol is also known to interact with certain herbal remedies and supplements, but there is limited information on the safety of these combinations. It's important to always inform your doctor about any other medications, herbs or supplements you are taking when prescribed bisoprolol.

In overdose, bisoprolol can cause serious symptoms like hypotension (blood pressure too low), bradycardia (slow heart rate, usually lower than 60), bronchospasm (constriction in the air ways), and hypoglycemia (low blood sugar levels). Treatment involves supportive care, glucagon, IV glucose, and in severe cases, isoproterenol infusion or pacemaker insertion.

Natural Alternatives to Bisoprolol

Potassium-Rich Foods

Potassium is a powerful natural beta-blocker that balances sodium levels and relaxes blood vessel walls to lower blood pressure and heart rate. ^1,5 Good sources include:

• Bananas
• Spinach
• Potatoes 
• Dairy products
• Fish
• Legumes

Garlic

Garlic is highly beneficial for the cardiovascular system. It lowers inflammation, reduces heart disease risk, and helps normalise high blood pressure. ^1,2,5 Garlic contains the antioxidant allicin which may account for its blood pressure-lowering effects. ¹

L-Arginine

L-arginine is an amino acid that helps produce nitric oxide, which can cause blood vessels to enlarge and help lower blood pressure. ^2,4 Good sources include:

• Poultry
• Red meat
• Fish
• Dairy products
• Nuts
• Seeds

Magnesium

Magnesium is an essential mineral necessary for metabolic processes like muscle contraction and nervous system regulation. ^2,4 Magnesium supplementation may help lower blood pressure and anxiety levels. Good food sources include leafy greens, whole grains, nuts and seeds.

Omega-3 Fatty Acids

Omega-3 fatty acids from fish oil can help reduce blood pressure and heart rate. ¹ The American Heart Association recommends consuming omega-3-rich fish like salmon, mackerel, herring, lake trout, sardines or albacore tuna at least twice weekly.

While these natural alternatives can help support heart health, it's important to consult your doctor before making any changes to your medication regimen. Never stop taking prescription beta-blockers without medical approval.

Interesting facts about Bisoprolol

Bisoprolol was patented in 1976 and first approved for medical use in 1986. It was approved for use in the United States in 1992. ⁶

Bisoprolol is a cardioselective beta blocker, meaning it selectively blocks beta-1 adrenergic receptors mainly found in the heart. This allows it to lower heart rate and blood pressure without significantly affecting beta-2 receptors in the lungs, reducing the risk of bronchoconstriction compared to non-selective beta blockers. ⁶

Bisoprolol was the 7th most commonly prescribed drug in the UK in 2024. 

Disclaimer:

This article is generated for informational purposes only. It was created in June 2024. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://www.medicalnewstoday.com/articles/natural-beta-blockers
2. https://www.healthline.com/health/natural-beta-blockers
3. https://www.adityabirlacapital.com/healthinsurance/active-together/2021/05/14/8-natural-sources-of-beta-blockers-to-treat-hypertension/
4. https://performzen.com/natural-beta-blocker-alternatives/
5. https://www.drberg.com/blog/8-natural-beta-blockers
6. https://en.wikipedia.org/wiki/Bisoprolol