Bisoprolol Fumarate for High Blood Pressure and Angina Pectoris

  • Type of Drug: Beta-adrenergic-blocking agent.
  • Prescribed for: High blood pressure, angina pectoris, and abnormal heart rhythms. The combination of Bisoprolol and Hydrochlorothiazide is prescribed only for high blood pressure.
  • Brand Name: Zebeta

Bisoprolol Fumarate: General Information

Bisoprolol is one of 14 beta-adrenergic-blocking drugs that interfere with the action of a specific part of the nervous system. Beta receptors are found all over the body and affect many body functions. This accounts for the usefulness of beta blockers against a wide variety of conditions. The first member of this group, Propranolol, was found to affect the entire beta-adrenergic portion of the nervous system. Newer beta blockers have been refined to affect only a portion of that system, making them more useful in the treatment of cardiovascular disorders and less useful for other purposes. Other beta blockers are mild stimulants to the heart or have other characteristics that make them more useful for a specific purpose or better for certain people. Bisoprolol is available in a single-tablet combination with Hydrochlorothiazide, a diuretic that also lowers blood pressure.

Cautions and Warnings

People with angina who take Bisoprolol for high blood pressure should have their drug dosage reduced gradually over 1 to 2 weeks rather than suddenly discontinued to avoid possible aggravation of the angina.

Bisoprolol should be used with caution if you have liver or kidney disease, because your ability to eliminate this drug from your body may be impaired.

Bisoprolol reduces the amount of blood pumped by the heart with each beat. This reduction in blood flow can aggravate or worsen the condition of people with poor circulation or circulatory disease.

If you are undergoing major surgery, your doctor may want you to stop taking Bisoprolol at least 2 days before surgery to permit the heart to respond more acutely to things that happen during the surgery. This is still controversial and may not hold true for all people preparing for surgery.

Possible Side Effects of Bisoprolol Fumarate

Side effects are usually mild, relatively uncommon, develop early in the course of treatment, and are rarely a reason to stop taking Bisoprolol.

  • Most common: male impotence.
  • Other: unusual tiredness or weakness, slow heartbeat, heart failure (swelling of the legs, ankles, or feet), dizziness, breathing difficulty, bronchospasm, mental depression, confusion, anxiety, nervousness, sleeplessness, disorientation, short-term memory loss, emotional instability, cold hands and feet, constipation, diarrhea, nausea, vomiting, upset stomach, increased sweating, urinary difficulty, cramps, blurred vision, skin rash, hair loss, stuffy nose, facial swelling, aggravation of lupus erythematosus (a disease of the body’s connective tissues), itching, chest pains, back or joint pains, colitis, drug allergy (fever, sore throat), and liver toxicity.

Drug Interactions

  • Bisoprolol may interact with surgical anesthetics to increase the risk of heart problems during surgery. Some anesthesiologists recommend gradually stopping your medicine 2 days before surgery.
  • Bisoprolol may interfere with the normal signs of low blood sugar and can interfere with the action of oral antidiabetes medicines.
  • Bisoprolol enhances the blood-pressure-lowering effects of other blood-pressure-reducing agents (including Clonidine, Guanabenz, and Reserpine) and calcium-channel-blocking drugs (such as Nifedipine).
  • Aspirin-containing drugs, Indomethacin, Sulfinpyrazone, and estrogen drugs can interfere with the blood-pressurelowering effect of Bisoprolol.
  • Cocaine may reduce the effects of all beta-blocking drugs.
  • Bisoprolol may worsen the condition of cold hands and feet associated with taking ergot alkaloids (for migraine headaches). Gangrene is a possibility in people taking an ergot and Bisoprolol.
  • Bisopropol will counteract the effects of thyroid hormone replacement medicines.
  • Calcium channel blockers, Flecainide, Hydralazine, oral contraceptives, Propafenone, Haloperidol, phenothiazine tranquilizers (Molindone and others), quinolone antibacterials, and Quinidine may increase the amount of Bisoprolol in the bloodstream and the effect of that drug on the body.
  • Bisoprolol should not be taken within 2 weeks of taking a monoamine oxidase (MAO) inhibitor antidepressant drug.
  • Cimetidine increases the amount of Bisoprolol absorbed into the bloodstream from oral tablets.
  • Bisoprolol may lessen the effectiveness of Theophylline, Aminophylline, and some antiasthma drugs (especially Ephedrine and Isoproterenol).
  • The combination of Bisoprolol and Phenytoin or Digitalis drugs can result in excessive slowing of the heart, possibly causing heart block.
  • If you stop smoking while taking Bisoprolol, your dose may have to be reduced because your liver will break down the drug more slowly after you stop.

Food Interactions

Bisoprolol may be taken without regard to food or meals.

Usual Dose of Bisoprolol Fumarate


  • Starting dose: 5 mg once daily. The daily dose may be gradually increased up to 20 mg.
  • Maintenance dose: 5 to 10 mg once daily.


May respond to lower doses and should be treated more cautiously.
People with kidney or liver disease may need only 2.5 mg a day to start.


Symptoms of overdosage are changes in heartbeat (unusually slow, unusually fast, or irregular), severe dizziness or fainting, difficulty breathing, bluish-colored fingernails or palms, and seizures. The overdose victim should be taken to a hospital emergency room, where proper therapy can be given. ALWAYS bring the medicine bottle.

Special Information

Bisoprolol is meant to be taken continuously. Do not stop taking it unless directed to do so by your doctor, because abrupt withdrawal may cause chest pain, difficulty breathing, increased sweating, and unusually fast or irregular heartbeat. The dose should be lowered gradually over a period of about 2 weeks.

Call your doctor at once if any of the following symptoms develop: back or joint pains, difficulty breathing, cold hands or feet, depression, skin rash, or changes in heartbeat. Bisoprolol may produce an undesirable lowering of blood pres^ sure, leading to dizziness or fainting. Gall your doctor if this happens to you. Call your doctor about the following side effects only if they persist or are bothersome: anxiety, diarrhea, constipation, sexual impotence, headache, itching, nausea or vomiting, nightmares or vivid dreams, upset stomach, trouble sleeping, stuffed nose, frequent urination, unusual tiredness, or weakness.

Bisoprolol can cause drowsiness, dizziness, blurred vision, or light-headedness. Be careful when driving or performing complex tasks. It is best to take your medicine at the same time every day.

If you forget a dose of Bisoprolol, take it as soon as you remember. If it is within 8 hours of your next dose, skip the forgotten tablet and continue with your regular schedule. Do not take a double dose.

Special Populations of Zebeta

Infants born to women who took a beta blocker weighed less at birth, and had low blood pressure and reduced heart rate. Bisoprolol should be avoided by pregnant women and those who might become pregnant while taking it; When the drug is considered essential by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if Bisoprolol pases into breast milk. Still, nursing mothers taking this medication should bottle-feed their babies.

Older adults may absorb and retain more Bisoprolol in their bodies, thus requiring less medicine to achieve the same results. Your doctor will need to adjust your dosage to meet your individual needs. Seniors taking this medicine may be more likely to suffer from cold hands and feet, reduced body temperature, chest pains, general feelings of ill health, sudden breathing difficulty, increased sweating, or changes in heartbeat.