Bisoprolol

Beta Blocker·Cardiovascular - Beta Blockers

Stable chronic HFrEF, hypertension, angina

PBSBETA BLOCKERBicor, Bisoprolol Sandoz1.25 mg tabletS4+1

Max Dose

10 mg/day

Half-life

10–12 h

Cardioselective

YES

Heart Failure

INDICATED

Rapid Summary

Overview

Highly cardioselective (Beta-1) beta-blocker. Exceptional evidence base for reducing mortality in chronic heart failure with reduced ejection fraction (HFrEF).

Maximum Dose

Max 10 mg/day

Clinical Focus

Titration in heart failure must be 'start low, go slow' to prevent acute decompensation.

Bottom Line

Bisoprolol is the most cardioselective beta-blocker with strong heart failure mortality evidence, but must be up-titrated slowly and never stopped abruptly.

Formulation & Access

Brand Names

Bicor, Bisoprolol Sandoz

Oral Routes

Tablets (1.25 mg, 2.5 mg, 5 mg, 10 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Stable chronic HFrEF, hypertension, angina.

Clinical Place

One of the three core beta-blockers (alongside carvedilol and metoprolol succinate) with proven mortality benefit in HFrEF.

Quick reference

Class & Role

Beta Blocker — Highly cardioselective (Beta-1) beta-blocker.

Route / Formulation

Tablets (1.25 mg, 2.5 mg, 5 mg, 10 mg). (Bicor, Bisoprolol Sandoz)

Usual Dose & Max

PO 1.25 mg OD. Double dose every 2-4 wks based on tolerance. Target Max 10 mg/day.

Key Indication Doses

Heart Failure (HFrEF): PO 1.25 mg OD. Double dose every 2-4 wks based on tolerance. Target Max 10 mg/day. Hypertension / Angina: PO 2.5-5 mg OD. Max 10 mg/day. Elderly / Frail: Strictly start at 1.25 mg OD.

Best Uses

Bisoprolol is the most cardioselective beta-blocker with strong heart failure mortality evidence, but must be up-titrated slowly and never stopped abruptly.

Avoid / Cautions

Acute decompensated heart failure, cardiogenic shock, 2nd/3rd degree heart block, severe asthma. Pregnancy Category C.

Key Risks

Cardiovascular: Bradycardia, heart block. MODERATE — Initial worsening of heart failure symptoms during early titration. Respiratory: Bronchospasm (though highly selective, risk still exists in severe asthma). Other: Fatigue, cold extremities, masked hypoglycaemia.

Key Interactions

Non-DHP CCBs (Verapamil, Diltiazem) due to profound AV node blockade. Amiodarone and Digoxin (additive bradycardia).

Monitoring

Hold if HR < 50 or SBP < 90. In heart failure, daily Weight is required to catch early decompensation during titration. Baseline ECG required.

Clinical Pearl

When starting Bisoprolol in HFrEF, the negative inotropic effect often makes patients feel worse (fatigued, slightly more breathless) for 1-2 weeks before they improve. Warn them to expect this.

Access

Bicor, Bisoprolol Sandoz1.25 mg tablet

Brand: Bicor, Bisoprolol Sandoz
Formulation: Tablets (1

Bisoprolol

Beta Blocker·Cardiovascular - Beta Blockers

Stable chronic HFrEF, hypertension, angina

PBSBETA BLOCKERBicor, Bisoprolol Sandoz1.25 mg tabletS4+1

Max Dose

10 mg/day

Half-life

10–12 h

Cardioselective

YES

Heart Failure

INDICATED

Rapid Summary

Overview

Highly cardioselective (Beta-1) beta-blocker. Exceptional evidence base for reducing mortality in chronic heart failure with reduced ejection fraction (HFrEF).

Maximum Dose

Max 10 mg/day

Clinical Focus

Titration in heart failure must be 'start low, go slow' to prevent acute decompensation.

Bottom Line

Bisoprolol is the most cardioselective beta-blocker with strong heart failure mortality evidence, but must be up-titrated slowly and never stopped abruptly.

Formulation & Access

Brand Names

Bicor, Bisoprolol Sandoz

Oral Routes

Tablets (1.25 mg, 2.5 mg, 5 mg, 10 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Stable chronic HFrEF, hypertension, angina.

Clinical Place

One of the three core beta-blockers (alongside carvedilol and metoprolol succinate) with proven mortality benefit in HFrEF.

Quick reference

Class & Role

Beta Blocker — Highly cardioselective (Beta-1) beta-blocker.

Route / Formulation

Tablets (1.25 mg, 2.5 mg, 5 mg, 10 mg). (Bicor, Bisoprolol Sandoz)

Usual Dose & Max

PO 1.25 mg OD. Double dose every 2-4 wks based on tolerance. Target Max 10 mg/day.

Key Indication Doses

Best Uses

Bisoprolol is the most cardioselective beta-blocker with strong heart failure mortality evidence, but must be up-titrated slowly and never stopped abruptly.

Avoid / Cautions

Acute decompensated heart failure, cardiogenic shock, 2nd/3rd degree heart block, severe asthma. Pregnancy Category C.

Key Risks

Key Interactions

Non-DHP CCBs (Verapamil, Diltiazem) due to profound AV node blockade. Amiodarone and Digoxin (additive bradycardia).

Monitoring

Hold if HR < 50 or SBP < 90. In heart failure, daily Weight is required to catch early decompensation during titration. Baseline ECG required.

Clinical Pearl

When starting Bisoprolol in HFrEF, the negative inotropic effect often makes patients feel worse (fatigued, slightly more breathless) for 1-2 weeks before they improve. Warn them to expect this.

Access

Bicor, Bisoprolol Sandoz1.25 mg tablet

Brand: Bicor, Bisoprolol Sandoz
Formulation: Tablets (1