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Title: Bisoprolol  
Author: World Heritage Encyclopedia
Language: English
Subject: WHO Model List of Essential Medicines, List of MeSH codes (D02), Beta blockers, Atenolol/chlorthalidone, Alprenolol
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Systematic (IUPAC) name
Clinical data
Trade names Concor
Licence data US FDA:
  • AU: C
  • US: C (Risk not ruled out)
Legal status
  • (Prescription only)
Routes of
Pharmacokinetic data
Bioavailability >90%
Protein binding 30%[1]
Metabolism 50% Hepatic, CYP2D6, CYP3A4[2]
Biological half-life 10–12 hours[3]
CAS Registry Number  Y
ATC code C07
PubChem CID:
DrugBank  Y
ChemSpider  Y
Chemical data
Formula C18H31NO4
Molecular mass 325.443 g/mol

Bisoprolol is a drug belonging to the group of health system.[6]


  • Medical use 1
    • Cautions 1.1
    • Side effects 1.2
  • Mechanism of action 2
  • Pharmacology and biochemistry 3
    • β1-selectivity 3.1
    • Antihypertensive effect 3.2
    • Cardioprotection 3.3
    • Renin-angiotensin system 3.4
  • References 4
  • External links 5

Medical use

Bisoprolol is beneficial in treatment for high blood pressure (hypertension), reduced blood flow to the heart (cardiac ischemia); congestive heart failure, and preventive treatment before and primary treatment after heart attacks, decreasing the chances of recurrence.[7] Bisoprolol targets hypertension (elevated blood pressure).[8][9] In cardiac ischemia, the drug is used to reduce the activity of the heart muscle, so reduces oxygen and nutrient demand, and reduced blood supply can still transport sufficient amounts of oxygen and nutrients.[10][11][12]

Bisoprolol can be used to treat cardiovascular diseases such as hypertension, coronary heart disease, arrhythmias, ischemic heart diseases, and myocardial infarction after the acute event. Patients with compensated congestive heart failure may be treated with bisoprolol as a comedication (usually with an ACE inhibitor, a diuretic, and a digitalis-glycosid, if indicated). In patients with congestive heart failure, it reduces the need for and the consumption of oxygen of the heart muscle. It is very important to start with low doses, as bisoprolol reduces also the muscular power of the heart, which is an undesired effect in congestive heart failure.


Beta-blockers can precipitate asthma and this effect can be dangerous. They should be avoided in patients with a history of asthma or bronchospasm; if no alternative is available, a cardioselective beta-blocker can be used with extreme caution under specialist supervision. Bisoprolol, metoprolol, nebivolol, and (to a lesser extent) acebutolol, have less effect on the β2 (bronchial) receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance, but are not free of this side effect, particularly at higher dosages.

Side effects

Overdose of bisoprolol leads to fatigue, hypotension,[11] low blood sugar,[13][14] bronchospasms, and bradycardia.[11] Bronchospasms and low blood sugar because at high doses drug can be an antagonist for β2 adrenergic receptors located in lung and in liver. Bronchspasm is due to blockage in lungs of β2 receptor and low blood sugar because of decreased stimulation of glycogenolysis and gluconeogenesis in the liver via β2 receptor.[10][11][15]

Zebeta 5-mg oral tablet

Mechanism of action

Bisoprolol is cardioprotective because it selectively and competitively blocks catecholamine (adrenalin) stimulation of β1 adrenergic receptors (adrenoreceptors), which are mainly found in the heart muscle cells and heart conduction tissue (cardiospecific), but also found in juxtaglomerular cells in the kidney.[10] Normally, adrenalin and noradrenalin stimulation of the β1 adrenoreceptor activates a signalling cascade (Gs protein and cAMP) which ultimately leads to increased contractility and increased heart rate of the heart muscle and heart pacemaker, respectively.[16] Bisoprolol competitively blocks the activation of this cascade, so decreases the adrenergic tone/stimulation of the heart muscle and pacemaker cells. Decreased adrenergic tone shows less contractility of heart muscle and lowered heart rate of pacemakers.[17][13][14]

These are the favourable factors that are decreased and treat hypertension, heart attacks, and ischemia. The decreases in contractility and heart rate are beneficial for hypertension because they reduce blood pressure,[8][11] but for preventive measures for heart attacks and cardiac ischemia, these decreases in heart rate and contraction decrease the heart's demand for oxygen and nutrients; primary treatment after heart attacks is to prevent recurrence of the infarction.[11][12][9]

Pharmacology and biochemistry

Selectivity of various β-blockers

Bisoprolol has both lipid- and water-soluble properties, making it a prime candidate over other β-blockers and even over other β1-blockers, being water-soluble, it has decreased incidence of central nervous system side effects (inability to diffuse into brain) compared to purely lipophilic compounds.[17][13] Bisoprolol has an approximate half-life of 10–12 hours, and when ingested has nearly complete absorption into the blood stream.[13][14] The high absorption is indicative of high bioavailability (approx. 90%).[13][14] When being eliminated, the body evenly distributes it (50–50) between kidney excretion and liver biotransformation (then excreted).[17][13][14] These factors make it a convenient once/day dosage when administered.[13][14]


Bisoprolol β1-selectivity is especially important in comparison to other nonselective beta blockers. The effects of the drug are limited to areas containing β1 adrenoreceptors, which is mainly the heart and part of the kidney.[17][13] Bisoprolol minimizes the side effects that might occur from administration of a nonspecific beta blocker where blockage of the other adrenoreceptors (β2, β3, α1, α2) occurs. The other receptors elicit a variety of responses in the body, and their blockage could cause a wide range of reactions, but β1 adrenoreceptors are cardiospecific for the most part, making bisoprolol ideal for treatment of cardiac events.[17][13][14]

Bisoprolol has a higher degree of β1-selectivity compared to other β1-selective β-blockers such as atenolol, metoprolol, and betaxolol.[18][17][19][20][21][22][23][24][25][26] However nebivolol is approximately 3.5 times more β1-selective.[27][28]

Antihypertensive effect

Bisoprolol has a stronger antihypertensive effect than propranolol.[18]


Bisoprolol in animal models has been shown to be cardioprotective.[18]

Renin-angiotensin system

Bisoprolol inhibits renin secretion by about 65% and tachycardia by about 30%.[18]


  1. ^ Bühring KU, Sailer H, Faro HP, Leopold G, Pabst J, Garbe A (1986). "Pharmacokinetics and metabolism of bisoprolol-14C in three animal species and in humans". J. Cardiovasc. Pharmacol. 8 Suppl 11: S21–8.  
  2. ^ Yuji Horikiri, Takehiko Suzuki, Masakazu Mizobe (March 1998). "Pharmacokinetics and metabolism of bisoprolol enantiomers in humans". Journal of Pharmaceutical Sciences. Volume 87 (3): 289–294.  
  3. ^ Leopold G (1986). "Balanced pharmacokinetics and metabolism of bisoprolol". J. Cardiovasc. Pharmacol. 8 Suppl 11: S16–20.  
  4. ^ "Bisoprolol Official FDA information, side effects and uses.". Retrieved 2012-03-17. 
  5. ^ "Drugs@FDA: FDA Approved Drug Products". Retrieved 2013-11-13. 
  6. ^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014. 
  7. ^ Rosenberg, J.; Gustafsson, F. (2008). "Bisoprolol for congestive heart failure". Expert Opinion on Pharmacotherapy 9 (2): 293–300.  
  8. ^ a b Amabile, G.; Serradimigni, A. (1987). "Comparison of bisoprolol with nifedipine for treatment of essential hypertension in the elderly: Comparative double-blind trial". European heart journal. 8 Suppl M: 65–69.  
  9. ^ a b Thadani, U. (2004). "Current medical management of chronic stable angina". Journal of cardiovascular pharmacology and therapeutics. 9 Suppl 1: S11–S29; quiz S29–9.  
  10. ^ a b c "A randomized trial of beta-blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). CIBIS Investigators and Committees". Circulation 90 (4): 1765–1773. 1994.  
  11. ^ a b c d e f Konishi, M.; Haraguchi, G.; Kimura, S.; Inagaki, H.; Kawabata, M.; Hachiya, H.; Hirao, K.; Isobe, M. (2010). "Comparative effects of carvedilol vs bisoprolol for severe congestive heart failure". Circulation journal : official journal of the Japanese Circulation Society 74 (6): 1127–1134.  
  12. ^ a b Castagno, D.; Jhund, P. S.; McMurray, J. J. V.; Lewsey, J. D.; Erdmann, E.; Zannad, F.; Remme, W. J.; Lopez-Sendon, J. L.; Lechat, P.; Follath, F.; Höglund, C.; Mareev, V.; Sadowski, Z.; Seabra-Gomes, R. J.; Dargie, H. J. (2010). "Improved survival with bisoprolol in patients with heart failure and renal impairment: An analysis of the cardiac insufficiency bisoprolol study II (CIBIS-II) trial". European Journal of Heart Failure 12 (6): 607–616.  
  13. ^ a b c d e f g h i Leopold, G.; Pabst, J.; Ungethüm, W.; Bühring, K. U. (1986). "Basic pharmacokinetics of bisoprolol, a new highly beta 1-selective adrenoceptor antagonist". Journal of clinical pharmacology 26 (8): 616–621.  
  14. ^ a b c d e f g Leopold G, Ungethüm W, Pabst J, Simane Z, Bühring KU, Wiemann H (September 1986). "Pharmacodynamic profile of bisoprolol, a new beta 1-selective adrenoceptor antagonist". Br J Clin Pharmacol 22 (3): 293–300.  
  15. ^ Hauck, R. W.; Schulz, C.; Emslander, H. P.; Böhm, M. (1994). "Pharmacological actions of the selective and non-selective beta-adrenoceptor antagonists celiprolol, bisoprolol and propranolol on human bronchi". British journal of pharmacology 113 (3): 1043–1049.  
  16. ^ Bristow, M. R.; Hershberger, R. E.; Port, J. D.; Minobe, W.; Rasmussen, R. (1989). "Beta 1- and beta 2-adrenergic receptor-mediated adenylate cyclase stimulation in nonfailing and failing human ventricular myocardium". Molecular pharmacology 35 (3): 295–303.  
  17. ^ a b c d e f Haeusler G, Schliep HJ, Schelling P; et al. (1986). "High beta 1-selectivity and favourable pharmacokinetics as the outstanding properties of bisoprolol". J. Cardiovasc. Pharmacol. 8 Suppl 11: S2–15.  
  18. ^ a b c d Harting J, Becker KH, Bergmann R; et al. (February 1986). "Pharmacodynamic profile of the selective beta 1-adrenoceptor antagonist bisoprolol". Arzneimittelforschung 36 (2): 200–8.  
  19. ^ Kaumann AJ, Lemoine H (October 1985). "Direct labelling of myocardial beta 1-adrenoceptors. Comparison of binding affinity of 3H-(−)-bisoprolol with its blocking potency". Naunyn Schmiedebergs Arch. Pharmacol. 331 (1): 27–39.  
  20. ^ Klockow M, Greiner HE, Haase A, Schmitges CJ, Seyfried C (February 1986). "Studies on the receptor profile of bisoprolol". Arzneimittelforschung 36 (2): 197–200.  
  21. ^ Manalan AS, Besch HR, Watanabe AM (August 1981). "Characterization of [3H](+/-)carazolol binding to beta-adrenergic receptors. Application to study of beta-adrenergic receptor subtypes in canine ventricular myocardium and lung". Circ. Res. 49 (2): 326–36.  
  22. ^ Schliep HJ, Schulze E, Harting J, Haeusler G (April 1986). "Antagonistic effects of bisoprolol on several beta-adrenoceptor-mediated actions in anaesthetized cats". Eur. J. Pharmacol. 123 (2): 253–61.  
  23. ^ Schliep HJ, Harting J (1984). "Beta 1-selectivity of bisoprolol, a new beta-adrenoceptor antagonist, in anesthetized dogs and guinea pigs". J. Cardiovasc. Pharmacol. 6 (6): 1156–60.  
  24. ^ Schnabel P, Maack C, Mies F, Tyroller S, Scheer A, Böhm M (October 2000). "Binding properties of beta-blockers at recombinant beta1-, beta2-, and beta3-adrenoceptors". J. Cardiovasc. Pharmacol. 36 (4): 466–71.  
  25. ^ Smith C, Teitler M (April 1999). "Beta-blocker selectivity at cloned human beta 1- and beta 2-adrenergic receptors" (PDF). Cardiovasc Drugs Ther 13 (2): 123–6.  
  26. ^ Wellstein A, Palm D, Belz GG (1986). "Affinity and selectivity of beta-adrenoceptor antagonists in vitro". J. Cardiovasc. Pharmacol. 8 Suppl 11: S36–40.  
  27. ^ Bundkirchen A, Brixius K, Bölck B, Nguyen Q, Schwinger RH (January 2003). "Beta 1-adrenoceptor selectivity of nebivolol and bisoprolol. A comparison of [3H]CGP 12.177 and [125I]iodocyanopindolol binding studies". Eur. J. Pharmacol. 460 (1): 19–26.  
  28. ^ Nuttall SL, Routledge HC, Kendall MJ (June 2003). "A comparison of the beta1-selectivity of three beta1-selective beta-blockers". J Clin Pharm Ther 28 (3): 179–86.  

External links

  • Monocor Prescribing information (PDF)
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