Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure
About : Always check the BNF link here
- Block Beta-adrenergic receptors in heart, peripheral vessels, lungs, pancreas and liver
- Atenolol is more lipid-soluble with potentially more CNS side effects
Indications
- Hypertension - reduced Cardiac output, block peripheral receptors, some reduce plasma renin activity. Full dose often not needed.
- Angina - reduces cardiac oxygen demand. Avoid verapamil as can precipitate heart failure
- Heart failure - only Bisoprolol and Carvedilol reduce mortality. Nebivolol can be used in mild to moderate heart failure in the over 70s
Contraindications
- Bradycardia <60bpm, systolic BP <100mmHg
- Asthma/Bronchospasm, 2nd or 3rd-degree heart block
- Avoid in Diabetes especially with thiazide
- Uncontrolled/Decompensated/Acute heart failure/severe heart failure
- Severe hypotension, Phaeochromocytoma except with an alpha-blocker
- Sick sinus syndrome
- Significant peripheral vascular disease
- Concomitant use of verapamil
Side effects
- Fatigue, Cold peripheries, Worsening diabetic control
- Bradycardia, Worsening heart failure
- Hypotension, Conduction problems
- Impotence, Worsening psoriasis
Dose
- Starting dose in elderly 2.5 mg od. Max dose 10 mg OD
Bisoprolol and AF
- Bisoprolol is the preferred oral therapy in patients with continuous atrial fibrillation. It is cardio-selective and offers good control of the ventricular rate. Starting dose is 2.5mg (1.25 mg in the elderly)
Dose range:You must check with BNF or drug datasheet
| Name | Dose | Frequency | Route |
|---|---|---|---|
| Bisoprolol (Heart failure) | 1.25 mg -10 mg | OD | PO |
| Bisoprolol (Hypertension/IHD) | 2.5 mg -10 mg | BD | PO |
| Bisoprolol (IHD/Angina) | 2.5 mg -10 mg | OD | PO |
| Bisoprolol (AF rate control) | 2.5 mg -10 mg | OD | PO (Use 1.25 mg in elderly) |