Bisoprolol belongs to the class of medications called beta-blockers. Beta-blockers reduce the workload of the heart and help it to beat more regularly by blocking the effects of certain hormones. Bisoprolol is used alone and in combination with other medications to control mild to moderate high blood pressure but does not cure the condition.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The usual starting dose of bisoprolol is 5 mg once daily at the same time each day, with or without food. If your blood pressure does not respond well enough to the 5 mg dose, your doctor may decide to increase the dose to 10 mg, and then if necessary to 20 mg once daily.

Swallow bisoprolol tablets whole. Do not crush or chew the tablets.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not take bisoprolol if you:

• are allergic to bisoprolol or any ingredients of the medication
• have a very low heart rate
• have cardiogenic shock or heart failure
• have right ventricular failure due to pulmonary hypertension
• have second or third degree AV (atrioventricular) block

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• cough
• diarrhea
• fatigue
• headache
• insomnia
• joint pain
• nausea
• sore throat

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur.

• dizziness
• peripheral edema (swelling of the ankles)
• rhinitis or sinusitis (inflammation in the nose)
• urinary tract infection (painful urination, frequent urination, or cloudy urine)
• very slow heart rate (less than 50 beats per minute)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• symptoms of a serious allergic reaction (e.g., hives, swelling of face or throat, difficulty breathing, rash, or itching)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Breathing problems: Although bisoprolol works mainly in the heart, it may have some effect on the lungs. Particularly at higher doses, bisoprolol can make symptoms of asthma and certain other breathing problems worse. If you have asthma, other breathing problems, or a history of breathing problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Hyperthyroidism: Bisoprolol may mask the signs of thyroid overactivity. If it is stopped suddenly, it may cause a worsening of the symptoms of hyperthyroidism (overactive thyroid). Do not stop the medication on your own. Instead, talk to your doctor about how to safely stop the medication by gradually reducing the dose over time.

Diabetes: The signs of low blood sugar may not be as noticeable when taking bisoprolol. Bisoprolol may also decrease the release of insulin, reducing the effectiveness of certain medications for diabetes. If you have diabetes and take insulin or other medications that affect blood glucose levels, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. It may be necessary to monitor your blood glucose levels more often when you are taking this medication.

Heart failure: Taking this medication if you have heart problems may cause the symptoms of heart disease to worsen. If you have heart failure or a history of heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Occupational hazards: Bisoprolol may cause drowsiness and lightheadedness. Avoid anything that requires you to be awake and alert until you know how the medication affects you.

Peripheral vascular disease: Bisoprolol may worsen the symptoms of diseases of the blood vessels, such as Raynaud's disease. If you have a condition involving the blood vessels, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stopping medication: The dose of bisoprolol should be gradually reduced, rather than stopped suddenly. There have been reports of severe worsening of angina and of heart attack or abnormal heart rhythms occurring for people with angina pectoris who have stopped this medication without gradually reducing the dose. Discuss the risks and benefits of stopping bisoprolol with your doctor.

Surgery: Before surgery (including dental surgery), tell the doctor or dentist that you are taking bisoprolol. If it is planned surgery and it is necessary to stop taking bisoprolol before the surgery, it should be done gradually to reduce the risk of chest pain and increased blood pressure.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if bisoprolol passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between bisoprolol and any of the following:

• aldesleukin
• aliskiren
• alpha-agonists (e.g., clonidine, methyldopa)
• alpha-blockers (e.g., alfuzosin, doxazosin, tamsulosin)
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• apalutamide
• apomorphine
• barbiturates (e.g., butalbital, phenobarbital)
• beta-2 agonists (e.g., salbutamol, formoterol, terbutaline)
• bortezomib
• bosentan
• bretylium
• brimonidine
• calcium channel blocker medicines (e.g., diltiazem, felodipine, nifedipine, verapamil)
• carbamazepine
• ceritinib
• conivaptan
• dabigatran
• dexmethylphenidate
• digoxin
• dipyridamole
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• donepezil
• dronedarone
• duloxetine
• enzalutamide
• eplerenone
• epinephrine
• ergot alkaloids (e.g., dihydroergotamine, ergonovine, ergotamine, methylergonovine)
• flecainide
• galantamine
• grass pollen allergen extract
• guanfacine
• insulin
• ivabradine
• lacosamide
• lanreotide
• levodopa
• lidocaine
• lumacaftor and ivacaftor
• mefloquine
• methylphenidate
• midodrine
• minoxidil
• mitotane
• morphine
• nabilone
• nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
• obinutuzumab
• octreotide
• other beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
• pasireotide
• pentoxifylline
• phenytoin
• phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pilocarpine
• pramipexole
• primidone
• propafenone
• rasagiline
• rifampin
• rivastigmine
• riociguat
• ropinirole
• rotigotine
• sacubitril
• St. John's wort
• selegiline
• sphingosine 1-phosphate receptor (S1P) receptor inhibitors (e.g., fingolimod, ponesimod, siponimod)
• sulfonylureas (e.g., gliclazide, glyburide, tolbutamide)
• thalidomide
• theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
• tizanidine
• tocilizumab
• tofacitinib
• tretinoin
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.