Beta blockers · Cardiovascular
Bisoprolol
Monocor® · Zebeta®(brand names vary by market)
The most beta-1 selective of the common beta blockers, once daily by design.
Mechanism
Highly beta-1 selective antagonist; the same cardiac braking as metoprolol with less beta-2 spillover at usual doses.
Open the interactive pathwayIndications
- Heart failure with reduced ejection fraction
- Hypertension
- Rate control
Formulations
Dosing concepts
Heart failure
One of the trial-proven HFrEF beta blockers (with carvedilol and metoprolol succinate); started low, doubled slowly toward the target dose.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~90%
- Half-life
- 10-12 h
- Elimination
- mixed: Roughly half renal, half hepatic: a balanced exit that tolerates single-organ impairment
Adverse effects
- Bradycardiacommon & serious
- Fatigue, cold extremitiescommon
- Hypotensioncommon
Contraindications & precautions
Contraindications
- Severe bradycardia or high-grade AV block without a pacemaker
- Decompensated heart failure
Precautions
- Asthma at higher doses
- Abrupt discontinuation
Interactions
Monitoring
Heart rate and blood pressure
Titration endpoints
Weight and congestion symptoms in HF
Introduce and titrate only in a euvolemic patient
Counselling points
- Once daily, same time each day.
- Do not stop suddenly.
- Report dizziness or a very slow pulse.
Clinical pearls
- Its balanced renal-hepatic elimination makes it forgiving in single-organ dysfunction, a genuinely useful within-class difference.
References & review
- Bisoprolol product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-15 · jurisdiction: global · drug information changes; verify against current references before practice use.