Bisoprolol is a selective beta-1 adrenergic receptor blocker primarily used for cardiovascular conditions such as hypertension, heart failure, and angina. Below are its key clinical considerations:
1. Indications
- Hypertension (High Blood Pressure)
- Heart Failure (Chronic, Stable, with Reduced Ejection Fraction)
- Angina Pectoris (Stable Ischemic Heart Disease)
- Arrhythmias (e.g., Atrial Fibrillation, Ventricular Arrhythmias)
2. Contraindications
- Severe bradycardia (HR < 50 bpm)
- Cardiogenic shock
- Decompensated heart failure
- Severe hypotension (SBP < 90 mmHg)
- 2nd or 3rd-degree AV block (without pacemaker)
- Severe asthma or COPD (relative contraindication due to beta-blockade effect on bronchioles)
3. Precautions & Monitoring
- Bradycardia & Hypotension → Monitor HR and BP regularly
- Worsening Heart Failure → Watch for signs of decompensation (e.g., edema, dyspnea)
- Bronchospasm in Asthma/COPD → Although beta-1 selective, some beta-2 blockade can occur
- Diabetes → May mask hypoglycemia symptoms (except sweating)
- Peripheral Vascular Disease → Can worsen symptoms (e.g., Raynaud’s phenomenon)
- Thyroid Disease → May mask symptoms of hyperthyroidism (e.g., tachycardia)
4. Drug Interactions
- Other antihypertensives (e.g., ACE inhibitors, calcium channel blockers like verapamil/diltiazem) → Risk of excessive hypotension and bradycardia
- Digoxin → Increased risk of bradycardia
- Insulin & Oral Hypoglycemics → May blunt hypoglycemia symptoms
- NSAIDs → May reduce antihypertensive effect
- Amiodarone → Increased risk of bradycardia and heart block
5. Dosage Considerations
- Start low and titrate slowly, especially in heart failure (e.g., 1.25 mg daily, increased gradually to 10 mg max)
- If stopping, taper gradually to avoid rebound hypertension or ischemia
6. Side Effects
- Bradycardia & Hypotension
- Fatigue & Dizziness (common)
- Cold extremities (Raynaud’s-like symptoms)
- Worsening heart failure (if not titrated carefully)
- Erectile dysfunction
- Sleep disturbances (e.g., insomnia, vivid dreams)
- Depression & Mood Changes (rare but possible)
7. Special Populations
- Elderly → Start at a lower dose due to fall risk
- Pregnancy Category C → Use only if benefits outweigh risks
- Breastfeeding → Caution, as bisoprolol may be excreted in milk
- Renal/Hepatic Impairment → Dose adjustment may be needed