Bisoprolol Oral: Dosing, Titration, and Precautions
Bisoprolol guidance for hypertension, angina, and stable heart failure, including gradual titration and abrupt-stop warning.
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Source reviewed
source date listed on the source page
Guide category
Oral drugs
Safety boundary
Prescription medicine information for clinician-guided use.
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Therapeutic action
Cardioselective beta-blocker.
Indications
- Hypertension and treatment of chronic stable angina pectoris.
- Chronic stable heart failure in combination with a converting enzyme inhibitor such as enalapril.
Forms and strengths
- 2.5 mg breakable tablet.
- 10 mg breakable into 1/4 tablet.
Dose
| Weeks | Daily dose | Tablet(s) |
|---|---|---|
| Week 1 | 1.25 mg once daily | 2.5 mg tab: ½ tab daily |
| Week 2 | 2.5 mg once daily | 2.5 mg tab: 1 tab daily or 10 mg tab: ¼ tab daily |
| Week 3 | 3.75 mg once daily | 2.5 mg tab: 1½ tab daily |
| Week 4 to 8 | 5 mg once daily | 10 mg tab: ½ tab daily |
| Week 9 to 12 | 7.5 mg once daily | 2.5 mg tab: 1 tab daily + 10 mg tab: ½ tab daily or 10 mg tab: ¾ tab daily |
| From week 13 | 10 mg once daily (max. 10 mg daily) | 10 mg tab: 1 tab daily |
Hypertension, angina pectoris
- Adult: 5 to 10 mg once daily, preferably in the morning, maximum 20 mg daily.
- In patients with renal or hepatic impairment: start with 2.5 mg once daily then increase, if necessary, according to clinical response, maximum 10 mg daily.
Heart failure
- Adult: start with 1.25 mg once daily and increase according to tolerance.
- Week 1: 1.25 mg once daily, 1/2 of a 2.5 mg tablet daily.
- Week 2: 2.5 mg once daily, 1 tablet of 2.5 mg daily or 1/4 of a 10 mg tablet daily.
- Week 3: 3.75 mg once daily, 1 1/2 tablets of 2.5 mg daily.
- Week 4 to 8: 5 mg once daily, 1/2 of a 10 mg tablet daily.
- Week 9 to 12: 7.5 mg once daily, 1 tablet of 2.5 mg plus 1/2 of a 10 mg tablet daily, or 3/4 of a 10 mg tablet daily.
- From week 13: 10 mg once daily, maximum 10 mg daily.
Duration
According to clinical response. Do not stop treatment abruptly; decrease doses gradually.
Contra-indications, adverse effects, precautions
- Do not administer to patients with asthma, chronic obstructive bronchopneumonia, acute heart failure, severe hypotension, bradycardia under 50 per minute, atrio-ventricular heart blocks, or Raynaud's syndrome.
- May cause bradycardia, hypotension, and worsening of heart failure; reduce dose if needed.
- May cause bronchospasm in patients with obstructive respiratory disease.
- May cause hypoglycaemia, gastrointestinal disturbances, headache, fatigue, muscle weakness, and erectile dysfunction.
- Administer with caution to patients with diabetes because of the risk of hypoglycaemia.
- In the event of anaphylactic shock, there is a risk of resistance to epinephrine.
- Avoid or monitor combination with mefloquine, digoxin, amiodarone, diltiazem, or verapamil because of the risk of bradycardia.
- Avoid or monitor combination with tricyclic antidepressants, antipsychotics, or anti-hypertensive drugs because of the risk of hypotension.
- Pregnancy and breast-feeding: use labetalol, particularly for the management of hypertension in pregnancy.
Source
MSF Essential drugs practical guidelines (January 2026)
This page combines source-derived medicine reference sections with Kenza editorial context, while leaving out the Storage and Remarks sections from the source batch.
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