9 Bisoprolol Side Effects You Should Know About

Bisoprolol is a beta blocker that treats heart-related conditions, such as high blood pressure (hypertension) and heart failure. If you’re taking bisoprolol, it’s a good idea to know what side effects to keep an eye out for. Below, we’ll discuss nine bisoprolol side effects you should know about and what you can do about them.

Bisoprolol side effects at a glance

Beta blockers like bisoprolol are typically well-tolerated by most people taking them. Common side effects are usually mild and go away once your body adjusts to the medication. Below is a list of side effects reported by people taking bisoprolol in clinical trials.

Common side effects (5% or more in clinical trials):

• Fatigue

• Headache

• Cold symptoms

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Less common side effects (less than 5% in clinical trials):

• Slow heart rate

• Low blood pressure

• Nausea

• Diarrhea

• Sleep disturbances

• Sexual side effects

Let’s take a closer look at why some of these side effects happen, and what you can do about them.

1. Fatigue

You may notice increased fatigue (tiredness) while taking bisoprolol. This is one of the most common side effects of the medication. 

You can help manage fatigue by staying hydrated and eating a healthy, balanced diet. It’s also helpful to keep your body moving and active throughout the day to boost your energy levels. But only do what feels comfortable —- listen to your body and take rest breaks when you need to. 

Fatigue will likely subside over several weeks. But if it’s affecting your quality of life, let your healthcare provider know. You may need a lower bisoprolol dosage or a different medication. Your healthcare provider can help determine the cause of your fatigue and treat it appropriately.

2. Slow heart rate

Bisoprolol helps the heart pump slower and with less force. And sometimes, it can cause your heart rate to drop too low. You may not notice when this happens. But it can make you feel dizzy, weak, or have trouble catching your breath. You may also find exercising or walking up stairs harder than usual. 

It’s a good idea to avoid strenuous activities when you first start taking bisoprolol. Your body may need some time to adjust to the medication.

Let your healthcare provider know if you notice any symptoms of a slow heart rate while you’re taking bisoprolol. They may want to wait and see how your body adjusts. Or they may lower your bisoprolol dosage to help lessen your symptoms.

3. Low blood pressure

Bisoprolol can lower your blood pressure, which is often why you’re taking it. But sometimes it can make your blood pressure dip too low. This is called hypotension, and may make you feel dizzy, lightheaded, and have blurred vision. It’s more common in the first few weeks after starting bisoprolol and will often go away over time.

Sometimes, bisoprolol can cause a rapid drop in your blood pressure when you sit up or stand too quickly after lying down. This sudden drop in blood pressure is known as orthostatic hypotension. Make sure to move slowly when changing positions to avoid falling and injuring yourself if this happens while you’re taking bisoprolol.

If you notice worsening or persistent symptoms of low blood pressure, let your healthcare provider know. They may want you to start checking your blood pressure at home. If it’s dropping too low, they may need to adjust the dose of your medication.

4. Headache

Headache is another common side effect of bisoprolol. But in clinical studies, headaches were just as common in people taking a placebo (sugar pill). 

You can help prevent and manage mild headaches by staying hydrated, exercising, and avoiding common headache triggers, such as alcohol and processed meats. Meditation or other stress-management tools may also be helpful. 

If needed, you can turn to over-the-counter (OTC) medications for help. The safest option is usually acetaminophen (Tylenol). Check with your provider before taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) — they may raise your blood pressure. 

Severe and persistent headaches shouldn’t be ignored. They could be a sign of a more serious condition. If your headaches worsen or don’t improve, let your healthcare provider know.5

5. Cold symptoms

Upper respiratory infections (URIs) cause cold symptoms like a runny nose or painful sinuses. They were a common bisoprolol side effect reported in clinical trials. URIs usually aren’t serious and go away on their own after a few days.

Rest and steamy showers can often help with URI symptoms. OTC cold medications may also be helpful, if needed. But be aware that some cold medications can worsen high blood pressure and other heart conditions. So check with your pharmacist or healthcare provider to be sure you’re choosing an OTC option that’s safe for you.

If you develop a fever that doesn’t go away, or your symptoms last more than 7 to 10 days, let your provider know. They’ll want to make sure there isn’t a more serious cause for your symptoms.

6. Nausea

It’s not common, but bisoprolol can cause nausea for some people. Taking bisoprolol with food can help with this side effect. Other ways to help prevent and manage nausea include eating smaller meals throughout the day and avoiding spicy and fried foods. Hydration is also key.

If home remedies aren’t working, you can also try an OTC nausea medication such as bismuth subsalicylate (Pepto-Bismol). But these medications aren’t for long-term use. So, if your nausea doesn’t go away after a few days, let your healthcare provider know.

7. Diarrhea

Diarrhea is another possible bisoprolol side effect. Dehydration is a concern when this happens. To avoid this, make sure to drink plenty of water or beverages that contain electrolytes. Try to stick to a bland diet until your stomach can handle regular foods.

OTC diarrhea medications include loperamide (Imodium A-D) and bismuth subsalicylate (Pepto-Bismol). They may be a helpful short-term option. But If your diarrhea worsens, lasts more than 2 days, or you also have a fever, contact your healthcare provider right away. This could be a sign of a more serious problem.   

8. Trouble sleeping

Although not common, bisoprolol can make falling or staying asleep more difficult. You may also have stranger dreams than usual while you’re taking it.

Set yourself up for a successful night’s sleep by following these tips before bedtime:

• Avoid caffeinated beverages, such as coffee or tea.

• Limit your screen time, and try not to scroll through your phone.

• Engage in relaxing activities, like reading a book or taking a warm bath.

If you’re still having sleeping problems, discuss them with your healthcare provider. They may want you to do a sleep study to make sure there isn’t another cause. They may also be able to prescribe a short-term medication to help you sleep better.

9. Sexual side effects

Beta blockers are well known to cause erectile dysfunction (ED). But this isn’t isn't a common bisoprolol side effect. Other beta blockers, such as atenolol (Tenormin), are more likely to cause ED than bisoprolol. Keep in mind that both high blood pressure and heart disease are common causes of ED, too.

You may also notice a lowered sex drive after starting bisoprolol, but the research on this is mixed.

If you notice sexual side effects while taking bisoprolol, talk to your healthcare provider. There are several treatment options available for ED. Or a different heart medication may be a better option to reduce these side effects. Your healthcare provider can discuss the best way to improve your symptoms. 

When should I contact my healthcare provider about bisoprolol side effects?

Most bisoprolol side effects are generally mild and should resolve once your body adjusts to the medication. But if you’re having side effects that affect your quality of life, don’t hesitate to discuss them with your healthcare provider.

If any side effects worsen or feel severe, let your provider know right away. If you have chest pain with symptoms such as trouble breathing and dizziness, seek emergency care.

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Written by:

ThienLy Neal, PharmD

ThienLy Neal, PharmD, has over 10 years experience in the pharmacy field, including in such settings as retail, hospital, compounding, and managed care. She has led various clinical programs while focusing on medication adherence programs, specialty drug initiatives, and polypharmacy safety initiatives.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

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