Is Bisoprolol a Beta Blocker? A Pharmacist’s Answers to This and 4 More Bisoprolol FAQs

Bisoprolol fumarate, often referred to as simply bisoprolol, is a medication that treats high blood pressure and other heart-related conditions. If you’re taking bisoprolol or considering it, your healthcare team likely went over what side effects to expect and drug interactions to be aware of. But it’s common to have other questions, such as is bisoprolol a beta blocker? And how does it work to lower blood pressure? 

We have pharmacist-backed answers to five FAQs about bisoprolol.

1. Is bisoprolol a beta blocker?

Yes, bisoprolol is a beta blocker. Beta blockers are used to treat high blood pressure, heart failure, and other heart-related conditions. There are two main types of beta blockers: selective and nonselective.

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Bisoprolol is a selective beta-1 blocker. This means it primarily targets beta receptors (binding sites) on the heart. Other selective beta blockers include metoprolol (Lopressor, Toprol XL) and atenolol (Tenormin).

In contrast, nonselective beta blockers bind to beta receptors in other areas of the body. This includes the lungs and blood vessels as well as the heart. Carvedilol (Coreg, Coreg CR) and propranolol (Inderal LA, Innpran XL) are examples of nonselective beta blockers.

2. What is bisoprolol used for?

Bisoprolol is mainly used for heart-related conditions because it targets beta receptors on the heart. It’s only FDA approved to treat high blood pressure (hypertension). But bisoprolol and other beta blockers typically aren’t a first-choice treatment option.

Bisoprolol is also prescribed off-label for other heart-related conditions. Studies have shown that it’s an effective treatment for heart failure and irregular heartbeats (arrhythmias). Bisoprolol can also help prevent chest pain and heart attacks caused by coronary artery disease (CAD).

3. How does bisoprolol work?

In general, beta blockers work by preventing a hormone called epinephrine from activating beta receptors. Epinephrine, also called adrenaline, is considered a “fight or flight” hormone. It makes your heart beat faster and harder when it activates beta receptors.

Bisoprolol and other selective beta blockers work specifically on the beta receptors on the heart. They act like a roadblock, preventing epinephrine from affecting your heart. This slows down your heartbeat and also makes it beat with less force. As a result, your blood pressure lowers and your heartbeat becomes more regular.

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Bisoprolol helps manage heart failure by giving the heart more time to fill with blood between beats, allowing it to pump more efficiently.

Good to know: Bisoprolol starts to lose selectivity for beta receptors at doses of 20 mg per day or higher. This can raise the risk of side effects, such as severely low blood pressure or worsening of asthma symptoms. It’s best to take the lowest effective bisoprolol dosage to help retain its selective effects and minimize side effects.

4. How long does it take for bisoprolol to start working?

Bisoprolol starts to work soon after you start taking it. It takes about 2 to 4 hours for it to reach peak levels in your body after your first dose. And the medication levels will remain stable after about 5 days of treatment.

In most cases, you’ll start taking a low dose of bisoprolol and increase it as needed based on your response. So it may take some time to find the bisoprolol dosage that works best for you. Your prescriber may have you check your blood pressure at home during this time.

It may feel frustrating to follow this dosing regimen. But keep in mind that this approach also helps reduce the chance of side effects. So it’s usually worth the extra time it takes.

5. Are there alternatives to bisoprolol?

Yes, there are alternative treatments if you’re unable to take bisoprolol or it doesn’t work well for your symptoms. First, your prescriber may have you try a different beta blocker, such as a nonselective option, to see if you tolerate it better. Outside of other beta blockers, the typical bisoprolol alternatives depend on what health condition you’re treating.

High blood pressure 

As mentioned, bisoprolol and other beta blockers aren’t considered first-choice medications for high blood pressure. Alternative treatment options include:

• Lifestyle changes, such as weight loss, regular aerobic exercise, and cutting down on alcohol

• Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Zestril, Qbrelis)

• Antiotensin II receptor blockers (ARBs), such as losartan (Cozaar)

• Diuretics (“water pills”), such as hydrochlorothiazide

Heart failure

Bisoprolol alternatives for heart failure are largely the same as for high blood pressure. Some additional options include:

• Watching your fluid intake

• Digoxin

• Vasodilators, such as isosorbide dinitrate (Imdur)

Coronary artery disease

Beta blockers are a mainstay when it comes to CAD treatment. If they aren’t an option, other CAD medications include:

• Calcium channel blockers, such as diltiazem (Cardizem)

• Ranolazine (Ranexa)

• Antiplatelet medications, such as clopidrogrel (Plavix)

• Statins, such as atorvastatin (Lipitor)

How to save on bisoprolol

There are ways to save on bisoprolol, which is only available as a lower-cost generic. Zebeta, the brand name version of bisoprolol, is no longer manufactured. GoodRx can help you save over 40% off the cost of generic bisoprolol. The cost of a 30-day supply of bisoprolol is as low as $9.00 at certain pharmacies with a free GoodRx discount.

Why trust our experts?

Written by:

Patricia Weiser, PharmD

Patricia has 16 years of pharmacist experience. She previously held positions as a community pharmacist, pharmacy manager, and hospital pharmacist.

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:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit (NICU) at Hassenfeld Children’s Hospital in New York City. His favorite part of the job is working with preterm newborns because they are strong and mighty despite their size.

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