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Pharmacologic class: Beta1-adrenergic blocker
Therapeutic class: Antihypertensive
Pregnancy risk category C
Blocks beta1-adrenergic receptors of sympathetic nervous system in heart and kidney, thereby decreasing myocardial excitability, myocardial oxygen consumption, cardiac output, and renin release from kidney. Also lowers blood pressure without affecting beta2-adrenergic (pulmonary, vascular, and uterine) receptor sites.
Tablets: 5 mg, 10 mg
Indications and dosages
Adults: Initially, 2.5 to 5 mg P.O. daily. Dosages up to 20 mg P.O. daily have been used.
• Renal or hepatic impairment
• Hypersensitivity to drug
• Sinus bradycardia
• Second- or third-degree heart block
• Cardiogenic shock
• Heart failure
• Children (safety and efficacy not established)
Use cautiously in:
• renal or hepatic impairment, pulmonary disease, asthma, diabetes mellitus, thyrotoxicosis, peripheral vascular disease
• patients undergoing anesthesia or major surgery
• elderly patients
• pregnant or breastfeeding patients.
• Give with or without food, but be consistent to minimize variations in absorption.
• Be aware that drug may be given alone or added to diuretic therapy.
CNS: dizziness, depression, paresthesia, sleep disturbances, hallucinations, memory loss, slurred speech
CV: bradycardia, peripheral vascular insufficiency, claudication, hypotension, sinoatrial or atrioventricular (AV) node block, second- or third-degree heart block, heart failure, pulmonary edema, cerebrovascular accident, arrhythmias
EENT: blurred vision, dry eyes, conjunctivitis, tinnitus, rhinitis, pharyngitis
GI: nausea, vomiting, diarrhea, constipation, gastric pain, gastritis, flatulence, anorexia, ischemic colitis, acute pancreatitis, renal and mesenteric arterial thrombosis
GU: dysuria, polyuria, nocturia, erectile dysfunction, Peyronie's disease, decreased libido
Hematologic: eosinophilia, agranulocytosis, thrombocytopenia
Metabolic: hyperglycemia, hypoglycemia
Musculoskeletal: arthralgia, muscle cramps
Respiratory: dyspnea, cough, bronchial obstruction, bronchospasm
Skin: rash, purpura, pruritus, dry skin, excessive sweating
Drug-drug. Amphetamines, ephedrine, epinephrine, norepinephrine, phenylephrine, pseudoephedrine: unopposed alpha-adrenergic stimulation
Antihypertensives: increased hypotension
Digoxin: additive bradycardia
Dobutamine, dopamine: decrease in beneficial beta1-adrenergic cardiovascular effects
General anesthetics, I.V. phenytoin, verapamil: additive myocardial depression
MAO inhibitors: hypertension (when taken within 14 days of bisoprolol)
Nonsteroidal anti-inflammatory drugs: decreased antihypertensive effect
Thyroid preparations: decreased bisoprolol efficacy
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, glucose, low-density lipoproteins,
potassium, uric acid: increased levels
Antinuclear antibodies: increased titers
Insulin tolerance test: test interference
Drug-behaviors. Acute alcohol ingestion: additive hypotension
Cocaine use: unopposed alpha-adrenergic stimulation
• Closely monitor blood glucose levels in diabetic patients.
• Assess for signs and symptoms of heart failure, including weight gain.
• Stay alert for blood pressure variations. Low blood pressure may indicate overdose.
• Tell patient to weigh himself daily at same time and to report gain of 3 to 4 lb/day.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from blood pressure decrease.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to restrict salt intake to help avoid fluid retention.
• Caution patient not to discontinue drug abruptly unless prescriber approves.
• Tell patient to carry medical identification stating that he's taking a beta blocker.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.
Pharmacologic: beta blockers
Time/action profile (antihypertensive effect)
|PO||unknown||1–4 hr||24 hr|
Adverse Reactions/Side Effects
Central nervous system
- fatigue (most frequent)
- weakness (most frequent)
- memory loss
- mental status changes
Ear, Eye, Nose, Throat
- blurred vision
- stuffy nose
- bradycardia (life-threatening)
- HF (life-threatening)
- pulmonary edema (life-threatening)
- peripheral vasoconstriction
- ↑ liver function tests
- erectile dysfunction (most frequent)
- ↓ libido
- urinary frequency
- back pain
- joint pain
- drug-induced lupus syndrome
Drug-Drug interactionGeneral anesthetics, IV phenytoin, and verapamil may cause additive myocardial depression.Additive bradycardia may occur with digoxin, diltiazem, verapamil, or clonidine.Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates.Concurrent use with amphetamine, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).Concurrent thyroid preparation administration may ↓ effectiveness.May alter the effectiveness of insulins or oral hypoglycemic agents (dose adjustments may be necessary).May ↓ the effectiveness of theophylline.May ↓ the beta1-cardiovascular effects of dopamine or dobutamine.Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension).
Hepatic ImpairmentOral (Adults) CCr <40 mL/min—Initiate therapy with 2.5 mg/day, titrate cautiously.
Availability (generic available)
- Monitor BP, ECG, and pulse frequently during dosage adjustment period and periodically throughout therapy.
- Monitor intake and output ratios and daily weights. Assess routinely for signs and symptoms of HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention).
- Monitor frequency of prescription refills to determine adherence.
- Lab Test Considerations: May cause increased BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
- May cause increased ANA titers.
- May cause increase in blood glucose levels.
Potential Nursing DiagnosesDecreased cardiac output (Side Effects)
Noncompliance (Patient/Family Teaching)
- Do not confuse Zebeta with Diabeta or Zetia.
- Oral: Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify physician or other health care professional.
- May be administered without regard to meals.
- Instruct patient to take medication exactly as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. If a dose is missed, it should be taken as soon as possible up to 4 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia.
- Teach patient and family how to check pulse and BP. Instruct them to check pulse daily and BP biweekly and to report significant changes to health care professional.
- May cause drowsiness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
- Advise patients to change positions slowly to minimize orthostatic hypotension.
- Caution patient that this medication may increase sensitivity to cold.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any Rx, OTC, or herbal products, especially cold preparations, concurrently with this medication. Patients on antihypertensive therapy should also avoid excessive amounts of coffee, tea, and cola.
- Diabetics should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication does not block dizziness or sweating as signs of hypoglycemia.
- Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
- Instruct patient to inform health care professional of medication regimen before treatment or surgery.
- Advise patient to carry identification describing disease process and medication regimen at all times.
- Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension.
- Decrease in BP.
bisoprololA selective beta-1-blocker used to manage hypertension and cardiac ischaemia, blocking the G protein and cAMP-signalling cascade, reducing cardiac contractility and heart rate.
Fatigue, hypotension, hypoglycaemia, bronchospasm, bradycardia.