From the Guidelines
The starting dose of bisoprolol should be 1.25 mg once daily, as recommended by the ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult 1.
Key Considerations
- This dose is specifically recommended for patients with heart failure with low ejection fraction.
- The medication should be taken at the same time each day, preferably in the morning, with or without food.
- Dosage adjustments should be made at intervals of at least 2 weeks to allow the full effect of each dose to be assessed.
Patient Factors to Consider
- For patients with renal or hepatic impairment, starting with the lower 1.25 mg dose is advisable.
- The gradual titration approach minimizes side effects such as dizziness, fatigue, and bradycardia that can occur when starting beta-blocker therapy.
Mechanism of Action
- Bisoprolol works by blocking beta-1 adrenergic receptors primarily in the heart, reducing heart rate and contractility, which lowers blood pressure and decreases cardiac workload.
- This makes it effective for treating hypertension, angina, and heart failure, as outlined in the ACC/AHA guidelines 1.
From the FDA Drug Label
The usual starting dose is 5 mg once daily. In some patients, 2. 5 mg may be an appropriate starting dose
- The starting dose of bisoprolol is 5 mg once daily.
- In some patients, a starting dose of 2.5 mg may be appropriate, such as those with bronchospastic disease or hepatic/renal impairment 2.
From the Research
Starting Dose of Bisoprolol
The starting dose of bisoprolol can vary depending on the patient's condition and the specific use of the medication.
- For patients with essential hypertension, the starting dose of bisoprolol can be 5 mg once daily, as shown in a dose-ranging study with parallel groups 3.
- The study found that bisoprolol had antihypertensive and beta-blocking properties both at rest and during exercise, and the 20 mg dosage regimen was more effective than that of 5 mg and 10 mg 3.
- Another study found that bisoprolol, at doses ranging from 5-20 mg, was effective in reducing blood pressure in patients with mild to moderate hypertension, with mean reductions from baseline diastolic blood pressure of 6.3,8.8, and 10.1 mmHg for patients receiving bisoprolol 5,10, and 20 mg, respectively 4.
Dose-Related Effects
The antihypertensive effects of bisoprolol are dose-related, with higher doses resulting in greater reductions in blood pressure.
- A study found that near maximal antihypertensive effects were achieved within 1 week of initiation of therapy with bisoprolol and were sustained over the course of the trial 4.
- The response rates for bisoprolol-treated patients ranged from 47 to 70% compared with 18% for patients on placebo, indicating a significant dose-related effect 4.
Comparison with Other Beta-Blockers
Bisoprolol has been compared with other beta-blockers, such as carvedilol and metoprolol succinate, in various studies.
- One study found that bisoprolol and carvedilol were both associated with lower mortality as compared with metoprolol succinate in patients with chronic heart failure 5.
- Another study found that the three beta-blockers investigated (bisoprolol, carvedilol, and metoprolol succinate) had similar effects on mortality amongst patients with chronic heart failure 5.