Combat high blood pressure with Bisprolol (generic Zebeta)

Bisoprolol is a popular high blood pressure medication that can also be prescribed to treat chest pain and atrial fibrillation. 

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Reviewed by Dr Roy Kedem, MD

Information last reviewed 10/17/19


What is Bisoprolol?

Bisoprolol, available at Medzino under the brand name Zebeta, is in a class of medications known as beta-blockers (beta-adrenergic receptor blocking agents).  Beta-blockers can be used to lower blood pressure, control the heart rate and rhythm, and to improve the symptoms of heart failure. Doctors at Medzino may prescribe Bisoprolol for the treatment of high blood pressure in suitable patients.

How does Bisoprolol work?

Bisoprolol, available at Medzino under the brand name Zebeta, belongs to a class of drugs called beta-blockers. Beta-blockers work by blocking the effect of the hormone epinephrine, also known as adrenaline.  Epinephrine acts to constrict blood vessels, increase the heart rate, and increase the force at which the heart contracts. Opposing the action of epinephrine helps dilate blood vessels, lower blood pressure and reduce the strain on the heart.

What are beta-blockers?

Bisoprolol belongs to a class of drugs called beta-blockers. Beta-blockers work by blocking the effect of certain natural chemicals in your body like the hormone epinephrine, also known as adrenaline, and helping blood vessels open up to improve blood flow. This helps your heart to beat more slowly and with less force, which lowers your blood pressure and strain on the heart. Some medicines may interfere with the effects of Bisoprolol, therefore always tell your doctor if you are taking the following drugs: other medicines for high blood pressure, certain antidepressants, drugs called nitrates (for chest pain), Baclofen (muscle relaxant), Tamsulosin, Co-Careldopa and Levodopa (medicines for Parkinson’s disease), non-steroidal anti-inflammatory drugs such as Ibuprofen, steroids like Prednisolone, medicines for diabetes, medicines for allergies such as Ephedrine, Noradrenaline or Adrenaline, or medicines for asthma. If you are pregnant, inform your doctor as taking Bisoprolol during pregnancy may harm the baby.  It is unknown whether Bisoprolol passes into human breast milk, therefore breastfeeding is not recommended while taking the medicine.

How effective is Bisoprolol?

Bisoprolol is effective in reducing blood pressure for up to 24 hours after an oral dose. For patients with impaired kidney function, the effect of bisoprolol can last up to 72 hours, 3 times longer than the normal period. Blood pressure usually returns to its baseline within two weeks of reducing or stopping Bisoprolol.

How long does Bisoprolol take to work?

After an oral dose, Bisoprolol can take between 2 to 4 hours to absorb into the bloodstream and lower blood pressure. It may take anywhere from 1 to 6 weeks before the medication’s full effects on blood pressure and heart rate are evident.  You may not feel any different while taking Bisoprolol; however, this is not an indication that the medication is not working, and it is important that you continue to take it as prescribed by your doctor.   

What does Bisoprolol treat?

Bisoprolol is used with or without other medications to treat high blood pressure (hypertension), which can help prevent strokes, heart attacks and kidney problems. Bisoprolol can also be used to prevent chest pain caused by poor blood flow to the heart (angina), and to treat atrial fibrillation, which causes an irregular and/or abnormally fast heart rate. 


Active ingredients

The active ingredient in Bisoprolol is bisoprolol fumarate. Each 5mg tablet contains 5mg of bisoprolol fumarate and each 10mg tablet contains 10mg of bisoprolol fumarate.

Inactive ingredients

Bisoprolol contains the following inactive ingredients: Colloidal Silicon Dioxide, Corn Starch, Crospovidone, Dibasic Calcium Phosphate, Hypromellose, Magnesium Stearate, Microcrystalline Cellulose, Polyethylene Glycol, Polysorbate 80, and Titanium Dioxide. Please note that different manufacturers of generic medications may contain different inactive ingredients to those listed here.

Which ingredients can cause an allergic reaction?

In rare cases, Bisoprolol may cause a severe allergic reaction. Signs and symptoms of a severe allergic reaction include wheezing, trouble breathing/talking, a rash and chest tightness. If you experience a severe allergic reaction after taking the medication, you might need immediate hospital treatment. It is imperative you call emergency medical services or go to your local emergency department if you notice any of the signs after taking Bisoprolol. 


Bisoprolol dosage

Bisoprolol is available at a concentration of 5mg and 10mg. The appropriate dosage will be determined by your doctor based on your medical condition and how well you tolerate or respond to the medication.

To treat high blood pressure, your doctor may initially prescribe you 2.5-5mg once daily.  The maximum recommended dosage is 20mg.  Never exceed the dosage that your doctor has prescribed you and always take the medicine as prescribed.

How to take Bisoprolol

Take Bisoprolol orally with a glass of water, with or without food.  For the treatment of high blood pressure, it may take time until you get the full effects of Bisoprolol. It is important, therefore, that you do not interrupt your treatment and that you continue to take the medicine regularly. Take the medicine at the same time each day to help avoid missing a dose. 

How do I stop taking Bisoprolol?

Treatment with Bisoprolol is usually long-term, with many users taking it for the rest of their lives. However, if for any reason, you decide to discontinue the medication, you must consult your doctor first. Stopping Bisoprolol abruptly can make your blood pressure rise rapidly, which can induce a heart attack or stroke. Your doctor will gradually decrease your dose before stopping it completely to avoid such issues from occurring. It usually takes around 2 to 3 days for the body to fully expel the drug.

What if I take too much Bisoprolol?

The amount of Bisoprolol that can lead to an overdose varies from person to person. Symptoms of an overdose include a slow heart rate, difficulty breathing, dizziness and trembling. If you have taken too much Bisoprolol, contact your doctor immediately.

What should I do if I forget to take a dose of Bisoprolol?

In case you forget your daily dose, take it as soon as you remember. Do not take two doses to make up for the one you forgot. If you only remember to take your dose the next day, leave out the forgotten dose and take the next dose as usual.

Side Effects

Bisoprolol side effects

Get immediate medical help if you experience an allergic reaction to Bisoprolol. Symptoms of an allergic reaction include: rash, itching and/or swelling of face/tongue/throat, severe dizziness, trouble breathing.

Common side effects include:

  • Feeling dizzy
  • Feeling sleepy
  • Feeling light-headed
  • Nausea (feeling sick)
  • Vomiting (being sick)
  • Diarrhea
  • Constipation
  • Headache
  • Cold fingers or toes
  • Trouble sleeping (insomnia)
  • Slow heartbeat

To lower the risk of dizziness and light-headedness, get up slowly when you rise from a sitting or lying position. Bisoprolol may reduce blood flow to your hands and feet, causing them to feel cold.  Dressing warmly and avoiding smoking can help improve these symptoms. If symptoms or side effects persist, worsen or cause any distress, talk to your doctor or pharmacist.

In rare cases, severe side effects may occur. Tell your doctor as soon as possible if you experience the following rare side effects:

  • Very slow heartbeat
  • Fainting
  • Blue fingers or toes
  • Severe dizziness
  • Severe tiredness
  • Difficulty breathing
  • Shortness of breath with a cough that worsens when you exercise (may be a sign of heart problem)
  • Chest pain (may be a sign of heart problem)
  • Swelling ankles and feet (may be a sign of heart problem)
  • Irregular heartbeat (may be a sign of heart problem)
  • Shortness of breath, wheezing and tightening of the chest (may be signs of lung problems)
  • Yellow skin or yellow eyes (may be a sign of liver problems)
  • Mood changes such as confusion, mood swings and depression
  • Unexplained or sudden weight gain


Before using Bisoprolol, always inform your doctor if:

  • Your are pregnant or breastfeeding
  • You have diabetes
  • You have asthma or any other lung conditions
  • You have liver problems
  • You have kidney problems
  • You have poor circulation or low blood pressure
  • You suffer from psoriasis
  • You suffer from myasthenia gravis (condition causing muscle weakness)
  • You have a slow heartbeat or heart block (a slow and irregular heartbeat
  • You have chest pain caused by a condition known as Prinzmetal’s angina
  • You are taking other medicines with or without prescription, herbal or complementary medicines
  • You have ever had an allergic reaction to a medicine before, or if you have ever had a serious allergic reaction


Bisoprolol is contraindicated in the following cases:

  • Patients in cardiogenic shock (when your heart suddenly can’t pump enough blood to meet your body’s needs)
  • Overt heart failure
  • Second or third degree heart block (abnormal heart rhythm due to a defect in the cardiac conduction system)
  • Marked sinus bradycardia (regular but unusually slow heartbeat like 50 beats/minute or less)
  • Anuria (when kidney can’t produce urine)
  • Hypersensitivity (allergy) to any of the ingredients in this drug or to other sulfonamide-derived drugs

Drug interactions

Some medicines may interfere with the effects of Bisoprolol. Always inform your doctor if you are taking the following drugs: other medicines for high blood pressure, certain antidepressants, drugs called nitrates (for chest pain), baclofen (muscle relaxant), Tamsulosin, Co-Careldopa and Levodopa (medicines for Parkinson’s disease), non-steroidal anti-inflammatory drugs such as Ibuprofen, steroids like prednisolone, medicines for diabetes, medicines for allergies such as ephedrine, noradrenaline or adrenaline, or medicines for asthma.


Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

  1. Mayo Clinic, ‘Beta blockers’, [website], 9 January 2019,  [last accessed 1 April 2019]
  2. WebMD, ‘Bisoprolol Fumarate’, [website], [last accessed 1 April 2019]
  3. Patient, ‘Bisoprolol-a beta-blocker’, [website], 26 March 2019, [last accessed 1 April 2019]
  4. FDA, ‘Ziac (Bisoprolol Fumarate and Hydrochlorothiazide) Tablets’, March 2011, [last accessed 1 April 2019]
  5. NHS, ‘Bisoprolol’, [website], 13 December 2018, [last accessed 1 April 2019]

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