Adults

Hypertension/Angina: Initially 5 mg once daily, adjusted to 10 mg once daily if needed. Maximum 20 mg once daily. Chronic heart failure: Individualized, initial dose 1.25 mg once daily, titrated gradually up to a maximum of 10 mg once daily.

Elderly

No specific dose adjustment required unless there is severe renal or hepatic impairment. Start with the lowest effective dose.

Renal_impairment

For severe renal impairment (creatinine clearance < 20 ml/min), the initial dose should be 2.5 mg daily, and caution should be exercised. Maximum 10 mg daily.

Onset

Within 2-4 hours

Excretion

Approximately 50% excreted unchanged in urine, and the remaining 50% as inactive metabolites via urine and bile.

Half life

Approximately 10-12 hours

Absorption

Well absorbed from the gastrointestinal tract, with an oral bioavailability of approximately 80-90%. Peak plasma concentrations are reached within 2-4 hours.

Metabolism

Approximately 50% metabolized in the liver to inactive metabolites. The remaining 50% is excreted unchanged.

Clonidine

Increased risk of rebound hypertension if clonidine is withdrawn abruptly while bisoprolol is continued.

Insulin and oral antidiabetics

Beta-blockers may mask symptoms of hypoglycemia (e.g., tachycardia).

Digitalis glycosides (e.g., digoxin)

Increased risk of bradycardia and AV block.

NSAIDs (Nonsteroidal anti-inflammatory drugs)

May reduce the hypotensive effect of bisoprolol.

Calcium channel blockers (e.g., verapamil, diltiazem)

Increased risk of hypotension, bradycardia, and AV conduction disturbances.

Other antihypertensives (e.g., ACE inhibitors, diuretics)

Enhanced hypotensive effect.