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Bisoprolol

Prescription ·Strong evidence ·Reviewed May 2026

Bisoprolol is a highly cardioselective beta-1 blocker with proven mortality reduction in heart failure from the CIBIS-II trial. It has the highest beta-1 selectivity among available beta-blockers, making it better tolerated in patients with mild airway disease.

Evidence tier
Strong
Indexed sources
10 2013–2026
Interactions
2
Depletes
1 nutrient
Read the sources → Compare profiles
What it's good for
  • Reduces mortality in heart failure (CIBIS-II trial)7,6
  • Highest beta-1 selectivity among beta-blockers4,5
  • Effective blood pressure and rate control8
  • Once-daily dosing
What to watch for
  • Bradycardia
  • Fatigue
  • Dizziness
  • Severe sinus bradycardia
  • Second- or third-degree heart block without pacemaker7

The bottom line

Evidence rating strong. Most-documented uses: reduces mortality in heart failure (cibis-ii trial), highest beta-1 selectivity among beta-blockers, effective blood pressure and rate control. 10 sources indexed (2013–2026), with 2 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Highly selective beta-1 adrenergic receptor antagonist. Reduces heart rate, myocardial contractility, and cardiac output. Decreases renin release. Highest beta-1/beta-2 selectivity ratio among clinically available beta-blockers (~75:1), reducing risk of bronchospasm and metabolic side effects.4,5

Class
Beta-1 Selective Adrenergic Blocker
Dosing

Dosing & protocol.

Common range
1.25–20 mg once daily (heart failure: start 1.25 mg, target 10 mg; hypertension: 2.5–20 mg) (as prescribed by your physician)
Recommended form
Oral tablet

Can be taken with or without food; approximately 80% bioavailability; minimal first-pass metabolism1

Depletions

What it depletes.

Nutrients this medication can lower over time, and what to replace.

CoQ10

Mild

Chronic beta-blocker therapy has been associated with lower tissue CoQ10 status and reduced mitochondrial electron transport support.

Replace Coenzyme Q10Monitor Plasma CoQ10Onset Usually over months of chronic use
Safety

Full safety detail.

Side effects

  • Bradycardia
  • Fatigue
  • Dizziness
  • Headache
  • Cold extremities
  • Diarrhea
  • Nausea

Contraindications

  • Severe sinus bradycardia
  • Second- or third-degree heart block without pacemaker7
  • Cardiogenic shock
  • Decompensated heart failure7
  • Severe asthma or COPD
Interactions

Interaction records.

InfoSynergy

Melatonin

Beta-1 selective blockers like bisoprolol moderately suppress melatonin. Supplementation can help with sleep disturbance.

Recommendation: Low-dose melatonin (0.5-1mg) at bedtime if experiencing insomnia on bisoprolol.

InfoSynergy

Coenzyme Q10

Beta-blockers as a class inhibit mitochondrial CoQ10-dependent enzymes, contributing to fatigue and reduced exercise tolerance. CoQ10 100-200 mg/day can restore enzyme activity and may slightly lower blood pressure, complementing bisoprolol's effects in heart failure or hypertension.

Recommendation: Consider CoQ10 100-200 mg/day with food if you experience fatigue or exercise intolerance on bisoprolol. Monitor blood pressure since CoQ10 can produce a small additional drop.

Search all 2 interaction records for Bisoprolol →

Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Meta-analyses & systematic reviews

4

Randomized controlled trials

1

Reference material

5
Keep exploring

Deep dives & adjacent profiles.

Goal hubHeart & Cardiovascular
MetoprololPrescriptionCarvedilolPrescriptionValsartanPrescriptionSpironolactonePrescriptionSacubitril/ValsartanPrescriptionRamiprilPrescription

This page is educational. Do not start, stop, or change a supplement or medication based on it without checking with a qualified healthcare professional.

Use this with your stack

Bisoprolol in NutriStack.

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NutriStack is an informational and organizational tool, not a medical service, and not a substitute for professional advice. Always consult a qualified healthcare professional before starting, stopping, or changing any supplement or medication.