bisoprolol fumarate

(bis oh' pro lole)

Zebeta

Pregnancy Category C

Drug classes
Beta-selective adrenergic blocking agent
Antihypertensive

Therapeutic actions
Blocks beta-adrenergic receptors of the sympathetic nervous system in the heart and
juxtaglomerular apparatus (kidney), thus decreasing the excitability of the heart,
decreasing cardiac output and oxygen consumption, decreasing the release of renin from
the kidney, and lowering blood pressure.

Indications
• Management of hypertension, used alone or with other antihypertensive agents

Contraindications and cautions

• Contraindicated with sinus bradycardia, second- or third-degree heart block,
cardiogenic shock, CHF.
• Use cautiously with renal failure, diabetes or thyrotoxicosis (bisoprolol can mask
the usual cardiac signs of hypoglycemia and thyrotoxicosis), pregnancy, lactation,
and in those with bronchospastic disease.

Available forms
Tablets—5, 10 mg
Dosages
ADULTS
Initially, 5 mg PO daily, alone or added to diuretic therapy; 2.5 mg may be appropriate;
up to 20 mg PO daily has been used.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
Initially, 2.5 mg PO; adjust, and use extreme caution.

Pharmacokinetics
Route Onset Peak Duration
Oral 30–60 min 2 hr 12–15 hr

Metabolism: Hepatic; T1/2: 9–12 hr

Distribution: Crosses placenta; may enter breast milk
Excretion: Urine

Adverse effects
 • Allergic reactions: Pharyngitis, erythematous rash, fever, sore throat,
laryngospasm, respiratory distress
• CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias,
sleep disturbances, hallucinations, disorientation, memory loss, slurred speech
• CV: Bradycardia, CHF, cardiac arrhythmias, sinoatrial or AV nodal block,
tachycardia, peripheral vascular insufficiency, claudication, CVA, pulmonary
edema, hypotension
• Dermatologic: Rash, pruritus, sweating, dry skin
• EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision
• GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia,
ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis,
hepatomegaly, acute pancreatitis
• GU: Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequent
urination
• Musculoskeletal: Joint pain, arthralgia, muscle cramp
• Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal
stuffiness, rhinitis, pharyngitis (less likely than with propranolol)
• Other: Decreased exercise tolerance, development of antinuclear antibodies,
hyperglycemia or hypoglycemia, elevated serum transaminase, alkaline
phosphatase, and LDH

Interactions
Drug-drug
• Increased effects with verapamil, anticholinergics
• Increased risk of orthostatic hypotension with prazosin
• Possible increased BP-lowering effects with aspirin, bismuth subsalicylate,
magnesium salicylate, sulfinpyrazone, hormonal contraceptives
• Decreased antihypertensive effects with NSAIDs
• Possible increased hypoglycemic effect of insulin
Drug-lab test
• Possible false results with glucose or insulin tolerance tests

Nursing considerations
CLINICAL ALERT!
Name confusion has occurred between Zebeta (bisoprolol) and DiaBeta
(glyburide); use caution.

Assessment
• History: Sinus bradycardia, cardiac arrhythmias, cardiogenic shock, CHF, renal
failure, diabetes or thyrotoxicosis, pregnancy, lactation
• Physical: Baseline weight, skin condition, neurologic status, P, BP, ECG, R,
kidney and liver function tests, blood and urine glucose

Interventions
 • Do not discontinue drug abruptly after long-term therapy (hypersensitivity to
catecholamines may have developed, causing exacerbation of angina, MI, and
ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring.
• Consult with physician about withdrawing drug if patient is to undergo surgery
(withdrawal is controversial).

Teaching points
• Do not stop taking this drug unless instructed to do so by a health care provider.
• Avoid over-the-counter medications.
• Avoid driving or dangerous activities if dizziness, weakness occur.
• These side effects may occur: Dizziness, light-headedness, loss of appetite,
nightmares, depression, sexual impotence.
• Report difficulty breathing, night cough, swelling of extremities, slow pulse,
confusion, depression, rash, fever, sore throat.

Adverse effects in Italic are most common; those in Bold are life-threatening.