Bisoprolol

Bisoprolol
Clinical data
Trade names Concor
AHFS/Drugs.com Monograph
MedlinePlus a693024
License data
Pregnancy
category
  • AU: C
  • US: C (Risk not ruled out)
Routes of
administration		 oral
ATC code C07AB07 (WHO)
Legal status
Legal status
  • ℞ (Prescription only)
Pharmacokinetic data
Bioavailability >90%
Protein binding 30%[1]
Metabolism 50% Hepatic, CYP2D6, CYP3A4[2]
Biological half-life 10–12 hours[3]
Identifiers
CAS Number 66722-44-9 YesY
PubChem (CID) 2405
IUPHAR/BPS 7129
DrugBank DB00612 YesY
ChemSpider 2312 YesY
UNII Y41JS2NL6U YesY
KEGG D02342 YesY
ChEBI CHEBI:3127 YesY
ChEMBL CHEMBL645 YesY
Chemical and physical data
Formula C18H31NO4
Molar mass 325.443 g/mol
3D model (Jmol) Interactive image
Chirality Racemic mixture
  (verify)

Bisoprolol is a drug belonging to the group of beta-blockers, a class of medicines used primarily in cardiovascular diseases. More specifically, it is a selective type β1 adrenergic receptor blocker. The U.S. Food and Drug Administration (FDA) approved an application by Duramed Pharmaceutical for Zebeta Oral Tablets (bisoprolol fumarate) as a new molecular entity on July 31, 1992.[4] It has since been approved by the FDA for manufacture by Teva, Mylan, Sandoz, Aurobino, and Unichem.[5] It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[6]

Medical use

Zebeta 5-mg oral tablet

Bisoprolol is beneficial in treatment for high blood pressure (hypertension), reduced blood flow to the heart (cardiac ischemia); congestive heart failure, and preventive treatment before and primary treatment after heart attacks, decreasing the chances of recurrence.[7] Bisoprolol targets hypertension (elevated blood pressure).[8][9] In cardiac ischemia, the drug is used to reduce the activity of the heart muscle, so reduces oxygen and nutrient demand, and reduced blood supply can still transport sufficient amounts of oxygen and nutrients.[10][11][12]

Bisoprolol can be used to treat cardiovascular diseases such as hypertension, coronary heart disease, arrhythmias, ischemic heart diseases, and myocardial infarction after the acute event. Patients with compensated congestive heart failure may be treated with bisoprolol as a comedication (usually with an ACE inhibitor, a diuretic, and a digitalis-glycosid, if indicated). In patients with congestive heart failure, it reduces the need for and the consumption of oxygen of the heart muscle. It is very important to start with low doses, as bisoprolol reduces also the muscular power of the heart, which is an undesired effect in congestive heart failure.

Cautions

Beta-blockers can precipitate asthma and this effect can be dangerous. They should be avoided in patients with a history of asthma or bronchospasm; if no alternative is available, a cardioselective beta-blocker can be used with extreme caution under specialist supervision. Bisoprolol, metoprolol, nebivolol, and (to a lesser extent) acebutolol, have less effect on the β2 (bronchial) receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance, but are not free of this side effect, particularly at higher dosages.

Side effects

Overdose of bisoprolol leads to fatigue, hypotension,[11] low blood sugar,[13][14] bronchospasms, and bradycardia.[11] Bronchospasms and low blood sugar because at high doses drug can be an antagonist for β2 adrenergic receptors located in lung and in liver. Bronchospasm is due to blockage in lungs of β2 receptor and low blood sugar because of decreased stimulation of glycogenolysis and gluconeogenesis in the liver via β2 receptor.[10][11][15]

Mechanism of action

Bisoprolol is cardioprotective because it selectively and competitively blocks catecholamine (adrenalin) stimulation of β1 adrenergic receptors (adrenoreceptors), which are mainly found in the heart muscle cells and heart conduction tissue (cardiospecific), but also found in juxtaglomerular cells in the kidney.[10] Normally, adrenalin and noradrenalin stimulation of the β1 adrenoreceptor activates a signalling cascade (Gs protein and cAMP) which ultimately leads to increased contractility and increased heart rate of the heart muscle and heart pacemaker, respectively.[16] Bisoprolol competitively blocks the activation of this cascade, so decreases the adrenergic tone/stimulation of the heart muscle and pacemaker cells. Decreased adrenergic tone shows less contractility of heart muscle and lowered heart rate of pacemakers.[13][14][17]

These are the favourable factors that are decreased and treat hypertension, heart attacks, and ischemia. The decreases in contractility and heart rate are beneficial for hypertension because they reduce blood pressure,[8][11] but for preventive measures for heart attacks and cardiac ischemia, these decreases in heart rate and contraction decrease the heart's demand for oxygen and nutrients; primary treatment after heart attacks is to prevent recurrence of the infarction.[9][11][12]

Pharmacology and biochemistry

Selectivity of various β-blockers

Bisoprolol has both lipid- and water-soluble properties, making it a prime candidate over other β-blockers and even over other β1-blockers, being water-soluble, it has decreased incidence of central nervous system side effects (inability to diffuse into brain) compared to purely lipophilic compounds.[13][17] Bisoprolol has an approximate half-life of 10–12 hours, and when ingested has nearly complete absorption into the blood stream.[13][14] The high absorption is indicative of high bioavailability (approx. 90%).[13][14] When being eliminated, the body evenly distributes it (50–50) between kidney excretion and liver biotransformation (then excreted).[13][14][17] These factors make it a convenient once/day dosage when administered.[13][14]

β1-selectivity

Bisoprolol β1-selectivity is especially important in comparison to other nonselective beta blockers. The effects of the drug are limited to areas containing β1 adrenoreceptors, which is mainly the heart and part of the kidney.[13][17] Bisoprolol minimizes the side effects that might occur from administration of a nonspecific beta blocker where blockage of the other adrenoreceptors (β2, β3, α1, α2) occurs. The other receptors elicit a variety of responses in the body, and their blockage could cause a wide range of reactions, but β1 adrenoreceptors are cardiospecific for the most part, making bisoprolol ideal for treatment of cardiac events.[13][14][17]

Bisoprolol has a higher degree of β1-selectivity compared to other β1-selective β-blockers such as atenolol, metoprolol, and betaxolol.[17][18][19][20][21][22][23][24][25][26] However nebivolol is approximately 3.5 times more β1-selective.[27][28]

Antihypertensive effect

Bisoprolol has a stronger antihypertensive effect than propranolol.[18]

Cardioprotection

Bisoprolol in animal models has been shown to be cardioprotective.[18]

Renin-angiotensin system

Bisoprolol inhibits renin secretion by about 65% and tachycardia by about 30%.[18]

References

  1. ↑ Bühring KU, Sailer H, Faro HP, Leopold G, Pabst J, Garbe A (1986). "Pharmacokinetics and metabolism of bisoprolol-14C in three animal species and in humans". J. Cardiovasc. Pharmacol. 8 Suppl 11: S21–8. doi:10.1097/00005344-198511001-00004. PMID 2439794.
  2. ↑ Yuji Horikiri; Takehiko Suzuki; Masakazu Mizobe (March 1998). "Pharmacokinetics and metabolism of bisoprolol enantiomers in humans". Journal of Pharmaceutical Sciences. 87 (3): 289–294. doi:10.1021/js970316d.
  3. ↑ Leopold G (1986). "Balanced pharmacokinetics and metabolism of bisoprolol". J. Cardiovasc. Pharmacol. 8 Suppl 11: S16–20. doi:10.1097/00005344-198511001-00003. PMID 2439789.
  4. ↑ "Bisoprolol Official FDA information, side effects and uses.". Retrieved 2012-03-17.
  5. ↑ "Drugs@FDA: FDA Approved Drug Products". Retrieved 2013-11-13.
  6. ↑ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
  7. ↑ Rosenberg, J.; Gustafsson, F. (2008). "Bisoprolol for congestive heart failure". Expert Opinion on Pharmacotherapy. 9 (2): 293–300. doi:10.1517/14656566.9.2.293. PMID 18201151.
  8. 1 2 Amabile, G.; Serradimigni, A. (1987). "Comparison of bisoprolol with nifedipine for treatment of essential hypertension in the elderly: Comparative double-blind trial". European Heart Journal. 8 Suppl M: 65–69. doi:10.1093/eurheartj/8.suppl_m.65. PMID 2967187.
  9. 1 2 Thadani, U. (2004). "Current medical management of chronic stable angina". Journal of cardiovascular pharmacology and therapeutics. 9 Suppl 1: S11–S29; quiz S29–9. doi:10.1177/107424840400900103. PMID 15378129.
  10. 1 2 3 "A randomized trial of beta-blockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). CIBIS Investigators and Committees". Circulation. 90 (4): 1765–1773. 1994. doi:10.1161/01.cir.90.4.1765. PMID 7923660.
  11. 1 2 3 4 5 6 Konishi, M.; Haraguchi, G.; Kimura, S.; Inagaki, H.; Kawabata, M.; Hachiya, H.; Hirao, K.; Isobe, M. (2010). "Comparative effects of carvedilol vs bisoprolol for severe congestive heart failure". Circulation Journal. 74 (6): 1127–1134. doi:10.1253/circj.cj-09-0989. PMID 20354334.
  12. 1 2 Castagno, D.; Jhund, P. S.; McMurray, J. J. V.; Lewsey, J. D.; Erdmann, E.; Zannad, F.; Remme, W. J.; Lopez-Sendon, J. L.; Lechat, P.; Follath, F.; Höglund, C.; Mareev, V.; Sadowski, Z.; Seabra-Gomes, R. J.; Dargie, H. J. (2010). "Improved survival with bisoprolol in patients with heart failure and renal impairment: An analysis of the cardiac insufficiency bisoprolol study II (CIBIS-II) trial". European Journal of Heart Failure. 12 (6): 607–616. doi:10.1093/eurjhf/hfq038. PMID 20354032.
  13. 1 2 3 4 5 6 7 8 9 Leopold, G.; Pabst, J.; Ungethüm, W.; Bühring, K. U. (1986). "Basic pharmacokinetics of bisoprolol, a new highly beta 1-selective adrenoceptor antagonist". Journal of clinical pharmacology. 26 (8): 616–621. doi:10.1002/j.1552-4604.1986.tb02959.x. PMID 2878941.
  14. 1 2 3 4 5 6 7 Leopold G, Ungethüm W, Pabst J, Simane Z, Bühring KU, Wiemann H (September 1986). "Pharmacodynamic profile of bisoprolol, a new beta 1-selective adrenoceptor antagonist". Br J Clin Pharmacol. 22 (3): 293–300. doi:10.1111/j.1365-2125.1986.tb02890.x. PMC 1401121Freely accessible. PMID 2876722.
  15. ↑ Hauck, R. W.; Schulz, C.; Emslander, H. P.; Böhm, M. (1994). "Pharmacological actions of the selective and non-selective beta-adrenoceptor antagonists celiprolol, bisoprolol and propranolol on human bronchi". British Journal of Pharmacology. 113 (3): 1043–1049. doi:10.1111/j.1476-5381.1994.tb17098.x. PMC 1510470Freely accessible. PMID 7858847.
  16. ↑ Bristow, M. R.; Hershberger, R. E.; Port, J. D.; Minobe, W.; Rasmussen, R. (1989). "Beta 1- and beta 2-adrenergic receptor-mediated adenylate cyclase stimulation in nonfailing and failing human ventricular myocardium". Molecular Pharmacology. 35 (3): 295–303. PMID 2564629.
  17. 1 2 3 4 5 6 Haeusler G, Schliep HJ, Schelling P, et al. (1986). "High beta 1-selectivity and favourable pharmacokinetics as the outstanding properties of bisoprolol". J. Cardiovasc. Pharmacol. 8 Suppl 11: S2–15. doi:10.1097/00005344-198511001-00002. PMID 2439793.
  18. 1 2 3 4 Harting J, Becker KH, Bergmann R, et al. (February 1986). "Pharmacodynamic profile of the selective beta 1-adrenoceptor antagonist bisoprolol". Arzneimittelforschung. 36 (2): 200–8. PMID 2870720.
  19. ↑ Kaumann AJ, Lemoine H (October 1985). "Direct labelling of myocardial beta 1-adrenoceptors. Comparison of binding affinity of 3H-(−)-bisoprolol with its blocking potency". Naunyn Schmiedebergs Arch. Pharmacol. 331 (1): 27–39. doi:10.1007/bf00498849. PMID 2866449.
  20. ↑ Klockow M, Greiner HE, Haase A, Schmitges CJ, Seyfried C (February 1986). "Studies on the receptor profile of bisoprolol". Arzneimittelforschung. 36 (2): 197–200. PMID 2870719.
  21. ↑ Manalan AS, Besch HR, Watanabe AM (August 1981). "Characterization of [3H](+/-)carazolol binding to beta-adrenergic receptors. Application to study of beta-adrenergic receptor subtypes in canine ventricular myocardium and lung". Circ. Res. 49 (2): 326–36. doi:10.1161/01.res.49.2.326. PMID 6113900.
  22. ↑ Schliep HJ, Schulze E, Harting J, Haeusler G (April 1986). "Antagonistic effects of bisoprolol on several beta-adrenoceptor-mediated actions in anaesthetized cats". Eur. J. Pharmacol. 123 (2): 253–61. doi:10.1016/0014-2999(86)90666-7. PMID 3011461.
  23. ↑ Schliep HJ, Harting J (1984). "Beta 1-selectivity of bisoprolol, a new beta-adrenoceptor antagonist, in anesthetized dogs and guinea pigs". J. Cardiovasc. Pharmacol. 6 (6): 1156–60. doi:10.1097/00005344-198406060-00024. PMID 6084774.
  24. ↑ Schnabel P, Maack C, Mies F, Tyroller S, Scheer A, Böhm M (October 2000). "Binding properties of beta-blockers at recombinant beta1-, beta2-, and beta3-adrenoceptors". J. Cardiovasc. Pharmacol. 36 (4): 466–71. doi:10.1097/00005344-200010000-00008. PMID 11026647.
  25. ↑ Smith C, Teitler M (April 1999). "Beta-blocker selectivity at cloned human beta 1- and beta 2-adrenergic receptors" (PDF). Cardiovasc Drugs Ther. 13 (2): 123–6. doi:10.1023/A:1007784109255. PMID 10372227.
  26. ↑ Wellstein A, Palm D, Belz GG (1986). "Affinity and selectivity of beta-adrenoceptor antagonists in vitro". J. Cardiovasc. Pharmacol. 8 Suppl 11: S36–40. doi:10.1097/00005344-198511001-00006. PMID 2439796.
  27. ↑ Bundkirchen A, Brixius K, Bölck B, Nguyen Q, Schwinger RH (January 2003). "Beta 1-adrenoceptor selectivity of nebivolol and bisoprolol. A comparison of [3H]CGP 12.177 and [125I]iodocyanopindolol binding studies". Eur. J. Pharmacol. 460 (1): 19–26. doi:10.1016/S0014-2999(02)02875-3. PMID 12535855.
  28. ↑ Nuttall SL, Routledge HC, Kendall MJ (June 2003). "A comparison of the beta1-selectivity of three beta1-selective beta-blockers". J Clin Pharm Ther. 28 (3): 179–86. doi:10.1046/j.1365-2710.2003.00477.x. PMID 12795776.
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