Difference between Bisoprolol vs Metoprolol in Heart Failure

Difference between Bisoprolol vs Metoprolol in Heart Failure: Heart failure is a serious medical condition where the heart is unable to pump blood effectively, leading to symptoms such as shortness of breath, fatigue, and fluid retention. Beta-blockers are a class of medications commonly used to treat heart failure. Two beta-blockers often prescribed for heart failure are Bisoprolol and Metoprolol. While both medications are effective, they have some differences that may make one more suitable than the other for certain patients.

Difference Between Bisoprolol and Metoprolol in Heart Failure

This detailed table provides a comparison between Bisoprolol and Metoprolol in Heart Failure, highlighting their respective focuses, applications, and methodologies.




Receptor Selectivity

Selective beta-1 receptor blocker

Non-selective beta-1 and beta-2 receptor blocker

Dosage Frequency

Usually once daily

Once or twice daily (depending on formulation)


Approximately 10-12 hours

Approximately 3-7 hours (immediate-release)

Available Formulations


Tablet, immediate-release, extended-release

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What is Bisoprolol?

Bisoprolol is a medication classified as a beta blocker, commonly used to treat high blood pressure (hypertension) and heart failure. It works by relaxing blood vessels and slowing the heart rate, which helps to improve and decrease blood pressure. Additionally, Bisoprolol is used to prevent chest pain caused by angina and to treat conditions like atrial fibrillation that cause an irregular heartbeat.

Several large-scale trials have demonstrated the effectiveness and safety of bisoprolol in treating chronic heart failure (CHF). The CIBIS trial, CIBIS-II study, and CIBIS-III trial showed the good tolerability of bisoprolol in a large CHF population, with evidence of a dramatic reduction in mortality with the use of beta-blocking agents. Bisoprolol has been shown to be well tolerated in patients with CHF, even in the elderly.

Common side effects of Bisoprolol include dizziness, nausea, headaches, cold hands or feet, constipation, or diarrhea. These side effects are usually mild and temporary. It is recommended to take Bisoprolol as prescribed by your doctor, and it may take 2 to 6 weeks to fully take effect. It is also advised to avoid alcohol when starting Bisoprolol, or when the dosage is increased, until you understand how the medication affects you. 

Key Features of Bisoprolol:

  • Bisoprolol is a selective beta-1 receptor blocker, meaning it primarily blocks the beta-1 receptors in the heart.
  • It helps to lower blood pressure, reduce the heart rate, and decrease the workload on the heart, which can improve symptoms of heart failure.
  • Bisoprolol is typically taken once daily, with or without food.

What is Metoprolol?

Metoprolol is a medication used alone or in combination with other drugs to treat various cardiovascular conditions. It is primarily used to treat high blood pressure, chronic angina (chest pain), and to improve survival after a heart attack. Additionally, Metoprolol is used in combination with other medications to treat heart failure.

Belonging to a class of medications called beta blockers, Metoprolol works by relaxing blood vessels and slowing the heart rate, which improves blood flow and decreases blood pressure.

High blood pressure, if left untreated, can lead to serious complications such as heart disease, heart attack, stroke, kidney failure, and loss of vision. Along with medication, lifestyle changes like maintaining a healthy diet low in fat and salt, achieving and maintaining a healthy weight, regular exercise, avoiding smoking, and moderate alcohol consumption are also recommended to control blood pressure effectively.

Key Features of Metoprolol:

  • Metoprolol is a non-selective beta-blocker, meaning it blocks both beta-1 and beta-2 receptors in the body.
  • It helps to lower blood pressure, reduce the heart rate, and decrease the workload on the heart, similar to Bisoprolol.
  • Metoprolol is available in different formulations, including immediate-release and extended-release formulations.

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Similarities Between Bisoprolol and Metoprolol in Heart Failure

  • Mechanism of Action: Both Bisoprolol and Metoprolol work by blocking the effects of stress hormones like adrenaline on the heart, which reduces the heart rate and the force of heart muscle contraction. This helps to improve symptoms of heart failure and reduce the risk of disease progression.
  • Effectiveness: Both medications have been shown to reduce mortality and improve symptoms in patients with heart failure in various clinical trials.
  • Safety Profile: Both Bisoprolol and Metoprolol are generally well-tolerated, with similar side effect profiles. The most common side effects are fatigue, dizziness, and low blood pressure.

Bisoprolol and Metoprolol are both effective treatments for heart failure, with similar mechanisms of action and clinical efficacy. The choice between the two medications depends on various factors, such as patient preference, tolerability and cost.


Which Beta-Blocker Is Better for Heart Failure, Bisoprolol, or Metoprolol?

Both bisoprolol and metoprolol are effective treatments for heart failure. The choice between the two medications depends on various factors such as patient preference, tolerability, and cost.

How Do Bisoprolol and Metoprolol Differ in Their Dosage Frequency?

Bisoprolol is usually taken once daily, while metoprolol may be taken once or twice daily, depending on the formulation.

What Are the Main Differences Between Bisoprolol and Metoprolol?

The main differences between bisoprolol and metoprolol are their receptor selectivity, dosage frequency, and half-life.

Are There Any Side Effects Associated With Bisoprolol and Metoprolol?

Common side effects of both medications may include fatigue, dizziness, and low blood pressure. However, side effects may differ from person to person.

Can Bisoprolol and Metoprolol Be Used Together?

Combining bisoprolol and metoprolol is not recommended, as both medications have similar effects and may increase the risk of side effects.

How Long Does It Take for Bisoprolol and Metoprolol to Start Working?

Both medications may start to work within a few hours, but it may take several weeks to see the full benefits in terms of symptom improvement and heart function.

Do Bisoprolol and Metoprolol Interact With Other Medications?

Both bisoprolol and metoprolol may interact with other medications, so it is important to inform your doctor about all the medications you are taking.