Bisoprolol

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Bisoprolol
Systematic (IUPAC) name
(RS)-1-{4-[(2-isopropoxyethoxy)methyl]phenoxy}-
3-(isopropylamino)propan-2-ol
Clinical data
Trade names Concor
AHFS/Drugs.com monograph
MedlinePlus a693024
Licence data US FDA:link
Pregnancy cat. C (AU) C (US)
Legal status ℞ Prescription only
Routes oral
Pharmacokinetic data
Bioavailability >90%
Protein binding 30%[1]
Metabolism 50% Hepatic
Half-life 10–12 hours[2]
Identifiers
CAS number 66722-44-9 YesY
ATC code C07AB07
PubChem CID 2405
DrugBank DB00612
ChemSpider 2312 YesY
UNII Y41JS2NL6U YesY
KEGG D02342 YesY
ChEBI CHEBI:3127 YesY
ChEMBL CHEMBL645 YesY
Chemical data
Formula C18H31NO4 
Mol. mass 325.443 g/mol
 YesY (what is this?)  (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.[3] It has since been approved by the FDA for manufacture by Teva, Mylan, Sandoz, Aurobino, and Unichem.[4]

Clinical use

Bisoprolol is beneficial in treatment for: high blood pressure (hypertension), reduced blood flow to the heart (cardiac ischemia); congestive heart failure, preventative treatment before and primary treatment after heart attacks decreasing the chances of recurrence.[5] During hypertension there is an elevated blood pressure, which is what bisoprolol targets.[6][7] In cardiac ischemia, the drug is used to reduce the activity of the heart muscle and therefore reduce oxygen and nutrient demand, so reduced blood supply can still transport sufficient amounts of oxygen and nutrients.[8][9][10]

Beta-blockers with a relatively short duration of action have to be given two or three times daily. Many of these are, however, available in modified-release formulations so that administration once daily is adequate for hypertension. For angina twice-daily treatment may sometimes be needed even with a modified-release formulation. Some beta-blockers such as atenolol, bisoprolol, carvedilol, celiprolol, and nadolol have an intrinsically longer duration of action and need to be given only once daily.

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 (cardio specific) but also found in juxtaglomerular cells in the kidney.[8] Normally adrenalin and noradrenalin stimulation of the β1 adrenoreceptor activates a signalling cascade (Gs protein and cAMP) which ultimately lead to increased contractility and increased heart rate of the heart muscle and heart pacemaker respectively.[11] Bisoprolol competitively blocks the activation of this cascade and therefore 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 heart pacemaker.[12][13][14]

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[6][9] but for preventive measures for heart attacks and cardiac ischemia these decreases in heart rate and contraction decrease the hearts demand for oxygen and nutrients; primary treatment post heart attacks is to prevent recurrence of the infarction.[9][10][7]

Cautions

Beta-blockers can precipitate asthma and this effect can be dangerous. Beta-blockers should be avoided in patients with a history of asthma or bronchospasm; if there is no alternative, 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.

Side effects

Overdose of bisoprolol leads to fatigue, hypotension,[9] low blood sugar,[13][14] bronchospasms and bradycardia.[9] Bronchospasms and low blood sugar because at high doses drug can be an antagonist for β2 adrenergic receptors located in lung and in liver. Bronchspasm 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.[8][9][15]

Indications

Zebeta 5 MG Oral Tablet

Bisoprolol (Concor,[16] Zebeta,[17] Concore,[18] Monocor[19]) can be used to treat cardiovascular diseases such as hypertension, coronary heart disease, arrhythmias, ischemic heart diseases and treatment of myocardial infarction after the acute event. Patients with compensated congestive heart failure may be treated with bisoprolol as a comedication (usually together 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.

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 will have decreased incidence of central nervous system side effects (inability to diffuse into brain) compared to purely lipophilic compounds.[12][13] 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).[12][13][14] These factors make it a convenient once/day dosage when it’s being administered.[13][14]

β1 selectivity

Bisoprolol β1-selectivity is especially important in comparison to other non-selective beta blockers. The effects of the drug are limited to areas containing β1 adrenoreceptors which is mainly the heart and a little bit of the kidney.[12][13] Bisoprolol minimizes the side effects that might occur from administration of a non-specific 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 blockage of them could cause a wide range of reactions; but β1 adrenoreceptors are cardio specific for the most part, making bisoprolol ideal for treatment of cardiac events.[12][13][14]

Bisoprolol has a higher degree of β1-selectivity compared to other β1-selective β-blockers such as atenolol, metoprolol and betaxolol.[20][12][21][22][23][24][25][26][27][28] However nebivolol is approximately 3.5 times more β1-selective.[29][30]

Antihypertensive effect

Bisoprolol has a stronger antihypertensive effect than propranolol.[20]

Cardioprotection

Bisoprolol in animal models has been shown to be cardioprotective.[20]

Renin-angiotensin system

Bisoprolol inhibits renin secretion by about 65% and tachycardia by about 35%.[20]

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. PMID 2439794. 
  2. ↑ Leopold G (1986). "Balanced pharmacokinetics and metabolism of bisoprolol". J. Cardiovasc. Pharmacol. 8 Suppl 11: S16–20. PMID 2439789. 
  3. ↑ "Bisoprolol Official FDA information, side effects and uses.". Retrieved 2012-03-17. 
  4. ↑ "Drugs@FDA: FDA Approved Drug Products". Retrieved 2013-11-13. 
  5. ↑ 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. 
  6. ↑ 6.0 6.1 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. PMID 2967187. 
  7. ↑ 7.0 7.1 Thadani, U. (2004). "Current medical management of chronic stable angina". Journal of cardiovascular pharmacology and therapeutics. 9 Suppl 1: S11–S29; quiz S29–9. PMID 15378129. 
  8. ↑ 8.0 8.1 8.2 "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. PMID 7923660. 
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 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 : official journal of the Japanese Circulation Society 74 (6): 1127–1134. PMID 20354334. 
  10. ↑ 10.0 10.1 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. 
  11. ↑ 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. 
  12. ↑ 12.0 12.1 12.2 12.3 12.4 12.5 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. PMID 2439793. 
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 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. PMID 2878941. 
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 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. PMC 1401121. 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. PMC 1510470. PMID 7858847. 
  16. ↑ "Merck Serono S.A. - Concor". Retrieved 2012-03-17. 
  17. ↑ "Bisoprolol". PubMed Health. Retrieved 2012-03-17. 
  18. ↑ "Pharmaceuticals". Merck Philippines. Archived from the original on 2007-12-22. Retrieved 2008-01-01. 
  19. ↑ "Products: Monocor". Biovail Corporation. Retrieved 2007-12-23. 
  20. ↑ 20.0 20.1 20.2 20.3 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. 
  21. ↑ 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. PMID 2866449. 
  22. ↑ 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. 
  23. ↑ 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. PMID 6113900. 
  24. ↑ 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. 
  25. ↑ 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. 
  26. ↑ 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. PMID 11026647. 
  27. ↑ Smith C, Teitler M (April 1999). "Beta-blocker selectivity at cloned human beta 1- and beta 2-adrenergic receptors". Cardiovasc Drugs Ther 13 (2): 123–6. doi:10.1023/A:1007784109255. PMID 10372227. 
  28. ↑ Wellstein A, Palm D, Belz GG (1986). "Affinity and selectivity of beta-adrenoceptor antagonists in vitro". J. Cardiovasc. Pharmacol. 8 Suppl 11: S36–40. PMID 2439796. 
  29. ↑ 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. 
  30. ↑ 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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