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What is Bisoprolol and explain in detail?
Bisoprolol, sold under the brand name Zebeta among others, is a beta blocker medication used for heart diseases. This includes high blood pressure, chest pain from not enough blood flow to the heart, and heart failure. It is taken by mouth.Common side effects include headache, feeling tired, diarrhea, and swelling in the legs. More severe side effects include worsening asthma, blocking the ability to recognize low blood sugar, and worsening heart failure. There are concerns that use during pregnancy may be harmful to the baby. Bisoprolol is in the beta blocker family of medications and is of the β1 selective type.Bisoprolol is on the World Health Organizations List of Essential Medicines. Bisoprolol is available as a generic medication. In 2019, it was the 249th most commonly prescribed medication in the United States, with more than 1 million prescriptions.

Medical uses
Bisoprolol is currently used for prevention of cardiovascular events following a heart attack in patients with risk factors for disease progression, in the management of congestive heart failure with reduced ejection fraction, and as a second-line agent for hypertension.Bisoprolol may be beneficial in the treatment of high blood pressure, but it is not recommended as a first-line anti-hypertensive agent without an accompanying comorbid condition, for example, congestive heart failure.In cardiac ischemia, the drug is used to reduce the activity of the heart muscle, so reduced oxygen and nutrient demand, and reduced blood supply can still transport sufficient amounts of oxygen and nutrients.

Side effects
An overdose of bisoprolol can lead to fatigue, hypotension, hypoglycemia, bronchospasms, and bradycardia. Bronchospasms and hypoglycemia occur because at high doses, the drug can be an antagonist for β2 adrenergic receptors located in the lungs and liver. Bronchospasm occurs due to the blockage of β2 receptors in the lungs. Hypoglycemia occurs due to decreased stimulation of glycogenolysis and gluconeogenesis in the liver via β2 receptors.

Cautions
Non-selective beta-blockers should be avoided in people with asthma or bronchospasm as they may cause exacerbations and worsening of symptoms. A β1 selective beta-blocker like bisoprolol may be cautiously tried in those with controlled, mild-to-moderate asthma with cardiac comorbidities. A 2014 meta-analysis found that cardioselective beta-blockers may cause detrimental changes in lung function and partially blunts β2-agonist response. However, a 2017 control study found no significant association with asthma exacerbations by dose and exposure duration while a 2020 clinical trial found bisoprolol being non-inferior to placebo in bronchodilator response to salbutamol.

Pharmacology
Mechanism of action
Bisoprolol is cardioprotective because it selectively and competitively blocks catecholamine (adrenaline) 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. Normally, adrenaline and noradrenaline stimulation of the β1 adrenoreceptor activates a signalling cascade (Gs protein and cAMP) which ultimately leads to increased myocardial contractility and increased heart rate of the heart muscle and heart pacemaker, respectively. 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.

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. Bisoprolol, whilst β1 adrenoceptor selective can help patients to avoid certain side-effects associated with non-selective beta-blocker activity at additional adrenoceptors (α1 and β2), it does not signify its superiority in treating beta-blocker indicated cardiac conditions such as heart failure but could prove beneficial to patients with specific comorbidities.Bisoprolol has a higher degree of β1-selectivity compared to atenolol, metoprolol and betaxolol