Treatment should not be stopped abruptly. The dosage should be diminished slowly by a weekly halving of the dose.
There is no experience with bisoprolol in children, therefore its use cannot be recommended for children.
The treatment of stable chronic heart failure with bisoprolol has to be initiated with a special titration phase. Especially in patients with ischaemic heart disease the cessation of therapy with bisoprolol must not be done abruptly unless clearly indicated, because this may lead to transitional worsening of heart condition.
Bisoprolol must be used with caution in patients with hypertension or angina pectoris and accompanying heart failure.
The initiation and cessation of treatment with bisoprolol necessitates regular monitoring.
Bisoprolol must be used with caution in bronchospasm, diabetes mellitus with large fluctuations in blood glucose values, symptoms of hypoglycaemia, strict fasting, ongoing desensitization therapy, first degree AV block, prinzmetal’s angina, peripheral arterial occlusive disease, general anaesthesia.
Patients with psoriasis or with a history of psoriasis should only be given beta-blockers (e.g. bisoprolol) after a careful balancing of benefits against risks.
The symptoms of thyrotoxicosis may be masked under treatment with bisoprolol. Abrupt withdrawal of beta blockade may be followed by an exacerbation of the symptoms of hyperthyroidism or may precipitate thyroid storm.
In patients with phaeochromocytoma bisoprolol must not be administered until after alpha-receptor blockade.
Bisoprolol is not recommended during pregnancy unless clearly necessary. If treatment with bisoprolol is considered necessary, the uteroplacental blood flow and fetal growth should be monitored. In case of harmful effects on pregnancy or the fetus alternative treatment should be considered.
Breastfeeding is not recommended during administration of bisoprolol