Moderate
Amlodipine × Bisoprolol
Calcium channel blockers (dihydropyridines)×Selective beta-adrenergic blockers
Mechanism
Dihydropyridine calcium channel blocker (amlodipine) + cardioselective beta-blocker (bisoprolol) – additive bradycardia and hypotension. In reduced ejection fraction (below 40%), heart failure decompensation risk.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).
Management
The combination is a standard hypertension and angina treatment. In heart failure with reduced ejection fraction, cap amlodipine at 5 mg/day. Check pulse and blood pressure at 1–2 weeks.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Sources
- ESC: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– McDonagh TA et al. Eur Heart J 2021;42:3599-3726