Biprez 2.5 mg, 5 mg and 10 mg film-coated tablets – bisoprolol for high blood pressure, angina and heart failure

Biprez is a medicine containing bisoprolol fumarate, a selective beta-blocker. It slows the heart rate, makes the heart pump more efficiently and reduces the heart's need for oxygen, so it is used for high blood pressure, angina pectoris and stable chronic heart failure.

This page refers to Biprez film-coated tablets in strengths of 2.5 mg, 5 mg and 10 mg (30 tablets each) made by Alkaloid. All three strengths are on the ALIMS list of interchangeable medicines (May 2026). The medicine is available on prescription, and treatment must not be stopped suddenly.

What is Biprez (bisoprolol) used for and how should it be taken correctly?

Key facts about the medicine

What is Biprez used for?

According to the official leaflet, Biprez is intended for the treatment of:

• high blood pressure (hypertension);
• angina pectoris (chest pain due to lack of oxygen in the heart muscle);
• stable chronic heart failure – in combination with other medicines such as ACE inhibitors, diuretics and cardiac glycosides.

How is it used and dosed?

Treatment is started gradually with low doses that are slowly increased, and the dose is adjusted according to pulse and response. General dosing from the leaflet:

Take the medicine in the morning, before, with or after breakfast; swallow the tablet whole with enough liquid and do not chew it. The tablets can be divided into two equal doses. Your doctor decides which strength and tablet division are used to achieve the prescribed dose. Bisoprolol treatment is usually long-term and requires regular medical monitoring, especially at the start, when the dose is increased and after stopping.

Special patient groups

• Hypertension and angina with mild to moderate liver or kidney impairment: no dose adjustment is needed; in severe impairment the dose must not exceed 10 mg a day.
• Heart failure with liver or kidney impairment: no data – the dose is increased with extra caution.
• Elderly patients: no dose adjustment is needed.
• Children and adolescents: the medicine is not used, as safety and efficacy have not been studied.

Contraindications – when the medicine must not be used

• allergy to bisoprolol or any of the excipients;
• acute heart failure or worsening (decompensation) of heart failure requiring intravenous inotropic medicines;
• cardiogenic shock;
• second- or third-degree AV block without a pacemaker, sick sinus syndrome, sinoatrial block;
• slow heart rate (fewer than 50 beats per minute) before starting treatment;
• very low blood pressure (systolic below 90 mmHg);
• severe bronchial asthma;
• late-stage peripheral arterial occlusive disease or Raynaud's syndrome;
• untreated phaeochromocytoma;
• metabolic acidosis.

Warnings and precautions

• Diabetes with fluctuating blood sugar – symptoms of hypoglycaemia may be masked; strict fasting or dieting.
• Desensitisation therapy for allergies – bisoprolol may increase sensitivity to allergens and the severity of anaphylactic reactions.
• First-degree AV block, Prinzmetal's angina, peripheral arterial occlusive disease (symptoms may worsen at the start of treatment).
• Personal history of psoriasis – only after careful assessment of benefits and risks.
• Symptoms of an overactive thyroid may be masked; in phaeochromocytoma the medicine is taken only after an alpha-blocker.
• General anaesthesia: the anaesthetist must know about the treatment; if stopping is necessary, the dose is reduced gradually and the medicine stopped 48 hours before anaesthesia.
• Chronic lung disease or milder asthma: tell your doctor immediately about difficulty breathing, cough or wheezing.
• Use of bisoprolol may give a positive doping test.

Interactions with other medicines, food and drink

• Do not take together without your doctor's advice: verapamil or diltiazem; class I antiarrhythmics (quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone) in heart failure; clonidine, methyldopa, moxonidine, rilmenidine (but do not stop them without your doctor).
• Caution and more frequent monitoring are needed with: dihydropyridine calcium antagonists (felodipine, nifedipine, amlodipine), amiodarone, beta-blocker eye drops (timolol), parasympathomimetics, sympathomimetics (isoprenaline, dobutamine, adrenaline, noradrenaline), oral antidiabetics and insulin, anaesthetics, digitalis, NSAIDs (ibuprofen, diclofenac), medicines that lower blood pressure (antihypertensives, tricyclic antidepressants, barbiturates, phenothiazines), mefloquine and MAO inhibitors (except MAO-B).
• Alcohol may increase the blood-pressure-lowering effect.

Pregnancy and breast-feeding

During pregnancy Biprez is used only after careful assessment by the doctor; beta-blockers may reduce blood flow through the placenta and affect the baby's development, so fetal growth and blood flow are monitored, and the newborn after delivery (low blood sugar and slow pulse possible in the first 3 days). It is not known whether the medicine passes into breast milk, so breast-feeding is not recommended.

Driving and using machines

In patients with coronary heart disease bisoprolol did not affect driving ability, but because of individual reactions this ability may be reduced – especially at the start of treatment, after a change in treatment and with alcohol.

Possible side effects

• The most serious relate to heart function: slow heart rate (very common in heart failure), worsening heart failure (common in heart failure), slow or irregular rhythm (uncommon).
• Common: low blood pressure, cold or numb hands and feet, dizziness, headache, tiredness (in hypertension and angina usually at the start of treatment, mild, resolving within 1–2 weeks), weakness, nausea, vomiting, diarrhoea, constipation.
• Uncommon: drop in blood pressure on standing, worsening breathing in asthma or chronic lung disease, sleep disorder, depression, muscle weakness and cramps.
• Rare: raised triglycerides and liver enzymes, hearing impairment, allergic rhinitis, hepatitis, skin hypersensitivity reactions, potency disorder, nightmares, hallucinations, reduced tear production, brief loss of consciousness.
• Very rare: conjunctivitis, hair loss, onset or worsening of psoriasis.

Report any suspected side effect to your doctor, pharmacist or ALIMS.

Overdose, missed dose and stopping treatment

• Overdose: tell your doctor immediately. The most common signs are slow heart rate, a marked fall in blood pressure, difficulty breathing, acute heart failure, dizziness and trembling due to low blood sugar.
• Missed dose: continue at the next scheduled time as prescribed; do not take a double dose.
• Stopping: treatment must not be stopped suddenly – in angina pectoris the dose is usually reduced gradually (halving at weekly intervals), as sudden withdrawal may cause acute worsening.

Related information

For additional care and support with high blood pressure and heart conditions (regular blood pressure and pulse checks), see also the Blood pressure monitors category – products in this category do not replace the medicine you have been prescribed.

Composition, pack and manufacturer

• Active substance: bisoprolol fumarate 2.5 mg, 5 mg or 10 mg per film-coated tablet.
• Tablet core: silicified microcrystalline cellulose (microcrystalline cellulose and colloidal anhydrous silica); crospovidone; glycerol dibehenate.
• Film coating: hypromellose; titanium dioxide (E171); macrogol 400; in 5 mg and 10 mg also yellow iron oxide (E172).
• Appearance: round biconvex scored film-coated tablets – white (2.5 mg), yellow (5 mg) and ochre-yellow (10 mg).
• Pack: perforated PVC/PVDC/Al blister of 10 tablets; carton with 3 blisters (30 film-coated tablets).
• Marketing authorisation holder: Alkaloid d.o.o. Beograd, Prahovska 3, Belgrade. Manufacturers: Alkaloid d.o.o. Beograd; Alkaloid AD Skopje, North Macedonia.

Storage

• Store below 25 °C in the original package, protected from light and moisture.
• Shelf life: 3 years.
• Keep out of the sight and reach of children.

Frequently asked questions

Which strength of Biprez do I need?

Your doctor decides the strength and dose according to the condition, pulse and response to treatment. For high blood pressure and angina the recommended dose is 5 mg once a day, while in heart failure the dose is gradually increased from 1.25 mg to 10 mg a day.

Can I stop taking Biprez when my blood pressure is normal?

No. Bisoprolol must not be stopped suddenly, as your condition may worsen; if stopping is needed, your doctor will explain how to reduce the dose gradually.

Can Biprez tablets be split?

Yes. According to the leaflet, the scored tablets can be divided into two equal doses, but they should not be chewed.

Does Biprez affect blood sugar?

Bisoprolol can mask signs of low blood sugar, such as a fast pulse and palpitations. People with diabetes should check their blood sugar more often, and the doctor may adjust antidiabetic medicines.

Sources

• ALIMS – Summary of Product Characteristics, BIPREZ®, 2.5 mg, 5 mg and 10 mg, film-coated tablets (Serbian)
• ALIMS – Package leaflet, BIPREZ® (July 2021, Serbian)
• ALIMS – List of interchangeable medicines (May 2026)

Date sources were checked: 24.10.2026.