Concor
Concor is bisoprolol 5/10 mg tablets from Merck — highly cardioselective beta-1 blocker. For hypertension (5-10 mg once daily), angina, atrial fibrillation rate control. For heart failure, the starter Concor Cor 2.5 mg is used for titration. CIBIS-II mortality evidence in HF-REF.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Concor?
Concor is a 5 mg / 10 mg bisoprolol tablet from Merck / E. Merck — highly cardioselective (beta-1). Primary use is hypertension; also used for angina, arrhythmia control, post-myocardial-infarction secondary prevention, and heart failure with reduced ejection fraction (HF-REF) (one of the three mortality-proven beta-blockers in HF-REF). Typical hypertension dose: 5-10 mg once daily (start 2.5 mg in frail/elderly). Contraindicated in asthma (relative for cardioselective agents; absolute for non-selective), severe bradycardia, second/third-degree heart block, acute decompensated heart failure, and phaeochromocytoma without prior alpha-blockade. Do NOT stop abruptly — taper over 1-2 weeks to avoid rebound tachycardia / angina / MI.
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What Is Concor?
Concor is an oral tablet containing bisoprolol 5 mg / 10 mg from Merck / E. Merck, supplied in 30-180 tablets. Bisoprolol is a highly cardioselective (beta-1). Highly beta-1-selective (roughly 2-3× more selective than metoprolol). One of the three mortality-proven beta-blockers in HF-REF alongside carvedilol and metoprolol succinate (CIBIS-II trial 1999). Once-daily dosing; good tolerability.
How Bisoprolol Lowers Blood Pressure
Beta-blockers reduce blood pressure through four mechanisms:
- Reduction of cardiac output — beta-1 blockade in the sinoatrial node reduces heart rate, and blockade in ventricular myocardium reduces contractility. Lower cardiac output = lower blood pressure.
- Renin-angiotensin suppression — beta-1 blockade in juxtaglomerular cells reduces renin release, lowering angiotensin II and aldosterone over 2-4 weeks. This accounts for much of the long-term BP effect.
- Central sympathetic reduction — lipophilic beta-blockers cross the blood-brain barrier and reduce central sympathetic outflow.
Beta-blockers are moderately hydrophilic — less CNS penetration than propranolol or metoprolol (fewer CNS side effects). Plasma half-life of bisoprolol is 10-12 hours.
Approved and Evidence-Based Uses
- Hypertension (primary indication)
- Heart failure with reduced ejection fraction (HF-REF) — mortality-reducing; titrate from 2.5 mg to 10 mg once daily over 8-12 weeks
- Stable angina
- Post-MI secondary prevention
- Atrial fibrillation rate control
Concor Dosage
Adult hypertension dose: 5-10 mg once daily (start 2.5 mg in frail/elderly).
Start low, titrate upward over 2-4 weeks to target BP (typically <140/90 in uncomplicated hypertension; <130/80 in diabetes, chronic kidney disease, or established cardiovascular disease). Check resting pulse before each dose-increase — do not titrate if <55 bpm.
Monitoring:
- Resting pulse and BP at 2, 4, and 8 weeks after starting or dose change
- Baseline ECG if any cardiac history; periodic ECG if symptoms change
- For HF-REF use: echocardiogram at 3 and 6 months; titrate toward target dose if tolerated
Administration: swallow whole with water. Take at approximately the same time each day.
Discontinuation: NEVER stop abruptly. Taper over 1-2 weeks (reduce by 25-50% every 3-5 days). Abrupt discontinuation causes rebound tachycardia, worsened angina, and — in patients with coronary disease — can precipitate myocardial infarction. This is one of the most important safety points for beta-blockers.
Side Effects
Common (>5%):
- Fatigue, lethargy — often adapts over 2-4 weeks
- Cold hands and feet (peripheral vasoconstriction)
- Bradycardia (check pulse; stop if <50 bpm)
- Exercise intolerance — maximum heart rate is blunted by beta blockade
- Dizziness, postural hypotension
- CNS effects possible but less common than with propranolol
- Reduced libido, erectile dysfunction (mostly at higher doses)
Less common: depression, reduced libido / erectile dysfunction, gastrointestinal upset, Raynaud-like cold intolerance, bronchospasm (more common with non-selective agents).
Important but uncommon:
- Masked hypoglycaemia in diabetics — beta-blockers blunt the tachycardia / tremor warning signs of low blood sugar. Monitor glucose more carefully; prefer nebivolol or bisoprolol in insulin-treated diabetes.
- Bronchospasm — can be severe in asthma / COPD. Absolute contraindication for non-selective agents; relative for cardioselective.
- Heart block or worsening heart failure — in susceptible patients. Start low, titrate slowly.
Contraindications & Cautions
- Severe asthma / severe COPD — relative contraindication (cardioselectivity is relative, not absolute)
- Second or third-degree atrioventricular block (without pacemaker)
- Sinus bradycardia <50 bpm
- Cardiogenic shock, decompensated heart failure requiring inotropes
- Severe peripheral arterial disease, Raynaud’s syndrome (relative)
- Phaeochromocytoma without prior alpha-blockade — paradoxical hypertensive crisis (never use a beta-blocker before alpha-blocker)
- Severe hepatic impairment (for extensively hepatic-metabolised agents: propranolol, metoprolol, carvedilol, labetalol)
- Severe renal impairment — dose adjustment needed for renal-excreted agents (atenolol, nadolol)
- Hypersensitivity to bisoprolol
Pregnancy: Category C; cross the placenta; small risk of intrauterine growth restriction, neonatal bradycardia, and hypoglycaemia. Use only if benefit clearly outweighs risk; labetalol is the pregnancy-preferred beta-blocker.
Breastfeeding: small amounts in breast milk; generally considered compatible with monitoring.
Drug Interactions
- Verapamil, diltiazem (non-dihydropyridine CCBs) — additive bradycardia, heart block, and negative inotropy; generally avoid combination. Dihydropyridine CCBs (amlodipine, nifedipine) are safer to combine with beta-blockers.
- Other beta-blockers — do not combine; additive bradycardia
- Clonidine — if stopping clonidine, stop the beta-blocker first (several days before) to avoid rebound hypertensive crisis
- Insulin and sulphonylureas — mask hypoglycaemia warning signs; monitor glucose closely
- NSAIDs — reduce the antihypertensive effect of beta-blockers; avoid chronic combination
- Alcohol — additive hypotension and CNS depression (particularly for lipophilic agents)
Beta-Blocker Class at a Glance
| Beta-blocker | Selectivity | Best for |
|---|---|---|
| Propranolol (Inderal, Ciplar, Beloc) | Non-selective | Migraine, tremor, thyrotoxicosis, performance anxiety, HTN |
| Metoprolol | Cardioselective | Post-MI, HF-REF (succinate ER), angina, AF rate control |
| Carvedilol | Non-selective + α-1 | HF-REF (mortality evidence), post-MI |
| Bisoprolol | Highly cardioselective | HF-REF, HTN, angina, AF rate control |
| Nebivolol | Ultra-selective + NO | Elderly, metabolic syndrome, erectile dysfunction |
| Atenolol | Cardioselective (hydrophilic) | Angina, AF rate control (second-line for HTN) |
| Labetalol | Non-selective + α-1 | Pregnancy hypertension, hypertensive crisis |
Highly selective beta-1 means it is one of the safer beta-blockers in mild asthma or COPD when a beta-blocker is clinically essential (still not absolutely safe; monitor PEF). Concor Cor 2.5 mg is the dedicated HF-starter strength; Concor 5/10 mg is the maintenance / HTN strength.
Storage
Store Concor below 25°C. Keep out of reach of children — accidental paediatric beta-blocker ingestion can cause life-threatening bradycardia and hypoglycaemia.
Frequently Asked Questions
How long does Concor take to lower blood pressure?
You should see some BP reduction within 1-2 days of starting; the full antihypertensive effect takes 2-4 weeks (driven by the gradual renin-angiotensin suppression, not the immediate heart-rate effect). Measure BP at home at the same time each day to track response.
Can I take Concor if I have asthma?
Bisoprolol is highly cardioselective, so it is relatively safer in asthma than non-selective agents. However, cardioselectivity is relative — at higher doses beta-2 blockade can still occur. In severe or brittle asthma, avoid all beta-blockers if possible. In mild asthma or COPD, use with monitoring and inhaler access.
Why should I never stop Concor abruptly?
Abrupt discontinuation causes rebound tachycardia and worsened angina within 24-48 hours, driven by up-regulation of beta receptors during chronic blockade. In patients with coronary artery disease, this can precipitate myocardial infarction or unstable angina. Always taper over 1-2 weeks when stopping.
Will Concor affect my exercise performance?
Yes — beta blockade blunts the heart-rate response to exercise, so your maximum pulse is lower and you fatigue faster at high intensities. For recreational exercise most people adapt; for competitive endurance athletes, beta-blockers can meaningfully impair performance and are banned in precision sports (shooting, archery — where they reduce physiological tremor).
Will Concor affect my blood sugar if I have diabetes?
Beta-blockers mask the tachycardia / tremor / palpitation warning signs of hypoglycaemia, making low blood sugar harder to detect. They can also blunt the counter-regulatory glucose response. Monitor glucose more frequently on a beta-blocker, particularly if on insulin or sulphonylureas. Nebivolol and bisoprolol have the best metabolic profile.
Can I drink alcohol on Concor?
Moderate alcohol is generally acceptable but alcohol potentiates the hypotensive and CNS-depressant effects. Stand up slowly after drinking. Alcohol is also an independent BP-raiser; reducing intake can improve BP control independent of Concor.
Does Concor cause weight gain?
Older beta-blockers (propranolol, atenolol, metoprolol) are associated with modest weight gain (1-3 kg) and worsening of insulin sensitivity over time. Nebivolol and carvedilol are weight-neutral or slightly weight-favourable due to their vasodilator components. For patients with metabolic syndrome, nebivolol is the preferred beta-blocker when one is needed.
Is Concor safe in pregnancy?
Category C. Use only if benefit clearly outweighs risk. For antihypertensive use in pregnancy, labetalol is the preferred beta-blocker; methyldopa and nifedipine are the two other pregnancy-safe options.
Can I take Concor with other BP medications?
Yes — beta-blockers combine well with dihydropyridine calcium-channel blockers (amlodipine), ACE inhibitors (ramipril, lisinopril), ARBs (losartan, telmisartan, olmesartan), and thiazide diuretics (HCTZ). Avoid combination with non-dihydropyridine CCBs (verapamil, diltiazem) — additive bradycardia and heart-block risk.
Where can I buy Concor online?
You can buy Concor (bisoprolol 5 mg / 10 mg tablet, 30-180 tablets) from MedsBase with discreet packaging and worldwide shipping.
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|---|---|
| Quantity | 30 Tablet/s, 60 Tablet/s, 90 Tablet/s, 180 Tablet/s |
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