Propranolol vs Bisoprolol
## Overview
Propranolol (non-selective) and bisoprolol (highly cardioselective) serve different clinical purposes. Propranolol's broad receptor blockade enables unique indications; bisoprolol's high selectivity and excellent bioavailability make it preferred for cardiac indications.
## Mechanism of Action
Propranolol: beta-1 + beta-2 antagonist, membrane stabilizing. Bisoprolol: highly selective beta-1 antagonist only.
## Pharmacokinetics
Propranolol: high first-pass metabolism (~70–75%), bioavailability ~25–30%, half-life 3–6 h, CYP1A2/2D6. Bisoprolol: bioavailability ~90%, half-life 10–12 h, once daily, dual hepatic/renal elimination.
## Clinical Indications
Propranolol's unique non-cardiac indications: essential tremor, migraine prophylaxis, thyrotoxicosis (symptomatic control + T4→T3 inhibition), portal hypertension. Bisoprolol's superior cardioselectivity gives it better tolerability in patients with pulmonary disease.
## Heart Failure
Bisoprolol: Class I evidence for HFrEF (CIBIS-II). Propranolol: not guideline-recommended for HFrEF.
## Key Takeaways
- Bisoprolol for cardiac indications (HFrEF, hypertension, angina) especially with pulmonary comorbidity
- Propranolol for tremor, thyrotoxicosis, portal hypertension, migraine
結論
Bisoprolol is the preferred beta-blocker for cardiovascular indications including HFrEF. Propranolol is irreplaceable for essential tremor, thyrotoxicosis, and portal hypertension. The two drugs serve largely different clinical niches.