Metoprolol or Bisoprolol?

At my follow up at the JR in Oxford following my 2nd ablation, it was recommended that I take a combination of Flecainide and, initially, Bisoprolol. As I have been off this since last October I was reluctant to take it up again, so the doctor prescribed Metoprolol.

My question is, having read all the side effects of this and what it shouldn't be prescribed for, is anyone else taking Metoprolol and if so, how are you getting on with it? Also, the combination of this and Flecainide, is there any reason to be wary of it. Am starting to think perhaps I'd have been better off just accepting the Bisoprolol, at least although it wasn't great I'm familiar with how it makes me feel.

I would be grateful for any feedback, thanks.

4 Replies

  • I have taken both. I was taken off Bisoprolol (as a daily drug) as it made my already slow heart rate slower. After one episode in hospital when they were unable to chemically convert me they put me on Metoprolol to control my rate. I then started taking Propafenone (same class of antiarrhythmic drug as Flecainide). This drug converted me back to NSR and I had to stop the Metoprolol as it also made my heart rtae too low if in NSR. I now use it as a pill in the pocket. So I take Propafenone every day and if I get AF, flutter or SVT start for any period I will take the Metoprolol until I convert back. The last time I had to do this was January when I woke in a fast but fairly regular rhythm that stuck at 130bpm (think SVT) so I took Metoprolol daily for about 9 days and stopped when I converted back.

    Main things

    I have taken Metoprolol at the same time as Propafenone with no ill effect

    I was told that they tried me on Metoprolol as it is a reversible drug (and I have found that when I stop effects don't take long to stop)

    It did reduce my blood pressure quite a lot - usually about normal but went to ~100/60 and at times as low as 95/57 so this might be a factor if you have low blood pressure

    Obviously does reduce heart rate (not sure comparison with Bisoprolol because when I was taking that it was every day).

    It didn't make me too tired or unable to function (but again only using it when I needed my rate reducing)

    I've not found issues with it apart from if I continue to take it when back in NSR.

    Just my experience; hope it helps.


  • Thanks for your reply, Jo, lots of helpful info there.

    I only have to take the Metoprolol as a p-i-p, together with the Flecainide, and it's good to know it gets out of your system fairly quickly. Will just have to see how it goes and refer back to my EP if I can't get on with it.

  • I do the same. 100mg flecainide dissolved in water so that it hits the bloodstream within 1 hour, plus 25mg Metoprolol. If you take the flecainide as a pill it takes 4 hours to reach maximum serum concentration. It is the surge of flecainide that triggers cardioversion (so I'm told), so dissolving in water is essential. It also works better on an empty stomach, but that can't be guaranteed unless you get your doctor to verify that you can administer the flecainide using an enema.

    The flecainide has roughly a 13 hour half life and metoprolol has about a 7 hour half life (from memory). I don't feel "normal" again until about 24 to 48 hours after taking this combination, but it is far better than enduring AF for 12-36 hours.

  • Thank you for your post, Michael. I actually woke up last night with fast AF so tried your tip of dissolving the Flecainide in water. After reading what you recommened I was hopeful that I would revert quickly but it did seem to take quite a lot longer than an hour (about 3 1/2 actually) but eventually I went back into NSR and got a bit of sleep. However, I will persevere as what you say does make sense.

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