Bisoprolol side effects

Hi I have had PAF for the past 3 years and take bisoprolol 2.5 mg morning and 1.25mg at night together with Apixaban 5mg twice daily .  Does anyone have symptoms of feeling extremely cold especially late afternoon . My resting pulse never goes above 50 bpm and at times 45 bpm ar rest . I also get out of breath even walking short distances. My cardiologist suggested taking Flecainide instead of bisoprolol . I tried this for I month but I could not tolerate the side effects.  

30 Replies

  • Oh yes ! In the early days of being on Bisoprolol, yes - but - now 6 years down the track no problem with it at all. Just occasional tiredness that's all now.

    For me it was so bad I often went to bed mid afternoon, freezing to death, put the electric blanket on, and had a hot water bottle (yes I know what your gonna say - water and electricity), had gloves on hands, thick socks on feet. I would then fall asleep for around 4 hours and wake up feeling like superman.


  • Thanks for your reply John . As I sit here I have a hit water bottle and blanket . I ve been on bisoprolol for 3 years now . Have tried to reduce the dose but when. I did I do I end up going into fast AF .  It's reassuring to know others have this side effect. 

  • Hi Caradomben,

    Yeah at one time, I think after about 3 years, I tried cutting my dose back from 5 mg under supervision of my GP, but as soon as we did my heart rate took off and went ballistic. So ever since its been the original dose prescribed i.e. 5 mg a day and I take it at night. Luckily when I did cut back I didn't go back into AF, just the heart rate went ballistic Lol!


  • Bisoprolol dilates the blood vessels to the heart to slow and steady it. A recognised  side effect is the blood vessels to extremities are reduced therefore feeling cold. How often do you get pay? Could you just take the bisoprolol as a pill in the pocket?

  • i have been on bisoprolol some time and my hands and feet are always cold. I never wore a coat at any time of year once upon a time but now always welll wrapped up i piput it down to meds. I also take Flecainide but once they got dose right ive been ok 

  • I take Flecanaide and am always cold! Gracey

  • yes i work out side never had a problem with cold feet and toes, but put on bisoprolol and my feet have been blistered all winter there that cold, and my fingers are so cold don't make any difference with i wear gloves or not still frozen, changed to cadovol but still the same, glad the weathers getting better, but not looking forward to next winter. 

  • My pulse rate is similar to yours but I am on a lower dose than you. I really feel the cold much more than I used to. I now regularly wear a thermal vest and two jumpers and have the heating in the car and home at higher levels than before. However, it may also be connected to my recent weight loss. I managed to lose nearly three stone and, at 160lbs, I am about the same weight as I was in my late teens, so no fat to keep me warm!

    After experimenting, I now take my bisoprolol in the evening. I used to be quite busy in the evenings catching up with paperwork and odd jobs but now I am only fit for snoozing and watching TV. (Maybe the room radiator is set too high).

  • Hi I'm on 5mgs of bisprolol once a day I started on 2.5 then they increased to 3.75 as my heart bate was still to fast and now on 5 as was still getting the odd palpations. Have been off work for the last 6 weeks due to feeling totally unwell did go back one day and was signed of the day afte. To say I'm fed up is an understatement. The main problem I believe is the side effects I feel cold. Am totally exhausted and have low mood and generally don't feel like me. Spoke to gp and they put it down to my af which I don't believe. Been on 5mgs for just over a week and still don't feel much better and I can't walk the length of myself. Hope you get it sorted there's nothing worse

  • Hi sorry that you are fed up . I know it is not easy . I think like me it is probably the side effects of bisoprolol . Hopefully you will feel better soon 

  • Thank you its just the total exhaustion and generally not feeling right. This site is so good you know your not alone

  • I'm on 2.5mg Bisoprolol only and have the same problem. I now keep a jumper and a jacket at (airconditioned) work - the coldness always seems worse in the afternoon.

    But as long as it keeps the tachy at bay, I don't mind.

  • Hi I do get cold on 5 mg of bisoprolol and 50 mg flecainide x 2. For me it's a trade off. Keep on the meds put up with the tiredness by pacing myself. I do go to sleep in the evenings when I work only 3 full days now due to retire next year. There must be alternatives other than bisoprolol but 3 years on I am just happy to do most things albeit not all in one go and not in and out if a and e. I have layers so as I feel warmer can just take stuff off or add as the case may be. Hot water bottle at night has helped me sleep. Hope you find some strategies to keep yourself warm. Best wishes Chris

  • I take 10mg bisop a day Ido feel the cold but As Iive in Perth wa not very cold at the moment

  • Hi Mazza,

    I also live near Perth (Blairgowrie) - I was wondering if we had same Cardiologist? I have Dr Currie.

  • I live in Perth Western Australia Dr EricYament think you live in Scotland xx

  • LOL Sorry. Small world!

  • Yes funny I know we have a lot of new suburbs but not heard of that one lol at least you know AF is world wide

  • I was on 2.5 mg bisoprolol for 6 months and was always cold and felt really tired by 1 pm. GP changed to nebivalol (another beta blocker) and still feel shattered some afternoons but I put that down to the ectopics, but dont feel the cold as much.

  • Life's all about compromises isn't it. Live with AF , or put up with meds side effects. 

    6 years ago my AFs were so frequent and so frightening I thought I was a gonna. I was prescribed Sotalol which didn't do the job. After continuing AFs it was switched to bisoprolol 5mg plus flecainide 100mg and that did the trick. No AFs. Bliss! . . But . Side effects were tiredness, weakness, occasional breathlessness and muscle wastage. Annoying but I'll put up with those rather than AF thanks. Interestingly no sign of coldness. 

    I'm now going to seek ways of addressing the side effects , particularly the muscle wastage. My resting heartrate is 52bpm, which is a bit too low, so my cardiologist is going to give me a 48 hour monitor to check it, then take steps to increase it a bit, either by reducing the dose of my meds, or changing them. I'm cautious though cos I don't want AFs again and would prefer to live with the side effects instead if AFs re-occur. My 70 miles per week cycling keeps me relatively fit and keeps my heart pumping. I'm 63. 

  • By coincidence I spent some time Googling the side effects of bisoprolol last night. I take 2.5 daily but pre-ablation I was on 10.

    I do not feel the cold effects but something is effecting the arches of my feet making walking very difficult. There is a terrible tightness under and over the arches.

    One list of side effects had " 1 to 10% numbness in the extremities."  My feet do feel numb in a bowl of hot water.

    I have been seeing an osteopath who seems confused by my problem. Is it wear in my lower spine?  I am going back to see my GP and hopefully will have an X-ray.

  • Having changed from bisop. to flec three years ago I can say that there was enormous improvement . I am on 250 mg flec and this has controlled AF reasonably but I do get huge waves of sheer exhaustion especially pm . Do other folk experience this with flec ?

  • Exhausted taking Flecanaide, if I sit down I fall asleep for sure. Gracey

  • I take 5mg once in the morning and have noticed im always freezing. My resting heart rate is usually low 40's but my cardiologist wont reduce tablets as heart rate jumps back up too high. For the tiredness im just learning now to pace myself as at min my af attacks are every couple days and lasting up to 16 hours. Awaiting my first ablation hopefully in next few weeks x

  • I think I am slightly fortunate in that although I've been getting AF every couple of weeks for 36 hrs since being diagnosed 5 months ago I feel ok. I get more of an irregular or missed beats and not long fast spells, at least not after the initial onset. I can carry on normally although a  bit breathless. But when I was on 2.5 mg Bisoprolol my feet and fingers did get cold, especially at night.  Also noticed my fingers would get a bit numb whilst driving and I was a bit tired and breathless with a slight asthmatic feeling. None of these symptoms unbearable though. As my heart dropped to a rather low 43 bpm from 58 we decided to try 1.25 mg per day and I have to say i feel much better at a heart beat of 53. As the Bisoprolol had no effect on my anxiety induced AF anyway there seems little benefit in taking the higher dose if at all. It strikes me as a very powerful drug as such small doses seem to have strong effects on the heart.


  • My two suggestions are to try Verapamil which is a calcium channel blocker, or nebivolol which is a far more cardiac specific beta-blocker which specifically avoids the breathless problems.  Of course neither may work for you as no drug works for everybody but it sounds like your heart is being slowed too much as a method of preventing the AF.

  • I've been on Bisoprolol for 5 and a half years now.  Currently on 10mg a day.  Yes I am always cold....others in the office complaining it is too hot and I'm there typing away in my fleece.  Never really thought about whether it's worse in the afternoon so I'm not sure ....I'll have to register it in my mind when I feel most cold next time.

    My bp is usually at 50, although I have a pacemaker which kicks in if it goes below that (according to last Jan 12 month check that's about 15% of the time). Blood pressure was 96/65 this morning.

    I used to get out of breath but usually quite good now...better off going up stairs than some of my 'healthier' colleagues nowadays.

    Seems strange replacing Bisoprolol with Flecainide as I though they did different jobs....but then I'm no doc so things may have changed since my early medications when I was on both of them.

    Stay warm and keep walking :-)

  • Hi

    yes,all of the above! I was put on 5 mg  at night of Biso,but could not tolerate it. Then we tried 2.5,much the same. Now I take 1,25mg am,and another if I have had a bad day at night.My pulse hovered around the 40-50 as well.Now I feel a lot better,pulse roundabout 65. Might be worth trying?

    i get breathless too but steady walking on the flat does help

    hope you feel better soon

  • Thanks for the reply . Think I am going to as GP to cut my dose again . 

  • was on 7.5mg Bisoprolol for years but with consultation with consultant asked if I could reduce and agreed now on 5mg taken in mornings along with 200mg amiodarone and don't feel as tired throughout the day, always cold though.  take atorvastatin and warfarin before bed and wake up in night sweating with "fast" heart beat 70-80bpm, day time 50-58bpm. Have medium calcification of mitral valve and slight leak in aortic valve (Rheumatic fever at 10 year old)  consultant thought this had worsened so recently had an internal echo performed swallowing echo camera, was told after that there was no change and had not got worse!

    No problem walking up hill at pace but have given up golf as member of very hilly course (Pontypridd). Play bowls now.  Snooker not good as don't seem able to cue as smoothly as before.  Sorry this reply going on a bit!

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