Bisoprolol again and Digoxin.

[7Helena]

My GP has stopped my Bisoprolol and has reduced my Digoxin by half with an intent to stop that too. She has done this because my pulse rate was 60 and also regular. Both these were prescribed by the specialist after my AF diagnosis. I'm rather concerned whether this is OK ? I must say that my pulse rate normally varies between 40 and 60 so it was just possible that the 60 rate was temporary. I know I should have questioned my GP but I find it extremely difficult to do this. My thought was that I'd come on to the forum and ask the question of my reliable friends!

[Mrspat]

I think this is something of a "turf war" question. There have been discussions before about who manages the treatment of AF sufferers. My cardiologist prescribed digoxin and Bisoprolol for me too. Although my GP monitors the digoxin level via blood tests, I know that she would be very reluctant to alter the medication without consulting the cardiologist.

I don't think anyone here is qualified to answer your question fully. When we are reliant on medications, the result of withdrawing them can be unpredictable.

[PeterWh]

There are quite a few questions that you need to answer to let people have more defined thoughts.

Was your AF paroxysmal or persistent?

What was your non AF rate and what was your AF rate?

Have you had an ablation if so how long ago.

When was your last consultation with EP?

What doses were you on for both?

I was told by two or three different medics that if possible bisoprolol should be adjusted up or down ideally by 1.25mg over a three or four week period. If need quicker reaction then 2.5mg.

Are you on any other medications?

What are you using to measure your HR?

What follow up reviews are in place?

A HR of 40 is low and I'm guessing that's the reason she is taking you off.

Did she say why she was prioritising keeping you on digoxin rather than bisoprolol?

Typically what's your BP?

Nearly all of us aren't medically qualified!!!

[Hidden in reply to PeterWh]

I'm adjusting drugs at the moment with the doctor as pulse and blood pressure too low. They made adjustments to the level without success so next step is to change drug or come off. Doctor said she would contact my cardiologist for advice. I think this is a great way as it's professionals working together.

[PeterWh in reply to Hidden]

Good when they do!!! Unfortunately some don't.

What is your BP?

Last November my BP was consistently low (typically 100 to 105 / 65 to 70) and at the time I was on 7.5mg Bisoprolol. GP dropped Bisoprolol to 6.25 for a month but little effect on BP. Then 6 weeks later a further 1.25mg and again not much affect on BP. However tended more to top of range than bottom.

[7Helena in reply to PeterWh]

My BP varies and I'm on BP medication to control it.

[Hidden in reply to PeterWh]

Hi, I can't remember blood pressure data just that is was too low. Resting heart rate around 55. Only on 1.25mg of bisophonol. Feel constantly tired and dizzy when standing still.

[7Helena in reply to PeterWh]

In answer to your questions -

I have persistent AF

Not sure

I haven't had an ablation

My last consultation was 2 years ago

I was on 1.25 Bisoprolol and 125 Micrograms Digoxin

I'm on various other medications including Amlodipine, Lisinopril, Atorvastatin.

I use an Omron monitor which indicates AF

No follow up reviews by EP, monthly checks at GP

No, she gave no reason for prioritisation

BP 180/90

Thanks PeterWh

[rosyG in reply to 7Helena]

Hi,

If your pulse rate is 40 then both Bisopholol and digoxin would not be appropriate as they would get it into the 30s which would be unsafe- I have been in this situation and so can't take either, Your BP is too high at 180 /90 are you being treated with something else for this?

It's good that your GP is aware and stopping this situation- I had to deal with this myself!!

If you have more fruit and veg and do gentle exercise you can get BP down somewhat

[PeterWh in reply to 7Helena]

I think it's time you saw the EP again.

[Mazza23]

My GP only monitors my meds he won't alter them if he thinks they need changing he sends me to cardio

[TenorJK]

Everyone seems to have different meds and of course we all react differently. I could'nt tolerate bisoprolol, never tried digoxin but have been on flecaiainide about 15years it seems to suit me I have PAF..

GPs don't usually change meds but refer back to hospital.

Best of luck.

[Bagrat in reply to TenorJK]

My GP is altering doses of flecainide but I feel one degree under all the time since back on 1.25 bisoprolol.

[bushy2016]

Hi i was told by my consultant to not let anyone other than them alter my medicines

[Dadog]

It's a jungle out there! My cardiologist and his team aren't able to monitor with any accuracy, the effects of any drugs they prescribe. They will do the safe average dosage and send me away. They aren't able to monitor any closer than the next visit, which could be in 12 months time. My GP and I have worked happily together on monitoring and adjusting my Bisoprolol in conjunction with several hypertension drugs and have reached a comfortable place. Bisop is down from 5mg to 1.25mg and everything is ticking away nicely. It isn't difficult if your GP is willing and interested. It's quicker and easier to contact and see him or her if you're not comfortable with your symptoms and adjustments can be quickly made. Works for me anyway.

[rosyG]

I think GPs are allowed to change beta blockers, digoxin etc but not the anti-arrhythmic drugs without consulting the consultant