Bisoprolol

[A-U-B-Y]

Can Bisoprolol be used only when AF occurs, instead of on a daily basis.

[BobD Volunteer]

It is normally used to try to hold heart rate down to ease symptoms when AF intrudes and since the effect is accumulative up to a point it is unlikely the reaction time would be fast enough to help short term. I do understand that some people may take it as PIP however.Since I have never taken it I can't comment on efficacy as PIP.

[Hidden]

Yes it can . I use it as a ' pill in the pocket '. ( not that it does very much but that's just me.....). If I have to attend A E with fast AF which does not abate they always start me on Bisoprolol or continue with it until my dose reaches 10mg

Sandra

[Hidden]

I take it once a day and flecainide twice a day

[jonjub]

I take it daily but was advised this week by my cardiologist to also pop an additional one if i experienced an A-Fib incident that continued for longer than 30 minutes. Not too sure what the next step would be if that didn't solve the problem. However, i am yet to put the theory to the test.

[Finvola]

I'm not a fan of Bisoprolol and thought I could do this but, because I also take Flecainide, my EP said it would not be a good idea. He explained that as Flecainide can be pro-arrhythmic it is important to keep the heart rate down during episodes of tachycardia.

This bears out what Bob is saying about the time lapse before the Bisoprolol would be able to take effect.

[Hidden in reply to Finvola]

Just for the record...when I'm given Bisoprolol in A & E they expect it to take effect within half an hour normally . It appears to be the drug of choice when first presenting with AF !

[Hidden]

I take it daily, at night - 5 mgs. I've taken it daily since first diagnosed way back in Jan 2010. It has kept my heart rate steady at around 63/65 bpm ever since. Can't imagine it would be anything but a limited success taken as PIP.

John

[RobertELee]

As well as taking time to become effective, bisoprolol is also a drug that you should withdraw from slowly, perhaps reducing dosage in stages over a few weeks. Both factors therefore would would seem to suggest it shouldn't be used on a 'casual' basis.

[ILowe in reply to RobertELee]

I have just been researching this. The Medscape site on drugs says that the usual onset of action for tablets is 1-2 hours, peaks at 2-4 hours. Half life is 9-12 hours. For Verapamil -- the one sometimes used for emergency IV control of rate -- tablets, peak at 1-2 hours, half life 4-7 hours. So, I guess Verapamil acts a little faster. Coming off it does not seem to be a problem. The major catch I think -- and we need to look for them -- is that it lowers the blood pressure, made worse by the fact that blood pressure is usually lower during tachycardia and harder to measure accurately. That is why my doctor a few days ago did not want to use Verapamil for Chemical Cardioversion, not even in hospital. The danger of over-reacting was worse than the current problem.

I understand that a single dose, maybe two, is fine. After that, you are right, you need to come off slowly. My guess is that it is like divers who decompress: it is the last step that counts. This needs another thread to work out the details.

[Stinky1953]

I take it as a PIP as recommended by my EP and ahrythmia nurse and i find that it lowers my HR by about 10% in a relatively short time. The down side for me is that when I go back to NSR, like this morning, my HR is 42 which leaves me feeling a little lethargic and tired. As my normal resting HR is around 50 i cannot take it on a regular basis. I don't think it has any affect on the length of time my AF episodes last. I have whilst in A&E been given further doses but it seems to have no affect on the duration of my AF episodes. As others have said we all seem to have different reactions to these drugs.

[A-U-B-Y in reply to Stinky1953]

I was diagnosed with Paroxysmal AF in December after being admitted to A and E with heart rate of 180. I went back into sinus rhythm after treatment with drugs ( I presume Bisoprolol,although nothing was explained at the time).

I have only become knowledgeable of treatments and effects by joining this forum and being able to ask many questions and having so much help and information from you all.

To Stinky 1953 , I'm interested to read that your resting heart rate is around 50 as is mine, and you have been advised not to take it all the time. May I ask if you take any other medications as I only take Bisoprolol 1.25 mg and Apixaban,

Thank you all for your advice

Regards

Auby

[Stinky1953 in reply to A-U-B-Y]

Auby when I was first diagnosed with AF about 13 years ago I was prescribed beta blockers (cannot remember what they were called) which I took for about a month but because they slowed my heart so much I quit taking them. I had been prescribed them in A&E and not by a cardiologist. I was later given flecainide as a pill in there pocket but only tried this once - it sent my HR up from 120 to 190. I had also been unsuccessfully cardioverted on intravenous flecainide - on that occasion my HR went way over 200 and the medics panicked. The only drug I take regularly is 60mg Edoxaban and only because I'm waiting for another ablation. I seem to be peculiarly sensitive to these drugs and try to avoid then as much as possible. My last ablation was in 2011 and was completely successful for 5 years. I only wish I had known earlier about this forum as it would have saved the NHS a lot of money. I used to always take myself off to A&E whenever I had an AF episode but since reading all the wonderful advice on here I am so much more relaxed about the AF and how to manage it. Thank you everyone for all your advice and posts and long may the forum and all of you last.

[A-U-B-Y in reply to Stinky1953]

Thanks for your informative reply.

I see from your reply that you have seen an EP

As the cardiologist that I saw at the hospital doesn't want to see me again! I wonder if it would be advisable for me to see an EP too so that my medication could be sorted out as I'm not feeling too clever on even 1.25 mg of Bisoprolol (this has been reduced from 5mg over the last few weeks ) or should I give the new dose a chance to work . I have been on the lower dose for 10 days

I get very dizzy spells , no energy and have dry eyes, bad legs, sorry I'm getting boring!!,

Any thoughts?

Thanks in advance .

[Stinky1953 in reply to A-U-B-Y]

Auby does your hospital have an arrhythmia nurse - she or he may be able to help otherwise I would get to see an EP or a cardiologist who specialises in arrhythmias.

Tim

[A-U-B-Y in reply to Stinky1953]

Thanks Tim

There are no arrhythmia nurses or EP's at my local hospital where I was treated but there is a specialist heart department at a hospital nearby.

I will discuss with my GP and pay to see an EP privately, I think it will be worth it to sort out the medication.

Thanks again for your advice

Lynne.

[Stinky1953 in reply to A-U-B-Y]

And Auby don't feel the need to apologise for asking too many questions. We all know what its like when one first gets diagnosed.

[A-U-B-Y in reply to Stinky1953]

Thanks for those encouraging words!

[nettecologne]

Bisoprolol can very well be taken as PIP, only when AFIB is on. I have done this with Sotalol and Bisoprolol (not at the same time) and both work. They take my heart rate down, conversion to sinus rhythm occurs later on spontaneously. No drugs can do that for me. Regularly taken for prevention does not work for me, I read that this does not work in case of vagal PAF but only makes things worse. That is what I always found. I take one Biso 5 mg or one Sotalol 80 mg when it comes on and it works within 30-60 minutes. If needed I take another 6-8 hrs later.

Biso is also what is given in hospitals A and E over here when you get there with PAF. So can't be wrong.

[A-U-B-Y in reply to nettecologne]

Thanks nettecologne

I'm hoping that this route will work for me too as I'm not feeling great on a daily dose, too many side effects!!

I will discuss this with my doctor asap

Thanks again!,

[A-U-B-Y in reply to nettecologne]

Hi Nettecologne,

Forgot to ask yesterday.

Do you think this only works when you are younger

I only ask as I'm a 65 year old female, and prior to my diagnosis I was reasonably fit and heathy going swimming 3 times a week , and since on Bisoprolol have very little energy.

Regards

Auby

[nettecologne in reply to A-U-B-Y]

Nope. I'm 57 and definitely not fit. An it works.

[A-U-B-Y in reply to nettecologne]

Hi Nettecologne,

Thanks so much for replying

I'm hoping that this will be the way forward for me.

Regards

Auby

[caos52]

If it helps, I have been given 2.5 bisoprolol for my pill in pocket in case I go into AFTER, to follow with a second tablet some 5 hours later. I am already taking Rivaroxaban daily (20mg) so I have been told only to take the bisoprolol only "on demand". So far 1 month in not had need. Hope it stays that way.

[A-U-B-Y in reply to caos52]

Hello caos52,

Yes it helps to know that it is possible to use when AF occurs.Glad to know that you haven't had need to take it

Thanks Auby

[Mike-tyson]

I was taken off Attenolol when admitted to Stoke Cardiology with af and a heart rate up to 180. They told me Bisoprolol was better for controlling Af. I had a Catheter Ablation last December so things are better now and heart rate between 65-70bpm.most of the time. I have managed to get my doctor to agree to reduce my Bisoprolol to 2.5mg per day from a high of 10mg per day, as it does tend to make me feel tired and strange. If my heart rate does get upto around 80 Bpm which it does at times but not very often, I have taken an additional 2.5mg tablet and it does seem to calm things down within an hour of taking the extra dose.

[A-U-B-Y]

Thank you all for your advice.

Much appreciated.

Regards

Auby