AF Association
13,279 members16,149 posts

What has it done to you?

It would be interesting (for me anyway) to know what Bisoprolol has done to members pulse rate upon being introduced to it, also what has altered when there has been any increase/decrease of mgs.

I'm on Bisoprolol 5mg. My heartbeat pre tablet of (when well) was 72 to 80 ish, it is now 46 to 52 bpm. My GP of whom I have little faith, wanted to put me on 10 mg! I think that my heartbeat at times is too low on 5 mg - what would it have been if I had not said NO?

Some of the doses on here seem awfully high - does a higher dose slow down pulse rates too much, or for that matter make ones BP too low?

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5mg since July, 2015 after a stroke. 60 ish fairly constantly ever since.

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Hi NickiC, do you know what your normal pulse was prior to present medication?

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I’m afraid I didn’t as I was asymptotic as far as AF was concerned and I thought I was in rude health so never checked my pulse!

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I take Amiodarone to lower my heart rate and keep it out of permanent AFib the Bisoprolol I believe is there for BP which it reduces well

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Bisoprolol is intended to lower heart rate .

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Yes I know but it also lowers BP and that is why I have it, the Amiodarone as I said lowers my heart rate to keep me out of A-FIB

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Amiodarone is a rhythm control drug.

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I do not like to disagree, but that is not what I have read, and not what I have experienced. See for instance aafp.org/afp/2003/1201/p218...

"Amiodarone is considered to be a class III drug (Vaughan Williams classification), which indicates that it prolongs the QT interval. However, the drug has many other effects: **it slows heart rate** and atrioventricular nodal conduction (via calcium channel and beta-receptor blockade), prolongs refractoriness (via potassium and sodium channel blockade), and slows intracardiac conduction (via sodium channel blockade)."

In my threads on Chemical Cardioversion by a bolus of oral amiodarone, I report how I remembered watching my heart rate go down as well as becoming more stable. I took the option to do it overnight under observation, because the consultant feared bradycardia.

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Yes it does have some rate value but primarily it should be used as a last resort rhythm control drug. It should never be used merely for rate control. Read the AF Association fact sheet on drugs.

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I agree it is usually used for rhythm control, and not for use merely for rate control. However, to say that this means it is a rhythm control drug, to me implies that it has no effect on rate. The effect on rate can be very significant -- it is not a minor secondary effect. I supported my assertion with a reference to a quality technical source, and from personal observations, when it brought my heart rate down from 150 to less than 60, in less than 12 hours. Amiodarone is a combined rhythm and rate control drug. The combined effect is particularly useful in AF because you may want to hit both at the same time.

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But should still be a last resort not given willy nilly. I liked the comment from Dr Fey at last years HRC. "Amiodarone does not have side effects. It has effects."

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Do you know what your average HB was before/what it is down to now?

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Sorry missed your question.

My HB is now around 54-58 it was in the high 70’s and obviously a lot higher in AFIB

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I was initially on Bisopralol but it dropped my rate far too low , normal rate 55 , dropped to 38 and I became dizzy, once changed to a different drug things were much improved.

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Hi Dovelady, It appears that you were already outside (unless you were an athlete) of the medically recognised 60 to 100 range. What dosage of Bisoprolol did they put you on? What did they change it to?

Thanks John.

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I Think I was on 2.5 which was halved but still too much and no, not an athlete although the two cardiologists I've seen have both asked me if I had been as a younger person. Bradycardia runs in the family both my sons have it. I was then put on a rhythm control drug Flecainide and got on much better!

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I was taking Bisoprolol for many years.

Eventually I was taken off it because I had a conductivity problem and I developed Bradycardia which when resting meant my heart rate was circa 45bpm. It regularly dropped below 40bpm.

We are all different but my low heart rate was on a dose of 1.25mg per day.

Pete

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I took Bisoprolol some 4-5 years ago. I have very low BP so I didn’t want to take it at all but my GP persuaded me to saying it could help to stabilize my BP. That is the ONLY good thing I can say about it, I felt constantly weak, breathless and tearful with absolutely no energy. It had no effect on my resting HR and no effect on HR when in AF. Resting HR 60 in NSR - 150-180 in AF.

Dose started at 2.5 and crept up to 10mg until I refused to take it. It turned out I had an underlying condition for which any Beta Blocker is contraindicated and I ended up very ill. Evidently I am one of 12 in a million - statistically but as far as I am concerned it is a drug from hell.

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I have just changed from Diltiazem to 2.5mg of Bisopropol. When I started on it, it caused me big problems with asthma and when not in AF caused my HR to drop to 50 and below on occasions. They wanted me to double the dose but didn't until Friday when I was on my third day of AF. It has caused me even worse breathing problems and tiredness so have dropped back to the lower dose. I will be asking to be taken off it.

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Bisoprolol is not recommended for people with asthma problems. There are other beta-blockers which are better.

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Thanks Polska, I will have that conversation with my EP (when I get an appointment).

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Hi Polski - good to know. Do you know the names of the other beta blockers that are better for asthma sufferers?

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Hi john6. I have agreed with my GP that I can adjust my Bisoprolol dose depending on my circumstances. A dose of 5mg held me back, and I could barely canter! My maximum dose now is 3.75mg, a level that I only take when in AF. My HR in AF is generally in the 70’s. When I am in SR I drop the dose to 2.5MG. The problem for me in SR with Bisoprolol is that my HR can drop into the 40’s which I believe is the cause of my dizziness. I have found that when I am in SR there is only a small change in my HR from 1.25mg to 3.75mg. TerryW

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This is basically where I am coming from! Too many medics are happy to put patients on too high a dosage, instead of working from the bottom up ie tweaking it 0.25 at a time. My thoughts are that they should be aiming no lower than the medically recognised 60 bpm, unless of course there are extenuating circumstances. At the moment they are saying that 40s + range is okay ! However they are not imo recognising that BP can/will drop, thus making patients dizzy etc.

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Hi john6. In the beginning (2004) I paid to see a Consultant and he initially put me on 2.5 mg before later doubling it to 5mg. I was initially naïve (and am still definitely not an expert!). The things that I have learned over time is that we are all different; the same drug affects us in different ways; it is in our own interest to increase our knowledge of our issues, and take a degree of responsibility for them and their treatment. Consultants and GPs are busy people and one is unlikely to get the fine tuning that we would all desire without providing direction and challenge ourselves. From our previous discussions my GP has enough confidence in my judgement on the tablets that I am taking to permit me to adjust the dose. I should mention that I am fortunate in that my AF is not of the ‘wipe out’ kind for which I am grateful. TerryW

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I suspect that very many people. like myself, have no knowledge of what their resting heart rate was prior to starting to use Bisoprolol. I was started on 1.25mg daily for two weeks, and then increased to 2.5mg. During that time, I had no records of my heart rate, but did occasionally take my blood pressure. After one day at the higher dose, I found it difficult to climb the stairs at bed time, and felt very weak and wobbly. I took a blood pressure reading that was alarmingly low. The next day I had an emergency appointment with a random GP at my health centre, who put me back on 1.25mg.

Subsequent to that, I was given a Fitbit for Christmas, which has their pulse monitor built in. It's only because of this that I now know my resting heart rate is around 55 bmp average, on that dosage. What it was prior to that, I don't know. I do know that the blood pressure monitor before I ever had AF would tell me a heart rate of 66 to 76 when taking a reading mid morning, but that is not necessarily a 'resting' measure as I always seem to have to wrestle with that gizmo to get a reading at all.

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I have, but I'm not on Bisoprolol. My RHR went from 46.4 before the meds to 44.1 after, which is only 5%. That's on Diltiazem & Flecainide.

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Mind has been adjusted a few times.Currently on 5 mg, 2.5 am and pm.HR similar range to yours.I can take an extra 2.5 if I get an episode of fast HR,which seems a good compromise.

When I was taken off biso abruptly,as I was begun in flecanaide,I went into AFlutter ,and was promptly put back on it.

Some people do do take the higher dose,but it seems your HR is ok.I am not a doctor though!

Do you have any appointments or contact with a heart specialist?or an arrhythmia nurse? They are very good,and if need be will get the specialist to both change meds advise your GP!

Best wishes

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I have an appointment coming up (god knows when) with a cardiologist - perhaps I will get some answers/wisdom. At the moment it feels like DIY.

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I've been on bisprolol for 5 yrs on a dose of 10mg and I've never had any problems. My pulse is pretty consistent about 60bpm which used to be around 90bpm.

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It's a big drop from your normal pulse (33%), however, it is still within a recognised medical range.

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Hi John, went for a check up on Tuesday and was told it was a good pulse rate. It was probably too high before. It's stayed around 60 all the time.

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I was diagnosed with AF 7 days ago and I have been put on 3.75mg of bisopralol. My heart rate is still very erratic fluctuating between 50 and 110. My resting rate was 73 prior to being diagnosed with AF

I have been given no idea of what is normal and what is not. I was sent home from the hospital with a bag of pills and that was it. I'm finding it all very distressing.

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My bpm had fallen to between 33 - 55 and I a regular irregular pulse pattern which then became AF. My bpm and BP have always been on the low side of normal and I have records of what they were. Because of the irregular beats I was put on Ramipril 10mg and Bispropol 5mg,the Ramipril has been dropped to 5mg, and my bpm haven't altered. Four years ago I had a Pacemaker and it was programmed to run at 90 bpm, I couldn't cope with this so it was reduced to 60 bpm and my medication remains the same (I also take Warfarin 8mg daily). I think we are all so individual and different that it can almost be dangerous to "compare notes", we rarely share the while picture. Just my opinion x

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Hi Nickibmibile, It is not so much as actually comparing notes. The point that you make of us all being individuals/different is well recognised on the forum.

I guess what I am trying to find out is this; Many of us have Afib and yet the treatment varies so much. Unfortunately it would seem that the medics often go in too high in terms of dosage. Having done that, they are then in many cases content to go outside of normally accepted guidelines of 60 to 100 bpm, to then tell patients that it is alright. Unless it is an extreme case - I cannot see that is correct.

We have people whose pulse has been reduced by 33%, (that is massive), and others by a lot less into what is medically accepted as being outside of the norm, (imo crazy). We then have tablets being given out by GPs, who really do not have a clue as to what (will) happen, only what (might) happen. In many cases there is no follow up, with patients having to fend for themselves. Unfortunately many are getting into a right old mess, due to misguided faith in the people who should be overseeing us. With this kind of random medicine, it is hardly surprising that a cure has not been found.

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My doctor tried to up mine too but I refused as my heart rate is between 50 and 58 generally x

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My GP can't wait to get me out of his room and either sounds sceptical at any suggestions or questions I ask or just agrees with everything I say!!

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He could be out of his depth. We tend to look to our GPs for answers to our medical problems, thinking that they have them! I know of one very prominent name in our neck of the woods, who apparently sat his medical exams numerous times in order to qualify. He eventually went on to become a surgeon.....with not a very good name.

My point being is that our GP, (mine inclusive) may not be the man/woman with the knowledge to do the job, in turn blagging their way through it at your/my expense. Maybe it is time to change your GP!

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I'm on 1.25 of Bisoprolol and my HR is around 48-52 sitting down. That's not much lower than it was before my AF and CV (in in normal rhythm for the last 3 weeks since my 2nd CV), but I am a runner and was reasonably fit. I'm also on 2.5 of Ramipril in the evenings (Bisoprolol in the mornings) and I don't know whether that has an effect.

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