Thoughts on the best beta blocker? - AF Association

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Thoughts on the best beta blocker?

Am seeing the consultant or his juniors tomorrow to discuss my meds am on bisoprolol, Ramipril, and Diltiazem, all three are 10 mg daily for AF but I am becoming breathless. Plus Apixaban twice daily. Any thought on a replacement?

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Well I swapped ramipril to lasartan due to bad cough it caused me I also felt tired all the time but that could have been the Bisoprolol to

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Hi Mickhall, a lot of people have made favourable comments about Nebivolol (betablocker) but my only recent experience is Diltiazem but are you sure you are taking 10 mgs as I thought the normal dose is 120 mgs. When I was first diagnosed, I took 3.75 mgs Bisoprolol and 120 mgs Diltiazem and it felt as if I was walking through treacle....good luck with the GP.....

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FlapJack sorry my mistake my Diltiazem is 180mg

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FlipJack did you take Diltiazem in the morning or night?

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morning, and fortunately no swelling of legs or ankles!

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I take 240mg twice a day. It DOES cause my lower legs to swell. I counteract / prevent the swelling by taking 800mg Hawthorne capsules 3 times a day. does the trick. That's been working for me for over a year. See these:

everydayhealth.com/columns/...

livestrong.com/article/4669...

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Hi Mickhall - I take Diltiazem 180, Nebivolol 5 mg(was on Bisoprolol until 5 months ago) and Ramipril 5mg and Rivaroxaban. I have permanent AF and HF. I changed from Biso to Nebivolol because of breathlessness and this is now much better since the change, pus I feel less tired and more alert. My doses of Biso was upped to 7.5mg a few times since I was diagnosed (nearly 5 years ago) but I cannot tolerate a higher dose, just cannot function, tired all the time and brain fog. Same with Ramipril so now stick with 5mg.

I remember when I first had AF the AF nurse told me that they would get my heart rate down into the 60's as I was on a low dose of Biso 2.5 to begin with and they could go upto 10mg. Thats fine if you can tolerate it, never got my HR into the 60's normally in the 80's but fine by me. I have noticed since taking Nebivolol that my HR and BP have gone down a little, my HR has often been in the 70's recently, so that is good.

I wish I could have changed Bisoprolol several years ago but was always told it was the best one for AF, it was quite a battle to get it changed. Hope you get yours sorted 10mg is quite a heavy dose- good luck.

Cassie

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This whole Bisoprolol versus Nebivolol thing is interesting. Is it money or prognosis? Does Bisoprolol give better outcomes, or does it come down to the doctors simply knowing more about it as it's been around for longer?

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Thanks Cassie this forum is so useful as the opinions of folk like you, FlipJack and others helps me chart my A F journey, (although it is not a holiday vacation that’s for sure;-)

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I am awaiting ablation and currently take Flecanaide and 7.5mg Bisopropol. I want to change the Bisopropol to Nebivolol as I feel tired, depressed and not up to doing anything much at all. In addition it’s messed up my eyesight. Thoughts?

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Krames25 - can I ask how it's affected your eyesight? I'm on 5mg daily and I've been told I'll have to take it for the rest of my life so your comment worries me.

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I am short sighted ( distance) and wear glasses). After taking Biso for a couple of weeks I noticed my vision with the glasses had deteriorated. The cardiologist said it was the Biso that has now been changed to Nebivivol. Hoping this will help.

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Interesting. Thanks for replying. Hope it's better on Nebivolol.

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Bisoprolol is more cardiac intensive. Awful as it is no beta blocker will give better results.

Generic Bisoprolol costs little, unless its Cardicor the original and best.

Phil

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Nebivolol is more cardio-selective. There are two beta-blockers that are even more so, but they are kept for special circumstances.

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Is that why people suffer less breathlessness on Nebivolol? Do you know if the prognosis/outcome is as good as on Bisoprolol, Mike11 ?

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Yes it is. As for prognosis, that is far less dependent on the actual beta-blocker and far more on how well you use it to control your heart rate. After months of me taking BP readings standing and sitting 4 times a day, my consultant and I have come to what we believe is the optimal dosage of nebivolol and ramapril to reduce the strain on my heart to a minimum.

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Thanks. Also Interesting to hear how you've titrated the optimal dosage. I might give that a go myself.

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Indeed, but may be best to talk to the consultant. It turned out I was on too much nebivolol, and too little ramapril, and not taking them optimally across the day so I was having an early afternoon 'crash' in both HR and BP.

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A few of us take Atenolol and generally we seem to like it. It's quite an old drug and perhaps out of fashion. I've taken it since 2002.

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