Why do cardiologists push for the highest dose of Bisoprolol the patient can tolerate?
[Preamble I am a grateful patient, all my treatments worked perfectly.]
Experience 1
Atrial fibrillation diagnosed, and Bisoprolol 2.5g prescribed. I immediately “felt” the drug controlling my palpitations. Heart rate reduced to 110 bpm from 120+. My consultant wanted me to up the Bisoprolol to 15g. I didn’t like it, but I agreed because he is an expert, and I had this (crazy) idea that a high dose may help my cardioversion.
Puzzle: my heart rate stayed the same (110) whether I took 2.5g or 15g of bisoprolol.
Experience 2
Cardioversion works, and restores normal sinus rhythm. My cardiologist now says: "take 5mg of Bisoprolol". The result is my heart rate is down to 45 bpm. I negotiate a dose reduction to 2.5.
N.B. My heart rate stays the same (45) whether I take 5g or 2.5g of Bisoprolol.
All things being considered, I am feeling very good, and coping easily with the new Bradycardia heart rate of 45 bpm. (Years ago it was 70 bpm).
Before I discuss a reduction to 1.25 with my doctor, I wonder if anyone knows why cardiologists push for the highest rate of Bisoprolol tolerated. What am I missing?
Written by
GuyThoma
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The thing that jumped out at me was your dose of 15MG of Bisoprolol. As far as I understand it, the max dose in 24 hours is 12.5mg, but I will try to double check this.
I was started on 2.5 back in 2013 as a ballpark dose. In the end I was on 10 as it didn't really control my rate at all.
When very unstable I've been on 10mg in the morning and an additional 2.5mg at night if required. I was told this was the maximum.
Normal rules are to start anything on the lowest dose possible and titrate up if ineffective, but I don't think these are hard and fast rules. I'm unsure why sometimes it seems to be the other way round.
I usually bite my tongue when I read posts like this, but this time I'm not going to.
I cannot understand why anyone would agree to take medication that lowers their heart rate when those drugs take their pulse as low as 45. You know I see old people collapse in the street, they're taking pills that have probably taken their BP down too low, but because the doctor has prescribed them they think they must take them no matter what! In their minds the doctor is god!
Do you really need to take the Bisoprolol? I think we both know the answer, but for now your doctor wants to make sure your pulse is kept low for your heart muscles to gain strength beating at a lower rate. Perhaps eventually you could just take this drug, or another when you have an AF attack.
A pulse of between 60-80 is ideal and 80-100 acceptable. Unless you are an athlete your level of 45 is not acceptable. Your old pulse rate of 70 mid way between 60-80 was absolutely perfect. So yes I'd certainly want to drop the drug to 1.25.
I've said this before on this forum and I'll say it again. If drugs slow down our heart rate, then I wonder if they slow down other organs in our bodies?
My default position: I respect the opinion of my consultant, and my GP is superb, I trust her implicitly. My body tolerated the increase to 15mg without any side-effects.
After successful cardioversions, a low pulse rate seems not uncommon when taking Bisoprolol to protect against another atrial fibrillation, and, or tachycardia. While too high a Bisoprolol dose, and a slow heart rate, cannot be desirable, I don’t presently have any problems with breathlessness when exercising moderately.
I was interested in your comment Bisoprolol slows the heart, then maybe slows down other organs.
Naturally I will report after I see my consultant in 3-weeks, or if I see my GP next week.
I'm on 5 in the morning and 2.5 in the evening. What do you do if your heart rate is never the same? Mine has been as !ow as 28 and as high as 70+ in the same day. I'm confused! I did have 150 heart rate last year and had always had probs with b.p. I would love to reduce the 15 tablets a day I take but my heart seems chaotic.
I can only speak as I find, but twice I've stopped my 2 x 100mg Flecainide and 2 x 12.5 Metoprolol and my heart has returned to normal rhythm within 1 to 2 days. For me, at times, it seems those drugs can create my AF.
Does your doctor know that your heart rate has gone down to 28? Really feel for you.
My GP guided me to "titrate". At each stage I felt fine so went willingly onto the next level. 2.5 -> 5.0 -> 7.5 -> 10.0 -> 12.5 -> 15.0 mg.
I reasoned that my consultant cardiologist is seeing patients like me every week, thus knows what he is doing. What was lacking was the "why".
He achieved the mission (miracle) of restoring normal sinus rhythm after 10+ months of Atrial Fibrillation, so I have to trust him some more. The nurse restored the rhythm 1st time, with no chest pain or marks. So I am thinking, "This unit has good defibrillation kit, and knows what it's doing".
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