New to Bisoprolol

[Tilly1973]

Hi I have recently been diagnosed with AF. Was told I have prob had it for a few years. I have been told to take Bisoprolol along with blood thinner. I started on 2.5 about a month ago but hasn’t stopped the AF so consultant has said to increase by half a tablet, try that for a week or so and then keep increasing until it settles down. All my Af’a are whilst i am asleep so wondering if it’s best to take at night or split the dose between morning and tea time. Thanks in advance

[rosyG]

You may have vagal af if at night and if so you need to get second opinion about having beta blockers. See Dr Bogles website/ blog on this he is head of medical education at my local hospital.

[Tilly1973 in reply to rosyG]

Hi rosy,

I will have a read. I have seen a consultant who never mentioned that.

Thanks

[Hidden]

Hi Tilly,

I am on 5 mg Bisoprolol and was originally prescribed it to be taken in the morning ( at breakfast). This gave me unwanted side effects of random nose bleeds. Originally people though this was a reaction to Warfarin ..... I never did and so spoke to my GP who then said take it at night. I have had no problems with Bisoprolol in any way shape or form ever since taking it at night. So, after 10 years I am still on the same dose of Warfarin and Bisoprolol as I was in the beginning and still take it at night.

I find your consultants advice a bit odd. Did he mean to cut a tablet in half ? Not sure I follow or has he given a prescription to adjust the doses by the following

Bisoprolol comes in the following pack sizes -

1.25 mg once daily for 1 week, if well tolerated increase to

2.5 mg once daily for a further week, if well tolerated increase to

3.75 mg once daily for a further week, if well tolerated increase to

5 mg once daily for the 4 following weeks, if well tolerated increase to

7.5 mg once daily for the 4 following weeks, if well tolerated increase to

10 mg once daily for the maintenance therapy.

The maximum recommended dose is 10 mg once daily.

I think you'll find that cutting a tablet in half is seriously frowned upon by the Pharmacy profession. If in doubt you could check with your regular pharmacy by way of a mini consultation or a phone call. At no time will you be permitted to go higher than 10 mg.

Bisoprolol is usually prescribed for heart rate control ( but also has application for blood pressure control too). I would be seriously bothered about increasing the dose by half a tablet a time if he meant cutting it in half. On the other hand if he prescribed seperate 2.5 and 1.25 mg packs of Bisoprolol by starting at 2.5 and increasing by 1.25 after a week or so that more or less falls in line with the above. and would be OK, so, what happens when you get to 5mg, did he say to contact him ?

Have a good read of the notes on paper in the pack too.

Just picking up on what rosyG wrote, my AF is definately vagal in origin. That is triggered by a dysfunctional vagal nerve. Its a nerve that acts as an information superhighway between the brain, the heart and the digestive system. So do you find this is hitting you at night some 6 to 8 hours after eating your evening meal ? If so the chances are good that its food or drink the night before that is contributing to your problem in which case you could try modifying your food intake. My other point is as I said I've been on Bisoprolol ( a beta blocker) for 10 years (on 6/1/2020) and my AF is vagal in origin and yes it does work ... holds my heart rate at 65 bpm. Once I have woken up with AF at night ( sleeping on my left side) and at other times, often with a rapid heart rate at night, but no AF. Others on here are also affected by AF kicking in when they are sleeping.

John

[Tilly1973 in reply to Hidden]

Hi john,

Yes the consultant has told me to cut the tablet in half and increase by half a tablet every few weeks if symptoms remain the same.

With it only happening at night I didn’t know if it was best to take the tablet at tea time.

[Hidden in reply to Tilly1973]

Wow! Not for me to argue with your consultant BUT I would certainly query this advice with a pharmacist who would have much more knowledge of the properties of Bisoprolol.

Based on advice I was given and which I still adhere to, taking at night is fine.

Good luck

John

[Tilly1973 in reply to Hidden]

Thanks John

[FancyPants54 in reply to Tilly1973]

I don't see why you can't cut a tablet in half or even quarters, with a pill cutter. Us hypothyroid patients have to do that all the time.

[paolina in reply to FancyPants54]

Tablets here in Padova are usually scored and fairly easy to cut, though I do find cutting a 5mg coumadin (warfarin) tablet in 3/4 a bit of a challange!

[Auriculaire in reply to Hidden]

If tablets are scored they are ok to break up. All thyroxine tablets come scored so that dosage can be tweaked without them having to manufacture umpteen different doses. The Bisoprolol tabs I have been prescribed except the 1.25 have been scored and I get 5mg Nebivolol tablets which are scored to break into quarters. The doc prescribed 1.25mg

[pottypete1]

Seems to me that you need to see a specialist Electrophysiologist Consultant Cardiologist.

Bisoprolol is only a rate control medication. A beta blocker which incidentally I no longer take due to a slow heart rate.

There are rhythm control drugs available which, depending on your diagnosis could be more effective with your AF.

If you see the right person you may also be offered an ablation.

An ablation is a procedure where catheters are fed into the heart via your groin. This procedure uses radio frequency interrupt the chaotic electrical impulses that cause the AF.

Pete

[Tilly1973 in reply to pottypete1]

Hi pete

I have been to see a consultant. They have done an echo and me left chamber is enlarged which means I have had it for a few years.

He has just put me on the list for an ablation but the wait is 9 months. He also said it might take 2-3 attempts for it to work.

It’s trying to get the af under control at the minute with the medication that I am struggling with. As is said I only get the notifications at night. But then it keeps me awake. As I am recently diagnosed you then lie awake worrying about it.

[CDreamer in reply to Tilly1973]

Keep going back. Just keep going back and don’t be satisfied if something doesn’t work for you. Bisoprolol is helpful for those with high HR - it’s not always helpful to take at night unless you know you have a high HR and I know because I tried and BIG mistake. Calcium channel blockers can be better taken at night, but be wary of Beta Blockers at night.

Unfortunately Bisoprolol is mostly the first drug that is prescribed and as mentioned a rate control drug - which doesn’t suit many of us. If Bisoprolol doesn’t work for you then there are other drugs to try. Bisoprolol is particularly problematic for those with asthma, autoimmune diseases and vagal AF.

Know what a drug does - Bisoprolol slows your heart rate and controls your BP and is useful for those with fast AF. Not everyone has fast AF. What is your HR in AF?

Remember that your heart slows at night anyway so I found - wearing a continuous HR monitor that my nighttime AF was triggered by my heart slowing when asleep because I had sleep apnea - Bisoprolol made everything a whole lot worse and I ended up zombie like because my sats would drop as my HR dropped at night and I had constant brain fog. It took me a long time to piece that together.

May I suggest you visit the AFA website for treatment information for AF. Once you are informed about the treatment options you are more likely to have a knowledgeable and meaningful dialogue with your consultant.

You haven’t mentioned if your consultant was an EP (Electrophysiologist)? Cardiology has 4 specialities these days so it’s worth while checking your consultants’ training and speciality as the advice from a general cardiologist can be more conservative than advice from an EP.

Lifestyle changes have been found to be as effective in controlling AF as drugs or ablation for some people as treating underlying causes - sleep, stress, nutrition and exercise can drastically reduce or eliminate the AF burden. I think this especially true for vagal AF.

Read all you can and go with what resonates for you.

heartrhythmalliance.org/afa...

[CDreamer in reply to CDreamer]

PS - if a tablet has a score line - it’s OK to cut into 2. If it hasn’t - don’t try.

medicines.org.uk/emc/produc... For info on Bisoprolol.

[pottypete1]

Yes unfortunately AF does play mind games particularly at night.

Next time you see your EP ask him if rhythm control medication might help you.

Pete

[Tilly1973 in reply to pottypete1]

Thanks pete I will do

[Hidden]

Unfortunately bisoprolol won't stop the AF, it will however slow down your heart rate.

Fast HR is part of AF for many and being like this over a period of time will cause enlargement of the heart.

Slowing it down can reduce the enlargement.

I was in AF with a HR of 195 bpm + for over 3 months.

My heart eventually returned to near normal size

[Bronte23 in reply to Hidden]

How many months/years has it taken for your heart to reduce to its normal size? Was your left atrium enlarged? Did you have an ablation?

Wishing you all the best and and a lovely Christmas,

[Hidden in reply to Bronte23]

Hi, yes my left atrium was enlarged, I think 25% rings a bell.

It was back to normal in 3-6 months.

I have had several cardioversions by shock and by medication and an ablation 2.5 years ago.

I have been in NSR since my ablation.

The cardioversions lasted between 3 weeks and 6 months prior to the ablation

The 6 month one was due to taking amiodorone which I wouldn't recommend.

Happy Christmas to you too and hope you get sorted in the new year

[Bronte23 in reply to Hidden]

Thanks so much. for your prompt reply. I’m so glad you are doing well. I had to really push for an ablation which was initially refused because of my severely enlarged atrium. I’m now three months into recovery from the ablation and so far so good.

[Tilly1973 in reply to Hidden]

Thanks for the information Mike.

Yes I have also had raised heart rate. I have been on Bisoprolol for about 4 weeks now. I am upto 3.75mg. It has brought my heart rate down a bit but I get the odd one that jumps upto 140 when I am resting.

I think my heart enlargement was about 25% in the left atrium also.

What dosage of Bisoprolol did you take?

Do you take anything now?

I am waiting for an ablation but the wait is 9 months.

Did you have Afib until u had the ablation.

Thanks

[Hidden in reply to Tilly1973]

I was on 12.5 mg a day which is 2.5 over the recommended maximum as they could not get my HR down.

I was an absolute zombie!

I was in and out of AF for about 2 years before I got my ablation, cardioversions worked for short periods.

I got off the bisoprolol about a year after my ablation as my HR went in to the low 30s.

All the best

[Tilly1973 in reply to Hidden]

Thanks mike

[Hidden in reply to Tilly1973]

No problem, I know how scary all this is, but there is light at the end of the tunnel

[rosyG]

They don’t all distinguish the type of AF . Possibly because many people have both. But if all at night you need to look at this soon!!