Comparing Beta-Blocking Effects of Bisoprolol, Carvedilol and Nebivolol

[Offcut]

Abstract

Objective: Bisoprolol, carvedilol and nebivolol have been shown to be effective in the treatment of heart failure. However, the beta-blocking effects of these drugs have never been compared directly. Methods: Therefore, we performed a randomized, double-blind, placebo-controlled, cross-over trial in 16 healthy males. Subjects received 10 mg bisoprolol, 50 mg carvedilol, 10 mg nebivolol and placebo on the first morning followed by 5 mg bisoprolol once daily, 25 mg carvedilol twice daily, 5 mg nebivolol once daily and placebo for 1 week. Heart rate and blood pressure were measured at rest and exercise 3 and 24 h following intake of the first dose, and immediately before and 3 hours following intake of the last dose of each drug. In addition, effects of the drugs on nocturnal melatonin release were determined, and quality of life (QOL) was evaluated. Results: Heart rate at exercise was decreased at 3 h following intake of the first single dose of each drug by bisoprolol (–24%), carvedilol (–17%) and nebivolol (–15%), and at 24 h following intake of the respective last dose of each drug following 1 week of chronic administration by bisoprolol (–14%), carvedilol (12 h; –15%) and nebivolol (–13%) (p < 0.05 in all cases). Thus, trough-to-peak-ratios at long-term were as follows: Bisoprolol, 58%; carvedilol (12 h), 85%; nebivolol, 91%. Nocturnal melatonin release was decreased by bisoprolol (–44%, p < 0.05) whereas nebivolol and carvedilol had no effect. QOL with carvedilol was slightly but significantly lower than with the other drugs, whereas bisoprolol and nebivolol did not alter QOL. Conclusions: These data show that peak beta-blocking effects of bisoprolol appear stronger than those of nebivolol and carvedilol. On the other hand, nebivolol exerts the highest trough-to-peak-ratio. However, beta-blocking effects of all the three drugs are similar at trough. Only bisoprolol but neither nebivolol nor carvedilol decreased nocturnal melatonin release, a feature which might cause sleep disturbances. Finally, only carvedilol slightly decreased QOL, whereas nebivolol and bisoprolol did not affect QOL. We conclude that different beta-blockers may exert clinically relevant different effects.

karger.com/Article/Abstract...

[BobD Volunteer]

A case of stating the bl**ding obvious I would have thought.

[Auriculaire in reply to BobD]

The melatonin results are interesting. Lots of people here who have not got on with Bisoprolol have said it disturbs sleep. Even more concerning is that melatonin disturbance has been linked to cancer.

[Offcut in reply to BobD]

Not really, I have never been told about Nebivolol! I have a complicated health history and I am now taking 23 tablets a day to try and keep me upright? I was on 10 mg of Bisoprolol due to persistent AF and IPAH. Since being on 7.5mg my sleep is still poor but improved on what I have had.

I try to keep up on what is out there with regards to my many conditions. This information was new to me.

Be Well

[doodle68 in reply to Offcut]

Hi Offcut people are not told about Nebivolol as a possibility when starting BBs, Bisoprolol is the drug of choice for the NHS because it is much cheaper.

I was prescribed Nebivolol because I am asthmatic and it is usually better tollerated by asthmatics than other BBs. It has caused a few comments from the pharmacy which is part of my GPs surgery due to cost .

I don't seem to have a lot of the muscular problems that many taking Bisoprolol experience.

[BobD Volunteer in reply to doodle68]

Nebivolol is very cardiac specific so good for asthmatics. My GP tells me quite a few cardiologists use it.

[Icenae in reply to Offcut]

I have just swapped from bisoprolol to nebivolol. And feel better and realise i am sleeping better. I have af and it really doesnt respond well all over the place. But hopefully helps the mild heart failure. Thanks for the info. I found it interesting.

[Offcut in reply to Icenae]

Nice to hear that it has improved sleep I still have the problem of trying to get my GP to even look at any changes to my drugs, I am complicated with a number of comorbidities plus have to go to a specialist centre in Sheffield for my IPAH

[doodle68]

Hi OC interesting thank you for posting.

I am rather surprised that the trial found ''nebivolol and bisoprolol did not affect QOL''

from what I have observed posting here bisoprolol seems to affect the quality of life of takers far more than nebivolol.

[Offcut in reply to doodle68]

I agree if I would love to get a good night's sleep without taking sleeping pills. Which I do not take that regular due to the addictiveness of them.

Be well

[Tesheron]

I have been taking 3.125 mg of Carvedilol for over a year now. It does not seem to affect my qol nor my rest. It does lower my heart rate although this effect has become less pronounced over time. My understanding it is that it is necessary to take along with my 50 mg of flecainide to prevent atrial flutter.

[reinaway]

All I can add is that nebibolol improved my QOL no end😍

[FancyPants54 in reply to reinaway]

Can you explain why? What did it improve for you?

My legs ache horribly, I have had heal pain for months and foot pain and tingling/numbness of toes and balls of feet. If I push myself to walk the pain afterwards is enough to make me want to cry. I used to be fit. I have to consider the 14 months I've been on Bisoprolol might be the cause of this. But being hypothyroid as well makes it hard to know.

[reinaway in reply to FancyPants54]

The main improvement was in my sleeping which is so important. I had awful nightmares with Bisoprolol where I woke up thinking I was dyeing. It has caused numbness in my feet though but no pain and it has lifted the general feeling of depression that I felt with Bisoprolol. The only problem I have with Nebivolol is that I can only tolerate two particular brands as others cause stomach pain due to the fillers in them.😇

[FancyPants54 in reply to reinaway]

Thanks for that. I think I need to try a different brand or something else to try and bring my resting pulse down a bit. I can't keep on feeling like this. It's horrible. If I vacuum one room that's it for the rest of the day. And my job needs to be physical a lot of the time and I don't do it, so everything gets left. After my cardioversion I had hoped to come off all beta blockers. But for some reason my HR remained high.

[reinaway]

Nebivolol!

[Offcut]

Until the lock down finishes I cannot discuss the change which is a pain. But I do have my PH Specialist states in the letter to the GP surgery that he see's no reason for me not to change? But if it does not meet their costings they will probably refuse me!