Bisoprolol alternative: I have a new... - AF Association

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Bisoprolol alternative


I have a new diagnosis for Atrial Flutter with AF and am struggling to get it under control. Having multiple episodes of flutter daily and some AFib episodes lasting in excess of 12hours. Finding it all exhausting. I’ve been on High dose of Bisoprolol which I don’t think is working, I’ve been offered amiodarone but am reluctant to change as have read lots of really bad reviews of the drug and the side effects sound hideous. I’d like to go back to the cardiac unit with some suggested alternatives. What has worked well for you? I’m hoping for an ablation but with current situation this could be a while.

28 Replies


Sorry to hear you are suffering. Amiodorone is usually a last resort drug and you are right about lots of side effects It's supposed to be OK for short term use but be advised by your doctors Lots of people here will suggest alternatives to Bisoprolol- which is very safe but doesn't suit everyone. I have used it on occasion to get heart rate down when having AF episode. Hospitals are opening up to non covid patients so do keep nagging if you want to consider ablation- make sure everyone knows frequency of your attacks Stay safe

Bisoprolol didn’t suit me, making me breathless and lethargic on the lowest dose of 1.25mg. I was changed to Nebivolol with excellent results and have been taking it happily for 2 years.

There are related posts on the top right which link to discussions about Bisoprolol alternatives and if you use the search box with bisoprolol you’ll find many threads about its effects on many of us.

What strength of Bisoprolol are you taking ? What is your resting pulse rate?

If it is too strong, my medically unqualified opinion says it can cause you to have more episodes due to lowering your HR too low.

CakeMaker70 in reply to john6

Have gone from 1.25mg (Prescribed for tachycardia 7 years ago) to 7.5mg (Over last 3 months) although was advised to go to 10mg. Have resisted as I feel completely washed out. Resting Heart raTe gone from 60bpm average to 80bpm so now feeling out of puff easily. I don’t think it’s working. And then having to deal with regular fluttering Plus AFib to keep me on my toes. When you write it all down it all sounds pretty dismal. I’d like to speak to the cardiac nurses on Monday and have an idea of a way forward as feel like I’m just existing at the minute.

john6 in reply to CakeMaker70

I was tending to think that the stronger your dose then it would have lowered your HR, which is not the case.

It would appear that it is sedating your body but not your HR for whatever reason, with that in mind I see no reason to take something that is clearly not working for you. I would make a point of notifying them that despite the higher dosage your HR has gone up and not down and that it is impacting on your quality of life.

You may get the "Try this higher dosage ie 10 mg" suggestion, in which case I would be saying that I do not want to be swapping one problem for another - please can we try something else. If they remain persistent then in light of the dosage not working for you I would be suggesting that perhaps it needs further investigation.

I have gradually come off Bisopralol as I believe by slowing my HR, it caused my heart to beat irregularly when exercising.

A few flutters yesterday on a walk so I tried taking 1.25mg to counteract them. It seemed to work after 2 hours.

I am having a 7 day ECG next week without any medication and we can see how that looks. I am interested in the pill in your pocket approach but obviously Bisopralol isn’t the drug for that.

Both my, 3 year apart AFs were when I woke up with it related to extreme stress so I can’t see medication is appropriate

Hi, not a doctor and no answer to your question directly, but... AF is something that you can spend the rest of your life with, in and of itself, I was supprised when my consultant said it may be something in the long term to get used to (assuming it is not an indication of anything else etc.. tec..). Tablets in any form will only suppress the AF, they will never get rid of it, have they spoken to you about cardioversion? That is usualy? the first step and less invasive. Just my thoughts from a random internet stranger :-)

Really your cardiac unit should be suggesting alternatives and the fact that they have jumped straight to amiodarone suggests they think other antiarrhythmics won’t work, however they may just be fans of amiodarone - there are some! I take diltiazem instead of bisoprolol - you would have to take it or bisoprolol if you took flecainide or propafenone because they can be proarrhythmic and you’ve got enough trouble! There are others but if you are keen to have an ablation I should push for that. You might find you are advised/required by your EP to take amiodarone temporarily to increase chances of success so better not to refuse it in that case.

Best wishes 💜

MtLSteven in reply to Buffafly

We only know what we have been told. The Cardiologists may have reasons for suggesting Amiodarone relating to their patients medical history and presentation. As you say it may be a temporary measure.

For What reason did they offer you amiodorone?

What do you take INSTEAD of amiodarone? Did you need to have regular blood work done?

I went through the A - Z of drugs before ending up on Amiodarone. It works but it is toxic and takes a good 6 months to get it out of the system. Side effects and potential damage is not good. Sounds like ablation is only option and keep any use of Amiodarone to less than 6 months

I suffered with persistent atrial flutter for a couple of months prior to my ablation in June last year. You'll find plenty in my posts from that dreadful period of my life that explains what a struggle this condition was for me both physically with exhaustion and dizziness and mentally with anxiety. You have my sympathies.

Luckily, I was well looked after by an excellent cardiologist at Leicester. He explained how atrial flutter was often the worst arrhythmia to suffer and was also the most difficult to treat medically, with amiodarone being the most likely to work. Luckily, he told me, ablation was almost always successful, so that was the route I took.

Before my ablation procedure, however, I found bisoprolol did very little for me, whatever the dose. Some kind soul here had written of their experiences with digoxin, so I asked my doctor about this and, in combination with a much lower dose of bisoprolol, it worked well, and my heart rate was finally brought down and I felt somewhat better.


AncientHouse in reply to Ppiman

Interestingly I was wondering about Digoxin

Easternmost in reply to Ppiman


I finally got a diagnosis of atrial flutter yesterday. I am currently running at about 90bpm as the IV medication failed to bring my rate any lower. I have been recommended to have a heart reset (terrifying prospect) and an ablation. I wonder if you could let me know your experience of this please?

Ppiman in reply to Easternmost

By "heart reset" they mean an electrical procedure ("cardioversion") that I never had in the end, but was considered for. The bisoprolol did the trick, so I didn't need it. The ablation was my first ever time in hospital, but it went fine. It took me a long time to get over it, though. I wrote some posts about it if you search my timeline here.


Easternmost in reply to Ppiman

Hi Steve,

Thank you so much - very interesting to read your other posts. I am a worrier by nature and likewise never had an operation, so a little daunted. I gain faith from the favourable outcomes that I read.

Best wishes

Ppiman in reply to Easternmost

I doubt you worry more than I do. Goodness, I often wish I had a dial to turn it down now and then! Really - there is no need to worry (but I know that won’t help!!). ;-)


Easternmost in reply to Ppiman

Thank you so much Steve - you have made me feel much better, I really appreciate it!

Thank you. This is so like what is happening to me at the minute. High heart rate, Bisoprolol not bringing it down and wearing off after about 10 hours. Fluttering every time I move. Out of Breath so can’t do anywhere near what I used to. And still going into AF with the sweats and physical shaking inside at least 3/4 times a week - some times for hours on end. And to put the boot in I’m now feeling pressured to return to work -a physically active job. You have given me some hope that normal life can return.

Atrial flutter is harder to help with drugs compared to Atrial fibrillation but ablation has a 95% success rate with flutter so ablation is the best answer. There is an extensive video on youtube which mentions this.

Apologies - no idea why link didn't work. The video to look for , if interested is "dr kapil kumawat typical & atypical atrial flutter ablation.

I'll admit it's a long video but at 8min 20 secs it states anti arrhymic medication doesn't usually work for flutter, something I found out myself after 6 trips to A&E before an ablation in March.

Finvola in reply to sandoval22

That’s what my cardiologist told me. I get occasional short bursts of AFlutter, caused, he told me, by Flecainide which controls my AF and said that typical flutter ablation success is in the high nineties.

Great that it has worked for you.


For a few years I was on Bisop. and it left me feeling exhausted all the time, I thought it must be me and persevered but eventually mentioned it to my new Cardio who changed me to Nebivolol which I have been on for about 2.5years, what a difference, I was me again.

I believe that this is a much more expensive option than Bisop. and this is often the reason that GPs don't always offer Nebivolol so I would recommend you speak to your Cardio.

P.S. If you get offered an ablation I would recommend it. Good Luck

Just a shame they didn't tell me that drugs don't work for Flutter. Just got IV magnesium to get my heart rate down then sent home and withing a week I was usually back in A&E.

Flecanide works for me. No breakthrough for many years. 100 mg bid.

Could I ask a question on here as I am a bit confused. I started with atrial fibulation yesterday morning about 11am. I had my usual morning pills late as I over slept and that was 100mg of flecanide and 7.5mg of bisoprolol. Then at 12 I took another flecanide 100mg to try to get rid of the atrial fib. It has been continuous and all day and all through the night. It usually lasts about 8 or so hours before I revert. Also a cold shower and various other methods work but didn't this time.. But last night it changed to fast but regular which I have never had before. So around 115 beatsbut regular on my oximeter. Today I took my usually pills and no change and now wondering about what to do. I feel a bit sweaty but better than when I was in atrial. Do I go to hospital and what could be happening is it flutter that I have developed? I'm over weight not on blood thinners as low Chad score and just taken another flecanide to try to slow it down. I have had one cardioversion in years and no atrial for weeks or months. Any advice would be so helpful thank you ☺️

CakeMaker70 in reply to emmap985

Do you have a contact at the hospital that you are under that you can ring? If ever I have any heart related query I am able to ring the cardiac nurses, or if it is out of hours, I can ring the cardiac registrar. I am under the QE in Birmingham. The advice that they usually give me is that if I feel okay then I am okay to ride it out at home whereas if I feel short of breath or dizzy then I need to go to A&E. I tend to ring them rather than my GP as GP's tend to be more cautious and always advise to go to A&E. Hope you are feeling better though. I hate it when it goes on and on. Take care.

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