Bisoprolol side effects: Hi. This is my first... - AF Association

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Bisoprolol side effects


Hi. This is my first post.

I was diagnosed with AF about 4 years ago and was prescribed Bisoprolol which keeps it under control to a certain extent. I also take perindopril to control high blood pressure and warfarin. Ever since taking bisoprolol I’ve been conscious of side effects getting worse. The worst being unable to climb a staircase without getting out of breath and any short sharp excersise having the same effect. I also have tinnitus which is another possible side effect. Plus I’m quite lethargic. I need to force myself to get on with any jobs around the house. My doctor has changed my Bisoprolol prescription to verapamil in the hope it will not have any side effects. I was wondering if anyone else has had the same experience with Bisoprolol and changed to verapamil and if they found it much better.

Thanks in advance


52 Replies

You just decfribed bisoprolol from what I have heard. Never touched the stuff myself . Devil's spawn some people say..

Auriculaire in reply to BobD

You might have seen the recent news about a study from Imperial which has "proved" that the side effects of statins are due to the nocebo effect ie you get them because you have heard bad things about statins or read the patient leaflet and expect too. A bit like voodoo dolls. Well guess what their next project is for nocebo effect?

BobDVolunteer in reply to Auriculaire

I have said for years that I never get side effects as I never read those slips of paper. Not entirely true as nebivolol slowed my heart too much but that is not a side effect it is what it is supposed to

Auriculaire in reply to BobD

But you do describe Bisoprolol as the "devil's spawn"! The " nocebo effect" study onto statins seems to have totally ignored the fact that there is a perfectly good biochemical and physiological explanation as to why people might experience muscle pain .

bantam12 in reply to BobD

Calling it "Devils Spawn" is surely not helpful or encouraging to anyone newly prescribed 🤦🏻‍♀️

Wightbaby in reply to BobD

Funny that......Bob! Suits me so much better than Metoprolol, which made me "snail like" consultant had said it might!!

BobDVolunteer in reply to Wightbaby

As I said, never had it as it hadn't been invented when I started my AF journey. Only reported what others have said. We ARE all different!

Hello David, welcome to the forum. Bisoprolol is a very effective drug but for some the side effects can be quite troublesome. It will be interesting to hear how you get on with Verapamil but bear in mind it can take a while for the body to adapt to changes in medication......good luck

DavidLyn in reply to FlapJack

Thanks. I start taking it tomorrow. My GP said to give it at least two weeks to see the side effects of bisoprolol disappear.

waveylines in reply to DavidLyn

Hi David, I had simular issues on Bisoprolol to you though mine quickly escalated as the cardiologist kept increasing the dose. I felt sooooo ill. I also switched to Verapamil took a little while to build to the optimum dose for me but I quickly felt the difference as my energy levels improved an awful lot once off the beta blocker. Im on thyroid medication due to an underactive thyroid and for me it turned out the Bisoprolol was interfering with my thyroid meds. We are all different. Hope the Verapamil works well for you.

Welcome to the forum David.

I was on Bisoprolol and found it ok. However for some there are side effects. I think though with many of these med's it can certainly take a few weeks (or more) for your body to adjust. I enquired about Verapamil ages ago and found a review in a US medical journal - the results seemed very positive so I hope it works for you. I'll have a look and see if I can find it again - if so I'll edit the post and include the link.


DavidLyn in reply to Paulbounce

Thank you.

sotolol in reply to DavidLyn

Hi I’ve been in 10 mg of devils spawn lol for 7 months so far so good. Just off to polish my fork. 👿

carneuny in reply to sotolol


I've been on 5 mg of devils spawn now for over 10 and half years. Right in the beginning I was told to take it first thing, then I developed random, full flow nose bleeds.

Saw my GP who looked up in her book of Magic and Witches Potions and Brews and said take it at night. Since then, no nose bleeds and devils spawn and Warfarin are my bestest friends ever.😂🤣😂🤣


sotolol in reply to carneuny

Mine too. I love your answer. I take mine at night it helps me sleep. So a very good potion. Mind you I stir it every few hours before decanting.

My bestie too.

Have a good day as much as much as possible.


Hello David and welcome to our forum.

I was 'stuck' with Bisoprolol for four years as, like so many physicians, mine described it as the drug of choice. Hopefully, your change of drug will have a positive effect. Mine certainly did when I was changed nearly three years ago to Nebivolol.

Your description of Bisoprolol's effects on you were exactly the same as mine - and I took the lowest dose of 1.25mg. Best wishes with the change.

DavidLyn in reply to Finvola

Thank you.

I was on bisoprolol for nearly a year and had initially some side effects that progressed so that l could no longer tolerate them any more. I was changed to Flecainide which was even worse. I am now on Sotorol which apart from lowering my BP and a bit of fatigue has been very good.

Hi David

I switched to nebivolol which certainly has less side effects.

Best wishes


Hello David, I think many people struggle with this drug but that said, it’s such a personal thing. I have very mild side effects from it & couldn’t tolerate an alternative earlier this year after another cardioversion. I was put back on a higher dose (5mg BD) of Bisoprolol & am quite happy with it currently. Funny how this all works.I sincerely hope your new drug works better for you.

Good luck


In had very severe side effects on Bisoprolol do only stayed on it or 8 days even on 1.25 mg. I was on Atenolol for.2 weeks , with less severe but similar side effects, and went onto 120mg mod release verapamil which had no side effects. I was on this for 20 months but my afib progressed and I had more attacks so I moved to flecainide with Diltiazem .Best wishes

Glemham in reply to KMRobbo

I have been having issues with insomnia with Bisoprolol and the cardiologist has suggested I could change to Diltiazem. How do you get on with it? Thanks

KMRobbo in reply to Glemham

Not very well but better than bisoprolol or Atenolol. I was on 200 mg mod release which I thought was too much . I tried 120mg for a while and it was Better but owing to an afib breakthrough ( which was purely owing to me missing an evening flecainide) the hospital put me back to 200mg. It was pointless as my my max HR on 200 was 140 and my max on 120 was 144 ish so it was not a lot different. My problems were tiredeness, some breathlessness (breathing always seemed to be half a minute behind what was required, eg walked up stairs in work no problem and got to the top then suddenly panting to get mybreath back), exercise intolerance, max HR running was 137 and it was agony at that level, poor memory and brain fog. The latter 2 seemed to get worse cumulatively. Post ablation when i stopped the meds it took 4 to 6 weeks before I got back to normal. I was surprised a I believe the drug half life is days. After that period I got my memory back, my focus and concentration and only then realised how bad I had been.

Having said all that other people on this forum swear by diltiazem so dont let me put you off trying it. This reply is just to add to your knowledge....We are all different with drugs.

Not medically trained.

Best wishes

Glemham in reply to KMRobbo

Thank you. You’ve obviously had a very difficult time. I had put up a post before to enquire about any issues with Diltiazem but not had much response. I’ll look for more info on the site. Luckily I only have very mild AF following an op to repair my mitral valve and think the Bisoprolol was prescribed as a precautionary measure when I left hospital. However I don’t want to risk not taking whatever is needed.

Hi David. I've been on it for several years, currently 1.25 mg a day. It made me very sleepy, so much so that I called it a similar name to the one BobD uses -- Devils Drug! Then a blinding glimpse of the obvious : my GP said "Why don't you take it at bedtime?" and that results in my getting to sleep without difficulty most nights. Now if someone could just help me to sleep longer than 3 to 3 1/2 hours and then lying awake worrying for two hours or more almost every night I'd really be ahead of the adverse effects problem....

DavidLyn in reply to jusjay9

I’ve always taken it at night and like you, sleep badly. About 5 hours a night and then feel tired all day.

BobDVolunteer in reply to jusjay9

So some people sleep that long? Best sleep I ever get is in front of TV, especially F1

Hello DavidMy experience with Bisoprolol.

I was diagnosed with AF just over 2 years ago and the initial treatment was 2.5mg of Bisoprolol (and Apixaban). In my naivety I think I expected the Bisoprolol to stop the AF and when it didn’t I went back to my GP and he doubled the dose to 5mg and then 10mg. I understood that 10mg was the maximum dose and the AF continued and I came to realise that it wasn’t going to stop the AF - merely slow the rate at which it was happening.

I had never suffered with breathlessness before and I do now but the worst effect for me is the overwhelming tiredness - every day for the last 2 years I get the feeling “I’ve never been as tired as this before”. It’s difficult to know whether this is due to poor sleep, the condition itself or the medication but the only thing I can change is the medication. To make things worse my optician told me a few months ago that I’m developing cataracts - I have no family history of this and Dr Google ( always dangerous!) had examples of Bisoprolol affecting eyesight.

I was due a medication review last week- this was carried out remotely and I suggested that maybe the dosage could be reduced and maybe I wouldn’t be so tired. The response was that the higher the heart rate, the higher the risk of clots forming so I shouldn’t reduce the dose. I have no idea if this is correct but as I thought about it (after the consultation) I thought it didn’t make sense because the only reason the dose changed was because I said I was still getting AF

I’m now waiting for blood tests as part of the review and am not sure whether to press to change the medication because I can live with it ( just no exertion so no exercise!) but I am concerned re the damage to my eyesight (which could be entirely unconnected)

Apologies for the lengthy post - hope I haven’t bored you too much

Best wishes


You should insist on being referred to an EP who might suggest trying a rhythm control drug or having an ablation. 10mg Bisoprolol is a hefty dose. I felt like a total zombie on 2.5mg and still sluggish on 1.25mg. I now take Nebivolol which is better but it does not work so well to reduce heart rate during an attack so I take 5mg Bisoproplol as a PIP.

cuore in reply to Blueyeltz

Nowhere in your story have you said that in two years your GP referred you to an electrophysiologist. My GP did the same thing, held me for a year to become persistent, then he had no choice but to refer me.

Nowhere have you stated that your GP asked you whether you wanted to live with AF or try to get back to sinus. You had to realize that Bisoprolol was a rate drug and not a rhythm drug yourself. Like mine, your GP has not been up front with you. When I got persistent in one year, I did ask my GP what about rhythm control? His answer was that he was not licensed to prescribe rhythm control medication, yet ,without conscience, he played with the electrical signals of my heart until I got persistent ( I had eleven appointments with him in one year.)

Your GP is not taking into consideration mono-therapy and combo-therapy. In mono-therapy, increasing the dosage generally may increase side effects; in combo-therapy, lower doses of drugs together have the effect of less side effects.

You are young, but if you were old like me, I'd say , with the current path you are on, you would be on the path to persistent. Because of my GP "treatment," I have had to have three ablations so far. I would suggest a second opinion of your treatment and a referral to an electrophysiologist. You might end up persistent and wondered what happened like I did.

Blueyeltz in reply to cuore

Thank you for taking the time to respond- you’ll wish you hadn’t bothered as I bore you with a bit of my history!It all started with me having what I considered to be palpitations but being a bloke I didn’t get round to seeing my GP and after what was probably a panic attack I was told to go to A&E by 111. A cardiologist confirmed that I had AF and arranged for some follow up tests which confirmed that my heart was structurally sound and that I did not have sleep apnea (4.5% of something which had to be 5% to qualify as sleep apnea but excellent oxygen levels). Following this I was back to the care of my GP who had increased the dosage of Bisoprolol within a month of the diagnosis and before any of the tests were carried out.

The cardiologist had recommended I get a Kardia monitor at the initial diagnosis and I obviously did some research so I did ask about flecainide (rate control) and ablation when I saw the cardiologist but I got the impression that they thought I was being ridiculous to even mention it.

You are correct that my GP hasn’t asked me about living with AF but my research had shown that some people have persistent AF and don’t even know about it and I suspected that I was one of those - in the 2+ years I have had the monitor there hasn’t been a single day without at least one reading of “possible AF” although maybe 50% are normal - however in that time I’ve not had a day’s illness or a day off work. The truth is that the majority of the time I’m not aware of it although occasionally I get a bit light headed. I guess that both me and my GP believe that not being aware of it means I’m pretty tolerant of it and surgical intervention would be excessive and the side effects of rate control drugs can be frightening and even make the condition worse! So I guess I’m ok with the laissez faire approach although I would prefer it not to happen at all!

I’ve been a member of this forum for 2 years without posting but the OP asked about experiences with Bisoprolol and that is my major gripe at the moment - I am incredibly tired all the time and have some very minor breathlessness (which I never had previously) so I don’t do any exercises which might make me breathless (I do 50 press-ups and 50 sit-ups a day which is no problem) - hence my suggestion to the GP about reducing the Bisoprolol dose plus, as I said, I’m developing cataracts which may be a side effect- who knows!

If you’ve got this far thanks for taking the time to read

cuore in reply to Blueyeltz

You do not state your age, and you do not state whether you want to have an ablation (you do say surgical intervention would be excessive) or remain on pills for the rest of your life. You do not bore me at all. I stay on this forum to tell people of my experience of how my going into persistent could have been completely avoided, and that it should not happen to them.

If you are getting an episode every day of AF (although you have not stated the rate, because if it is below 100 it could be something else and not AF), you are well on your way to becoming persistent which is a short path to permanent.

It is mind-boggling that that cardiologist sent you back to your GP who is not trained in arrhythmia and not to an electrophysiologist who is. Your GP's entrenched position of doubling the dose is out of fashion. If you wish to remain on drugs and not an ablation, insist that you be sent to an electrophysiologist who can properly medicate you. There is new literature out there that rhythm control is better than rate control, and the GP cannot prescribe a rhythm control pill. If you wish, you can pm me and I will find the articles and send them to you.

Flecainide is a rhythm control pill. Personally, I think you were wise in asking for the drug. I think you hit a cardiologist like my one-visit one who had insufficient knowledge of AF or who didn't care bout AF patients.

You say "the side effects of rate control drugs can be frightening and even make the condition worse!" Bisoprolol is a rate control drug.

And now about symptoms. You do say that you do get lightheaded, and your work is probably mental and not physical. When you are in AF, can you still climb hills and lift heavy objects?

Do excuse me if I say so, but, because you are getting AF everyday, you should see an electrophyiologist as soon as possible to get proper treatment. And, from him/her, you would get proper advice about Bisoprolol.

Blueyeltz in reply to cuore

Thanks for your response. I'm 59 and what I would like is simply not to feel so tired all the time! As I said in my first post I don't know whether that is due to poor sleep, the condition itself or the medication but the only one I can change is the medication - hence my question to the GP about reducing the dose.It's not a case of my getting a single episode every day - it could be multiple episodes - I could take a Kardia reading now and it would tell me "normal" and then in 5 minutes it would say "possible AF" and it would go on like that all day if I obsessed over doing them but I've long since realised there's no point in obsessing over it as I usually don't feel any different when it says "normal" or "possible AF". The normal readings usually tell me my heart rate is between 55-60 and the "possible AF" are usually about 80 although I had one a month ago of 135. When I first had the monitor I did get readings of 140 so I guess the Bisoprolol did it's job in reducing the heart rate.

I am aware that Bisoprolol is a rate control drug - I must have had a bit of "brain freeze" when I said otherwise - I meant the side effects of rhythm control drugs can be frightening. As I said I asked the Cardiologist about flecainide as I was aware that Bisoprolol wouldn't stop AF - merely reduce the rate at which it happens.

You say that if the rate is below 100 it could be something else - occasionally the rate dips below 50 and the monitor says "Bradycardia" but I know that's when I'm zonked out by the bisoprolol so I don't concern myself too much. If not AF what else could it be?

I am a Quantity Surveyor so other than occasionally walking around building sites the most physical aspect of my job is lifting my laptop! The condition doesn't stop me doing anything - I was walking in the Alps last year and as I go in and out of AF all the time I must have been in AF at some point but I was unaware of it.

The light headedness has only really happened after being started on blood pressure medication (Amlodipine) but that's another story! About 10 years ago I went to a "well man" check at my GPs and my BP was a little high (maybe 150/90) but they put me on a 24 hour monitor and it seemed to be OK so they said it was "white coat syndrome" - i.e every time I see a doctor my BP goes up! That's happened a couple of times but last year the GP decided that due to the risks with AF and my getting older they probably ought to start me on BP medication (I declined the statins as my reading was normal). I think that previously my BP trundled along at 125/85 but now it sometimes dips to 100/70 and I think that's when I get light headed but it passes quickly and doesn't affect what I'm doing.

I note your comments about the Cardiologist - the QE Hospital in Birmingham has an excellent reputation in cardiology and the cardiologist did initially suggest he might refer me to a colleague (presumably an EP) but at the conclusion of the tests he must have considered it not appropriate at that time but as the condition is degenerative I guess this advice may change.

As I said I have blood tests due next week and if I can get to see my GP face to face I'll ask again about the medication - it wasn't my normal GP on the remote consultation - it was another GP at the practice that said a higher heart rate leads to a higher risk of clots which does not sound logical to me (I would have thought the opposite!) I guess he didn't know enough about my history and didn't want to sanction changing the medication - much easier to leave things as they are!

Thank you for your comments - I would be interested in the literature you refer to - do you have a link?



cuore in reply to Blueyeltz

This is one of the more recent trials, the EAST-AFNET 4 trial :

You will note that 73 % were asymptomatic.

Oussama M. Wazni, M.D is famous in atrial fibrillation research:

I''m not an MD, so I say this with a disclaimer. It has been said on this forum that you can still be in AF even though your rate is below 100 or it could be ecoptics when you say your rate is 80. Bradycardia is the term used when your heart is below 60, although the Kardia uses below 50 as the threshold. Bradycardia means that your heart is beating slower than the majority. Drugs can get your heart rate down below normal. Keep in mind that it is normal for athletes to have their heart rate in the forties.

In terms of the higher heart rate leading to clot -- when your heart is beating fast in AF, not all of the blood may get pumped out of the atrium to the ventricle which can result in the blood pooling leading to clots . I hope I have that correct because I am going from memory now.

Blueyeltz in reply to cuore

Thanks for that.

It's a bit of a family joke that I've suddenly become an athlete without leaving my armchair! But seriously the fatigue caused by Bisoprolol (?) makes it difficult to leave my armchair.

I understand that blood clotting in the heart is the risk generally with AF but is it more likely to do this if the heart is beating faster? I would have thought it more likely that the opposite was true i.e if its beating more slowly its more likely to lead to pooling

cuore in reply to Blueyeltz

Try looking at it from the viewpoint that, in AF blood, is rapidly coming into the left atrium for oxygenated blood from the lungs but due to the rapid beating (irregular) not all of the blood can get pumped into the left ventricle which is then dispersed to all parts of the body. The blood that fails to get pumped out to the ventricle is susceptible to pooling which results in a clot.

If you put in the address bar "racing heart and clots in the atria" you will find many sites. Here is an example:

This site uses "incomplete cycle" to help understand the clot formation in the atria:

For AF, the focus is on "irregular," and it is the irregularity of a cycle ( a beat) which is fast, not slow, that causes some of the blood to be left behind in the atrium and clot.

I am not an MD, but this is my understanding of it.

Hi David, I was on a gradually increasing dose of Bisop until I was on 7.5 mgs after 4 years. I felt like I was wading through treacle with wellies on. After my last ablation I weaned myself off Bisop but after 7 months of no AF I started to get some episodes of what turned out to be flutter so was put on Verapamil which I have had no side effects from at all and am feeling much more like normal and even able to attend 3 exercise classes a week. Hope it works for you too.

Good luck with your medication change. Does make he laugh when people criticize certain drugs , I'm on Amiodarone and Bisprolol and whilst I have certain side effects I would certainly prefer them than another full blown episode of AF. We are all so very different in so many ways , but I always work on the principle the person who knows you best is the one who has actually seen how your very individual heart works ( often from the inside ) I have been on many different drugs and the current combination seems to be the only one to keep my AF at bay. I think there is a big difference in trusting your cardiologist and knowing when you are just a number. Keep well.

Just to add my experience with Bisoprolol: hadn’t realised until I came off it, after about eighteen months, just how many awful side effects I had been experiencing. I was a new woman once I came off it. Fortunately for me, my Doctor didn’t think the Bisoprolol needed to be replaced with anything.

Hi DavidI took Bisoprolol for two years and the side effect I had was one of Depression, and lowering my heart rate to about 40 beats per min.

I went in for an Ablation and found out I did not have A.F but Flutter and had an Ablation for this I was then put on Verapamil as a caution but now only use it as Pill in the pocket

But am certainly better for not using the Bisoprolol.

Hope it helps.

I have been on Bisoprolol since April. At first I was tired, but gradually it became better. I take it at breakfast time every day. At 75 years of age, I am able to do most things. I call it my `life saver`.

Hello DavidLyn. When I went into Agib in September the hospital put me on bisoprolol, despite me telling then that I had mild asthma. They said it was given as standard, but it made me feel worse! I had to sit for ages at the top of the stairs, my chest felt tight and my GP prescribed a steroid inhaler. I felt like I could only take shallow breaths.

I was changed to Diltiazem

and felt better pretty quickly.

My problem is that although I take two 180mg daily, my blood pressure is still too high!

I hope your new tablet works better for you.


As a matter of interest, when you talk of high BP, what was your reading. Do you monitor it at home?


DavidLyn in reply to carneuny

Hi. It used to run at about 170/90. Perindopril keeps it to around 130/90.

Yes, I do it at home. Today it was 146/109 and pulse was 132. Thanks so much for asking me.

I was on 5mg bisoprolol in the morning I still had lots of AF attacks but only in the evening, my son, who is an emergency doctor, suggested dividing the dose to morning and evening. It worked with no attacks for 3 months and my cardiologist totally agrees. I agree horrible drug though, so lethargic. As to research into side effects of statins being psychosomatic, it was a very poor trial with few participants but like so many headlining poor trials reported in the press

With reference to Nocebo effect generally = A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have.[1][2] For example, when a patient anticipates a side effect of a medication, they can suffer that effect even if the "medication" is actually an inert substance.[1]. - Wikipedia. Which is probably why your doctor will often tell you not to read the possible side effects on the accompanying leaflet, my GP certainly does.

The study of Nocebo is a very recently researched phenomena and it seems the flavour of the day and I believe, not at all well understood. We think we know about Placebo but I’m not sure we really do as there are so many variables which are never adequately explained or accounted for in many studies.

What is clear to me anyway, is that there are both physiological affects from compounds and psychological affects - distinguishing with any certainty which is which seems unreliable as many people will be more suggestable psychological than others.

Yes I read the mentioned study and I will still refuse to take statins, period, thankfully my GP agrees they wouldn’t be a good idea for me, even though my cholesterol level is over the NHS suggested level. To be honest, I’m a bit

My response to Bisoprolol was certainly Devils’ Spawn! I now have Red Alert on my Medical file so that I am NEVER given it again and I know that the affects I had were all physiological.

bantam12 in reply to CDreamer

Has your Dr said anything about taking bile acid sequestrants for lowering cholesterol ? I'm taking one for a different reason but they are prescribed mainly for high cholesterol, it makes up into a pretty horrible gloopy drink but it's working for me 🙂

CDreamer in reply to bantam12

Interesting, no never heard of it. I’m not worried about my higher total cholesterol as my ratio of LDL:HDL is good and Triglycerides are acceptable level. Last bloods total = 6.8 (down from 7.2),

H David Yes I had exactly the same side affects,eventually managed to persuade my GP to change me onto Nebivolol, with in two weeks I felt loads better. I have a friend who has no problems with Bisoprolol so it is just a question of trial and error. Good luck , do hope you get sorted and feel brilliant again.

Most people are under the impression that the Nocebo effect study was only done with 60 odd patients taking a statin.This is incorrect.

There are quite a few Nocebo studies done and one with beta blockers. I forget which one.

There were 1 300 patients in groups A, B and C.

Group A was given a bb but were not told of any side effects or what tablets they were given.

Group B was also given bb only and told they were taking bb.

Group C was told that the bb they are given could cause sexual dysfunction.

Results were;

In Group A 3% complained of sexual dysfunction.

In Group B 13% complained of sexual dysfunction.

In Group C 31% complained of sexual dysfunction.

Psychology was used and over 90% reverted back to bb with no side effects.

They made me feel dreadful I could hardly get around. I operated at the pace of a snail and there were other side effects as well. Shortness of breath, depression, aches and pains. I started to take half and when I went to see the cardiologist I told him how awful I

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