1.25mg bisoprolol

[Profound15]

I’ve got my cardio appointment on Tuesday and I suspect that I’ll be going on a maintenance dose of flecainide. The cardio on the last appt suggested that I’ll have to take 1.25mg bisoprolol, the lowest dose. This is due to my blood pressure average being around 115/75. I’m aware that beta blockers reduce your pressure and heart rate a bit (my resting HR is low 60’s). Does anyone know how much 1.25mg bisoprolol will reduce both figures by please. I know we’re all different but it’s just a rough idea I’m looking for. The other option is a calcium channel blocker with the flec but I don’t know if that causes the same drop. Thanks

[BobD Volunteer]

This is an impossible question to answer I'm afraid since we all react different;y to drugs. For example many people find nebivolol a revelation but on even half the lowest dose my rate and pressure dropped to dangerous levels.

You will find that with a condition like AF it is all a guessing game and trying different things till you find one which works for you.

[Hidden]

Try as I can, I cannot remember the reason, if Flecainide is taken as a daily maintenance dose, it must be accompanied with either a daily beta blocker or calcium channel blocker. I think it is something to do with triggering other types of arrhythmias. I know that doesn’t answer your question, but as BobD says, it’s not a question we can answer because we all react differently to different drugs so it’s trial an error. If Flecainide is used as a Pill in the Pocket, we are told it can be taken on its own.....

[Profound15 in reply to Hidden]

Yes I thought that would be the case but thought I’d ask. I’m going to ask the cardio if I can use pill in the pocket when I feel afib coming on rather than when in full blown afib. Afib comes on when I have a sustained period of what I would describe as fluttering. Sometimes this fluttering doesn’t last for 30 seconds and sometimes it doesn’t end up as afib as well but flecainide does seem to really help

[Jalia in reply to Profound15]

I use Bisoprolol as a Pill in the pocket and it works to a degree ....usually start at 1.25 and can titrate up to 10mg . I do not take it on a daily basis as it makes me very lethargic plus I'm already taking an anti arrhythmic drug daily ..Disopyramide.

You really would have to try Bisoprolol to find out the effect on your BP. You would notice within 24 hours....or rather perhaps I should say that I did!

I notice a reduction with just 1.25mg

I can recall an occasion some years ago when a cardiac registrar treated with derision my action plan to take 1.25mg He said that I may as well just put it on a table and look at it at that strength .Not so !

[Profound15 in reply to Jalia]

Thanks for the information. The only way to tell would be to use it as everyone has said.

[DevonHubby1]

All I can say is that GP is currently reducing my wifes daily dose of Bisoprolol from 3.75mg as its dragged her resting heart rate too low (low to mid 40s) but her BP is fine. Dr doesn't know what the right dose is so were back now at 1.25mg and he'll monitor and increase if needed.

[lindat15]

Pre- AF I always had a HR which tended to be on the low side. I was on 1.25 of Bisoprolol( to counteract possibility of Flec causing high rate arrythmia) along with max dose of Flec until my latest review with EP back in Oct. He stopped Bisoprolol as my HR was dipping to very low 40s and also causing my BP to drop on occasion below 90/60 which made me feel awful. As others say it's very individual and probably just need to try it and see. I now use Bisoprolol as a Pill in the pocket. Frustratingly for many it may take a long time to reach an acceptable balance 😏 Hope your appt is helpful.

[wilsond]

HiConfirming what Flapjack referred to: if you begin flecanide it is important to take bisoprolol / other betablocker as a protection against going into Atrial Flutter.

I wasn't given bisoprolol ( or other) when given flecanide in hospital. One week later was back in with flutter!and given bisoprolol.

I have stayed on both since.

But it's impossible to predict if you would be the same,however at least now you know why it is given alongside flecanide .

I only needed 1.25 once a day too for a long time .

Good luck

[Profound15 in reply to wilsond]

Thanks Wilsond. What was the impact of 1.25mg on your heart rate please

[wilsond in reply to Profound15]

It didn't lower it dramatically ,although at the time I had a resting rate of 60-65. It took me about -5 of that. Recently I have had a lot of flutter and it has been increased to 2.5 as I was resting at 90-100( unknown reason) now about 80-85.

Trial and error I expect ? Monitor carefully .

It does make me fatigued so I hope to reduce it again one day if appropriate .All the best x

[Profound15 in reply to wilsond]

Thanks wilsond

[Vince1001]

I take this medication as a weak anti-arrhythmic as I have adrenergic AF so don't know how that compares with your situation. The leaflet said not to take below 60bpm but the NICE guidelines say not below 50bpm. My normal resting pulse is 50- 60, so with Doctor's agreement I started off on initial1.25mg dose (rather than 2.5mg prescribed by cardio). Pulse dropped to 45-55 with no adverse effect though tired at times- BP unchanged at ~ 100/60. Then went to 2.5mg with no probs though AFib still present but with less frequency. Doctor doesn't want to increase dosage any more as doesn't want it to go below 40bpm so I'm just monitoring things and so just optimising my diet. Note that I'm very fit and active so these conditions may not apply to others.

[Hammerboy]

I'm in a very similar situation to you and found Bisoprolol at 1.25 mg daily made me feel very tired and my already low HR drop to around mid to high 40's .My personal solution was to stop taking it daily and just use it as a pill in the pocket when an AF episode started ,which seems in my case seems to help .My eposeds of AF are relatively mild and a year on from a cryo ablation tend to come on about once every 5 or six weeks and last for no more than 5 or six hours .I do get ectopics occasionally but I try not to get anxious .I have one year follow up with my EP later this monthBest wishes

[Profound15 in reply to Hammerboy]

Thanks Hammerboy that sounds like a good alternative and I’ll ask my cardio tomorrow about that option. The only thing I think he might say is that it protects against atrial flutter by constant use.

[Boombiddy]

Hello,

I think we have some similarities so I wonder if my experience with bisoprolol might help you.

I have chronically low blood pressure. For many years I have been on medications to make my BP higher, but I still felt awful when I started on 1.25mg bisoprolol. (As rate control to prevent AF).

My resting heart rate being 60 and sometimes 50, when I started taking bisoprolol it went down to 40's at times but my body adapted eventually.

My cardiologist made a helpful suggestion: take it in the evening. This is because my blood pressure improves (is higher) in the evening (lowest in morning).

Result: Taking bisoprolol in the evening has been really beneficial, because it doesn’t affect me so much in the day, and it helps me wind down in the evening, and sleep better.

Because when first taking bisoprolol 1.25mg. I experienced low heart rates, I found it a bit worrying, I expect you would too, so I would recommend you don’t start taking it at night until you've got used to it.

[Profound15 in reply to Boombiddy]

Thank you Boombiddy

[Zacky19]

Hi, I take 2.5mg of Bisprolol twice per day and my bpm is approx 46/7 which is quite low but BP is normal. I've asked to reduce to 2.5mg per day but was advised not too due to my exercise and risk of VT. As other people say your body gets used to it and will adjust. I don't have any other side effects. Good luck.

[Profound15 in reply to Zacky19]

Thank you

[smwdorset]

Hi i agree that it’s impossible for any of us to say what is good because we are not experts on your unique condition let alone the details of the different drugs and their interactions. However reading your question makes me wonder wh Weber you have yet had a chance to have a proper conversation with your cardiologist and to ask for explanation of the proposed treatment regime and to lay out your concerns . Starting on drugs like these to be taken on a permanent basis is a significant step and you need to understand what they are for - what alternatives are if any ( including possibly relying instead on a PIP) and what the relative pros and cons are . I appreciate that your doctor is a busy man but the principle of informed consent means just that ! To be informed means you need to have a dialogue! So go ahead and ask for more explanation . Good luck to you.

[Profound15 in reply to smwdorset]

Just back from appointment with cardio. My holter showed around 10000 atrial ectopics but no atrial fibrillation. That’s a massive amount to have although this is the worst I’ve ever felt. Upshot is I’m starting regular medication today, 50mg flecainide twice a day and 1.25mg bisoprolol. Am I best to take the flecainide on an empty stomach and the bisoprolol in the evening before bed please

[Boombiddy]

Hi Profound15 ,

I have just seen your question, I didn’t get a notification or would've tried to answer.

Usually the Healthunlocked system notifies if there's a reply/update but I didn’t receive a notification this time, so the system must have been on the blink. This must be why you didn’t get replies to your question.

I'm sorry you've been feeling so awful. Has there been any improvement?

I cannot advise on flecainide because I haven’t any experience of it, but I can say that taking the bisoprolol in the evening has helped, but an hour or 2 before bed so it has time to take effect.

The reason to try the bisoprolol at night is to avoid daytime confusion, but I find a welcome side effect is, taken at night it makes you sleepy.

I do hope you are getting some stability and feeling somewhat better.