Currently taking bisoprolol 2.5mg. Hopefully going to be having an ablation this year at some point so will 🤞🤞🤞🙏🙏 be coming off this ASAP! I was recommended to go on sotalol by EP but I started to get less symptomatic on the bisop so I said I’d rather stay on this. Just thinking I might be able to rid the fatigue and give myself a back a bit more energy if I change. Also I’ve seen nebivolol mentioned a few times so thought I’d ask about these in a post to get a general opinion.
Just after some advice from anyone who knows about the 3 drugs mentioned, had experience with them or knows any better alternatives that I could try to hopefully rid the fatigue until I can come off entirely 🤞
Thanks guys 👍
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Elli86
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Elli I can only say I felt like I was wading through treacle on 1.25mg bisoprolol really lacking in energy . Couldn’t hack the withdrawal symptoms from biso so changed to Atenolol and much of the fatigue and other symptoms of biso lifted. Still didn’t agree with me and am delighted to be off but it was a better experience for me. Haven’t tried the others but lots of people have made the switch and will be along to help. Problem is you can’t tell what’s what with regard to fatigue when you are on biso in particular and beta blockers in general . Any update on possible ablation ?
Yeah I’m knackered on it as well to be honest. Get tired very quickly. Nowhere near as bad as flecainide and better than my first try with bisop but just thinking I could benefit from switching. In regards to the ablation my docs are now dealing with it apparently. Got a phone call from doc and he said he wasn’t happy with how they’ve gone about it and he’ll sort it as soon as possible. I can’t get through too who I need to speak to at st barts. Keep leaving messages but no one is calling me back 👎
Even though your ablation is in the pipeline I would still see about changing from bisoprolol if it doesn't suit you. The date of your ablation won't be set in stone and you could start feeling better long before then. Your GP, I believe, can change your beta blocker.
Thanks for reply. My EP wanted me to go on sotalol but I said I wanted to stay on bisop as I thought I was starting to improve. When I said to GP that’s what I wanted to do he said I needed to get it in writing from my EP 🙄 they don’t seem to want to go against what the EP says as I don’t think they know what they’re doing or are at the very least not too confident about it.
Ah, I m sorry about that. My GP was very helpful abut reducing my flecainide to use as a PiP and stopping bisoprolol, I probably wouldn't have had the nerve or knowledge to do it on my own. Why not ring your EP's secretary?
Well thing is I say “my EP” but I’ve only actually spoke to him once and he’s private so I paid to see him. I’ve asked a few questions since and had some answered and some not. Seems like now I’m not paying he doesn’t seem to interested. So now I’m waiting to be seen at st barts so I have a point of contact again but after the continual cancellations I’m not too confident about them now either 😩 feel a bit stuck at the minute so thinking about taking the bull by the horns and trying things myself in terms of reducing meds slowly
That does explain it. As you know there are few on here that are medically qualified and we don't give medication advice. But a lot of people have gone the route you are thinking of. Best of luck whatever you decide.
Many thanks Irene. Am much improved at 13 weeks but yes still going through it. Slept through last night for the first time in ages. Have been disturbed by cortisol surges in the night bringing with them palpitations and burning lower legs . Gradually lessened. The vivid dreaming was another disturbing factor that has quietened but not gone. The anxiety is much better . Still get fatigue that comes and goes. Feel like it’s getting better then goes off again . Nothing like initially but not out of the woods . Any of this sound familiar ?
Not the burning legs but yes to tachycardia, palpitations, (I could see my heart visibly thumping through my jumper) and bursts of adrenalin coupled with really odd feelings/sensations of excitement and fear. In the first three months my heart rate didn't go below 75 - 85bpm at rest. I am now down to 65bpm during the day and slightly less at night. Stick with it Peony, you are nearly out the other side, if my experience is anything to go by. Best of luck!
PS I still use bisoprolol with flecainide as a PiP 3 - 4 times a year and have never had a strong reaction, apart from feeling wiped out on the day of the episode.
Many thanks for replying Irene things are made worse when you don’t have a map for where it is going . Still get some hours of elevated heart rate, and bursts of tachycardia in the morning but less frequently by a country mile ! Thanks for the tip about biso as a pip because that would be my first port of call . Still have a few boxes . Fingers crossed the improvement continues and glad you made it out the other side !
I was asleep 40 minutes after every one of the eight 1.25mg Bisoprolol tabs i took. I woke up 4 or 5 hours later feeling terrible with aching chest and arms, and had terrible exercise intolerance being unable to run more than a hundred yards as my max heart rate was so low ( the week previous I was able to run 6.4 miles at 8 min mile pace).I then tried 25 Mg Atenolol for 2 weeks with similar but a lot less severe side effects, before my GP suggested I did not tolerate beta blockers and put me on Verapamil, a calcium channel blocker, which for me had no adverse side effects, but possibly was not as good at rate control. There are other beta blockers to try also, so why not try something different either beta blocker or CCB? The worst result would be returning to what you already take.
Thanks for reply. Yes I think that’s what I’m going to do. I’ve tried flec as well and was horrible so think I may try another bb such as sotalol or nebivolol
My view in drugs was try something, if it's horrible try something else. If I could not have found anything good, I would have gone back to the "least worst". But in the end when the " good" stopped working and I had to try to find a new good drug for rate control and the first one I tried had side effects . I just decided to have an ablation.
Yeah I’m hoping for ablation this year also. Just want to sort meds out for in meantime. Want to come off them all together as in my view they are just a stop gap. I don’t see them as a lifelong thing personally. I don’t think they do you any good in the long run. Do you still take meds even after ablation? How long ago did you have it?
Ablation 3 years 2 months 1 week and 2 days ago. (Not that I am counting 😁) No drugs at all except paracetamol , since May 15th 2018 so not far off 3 years either.
No your clearly not counting 🤣🤣 good on you mate! Seem to be going strong 💪 hopefully mine is as successful 🤞🤞 have you made any major lifestyle changes as well or just the ablation?
Mostly just the ablation. I have lost a bit of weight , and have concentrated on avoiding stress at work as much as possible. (ie how I deal with it)I kept fit any way
I was fine in a few days after the groin had healed and back at work the week after. I was asymptomatic even in high rate AFIB, the only issues were the meds and then trying to get out of AFIB which became more difficult the more I had it.
Unfortunately I then developed re-entrant atrial flutter after 9 days, the flutter rate controlled by the Diltiazem I was taking. There had been no flutter on my previous ECGs, (flutter is obvious by the sharktooth trace) so my EP advised it as probably caused by the flecainide I was still taking for the AFIB in the blanking period. (if you look on your flecainide leaflet you will see a warning it promotes arrhythmias which I thought was bizzare when I read it first time).
Flutter is right atria and I had an ablation for that 3 weeks later and that stopped the flutter and it has never returned , but it was not expected to . Flutter ablations right atria are generally simpler, 95% successful and flutter rarely returns.
I have experience of all three! When first diagnosed with AF several years ago I was started on 1.25mg Bisoprolol. The first prescription was for Cardicor which is the branded version. However, I was given a generic and that caused severe diarrhoea,Next came Sotolol, which caused problems with my vision among other things.
I asked to go back on Bisoprolol, but my prescription stated Cardicor so that was OK.
As time went on, my dose was gradually increased to 2.5mg twice a day.
Eventually about 18 months ago I decided enough was enough and asked my cardiologist for Nebivolol having read about it on this forum.
My cardiologist wasn’t keen and said that it wouldn’t slow my heart rate as well as Bisoprolol. Anyway, I won the argument and have never looked back.
I do agree that Nebivolol probably isn’t as effective as Bisoprolol but I feel much better on it. I use Bisoprolol as a PIP, if AF is fast. Nebivolol is no good for that.
I am quite an unusual case because I don’t tolerate many meds. I seem to get a build up after a few months, which in turn causes AF. Having failed on all of the DOAC’s, I started Warfarin about 6 months ago. Intolerance has just started, severe nausea and currently in AF for 2nd time in a week.
Where do I go from here?
Only you can decide with your doctors what is best for you, but this is my experience of the three drugs in question.
Thanks for the response val. I am very interested in nebivolol and my AF is not particularly fast either. I think the most I’ve recorded is around 150 resting but normally around 110/120. I think it may be worth me trying at least and hopefully I feel better on it with more energy. I’m also interested about trying bisop as PIP and have done another post on this. I think it’s definitely worth a try either way. I was thinking about reducing my bisop to 1.25 to see how I got on and then if no issues hopefully come off and just use as PIP. Haven’t had any episodes since February 16th now so I’m doing well on bisop which is why I haven’t wanted to rock the boat but I think it’s time to try something different now. Just can’t make my mind up which one 🤣
If you use Bisoprolol as a PIP and you are on daily Nebivolol does that mean you are taking both when you have fast AF.Nebivolol does nothin to control my heart rate when in fast AF and I would like to try your method.
Yes that is correct. My cardiologist suggested it because Nebivolol doesn’t slow the heart rate. I don’t always take the Bisoprolol, depends on my rate. Anything up to 130, I don’t take it. My worry is that it reduces BP and electronic monitors aren’t accurate when in AF.This works for me when I need it, but you need to speak to your doctor and suggest it. My cardiologist wasn’t keen on me swapping from Bisoprolol to Nebivolol, but he knows me well enough to know that I was going to stop the Bisoprolol regardless.
Thank you for your reply.I did suggest this to my doctor after reading your post but he says it's one or the other and I shouldn't take both.Just had 4 days of fast AF which Nebivolol did nothing to alleviate so took Bisoprolol 1.25 mg and back in NSR two hours later.It was such a relief! Now doctor has told me to try the Bisoprolol daily again which I don't tolerate.Was on it before changing to Nebivolol but side effects were awful.Think maybe I should have been on a higher dose of Nebivolol as I was only taking 1.25mg. Not sure what to do next as I don't want to go back on daily Bisoprolol.Any suggestions?
I don’t blame you not wanting to go back on Bisoprolol on a daily basis, I wouldn’t go back to that. When you say you spoke to your doctor, was this your GP or a cardiologist? GP’s are pretty useless when it comes to AF. I see my cardiologist privately, so I have easy access to him. Sometimes I just email him. When he replies I forward to my GP if it needs him to change meds etc.All I can suggest is that if it is your GP, you ask for a referral to a cardiologist/EP. The other option is to see a cardiologist privately, then transfer back to NHS.
Came across your article and was wondering how bisoprolol affected you, I too do not tolerate a lot of meds and my cardioligist would like to start me on a low dose because although ablation worked very well am still getting the odd spike of afib lasting usually 10 to 20 minutes. Would rather stay away from another pill but if it will work without side effects worth a try.
I have a lot of intolerances. In some cases I will be fine with a tablet for a few months or longer, then become intolerant to it. I won’t repeat what I have said previously on this thread, but it got to the stage where I was permanently nauseous and really sluggish. If I sat down in an afternoon, I would doze off to sleep. Also very breathless. No energy and generally felt unwell. AF episodes were also becoming more frequent.
In the early days, I had not been able to tolerate the generic versions. I could only have Cardicor. Interestingly, though I didn’t realise at the time, there is a filler in Cardicor, and many other drugs that I cannot tolerate. It’s called crospovidone.
Once I changed to Nebivolol (can only have certain brands), I felt so much better and never looked back.
I found Nebivolol better for eveyday but as Val says it won't slow the heart like Bisoprolol does when having an afib attack. I am running out of the Bisoprolol I had before switching and my GP would not give me a prescription for some more ,as he said the two should not be mixed . I don't think that is right as some people on here use Bisoprolol as PIP even though they take Nebivolol on a daily basis. I will probably have to go back to my cardiologist and see what he says. He might offer Flecainide as a PIP but I really don't fancy that. My afib usually lasts between 8 and 12 hours and runs between 140 - 150bpm. The Bisoprolol will bring it down to about 90.
😬😬😬 no I wouldn’t fancy flec either. Horrible stuff! Doesn’t agree with me at all. I’m thinking bisop PIP might be the way to go. Think I’m gonna drop down to 1.25 and see how it goes. If goes well then hopefully come off all together and use bisop as PIP. I’m really not sure which way to go to be honest. Too many options 🤣
Bisoprolol should be weaned off slowly to avoid rebound palps and tachy. I had no trouble going from 2.5 mg to 1.25 mg. Weaning lower needs to be done in more gradual stages for a lot of people. There are problems in dividing the tiny tablets as well!
Yeah I’ve heard that before. That’s what I told my gp when he took me off the first time round and put me on flec but he said as it’s such a small dose I would be fine so I literally came straight off and went on flec.
Last time I tried 1.25mg bisop it wasn’t enough to keep me in NSR though. Hopefully would be different this time round as I’ve had a decent amount of time in NSR
Take note of what Auriculaire has said about weaning slowly. I tried dropping from 2.5 to half a dose a day and got horrible pounding and higher rates etc. I had to start taking it again because I couldn't stand it. I then asked my GP if I could try Nebivolol and he agreed. I swapped to 2.5 Nebivolol. The switch was a bit rocky for a couple of weeks (I'm in persistent AF so it's always there) but then settled. I much prefer Nebivolol. I'm not as down on it at all and I often can't tell I'm in AF. But it doesn't bring my heart rate down as much. I'm running in the 90's most of the time and that doesn't give me far to go as regards exercise. But as I'm suffering horrible thyroid issues anyway I don't exercise, too knackered.
I was on them longer than that, but you still need to try it slowly. You might be OK. A GP will tell you there's no need to wean off 2.5, mine did. But oh boy was it a rough ride.
Lol I basically was weaning from about three days in. I failed twice and had to reinstate the worst when I was 10 days off . I was advised by cardiologist to switch to Atenolol which is much less likely to cross the blood brain barrier so less centrally mediated side effects . Came off very slowly ( involved a magnifying glass and a Stanley knife blade . ) So from beginning to end I was taking them for 7 months and am now 13 weeks off . A lot of people can just stop without problem you will soon know which group you are . I hope very much you don’t have problems . It caused me to have all kinds of arrhythmia I didn’t have before which have settled
Self administered aspirin I started about 10 years ago when fashion was it was a wonder drug reducing the incidence of various cancers as well as anti platelet . I also take fish oil I have taken since forever and magnesium I started this year
No Elli I am an oddity ( surprise surprise ). I had one episode of AF 8 months ago specifically triggered by an anti inflammatory medicine Celebrex. I took a 100mg capsule ( tiny dose) two days running for back injury then woke up at 4am blown up like a balloon and heart going at 180 bpm couldn’t tell it was irregular it was going too fast . Went into A&E after 4 hours which is when I found out. In some people the Celebrex interferes with the potassium channels in your heart and if you are going to be affected happens after first few doses . So came out on bisoprolol hadn’t liked the cardiologist so went to see one a few days later who said he wouldn’t have put me on anything and I could stop which is when the fun started . So I don’t know if I will have another episode or not . Everyone tells me if you have one more will follow but I do know of people who have had AF due to a specific trigger and it’s just been a one off . I will have to wait and see while following the lifestyle thing . An AC was suggested but said no unless more come along
Oh right I see! So your a special case. Why am I not surprised 😉 well that’s good that you’ve only had the one 😃👍 hopefully it stays that way. How old are you p if you don’t mind a cheeky young git like me asking 🤣🤣
At least ! I had supraventricular tachycardia from 28-33 and never took anything for it and it went away . Ditto with periods of ectopics . Sometimes taking drugs is unavoidable but when told something isn’t dangerous I have sat it out ( not calmly I may add) on the assumption that things can get in the way of the heart healing itself . The biso was a good example of that it caused me to have several arrhythmia i didn’t have before . My son also had SVT for a few years at uni was worse than me was cardioverted on one occasion but his calmed down and he hadn’t had an episode for 15 years . Occasionally things sort themselves out ( not talking about dangerous things here ). Which is why I have great hopes for you as a 34 year old getting past this 🙂
That’s interesting that you basically just left it too sort itself 🤔 I make you right though. Drugs are not always the answer! I can’t stand them to be fair, I just think they cause more problems that you end up having to take more drugs to sort! Vicious cycle.
I’m glad you optimistic about me getting better 😃👍 I’m fairly confident I can sort myself out with a VERY strict lifestyle and hopefully get off the drugs, possibly with an ablation as well.
If not I’ll just have to pray to one of the many gods every night. Problem is there are so many, which one do you go for? 🤣
You can’t just leave it if you are in frequent AF. A friend of mine developed post viral AF when he was about 40. He had an ablation about 15-20 years ago and nothing since absolutely fine . Do all the lifestyle stuff and put yourself in the best place for if you have your ablation . You might do better praying to your EP or St Bartholomew in this situation !
Thanks for advice. Still deciding what to do 😬 my tickets been chugging along at the minute 🤞🤞 7 weeks since last episode. I know that the longer you can stay in NSR the more chance your heart has got of staying there. Hard decision. Need st barts to hurry up and stop messing me about so I can get in there and have a chat about my options
Don't think it was me. All sorts mess up conversion. I've got the Dio2 problem with mine. I had conversion problems long before beta blockers came into my life.
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Change from Bisoprolol to Diltiazam. 
Amiodarone or Sotalol
