Nebivolol timing and low blood pressure

[Finvola]

I take 2.5mg Nebivolol and 200mg Flecainide daily, taking the Nebivolol in the mornings. I have low normal BP but recently have had readings in the 80/50 range which make me feel pretty bad. I drink water and keep my salt level up but every day down it goes about 2 hours after I take the Nebivolol.

Does anyone with lowish BP take their betablocker at night? I have read up on the new research which suggests that taking it at night makes it more effective at lowering the BP during the night - which is not what I need!

I'm going to refer this to my doc - if I can get to him - and would really appreciate anyone's experiences.

[BobD Volunteer]

I'm struggling with nebivolol myself. Even 1/4 of a 5mg pill in the evening sends my HR and BP to the basement after two days.

[Finvola in reply to BobD]

That's awful Bob - my heart rate goes up - usually around 80 when the BP is low. I've been taking it for about 3 years but this carry-on is a new thing in the last few weeks.

[Silvasava]

I'm on 5mg of Nebivolol and I take it at night. I do have low blood pressure on the odd day, today being one of them although it's coming up a bit now. I used to be on 10mg to replace Bisoprolol, TBH I'm still breathless and hav'n't noticed a great deal of difference

[Finvola in reply to Silvasava]

Thank you Silvasava - sorry that Nebivolol hasn't helped your breathlessness, it so limited what I could do when I took Bisoprolol. Sounds good that you can take your Nebivolol at night without trouble.

[secondtry]

My cardio's advice was not to take anything with the 200mgs Flecainide as my pulse was around 60 & my BP 115/65. However that was at 60yo with no other heart issues, his advice may change once I hit 70. Best wishes.

[Finvola in reply to secondtry]

Thanks secondtry -my EP insisted on a beta blocker becAuse I was having runs of AFlutter which he attributed to the Flecainide. My normal BP is like yours but my pulse is usually in the 70's. All the best to you too.

[doodle68]

Hi Fin I was prescribed Nebivolol on diagnoses with AF 4 years ago.

I was prescribed 2.5mg once daily , my BP came down and stayed at a reasonable level in the 120s over75 but with a low heart rate usually in the 40/50s . I was quite ok with that but developed painfully cold feet and legs with some loss of feeling which I attributed to taking a BB , all meds can have side effects so I stuck with it.

When I saw the EP last Autumn he said I should be taking 5mg but I was reluctant to do so because of having asthma also the low heat rate , Nebivolol it is a selective BB so usually tolerated by those with asthma can still cause problems for some .

I take the Nebivolol at night, I asked if it was ok to continue to do so with an increased dose when the heart rate naturally slows and BP drops with sleep , I was worried it might go really low with sleep but he said it would be ok.

In January I gradually increased the dose of Nebivolol to 5mg over a period of time. The problem with my legs has increased, painfully cold and tingling with a loss of sensation not nice at all. I also have increased fatigue and am more wheezy.

I am supposed to take an extra dose of Nebivolol as a PIP when in AF which I did recently so I am out of sequence with taking my daily dose and am taking it in the morning at the moment until I can move it back to night gradually .

I have recently had a few occasions mid morning of feeling awful with low heart rate and BP and feeling faint. I quickly drank some water lay down and raised my legs higher than my heart and felt better. I thought this might be connected to the more frequent chaotic episode of AF some short and slow some normal that have been happening since I had a bad reaction to my second dose of vaccine almost 2 weeks ago.

I would really like to get back to 2 .5mg daily but am worried reducing the dose might cause a problem with my BP or trigger AF . I will move the dose back to night gradually and reduce it slowly.

I don't want to speak to the doctor if I can avoid it and risk being put on some other meds which might have worse side effects.

I am still waiting to try Flecainide now lockdown is easing and I can be monitored taking the first dose.

You could try a night time dose of Nebivolol but I would move it slowly .

[Finvola in reply to doodle68]

Hi doodle - Nebivolol has been a real benefit to me, blunting my ectopics and (fingers crossed) avoiding runs of AFlutter and I'm forever grateful to you and others who shared your experiences of taking it.

I can imagine how awful you must feel with the low BP and a low heart rate - my heart rate seems to go up as my BP goes down! I've done exactly what you describe with water and lying down but it is usually the afternoon before my BP goes up again.

Thank you for the advice about moving my timing - I was thinking of moving my dose by an hour each day and stopping for a while at midday when my BP should be higher than in the morning to see if that works.

I hate to attribute blame to the vaccine but all of this started after my second AZ with runs of ectopics then the BP drop. Co-incidence probably . . . .

[doodle68 in reply to Finvola]

Hi Finvola I was interested to read you take 2.5mg of Nebivolol, I don't know why two GPs and an EP insisted I should be on 5mg when I was doing ok on the lower dose. I read that the correct dose is the one which the patient can tolerate and that the elderly may not need such a high dose . I am a bit cross and wish I had not listened to the Doctors and left well alone. Now reversing the increase is difficult. If Bob is struggling with 1/4 of a 5mg it shows how effective the medication can be.

I too didn't like implicating my second vaccination in the 9 days of chaotic heart events I have been experiencing but it all started 6 hours after having the vaccine which rendered me unable to move for hours then my heart went crazy. I then had 2 days in AF.

Last Monday I suddenly felt ill, my BP was 88/74, HR 38 pulse oxygen in the 80s and I had difficulty staying conscious and considered calling an ambulance but decided to try raised legs and water instead. It lasted some time. I am a great believer in 'see how it goes you will be better tomorrow' and I usually am.

Then another day I felt ill and my BP was high 188/89 and HR 38 it has been all over the place with ectopic and short runs of AF daily. It is only in the last 2 days that things have settled down .

I hope you are ok now and manage to sort out a good time for you to take the Nebivolol

[Finvola in reply to doodle68]

It certainly sounds like a 'third party' is involved in your reaction on Monday - it sounds frightening. I'm glad you are starting to feel better. The vaccine is an unknown quantity to some extent and I suppose various effects can be expected - better than COVID any day though for most of us.

I so agree with the lowest dose of any drug from day one. When I started Flecainide, one cardiologist recommended 50mg x 2 but the EP decided on 100mg x 2 'in the interests of clinical effectiveness'. I tried twice to lower my dose and failed and so regret not being more knowledgeable at the time to ask if I could try the lower dose.

Let's hope the bump is over for both of us but I will move my dose slowly and when I have done that I'll run it past my GP. Like you, I don't want anyone rocking my drug boat - it works at the moment.

🙂

[Silvasava in reply to doodle68]

I'm another one who has cold feet and legs and purple feet when I stand, but I've had them since I started on the various meds for aFib TBH I've not been able to identify which ones have that effect! Some nights it takes ages to get them warm when I go to bed.

[doodle68 in reply to Silvasava]

Hi Silvasava betablockers slow things down including the blood flow to the extremities hence cold hands at feet.I didn't have half as much trouble with my legs, feet and breathlessness until the EP doubled the dose of the betablocker Nebivolol.

[Auriculaire in reply to doodle68]

If you want to go back down you could try going to 3.75 mg rather than back to 2.5 mg straight away. Because of the scoring I find Nebivolol tablets hard to cut but I do manage it. I take my Nebivolol in the evening when I am preparing dinner. My afib attacks are nearly always after dinner.

[doodle68 in reply to Auriculaire]

Hi Auriculaire I took 3.75 /threequarters of tablet when I was gradually increasing the dose and will reverse the process once I am happy this bad period has really settled. I don't have any trouble dividing Nebivolol since I stopped trying too cut them , the secret is to turn the pill upside down with the scoring side facing downwards then snap them with your fingers .

[Auriculaire in reply to doodle68]

Mine changed some time ago so they are no longer just flat with the score on one side. They now have pointy bits in the middle of each quarter on the upper side making them harder to divide!

[doodle68 in reply to Auriculaire]

Mine are the same but I have just noticed the new ones I have yet to try are torpedo shaped with 4 little lines on them they look like a challenge to break..

Edited to Add: I was wrong the torpedoes are easy to break ...

[Silvasava in reply to doodle68]

Thank you for that Doodle, I've been changed from 10mg Bisoprolol to 5 mg of Nebivolol but no improvement on my cold hands and feet Mind you I have no thyroid so that doesn't help either with feeling the cold, never mind, I sported out on a heated throw and I bless it as DH is never cold and I can snuggle to my heart's content!

[Finvola]

That's the truth john6 - every drug and every person taking it produces an infinite number of different reactions. I'm hoping this problem will go away with a bit of tweaking of timing of the Nebivolol.