Beta Blockers: Are beta blockers a must have... - AF Association

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Beta Blockers

tabletphobic profile image

Are beta blockers a must have for afib ? And if so is 10mg Bisprolol or the equivalent 25mg Cardivelol a high dose does anyone know ?

50 Replies

They are very useful if you can tolerate them. Many can't. Yes, 10mg bisoprolol is considered a high dose

Hiya tabletphobic,

It is what it is I'm afraid. My cardiologist who initially diagnosed and treated me put me on 5 mg back in the day, January 2010 and prescribed them to be taken in the morning. I had some initial side effects ( strong flow, random nosebleeds) however, once my GP changed the dose to night time I've had no nosebleeds and no other side effects ever since.

My GP increased the dose to 7.5mg in January 2021 in the belief it will help with my blood pressure. It hasn't !

I am no pharmacist but am led to believe Bisoprolol is primarily used for heart rate control, that's what my cardiologist told me. It holds my HR steady and consistently at around 64 to 67 bpm. Ideal ! I also believe that it has some properties that make it useful for blood pressure control. It is a very tricky drug, once on it, you just can't stop it, must be weaned off it very slowly. From what I've seen written on this forum over the last 11 years most people cannot handle it.

My belief is that 10 mg is a high dose. In hindsight if I were prescribed it for BP control I would seek out an alternative first before scoffing Bisoprolol.


Thanks, I think its prescribed for heart rate following having a pacemaker fitted to balance it out. They got me on 10mg very fast, my stomach couldn't take it. I now take carvedilol spaced out throughout the day, stomach not right but not as bad, very fatigued though, haven't felt well since going on them. I've reduced by a quarter now to see if there's any difference ( with Dr ) not much yet though. It's just the GP said I may be able to come off them but what happens to the afib then ? Interesting that the night time dose helped

Jalia profile image
Jalia in reply to tabletphobic

I'm supposed to take bisoprolol as a 'pill in the pocket ' Monday night went into fast AF at 11.30 so started on 2.5mg and went up to 7.5mg by 11.30 am the next day( yesterday) effect on my rate so very reluctantly went to AE where I was seen immediately , given a further 2.5mg to no effect and then admitted and was cardioverted in theatre early evening!So, 10 mg in 24 hrs, I had some difficulty in walking 🙄

Still feeling effects today but I am staying in a beautiful country house hotel fir a couple of nights in Battle , Hastings. 24 hours ago I did not think this would be happening but heigh ho! I'm in sinus rhythm and the sun is shining!


tabletphobic profile image
tabletphobic in reply to Jalia

Every Cloud as they say😀

I take 2.5 of Bispoprolol for Afib, 10mg would completely knock me out 😳

I had started to notice that most were on 2.5 mg, which made me wonder

I also have a pacemaker and was started on 1.25 of Bisoprolol, went up to 2.5 which I take at night. As I still get SVT my Cardio suggested 5 mg but it made me to squiffy so we agreed to stick with 2.5.

Sorry what's SVT ? Also I never see a cardiologist, just the pacemaker clinic which will not be for another year now. The nurse said follow up with the GP although I got the feeling he was waiting to hear what the clinic said. Its still confusing

SVT is where the heart suddenly beats to fast.I have a 6 monthly check with my Cardiologist and yearly at the pacing clinic but if there's a problem I can call the Cardio clinic and be seen.

Were you not given the number of the clinic arrhythmia nurse ? they are usually very good and can organise any extra tests or appts that you might need.

My GP has nothing to do with my pacemaker or Cardiology stuff, they just say call the clinic if there's a problem !

No I only have the pacing clinic number, the nurse said see the GP for issues.

I guess if Cardiology have signed you off then you are stuck with seeing the GP, you can be referred back if necessary.I wouldn't trust my GP with any of my heart problems, and they don't mess with my meds !

Supra Ventricular Tachycardia. As others said, 10mg is a high dose. Made me like an exhausted zombie so I begged to come off it after 3 months.

Yes, I've come down to 7.5 mg and although still fatigued I'm now not falling asleep as much during the day.

My pharmacist explained that, although cardio specific, Bisoprolol can attach to receptors in the lungs as well as the heart, which causes breathlessness and fatigue.

Oh right, that's good to know

ETHEL103 profile image
ETHEL103 in reply to Ducky2003

Did just that to me.

I would consider 10 mg a high dose. I found 5 mg knocked me for six and the doctor said to half it to 2.5 mg. I'm now off it and on Sotalol - however it's not as effective as Bis (for me anyway lowering my heart rate).

On 5 mg of Bisoprolol my HR would be in the low 60's during the day - perfect. On Sotalol it might drop to 85 (108 bpm this morning) - not perfect. This is at rest but I'm on a low dose (40 mg twice a day). I'm expecting a call any day now and hope they up the dose. I don't mind a week or so of this rate but I don't want it for much longer. I'm being patient at the moment and waiting to hear about the 'fast track' from my cardio's secretary. Echcardiogram booked in for the 24th but I want to lower my HR before then.

TP wrote

"Are beta blockers a must have for afib ?"

This is not meant in any shape or form as medical advice. Beta blockers lower your HR and are 'rate' control. Med's such as Flecaincide can help with 'rhythm' control. They are different and depending on your situation you maybe advised by your cardio to take one or the other - or both.

This is my personal take. We are all different - what's right for me might not be right for you. For me though I want my HR to drop - I'm not to chuffed about these sort of rates. I'll wait another few day's but then it's follow up time. I know I can drop my HR pretty quick (and I have done so sometimes when it's shot up) but self medicating is not the best of ideas. It saved a trip or two to A&E though. 114 bpm per minutes to 77 bpm in 40 minutes everytime. Before you ask I'm not going to go in to detail - if I do I'll start a new thread and let others comment.


No drugs are a ‘must have’.

They are always a choice and hopefully a positive, informed choice. In my view one that needs to be carefully assessed as to the benefits and the risks - which includes making you feel worse than the dis-ease.

I was a definite NO to Beta Blockers.

No choice and no information really

You always have choice. What sort of information are you lacking?

Everything happened so quickly, before I knew it I was in hospital getting a pace maker. Given beta blockers to take home, was told I needed them to balance out the pacemaker speeding up my HR. Never seen a cardiologist since and apart from blood pressure checks early on had a few telephone conversations with GP who quite frankly didn't even have the right info when spoke to him. The nurse at pacing clinic says any issues talk to GP. I am really learning what's going on from this forum and Dr Gupta's ' vlogs ' more than anything else.

PS. I also have Pacemaker and occasional Tachycardia - which I can tolerate quite well. I can’t tolerate the Beta Blockers.

I think they are awful, on anti coagulants as well and don't seem to have any bother with them

I have recently been put up to 10mg bisoprolol following afib diagnosis in April. I was started on 2.5mg after two stents following unstable angina and high blood pressure diagnosis in October. I feel ok on 10mg luckily, though I know many people don’t. It has not yet stopped my tachycardic (probably a symptomatic ) episodes, though has reduced them.

My resting heart rate is down now to between 48 and 64, but I feel ok.

Are they a Must? Definitely NOT in my case. After 22 years of AF without taking them, because my heart rate went to over 190bpm, during an unrelated operation in hospital a hospital doctor put me on a beta blocker. It worked for 7 weeks then I started with the first side effect, it triggered painful urticaria. While I was being weaned off them the second side effect, sudden exacerbation of my asthma landed me in hospital for two nights. There's now a warning on my medical records to not prescribe beta blockers. For my current mainly asymptomatic permanent AF my only medication is an AntiCoagulant, tried and tested Warfarin.

22 years of AF, so it clearly hasn't affected you badly

First 9 years it went undiagnosed. GP said "if it's only now and again don't worry about it. 9 years later it was much more often, advised by a different GP to go to A&E when it next happened. I did, was admitted overnight and next morning was okay. Armed with Amiodarone and an appointment for the ultrasound job on my heart, I went home. I didn't tolerate Amiodarone well. Had 3 emergency ambulance turnouts while waiting to see a cardiologist.Amiodarone stopped, put on Flecainide 50 x 2 a day, rising to 150 x 2 a day during the next two years. On that dose for 11 years until found to be in asymptomatic persistent AF. After discussion with a specialist agreed it was permanent AF.

AF gave me trouble between year 9 and 10. Flecainide and an avoidance of what I deemed were, in my case, triggers, meant I had only one or two short episodes a year.

I have been in permanent AF for about five years.

For the last 47 years I've also had asthma. For about six lymphoedema in my lower legs, a benign prostate problem, and for the last 11 months a malfunctioning / damaged Peroneal nerve in my right lower leg. That happened when I fell downstairs on my bottom with my right leg bent. I had a hairline fracture of my fibula just at the point where the Peroneal nerve passes by. As a result I use a stick to give me confidence when walking outside and I can no longer drive.

However apart from being unable to drive my ailments haven't affected daily living. I do it more slowly than I did in the past. I am nearly 76 yes old and still 6ft 7inches tall.

How can I put this...NO.... There are not MUST with afib. It is your responsibility to get information on afib, medications, side effects, alternative treatments, surgical intervention, doctor "suggestions" (not must take or must do) then weigh all that information against YOUR situation; how does it affect your quality of life. Then once you have as much information, wait a week, and learn some more. Talk to others, and always check with Dr. Google for more information. Once you have immersed yourself and have educated yourself, then you will be able to make an informed decision for YOUR body. Welcome to the Afib world, where everything is possible.

tabletphobic profile image
tabletphobic in reply to Bambi65

I agree with all you have said, I am now starting to realise that I may not drop down dead if I don't take beta blockers. But I know to still be careful and drop doses slowly and note how i feel

Bambi65 profile image
Bambi65 in reply to tabletphobic

i tried it for 4 days and felt tired, sleepy and totally zoned out, like i didnt care about anything. I told my husband (a surgeon) about it and he said "oh, thats probably the beta-blockers". I got off them immediately and went back to normal in 2 days. I can not tolerate feeling like that. The afib was so much easier to deal with.. LOL

I’ve been on 10mg, 7.5 wasn’t cutting it for me, I do feel more stable now. I have PAF & I’m always tired & slightly breathless doing stuff, could be the bisoprolol I honestly don’t know, I just do stuff that bit slower

tabletphobic profile image
tabletphobic in reply to Jgc61

I feel like a different person getting so fatigued for the simplest thing, I hate it

I started on 2.5 but did nothing. Then upto 5 still no good. Now on 7.5 and no side effects. Seem to be doing the job reducing my HR down to a reasonable level. 5mg am and 2.5 mg pm. Works foe me.

I was started on 10mg bisoprolol when I went into rapid AF 2 years ago, and it only reduced my heart rate to about 90bpm and was still very irregular. My pulse became very slow immediately following cardioversion 17 months ago, and despite reducing the dose to 8.75mg soon after, but I've been advised to carry on with that dose. The leaflet with the tablets says that for high blood pressure, doses up to 20mg can be given. It's very individual.

I started on 2.5 mg bisoprolol with 50 mg flecainide (x2) daily for my PAF. After a few weeks, my HR and blood pressure dropped too low and I had a tingling feel in my hands and feet. I then had the bisoprolol dose reduced by my GP to 1.25 mg and I am fine with that.

I would, therefore, consider a 10 mg daily dose of bisoprolol as being quite high (for me anyway).

Originally I was on 10mg Bisoprolol but didn't take to it well. My Arrhythmia Nurse suggested dropping to 5mg but I am also on 100mg Flecanaide twice daily. This has helped immensely taking AF episodes from 2/3 a week to 1 every 2/3wks.

I also use 100mg Flecanaide as a 'pill in the pocket' which for me has been, as recently as yesterday, quite successful. I would say its probably about 90%+ effective.

It goes without saying that everyone will react differently to different medications and it does take a bit of trial and error to get right.

I'm on 7.5 mg for Afib. which may have been triggered by PMR and the steroids I take.

I have had Afib now for over 12 months and was told by the cardiologist he couldn't help me.

I can't feel my fingers and blue toes. I have back spasms which mean I can only stand or walk for a few minutes. My legs are swollen and leaden. I usually end up on all fours climbing stairs. I'm breathless most of the time. Add chronic fatigue to the above and that's more or less my symptoms.

I inadvertently ran out of Bisoprolol last week and found myself doing housework, gardening and some repairs I had been putting off, before cooking the evening meal. I felt great.

My tablets turned up the next day and I seem to have reverted to how I was.

I'm starting to think Swiss clinic.

From what you have said it would seem that it could be the Bisprolol that's causing your symptoms, no need for Swiss Clinic

I've been in PAF for about six years following a mitral valve repair. I have a pacemaker and take 10mg of bisoprolol which I seem to tolerate. But I am terribly breathless and taken together with spinal problems limits my ability to walk more than 50 yards before stopping to get my breath. I get no helpful response from the medics.

I wouldn't like to be so breathless

If it's worth anything, I have been diagnosed with PAF, and initially was put on beta blockers by the ER staff. Made me feel like a zombie. I endured that for 3 days until my GP saw me for follow up. He immediately called the Cardio and EP while I was in his office. Now I know most of you distrust your GP's with a passion, but I've been with mine for almost 20 years, and he is smart and trustworthy. His words.."well, I was wondering why they put you on Metoprolol, it is a BETA blocker,I would have gone for Dilltiazem a CHANNEL blocker...just called my heart people to get their opinion." So, Switched and right as rain ever since. No side effects whatsoever.I realize every afib/person indifferent, but just thought you may want to get a second opinion.

Thanks, sounds like you have a good Doctor

I have paroxysmal Afib and only on an anticoagulant. I take another medication that has possible interactions with beta blocker and antiarrhythmia meds. Thankfully my episodes are few & far between right now.

My first question would be, do I really have AFib? If you go to a cardiologist and you have PVCs or anything like that, they give you the same diagnosis that they give everyone else who walks in the door. They also have the same "treatment" for you that they give everyone else. A lot of these cardiologists are drug happy or even ablation happy-you don't know which one you will get.I would try every natural approach to any heart rhythm or heart rate problem first.

I have had weird beats and PVS since I was 12 years old and I am 62 now.

I observe myself and my heart and i am sure that most of the heart irregularities are brought on by stress or insufficient sleep. When I am asleep, I have no abnormal beats. When I am awakened to early and I start to think about my life, the unusual beats begin.

Check out a Cardiologist named Sinatra. Read all of his stuff and try his natural approach.

I am taking the supplements he recommended and they are helping and they have other benefits as well. I take no "medicine' at all now.

Sinatra also agrees that much of this heart beat annoyance is psychologically or emotionally triggered.

When I read the phrase, " deep sorrow", that alone almost cured me.

If you ask anyone with PVC's or AFib if they have had anxiety attacks in the past, they will say, yes.

To be honest I questioned what was happening, it came on very sudden with strong palpitatons, extreme dizziness this happened twice and then I carried on with less strong palpitations and lighthead. Since then A&E said the palpitations were stomach related and the lighthead was viral related. So I have no idea, they did say I had sick sinus and AV Block. Never heard of this before so not too sure. I'll check him out.

When was your last stress test and echocardiogram?

I don't know what a stress test is and my last ECG was about 3 week ago in A&E

A stress test is standard test in conjunction with ECG to detect heart abnormalities. They hook you up to an EKG monitor, put you on a tread mill, and have you walk..or as in my, for ten minutes and monitor and record the results. If you are not physically able to do either, they administer a drug to raise heart rate to mimic the heart under load.

Oh in that case no I've not had a stress test

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