Cutting out Bisoprolol?

[BigArnie]

All,

I currently take 2.5mg of Bisoprolol twice per day for paroxysmal Afib that typically occurs 1-2 times per week and is usually terminated by 100mg Flecainide PIP within 2-3 hours. Recently I have had some success with lifestyle changes in reducing the episodes (2 in last 30 days) and due to tiredness etc from the Bisoprolol I would like to consider reducing or removing it.

TBH, the Bisoprolol appeared to be a great help when I started taking it around 16 months ago, but I do wonder if it may now be a negative influence.

I suppose my premise is that now I am healthier, perhaps the Bisoprolol is solving a problem that I don't have any more and giving a net negative effect since it makes life/exercise harder and perhaps is bringing my HR or BP too low some of the time, which might in itself prompt an episode. Conversely, I wonder if the speed with which Flecainide terminates the episodes (definitely desirable!) is positively impacted by having the Bisoprolol in my body.

Any thoughts welcome please.

[mjames1]

Until I started taking daily Flecainide, hardly ever took a daily beta blocker like bisoprolol, or a calcium channel blocker except for rate control during afib episodes. The few times I did, I found them counter productive. I would therefore definitely have a discussion with your doctor and ask for a trial period off of it.

Two things to be aware of. First, you will probably want to wean off bisoprolol and not stop taking it suddenly. Second, if you continue with Flecainde PIP you will probably have to take it either "X" minutes before the Flecainide or at the same time of the Flecainide, depending on your doctor's protocol. That's because the the Bisoprolol will act as an AV Nodal Blocker and keep you out of 1:1 flutter which sometimes happens with Flecainide. Alternatively you could use the calcium channel blocker, diltiazem as an AV Nodal Blocker.

I get side effects from both beta blockers and calcium channel blockers and my quality of life is so much better off of them. YMMV.

Jim

[BigArnie in reply to mjames1]

Thanks Jim, that is really helpful. I also take an additional Bisoprolol when I have the Flec PIP.

[Singwell]

Pretty much as Jim says. People here take both as PiP but you need to discuss dose with your cardiologist. Personally I found Diltiazem preferable to Bisoprolol but you have to be careful with dosage and yes, it has side effects. I'm on the lowest dose of Flecainide and not aware of side effects.

[secondtry]

Two points: my cardiologist favours a regular daily dose of Flecainide, as a PIP with regular episodes does not help heart stability. Second, as I was 60 (now 68), active, no comorbidities, I was never put on Biso, so I can't comment on it specifically. I know I am in the minority but can only say Flec only has worked very well and I don't suffer from lack of energy which some members complain of here.

[BigArnie in reply to secondtry]

Yes I can see some logic there. Unfortunately I was very unable to tolerate Flec on a daily basis, which was the first drug that I was tried on. Curiously this was without a matching Bisop daily dose at the time, so I do sometimes wonder.... That said, whilst the Flec PIP is great at terminating my episodes, I do feel the effects in my body for at last 24-36 hours from even one 100mg tablet.

[Kent2007]

I have PAF and was put on Flec, which I used as PIP until I was advised to switch to daily dose (2 × 100), plus 1.25mg of biso., during a period when the PAF was becoming more severe. This was increased to 2.5 as the AF continued. Although I wasn't significantly affected by the biso, I do ask a lot of my body. I am now 5 months past my last AF event and have weaned myself off biso but kept Flec the same. So far so good. Over the last 3 days, I've been rock climbing and cycled around 70 miles (And it's hilly round here). To top it off (my 67th birthday), meal out and a few glasses of wine last night. My run of time free of AF continues. Long may it continue.

[DevonHubby1]

Wife doesn't respond to PIPS or cardioversion so regular doses of Bisoprolol are all that keep the episodes at bay. Due to a lowering of her resting HR they did try reducing her Bisoprolol significantly (from 3.75 to 1.25) but the AF events got far too frequent. She's now at 2.5mg and events are not so frequent and her resting HR has improved.

[saulger]

Hello Arnie. As you know, you should not use hearsay when deciding on medication.But, I can share my experience.

I was also initially on Bisoprolol alone and it worked for about a year.

I was then on Flecainide alone and it worked for about two years.

I then stopped everything, and experienced initially ectopic beats that went away after the heart got used to the new regimen.

But, the AFib would return when I was anxious or after exercising.

I then upped my vitamin D3 to get up to 64ng/mL as Sreve Carr suggests and the heart felt more solid and resilient to stress.

Now I take 100mg Flecainide and 1.25 mg Bisoprolol an hour or two before or after exercising.

I find that exercise makes a huge difference for resilience and stay at maximum heart rate up to 110 bpm, whereas before I was up to 140.

Hope that helps. Saul

[BigArnie in reply to saulger]

Thanks Saul. Yes a big loss for me was running because I found that very often in the hour after a run I would get an episode. This was both when on Flec PIP only and to some extent when on daily Bisop. I do find the pre-run dosing idea quite tempting and will discuss with my cardiologist soon.

[Gertsen]

I think you need to talk to your doctor. I take 1.25 bisoprolol in the evening I also take Dronedarone and the keepThe rate down but I still get AF about once a week lasting fro 30 to 40 hours

[BigArnie in reply to Gertsen]

Thanks Gertsen, yes you’re probably right. In general, the Afib is currently the best it has been in three years, apart from a halcyon couple of months last year in spring before it was upset by my second Covid jab, so I should probably keep that run going before anything too radical… (mind you that was my thinking last spring as well).