Morning. I’ve recently started on bisuprolol after an AFib episode diagnosed in A and E. initially 5mgs and now dropped down to 2.5 mgs daily. They are making me really tired and now I’ve started sleeping in in the morning for an couple of hours extra and groggy afterwards. Also hard to walk for long periods so getting exercise has been limited.
I’m know from this forum that others have changed meds. If so has the tiredness improved for you? And which to recommend?
Thanks in advance Liz x
Dilitiazem is often substituted. Unlike bisoprolol, a beta blocker, Diltiazem is a calcium channel blocker. You might do better on it, worth a try.
That said -- and I really don't know your history -- you might ask if you really need either.
For the first thirty years of my afib journey, I only took beta blockers and calcium channel blockers for rate control when I was in afib. I never took them daily like a lot of people do and I don't think it affected my outcome at all.
Medications have side effects and if they are not absolutely necessary, question them. Especially if you have side effects. I'd ask your doctor for trial off bisoprolol (and no diltiazem) unless they have a convincing reason why you should be on it.
Jim
Hi Jim thank you for your reply. I’ve had one episode of tachy 10 wks ago but probably aome silent AFib before that. I haven’t been able to work out what’s best for me going forward. My AFib nurse suggested lowering the dose of bisuprolol to 1.5 a couple of weeks ago and I guess I’m a bit scared of a repeat of that trip to A and E because of the tachy symptoms that I haven’t agreed to that yet. Also I was advised that repeated tachycardia damaged parts of the heart hence taking them for rate control. When you say it didn’t affect your outcomes by not taking meds for 30 years could you provide a bit more detail about how your AFib progressed. ? Best wishes
I would challenge the afib nurse's opinion that "repeated tachy's can damage your heart" and/or get a second opinion from an ep.
Recently, I had intermittent bouts of SVT, Aflutter and afib for a few year and only took beta blockers or diltiazem to bring down my rate during an episode not on a daily basis. I did ask about if I could cause any damage and they said "no".
But we are all different. I was in my early 70's during that time.
Look, if beta or calcium channel blockers are really needed, then you take them. However, if not, you can improve the quality of your life dramatically without them. So again, ask for a trial off of them. Or perhaps only use them daily when things feel very irritated. And depending on what type of tachy you have, ablation is an option. If the tachy's are on the right side -- flutter or afib -- it's a more minor procedure than the traditional left sided PVI and the success rates are very high like over 95% I believe.
First afib episode around age 40. Next episode 6 years later and the next about six years after that. Then I think it was 4 years to the next. Then 2 years. In my early 70's developed SVT and then aflutter. Now mid 70's and am on daily flecainide as the afib became weekly and lasted longer.
But I had a really good ride, drug free, with great quality of life, for many, many years.
Jim
I also don’t understand how two completely different drugs ( bb and calcium channel blocker) can perform the same functions to control AFib rate and that patients can choose one or the other?
Yes, they can perform the same function for rate control when in afib. They are also sometimes taken in combination. I prefer diltiazem because I don't like the side effects of beta blockers. That said, when I had an afib episode I would take a very small dose of a beta blocker with the diltizem. I found that combination worked best for me until I naturally converted. Just talking about afib here. My flutter and SVT epiodes were under 10 minutes so never took drugs, just waited them out.
Jim
I just noticed you said "patients can choose.."
In the end it's the doctor who writes the prescription, however if you're lucky to have a doctor who believes in shared medical decision making -- and they really all should -- then patient input is taken into account and a decision is made together. In my case, I told my doctor I reacted badly to beta blockers so together we chose diltiazem.
Jim
Really interesting thank you. I don’t know which side I have the AFib I thought everyone had it in the same atria. There’s a lot I need to understand and I thought that repeated tachy could affect the ventricles and result in heart failure. Is this a contested view? I believe my episode was caused by oesophageal spasm which I’d had for a couple of days with a lot of pain before I felt the palpitations. I’ve had reflux for a long time and I think the spasms I get which tbf are infrequent are related to the the reflux/gerd. I’m usually very careful with what I eat and avoid triggers. No dairy, very little wheat ( now going gluten free) maybe a couple of pounds overweight and usually walk a good few miles a week. Getting to know the framework for your own AFib is complicated ! I’d consider no drugs if it wasn’t going to make my heart more vulnerable , whilst it’s still paroxysmal and put up with the symptoms. Looking for the least worse options. Still learning. Best wishes
Afib is a left side issue and is surgically treated by some sort of PVI ablation. SVT is usually a right side issue. Flutter can come from both sides and an ep study is needed to determine where and the best treatment.
I guess it depends what you mean by "repeated tachy". I had SVT and aflutter episodes 1-2 times per week, each 3-12 minutes, for a couple of years and my doctors were not concerned about heart failure. My afib episodes were longer so I took diltiazem and a low dose beta blocker to bring my heart rate down. YMMV.
I also have GERD and they trigger my episodes. So sometimes I take PPI's. Also am on the FODMAP diet.
Jim
Hi Lizzie, I used to feel really tired like you and blamed it on AF, but it was an under active thyroid. Have you had your thyroid checked lately?
Jean
I could not tolerate Bisoprolol. JUST 2.5mg put me to sleep in 40 minutes, for 4 or 5 hours, woke up feeling dreadful hr dropped into the mid forties from 70, max hr massively reduced. Tried atenolol another beta blocker at 25mg ( min dose tablet) a lot better but still bad for tiredness. My GP decided I did not tolerate beta blockers and tried me on verapamil a calcium channel blocker. ( 120mg extended release). I had no issues with that from side effects. Later on in my Afib journey I was on Diltiazem another Calcium channel blocker. That did cause a touch of tiredness but nothing like the Bisoprolol did. However we are all different with drugs. Also be aware the dosage of drugs changes their effecto on you.
My advice woukd be to explore different drugs / dosages with your medics until you get something that works without side effects or is the " least bad" .
Not medically trained.
Best wishes.
Bisopropol didn’t suit me at all! I was changed to 2x5mg Eliquis apixaban twice daily. No side effects and after a successful Cardioversion last Autumn I continue to take it.
Eliquisis is a thinner (NOAC). Cannot be substituted for bisoprolol, a beta blocker. Nor vice versa. Sounds like your doctor just dropped bisoprolol and added Eliquis for a different reason.
Jim
Many thanks for correction - my reply was muddled and your assumption is correct. If I could only get better care in respect of my Thyroid problems perhaps my brain would be less ‘addled’!
Hi Lizzie. When I was first started, four years ago, on 1.25 mg Bisoprolol on its own for AFib, the feeling was that I had just run a marathon. Now I take 1.25 mg Bisoprolol with 50-100mg Flecainide before exercising (and recently nothing at all), and it is tolerated.I feel slightly more breathless with it and my heart rate is a few beats down, but nothing like when I first started, so your body seems to get used to it.
Would you doctor recommend 1.25 mg (it is sold here as 1.25 / 2.5 / 5mg etc) to start off?
Hi Lizzie, Bisoprolol with me on 2.5 I felt tired before I even started my walk…..it was dropped to 1.25 and it’s easier. I’m still not in top gear probably fourth,
I think it’s a well known part of bisoprolol.
My cardio when he reduced it said it wasn’t a big reduction and the lower dose would suffice. Could u ask for a lower dose? Plus this drug takes a while to settle in yoir system with its side effects, I reckon it took a couple of months with me .
Sue
I have slightly different experience. I’ve been on 5mg per day of Bisoprolol for 5 months. Initially started on Metroprolol and had severe headaches and side effects, so switched. Bisoprolol made me tired for the first 2 months or so , but since then I’ve been getting better and better. Not sure if it is something you get used to or not (but also a little concerned about what that means about coming off). One doctor has told me I cannot miss a day, my second doctor advised me to stop taking it… anyway just wanted to share that if you’re feeling tired, it may pass like it did for me.
Bisoprolol didn’t suit me…I took it for eighteen months, decreasing the dose half way through that time. I never got used to it: felt breathless, tired, unwell. Came off it with GP blessing and am so pleased I did.
I take my dose 1.25 mg at night that helped a lot xc
Both me and my wife take it, we both suffer from tiredness, in my case very severe. I was told recently to increase the dose to 5mg. Two weeks later reduced back again as it was slowing my heart to much. I would also be interested in an alternative.
Bisoprolol is pretty much a standard treatment and very similar to any other beta blocker. It might be that your heart rate has been brought down a bit too fast and far (also it has a small effect on blood pressure).
Unfortunately, you won’t now know what your normal rate and BP was, but you could ask your GP if you could drop down to 1.25.mg bisoprolol, which is what I take as needed rather than regularly, and some seem to find even half that effective. As ever, let your heart and your GP be your guide.
If you don’t feel your heart so can’t know if it’s racing or in AF, then taking your pulse manually is well worthwhile (or even buying an Apple Watch or Kardia device).
Steve
Bisoprolol is mainly a rate control drug and will not necessarily stop afib episodes. Some people even find that their heart rate drops too low at night (when heart rate drops naturally anyway )and this actually tips them into afib in their sleep. Putting people on 5mg Bisoprolol after their first or second episode of afib is all too common. It happened to me and I felt absolutely awful - exhausted , breathless and a bad headache would start like clockwork 2 hours after taking the tablet. Women seem to be particularly badly affected by Bisprolol and it can lead to weight gain as well. The longer you are on it and the higher the dose the harder it can be to wean off. As for whether you will relapse into tachy and afib without it on a daily basis the only way is to see. It is highly unlikely that a few such episodes will damage your heart and you can always take it on a PIP basis to bring your heart rate down if an episode strikes. When first put on Bisoprolol I lowered my 5mg dose to 2.5mg and then 1.25 mg with no other effect than losing a lot of the rotten side effects. I then weaned off with my cardiologist's ok ( he said I could just stop but I'm cautious) . Afib did not return for nearly 2 years ! So all that time spared from feeling bad. Afib treatment is about QOL. If the rate control drugs make you feel worse on a daily basis just to stop a couple of episodes a year I personally don't think they are worth taking. What is important is the anticoagulant.
I couldn't tolerate bisopropol and changed to nebivolol which doesn't have such bad side effects. Having tachycardia at a very high rate for long periods of time can damage your heart and put you into heart failure. Even if you don't take a tablet daily, you should have a pip to take if you don't revert naturally into n.s.r.
I’m on 5mg Bisoprolol morning and 5mg night since I came out of A & E in early March, and must admit feel so so tired, breathless. Waiting for my 2nd Cardioversion in the next few weeks fingers crossed. Just an awful feeling and brain fog too
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