Question about beta blockers - see edit

Hi all you knowledgeable people out there - I have a question. I've been prescribed Bisoprolol 1.25 mg as PiP but my problem is that my HR is usually pretty low, typical resting HR is low 50s and goes down to 43/44 when sleeping. Bisoprolol seems to take quite a while to 'kick in' and lower HR when I need it to but then stays in my system for ages, which results in HR down in the mid 30s at night.

Does anyone know of a beta blocker that is quick acting but has a short half life?

Thank you.

EDIT: Thanks so much to everyone who has replied, but I should preface this by saying that I, relatively speaking, have 'minor' episodes, as in my HR doesn't go that high compared to most, and my episodes don't last that long 8-14 hrs before spontaneously converting. I really was just looking for a simple answer as in a beta blocker that's not that strong that works quickly and passes out of the system quickly.

[Gumbie_Cat]

I can’t help but will be interested to hear the answers. I have a similar resting heart rate, and have just come off dronedarone - which had lowered it into mid 40s. I don’t know what it is during the night, as I take my watch off.Getting an echo next week, and all being well, they will prescribe Flecainide plus Bisoprolol as a PIP. I’ve been told that the Bisoprolol is to help prevent the Flec causing atrial flutter.

I’m also on the waiting list for a cryo-ablation. It seems like a low resting heart rate can complicate the medication route. The procedure does worry me, but I’m trying to balance up the benefits - getting it done before this progresses further seems to make sense.

[pottypete1]

I was taken off Bisoprolol because my heart rate pattern is very similar to yours.

Maybe you should discuss this with your EP if you have one.

Beta Blockers regulate (slow) the heart rate.

Pete

[Hidden in reply to pottypete1]

Hi Pete - no, I don't have an EP, but thanks for replying

I'm only prescribed PiP as I have a low HR

[Hidden]

Hello Helen, I’m not medically trained therefore as I’m sure you are aware, not able to advise on prescribed medication. I assume you have paroxysmal AF and that you have been asked to take the Bisoprolol when you experience an episode. Your heart rate is obviously low normally but do you know what the rate is during an episode. It would be helpful to know who prescribed taking Bisoprolol as a PiP, was it your GP or a cardiologist/electrophysiologist……

[Hidden in reply to Hidden]

Hi FlapJack - yes, I have PAF and was prescribed it by a cardio over the phone, which is the only input I've received thus far. I was just wondering if anyone knew of any alternative that I can ask my cardio about as, as I've said, Bisoprolol (which is the go to, it seems like) takes a while to work but then stays in my system for a long time which makes me loathe to take it any time unless I have an episode first thing in the morning, which has only happened once.

[Hidden in reply to Hidden]

I’m off to have a blood test but will get back to you later. It would be helpful if you knew what your heart rate is during an episode…….be back in about an hour or so…….

[jeanjeannie50]

Hi Helen

My very experienced AF nurse told me that Bisoprolol taken once daily has an equal strength over 24hrs. Metoprolol which I take has a 12hr life and starts off low and builds up to a peak of strength at 6hrs then goes down again, so needs to be taken twice daily. Metoprolol may be the drug for you, but seek medical advice. It has a strong effect on me and comes in 50mg pills, so I just take a quarter of one being 12.5mg.

Jean

[Hidden in reply to jeanjeannie50]

Thanks, jeanjeannie! That's useful to know, but doesn't sound like it's going to be for me though as ideally I need the HR lowering effect immediately rather than 6 hours in. My AFib episodes typically last about 10-14 hrs and HR is highest right out of the gate.

[jeanjeannie50 in reply to Hidden]

A lot of people are prescribed it for AF attacks. I've also had Sotalol as a pill in the pocket, which is a mixture of a heartbeat rate corrector and a beta blocker to slow it down.

Jean

[Hidden in reply to jeanjeannie50]

Hmm....interesting! I actually have my first appointment with a cardo next week so will be discussing all and any options. I've very interested in what's available as a rhythm corrector to be used as PiP so I'll bear that in mind and see what he says.

Edit: I just looked it up - not suitable for people with low BP & HR, which would be me. Thanks for replying though!

[pottypete1 in reply to Hidden]

Hope the Cardo is a cardiac electrophysiologist (EP) specialising in heart rhythm problems.

Let us know how you get on.

Pete

[Hidden in reply to pottypete1]

Hey Pete -No chance! It's taken a year for me to get more than a phone call, and I had to do some jumping up and down to get that. I will be asking for a referral to an EP but I'm not holding my breath.

[pottypete1 in reply to Hidden]

It is so hard isn’t it.

I first had AF 33 years ago and it wasn’t until I moved house 17 years ago that I was referred to an EP at my now local centre of Cardiac excellence that I finally was put under the care of an EP specialist.

I have been a patient there since then having had numerous procedures to address my issues. Now they are an open door to me.

I totally understand how difficult it is to get onto the list of these specialists.

Incidentally it is Flecainide that I use as PIP as necessary, as I said in my earlier reply I am banned from taking Bisoprolol now as I have Bradycardia (slow heart rate)

Pete

[Hidden in reply to pottypete1]

33 years??! That must make you some kind of resident expert! I'm just a baby scooting along in my baby walker here

So you don't take a beta blocker PiP with the Flecainide?

[pottypete1 in reply to Hidden]

No I do not take a beta blocker because I have conductivity disease resulting in Bradycardia. I used to until things changed.

Since my last ablation 5 years ago I have gradually had AF less and now it is very rare for me which after all my years of regular AF is very good now.

Pete

[mjames1]

We use Metoprolol Tartrate in the US instead of bisoprolol. Metoprolol has a shorter half life. There's also Diltiazem, a calcium channel blocker, that will also lower your heart rate when in afib. That's what I take. It also has a shorter half life than bisoprolol.

Jim

[Stentrunner in reply to mjames1]

Me too. My GP persuaded the cardiologist to use diltiazem instead of bisoprolol. An added benefit was that I could stop taking amlodipine for my BP. Diltiazem does both. I’ve been very pleased with the outcome.

[mjames1 in reply to Stentrunner]

I'm glad that worked out for you. While diltiazem can be used for bp control, amlodipine is stronger and I had to use both. Curious, how much diltiazem were you taking?

Jim

[Stentrunner in reply to mjames1]

Quite low dose I was on 5mg Amlodipine. Now on 60mgx2 Tildiem.

[mjames1 in reply to Stentrunner]

That just goes to show how we will react differently to drugs. 5 mg amlodipine lowers my bp pressure but 120 diltiazem does not.

Jim

[Hidden in reply to mjames1]

I looked up Meoprolol on the NHS website and there's no mention of it being used as PiP. Unfortunately I see that Diltiazem also lowers BP, which is no good for me. Thanks for replying though

[mjames1 in reply to Hidden]

Bisoprolol and Metoprolol are pretty much interchangeable. I doubt the word "PIP" appears for bisoprolol on the NHS website either. In any case, they both lower heart rate in a similar fashion. For whatever reason, some countries often prescribe one over the other.

I have used Metoprolol to lower my heart rate when in afib (PIP) but I primarily use Diltiazem. As far as blood pressure is concerned, bisoprolol also lowers blood pressure, and possibly even more than diltiazem.

If you're having issues with bisoprolol, doing a trial on Diltiazem would be a very reasonable next step.

Jim

[Hidden in reply to mjames1]

You said: I doubt the word "PIP" appears for bisoprolol on the NHS website either. Good point

My issue is that the bisoprolol (1.25 mgs) does bring my HR down during AFib but stays in my system so that by the time I'm in bed my normal nighttime HR of 43-45 goes down to 30s. My BP is currently often around 95/65 and I really don't need or want anything to bring that any lower!

Reading all of the above and looking into the various meds I really think I'd be better off just taking a Diazepam and sitting it out, because my HR really doesn't go that high, compared to what other people on here are describing. The elevated HR makes me anxious but I'm not over keen on sleeping all night with a HR of 35 either!

[mjames1 in reply to Hidden]

Sounds reasonable as long as your hr is relatively low, say under 120, and the episodes are fairly short. But as long as you're researching, look up the half lives of bisoprolol and diltiazem. They are dramatically different.

[Hidden in reply to mjames1]

It can go a bit above 120 and they usually last 10-14 hrs. My last one, in May, was 14 hrs but it started at 9 a.m. so the Bisoprolol 1.25 mg had 'worked through' my system by nighttime enough that it didn't bring my HR lower than usual, but that's the only time I've had an episode start in the morning.

I did get a Kardia 6L a few weeks ago, and signed up for one month of the extra service so I could get a physician review. There's been no other arrhythmia's show up and the reviewed ECG came back as "Sinus Bradycardia - Your cardiac rhythm is stable and does not require further evaluation".

[Hidden]

The only thing I was going to add Helen is that a doctor really needs to see an ECG to make a diagnosis and this is why a Cardia or some other form of monitor can be helpful. Bearing in mind you had a telephone appointment, I wondered if he has actually seen an ECG. With rates as low as yours seem to be, it’s a bit surprising that a beta blocker has been prescribed as I think it would be more usual to prescribe a rhythm PiP such as Flecainide. As I said early, I’m not medically trained so cannot advise on specific medication or treatments but as I understand it all beta blockers and calcium channel blockers are prescribed to slow the heart rate and on the face of it, that’s not what you need. It’s a bit difficult to know what to suggest for the best, but if you know he not seen an ECG, that may make it easier to get back in touch and express your concerns about making a slow heart rate even slower……

[Hidden in reply to Hidden]

Also, 1.25 mg is the lowest possible dose for Bisoprolol and I have heard many Consultants say that this dose has minimal impact on a patient…..

[Hidden in reply to Hidden]

Yes, I'm sure that's true. It's another reason why I'm so resistant to medications as I seem to be super sensitive to them, I've always been like that, but few doctors seem to take that on board. Also, I'm only 5'2" 8 1/2 stone and it always amazes me that I'm given the same medication doses as a large male!

[baba in reply to Hidden]

1.25 mg Bisoprolol made me incapable of functioning. Effects worse than AFib

[Hidden in reply to baba]

Really? That sounds awful! Were you taking it daily?

[baba in reply to Hidden]

Yes for short period. Diltiazem also brought my heart rate and BP too low.

[Hidden in reply to baba]

Sorry to hear that. Seems like a lot of people on here have a problem with it as a daily med.

[pottypete1 in reply to Hidden]

I was on only 1.25mg of Bisoprolol and my EP still stopped me taking it because of my slow heart rate.

Pete

[Hidden in reply to pottypete1]

I get it. I was just asking because, as discussed, I have that problem with Bisoprolol 1.25 and I'm going to ask about Flecainide as PiP but mjames1 pointed out that they usually prescribe Flecainide with a beta blocker.

I'll have to see what the cardiologist suggests.

[pottypete1 in reply to Hidden]

This is why whilst we all have personal experience, we are all different and you must talk to the expert doctors if you can get an appointment that is.

For what it is worth I was on both Flecainide and Bisoprol for many years and then when after my last ablation my heart got slow I was taken off Bisoprolol.

Regarding the prescribing of both together I believe it is because Flecainide on it's own can create rhythms of its own thus those that are on a higher heart rate are prescribed bisoprol too.

Pete

[Hidden in reply to Hidden]

Hi FlapJack - I did have an ECG done as I went to A & E with my first episode and they were able to 'capture' it on ECG. I very much doubt that my HR was low at the time, though, as I was freaking out! I do have a Kardia 6L now, also.

I have got an actual appointment (face to face) with the cardio next week and will be asking him about Flecainide as PiP. I was prescribed the Bisoprolol without anybody asking me about HR, amazingly. I had to tell him that a beta blocker wasn't going to work for me! So then I was given the Bisoprolol as Pip which is fine for the early stages of an AFib episode but it stays in my system for quite a long time by which time my heart has settled down and then I end up with my normal nighttime HR of 43-45 going down to mid 30s all night, which I'm not too keen on.

I was asking on here because, as others have noted, it's helpful to see the doctors with an idea of what might be good options already, I find.

Thanks for your response, FlapJack, and your excellent suggestion of the Flecainide

[mjames1 in reply to Hidden]

FYI if you take Flecainide as a pill in pocket, they usually want you to take an AV Nodal Blocker with it for safety reasons. In the UK that is usually bisoprolol, so unfortunately you are back to the same issue, but again, Diltiazem can be substituted for bisoprolol. Unfortunately, the only way we really can tell how drugs affect us is by actually taking them.

Jim

[Hidden in reply to mjames1]

Ohhhh......good point. I guess I'll just have to see what the man says!

[Hidden]

It worked well for me but not been needed for almost 2 yrs now 🤞🤞🤞

[Clyde12]

Hi there, I have a similar problem to you with low HR (43/48) when asleep. I have also been prescribed Bisopropol (2.5mg) as a PIP. When I have an episode of AF my heart can reach 160/180 for a couple of hrs and then it reverts to SR. My concern is the same as yours….that the bisopropol doesn’t work quickly enough and will affect low night time HR. When I was first diagnosed I was, like a lot, put on to daily Bisopropol 1.25mg and that wiped me out. I will be very interested to see what your cardiologist says.Best wishes.

Mary.

[Hidden in reply to Clyde12]

Thanks Mary - It's interesting to hear other people's experience, and to know that I'm not alone. I'm intrigued to hear what he'll say but it will, I suspect, be not a lot!

[etheral]

Atenenol (Tenormin) peaks orally at 2 hrs and half life is listed at 4 hrs by Merck. This is a shorter acting beta blocker than metoperol. Low dose is listed at 25mg twice daily in adults with normal renal function. etheral

[Hidden]

Hi etheral - I just looked that up and the NHS website says it's for hypertension (and AFib) and it lowers BP and HR which is a shame because otherwise it sounds great!