to bisoprol 1.25 or not

[09Bumblebee]

hi after 4th visit to GP following an episode of PAF then ventricular tachycardia and then an episode of tachycardia I have finally agreed to go on bisoperol 1.25 but am absolutely dreading it. I haven’t had any further episodes of PAF since July. Interested to know what you guys think. Yes or no to bisoperol?

[rosyG]

Others will comment on Bisoprolol which is usually thought to be safe but makes you feel tired. However you shouldn't have it if you have vagal AF but more importantly if you have had Ventricular fibrillation you need to see a cardiologist urgently . I doubt it was VF unless you were resuscitated??

[CDreamer]

Short answer - it’s a no from me - said from hindsight when I did take it - but RosyG’s answer is a lot more knowledgeable so I would take her advice and have a cardiologist confirm a diagnosis & prescribe - unless your GP has cardiac experience?

[Threecats]

Hi Bumblebee

I took Bisoprolol (1.25mg but up to 5mg if needed)) as a pip (pill in the pocket) for a while, as my attacks were well spread out, so I only took it when I had one. That worked well for me. I have PAF with a high ventricular rate, usually up in the 180s. Whilst the Bisoprolol didn’t shorten the length of episodes it kept my rate down to around 100 which was much more manageable., so I wonder if it’s worth asking your doctor if that’s an option, given that your episodes are quite far apart by the sound of it. For me, at the time, it seemed pointless taking medication daily for something that happened only very occasionally.

Over Christmas last year the frequency of my episodes increased to every other day, so the cardiologist suggested I took it daily (1.25mg) I was very fearful of doing that as I was certain I have vagal AF - episodes only at night after meals etc. and I’d read that beta-blockers were contraindicated. The EP dismissed that - AF is AF as far as he is concerned and eventually, in desperation I did take it and was absolutely fine! I went from four episodes a week to not having one at all for over four months.

As others have said, a referral to a cardiologist at least for an echocardiogram to check your heart structure etc would be a good idea I would have thought - unless you’ve already had one, of course.

Anyway, I hope this helps a bit. All the best to you, TC

[Leechg]

I've been on it for seven years. Try not to worry. 1.25 is a very low dose. It makes me a bit tired sometimes but keeps the rate down nicely.

[Tellingfibs]

Bisoprolol, like all the drugs associated with Afib, has its fans and it’s detractors. It is a blessing to some and a nightmare for others. I am a fan. I started on the drug 5 years ago - 1.25 mgs - and over those years it has been increased so that I now take 5 mgs twice a day. Each time the dose has been increased, it has because of a spell of Afib with Tachycardia. The specialists don’t seem too worried about my actual Afib as I just feel a bit rubbish now and then, but a heart rate that is only a bit high makes me feel dreadful - and the Bisoprolol deals with that well. I think it makes me sleepy, but I do all the things I want to, it’s just once I sit down, I just want to stay there and be lazy ! I am 71 tomorrow so I tell myself I can relax a bit - as long as it’s not too much ! Certainly I think it’s worth you trying Bisoprolol, and try not to have too many pre-conceptions about it. It might just be perfect for you !

[July30]

Hi I take 5mg a day no problems be guided by your cardiologist they know best

[Drounding in reply to July30]

Me too. It slows me down but does keep my hr in check.

[Ppiman]

I think of it in some ways as a friend since, taken on an as need basis, it calms my tachycardia and allows me to function better with less fear. I only occasionally get AF so use it more for mild tachycardia and ectopics.

Steve

[JOY2THEWORLD49]

HiI take Bisoprolol for rate and rythmn. 2.5 it doesn't bring down my night H/R less than 47. My H/R was high at avge 156 day and this gets me brought down with Diltiazenm 120mg to 77-88.

cheers JOY. 73. (NZ)

Bisoprolol alone did not control my rapid persistent H/R with AF

[Leggylady]

Hi there. I’m on 1.25 Bisoprolol and have been since I was diagnosed May 2021. It seems to be controlling my PAF, only one episode last November, but I can’t say I like it! I do have side effects - tiredness, heat intolerance etc.I’m having an ablation in November and am hoping I can get off it afterwards.

That said, I would do the same again, given the choice. I’d rather be without the episodes.

Good luck! X

[Hidden]

Hiya Bumblebee,

Well, I'm gonna be the loose cannon on this one ... sorry.

Yes, I support the prescribing of Bisoprolol. My own life experience is that it was initially prescribed when I was diagnosed with paroxysmal AF in January 2010 by my then Consultant .... 5mg to be taken in the morning...... Bisoprolol Fumerate by the way. Initially all went well ( he also prescribed Warfarin at the same time). Some months later I began to get full flow random nose bleeds. In these early days I was already on Simvastatin and Ramipril. My consultant at East Surrey Hospital in Reigate made it clear to me that Bisoprolol was being prescribed as a heart rate control drug. Up until January 2021 it did that and held me nice 'n steady at around 62 to 67 bpm. Prior to AF mugging me my HR was around 88 to 95 bpm, almost the very top end of the normal range. When AF hit it was clocked at 156 bpm. I spoke to my GP about the nose bleeds and did much table thumping in her office as she was trying to blame Warfarin. In the end I got my message through and she got out her book of witches potions and brews and said take it at night. I did that ........ I've never had a nose bleed since !!!! Ever ! Ever !

Late 2020 I began to get unexplained BP variations and since a rapid drop in BP was instrumental in my being diagnosed with AF in the first place I got a bit alarmed. ( originally my BP dropped from 136/80 ish to 76/50 ish in around 6 hours). GP gave me an extra 2.5mg of Bisoprolol to be taken (initially) as and when required - a pill in the pocket so to speak. Didn't help so she jacked the dose up to a nightly dose of 7.5mg. So, from then until Jan 2022 that did the trick. Then I began to feel unwell again .... like a bloody Zombie from the Land of the Living Dead. So, if you go back to late July/early august and click on my user name you'll see my original post ( and replies) entitled .......... " Bisoprolol beats me at last". Maybe around 2 or 3 August. It discusses side effects and I list mine.

Tried to speak to my GP but it was bloody waste of time. So I began to cut back my dose of Bisoprolol on my own initiative notifying my GP by hardcopy letter .... which didn't win me too many accolades from the surgery.

Using the recommended technique to be used with Bisoprolol I cut back very slowly, 7.5 to 6.25 for 10 days, then cut back from 6.25 to 5.75 for 10 days then finally settling at 5 mg ....... right back to where I wanted it.

Now I am back to the normal dynamic human being I always used to be in the previous 10 years or so with 5mg doses. All my side effects are now gone but in fairness I still tire more easily than I used to. I tend think Bisoprolol is causing a tug o war in my chest where my heart now damaged by AF is wanting to naturally gallop away to 100 or higher and the Bisop is forcing it to slow right down to 62 and keep it there.

My GP now doesn't want too much to do with me which doesn't worry me in the least and I am now in the care of my Surgery Pharmacist.

Finally this business of vagal AF as RosieG discusses is interesting. I have never seen anything in print that discusses 'Vagal AF' as a diagnosis. Persistent AF - yes, Paroxysmal AF - yes. Indeed its my belief that Vagal AF is not a term many GP's, Cardiologists or EP's use to describe or recognise as a trigger for AF. I accept it personally because food upsets my digestive system which implies food causes my vagal nerve to become dysfunctional and trigger me into AF. The vagal nerve is like an information superhighway linking the brain with the heart and digestive system ( in its basic understanding) and many other organs too. If I try discussing vagal nerve with my GP she either rolls her eyes or they glass over.

You will find that Bisoprolol is a very effective drug but the dose is a very personal thing as different people react differently to a range of doses. I function brilliantly at 5 mg others are the same at 1.25mg others at 10 mg. These days one often reads its prescribed as a BP control drug. It is not. Its a HR control drug. I discussed this with my Pharmacist the other day and her explanation in laymans terms is it normally used for HR control but has properties which - when used alongside, hand in glove with existing doses of blood pressure drugs, like Ramipril or Felodopine, helps to maintain a sensible blood pressure level and HR.

Apologies for the length of this if you are still with me and not fallen asleep or been frightened to bits.

Good luck.

John

[CDreamer in reply to Hidden]

Here you go John - Dr Bogle, as Rosie will tel you, was a speaker at the Surrey Support Group - which is how it came to be discussed originally on this forum.

richardbogle.com/blog/vagal...

I have a Red Alert on my medical file NEVER to be given any Beta Blocker but Bisoprolol in particular.

Whilst it may suit some people SO many have real difficulties with this drug for many different reasons. I know it is the drug that is the first choice for GPs and is recommended Protocol but my personal experience of it and counselling those for whom it has been prescribed for anxiety (Biso is also an adrenaline blocker and THAT is the reason it should not be prescribed for anyone with suspected vagal AF). Watching someone or experiencing withdrawal symptoms attempting to come off the drug is not pretty and I wouldn’t wish it on my worst enemy.

Sorry if I am being so vociferous but I believe a lot more care should be taken to assess the suitability of prescribing this drug to anyone with AF.

[Hidden in reply to CDreamer]

Thanks CD. Never seen that on this forum but thats not surprising the amount of time I've spent driving buses over the years ..... don't always see things and when I do my comments are out of date. Looks like some light reading in my off duty time this afternoon. At the 5 mg dose which I am now back to I function best ........... absolutely gone are ...... "feelings of intense coldness, at extremities and through limbs to the bone; brain fog behind the eyes; resting HR far too low falling in range 41 to 58 bpm; runny nose particularly when having a meal, stuffy nose, coughing fits; tiredness beyond just extreme fatigue and increasing incidence of nightmares and sleeplessness".

For the record though, no MD or GP has ever advised me that my AF is recognised as Vagal AF. It was my diagnosis and mine alone and my own treatment from a Nutritionist that got me where I am today, no thanks to my surgery (past or present). Perhaps I should send a copy of this document to the Medical Lead in my present practice.

Stay well, hope your move back to my home territory (S.E.) where I was briefly last week went OK and you are now settled.

John

🙂🙂

[Threecats in reply to CDreamer]

Hi CD,

Thank you for the link to Dr Bogle, I’d missed that, too😊

I do appreciate that Bisoprolol was a bad drug for you and never to be repeated but, with the greatest respect, I understand from previous posts that you also have a fairly rare underlying health condition and I can imagine that was not helped by the beta-blocker.

I also see that Dr Bogel suggests the vagal form of AF is more prevalent in younger patients, particularly men and those engaged in endurance sports. I’ve no idea of the OPs sporting activity history but she appears to be in middle-age according to her Bio.

Whilst I am certainly not going to go against Dr Bogel’s explanation regarding the drivers of AF, I do think it is sometimes quite difficult for us to differentiate what type we may have, or indeed, whether we have a mixture of both types. I was convinced, due to the symptom picture, that mine was vagal AF and hence very much afraid of taking Bisoprolol daily as I was certain it would worsen my episodes. As it turned out, I was wrong and it was clearly not vagal AF I had, despite me apparently fitting the picture in terms of when attacks occurred etc (not the endurance sport part, that’s never been a factor😊)

Whilst I wouldn’t, for a moment, wish to play down the side-effects of any drug and, let’s face it, they all have them, there are plenty of folk for whom Bisoprolol alone has helped. As you say, it is commonly offered as a first line therapy.

My concern is that such passionate and heartfelt comments, understandable though they are, based on your own experiences, may put off folk from taking it who might otherwise genuinely benefit from doing so, as I have and as have others who have already posted here.

[CDreamer in reply to Threecats]

Accepted, I am biased. My comments to John were not solely based upon my own reactions to the drug, but also included observations of other people’s experiences and as a quick search of Bisoprolol withdrawal symptoms on this forum will reveal.

I accept Bisoprolol can help many but I find it sad that it is a ‘suck it and see approach’ with little assessment by GPs so when harm occurs, it can be quite devastating. My heartfelt plea was for GP prescribing without due diligence to a patient’s history and contraindications and denial that Bisoprolol by many can cause people harm. As you say my condition is rare, but asthma and vagal AF are not that rare. Both sides of the story need to be heard and represented and it is at the end of the day - patient choice to take a med or not.

I attempted to keep my orginal reply to the poster unbiased but also true to myself. My reply to John was to provide the written evidence that there is some evidence for contraindicating Bisoprolol and that written evidence can be useful to many AF sufferers when they want to challenge their GP about side effects they are suffering.

I hold to the principle that we all react differently and the old adage ‘one man’s meat is indeed another’s poison’.

Best wishes

[Threecats in reply to CDreamer]

Of course, I’m not for a moment denying the withdrawal effects of Bisoprolol can be challenging if it’s stopped abruptly and sadly, a lot of medics consider 1.25mg a low dose that can be stopped without problem. For some that maybe so but certainly not my experience. At least there are other responses on the forum explaining the slow and gradual taper is the best route to take when stopping the drug.

I also appreciate your comments were addressed to John but, of course, were posted to the public forum and so open to anyone to read.

My concern was, rather, the emotive nature of the language used. I understand you had a bad experience with Bisoprolol and I’m sorry you had to go through that. However, had I been newly diagnosed, anxious about starting Bisoprolol, and I’d read your post to John first, I wouldn’t have touched it with a barge pole! That would have been a shame, as it has been helpful.

I’m not suggesting for a moment that side-effects or contraindications are glossed over but wonder if perhaps a more measured approach could be adopted in replies posted to the public forum.

All the best to you, TC

[BorgUK1of9]

I take 1.25mg post SVT ablation to keep the lumps and bumps under control, at that level the effect is not significant and I hardly notice it.

[Morzine]

I take it have done four years now, I don’t like it as it’s slowed me down energy wise, but it is a low dose like me 1.25. It’s keeps the pulse lower. Yes or no? Well I’m still on it, I guess I just go by what I’m told……and cardio. Advises it….so I’m not much use helping you, but I would say whrn u take it don’t judge it within a couple of weeks as it really needs to settle in your system a bit.

Sue

[Teresa156]

Hi,

I’m on daily Bisoprolol, only 1.25mg as well, which is a really low dose. I would say I have a love/hate relationship with it.

I love the fact that it controls my paroxysmal episodes, in that I haven’t had an episode since last November, but I hate how it has made me feel overall. I don’t get the breathlessness that some get, however, there are side effects, as with all medicine and some of these you may get and some you might not. For me now, there is a definite fatigue, my heart rate is a lot lower than it ever was and I also have the feeling that I’m just not ‘myself’ anymore, but having AF could also be contributing to that, as I think that also can change how you feel as a person. But it’s all ‘manageable’ and you do get used to it, as I have. I think all medicines for Afib have side effects of some sort, I don’t think you can escape that and you have to weigh it up.

If you are paroxysmal, as I am, you could consider taking it as and when you have an attack, but if your attacks do get more frequent, you could consider taking it daily. It depends how you feel with your episodes.

Some say that you cannot take Bisoprolol if you have ‘vagal’ Afib. I don’t think that is entirely true, or proven, especially as I know mine is definitely vagal and how well it works for me, but everyone is different.

What I would say is try the very lowest dose you can first if you do take it, as for me, 1.25mg reduces my heart rate to exactly the same level at 2.5mg strangely. You can always increase upwards, but it’s much harder to reduce.

Good luck,

Teresa

[jamestuart]

I have been on BISOPROLOL 2.5 for a while made me tired so doc said stop it bad idea was addmited to hospial with hb 185 be carefull with this stuff.

[Sylviep7]

Some people seem alright on Bisoprolol, I wasn't. Took 1.25mg for 2 months. Kept the heart rate reasonable but I felt dreadful most of the day. Dizzy and spaced out and couldn't function.I stopped taking it and Doc then gave me the lowest dose of Atenolol, an older drug which doesn't cross the blood/brain barrier. That's doing the job and after the initial period where I got a bit of a headache I can function!

[Teresa156 in reply to Sylviep7]

Hi Sylviep7,

I’m glad you are better on atenolol - as Bisoprolol can have many side effects, however, it too doesn’t cross the blood-brain barrier either I believe, especially at low doses.

I thought I’d better point that out, in case 09Bumblebee or anyone, thought Bisoprolol was going to affect their brain 😳

Teresa

[Sylviep7 in reply to Teresa156]

Just checked and you are correct! Thanks for pointing that out.My Doc needs to go back to school...there are betablockers that do cross blood/brain barrier however, namely"

Lipophilic agents, such as propranolol, metoprolol, and nebivolol67 have the ability to cross the blood-brain barrier." Quite a minefield isn't it.

[Teresa156 in reply to Sylviep7]

Hi SylvieP7,It certainly is a minefield 😃

I think we’d give ourselves headaches just trying to fathom it all out!

Teresa

X

[Tomred]

Im on 1.25 bisoprolol also , and dreaded starting it, but it does keep heart rate down ,dont know if its causing fatigue or is it the paf or both, otherwise so far its not been too bad, might have worried for nothing.

[Tomred]

Also maybe increased tinnitus .

[Hidden]

Hiya Bumblebee,

Well since I wrote my comments to your question I have read through all the comments from others. I was most interested in Bogles comments on vagal AF posted by CD. TBH, there isn't much in that that I can't identify with ........... if I created a box to tick for each issue raised ( with the exception of different/other medications which I haven't any experience of) I would be able to tick 90 to 95% of all boxes. And medications is the issue in the treatment options. We are all different, we all have different medical conditions in our bodies, some we are aware of and some we aren't - we are all fed a cocktail of medications to deal with it. I am in good health with no other medical issues ( apart from at times painful osteoarthritis in some joints). I've had 2 ECG's, the first when I was when I was in Cardiac Ward when I was diagnosed which described the damage to the left atria - which is the source of my AF and would be the source of any stroke if it were'nt for Warfarin. My second ECG was about 11 years later and showed the original damage still existed, the shape size of the left atria was the same. Now that I have taken control of my own medication and removed my GP from the equation and reduced Bisoprolol to its original dose I am just fine and dandy. The only thing she does now thats of any use is to sign my repeat prescriptions.

Look with all medications for many, many medical conditions, its all horses for courses. It will always be a case of whats good for the goose isn't always good for the gander. Its the way of the world. But for me Bisoprolol would be my drug of choice for HR control.

John

[09Bumblebee in reply to Hidden]

Thanks John taking responsibility for our own health is the holy grail. One day….

[SeanJax]

How do you know you have ventricular tachycardia? PAF is treatable. But ventricular tachycardia is another story.

[09Bumblebee in reply to SeanJax]

I had one recorded episode of SVT using Kardia which appears to be pretty accurate. GP’s are now using them in their surgery.

[CDreamer in reply to 09Bumblebee]

Just a point of clarification - there is a massive difference between SVT - supra ventricular tachycardia ie:- tachycardia causation is above the ventricles which is relatively benign and none immediately life threatening and ventricular tachycardia which unless treated immediately is life threatening because the it means the cause is within the ventricles.

It is easy to confuse the two meanings - hence your repliers requesting clarification.

[09Bumblebee in reply to CDreamer]

thank you. Sorry I was a bit excited re posting it was sinus rhythm with super ventricular ectopics which lasted for quite a while which was very disturbing. Especially as I was lying down in bed. I know ectopic beats are common I was concerned that the episode was extended.

[CDreamer in reply to 09Bumblebee]

very pesky things SVTs, in many ways worse than AF I found.

[NLGA]

I take 15mg and have no issues I have loads of energy now before I took it I use to need a kip every afternoon

[listerines]

At that low a dose I would suggest giving it a try for 3-4 weeks and see how you feel. It should bring your resting heart rate down a bit but should not be crippling (1.25.mg can be a dose used for children). That said, some people react strongly to certain drugs so keep a journal of any side effects to discuss with health professionals. Beta blockers have overall a safe usage profile. Hope it goes well for you and assists with no side effects (for what it is worth I have no side effects from 5mg of bisoprolol though I was a zombie on sotalol and it was unliveable)