I had Afib for the first time at the beginning of December …and was put on Apixaban. I will be having an echocardiogram scan in due course. In A&E the doctor told me to continue with my BP meds of Indapamide 2.5mg and Propranolol. I had an assessment two days later and another ECG …by then my heart sounds were all normal, and another doctor prescribed Bisoprolol 1.25mg along with Indapamide 1.5mg. I was told to stop taking Propranolol.
The thing is as I took Propranolol 20 to 40mg per day for anxiety and it is a beta blocker too of course, and it suits me perfectly, I was a bit upset to give it up. The doctor told me there were plenty of anxiety related meds I could get from my GP, and so on a visit to my GP I was prescribed Lorazepam for anxiety, a very addictive medication. I have a big problem with this in that I cannot take it every single day due to being so addictive plus I was only given 14 pills.
I did take the Bisoprolol, but after 11 days, it made me feel insanely anxious, (so hard to explain how bad it was), miserable and I felt as if I’d had a change of personality. I felt so depressed as well. I had to stop taking it and put myself back on to Propranalol which suits me 100%, and as this was over the Christmas and holiday period, my GP was not available to ask. However, remembering the first doctor at A&E who was very informative and thorough, who said I could continue with it no problem, I hung in to this for approval. Nonetheless I do still have two very different opinions.
My BP sits around 123/63 pulse 56, but it does seem to go up at night….as my anxiety increases then for some reason. The Propranalol sorts usually sorts this out.
I will have a word with my GP but am wondering if anyone has been given Propranalol instead of Bisoprolol.
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Carole1212
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Hi I have been a regular Bisoprolol taker for a number of years, mainly to help with ectopic beats and I was also advised to take it alongside my rhythm control medication ( Flecainide).
More recently, I did develop some anxiety problems, brought on mainly by the ectopics, which became a bit of a vicious circle. Eventually my doctor suggested changing from Bisoprolol to Propranolol, and there is no doubt that it helped with the anxiety.
Unfortunately, I also put on a lot of weight and after a few months I decided with the doctor's approval to go back on Bisoprolol. I think it is horses for courses. I have been told that Bisporolol is a newer drug which is more targeted than Propranolol, and has fewer side effects. However, I also know that Bisoprolol doesn't suit everyone and certainly slows me down more than I am comfortable with. I was also told that switching between the two wasn't a big issue, and I may well go back on Propanol again if my anxiety comes back as bad as it was before.
Of course the dosages also have an effect, but at 20 mg of Propanolol and 1.25mg of Bisoprolol, these were considered lowish doses for me. I don't think there is a hard and fast rule here, but obviously better to get your doctors ok for changing any medication. If it works for you then I would like to think your doctor would be supportive. Good luck!
Thankyou so very much for your response. I am so very grateful for this info.
I’ve never had any side effects from Propranalol thankfullly and have been on and off with them for around 4 years now (only taken as and when needed in the past). Yes, the doctor at my assessment did say that Bisoprolol target only the heart whereas Propranalol targets the heart plus other things as well. All I know is that Bisoprolol did not stop my knotty stomach and anxiety whereas Propranolol does the job. Another doctor long ago did tell me that Propranalol is a much older drug which has stood the test of time and has come out good.
I’m so pleased you are quite sorted and if you do change, you have experienced what is good and best for you. xx. Thank you once again.
I forgot to add I was told that Propranolol crosses the blood brain barrier more effectively than Bisoprolol, hence it use for helping with anxiety. Of course, in other cases doctors may not wish their drugs to have too much effect on the brain, and Bisoprolol might be their preferred option. This was the "dumbed down" version given to me by the doctor, but think it holds true.
I did read something along these lines. This is understandable that maybe Bisoprolol would be preferable. I’m believe Lorazepam / Alzam …and benzos cross the blood brain barrier as well. If I risk using Bisoprolol for a second chance, I wonder which anti anxiety drug would be safest? These are questions I guess I must ask the GP. Swings and roundabouts. I just wish I could stem these adrenaline rushes that come on for unknown reasons, as they are most uncomfortable. Thank you again for this info which gives me a little more to think about.
Hi Carole, my heart problems over the years were all put down to anxiety, as is usually the case for a female, anyway I was prescribed propranolol for this.
I was referred to cardiology & the cardiologist said ‘I have something better than propranolol’ & prescribed bisoprolol.
Like you my anxiety went through the roof when I changed over & I felt much, much worse, so I phoned the cardiologist’s secretary & explained how I felt.
The cardiologist phoned me back very quickly & said ‘I want you to feel better not worse’ so he was absolutely fine for me to go back to propranolol & I’ve been on it ever since.
I have only had 2 episodes of AF since diagnosis in April 2018 so it’s working well for me up to now 🤞🏻🙏🏻
Thank you so much for this info. I’m so pleased to hear that you’ve never had another AF since 2018 and that Propranolol has gone well for you. I’m hoping never to have that experience ever again. x
Just to add that you do not have to take a particular medication if you don't want it and especially if it doesn't suit you. Waves of anxiety are horrible and incapacitating and reduce your ability to get on with an enjoy your life. Make this clear to your GP. Treatment regimes are a matter of discussion between you and the medics working with you. Stand firm on what you need.
this is exactly how i felt four years ago on bisoprolol anxious and depressed i took it for a year 2.5mg for anxiety palpitations then i took nebivolol but it wasn't good for me i had a headache now i'm on atenolol i cant say i feel good I went to a psychiatrist and he told me that the worst thing for me would be ideral, but now I want to take an anti-depressant and in six months stop everything,
The anxiety that you felt when you started taking the Bisoprolol might possibly have been a reaction to stopping the propanolol and changing to a different beta blocker. These are powerful things and anxiety can go through the roof with any sudden changes. I only say ‘might’ - but even changing beta blockers that operate differently, I would think you would expect some sort of anxiety reaction for a while, as both beta blockers don’t work in the same way. If you have been taking 40mg propanolol more often than 20mg for many years, then switching to 1.25 mg of Bisoprolol is half the equivalent of 40 mg propanolol, so there is bound to be a reaction.
I gather that it may have been a cardiologist that put you on Bisoprolol from what you said above and I think that if your Afib has started since being on propanolol, he is thinking that this might be better for you as it is more structured for the heart and could stop breakthrough Afib. It is the main beta blocker they use now for Afibbers. I’m not a fan of it, believe me, but it has really helped my Afib episodes. Right now, you are back to where you started (apart from the anti coagulant and Indapamide).
I don’t agree that you should now need to take more medication in order to help your anxiety and certainly not lorazepam and can see why you have put yourself back on the propanolol. There are plenty of SSRI medications that are not highly addictive like Lorazepam for anxiety, but these do take time to work.
I see that Indapamide which you have also recently started, is given for high blood pressure ( I hadn’t heard of it) - I did do a quick Google and one of the side effects is anxiety.
It sounds like they need to readdress your Afib medication as soon as possible or give you a ‘regime’ to try and switch successfully from propanolol to another medication, or take an additional medication for the Afib. Even if you try Bisoprolol again, there might be a better way to try and switch from the propanolol to it, so anxiety doesn’t go into overdrive.
I know it’s easier said than done to get an appointment with any medic at the moment, but I do urge you to explain your issues again to your GP and preferably a cardiologist to try an alternative way to get better medicated fir your Afib. Lots of us try different alternatives before we get the right one and it can take time, but they do need to help you more in getting it right.
Also, the doctor in A&E that said to stay on Propanolol aren’t cardiologists. They are generalist consultants ( I know this from experience) but it sounds like it was a cardiologist who prescribed Bisoprolol a couple of days later from what you have said.
Hallo…and thank you so much for this response. I do agree that at the assessment I’m sure it was a cardiologist who advised on the Bisoprolol. It certainly makes sense in what you mentioned….that the Afib experience was whilst on Propranalol……and I really do understand all that you have mentioned. I appreciate it.
However, I was never a regular user of Propranolol. This is the question mark that I have. I’m sure the cardiologist thought I was a regular user. If I could mention ‘high days and holidays’ this would sum up my use of it. As and when I felt anxious. Since being on Indapamide since April 2022 my anxiety has been so calm due to the fact that my BP has been nice and low. Less anxiety for me as a high BP prior to taking it was a concern for me and it produced anxiety. So during at least 8 months of using Indapamide I’d hardly touched the Propranalol.
Since the Afib episode, it would now seem that a beta blocker is now on the cards. Another thing with the beta blockers is that my pulse rate, which is already around 54 now goes even lower. Last night it registered 51 with 20mg of Propranalol. How much is too low? Although I have been told to take a beta blocker, I did think it was because of a high heart rate, which I don’t have. Am I correct in asking if this would be used as more of a preventative to an Afib episode?
The cardiologist did recommend anti anxiety meds, but did not suggest any particular one, and I have read that the SSRI’s don’t interact well with Apixaban ? Would this now be another problem? If the SSRI’s could get rid of anxiety , I’d be very happy to give them a try.
By the way, the anxiety I feel is all in the tummy area….as in knots and butterflies that don’t want to go away. They come for no reason. When I experience the knots going away …It’s as if I’m on cloud 9, and feel so happy. It’s all in the adrenals. I’m trying deep breathing at the moment.
Ah, I understand more now - I obviously misunderstood before as it looked like you’d been taking propanolol regularly and then when you were diagnosed with Afib, they put you on Indapamide - which is why I thought what I thought 😳 now from what you say, A&E should have been more helpful to you, rather than saying to remain taking propanolol - perhaps they too thought you took it regularly? They sound like they didn’t do anything much for you regards advice for your Afib to be honest.
Perhaps it would be good to understand what led you to A&E as I too got diagnosed there but I’d had palpitations on and off for many years that were never caught, until I got A&E to stick me on a machine, which is what sounds like happened to you? You say your heart rate is 51 ( presumeably when resting/sitting?) with 20mg of propranolol and that is very low to be sustained. My GP said that ideally try and stay above 54 which is what mine can go to ocassionally, as I was worried. I’m afraid it does sound like your cardiologist thought you were a regular user if propanolol as they probably thought your lowish heart rate was as a result of that, when you had your second ECG, which is why they might have thought it was safe to prescribe Bisoprolol for you. When you visit next time, you probably need to explain more and about your low heart rate especially without a beta blocker.
Back to your Afib though - do you know what your heart rate was in Afib? How did they get you out if Afib and back to sinus rhythm ( a normal rhythm?) at A&E? Normally Afib is a very fast, irregular pulse rate, so presumably you had that for some period of time? When paroxysmal ( which is what it sounds like yours is, as it comes and goes, as mine does too) a beta blocker or other medication slows down the high heart rate which can often help in getting the heart rate back to normal. For some people it doesn’t and for some it does.
You can be prescribed a daily beta blocker for the prevention of Afib, even if it is something that comes and goes as rate control is generally thought to be a good daily control of Afib and helps prevent it, but only of course if the heart rate doesn’t go too low in doing so. Some medics prescribe a beta blocker to take ‘as and when’ in Afib and this is called a ‘pill in the pocket’ or PIP…but as you take propanolol, I’m not sure if this would be helpful for you though as presumably, the propanolol didn’t help you go back to rythm after your episode?
There are other medications that the cardiologist can prescribe, apart from beta blockers, such as calcium channel blockers and these don’t lower the heart rate as much, though I’m not sure if you can take them with propanolol. You ask about an anticoagulant and SSRI and I’m afraid I don’t know the answer to that one unfortunately.
Bisoprolol has a small amount if an anti arrythmic effect on top of the beta blocker element, which is probably why it’s prescribed more for Afib as a preventative measure.
There is a wealth of info on this forum and lots of info and links to look through which may help in understanding Afib more , but it sounds like your cardiologist needs to work with you to find the right medication for your needs and to understand clearly what’s happening with you.
Lifestyle choices also help in preventing Afib - they’ve helped me and many others and you probably know what to avoid? So many things to take on board.
Hi and thankyou. I’ve just taken a look at my Omron connect history and I do see a creeping of resting heart rate (pulse) a few weeks prior to the Afib but still within normal range. However on the Afib morning my BP was crazy at 150/122 91 pulse! Thereafter not knowing what it was I took 40mg Propranolol to settle it which although my BP and pulse gradually came down …..137/90 74pulse ; 108/77 56pulse etc to 100/69 74pulse the Afib was still irregular until the following day. I did feel a lot better despite the Afib going on the following day though. I can’t remember but I must have taken Propranolol and Indapamide as usual on the following day. The Afib did just come to a halt but how it did this I can only guess. Not sure if the new blood thinners played a role? This is all new to me. By the way, when I phoned the surgery on the day this all started, the doctor recommended that I go to A&E. I also tried to get a booking through 111 who confirmed that I should go.
I’d like to be linked to ‘lifestyle changes’ very much if possible.
I don’t think your resting HR a week before hand would have had anything to do with your Afib in the day you went to A&E. When you’re in Afib, blood pressure can be all over the place, so it’s not ideal to try and take it or get a good reading. Mine for instance goes very low or very high on the home monitors.
Your HR for Afib before and when you went into A&E was actually quite a low rate for Afib generally, but that could be because if your normally low heart rate anyway, I don’t know. I am only guessing. My HR for instance, at its highest could go to 188 - others have experienced if up to 200 or even more. A pulse at 91 is actually still considered within the normal range but the key is it was irregular and that is why they diagnosed Afib.
The thing with paroxysmal afib is that you can ‘convert’ back to rythm at any time and it’s either due to medication or just your body deciding it wants to go back. Before medication and after so many hours, this is what mine used to do. Make a note of how long your episodes are ( hopefully not many) to discuss with your cardiologist. You can also take an ECG yourself at home with a Kardia machine if you have a smart phone? Look up Kardia in line - they’re approx £100 and your cardiologist will be able to read the ECGs. Do a search on this forum as well as posts will come up.
I’m afraid I can’t send you links about lifestyle changes, as there aren’t any that I know of but there is lots on the internet and again in this forum, if you search some posts? People find they can pin point their “triggers’ such as alcohol, heavy meals, sleeping on left side, certain additives to name some.
Apixaban wouldn’t have helped get you back into rhythm by the way, but it does help prevent blood clots from your heart as you probably know.
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