Nebivolol side effects even at a low dose of 2.5 mgs daily

I had been on it for 4 years since my ablation for persistent atrial fibrillation which didn’t work. I decided to settle for permanent AF, but after a while I was getting tired all the time and short of breath walking on the flat or going upstairs.

I had all the tests in the cardiology department last year and no reason was found.

I remembered a cardiologist I had seen some years ago saying Nebivolol 2.5 mgs daily was a negligible dose. I was getting very fed up with the situation so I just stopped it. Within 72 hours I felt so much better. I have much more energy and I can walk at speed for miles on the flat, without my heart rate going unacceptably high. Slopes are still a problem unfortunately.

My GP disapproves of me changing my medication as recommended by the cardiologist so I haven’t told him yet ….

[BobD Volunteer]

I am very surprised . Nebivolol is highly cardiac specific so does not normally cause breathlessness.

[jeanjeannie50]

It certainly sounds as though you've done the right thing Bill.

Jean

[Buffafly]

Maybe your heart adjusted in the meantime! I would want to know why your cardiologist thought you needed Nebivolol and if so if Diltiazem or another calcium channel blocker would have the desired effect?

[Hidden in reply to Buffafly]

Thank you. I’ve forgotten, anno domino I’m afraid! But I don’t have angina. I do have high blood pressure which is ok with Lisinopril. And I expect the Tamsulosin (man thing🥴) helps, being an alpha blocker.

My understanding is that in permanent AF, the important thing is to keep the heart rate down including with exercise and there are different drugs to do that. And without even this “negligible” dose of Nebivolol 2.5, Dr NICE seems satisfied!

Anyway, I would rather feel better than live longer ….

[oscarfox49]

Any beta blocker will suppress the heart rate and slow us down. I get a lot of breathlessless with Sotalol but know that if I stop that I immediately get the return of AF symptoms (mine is 'permanent'.) If you can get away with not taking it then there is nothing to stop you using it at the point when you DO suffer from unpleasant AF symptoms. I see Nebivolol has a half life varying from 10 to 30 hours so noticing the positive effect after 72 hours shows you are clearly coping without it. Depending on what your cardiologist said, there should be no adverse effects of just not taking it although you must expect a return to paroxysmal AF from time to time.

[Ppiman]

It's such a variable illness that it's hard to know what causes what (and the doctors don't always even know or have the time to find out). Beta-blockers have such a wide range of actions, even specific ones like nebivolol and bisoprolol, but are still not properly understood.

I gather that nebivolol has its own somewhat different mode of action and uses metabolic pathways differently from others which can make it rather more troublesome at times compared with bisoprolol. It doesn't surprise me to read your story. The only thing is to check with your cardiologist that it wasn't prescribed for other reasons than AF as beta-blockers do have long term protective effects on the heart, for example.

Steve

[Auriculaire in reply to Ppiman]

That's interesting. I take a tiny dose of Nebivolol but have noticed that I get even more bizarre and intense dreaming than I did with Bisoprolol. I had thought it would be the other way round. Have you read about anything specific in the differences of action?

[Ppiman in reply to Auriculaire]

I’ve lost the web links but it was on Google Scholar so a search ought to resurrect the same studies.

I asked my doctor to prescribe it when I was having a lot of chest discomfort taking 10mg bisoprolol. He assured me that I’d feel the same on nebivolol and that it was the beta blockade itself rather than the beta blocker causing my feelings. He assured my it wasn’t a matter of cost (nebivolol is significantly costlier).

I was quite surprised to read how much still needs to be discovered concerning how beta-blockers work. Their centrally acting properties, for example, as you’ve found, can be profound. I’ve read that some people just can’t cope with the ultra vivid and weird dreams they cause them to have.

Nebivolol if I recall also uses very different metabolic pathways from bisoprolol.

Steve

[Auriculaire in reply to Ppiman]

I don't mind the dreams but I do have the impression that I dream too much. I feel I don't get enough of the deep sleep where the body repairs itself. Even if I have a short nap I go into dreams almost straight away. Physically I do feel better on Nebivolol than I did on Bisoprolol even though I was also taking a tiny dose of Bisoprolol - less lethargy . I don't think Nebivolol works as fast to reduce heart rate during an attack . My cardiologist told me to take 2.5mg but that's useless. I need to take 5mg or even 7.5mg.

[Peacefulneedshelp in reply to Ppiman]

My understanding regarding Nebivolol is that it keeps the anxiety we sometimes feel off the heart.

[Ppiman in reply to Peacefulneedshelp]

I’ve heard that about beta blockers in general. If I take a bisoprolol tablet in the morning, I do feel calmer during the day. The heart and anxiety go hand in hand for me.

Steve

[Swimsyroke]

When I asked about Nebivolol when visiting a cardiac nurse he said it was only prescribed for those in paroxysmal afib. I am now in permanent afib Maybe this was just to put me off as presumably Nebivolol is more expensive than Bisopropol.

I am in any event managing very well on Bisopropol and Edoxaban.

[Bunnyuk]

I hqd very frequent symptomatic PAF, and struggled with betablockers. Eventually my dose was reduced to just half tab of the lowest dose of nebivolol( so half of 2.5mg tab, 1.25mg). I had cryoablation in September 2022 and no afib since (🤞🤞🤞), but I'm still on nebivolol awaiting review. You're post gives me hope that my energy might improve once I'm off it entirely- which I hope i will be soon.

[Auriculaire in reply to Bunnyuk]

I am prescribed 5mg Nebivolol (I believe they are cheaper) which are scored in quarters and break very easily. I manage to cut a quarter in half so only take .65 mg on a daily basis.

[Bunnyuk in reply to Auriculaire]

I was told I was on the lowest effective dose, any lower wouldn't work !??!!?

[JayDJ in reply to Bunnyuk]

The medics imo can tend to over prescribe dosage. I've always thought that they should go from the lowest dose and work up until it is satisfactory as medication is not a one fits all situation. I've had Bisoprolol & Nebivolol 5 mg and found that Nebivolol is the weaker of the two ie Bisoprolol will in my case drop my HR very low whereas NebivoloI will allow my HR to beat an extra 14 bpm and the side effects being no different, I also understand that the costs difference is negligible.

I honestly do not think that your medic would know if a lower dose would work without trying, as we are all different. Having been on Bisoprolol 5mg and many years later was put on Bisoprolol 2.5 mg and then down to 1.25 mg before I came off them, I can honestly say that I noticed no difference whatsoever. So in many respects I was overdosed for a long time.

In your case and with the knowledge of my experience, I would be inclined to split the pill as AurAuriculaire has, if it works then you take less and if it gives you problems then revert back to as was.

[Auriculaire in reply to Bunnyuk]

I am very sensitive to drugs . I have normal resting rate between attacks so I don't want too many side effects from taking a dose I don't really need. I am supposed to take 1.25 mg but I'm a poor patient. I have thought about stopping it altogether. Beta blockers don't really stop my attacks just lower rate and my afib burden is not very great. On bigger doses I felt rubbish.

[Peacefulneedshelp]

this is interesting because I am on 5mg of this medicine. I have noticed when walking I am a little more breathless. It is confusing for sure because the cardiologist didn’t put me on anything but the GP decided to get my BP lowered. At the moment I do feel better on it medication. But believe me I hate taking anything. My GP assured me that Nebivolol had the least amount of side effects. That I have no way of knowing. Does anyone else have any insights on this?

[Hidden in reply to Peacefulneedshelp]

You mentioned earlier about Nebivolol helping with anxiety. That’s true for me too, but I’ve found better ways of dealing with that.

[Peacefulneedshelp in reply to Hidden]

I am working on controlling anxiety also. But it isn’t always easy either.

[Hidden]

Thank you all for your helpful replies