Hi everyone. I’ve been on 10 mgs of Bisoprolol for a year, having had the dose gradually increased since my diagnosis in 2017. This drug has served me well in lowering my heart rate when it has gone into Tachycardia territory. My cardiologist has said that if my Afib bothers me me more, then as I am on a high dose of Bisoprolol, he would consider changing it to Sotalol ( I assume changing it, not ADDING Sotalol ! ). I wonder if any of you have thoughts on this. My heart rate is in the low 60s at rest, but I am getting more Afib episodes - although they are not debilitating. I am very sleepy these days, but when I saw my cardiologist back in the summer ( when I was less sleepy and also having less Afib ), he suggested it was the Afib causing this rather than the Bisoprolol. Now at the moment, I can’t see that he would change my drugs as my heart rate is good, and I know Sotalol is similar to Bisoprolol and neither drug affects Rythmn , which is what is concerning me now. Perhaps as my heart rate is ok, there is no point in me mentioning the increase Afib episodes I suppose at worst they just make me miserable, anxious and lower my mood drastically. In fact even with no other indications, I can tell I am in Afib just by my mood - then if I check with my Kardia, sure enough - Afib. Sorry to ramble on, but you are my Therapy Group !
Bisoprolol to Sotalol: Hi everyone. I... - Atrial Fibrillati...
Bisoprolol to Sotalol
Solatol is an anti-arrhythmic drug.
Thanks. I thought that it wasn’t, as it is a beta-blocker.
It's both.
There is definitely a point in mentioning the increased episodes, and in seeking the right treatment for you. If the A Fib is making you feel low, and sleepy, then it is affecting your quality of life. It’s so easy to decide that we’re not feeling too bad compared to others, but this is a progressive condition. I feel that it sort of creeps up on us!
I was also on Bisoprolol for about six years years, until one particular nasty fast AF episode which led me to A&E where I was cardioverted back to sinus rhythm. The on call cardiologist at the time took me off Bisoprolol and sent me off with Sotalol, which I'm still on to this day (about 5 years now). In the meantime I also had an ablation after a couple more AF episodes that weren't as bad. After the operation I was kept on the Sotalol as my EP didn't think it needed changing as its anti-arrhythmic properties were mostly effective in my case. The main thing I noticed is that it did slow my heart rate down, sometimes as low as 50bpm when resting, but I feel ok with that. I still get quite a few PVCs and I'm due to meet with my EP to review that situation. Touch wood, I've not had a full blown AF episode since my ablation in 2020. So possibly the continued Sotalol has contributed to that also. It might also help reduce your AF episodes too, although as we all know we are all different. Good luck!
Thanks for your message. I have heard such negative things about Sotalol that I was getting worried. It’s reassuring to hear you have done well on it. I have that low heart rate at rest on Bisoprolol anyway. I would be interested to know how you changed from one drug to the other - another thing that is worrying me !
Hi Stu13 I am on sotalol, if you don't mind me asking what dose are you on? I was put on 40mg twice daily which has now been increased to 40mg three times a day but I still have afib episodes about every 4 months. Normally very symptomatic and last over 24 hours but the one I had last week went on for about 3O hours but didn't really bother me as it was much slower
Hi, no problem you asking. I am on 80mg twice a day. This has been my dosage before and after my ablation in 2020. Like I said, I still get palpitations and PVCS, but no AF since 2020. Although I know it could return anytime.
I think my EP is going to put me to the dose you are on as he hinted this last time I saw him. I am a bit scared though because I already have low BP (no symptoms) at around 100 over 65 and heart rate around 56 when not in afib. I am afraid that an increase will make this worse. Do you get any side effects?
Do you mean Bisoprolol ? I have varying blood pressure. It can be as low as 103/55 to 132/63 ( always low diastolic ) and heart rate can be as low as 52 at rest. I’m not even sure the tiredness is the Bisoprolol; the cardiologist said it was more likely the Afib causing that. I don’t think they would put the dose up if they were worried about your BP and HR. In 2021, I was on 5 mgs and after a few months on that dose I started to have more Afib episodes. My GP was too nervous about my BP to increase it so referred me back to cardiologist. I waited about 10 weeks to see him and he then increased my dose to 7.5 mgs. That didn’t make a difference so after a few weeks I went to another GP in my practice and he upped my dose to 10 mgs. After 2 doses of the 10 mgs I felt my chest resume ‘calm mode’ - bliss ! Now, a year later, I am having more frequent Afib episodes, but not increased heart rate. I am expecting to be changed to Sotalol as that was what the cardiologist said would be the next option. If you have been ok on Bisoprolol, I don’t think the increase will affect you adversely ( although there is no knowing - even for the experts ! ) Well worth a try though 👍
Thanks for you reply. I am on sotalol already at 40mg three times daily, sorry for the confusion! Couldn't cope with bisoprolol. Under EP so will see what he says when I see him on 20th March.
I can honestly say I’ve had no side effects with Sotalol. My BP was quite high 18 months ago for some reason (188/98). My GP put me on the max dose of Ramipril and Amlodipine. So quite a cocktail! My EP seems ok with this also. Again no major side effects. Like I said previously, we are all different though.
I think we always worry about switching drugs as we see them as a reassurance, especially if the current ones are working for you.
In terms of how I changed, from what I remember, it was a case of “from tomorrow start the Sotalol and stop the Bisoprolol” Got to be honest I was worried, but went with it and genuinely didn’t notice any major difference initially. Noticed slightly lower HR about two weeks in, but felt ok. Still get occasional palpitations and PVC s but not full AF.
I would mention the increased AF episodes as it is obviously getting you down.
That’s really useful info, thanks !
I have had several med changes in the past five months because everything fails within a couple of weeks. I am happy to say I had nothing that really stands out to me as a problem changing I meant other than a little bit of relief until that one stopped working as well. I am still on metropolol XR and will remain on a blood thinner for life which is fine with me. It is much better than the alternative. It will be two weeks one day, since my special pacemaker was activated. I imagine we will speak more on meds at my visit in May unless I hear from myEP sooner. Unfortunately, everything has a side effect and I wonder if building up stamina is hindered by what I am still on. They stopped the digoxin the day I left the hospital. One less necessary poison in my system. It really is terrible not knowing if what we have makes us feel tired, and not well over the medicine. Thanking of everyone out here waging the same war against afib
there is no point in me mentioning the increase Afib episodes
Always need to mention Afib episodes. 🙂
You have an excellent heart rate, but may want to consider asking to wear a holter monitor or other medical device for a continuous period. Would also determine need for proper medication.
Not familiar with Kardia, does it monitor for a continuous 24 hr or longer period ?
Thanks mav7. Kardia is a little hand held device linked to an app on the user’s mobile. It’s great but unless you use it multiple times over a period of time ( life’s too short ! ) it’s difficult to assess how long either the Afib or NSR episodes last. Of course, for anyone who experiences very symptomatic Afib, they can tell without it. Mine are no where near debilitating, but I would like to know how long the episodes last. Sounds like a Holter would help with that.
Just to your question about the Kardia device (I have the 6L model), you can vary the length of the ecg you record from 30 secs to 5 mins. But for longer recording, and/or 24/7 monitoring, there are other devices available. These usually have a chest strap or 2 chest attached electrodes, and can record throughout the day and night and during activities and sleep.
I don't know if I should even mention this, but I feel conscience-bound to do so. I'm fairly new to A-F (as of 18 months ago). Was put on Apixaban and Bisoprolol but the Biso I believe from the start made me excessively tired, sleepy all day, no energy, much weight gain. I saw three Cardiologists, who contradicted each other's opinion. I did my own research and read that Biso apparently causes excessive tiredness as it affects the thyroid, reducing its activity, and causes weight gain progressively. Two GPs have denied knowing that Biso makes people tired. The last Cardio prescribed a change to Sotalol for me but said not a thing about side-effects or what to expect especially. I then checked Google for sensible and sound advices (I do this with all medications I know nothing about, to see what side-effects each has, ensuring it is from reputable medical sites) and was shocked to see the first screen came up with a Black Box warning given by the FDA on Sotalol - especially for those with COPD, which I also have. It advises people with certain conditions shouldn't take it - all my health problems are on my medical record but not one thing was said to me about this! The warning also states patients with certain conditions when starting Sotalol should spend the first 3 days in some medical monitoring facility (clinic, hospital etc) - again, nothing said to me before handing me the script! I checked with my pharmacist, who told me many people take Sotalol, but the warning totally freaked me out. I refused to start it and so am still on Biso and Apixaban. Here's just one Internet warning from the FDA which I think people should ask their GPs about, or Cardiologists. Sotalol may suit some, but it seems to me every patient should be warned about this medication, or at least doctors should ensure it is fully discussed with someone they're recommending it to - it may be okay for some, but for others it very obviously isn't!
"SOLATOL WARNINGS
• This drug has black box warnings. These are the most serious warnings from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
• Administration warning: If you start or restart this medication, you should be in a facility that can provide continuous heart monitoring and kidney function tests for at least 3 days. This will help to minimize the risk of heart rhythm problems.
ALLERGY WARNING
Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.
If you have a history of getting severe life threatening allergic reactions to a variety of allergens, you’re at a higher risk of developing the same response to beta-blockers. You may not respond to the usual dose of epinephrine that’s used to treat an allergic reaction."
Yes, unfortunately, there is not a med out there without similar warnings other than the black box. Apparently we have to choose to have our heart work and deal with the side effects or suffer the consequences of a fib, etc.
following my second cardioversion I was to be put on Tikosyn and kept in the hospital up to five days in the ICU to be monitored for the medication. Unfortunately, my cardioversion failed so everything was canceled. One of my nurses told me that there could be serious possible deadly fluctuation with the medication and that is why I was going to be monitored so closely. Someone here had told me it was something written up by the company probably for liability. Again, you have to feel concerned about what you’re putting in your body to supposedly feel better.
Afib seems to still have more unanswered questions than answers. From what I can tell, we just have to be happy with getting quality of life and nothing more. Best of luck.
I'm not sure what "more" you'd like from pharmaceuticals. The only "cures" with drugs are with antibiotics against susceptible organisms. Everything else is merely an intervention to try and restore quality of life. Look upon drugs as not poisons, but a necessary supplement to help restore our failing bodies to a somewhat normal state and a better quality of life. Most times they work, sometimes they don't, but the basic fault is our bodies, not the drug. I'm perfectly happy taking a drug for the rest of my life, or switching to a more effective drug if my body is no longer capable of doing what it is supposed to do.
Wise words indeed!
Hi
But it seems not everything has been tried..
Disallowed a ablation!
cheri JOY. 74 (NZ)
That is horrible. I don’t know what the refusal of the ablation was about. Was it the doctor or the government? My doctor did not want to do any more on me because of scarring. I did have the AV node a blade it but he would do no more a fib ablations. It simply was not working and was apparent that I would continue to have new spots act up. For me the same with medication. I’ve been on most of the ones that are known for success, and even an older one. My body rejects help apparently, and after two weeks, the meds would no longer do their job. I had some of them doubled, and in two weeks they were failing again.
Hi
An enlarged rapid persistent AF.
Diltiazem CCB brought it down controlled.
Glad no ablation for me.
cheers JOY. 74. (NZ)
I am so glad it worked for you. That’s why I say we are all so different so it wasn’t you that was not allowed an ablation? As I said, it depends why they are not allowed. I wish we had magic wands and could make everyone better.
Hi
But it's a round up question .. Reason for 'NO ABLATION'Stroke 2019, Thyroid Cancer removed Feb 2020.
1. Length of time with AF. If left hearts become enlarged.
2. No followup after stroke
3. Requested a Heart Specialist 2 yrs 3 mths later!
4. Echo was done at Feb 2021
5. Changes in meds from Metroprolol - PRIV SP ..Bisoprolol - Diltiazem 120mg AM/Bisoprolol 2.5PM
If meds work also they don't ablate tou.
PRIV SP said your age, weight would also be a factor. A little bit cuddly! Good for women as prevents osteo and more oestrogen is found in 'cuddly' women.
Also a greater risk of complications with procedure in women than men.
How are the crocs? You wouldn't want NZ's recent floods.
cheri JOY. 74. (NZ)
I was addressing someone else not you about the treatment they received when there are some serious warnings not to mix the two items. It is not the pharmaceutical item, but the doctor who screwed up. It is their responsibility to know about drug interaction. What I would like, is for them to find a way to do it without poisoning me. I really would prefer to take some thing for a problem that it’s not going to cause me other problems such as kidney failure. We all take what we can to try to get a break from our health issues. I would like to know if when they tell us we need to be monitored if that is coming from big Pharma to cover their butt or if it is a medical reason to add to the cost for all of us. Five days in ICU it is not cheap along with everything else with it unless you have good insurance. I have good insurance but it’s still cost me over $300 a day for the first five days. Tell me it’s to keep me alive then OK but when someone says it comes from the manufacturer, not as a medical prevention. 😡
I have been on Sotalol for a few years and find I am far less tired and breathless than I was on bisoprolol. I started on three x 40mg a day but have been able to reduce the dose as it settled me down well over the years. I'm now on one a day.
Thanks for the encouraging note - it all can be so alarming and confusing especially when doctors basically leave it up to the patient to decide, and we have no idea what we're choosing. I feel as if I need to complete a course in drug side-effects and interactions to even feel halfway safe in accepting what they prescribe. Their lack of care is the other concern I have.
Yes. We are the guinea pigs, so it's good that we share our experiences. 🤗
Hi I was first put on bisopoprol, seems to be normal, it did nothing for me as soon as they saw me in the hospital they changed it to sotalol, it didn't work straight away but now I'm nsr it seems to work fine. I've had no side effects and wouldn't want it changed unless it's a good reason.
Thank you also for the encouraging report - as I say, for a 'newcomer' to all these heart issues, it is very confusing and distressing to be simply handed prescriptions with no explanation or advice on what the medications contain, or can do.
Hi Dudtbin, I've been on Biso for 2 months since flipping into permanent AFib, but it is making me tired and breathless and I can feel it as well. Just been switched today to 2 x 40 Sotalol. Went onto one site which said I should have an ECG weekly at first, but the AFib Dr hasn't mentioned that. Are you in the UK and did you get monitored when you went on it?
i am in Uk. Was put on sotalol by arrhythmia clinic had ecg. It didn’t work straight away and i spent a week in hospital so i had a lot of ecg’s ! Was never told i had to have them after that in fact haven’t had one since December ! Ive had no problems on it at all. Bisoprol didn’t work for me at all.
Many thanks for the reply. No mention was made yesterday of needing to monitor with ECGs. Just pick up your prescription and let us know how you're doing!! And that's Barts in London, who are supposedly the whizz kids on this LOL. How long before the Biso cleared your system and you stopped feeling rubbish? Plus how long before the Sotalol kicked in and what dose are you on if you don't mind me asking?
im on 40 3 times a day. I was only on biso for a couple of weeks - heart rate went up to 160 a lot of the time so i was hospitalized. Then they added digoxin which put me back to nsr, then rate was too low 40! Took digoxin away as soon as i was nsr. Been steady ever since. Heart rate gradually increased to about 53 resting. Still have breathlessness on stairs and hills but gradually heart rate coming down then as well.
Thankyou. What hospital are you under?
glenfield in Leicester, i was on a virtual ward two weeks after being diagnosed with af. That was how we knew my heart rate was so high. Also saw the damage to the heart quickly. When i read the problems people have seeing a cardiologist- i feel very lucky.
Am going for a TOE next week which is a month earlier than they had said it would be!
TOE?
Trans oesophageal echo. - probe down into heart to check it out!
morning......am aged 72 and just over 2 years into diagnosed AF........at first two or three really scary episodes...ending up in AE, for 12 hours plus. I was started on bisoprophol ...ran with it for about 3/4 months but it zonked me out......was tired and listless......almost wore the sofa out.........after meeting with a cardio he suggested Sotalol......i checked it out on google and half scared myself to death but you gotta trust the experts who are looking at your personel health situation.......as for Sotalol ,its worked out much better. I am not as tired, the episodes i get are less frequent and not as extreme....my only "concern" is it sometimes lowers my heart beat to low 50s...even high 40s..........but talking to two different cardiologist, they say its not unusual and because your heart is pretty sound that i am ok........we can only go on what we know and experience....i have changed my life style drastically. Good luck, it can be a bumpy ride.
I was told that sotalol is a rather older and somewhat less safe alternative antiarrhythmic to flecainide, but that I couldn't have either for some reason!
Steve
I was put in Solatol by a private doc instead of Bisoprolol 10 which I’d been on for six years. AF was bad after Covid and couldn’t see one quick enough on NHS. Solatol didn’t work. Was put on digoxin. Made me ill with stomach problems. Eventually NHS doc put me back on Bisoprolol 20 and a reduced dose of flecainide (50 instead of 100). So far so good but you never say never as far as AF is concerned.
72 and have had 10 paroxysmal AF episodes since diagnosis mid 2020. Was prescribed Bisopropol but it gave me diarrhea ( after years of such misery on Metformin) and ineffective anyway, so was switched to Atenolol and Rivaroxaban, followed by statin after ct scan showed mild coronary disease. Cardiologists now discharged me, not interested. GPs think they've done their job, just have to live with it. Now in AF again, no obvious trigger and no solution on the cards. Can't believe nobody has come up with a simple way to reverse AF like GTN for angina. Pretty useless state of affairs.
I'd be getting other specialist advice. Not good just leaving you to cop everything. I'd like to refer you also (as I've done to a few people who've commented on HealthUnlocked), to Dr Sanjay Gupta, Consultant Cardiologist at York Cardiology, York, U.K. If you go into YouTube and type in York Cardiology, or his name, it will open to many of his wonderful and comforting videos. He is truly one in a million for helping people with heart issues. You can also email him - his address is beneath each video and you also can arrange an online consultation with him - not sure of cost but I think it's cheaper than the Cardios' rates where I am in Australia. The anxiety and fear he takes out of these conditions is wonderful. I know he'll able to give you reassurance and answer your queries - he's not at all in agreement with the way medics are treating or advising heart patients today and understands all the issues we're finding ourselves facing, especially from doctors who are more interested in pushing their patients out the door after handing them yet another script for more pills, than in listening to and advising them on their concerns. I know you'll like him - as you'll see, thousands are so grateful to have found him. Praying for you! - best wishes.
Sotalol is an effective antiarrhythmic. I've been on it for about 4 years, since my ablation, and had only 1 episode of AF in that time, caused by a nasty non COVID chest infection. It affects my resting HR, usually low 50s but cardiologist is fine with that. No other side effects. It works well for me. I was on bisoprolol before that and it was terrible, very tired all the time, no energy, brain fog. Glad to get off it.
Thank you so much for this encouragement - I've been tolerating that excessive tiredness over now 18 months, plus weight gain which I'm told Bisoprolol also causes, and so I might ask to transition off it and (trying to be brave) try Sotalol after all. The warning frightened the life out of me so much that I asked the Cardiologist to refund my fee! Which of course he had no interest in doing!
I recently went from S to B without any ill effects.
Afternoon , my experience with bisoprolol is that when I was on 10mgs , when I was very first diagnosed with AF 6 years ago I could barely function as I was so SOB and fatigued . Since then I have been on 7.5 mgs following very fast uncontrolled AF and this too made me feel very slow , lethargic and SOB on minimal exertion . But also in very unstable AF too . Post cardioversion I’m on 2.5 mgs and dronedarone as an antiarryhtmic drug . Should I require a higher dose of betablocker in the future I will definitely ask to try a different one that suits me better . I’m now 58 and a woman and so far have had 2 ablations but my persistent AF returned .
Hi
Why are you not offered CCB Calcium Channel Blocker! My private Heart Specialist did.
On 24 hr monitor Metropolol avge day. 187 Day. 47 Night. 2 pauses night.
" " " Bisoprolol avge day 156 Day. 47 Night. No pauses at night.
" " " Diltiazem CCB 120mg Slow Release AM. Day. 69-88 Day. No pauses. 47 Night. (Bisoprolol 2.5) PM.
Under care you will get it right.
cheers JOY. 74. (NZ)
I don’t know Joy , I think I need to be more proactive in requesting alternative meds as I know it’s trial and error x
Sorry Ossie but what does SOB stand for please?
sorry Cabinessence , it’s ‘shortness of breathe ‘ . That’s my medical background breaking through ! ( at least not my AF ….. so far 🤞🤞🤞)
Hello all I too am on Sotalol for Afib! Have been for about a year! Started on 80 mg twice daily in hospital! Over time they reduced it to 60 mg twice daily because my resting heart rate was in mid 40’s and was so tired all the time! So far it’s working and no Afib for months! Also take Eliquis twice daily!
Hi
I changed to a CCB AM as on Bisoprolol I was over 120 at rest.
On CCB Diliazem180mg it dropped to 51 within 2 hours.
I am now on 120mg and day I'm 69-88 Day but always staying on 47
at night at rest.
You have low H/R.
Usually I have read with AF they do an ablation and put in a pacemaker if necessary.
But since then my friend is warned by Pacemaker that H/R 35.
Care must be taken.
My Dr says that both a CCB and a BB treat rhythnm.
CCB is more H/R controlled and BB the BP. I take 2.5 Bisoprolol at PM.
You must tell everything happening. May be you have had AF for too long but another friend did have the catheter ablastion and was found to have 2 AFs going same time. 1 ablation now no AF or meds. He is late 50s.
cheers JOY 74. (NZ)
Hi Tellingfibs, I had bisoprolol and couldn't tolerate it. My EP changed me to Sotalol and it is ok with me although I have had some breakthrough episodes.Sotalol is a potassium channel blocker and therefore an antiarrhythmic so does control rate and rhythm.
I am back to see EP next week and dreading him wanting to increase the dose as he has already done this once to taking 40mg twice daily to three times daily. I have had 3 episodes in the last 6 months (one after the covid vaccine) but I know he will say my afib is not under control. My episodes are normally one every 4 months and very symptomatic going on for 30 hours plus.
Thanks for that. My Afib episodes are quite mild but becoming more frequent. They don’t last long - I slip in and out of them really but I get them every day now instead of every few days. I think that despite them being mild, the frequency is probably what is tiring me. It’s interesting hearing all the different ways these drugs affect everyone !
I was mortified last Monday, being away on holiday I had a lovely meal and then went 'bang' straight into afib. I thought here we go in it for the long haul and sure enough almost 30 hours later I went back into NSR. This time I wasn't too bad with it as it was much slower but I wish it would do one! Always waiting for the next one to hit me!!
switch from sotalol (80 mg x2) to bisoprolol and flecanide 50 mg x2
Sotalol - Brutal Side Effects
Sotalol versus bisoprolol
Bisoprolol 
Changing from Sotalol to Flecaine side effects. Who has made this change too?
