I posted a couple of months ago asking for advice on alternative to Bisoprolol. After reading reviews I thought I would like to try Nebivolol.
My GP wouldn’t prescribe Nebivolol ,only carvedilol, as I had an appointment with a cardiologist in 8 days I thought would ask the doctor then.
During the appointment I told the doctor that my last cardioversion only lasted 2 weeks, he said we won’t bother with any more cardioversions for you then . So I asked if I could stop Bisoprolol and try Nebivolol , no , he wants me to still take Bisoprolol and added another three different medications. As I’m tired all the time ,he’s sending me for a sleep study,and I have to lose weight.
I told him my weight problem was down to having thyroid symptoms for 10 years but not having treatment.. no reply .. He prescribed Dapagliflozin , Papworth has done trials on this drug which is for type 2 diabetics ,they found it also helped people with heart problems. He was quite excited to prescribe this drug .
He also prescribed Spironolactone , and Digoxin , I also take Ramipril ,Bisoprolol, adoxopan and frusemide .
As soon as I came home I researched this doctor, he’s a leading cardiologist and electrophysiologist at Papworth hospital. , I have always had low blood sugar symptoms,but the feeling I had after taking these new meds was awful , I couldn’t stop eating and all the symptoms that go with low blood sugars. I spoke to our pharmacist and she told me I could just stop taking Dapagliflozin.
I still feel terrible , I sleep about three times a day , if I do any activity I get so weak ,shake , sweat ,my legs feel like jelly , even taking a shower tires me out . The past week I have been woken up during the night sweating . I have had these symptoms since I had AF 3 years ago ,but they have gotten a lot worse . Is it symptoms of AF ,or side effects of the medication ?
I have contacted the doctors secretary . I don’t think I can tolerate any of the new drugs he’s prescribed. Has anyone had bad side effects with Dapagliflozin,Spironolactone and Digoxin please ? I will be very grateful for opinions.
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Beverleyb
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I took Furosimide and Spironolactone for fluid retention around heard and in lungs. Worked a treat. Two years on the Spironolactone exacerbated high potassium and creatinine levels so it was discontinued but I continued with the Furosimide. I also take Bisoprolol to control Afib 'attacks'.It does the trick for me.All of these meds affect people differently so it is a wise move to speak to the cardios secretary and hopefully she will get some feed back for you from the cardio/ep. as to why he prescribed the various meds. you are on and why he has prescribed them and if you can stop any of them.
I was on 20mg Furosimide and 12 and a half mg of Spironolactone once daily in the morning. This worked very well for me and even got rid of massive upper thigh and leg swelling before I started to take it regularly to stop the accumulation of fluid later. But you must be guided by your doctor and less by others meds.Spironolactone was stopped for me recently when my potassium and creatinine shot up unexpectedly .
Hello Ginger, may I ask what dose of Spironolactone you were on? I have this swelling on the tops of my feet, hardly ever my ankles. My GP prescribed a diuretic which had no effect on the swelling but raised my heart rate. She discontinued it and I went for my routine Cardio visit - he gave my feet a cursory glance, said it's not bad and prescribed half a 25mg Spiractin tab. I read up that it was potassium sparing so I discontinued my daily banana !!!! As half a tablet had no effect my GP raised it to 25mg, which has no effect either ! When I spoke to her she said she did not want to increase because of damage to the kidneys.(this was not a consultation but in passing) This has been going on for 9 months - I had been taking a small dose of Verapamil but that was stopped and made no difference . What is Furosimide - I wonder if I should suggest that to Leanne my GP when I see her next month?
You weren't even doing well two months ago before these other drugs were added, so let's go back.
You weren't doing well on Bisoprolol, so you decided to switch to Nebivolol, but the doctor said no and gave you cardivilol. Fair enough. Except you didn't do well on that either.
Here's the thing. Bisoprolol, Nebivolo and Cardivolol are all beta blockers. Some people don't do well on any beta blocker. I don't. So what you really want to try is a different class of drugs that will serve the same function.
Many, including myself in your situation, have done well on Diltiazem. It's a calcium channel blocker that serves similar functions to beta blockers, however many people tolerate it better.
As to the other drugs they are adding, I am not qualified to say what you need or not, but often doctors just keep adding drugs to solve problems rather taking the time to change, eliminate or reduce drug dosages. Even the "leading" ones.
So take Digoxin which was added. Is that really necessary when you're already on a beta blocker?
I not qualifed to answer that, however, if it were me, I would have a frank conversation with my doctor and ask to find a drug mix that didn't make me feel so terrible. I'd start by asking to stop the Cardiovol and switch to Diltizem. If I didn't feel better then, I'd ask for a trial off the Digoxin. As to the other two drugs, not familiar if you need them or not.
Thank you again mjames1 . I think a lot of the problems come from not seeing the same consultant at every appointment. They all seem to contradict each other .
I’m hoping for a call from the doctor this week ,I will put to him your suggestion than you .
Great in theory but many people (like me) can't take calcium chanel blockers such as diltiezem because of fluid retention and swollen ankles. I do agree though that AF means a long journey of trying different drugs till you find a combination that works without producing synptoms worse than the AF and the sad thing is that if you have multiple health issues that may never happen.
Diltiazem may not work for everyone, but it does for many, so often worth the try. Like yourself, I also eventually developed swollen ankles on diltiazem, but that went away with a dose reduction.
We both agree that "trying different drugs till you find a combination that works without producing symptoms worse than the AF." And yes, it can be challenging with multiple health issues, but the effort is worth it, even if we don't get exactly to where we want to be.
One issue here is that many seem reticent to speak up to their doctor and get involved in the decision making process. That never has been an issue for me, and I doubt for you as well
The other issue -- and I don't want to get into a debate on different medical systems -- is that it seems a lot more difficult and time consuming in the UK to switch doctors than with the US system. So if you get stuck with a "my way or the highway" doc, you may be stuck for awhile.
Here, I can find another cardio or ep within days if I want. And then another if necessary, until I find one that believes in shared medical decision making.
I don’t have anywhere near the knowledge or experience to advise you on your medication but it seems you are on quite a cocktail of drugs, which suggests that your medical history may be quite complicated. For example, a couple of them are to treat oedema which is not typically a symptom of AF. Is your kidney function normal or another condition that causes fluid build up? Are you on thyroid medication? There are a lot of AF ladies here who also have thyroid issues who can offer their valuable experience. Is your BP well controlled or do you need medication to manage it? You mention your weight but you don’t say why the consultant sees it as a problem. Is it something that would prevent him from recommending you have an ablation, for example? I know some health care professionals make a deal about weight when it’s not necessary or even relevant, but in some cases it can be an issue. You mention that your thyroid problem has gone untreated for 10 years but are things improving now? I’m afraid you need to look at the whole picture and unfortunately that doesn’t seem to happen in most healthcare settings. I’m not surprised you have side effects on such a cocktail of meds and agree it’s better to reduce the number of different tablets. However, asking on the internet and following the advice of random strangers isn’t the best way to go about it. You really need to talk with a healthcare professional who knows about these drugs, why they are prescribed and whether you actually need them. Keep pushing until you get answers.
My problems started after I had a hysterectomy at 42 . I put on 3 stone of weight very quickly , I had lots of different symptoms and I had a lump in my neck. I felt awful for 10 years, I knew there was something wrong but didn’t know what . I went to see an ENT consultant about snoring , he took one look at my neck and snoring wasn’t mentioned . Two weeks later I had all my thyroid removed . The next 7 years were spent trying different combinations of medications . I joined healthunlocked, thyroid group ,found a private endocrinologist and finally felt good . I can’t thank the thyroid group enough. At 62 I felt the best I ever had. At sometime during this period I started having high BP, I also had a lot of stress in my life, my GP couldnt control the BP , Then in 2020 I was diagnosed with AF,and now I’m trying to find suitable medication so I can enjoy my retirement, and I’m not giving up until I do . I understand I need to lose weight for health reasons , this consultant is the first to mention my weight .
I was also quite surprised he added three different tablets .
Although you do not say so specifically your reply to autumn leaves suggests that (like me) your thyroid treatment was blamed for your afib starting and was either reduced or stopped altogether. I find it difficult to believe that it was stopped altogether after a total thyroidectomy. Often cardiologists know very little in detail about the thyroid and how it's malfunction can impact ALL our bodily systems. Oedema is a very common symptom in hypo . Weight gain despite lack of appetite and symptoms of low blood sugar ( despite blood sugar on measurement not being particularly low) are also common. Before my hypothyroidism diagnosis I had night sweats. This was misdiagnosed along with myriad other symptoms as menopause. Once you have afib it is very difficult to get proper treatment for hypothyroidism as many doctors will blame the afib on overtreatment for the hypo even when sometimes it is the undertreatment for the hypo which is causing or contributing to the afib!
The info on the NHS website about Dapagliflozin says it can cause hypoglycaemia attacks if taken with another diabetic medicine. It also points out that low blood sugar can happen with hypothyroidism. In interactions with other meds it says "There are some medicines that may increase the effects of dapagliflozin. This can make you more likely to get side effects" . It then lists Furosemide and Ramipiril. Drugs.com says" Dapagliflozin can cause some people to become dehydrated (the loss of body water and salt). Dehydration may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). "It then states that this is more likely to happen to people taking blood pressure medicines including diuretics. So it is possible that it is the cocktail of Dapagliflozin, Furosemide and Ramipiril that is making you feel worse. Adding yet another diuretic like Spironalactone could be adding to to this as ,dizziness and muscle weakness are listed in the side effects on the NHS website. The muscle weakness is considered a serious side effect which needs to be reported pronto.
Unfortunately it is very common for hypothyroid patients ( of whom 9 out of 10 are women) go be put on masses of meds to treat the individual symptoms that hypothyroidism can cause rather than recognise the root cause and treat the underlying condition. This polypharmacy approach does not lead to them recovering their health.
I think I might not have explained myself properly, sorry, after I had my thyroid removed , I never felt well , didn’t have all the info about thyroid then, and certainly didn’t know about TSH levels etc. I found a private endocrinologist who helped me find the correct thyroid medication . I think it was about that time I started getting high BP , my GP couldn’t control my BP and that is when I was diagnosed with AFIB.
Thank you for the information on the medications, I have looked at some websites , and will continue to look for more info. Thank you for your reply .
Are you still being medicated for your thyroid? A total thyroidectomy usually entails treatment for life as we cannot be healthy without thyroid hormones.
oh yes ,I realise this, I found a private endocrinologist , she gives me prescriptions for Liothyronine which I pay for ,I get thyroxine through my GP .
That’s certainly a very complicated picture, and I’ve learned more about these drugs and their side effects from the other replies. It seems a bit crazy to keep someone on a drug that is causing a side effect like fluid retention and then prescribing yet another drug to treat the side effect. The more logical approach would be to try another medication that didn’t have this side effect and thus reduce the polypharmacy load on your body. Having more than one condition that requires medication certainly complicates these concerns but I’m not surprised you feel awful on so many meds. I really do wish you luck in getting somewhere with this, especially with the impossibility of getting appointments at the moment. You deserve proper treatment especially as this is impacting on your quality of life.
The first time my wife went into persistent AF she was in the cardio ward for a week and they eventually discharged her on a combination of Bisoprolol and Digoxin. She was on this for 3 months and tolerated it well and had a good QoL. She self reverted out of AF so they took her off Digoxin. 4 years later she's back in persistent AF and struggling. Paying to see a consultant tomorrow who hopefully will suggestcazway forward.
I've been taking digoxin for about 9 months or so with no side effects ( I take thyroxine too for underactive thyroid). I don't know about the others but that's a whole lot of drugs. I couldn't tolerate bisoprolol at all. Made me really breathless and (even more) fatigued.
When I was first diagnosed with AFib I was given a blood thinner and bisoprolol, I was already taking meds for high blood pressure, two years later I take 5 different drugs , and feel worse than ever !
I think that's a common issue. I have had similar experiences. I have underactive thyroid because of amiodarone and I have a salycilate allergy due to aspirin. I also developed an allergy to flecainide and bisoprolol triggered asthma, so this limits the options available. I'm currently transitioning off all meds as a trial. I had been on dronedarone, digoxin and apixaban without any side effects. 3 x unsuccessful ablations means the current plan is to move from rhythm control to rate control. I will be starting on candesartan (heart failure med) and will go back on digoxin if heart rate too high without it. This is a short term plan as I'm too young for pacemaker but that's the next step, I'm told. I've had AF for 18 years though. About a decade in persistent.
Hello . I feel you pain. I feel exactly the sane on bisoprolol . It was really terrible. I went to private cardiologist . Explain my situation . He change it for nebivolol . And now gp prescribe me it too. Never give up . Maybe try go privately, just to change you meds . Best regards .
Hi Beverley, the end of lat year I bagan taking dapa, a lot of people said it made them lose weight but it didn’t make me. After 3 months weight began falling off me, my kidney and heart function went up. I must admit I was getting very bad night sweats, but I didn’t put it down to dapa.
I’ve been taking spironolactone for years. It does mention men shouldn’t take it as it can enlarge breasts. I can never pinpoint what if any tablets are affecting me because so much of my symptoms can be down to my illnesses.
I don’t know about digoxin, I was given that as a 15 yr old through a drip, when I went into supra ventricular tachycardia to stop it. When I came out of hospital I was given the tablets, but over the years when SVT flared up I would be prescribed propranolol.
I don’t feel able to advise, but my reaction is to observe the large cocktail you are being offered.
You say little about your thyroid condition: in my case my thyroid status seems to be directly linked to the atrial fibrillation. Once my thyroid medication was adjusted (in my case, adding liothyronone) to better suit my thyroid needs, the atrial fibrillation settled a lot. (As did other symptoms.)
I personally couldn’t tolerate bisoprolol, even a smaller dose. I was very breathless and extremely fatigued, with bad pain.
I would suggest, like a previous responder, that you need to look at the whole picture. It’s difficult to get the medics to do that, (but at least my endocrinologist talks to my cardiologist now.)
I also take Liothyronine , it was like a light switch moment for me the day I started those tablets . My thyroid levels are fine thank you , I test them regularly with home test kits .
If I don’t receive any replies from the consultant this week ,then I will look to go private ,otherwise I will still be going round in circles for months.
wow Bev you are on a cocktail of meds! I’m allergic to Bisoprolol and most of the beta blockers. I was a persistent afiber and after quite a few cardioversions, ablations I was put on Flecainide 100mg twice a day and for me it is the drug that helps. I know it’s a Pill in the pocket but it’s ok for me.
In January I had OHS for new mitral valve and atrial valve. After the op I was in Afib so a month after I had another cardioversion and thank god been clear since then. Like u I also have thyroid, taking 150 thyroxine daily’s. I’m type 2 diabetic and have recently been added to my list of meds for Dapagliflozin. Not sure why they would put you on this if you have low sugars? It is good for heart and kidney probs, I have CKD. Do you mind me asking your age? I’m 74. I research any new drug I’m prescribe and I will argue with consultant if I think it’s wrong for me. Wish you luck but do keep telling them how you are feeling on some of the drugs.
Hi Sally _Scott , sorry to read you have a lot of health problems, I hope Dapagliflozin works for you . The consultant I saw works at Papworth hospital where they did the trials for Dapagliflozin, he was quite excited about it , he totally ignored me when I told him I get low blood sugars . I asked him if I could stop taking Bisoprolol , and try another beta blocker because of the side effects, no, I want you to keep taking it and I’m going to add three more types of medication. He wasn’t really up for a discussion, so I gave up then . I will be 69 next week .
I m currently taking 10 mg Bisoprolol and 125mg Digoxin and feel dreadful. I'm Currently in rapid AFib and the combination of meds has managed to get my Bpm to just over or just under 100 bpm resting. It has also disrupted my sleep, made my extremities very cold - worsening very dry skin on my hands and Skin cracking, made me more breathless and made my chest a bit wheezy. I'm piling on the pounds irrespective of what I eat and am fighting to stay awake most of the day. Ive got no energy and feel very ' flat'. I stopped the digoxin a few days ago as it was giving me rampant diarrohea which strangely enough didn't stop me from gaining weight. I'll try it again when my bowels return to normal.I also take furosemide which doesn't seem to have much in the way of side effects other than giving me an urgent need to urinate an hour or so after taking it which is Very inconvenient.
When not in AF I don't take the Digoxin . and am on 1.25mg or 2.5mg Bisoprolol which still causes me breathlessness Cold extremities, tiredness, sleep disruption, and makes it very difficult to lose weight. My blood thinner is Dabigatian.
I hope this helps. Meds are such a problem - Very much a double edged sword !!!
No one Dr or our DHB Heart Specialist controlled me - raoid and persistent.
But saw a private Heart Specialist Dr B Wong Whangarei. Introduced CCB Diltiazem. Too much @ 180mg 1/2 dose.
Take 120mg Dilriazem AM
2.5mg BB Bisoprolol PM
Pradaxa 110mg x twice daily.
125mg Synthroid (Thyroxin) 1 x 100mg. 1 x 25mg. Take 25mg if creeps up
Keep 1-2 TSH above .7 normal and below 4.2 normal.
Had a blood clot stroke with undiagnosed AF due to thyroid papillary cancer.
So 4 mths after stroke (shadow on thyroid whilst doing a carotid artery scan 4th day after stroke). Biopsy test 6 weeks later showed papillary cancer. LUCKY
Control with H/R under 90 h/beats min at rest. 65 ideal though.
Hi, sadly I think what you describe is the current state of the NHS. Docs are over worked, and arrogant and they just want a quick fix so they will prescribe anything without much thought about the individual and their needs, its just to get you out of the door, check up in a years time if you don't die first. My experience is the more questions you ask the more defensive they get and are reluctant to explain anything.
Spironolactone gave me, male, sore and enlarged breats so stopped that. You might not need bisoprolol and ramipril together, can depend on your BP.
I would ask for a full meds review as you seem to be taking a lot of tablets, or even speak to pharmacy and ask if all these drugs can work together okay
l think that many doctors are crazy and use us for experimental purposes. I cannot believe that you consented to all those changes at once. No way Jose would l do that. Of course you are feeling awful. I am not a doctor but what works for me very well is sotalol … for afib … Eliquis for potential blood clots… along with a statin. Nothing else other than tons of vitamin supplementation. I think that one should start with one change for a couple of weeks then the next one for a couple of weeks, etc. Carefully check drug interactions. Otherwise how do you know what is causing what. I wish you the best but question what they are giving to you … why are they giving it to you … is it absolutely necessary… can you make the changes in stages?
Hi Janith , thank you for replying, I am still learning about Afib and the different medications . I don’t have enough knowledge to question the cardiologist, but I was puzzled as to why he would prescribe three extra medications . You are so right , it would be a lot easier if we could introduce one at a time .
l have something called Paroxysmal Afib … meaning that it occurs on an irregular basis and usually stops without intervention (usually) … l always go to the emergency room when it happens … but l am in the US. It goes away after an IV after about one hour. When l was first diagnosed … the cardiologist prescribed sotalol. That was four years ago. I have zero side effects. The cardiologist wanted me to take blood thinners … l refused … and continued to refuse until one year ago when l decided that l perhaps should take the blood thinners. So l chose Eliquis after much research. Zero side effects. I highly recommend that cocktail for my type of afib. I wish you the best. You should NOT have to suffer like that! Jan
Hi Jan , I am pleased that you have found the right cocktail of medication. I believe a few members on here use sotalol , all positive reviews . I am going to look for a good cardiologist and go private , it’s the only way forward, especially when I see a different doctor at every appointment, and they all change my medication.
Yes private is the only way to go … seeing the same cardiologist is sooooo important. They get to know you and your body and your quirks … l have many! I know that it can be expensive but worth it. When we go to Europe (yearly) l always pay if something goes wrong … thus far l have escaped afib when in Europe or abroad. Best, Jan
There is loads of stuff on here by people who don't tolerate Bisoprolol that well, including me. Typical comments include, overwhelming tiredness and the need to sleep, breathlessness on just walking up the stairs, as well as feeling spaced out, all of which applied to me. I stopped 10 days ago and was put on Sotalol and all of those side effects have gone.
hi , I had my thyroid removed about 16 years ago due to having a goitre. So i am hypothyroid . My TSH levels have been controlled for a few years now , so I don’t have any problems there . You say you had fatigue and sweating due to exertion , was that before you had your thyroid removed ?
Hi Cheri JOY , It took me years to get the correct medication after having thyroid removed. Then I developed high BP then AFib , I haven’t got my thyroid results on hand but I always make sure my TSH is 2 or under and T4 and t3 levels ok .
The doctors say my fatigue, weak and sweating are not Afib symptoms so I assume they are side effects from meds .
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Help and Advice needed please
Could I have some advice please?
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Hello! Any advice would be gratefully received, especially re Digoxin. Thanks. 
any advice appreciated !
