I have some questions on the above - if any of you extraordinary people can give me simple, unambiguous answers, would be good.
BACKGROUND
I was put on this by the Cardiac Consultant (name witheld) at East Surrey Hospital when he confirmed the diagnosis of paroxysmal AF in January 2010. I have been on it continuously, non stop ever since .... none of this PIP stuff at all, at any time. I was told it was for HR control
In Jan 2010 I was 65, now coming up for 79.
My current GP here in Cornwall increased the dose in early 2021 to 7.5mg to assist with BP. After quite a while on it I began to feel more and more like the zombie from the land of the living dead, I took it on myself to wean myself back do to 5mg. Told my GP after the event.
On the plus side - it holds my resting HR brilliantly in daytime at around 64 - 67 bpm. At nightime (asleep) it settles to around 52 to 56 bpm. Sorted, job done as originally intended by the said Consultant.
On the minus side - initially, nose bleeds, then followed by coldness of extremeties, then as years rolled on - lethargy and now constant tiredness.
Can't remember my last AF event, at least 18 months ago (and according to Mrs BenHall1) maybe as long ago as 4 years when we were away in Twickenham with friends for a long weekend, which laid me out in our hotel room for the duration.
QUESTION (S)
1 Is Bisop a - multi purpose drug, a HR control drug or a BP control drug ?
Simple innit !
2 In 13/14 years should any GP have reviewed my original cardiac medication ?
3 Does anybody have any similar experience AND have the experience of moving from Bisop to another beta blocker without the tiredness side effects. Or even just reducing the Bisop doseage.
4 Given the passing of these years can a drug be altered by a manufacturer, i.e. in 2010 flog it as a HR drug and over the years that follow, say 2021 and up to date, add another concoction to the mix to make it a HR and BP drug (a multipurpose drug).
Following a weird incident I experienced two weeks ago which grounded me from driving I have a TeleCons with my GP next Tuesday. It could be stressful time for one of us .... not for me!
Thanks in advance.
John
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BenHall1
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John, I was put on 2.5mg Bisoprolol at diagnosis and felt like a walking zombie, unable to walk more than a few steps with breathlessness and fatigue. Dose was reduced to 1.25mg with some improvement but I was still short of breath and easily worn out.
A poster on here talked about Nebivolol and its effectiveness without causing the breathing/fatigue symptoms of Bisoprolol. After 4 years of misery, my GP prescribed Nebivolol when I told him of the negative effect on my quality of life, emphasing that - rather than the symptoms themselves. Five years on, I'm, still on 2.5mg Nebivolol and feel great. No breathlessness, able to do normal tasks and no more chilblains on my fingers in winter.
Both drugs are beta blockers but I read that Nebivolol is more cardiac-specific, so is not acting on lung tissue. I think both are used for BP and rate control but I might be wrong there. Having said that, my cardiologist thinks that Bisoprolol is 'the drug of choice'.
I would expect some sort of review of medication after 13/14 years - my reviews are twice yearly but I take 200mg Flecainide as well for rhythm control. I can't help with the idea of a drug being changed but imagine in the UK that there would be stringent medical and legal hoops to be jumped through.
I don't think drugs are changed ie new ingredients added. That would be a to tally new drug but they are often authorised for different conditions other than what they were intended for. Amitriptylene for example is an anti depressant but it was found that in very low doses it helped to relieve nerve pain.
You're quite right Qualipop - BCG vaccines were originally developed to act against TB but BCG is now used as an instillation in the treatment of high risk non-invasive bladder cancer. Amazing how research uncovers these uses.
Well I have considered your post and yesterday had a telephone conversation with my GP. Notwithstanding my intense dislike of the Post CoVid NHS that we have to put up with it was a very constructive discussion. We touched on the ongoing tiredness issue and the more recent blood test results which suggested I was normal in everything except Thyroid. Also latest batch of blood pressure readings.
She did ask me a number of questions about what I ate at lunch time, whether I was on a working day or off duty as now in College holiday time. She wasn't impressed. She asked me about my alcohol consumption and my sleep patterns ... all of which came in for some delicate polite criticism - and suggestions on how things could be improved.
Then we got onto the King hit - Bisoprolol. She acknowledged that I wasn't a great fan of the drug, even though I can't really complain about it as it has served me so well for 13 years. But she did acknowledge it can be a 'tricky' little number. I put it to her that (without naming names etc) there was some anecdotal evidence that Nebivolol might well be an alternative to Bisoprolol without moving away from beta blockers. I also drew her attention to the fact that I'd got some information on this by way of NICE Fact Sheets. End result she is referring me to a telephone consultation with the Surgery Pharmacist and see where we go - in principal she wasn't against it but she was concerned about the process of making the move betwixt. So I have that appointment on 3 August at 13.10 hrs.
Thanks for the update John, it all adds to our collective knowledge.
It sounds like you have a very good GP who listens and takes the broad approach to dealing with symptoms - very much like my own GP. Interesting that she called Bisoprolol 'tricky'! My guy said it can cause breathlessness in certain people (understatement) and that he prescribed Nebivolol for asthmatics and said I should try it for a month. It worked.
Someone mentioned the cost of Neb over Bis - when I was prescribed it, the 5mg dose worked out much cheaper than the 2.5mg and some members mentioned that they got the 5mg to cut if their dose was 2.5mg. Don't know if that is still the case 5 years on but worth looking at if your practice is cost-cutting.
Best wishes with your appointment on the 3rd - I hope you get a good result.
Thought you'd like to know that after a lengthy conversation with my GP, I was referred to the Surgery Pharmacist.
She phoned me this afternoon and as a result it has been agreed that I'd move from Bisoprolol to Nebivolol - she has also suggested that initially I cut the dose from 5mg of Bisoprolol down to 2.5mg of Nebivolol and if need be move up back to 5mg of Nebivolol. No special changeover procedure, discontinue one and pick up the other. By the time the prescription is processed it'll be a week before I start the Nebivolol. We will review it on 29/8 meanwhile she wants me to keep a record of my BP and HR for the intervening period.
No great stress or heated argument with either GP or Surgery Pharmacist 😂😂😂😂
John - Thank you for the update and it's interesting that you were moved down to 2.5mg Nebivolol - that's my dose too - up from 1.25mg Bisoprolol. I hope it does the job for you and that your quality of life will improve as much as mine has done
Bisoprolol is no longer a first line remedy for high BP, there are other more recent meds with potentially fewer side effects your gp IMHO is behind the line
You've sang the praises of Bisoprolol for years! You haven't had a knock to your head have you? 😅I take 1.25 of Bisop per day and feel so much better than when I was on Flecainide and Metoprolol. Could your dose be too strong for you?
Correct, I have indeed but mostly in the context of taking it permanently, 5 mg night after night ... continously for 13 years ( 14 in January) .... never as a PIP ! However, what has been happening insiduously over the last 10 months or so, is a dramatic increase in levels of extreme fatigue and a need to sleep for a hour or so. Now I am talking about fatigue/sleep, NOT, nodding off in front of TV, NOT dozing off behind the wheel when driving .... the need to go to bed for a full blown sleep. What Finvola wrote describes it - breathing/ fatigue. My breathing has also got worse and Mrs BenHall1 has been writing it off as pollen/allergy etc. We live on the outer edge of an urban area, yet surrounded by farms and farming activities. Tree and shrub lined hedge rows - sure - a great source of pollen. Apart from my NHS supplied medication I am needing heaps of nasal spray and cough mixture to dry out my nasal passages and chest.
Yeah I could go on with Bisop for ever, but, if there was a chance of say, Nebivolol (or any other olol) improving my breathing I'd take a chance on the HR side of things. After all, my total medication package has never been reviewed in 13 years ( not that I would change from Warfarin anyway). I have been onto NICE website ( I prefer NICE to NHS ... my feelings about the Post CoVid NHS is that I'd rather talk to the organ grinder than the monkey. NICE, being the organ grinder !), and reviewed their fact sheets on Bisoprolol and Nebivolol ..... might talk to GP on Tuesday. Sure 5mg of Bisop maybe too strong, and so we come back to my statement about my medications not being reviewed in 13 years. TBH, I could well handle a HR of 72 to 75 bpm as a trade off for reducing my dose of Bisop.
Know that all Beta Blockers will have affects such as brain fog, fatigue and other unwanted affects, so much so that some people, me included just cannot tolerate them at all.
Beta Blockers are not the only option, there are plenty of other options but often above GP grade to prescribe so having a review from your cardiologist/EP every couple of years is preferable. Beta Blockers are also used for anxiety but they also cause anxiety when you try reduce them.
For BP control many doctors now favour giving a mix of 2-3 drugs at a low dose which has added benefits - better all round control and fewer problematic side effects.
You will never get an unambiguous answer because we all react differently and doctors’ opinions vary and there is no such thing as one size fits all.
I note Jean’s reply - talk to your GP and ask for a review but if not satisfied ask your GP to write to secondary care for an opinion - or better still get a private appointment, which seems to be the only way these days to get to see a cardiologist EP unless you are considered a priority for medical reasons, so you have the time to sit down and talk to someone about your meds with a specialist.
Could not take the zombieness from 2.5 Bisoprolol for a couple of months so good job you did not feel like that for years. A good cardiologist review seems like the way forward
My Bisoprolol journey has been one of phases .... spread over 13 years. The original Cardio Consultant prescribed it to be taken in the morning.
Phase 1 - was random and full flow nose bleeds. My GP then told me to take it at night, nose bleeds stopped .... never had one since. Ever!
Phase 2 - next came the intense coldness of extremeties a regular feature of my life for some months.
Phase 3 - lethargy and weariness ... but not unmanageable. I just picked my moments for activities, and finally,
Phase 4 - now absolute fatigue and tiredness.
Its been a journey .... but one which has held my HR just where it needs to be, a nice regular beat and highly controlled. Whats not to like ? .... well, its Phase 4. So, if as Finvola says maybe Nevibolol will do the same job without Phase 4 ... then thats the way to go. I'll put this to my GP at one of her NEW NHS telephone ( NOT ZOOM !) consultations.
My thoughts are to wonder whether your tiredness might be related to other things including no more than getting older, as I am finding, and I am ten years your junior. What I would be doing if I were you - but I am a natural worrier - is to arrange for an echocardiogram so your GP can get some detail on your heart and its current functioning. I don't know what the wait is on the NHS, but a private one is likely to cost around £500.00+. If it can be afforded, even better would be a cardiac stress MRI as this would reveal far more but at about three times the cost (it won't be available on the NHS without good cause).
Thanks for that. Yep, sure, getting older is clearly a factor, although that said I'm in the process of repainting a brick wall .... but what I've learned is to pace myself. On the question of Echo's I am now into a pattern with my surgery .... they send me off for a formal ECG at a local clinic, every two years to monitor the state of my ticker post AF. Not due for another (unless an emergency) for 14 months. In terms of AF damage there was no real change although the guy who did the ECG did admit my heart was pretty worn. Well what the hell does he expect at 77 - ( as I was then - the heart of a 30 year old) including 20 years in my younger day as a heavy smoker. Stupid boy. I then discussed the ECG's with my GP (who I am not convinced really understands how to read an ECG anyway) and she did a comparison like for like between the two year ECG's and admitted there was wear but no change to the bits that can be related top AF ( can't remember detail left atria was one, can't remember the other indicators).
The problem is I live down the pointy end of Cornwall ... closer to NW France than to Westminster. Cornwall is one of the poorest counties in Britain, GP's Surgeries are largely full. There are ONLY 2 hospitals one private, one NHS and a large number of clinics. Care is slipshod. Post CoVid Care is total rubbish, rarely get a GP face to face appointment .... and so it goes on ... then ( as I mentioned on here the other day) you have the age discrimination factor not obvious, not blatant ...much more a very subtle approach , like the way GP's phrase the way they say things.
I have had the benefit of living many years in Surrey - a well off county to be sure. I also lived in a well off area of NW Sydney when I lived in OZ ... I understand crap GP service and high standard GP service. Cornwall is crap and I suspect to a large degree NHS is staffed by mediocre practioners.
I might add I am still waiting for a hardcopy of a full range of blood tests from my GP undertaken on 11 July 2023 ! Something else to have a go at my GP about next Tuesday.
I know your thyroid was at least partially checked but did they check Vitamin B12, Vit D, Ferritin etc. If not at optimal levels can leave you very tired.
An ECG is limited in what it can show, so an echo or MRI would allow more certainty to explain, for example, what might be happening to the left ventricle (i.e. the bit that matters in terms of feeling washed out, and so on). An MRI would salso how how good the blood supply is to the heart muscle itself. I was thinking, having been a smoker, do you know if your lungs are functioning well, still?
As for the NHS, it's very mixed. I've worked with a lot of doctors in my time (a good while back now) but I think we have a lot of excellent people. How, as a people, we have stood back and allowed it to be so wilfully mistreated this past decade or so defeats me.
Yeah I take your point on lungs. No, never had anything checked out unless anesthetist did any pre op checks at the time of my knee replacement surgery back in 2015 and never discussed it. Lungs aren't/haven't been a problem other then a phglemy cough from a combination of Ramipril and the rural environment/ pollen count of where I live. This year I've had the worst hayfever ever. TBH, this is a problem for me now, only because I don't have any ailments that cause me to constantly need to consult my GP. Even then she won't see me - only telephone consultations for this lady.
I stopped smoking in October 1985. In the years that have followed I've never had to seek advice on lungs.
I hold the view that a certain politician who guided us through CoVid, worked away discretely in the back ground using CoVid as an excuse to dismantle the NHS as it was. Now you've mentioned my Left Ventricle I must get out the last two ECG write ups and refresh my memory on what they picked up.
Yup - that guy has much to answer for. But he was just a part of a bigger whole who seem at times to be willing the NHS to fall on its knees so that those who can will go private.
Going back to your point 3 in your original post. I was on Bisoprolol for several years starting at 1.25mg a day and increasing to 2.5mg twice a day.
I got to the point where I was so breathless, nauseous and sluggish that I could take no more. My cardiologist reluctantly agreed to change me over to Nebivolol. I felt so much better within a week and my frequency of AF episodes reduced considerably.
More recently about 8 weeks ago, my AF episodes increased big time. I had an episode lasting 5 days. My cardiologist told me to increase the Nebivolol to 10mg spread across the day. This then had the same effect as I had experienced with Bisoprolol, however it did convert me to NSR.
I reduced back to normal dose and went back into AF 3 days later. This pattern continued . I was feeling so unwell with keep having to increase the dose. The increased dose has caused me to become intolerant to Nebivolol. So back on Bisoprolol. Still getting AF for 3/4 days a week and feeling rubbish.
I finally flipped and told my cardiologist no more beta blockers. Over the years he has tried me on them all. I cannot tolerate flecanaide either.
Just today, I have started on Verapamil, my very last option. Who knows what this will do.
I do have a history of intolerance to most medication, including Apixaban, Rivaroxaban, Edoxaban and Warfarin so don’t let this put you off. I am just unusual having so many intolerances.
Sorry for the long post. I do think that it is worth you asking your GP to change you to Nebivolol. You will feel much better on it.
I believe that Nebivolol is more expensive than Bisoprolol so you may have to push hard for it.
Thanks for that, no worries about the long post .... mine was too 😂😂
Yeah, well Bisop does the job, no question, no doubt. I don't accept that Thyroid has any influence on my tiredness, but a second blood test on 18 August will give more info on that. I certainly don't wanna go down the route of having more medics experiment with me WHEN if I can ditch Bisoprolol and move onto Nebivolol, maintain the steady HR and get rid of the tiredness, why not do it. Nice n' Simple.
I wish you every success with your Verapamil journey ... you poor thing with so many intolerances.
John (formerly CarnEuny in a previous incarnation)
I had a lengthy telephone consultation with my GP on 25th and we covered a range of issues.
Just by way of feedback she has agreed to consider my request to change to Nebivolol and as a start point I now have an appointment with our Practice Pharmacist to discuss the changeover and more importantly the process by which I will withdraw from Bisoprolol and restart with Nebivolol.
Hopefully, toddler steps will result in great strides. I have dealt with this Pharmacist before and she is very good and we got on well. Fingers crossed 🤞🤞🤞🤞
Hi John, that sounds promising. The change over is quite straight forward. You just stop Bisoprolol and replace with Nebivolol.
My cardiologist wanted to give me a higher dose of Nebivolol than I was on Bisoprolol, but I resisted that saying that we could increase if necessary. I had 2.5mg twice a day for both tablets.
Good luck with it all. Hopefully, the change will be a good move for you.
Thought you'd like to know that after a lengthy conversation with my GP, I was referred to the Surgery Pharmacist.
She phoned me this afternoon and as a result it has been agreed that I'd move from Bisoprolol to Nebivolol - she has also suggested that initially I cut the dose from 5mg to 2.5mg and if need be move up back to 5mg. No special changeover procedure, discontinue one and pick up the other. By the time the prescription is processed it'll be a week before I start the Nebivolol. We will review it on 29/8 meanwhile she wants me to keep a record of my BP and HR for the intervening period.
At last you are getting somewhere. Hope the Nebivolol suits you better. I am surprised that the Nebivolol is lower than the Bisoprolol. It’s usually the other way round.
When I first changed from Bisoprolol to Nebivolol I felt like I had been given my life back. I felt so much better. I am sure you will too.
I can’t remember if I told you that I changed from Nebivolol because cardiologist told me to take 10mg daily to try and stop the AF. After doing this a couple of times, I became intolerant to it. Nothing new there.
Anyway, he put me on Verapamil 80mg twice a day, no more beta blockers.
A week after stopping Nebivolol, my heart started to race just walking across the room. I contacted cardiologist again and he said well of course it would because you are not taking beta blockers!
So now I have to take either 1.25mg Bisoprolol or 2.5mg Nebivolol daily together with the verapamil. I have opted for the Nebivolol as the lesser of the two evils.
I have my first consultation with the cardiac surgeon on Tuesday, in the hope that I am suitable for a mini maze so that I can get off of all this toxic medication.
I've been on Bisoprolol 10mg for nearly 30 odd years for AV re-entry tachycardia caused by an accessory pathway in my heart and have only recently reduced it to 7.5mg because now I'm in my seventies I needed a bit more energy and my nightime HRs were in low 50s! The only nosebleed I ever had was last year when I had Covid and it was terrible apparently because of Apixaban. My cardio when first prescribed said it was the best beta blocker for heart control and to take it at night so that the fatigue effects would wear off while sleeping. Never had problem with cold extremities and do not have high BP. I also take an anti-arrhythmic as well for my AVRT which possibly maybe why my PAF is asymptomatic (fingers crossed it stays that way).
3. I was taken off 1.25 bisopralol as it dropped my bP way too low. I was given I think, candesartan which I think is a calcium channel blocker not a beta blocker - same effect; like a zombie.. They are now considering nebivolol for arrhythmia but I haven't had any yet.
2 med review; absolutely. It should be done yearly.
Bisoprolol can have HCTZ as a part of it that is a blood pressure med. Many drugs do and doctors may not know about this or its side effects, some of which of course are bad. I looked at Bisoprolol fumarate and this was not on the list but one never knows what the soup is in any drug by different manufacturers, some of which are generics. So a different manufacturer’s drug might give you different symptoms. See if another one is available or the original drug.
Good to see you on here again EngMac, I remember your posts from the past ..... I was previously, in an earlier incarnation .... CarnEuny.
Thanks for your comments .... yeah well those thoughts run pretty close to what I was getting at. I am already on Ramipril and Felodopine as direct BP drugs, Bisoprolol does absolutely nothing for me in terms of BP as far as I can see. My 5mg of Bisoprolol daily has, I feel, done its job, a nice steady regular HR over a long time period. I'll try my GP when I talk to her on Tuesday for the Nebivolol.
If she says no then I'll put to her your suggestion.
Apparently generics can contain the active drug but the maker of the generic does not know the content of the rest of the original drug. Sometimes the original drug manufacturer makes a “generic” which is the original drug to make more money. If you can get this one, if it exists, maybe by accident, or the original drug, you might get better results. I asked about getting the original and I was told it was not available since it is an old drug and generics are more readily available and the predominant ones in the market.
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