Becoming a grumpy old git !

[BenHall1]

Hi all,

Just an enquiry .... one of my rare ones. It concerns a possible side effect of medication.

In the last 6 months or so I have changed three precribed medication. I list these as below ....

Simvastatin was started in mid 2007 and taken continuously until, my Surgery Pharmacist asked me to switch to Atorvastatin on 12 Nov 2023, claiming it was a more modern statin than Simva ????

Warfarin was prescribed when first identified with paroxysmal AF in Jan 2010 till late Dec 2023 when changed to Edoxaban on 31 Dec 2023. My GP pulled a swiftie on me and conned me into the switch ???

Bisoprolol was first prescribed in Jan 2010 when I was first diagnosed with paroxysmal AF until changed to Nebivolol on 17 Sept 2023. This was done because I was complaining that finally I had succumbed to becoming like the family member of the Zombie from the Village of the Living Dead.

My problem is that in recent months I have become more tired, more grumpy, more irritable and intolerant ... all confirmed by my wife. 😱😱 Yes, it must be old age ( 80 in Sept ) you would think ?

Personally, I tend to disregard the Statin change. I am concerned about the change to Nebivolol, has to be a primary cause, but I cannot exclude the switch from Warfarin either. So before I go to my Surgery Pharmacist and start quizzing her I thought I'd lob this around on here and get peeps views.

If any of you kind folk have any experience of changing drugs, exactly the ones I have just described or if you have any experience that you'd like to contribute .... all thoughts would be welcome.

However, please be aware than in mid November 2023, I tripped over our cat, end result was a torn ligament from the left shoulder rotator cuff along with pre-existing osteoarthritis of left shoulder. so pain is the name of the game, particularly at night generating much disturbed sleep. Can't get anywhere with NHS until 15 April when I have an appointment with the local MSK Interface Unit Whizz Kid. Unfortunately, I am a side sleeper ! GP has tried me on different anti depressants alias pain killers and they gave me unacceptable side effects .... so back to CoCodomol 30/500 for pain relief.

Mind you I have to say, sleep has been my problem child for many decades which I have always attributed to being a shift worker ( driving buses )

The cat is well, thank you !

Many thanks in anticipation.

John

[Threecats]

Hi John

I’m sorry to hear about your mood changes but probably not as sorry as your wife is😀

When I tried Nebivolol for a brief period I did read that taking too much of it can cause mood changes and depression, so I suppose that’s a possibility. I must say though, I think my money is on the fact that you’re in a lot of pain and unable to sleep properly with it. I know you say you’ve always struggled to sleep . That is indeed challenging but adding the pain factor in to the mix as well, speaking from experience, is the thing that really wears you down.

I do hope the “whizz kid” you’re seeing in April is able to offer you some relief from the pain.

All the best, TC

[BenHall1 in reply to Threecats]

Hiya TC,

Thanks for your comments. By the way TC, how is your feline 'Wild Child' 😂😂😂

Pain, yep, your description is exactly that ........ 'wears you down' ... spot on ! Since I put my post on I've been doing some more research and I have made an appointment with our Surgery Pharmacist for 2 April and I am gonna propose something radical ........ come off beta blockers totally, phasing my withdrawal over 4 months. My point is that I have been on them for 14 years and TBH I cannot now tell you (or anyone else) that there is any difference between Bisoprolol and Nebivolol........ for me they are past their usefulness. Out of the 14 years, the last 4 I have been AF free, my BP is generally stable around 130/70ish, my HR is around 68 to 72 bpm. My point is that if by July I can cut them out without any change in my HR and BP, and if at the same time I become more 'dynamic', then it may be worth continuing without beta blockers. All subject to advice of course.

I have to admit though I am aware that 'pain', does to weird things to a person.

Meanwhile ........ the cat is well: the wife is well 😱😱😱

[Threecats in reply to BenHall1]

You are right, John, pain, coupled with lack of sleep, can certainly have detrimental effects on one’s decision making abilities. Having said that, it certainly sounds like it’s worth having a conversation with the pharmacist about stopping the beta blockers. As you say, a very slow and tapered withdrawal would be the order of the day if you do decide to go down that route. I had to stop them myself last year, due to them causing chest pain. Since switched to Verapamil which is suiting better. I think I recall you saying before that you get on well with the pharmacist, so I hope the appointment is productive.

As for my “Wild Child” she is doing well, thank you, more than the local rodent population is🙄 It was carnage out in the hall the other night - three young rats I think they were. I told her one wouldn’t count though, as it had been caught in one of those spring traps and she’d brought it in complete with trap. Goodness knows how she got that ensemble through the cat flap! Trouble is, I’ve no idea who the trap belongs to, so can’t return it.😀The joys of springtime in a rural area! Madam is now snoozing peacefully in her bed like butter wouldn’t melt🤣🤣 At risk of being thrown off the forum for posting something not AF related, I attach a picture of the little horror, so you know who I’m talking about🤣 I took the picture last Summer when she was in one of her favourite hideouts in the wisteria. I’d spotted her that time so she wasn’t very pleased. Normally I don’t and get reminded of her presence with a whack on the head when I walk through the arch - blo*dy cat😠🤣🤣

Glad to hear both your cat and Mrs BenHall are well and there have been no further attempts on your life🤣🤣

Tabby cat lying in wait in wisteria

[BenHall1 in reply to Threecats]

Hiya TC and Wild Child,

Wild Child looks absolutely gorgeous despite rodent deposits and whacks over the head 😂😂😂🐱🐱🐱

I had my telephone appointment this morning with and went through all my speil. End result was she wants me to cease Statins immediately for 2 weeks. So that stops the Atorvastatin ! I went on and on about stopping Edoxaban and returning to Warfarin and stopping beta blockers altogether. That went over like a lead balloon !! I then gave her an out by saying well returning to Bisoprolol but only 1.25mg. No response.

I guess what she is doing is dealing with the medication that is the least dramatic first. On 10 April I have to have full range blood tests with a focus on Thyroid. Then she'll phone me on 17 April and discuss results.

The wheels of industry grind away slowly..... Wild Child makes me laugh though.

John

[Threecats in reply to BenHall1]

Hi John

Thanks for the update. Whilst it must be incredibly frustrating for you, as I know you’d pretty much got your heart set on returning to Wafarin and getting off the blockers, I can sort of see where your GP is coming from with her very cautious approach. I suppose, doing it this way at least means you might be better able to identify which drug is causing you problems . Good luck with the blood test next week. Have you seen the “whizz kid” at your surgery about your shoulder yet?

As for my Wild Child , she continues to run rings round me and my other two cats! She’s a small cat and only has little legs, as she was left to fend for herself outside as a kitten and didn’t fully develop I think. However, what she lacks in size she more than makes up for in attitude and temper😂😂 She’s reasonably tame at the moment, as she spends most of her days indoors whilst the weather is bad but, come summer, she’ll be out all day and back to full feral mode😂

Anyway, do let me know how you get on.

All the best, TC and the Wild Child

[BenHall1 in reply to Threecats]

Hi TC and Wild Child,

I see the 'Whizz kid' about shoulder at 2.15pm on 15 April, when, hopefully he will wave a magic wand and all will be healed. But then, we're talking NHS here so I'm following the advice of one of my favourite book characters ..... Jack Reacher - 'Hope for the best, plan for the worst'.

So far I am doing as directed and off the statins. The worst is yet to come .......... getting agreement to Return to Warfarin. 😀😀

Our little cat, Dotty, has been out most of the night and left a corpse at the front door this morning and is now fast asleep. A similar pose to this .....

A sleeping cat ..........

[Threecats in reply to BenHall1]

Hi John

What a beauty Dotty is! I do like ginger cats I must say. My neighbour has a big ginger ex-tom who is as soppy as a sack. Despite that, my other two cats behave like a couple of maiden aunts who’ve been goosed in the shrubbery if they clock him in the garden. Needless to say, Wild Child thinks he’s a bit of alright, the brazen hussy😂. They share a common interest in murdering the local rodent population but fortunately, as they’ve both been “done” their relationship is purely platonic😂

Good luck with your appointment on the 15th. I hope it goes well for you but think you are wise in following Jack Reacher’s advice!

TC & WC!

[Popepaul]

I agree with 3cats. You are unlikely to be full of the joys of life if you have intermittent pain and poor sleep.

[jeanjeannie50]

Hi John

I'm with you re looking for something to blame for you feeling like you do. It gives us hope of being normal again just by just stopping it. Your question made me think of the Antiques Road Show and their basic, better and best.

As you know I have taken Warfarin for many years and it has given me no problems whatsoever and has been around for 70 years. Edoxaban is a newer drug in comparison - so it could be that.

Simvastatin is often accused of causing problems and I knew someone who had dreadful leg pains with it. You got on with it fine, so you're probably ok with statins - Atorvastatin.

Didn't you find that you felt better on Nebivolol when you first changed to it? If so I don't think it will be that.

My guess then is it's the Edoxaban and that is only a very wild guess.

As others have suggested, you have had a traumatic time lately, being in pain and not sleeping well, so your mood could well be because of that. When you see your GP tell him about your difficulty with sleeping. I had that for years and it would make me feel like I had flu. For many years now I've taken a low dose sleeping pill Zopiclone and lack of sleep is no longer a problem. I'm so glad there's such a thing, ask outright if he/she doesn't suggest them - just to help you right now.

Hope you will soon feel better.

Jean

[BenHall1 in reply to jeanjeannie50]

Hi Jean,

Thanks for your comments. Basically, in my own mind I've eliminated statins from the 'cause and effect' problem.

Although I'm tending to blame betablockers I can't remove from the problem Edoxaban. As I said to TC, I have an appointment with my Surgery Pharmacist on 2 April and I am gonna test the water for coming off beta blockers all together. A phased withdrawal over 4 months. So, this will give me the opportunity to have a deep and meaningful chat about it and also to challenge the wisdom of moving from Warfarin to Edoxaban. My personal preference is for Warfarin, nothing scientific or medical in that ... just my gut feeling.

Yes, you are correct Jean, when I first switched to Nebivolol I did feel good ... but much time has passed and I cannot truly say I notice any difference - RIGHT NOW - in how I feel between Bisoprolol and Nebivolol. Both the same, even though Bisop was 5 mg and Nebivolol is 3.75mg.

I will write more when I have something useful to add to this particular 'medication journey' but thanks for your comments. And everyone else too. Meanwhile I will research the Zopiclone you mentioned and bring that up with the Pharmacist too. Did you have any side effects with it ? .... or was it like a duck to water, so to speak 😂

John

[BenHall1 in reply to jeanjeannie50]

Hiya Jean,

Been doing a bit more research this morning and I think you are right Edoxaban certainly has noted side effects consistent with my complaint .......... and, as a double whammy so does Nebivolol. So given my good run without AF, (4 years) with no cardioversion, with no ablation and stable low HR I'm gonna have a crack at cutting out beta blockers. I plan to talk to the Surgery Pharmacist with the view to cutting out Edoxaban and returning to Warfarin PLUS reducing beta blockers ( Nebivolol ) till I cut them out, so that's 3.75 down to 2.5, then down to 1.25 then zilch.

Thanks again for your thoguhts.

John

[kitenski]

Ben,

I'm not sure why you'd want to stop the beta blockers after 4 years without AF, low HR and a stable BP?

Surely it's the Beta Blockers that are doing that? I'd be eliminating all other suspects before looking at the beta blocker personally.

Warfarin is a pretty old anticoagulant and IIRC you need to be tested every 12 weeks and dosage adjusted whilst you are on it, there are much more modern anticoagulants around.

I can't see "grumpiness" listed as a side affect of Nebivolol I'd hazard a guess that it's more down to the constant pain, leading to poor sleep that would be the root cause?

healthline.com/health/drugs...

[BenHall1 in reply to kitenski]

Hi kitenski,

Thanks for your thoughts. I need to expand ......... food is my trigger ( or was/or can be ) for AF to kick in. My personal mantra for many years has been ........ calm the vagal nerve .... calm the heart. I have always said no cardioversion/ no ablation for this guy ! It has been medication and diet.

So ... no! it isn't the beta blockers doing it - it's diet mainly. So long as I maintain the diet the heart will behave ... its only a rate problem, not a rythmn problem. This is why I feel it time to move off beta blockers, and nobody can tell me what will happen, only doing it will tell me !

On the matter of Warfarin .... my forever best friend ... all the things you say are always used and thrown around ......... of course it is old, tried, proven and well tested. More than can be said of the latest batch of NOAC's ...... but I have my own Coaguchek Testing device, test myself, report at regular intervals to my INR Clinic and just get on with living the dream. Because I have my own testing device I can test as frequently ( or not ) as I like, I'm not bound by anything. When I visit Australia I take my kit with me, no problem at all. I have also had three medical procedures involving my stopping and restarting Warfarin including a knee replacement surgery. So what's the problem ....... what problem do you see with that. I don't, nor did my surgeon and anethestist. It's nowadays all a 'Big Pharma' marketing issue ..... they would like to wipe Warfarin off the planet ..... just to be able to replace it with a batch of unprovens. I need to correct you ............. you do not need to test your INR every 12 weeks, you can do it as deemed necessary by your INR clinic. Your statement is incorrect. Do you use Warfarin ? have you got your own testing device ?

John

[kitenski in reply to BenHall1]

Thanks John,

No I don't take Warfarin, my 50 year old brother did for a number of years before he sadly passed away and he had to be constantly monitored.

If food is the trigger then it sounds like gradually reducing BBs is worth a go. The only thing I'd suggest is keep a diary of what you change and on what date, then record if you have any AF episodes.

I've been doing that since 2019 and it's been really helpful when I took myself off flecainide despite the nurse saying not to (but the consultant agreed when I finally spoke to him)

Good luck, keep us updated!

[BenHall1 in reply to kitenski]

Hi kitenski,

Thanks for your thoughts. Your second para is attractive as it is something I'm quite good at ( goes back to my management days in a different galaxy ! ). I am very good at record keeping and the Nutritionist I consulted years ago for my diet taught me much about recording food etc and its effects. So using the same techniques for medication is not a problem for me. I already do this for BP and blood sugar (diabetes ) - no, I don't have a blood sugar problem but it is in my family so I have my own testing device which I use occasionally just to make sure things are staying okay.

Recording my AF events is easy enough to do .... in the past I used to feel events ... like, my chest was often a combat zone for squadrons of butterflies in dogfights, or a plastic bag of damp soil with loads of earthworms wriggling away, or my chest would feel heavy - or light. Whenever my chest felt heavy and breathing laboured I always knew I was in trouble ------------ when it was light and as free as a bird I knew I was quite normal as in a fit, non AF person.

As the years have moved on it is usually light or heavy are the clues and of course now, technology. Now what I do is if I feel heavy I go for BP monitor or Kardia and get a reading, just depends on when and where .... but seriously, as I've said, 4 years is a long time now. I've considered all comments on here and will probably press for getting off Edoxaban and back to Warfarin - I've still got all my testing kit. Then try for a gradual reduction of Nebivolol and watch the readings.

Thanks again and I will post updates on here so that you guys can see what happens.

John

[Keepcool]

hi Ben, enjoyed your post. A bit of humour amongst the gloom is much appreciated.ive been on Apixaban blood thinner for years since my AF diagnosed. Have never had any problems. My cardiologist at the time (hugely respected man) told me Warfarin would never pass regulations today, think he meant the monitoring aspect. But we all know our bodies better and if you are unsure of the new meds then stick with what makes you happy.

My problem is bisoprolol. Many moons ago I was diagnosed with AF and first port of call was betablocker. Tried atenolol then bisoprolol. Couldn't climb stairs in house with either. Couldn’t catch breath …..scary! Doc then prescribed Flecainide and small dose of bisoprolol which worked until my heart rate went too low 48. New cardiologist told me to stick with 2.5 a day alongside Flecainide but I thought no way and reduced to 1.25 which worked just fine.

Anyhoo over the years have had 3 ablations and cardioversions. Last ablation was aug24 and resulted in A&E following week with horrendous symptoms. Cardioverted and all fine till I weaned off flecainide and back with a vengeance a month ago.,This time I am mostly in rythmn but very fast heart rate. On exertion heart goes slow and irregular for 5mins. It’s as if it’s trying to reset itself. But slow HR with exertion is troubling.

So ……and finally to the point…..I was put on high dose of flecainide but also……the dreaded betablocker. I’ve cut flecainide back a bit but just been short walk and chest pain back.

I’m sure it’s bisoprolol as I can run upstairs in morning but couple hours after meds I’m struggling.

I’ve taken statins for short time but if I remember right it caused sleep problems and I ditched them…..promising to watch diet instead.