I recently posted a question about taking a medication to shorten an AFib episode and received some really helpful replies- thanks to everyone who replied. I was surprised that a few people were amazed that one of the blood pressure medications I take is 15mg of Bisoprol per day and say they would not be able to function on it. I was put on Bisoprol perhaps 30 years ago, I can’t remember my original dosage but I have taken 15 mg for probably 20 years. I have never thought about it being high and for the last year I have been seeing a cardio privately since my blood pressure went a bit erratic and my GP didn’t seem to be able to sort it out. I am on Prednisolone for Polymyalgia Rheumatica and am now in my 4th year of taking it and this has compounded the BP problem. My cardio did change 2 of the BP medications I was on but left my Bisoprol dosage as it was. My resting heart beat tends to be in the 50s very occasionally 60-63 which I know is on the low side. Is anyone else taking such a high dose please?
Does anyone take 15mg Bisoprol daily? - Atrial Fibrillati...
Does anyone take 15mg Bisoprol daily?
Oh wow. I couldn't tolerate 1,25mg daily and there are people who take more than 10 times that and basically tolerate it. It just goes to show how are all of us different. Can't help you much with the issue, hope you sort it out soon!
Hi Jomaur.
I was one of the posters who said I couldn't cope with 15 mg of Bis a day - no way. 5 mg knocked me out!
A heart rate of 60 - 63 is perfect IMO - I'm not a medic though so consult with your doctor if you have concerns.
Paul
Thanks for your reply. I can concerned as it seems that some people are given a low dose of Bisoprol to use as a “pill in the pocket” yet my dose of 15mg doesn’t prevent me getting AFib episodes that last someimes 6+ hours. Also I am going to ask my cardio again about the possibility of having Flecainide as a “pill in the pocket” but I’ve read in the NICE guidelines that it shoukd be given to people with a resting heart rate of 70 +, so I wouldn't be eligible.
Hi Jomaur
You wrote
Also I am going to ask my cardio again about the possibility of having Flecainide as a “pill in the pocket” but I’ve read in the NICE guidelines that it shoukd be given to people with a resting heart rate of 70 +, so I wouldn't be eligible.
Hmmm. If your HR is 70 or below you'll likely not to need Flec. However, Flec helps control rate and rhythm. If your HR hits 140 or above Flec can be a very good PIP.
OK Jomaur as stated before - I am not a doctor. No way is my post intended as medical advice - just from my own experience.
Paul
Oh sorry maybe I am confused about the heart rate thing. When it say resting heart rate of 70+ I thought it meant when you are in Normal Sinus Rhythm. Does it mean when you are having an AFib episode because my heart rate then is well above 70+ more like 130+. Have I misunderstood this?
To the best of my knowledge Bisoprolol is a heart rate control drug WITH some blood pressure control properties. There are drugs more appropriate for BP control such as Ramipril and Felodopine. Why not, as a first step, make an appointment with your local pharmacist and discuss the pros and cons with the view to asking for a medication review.
Well this was prescribed as I said quite a long time ago. I shall be seeing my cardio on Saturday and will bring this up with him.When I first saw him about a year ago he changed 2 of my medications but left the Bisoprol as it is so assume there must be a reason for that.
130+ is a little high but if you are in AFib it's not unusual. Again this is just my personal view - I would sit that one out for a few hours. Try deep breathing to see if it claims down.
If it goes higher or continues dial 111.
Best of luck.
Paul
Well I do just that but it can last anything up to 6 hours plus which is why I would like a one off drug that I can take to shorten it. I think it’s recommended to go to A&E if it lasts longer than 24 hrs or if your condition worsens.
Ive been in AF for 6 weeks + regularly prior to ablation. You won't drop dead, A n E will just monitor you and send home. AF is not an emergency or an accident .
Keep a record,and contact your consultant.
They may prescribe Flecanide, a powerful rythym control drug if you are suitable, can take as and when AF or worse for me AFLUTTER begins.
I took 1 flecainide once and my heart went completely crazy. I react so differently than most to medications. I have my whole life. I have been in aflutter alternating with afib since 3-22. HR from high 80s-140s. They have doubled my diltiazem and atenolol with little change. I have had this since 2002. I have had 4 ablations. I had 2 pathways in my AV node and a lot of abnormal things on my ekg. I have always been able to get in and get treated. Prior to this longest aflutter was 48 hours and cardioverted in 2013. Then all of my regular cardiologist retired and my EP moved. Then my new EP cut back to 2 days a week the week after I went in to aflutter so they referred me to a new EP who would not listen to anything I said and it was his way or the highway. I have been a nurse for 30 years and have dealt with my heart since I was 25(starting with SVT). I am 59. That Dr basically said no and walked out of the room right during my visit. Then they filled my paperwork work out wrong so hospitalization got denied for my cardioversion! I told my husband who was with me that if a Dr will treat you like that in an office visit there was no way I was going to let him touch me in a procedure!! I live in a rural area so it is 1.5 hours to that city. I looked to see if my original EP that left there in 2010 to go 2 hrs in the other direction from where I live to teach at a university was by any chance seeing pts and he does now. So on May 30th I am finally going to see him! 6 more days!! This has been exhausting! And my heart runs mostly in the 120 area on average. It's like the beta blocker does nothing for the rate. I hope he can cardiovert me the next day and then I'm sure I'm facing another ablation. This has been so strange bc usually when I went into afib or flutter my rate was 180s to well over 200s. So when I went in to aflutter on 3-22 it was only 140. Praying for these 6 days to go fast!!!
For sure Jomaur. I don't think you'll find you'll find a med that will kick in after 6 hours - it's either a few hours or not at all. Yes for sure if your AFib goes on for 24 hours at that rate then I would go to A&E. Personally I wouldn't wait for 24 hours - I would just head off. Call 111 to double check but I think I know what they will say.
Paul
For me 250 mg of Flecainide stops Afib that has been going on for about 15 hours in 2 hours.
Hi Abbyroza.
Sure - 1 or 2 hours worked for me too. 250 mg is a fairly large dose to take at once. Did your cardio / EP suggest this?
Paul
Yes, per cardiologists orders! He said I could even go up to 400 mg if there ever should be a second breakthrough in 24 hours.
Hi Abbyroza.
Far be it from me to correct your cardio - he/she knows more than I and is the expert in your case and knows your medical history. My understanding is 300 mg max of flex in any 24 hours is enough. Also be careful taking to much as it can lead to flutter. I might get a a second opinion about taking 400 mg within 24 hours of taking 250 mg?
Maybe I have misread your post - however 400 mg is a lot.
Paul
Well, I did exactly what you suggest and asked a second cardiologist (a friend) for his opinion. He also warned me for an overdose that could prolong the QTc-interval and cause flutter or torsades de pointe. So he advised me to check that if and when I should take more than the usual dose. Luckily my Withings Watch provides a reading of QT and QTc.
We are no longer allowed to post links. However copy and paste is still allowed. Here is some information about QT. There is a lot of information about it on Google.
Paul
Normal QT=0.39 times the square root of RR (sec) +/-10%The QT interval is a measurement that represents the total time from ventricular depolarization to complete repolarization. This process begins at the start of the q wave and extends to the end of the T wave. If there is no q wave, then the starting point would be the very beginning of the R wave. The QT interval is affected by many things. Heart rate, autonomic nervous tone, sympathomimetics, electrolytes esp. calcium, some drugs, age, sex of the patient and even sleep affect this duration. Because of the complexities of assessment and interpretation, this measurement is often overlooked by Paramedics. This is unfortunate because the QT measurement can help you to recognize life threatening problems before they happen. Charts have been devised to make QT assessment easier. Most charts look at heart rate, and often, sex and age of the patient. These charts usually give the normal and upper acceptable measurements.
Wow! That's surely a record dose on here!I can only take 1.25,and weaning off ! ooh
Hi 'our' Wil.
Hope you are OK. 15 mg of Bis is certainly a high dose!!! Personally I would be like a zombie taking that amount.
Have a great weekend.
Paul👍
You too! Exciting,painting a fence lol!, xx
You can come round here Wil and paint mine when your done lolz 
Paul
A very kind offer lol!
I'm waiting Wil. Minimum wage applies but I'll chuck in a cup of tea if it's a good job.
Enjoy your weekend Dawn.
Paul
are you sure you were not on the other beta blocker Metoprolol? 12.5mg of that equals 1.25mg of bisoprolol
I too am not a doctor, but I have read that 20mg of Biso is the maximum dose for BP control if needed, so presumably there are plenty of people not on this site who take that. What does interest me though, is, do you take the 15mg as one pill. or is it 2 pills, eg one 10mg and one 5mg?
I’m on 7.5 mg which works for me. Much better than when on 5mg. We are all different.
I take 10mg and am fine on that dose-fingers and feet get a bit cold in Winter however. I was told it could be increased if necessary but only if approved by a cardiologist. I imagine there are people who are fine on 15mg - I suspect much depends on body mass, metabolism etc..
I take 10 mgs Bisoprolol daily, split into two doses. Over the last seven years, it has been increased from 1.5 mgs when my afib was diagnosed, each time I have had episodes of Tachycardia. My heart rate when resting is anything between 55 and 65, which all my medics say is great. Bisoprolol is a rate control drug rather than a rythm control drug and as pusillanimous says, up to 20 mgs can be prescribed for high blood pressure. I feel fine on 10 mgs daily, and although I feel less energetic than I used to, I am 72 now ! I do ponder whether I might actually be Wonderwoman if I didn’t have to take it at all !
Hi Jomaur. I was on 15mg daily of Bisoprolol following diagnosis of persistent Afib last August. Following a successful cardioversion last December this has been gradually reduced to 5mg. I asked why such a high dose and was told that my heart rate was difficult to control as was often in fast Afib. Am now also taking Flecainide 50mg twice daily as an anti arrhythmia med. I did feel very tired on 15, better on 5 now. On the waiting list for an ablation now. Wishing you all the best .
The dose response to bisoprolol, I have read, is variable, so 15mg does not necessarily give a three fold response to the more usual and typical 5mg dosage. Many people get a good response to lower doses and for the last year I, for example, was taking 1.25mg, and, more recently, with worsening palpitations and AF episodes, it's been 2.5mg. My heart rate can drop to 40bpm in the early evenings though, on this dose. I was told that the lower rate is quite okay so long as it doesn't cause symptoms or go too low.
I was given 10mg a day while I had persistent atrial flutter in the spring of 2019 and understood then that higher doses were more often used to treat hypertension than arrhythmas. My heart rate with AFl was stuck at a 2:1 flutter ratio of 155bpm (which means the atria were beating at 310bpm, which is typical); the bisoprolol reduced that only to a still uncomfortable 105bpm. I seem to recall trying 15mg but with no extra effect on my heart rate so I stayed on 10mg. I felt truly unwell during this period until a successful ablation in June that year (pre-covid, thank goodness, or I doubt it would have happened!). Looking back, I have no idea how much that un-wellness was down to the AFl, the persistent high rate, the bisoprolol or (more likely...) the intensity of the stress and anxiety it caused me.
Finding this wonderful small corner of the internet, having only previously found a rather less friendly or helpful FB site, a kindly person here explained how digoxin had helped him, and my GP then prescribed it for me. Happily, it worked well, allowing me to reduce the bisoprolol dose to 5mg. I felt much better at that lower dose and had a heart rate of, I think, 60bpm (atrial flutter, unlike AF, gives a fixed - ventricular - heart rate being a ratio of the fixed atrial rate of ~300bpm). I suspect much of the relief, however, came from reduced anxiety.
Steve
your heart rate is not low in the 60s. 15 does seem a high dose but I suppose with your BP possibly high I guess that’s why your cardiologist keeping you on that dose
As you know bisoprolol is a rate control drug and flecainide is a rhythm control drug
I have been in flecainide for about 7 years and personally I found it a miracle drug. I do still get the occasional breakthrough of afib/tachycardia but that is usually because for example I had covid then other problems
I had a pacemaker fitted last September and even better since then as my heart rate kept going down in the 30s
All the best
Hi
Why isn't CCB Diltiazem introduced for rate control! It also drops the H/Rate and in turn reduces the arrhymic rhythmn.
No flec.. needed. 156 down to 60s beats Bisoprolol anytime.
Lowered Bisoprolol 2.5mg for BP but separated.
cheri JOY. 75 (NZ)
Hi
I was on a heighted Bisoprolol to 10mg (top dosage).
It was not doing its job.
BBs do not control my heart rate.
Private H/Specialist introduced CCB Calcium Channel Blocker Diltiazem. 180mg too much, 120mg settled AM for control of H/Rate.
Reduced Bisoprolol 2.5mg PM for control BP.
You must separate CCB and BB.
My H/Rate dropped from 156 to 51 them twinked to 60s.
cheri JOY. 75. (NZ)
I have been on 10 mg for 12 yrs no probs
Thank you to everyone for your replies, unfortunately not enough time today to reply to you all individually. I have sent printouts of my EKG readings to my Cardio and am seeing him tomorrow with plenty of questions. I am sure he is very knowledgeable but I feel he does not understand how scary an AFib attack is to us non medics and just telling someone that an AFib attack will not kill them is not really the answer. If after tomorrow I feel that he is not the best person for me then I have found another cardio as qualified as mine who actually describes himself as a good listener and shall make an appt to see him. I would happily be referred to the NHS Cardiology dept but knowing how long the wait for an appointment would be I feel I have no other choice than to stay in the private sector. I might add that we are not wealthy but would rather make economies for the sake of our health,Like a lot if people both of us worked for years and paid N.I. and Income Tax and it shouldn’t be like this but that’s unfortunately the situation in the UK at the moment.
Hi Jomaur, just to ask if you clarify the NICE guidelines on Flecainide (and low resting rate) with your cardio could you let us know? I have PIP Flecainide and my resting heart rate anywhere between 46 - low 50s. It works every time so far, but is very strong and I have side effects for some days afterwards. I looked on NICE but couldn't find the reference to resting HR?
LIke you I saw private cardio after several months not getting any kind of diagnosis from local GP. When I asked GP for private referral he actually said 'you'll be going down a rabbit hole' .... The private cardio diagnosed AF very quickly after suggesting I get Kardia. He then kindly put me into the NHS cardiology stream and I now have a good nhs cardio who listens and is helpful. Took a while to get here though. I think nhs was knocked about by Covid and haven't recovered .. also the lack of funds and govt support.
I hope you get things sorted out .. best of luck
Thank you for your reply, it’s very reassuring. Sounds like you found a really nice private cardio and your NHS cardio seems to have exactly the qualities that are so important in a doctor and which I find lacking in mine. I shall ask him about the NICE guidelines and post any information I may have.
it seems very high to me! It must really slow you down. I am on 2.5 grams and that is high enough!!
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