Cutting bisoprolol dose and Dronedarone

[Samazeuilh2]

I had my annual review at Barts yesterday, and reported increasing frequency of PAF episodes: five episodes so far this year as against only one in 2023. I’m in AF as I write this -the last episode was only two weeks ago. This feels a bit more symptomatic than usual. It was suggested that I cut my daily dose of bisoprolol from 10mg to 7.5 or 5 mg as my heart is slow at night and if it were faster the PAF (which is always nocturnal) might be less frequent. I’m not convinced this strategy will work as I’ve always had a slow rate at night. If that strategy doesn’t work, dronedarone was proposed. Before taking this it’s necessary to have a prostate test, apparently (not sure why). It should allow the heart to beat faster and hence make it less likely to go into PAF. Has anyone taken this drug? How effective was it and were there any side effects?

[JayDJ]

I took Dronedarone for a number of yrs but always felt that an Afib episode was never far away. During that time it did break through on a constant basis. It was at my suggestion that I eventually stopped it as it was doing absolutely nothing ie I was now in permanent Afib of varying levels, the Cardiologist knew that it wasn't doing anything but only when I said "What is the point" did they eventually stop it.

My BP was a little on the high side when my GP decided to put me on Amlodipine 5 mg and what a difference it's made. Yes I still have Afib but most of the time it is not very noticeable.

I have my yearly 5 minute telephone appointment next Monday and will be interested as to why the are suggesting that I take Ramipril. If you need further input re Bisoprolol or Dronedarrone then just ask.

[Samazeuilh2 in reply to JayDJ]

Thanks for your reply. It has confirmed my worst suspicions that this isn’t a very effective drug. I’m on 10 mg bisoprolol daily following a bypass 18 months ago. For over a year I had no PAF -absolute bliss. However, this year I’ve already had five episodes, some only two weeks apart. The consultant I saw yesterday said that as all the episodes are at night I should reduce the bisoprolol to 5mg. This should speed the heart up at night and make the episodes less likely (since they are more likely when the heart is going slowly). I’m doubtful about this as when I took only 2.5mg prior to the 10mg that wasn’t sufficient to control the PAF at all. I fear 5 mg will not be enough. His second solution was the Dronedarone which can, apparently, cause prostate problems and doesn’t sound as if it’s got much strength. So not a great consultation overall.

[JayDJ in reply to Samazeuilh2]

I initially had exactly the same problem with Bisoprolol which dropped my daytime resting rate of 44 bpm to an even lower level at night. This was proven by moving over to Nebivolol 5 mg which allowed my daytime resting HR to go to 56/58 bpm and allowed a night time drop to stay out of the 30s = problem eliminated.

Re Drondarone it must work for some but it didn't for me - you might be lucky.

[Samazeuilh2 in reply to JayDJ]

Once again thanks for the reply.

[Jajarunner]

I took it for a few months but still went into afib. So then switched to amiodarone so only one event in 17 months.👍

[Samazeuilh2 in reply to Jajarunner]

Did you have AF particularly at night?

[Jajarunner in reply to Samazeuilh2]

Yes, sleeping or daytime knap or meditating 😂

[Ppiman]

I also have bradycardia at night, and often during the day. I have read that an overly slow heart can have more chance of arrhythmia forming and this can trigger AF.

Your mention of a prostate test sent me off reading. I gather that there has been a suggestion from anecdotal and theoretical evidence of a link between use of heart drugs and increases in prostate problems, but not specifically dronedarone. Perhaps your doctor is taking part in a study onto this? One large study I read found no link, thankfully, so it seem anecdotal or hypothetical at present.

Steve

[Samazeuilh2 in reply to Ppiman]

Yes, that’s the very point which the consultant made to me (re slow heart rate). He didn’t go into detail about Dronedarone but suggested it could make frequent nocturnal visits to the loo a problem (thankfully that’s not an issue at the moment).

[Ppiman in reply to Samazeuilh2]

I am plagued with this but is comes and goes. I also have a slow heartbeat but had never known there was a link. I also notice if I have any level of constipation, the issue doubles. As a poor sleeper anyway, this has multiplied my problems.

Steve

[Samazeuilh2 in reply to Ppiman]

The poor sleep could be the result of your medication?

[Ppiman in reply to Samazeuilh2]

It likely does not help but it’s been a part of my life for longer than the tablets have. It’s an over-active mind.

Steve

[Vonnegut]

How different we all are! The lowest dose of Bisoprolol - 1.25 mg was too much for me to take daily! Flecainide taken regularly has virtually put an end to episodes for me though it might have increased my fatigue.

[Samazeuilh2 in reply to Vonnegut]

Unfortunately I can’t take Flecainide after a bypass. Although it seems sotalol (which I took before) is possible.

[Vonnegut]

Hope it does then. From all the posts here, we can see how different we all are and hopefully, eventually, the medics will realise this and treat us as individuals.