Bisoprolol. I have atrial fibrillation a lot of the time. Sometimes with my pulse in the 60s, sometimes 90s and sometimes 130s. My cardiologist has prescribed 5 mg Bisoprolol every morning and 2.5 mg every evening.
I would prefer to vary these amounts and I wonder if anyone has any suggestions for me.
When I take the 5 mg in the morning and my pulse rate is only in the 60s the Bisoprolol takes my pulse down to the low 50s which does not seem good. In addition the higher dose makes me more lethargic. So my choice would be some sort of regime depending on my pulse rate in the mornings. I check if I am in atrial fibrillation using a Kardia.
In addition to the Bisoprolol I am taking 200 mg a day Flecainide plus Pradaxa.
Thanks everyone!
Written by
Yashen
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I was told that a low pulse rate is harmless if it does not cause symptoms. However, bisoprolol soon develops what is called a "steady state" in the blood stream, and has a long half life, meaning it is needed to be taken just once a day. Taking twice daily seems to be an idiosyncrasy of some doctors, but might cause a boost in levels temporarily that they deem helpful.
So far as I know, the time of taking of largely of no consequence, so long as the spacing is regular.
If you are taking Bisoprolol to counter the Flecainide you could ask your cardiologist for an alternative such as Diltiazem. Diltiazem is a calcium channel blocker that is often given with Flecainide. It has other side effects but if you get the right dose for you it shouldn't make you feel lethargic. I think the alternative as others suggest is to switch your dosage around, so long as your HR doesn't drop too low at night.
If Bisopolol is not enough for your rapid AF Heart Rate I would suggest the your Heart Specialist could look at CCB Diltiazem. Taken in the AM to CD one it tends to leave me at 60s. Also leaves my normally low heart rate night 47bpm alone. Never changes although Metoprolol gave me pauses t night and 186bpm avg day I could not exert myself.
We are all different.
I was hiked up to 10mg Bisoprolol and 156bpm. Still no control on a BB.
Trouble is Dr just increase and that is not always the right thing to do.
In other countries outside NZ Diltiazem cmes in 39mg ang 60mg. Lowest 1 here is 120mg.
60s rate is great for me.
Where are you in NZ. I would suggest you go to my private heart specialist as he really assesses you.
Yes maybe try taking all at night. My pulse goes to mid 40s on 3.75 mg and can still be in AF a lot of the time. I also take flecanide 50mg 3 times daily,
My EP consultant said that Bisopropol works for 17 hours so he recommended I take it in the morning. I'm sure other consultants say different things. I manage okay on 1.25mg per day and a lot of the time I don't notice the afib except when I overdo exercise or eat the wrong thing . I am now permanently in afib and my heart rate is usually in the 70s.
My cardiologist has prescribed 5 mg Bisoprolol every morning and 2.5 mg every evening.
Like my cardiologist, he has recommended the higher dosage in the morning to control your heart rate when you are most active during the day.
Suggest you discuss the dosage pattern with him including your heart rate especially the 130 if it remains for a period. A side effect of beta blockers is to feel lethargic but many improve over time.
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76 years old with A F
apixaban and hematuria 
shortness of breath
3% Afib burden and proposed medication
