Bisoprolol and Beta Blockers

[JezzaJezza]

Hi all - I wasn’t sure if I could post links, so I have pasted the entire article.

There is a lot of misinformation and confusion about BBs and I thought this would help, especially the bit about being ‘beta blocked’. I am a male, 55 with history of SVT and palpitations. I take Dronedarone and 2.5mg of bisoprolol and between them they have been extremely effective at stopping the attacks. I have full bloods checked every 6 months and all are fine (thyroid, cholesterol, vitamins etc etc). I have always had low resting heart rate of circa 55 but now firmly 40-45 and at night sometimes as low as 36. My cardiologist is perfectly happy because I do not have any symptoms of bradycardia. Here’s the article….

An article by Dr Edward Leatham, Consultant Cardiologist, author of The Naked Heart a series of simple blog and video explanations covering all of the main common medical conditions that can affect us, as we age.

Beta blockers work on the beta receptor situated on the surface of cells that are affected by circulating adrenaline which the body releases in times of stress. Small amounts of adrenaline circulate, even at rest and help determine the resting heart rate and cardiac output. They also have a direct action on the Sinoatrial node which sets the heart rate and the AV node, which becomes very important in patients prone to atrial fibrillation and flutter. Beta blockers have been developed over 50 years and are used to treat a wide range of conditions, including palpitations due to arrhythmia, high blood pressure, anxiety, migraine to name just a few. For a cardiologist, beta blockers are a commonly used medication, possibly because we live in a high stress world and patients come to us with symptoms that are often improved by taking blockers. Cardioselective beta blockers are more popular as they are far less likely to trigger bronchoconstriction or asthma. Here are a few points that are often raised by our patients.#cardiologist #afib #beta-blockers

Cardioselective Beta Blockers work by competitive inhibition of beta receptors on the heart, which normally bind adrenaline

This ‘blocks’ or dampens adrenaline activation of the heart

Beta blockers thus lower the heart rate as well as peak contractility of the heart pump.

They are widely used to prevent and moderate heart rhythm disorders and to treat heart failure.

They also work as a ‘chill pill’ to lower adrenaline effects caused by anxious thoughts

Dose range. Everyone is wired differently, so to find the best dose, your doctor will often oversee a trial of various doses to find one that suits. The optimum dose of beta blocker to take varies between individuals For Bisoprolol (Cardicor) it varies from 1.25 mg to 10 mg once a day. It is normal when starting to notice a few days of slowing down as the body adjusts Upto 1 in 20 people find even the smallest dose makes them feel lethargic.

How do healthcare professionals (HCPs) find the best dose?

For Bisoprolol, we often start at the lowest dose of 1.25 mg taken every morning on 1st rising. Due to its long half life, it will then take up to 3 days to be steady state Assuming a normal pre treatment pulse or heart rate in range 60-90 beats per minute (BPM), we then look for a drop in heart rate to roughly 45-55 BPM. If the pulse rate exceeds 55 BPM your HCP may then advise you to increase by an extra 1.25 mg each morning.

Whats the dose range of Bisoprolol used in my patients?

As a rough, non audited or precise guide, I would say that the most popular dose is Bisoprolol 2.5 mg for woman and 5 mg for men, however there is a wide range of repsonses: 20% of patients only manage 1.25 mg once a day. 10% of patients require 10 mg once a day:

I have a low resting heart rate, can I take beta blockers?

Your resting heart rate is determined by several factors including the vagal nerve. Some people have high resting vagal nerve activity which produces low resting heart rate. You can tell, by assessing how your heart rate rises on exercise (when vagal tone is switched off). This means that some patients with low resting heart rates will still be offered beta blockers (only after an ECG) to moderate symptoms of palpitation or to temper heart rate response to exercise

Be aware

Once you take a betablocker it is perfectly normal for your heart rate to drop as low as 35 BPM overnight during sleep. Heart rate monitoring devices like Apple watch will often alarm if the heart rate drops. Providing there is no heart block showing on your regular ECG and you feel fine, there is no need to be concerned about low heart rates at night. Your heart rate response to exercise will be damped

If you are taking too much

If the dose is too high or you are intolerant to beta blockers you will feel less well after day 2, in which case its best to go back to the previous dose you felt fine on, or stop it until advised If you have blackouts or major dizzy spells you should get urgent medical advice and may need to stop the beta blocker

If you are taking too little

If the dose is too low you will notice very little change in your resting heart rate. Only when your pulse rate drops from your normal into the range 45-55 BPM have you reached the effective beta blockade zone.

Once on beta blockers, the normal algorithms used to calculate target heart rate for aerobic exercise are messed up, and cannot be used.

As a guide, exercise to high level to get hot and sweaty, red in face, take your pulse- insead of 150-160 it may only be 90-110 BPM.

Thats your new target heart rate to work to!

[Paulbounce]

Hi Jezza.

Anything around 70 bpm and under is my target. At the moment my HR is like a yo-yo and ranges from 60 to 125 at rest. I see the doc on Thursday to discuss this and had a blood test today.

Paul

[JezzaJezza in reply to Paulbounce]

Best of luck Paul.

Are you on Beta blockers yet?

Thanks

J

[Paulbounce in reply to JezzaJezza]

Hi J.

Yes but they don't seem to be very effective. The hospital cardio changed them from Sotolol. That worked and makes you think 'why fix it if it ain't broke'.

Have a great evening.

Paul

[Ennasti]

Thanks for posting. I’m glad it also mentions that beta blockers reduce the force of the beat as well. This is really important for protecting the heart’s walls, which is especially important for anyone with cardiomyopathy. While it may not stop things like ectopics for everyone, it will have an impact and reduce them but it importantly will protect your heart.

[Thomas45]

I'm asthmatic so was never prescribed beta blockers, until a well-meaning hospital doctor prescribed Bisoprolol after my heart rate had exceeded 190bpm while under general anaesthetic for removal of my appendix.He couldn't understand why I had not been prescribed a beta blocker. I told him. I was asthmatic but he dismissed that as having any significance

.7 weeks after a daily dose of 2.5mg of Bisoprolol I started to get intermittent painful rashes anywhere on my body, apart from my face. A skin specialist GP recognised them as being caused by Bisoprolol. I was weaned off it. During the weaning I had a sudden onset of asthma, sudden in that I went from breathing normally to gasping for air with chest pains in 10 minutes. Fortunately I was in a pharmacy at the time. I was taken to hospital by ambulance and admitted. I needed to take daily doses of up to 40mg of Ceterizine antihistamines for 4 years to get rid of the Urticaria.

[Buffafly in reply to Thomas45]

My first reaction to bisoprolol was a little itch in my throat. After a few days I suddenly had a bronchospasm which felt like a ball stuck in my throat but luckily the full ‘rescue dose’ of my inhaler allowed it to relax. Hearing your story I was lucky in a way!

[Fannyphasbees]

Thank you. I found this very useful. I take 10mg Bisoprolol and 125 digoxin.

[Vonnegut]

I was taken off 1.25 Bisoprolol daily as feeling tired and heart rate considered too low when I think it was in the low 40s. Interestingly, another doctor said she thought those figures were fine but I’m glad that since Flecainide has prevented episodes, I have stopped taking anticoagulants.

[Tomred in reply to Vonnegut]

Hi Vonnegut, why have you stopped taking anticoagulants.

[Vonnegut]

Because Flecainide has virtually put an end to episodes of AF for me. The EP who prescribed it for me told me that unless episodes went on for a long time with a high heart rate, I would not be at risk and mine never were. The anticoagulants messed up my digestion dreadfully. The last episode I experienced ended an hour after it started thanks to Flecainide 100mg, so no risk of stroke. But we are all different - an echocardiogram showed my heart is structurally sound which might help:

[magendomike]

Many thanks for that oost

[JaneFinn]

Thank you for this, Jezza, that’s really helpful. It’s answered a lot of the questions I’d had, especially around my low resting rate (sometimes mid 30s) and inability to get my heartrate above 95. (Other than in arrhythmia!)

[Alemo27]

Being on BBs for many years , it became necessary to increase . Now 5 mg twice a day.Yes it is mostly prevent arrhythmia and hold BP around 90x65 . Taking anticoagulant a must as the cardiologists insist. What happening now is BP at night going up to 150/160x80/90 , though I am taking Bisoprolol before bed. I am trying to lower BP placing cold pads on the neck behind.

In case of the arrhythmia symptoms started with heart rate increase taking Flecainide helps to lower HR to 45-55.It is usually gives fatigue and depression.Well….

better that be in AFIB