A month after diagnosis in A&E (and thanks to a delay with paperwork) I am due to start bisoprolol. As I've got a very busy two weeks ahead, I've agreed with my arrhythmia nurse to take them 'pill in pocket' until I can get some time off work to adjust to taking them every day. So far I haven't, to my knowledge, had any further AF episodes. I thought I was picking some up on my watch but was doing the readings wrong, and the arrhythmia nurse saw the readouts and told me they weren't, thankfully. Since diagnosis I now have horrible insomnia and anxiety. Ive read from others that bisoprolol can make this worse, although the nurse said it might help (any thoughts?). I won't be prescribed anticoagulants as my CV score is only 1, for being female.
I'm due an echo at some point but the nurse said they'd only ever do an ablation if the medication didn't work. It seems I won't be seeing a cardiologist, only the nurse, apparently. She's very helpful, to be fair.
Sorry for the long preamble but I'm just wondering what the criteria is for remaining PIP. I hate the idea of permanent medication, especially at this early stage.
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Dwts20
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Many folk try pill in the pocket and have great success. Have they only prescribed bisoprolol? That is a rate control tablet to control the heart speed, it isn't an anti arrhythmia drug.
TBH, it seems to me that the P.I.P. approach is the go to approach these days. When I started my AF journey in 2010 it was not so in vogue, if at all.
So, tell me ......... what if you are asymptomatic .... how do you know when to pop a pill ?
For my money taking a Bisop daily at night, regardless - is the way to go. I did it for 12 years before changing to another beta blocker. So far I've been on one BB or another for just on 15 years .......... no sweat. Nice regular HR.
Bisoprolol can be a tricky little number BUT as an experienced consumer it may well take many, many weeks to get used to it. I was originally prescribed to have it with my morning meds .... but it messed me up too much with random, full flow nose bleeds. My GP back in the day looked up in her book of magic potions and brews and said take it at night. I did her bidding and have never had a problem with any beta blocker since - ever.
I would be very wary about what advice I took from an arrhythmia nurse ! I would want an arrhythmia nurse who was alot more than helpful TBH. If you haven't, I do recommend reading the paper in the packet.
Hi JohnThey've prescribed it daily but I'm trying PIP for the next couple of weeks until I get some time off work, but was hoping to continue PiP if possible.
You asked about being asymptomatic- I have a smartwatch and been taking regular ecg readings - all sinus so far. Hopefully if I feel anything different it'll pick it up.
It depends on your AF though. Mine comes when my heart rate goes low, always at night in bed, never any other time so that would make me worse. Fortunately Flecanide as pill in pocket always worked for me but I’ve had ablation now so hoping I’m fixed 🙏🙏🙏🙏
I have had three 24 hours bouts of af averaging 2 years apart. Initially they gave me bisoprolol and I had an awful time with it. Resting heart rate of 60 and low blood pressure . Why should I take horrible drugs every day that I don’t need everyday just because medics have a one size fits all approach ? I take Edoxaban and am on waiting list for ablation . Am very very careful with lifestyle management
I think pip is a good way to go, less meds the better. I take Propranalol - 5 mg twice daily which is half the minimum dose but have taken a 10 mg tablet as a pip. I recommend taking the absolute lowest dose of Bisopralol to begin with which I think is 1.5 mg. Some people are more sensitive and don’t need much even though your Dr may say it’s not enough. My bp is too low and I have other side effects if I take the amount prescribed originally which is the usual minimum dosage.
The lowest dose of Bisoprolol is 1.25mg and it proved too much for me to take daily after only three days! Thankfully, the pharmacist knew far more about the drug than the doctor who originally wanted me to take twice that amount daily. One size certainly doesn’t fit all! Why do doctors think that when it is so obvious how different we all are?!
Quite, always best to talk to the pharmacist. Sadly, I think people give up on meds because of the side effects without realising they can take less. Bisoprolol seems to upset a lot of people but my Dr wanted me to change from Propanalol but I like that it’s faster acting whereas Bisoprolol is slow release - not ideal when using as pip.
I had a diagnosis of PAF 20 months ago, and took Bisop as a PIP (actually never needed it and heart rate 45-70bpm ) Although I rarely feel fine, bothered by what feels like Arrhythmia and light headed. A friend's GP told her that iBisoprolol 'calms the heart' so I take 1.25mg (1 tablet at night)it helps! No advice just my experience!
I would have uppermost in your mind that all episodes have to be stopped, as any AF begets more AF. If you agree, then low level daily medicine is the answer as PIP presupposes an episode.
As far as I am aware (I don't take it) Bisoprolol is for controlling rate only, my cardiologist gave me a scrip as a precaution in addition to my daily Flecainide.
If you want to stop AF episodes then Flecainide low daily dose may be the answer along with improving lifestyle choices. Have a full frank discussion with your cardiologist; it's worth if funds allow a private appointment around £250.
Don't get me wrong I am no pill pusher, 11+ years ago I was put on a medium dose of daily Flecainide, swore I would wean myself off within 6 months and instead just lost my bottle and it went on to give me 10 years virtually (just 2 half hour episodes with recognised triggers) AF free. nb I have no comorbidities and my echocardiogram was then and again this year (after 11 yrs of 200mgs Flec) all good.
Bisoprolol daily 2.5mg is standard prescription to limit heart rate after first diagnosis and until echocardiogram checks heart function. After discussion with GP I went against cardiology advice and started at 1.25mg daily (using pill cutter), but even then was not happy with the bradycardia it induced. I stopped completely once I had assurance that my heart was in good shape. I don’t take Biso as PIP because my infrequent episodes of AF last no more than half an hour before heart reverts to NSR. Whether it’s any good for you as PIP depends on the duration of your episodes of AF. Maybe still worth considering daily until you get your echo so before you get your results you can still assess the impact on your heart rate and how you feel when taking it.
My experience is that the only reason to take bisoprolol is to slow an uncomfortably racing heart (i.e. "rate control") - when AF hits; taken outside of this scenario, the drug will be having its effect on a "normal" heart and that's when it will likely cause side effects.
Taken PIP worked well for me even though the doctor I see said that since it takes an hour to work, it is hardly worthwhile taking it that way. I was lucky, though, that my heart rate never went crazy and I could rest till the tablet did its trick. If you do have very high or uncomfortable heart rates when suffering AF, and are sure the rate is a product of the AF and not exacerbated by anxiety and fear, then daily bisoprolol surely makes sense. I ended up on 1.25mg daily, increased to 2.5mg, but then had to reduce back to 1.25mg as it worsened my bradycardia. I now would like to go back to PIP but my GP fears my heart rate might go too high if I do and I am otherwise coping well.
I too had a terrible time on bisoprolol. Nightmares and really exasperated anxiety. I explained this to the EP who said it can affect people differently and agreed I needed to stop taking it. Was given Flecanide 50mg instead. Good luck. Please get advice from your gp if worried.
Bisoprolol taken PIP will slow your heart down during an episode of AF, allowing your heart to pump blood around body more effectively and reducing stress on heart.
But I don't see this doing much for reducing your time in AF and because taken as PIP, it does nothing to prevent episodes.
I'm not a medical professional. However, I believe reducing the duration and frequency of AF episodes can only help to slow progression of AF, reduce wear and tear on your heart and potentially lower my risk of stroke.
From a medication perspective that involves daily medication of anti arrythmic e.g. flecainide using with a beta blocker.
However, we're all different. If your episodes are rare and short then I can understand why PIP is being considered but question why no Flecainide PIP to try minimise time in AF. Is it contraindicated for you because of structural heart problems or previous heart attack?
All are issues for you to discuss with your trusted medical professional. What is proposed might be the best for your circumstances but it isn't what I am doing for my paroxysmal AF even though it's low burden. An ounce of prevention is worth a pound of cure.... YMMV
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AF - Sudden Increase To Every Night
Daily episodes
EDIT : Stop betablockers
breathlessness, exercise and sotalol
