pill in pocket advice

[thejepo]

when having an episode of af I will have another 5mg of bisoprolol on top but not with my daily 5mg (cardio’s advice) is it safe to have a further 5mg within 24 hrs to stabilise heart? (Max dose fed day can be 20mg the literature says) any advice

[BobD Volunteer]

Not something we should comment on I'm afraid. Best check with your arrhythmia nurse or consultant.

[thejepo in reply to BobD]

Appreciate it bob. Usually do as you recommended but sometimes nice to hear what other's do.

[secondtry]

I would ask a medic and then question their opinion with a discussion.

I am 71yo with Lone PAF taking just Flecainide. I persuaded my cardiologist to give me Bisoprolol as a PIP just in case of sudden high HR. He gave me 2.5mg tablets and the instructions are 'One to be taken immediately as required. No more than one tablet in any 24 hour period.'

[thejepo in reply to secondtry]

Thanks

[Popepaul]

I take 2.5 mgs in the morning. I sometimes wake up in afib. I then take a further 2.5 mgs. Then in the morning I take 1.25 mgs, this is half the usual dose. The following morning I restart the 2.5 dosage.

[Emoryrich]

That's similar to my experience. I'm on 5 mg per day, but take another half on occasion when my heart rate is sitting high or palpitating. Can't advise on your situation or dosages, but my cardiologist says he has many patients on 10 mg per day.

[JaneFinn]

My understanding is that it may be dependent upon your baseline heart rate when in normal sinus rhythm. That’s certainly how it’s been explained to me. So it will be different for each person, and I think the amount of extra ‘Pill in Pocket’ dose of Bisoprolol that’s safe/right for each of us can probably only be confirmed by whoever is treating us.

Eg my own situation means I can only take a far lower dose than the ‘allowed’ maximum. I’m on 2.5mg Bisoprolol daily to ward off PAF, and it keeps my heartbeat low, at around 50bpm, dropping to 40 at rest. When I go into AF, my heart rate averages 150-180 bpm. My EP told me that while in PAF, I can take up to 5mg additional (PIP) Bisoprolol in any 24 hour period, but I should add it in 1.25mg doses spaced out over that time. That’s because if I go back into NSR he knows my heart rate is already v low and doesn’t want it to plummet lower. (Even though for me it’s not an effective dose, it’s not enough to bring my heart rate down anywhere near to 100bpm in PAF, but it improves it.) Whereas other people can take much higher doses safely. So I think everyone’s situation is probably different? Jx