I have been on Bisoprolol 2.5mg once a day in the morning since Nov 2021. I always understood it to be for rate reduction.
However, since being on this site, I see that many people use it when in AFib to hasten a return to NSR, or at least to calm the symptoms.
Is Bisoprolol routinely prescribed as a pill in the pocket to be taken as soon as an AFib episode starts?
I am still on my beta blocker journey. In the beginning ( 6 Jan 2010) I was put on Bisoprolol courtesy of the prescribing medico. 5mg to be taken first thing in morning. This gave me random, full flow nose bleeds. Saw my GP and she said take it at night. I was originally told Bisoprolol was a heart rate control drug with some properties that helped with BP control.
I stayed on Bisop for about 12 years when it became a nuscience so I was then put on Nebivolol, and nowadays I'm on Sotalol. Still take it at night. Feel fine, no sweat.
TBH, these days it seems to be prescribed according to the whims and fancies of the prescribing medico. I wouldn't use it as a PIP. Much happier using it as a permanent drug for long term rate control.
John
John, How did you find nebivoloL? I am on very low dose of this 1.2 because before Bisoprolol made me a bit wheezy. I thought they were both cardio specific and ok for asthma users? I have been told that Bisoprolol will not get you back into sinus although years ago when I first took it in hospital my heart did revert to sinus.
I think it might be that it reduces the heart rate and that encourages the heart to go back into sinus. I take Nebivolol and my cardiologist told me to double the dose to 2.5mg during an episode. It does nothing to reduce the rate. I have tried taking 5mg and then after a nights sleep often if I do a Kardia reading it is still beating at the same rate as before I took the dose. I don't feel it in my chest though.
Hiya Moonriver,
I found Nebivalol just as effective as Bisoprolol, does the same job - BUT IS A BIT GENTLER. From memory, I think I was on 5mg of Nebivalol - still took it at night. I have just completed some Lung Function Tests ( Spirometry with Reversability) aimed at confirming if I am an 'official' Asthma sufferer. So far no beta blocker I've taken has had any side effects ( apart from the nosebleeds I mentioned ).
Sure I am constantly weary but am putting that down to Asthma - have been prescribed Easyhaler with Sabutamol which is making life a bit easier but not that much.
From my experience I would agree that Bisoprolol will not revert you to NSR. It will maintain a steady, regular heart rate and will help you with blood pressure.
I have had those asthma tests too. Mine is not severe, mild more like. I use preventer Flixotide 250 and so far has been effective so I rarely need to use Salbutamol. If I increase nebivoloL dose from 1.2 to 2.5 I do get a little wheezy but this seems to be getting better. Maybe the preventer counteracts it? I was put on nebivoloL originally to counteract PVCs.
Hi Ben the words in your post that struck me were nosebleeds. I've had a few the last couple of years but had my first about 20 years ago at the dentist before treatment. At the time gp said it could have been high bp which she diagnosed at the time, I was 60. Then no more till about 2 years ago. I always assumed it was the Apixaban which I started 2019 following diagnosis of AF. I was also given 5mg bisoprolol twice a day. 2023 it was reduced to 1.25 am and 2.5 pm. I have Naseptin cream for the nose bleeds which are random! Was considering a procedure to cauterise nose vessels but have also met someone where it didn't work!
Hi Camelia23,
I have to say my AF journey, right in the beginning was full of surprises ! Bisoprolol being the first. I started it in hospital where the diagnosis was made. 6 Jan 2010 ! I was already on Ramipril ( for high BP) and Simvastatin, the hospital Cardiac Consultant added to the party bag, Warfarin and Felodopine and Bisoprolol. I had been on this party bag of drugs for some 3 or 4 months ............... taking Ramipril, Felodopine and Bisoprolol in the morning. Then started the nosebleeds.
I immediately thought that it was the Warfarin. Went to my GP and did some table thumping ....... my GP then got out her book of "Magic Potions and Brews" and said take your 5mg Bisoprolol at night. I did her bidding and have never had a nose bleed since ... ever ... ever !
So, based on my experience I would ask my GP for a further Bisoprolol review - so, if I may suggest ................ Bisoprolol seems to be the first drug of choice in the battle of a combo of high BP and AF (its what happened to me) and I stayed on it for 12 years, it held my heart rate steady and, in conjunction with Ramipril and Felodopine it controlled my BP. Personally, I believe that Bisoprolol had no impact on my BP at all. Perhaps you and your GP might consider taking your 3.75mg of Bisoprolol ALL AT NIGHT.
Eventually, after 12 years I began to weary of it and my GP put me on Nebivolol ( another type of beta blocker) I stayed on it for about a year when my heart kicked off again and my new Cardiac Consultant then put me on Sotalol which I'm still on. My GP also cut out Ramipril as it seemed to be promoting coughing fits ( coughing is a side effect of Ramipril). So now, my morning meds are: 40mg Sotalol, Felodopine 5mg and another drug which isn't cardiac related. My evening meds are Warfarin (dose varies according to INR), 40mg Sotalol, 40mg Simvastatin. Sorted!
I think the advantage of Bisoprolol at night is that it works through your system whilst asleep, thus minimising any possible daytime side effects. Anyway, good luck.
John
My OH was put on Bisoprolol for AF when he was in hospital and has been on them ever since. His daily dose is 1.25mg and then when he suffers an AF attach his PIP dose is 5mg .
When he first came out of hospital he was on 10mg, but was like a zombie and could hardly function.
Hi
I have PAF, diagnosed 5.5 years ago after a HA (the former being the cause of the latter).
Currently on a daily maintenance dose of Flecainide (2 x 50mg) with no sustained for 4.5 years. No anti-coagulant or beta-blocker.
In addition, I do have a PiP. In the event of an episode, at my discretion, I can take 2 x 100mg of Flecainide and also 2 x 2.5mg of Bisolprolol. I've never had to use it but hopefully it would 'nudge' me back into NSR before having to seek help. The beta blocker is there to protect my ventricles (rate reduction) because my previous Afib is usually fast with RVR.
I don't take Bisolprolol routinely as my RHR is quite low anyway. Taking a beta-blocker just drops me of an edge and I feel lousy - tired & slow.
A
That's the first I've ever heard of PAF causing a heart attack!
Hi, atrial fibrillation on its own doesn’t usually cause a heart attack; its not common. However, like a lot of things, there are exceptions and there can be circumstances where it it might happen or so I am told.
My HA was diagnosed as NSTEMI type 2 - myocardial ischemia resulting from mismatched myocardial oxygen supply and demand that is not related to unstable coronary artery disease (CAD).
On the Angiogram, there was no evidence of thrombosis and no occlusive heart disease (no stents). However, during the procedure I was having runs of Afib - "making an embolic cause of his myocardial infarction likely".
It was not clear, there isn't a "smoking gun" and I've given up trying to understand the why or how. I am just happy that I fully recovered from the HA and my heart is classed as structurally normal. My Afib responds to the medication and for the moment it is behaving itself. Carry on ..... 
My experience:
Yes I think my cardiologist would agree with your medication. He put me on the same when my PAF was first treated at age 60.
However, I found Flec 50mgs x2 did not stop my AF so I requested and was given 100mgs x2 instead of an ablation and that worked well for 10yrs given that I also made lots of accompanying lifestyle changes.
I have often queried no BB (eg Biso) or CB to accompany the Flec but having never had a v fast HR for any prolonged time he thinks the risk of anything dangerous gets less with age. So now the wrong side of 70 I still take the same Flec dose, AF has come back but is less troublesome and I haver Biso on my request as a PIP but never used.
I take one daily and have had AF since 2021. Only this week my GP advised to take an extra Bisoprolol when in AF to see if it would help reverse the affects. Touch wood my attacks only seem to happen when I have a cough/chest infection so this is the first attack in a year.
I am in very low dose of metoprolol which is similar to Bisoprolol. I asked cardiologist why he put me on it as my resting Heart rate was always 60-65 and when in AF my resting HR is around 85. His explanation was that in my case it’s not to lower HR but it helps to tamp down the adrenaline spike one sometimes gets that kicks off AF
Hi
Bisoprolol is a Beta Blocker of Adrenaline.
Some use it as the Dr has prescribed for anxiety.
I found it great for BP control. The 2 BBs I used left me with an avg H/R Day of 186 with pauses and Biso.. 156 no breathlessness or pauses at Night on my normal 47avg bpm.
A few use it as PIP to bring H/R down and / BP if your H/R was an rapid as mine it would not control it.
I depend on a CCB Ditiazem low med 120mg CD AM.
Recently the 2.5mg Bisoprolol for BP had to be stopped as my BP went low.
So I'm dependent on the CCB, only for heart.
From time to time review of meds is required so at least twice monthly take your vitals or if you have new symptoms.
Beta Blocker Bisoprolol is best for AFers. Not recommended for Asthmatics.
There are a lot of different Blockers. ACE, BB, CCB just a few.
At the first stage they medic staff make a decision whether Heart Rate, BP controls most important or rhythmic control. Thence folks are given different meds.
cheri Joy. 75 (NZ)
I take it every day but with an extra prescription to be taken as a pull in the pocket if I have symptoms.
I have Bisoprolol to take with flecanide as pip. I don’t take it otherwise.
The EP who prescribed Flecainide for me originally told me to take the 1.25 mg of Bisoprolol only if my heart rate exceeded 140 twenty minutes after taking the Flecainide, which it hardly ever did.
I used it as PIP for about a year on recommendation for my GP, but my specialist said it wouldn't be much use used that way as my AF events were short and the bisoprolol would take about an hour to have any effect. For longer events, he said, it would work to reduce the rate the AF causes and that can reduce symptoms a great deal, or even calm the heart sufficiently to stop the AF.
These days, with altogether more frequent and longer AF, I take 1.25mg daily.
Steve
I have bisoprolol as PIP. It slows my heart when AF occurs and lessens the symptoms. My usual resting heart rate is mid 40s so I don't want to take it every day and bring that lower.
bisoprolol is a rate control drug and I’m told best to take every morning. It has been known as a pill in the pocket, but as you probably know AF is not always symptomatic
All the best
Similar to Sixtyslidogirl , both flecainide and bisoprolol as PIPs, "take together" was the advice from the Arrythmia Nurse. However, I think this advice does vary according to "experts", and my limited experience and experimentation over only 8 events has me more confused than ever about the wisdom for me of taking either alone or together during an event.
ozziebob Is an arrhythmia nurse a specialist nurse and are these common in cardiology clinics? The only specialists I have seen were cardiologists. The last one I saw was FESC AND FACC along with the basic MD and FRCP.
Yes, Arrhythmia Specialist Nurse, specialised training in arrhythmias. Perhaps only affordable in the larger hospital groups?
I haven't ever seen a cardiologist (or an EP), my cardiology appointment was with an Arrhythmia nurse. Not ideal as I have unanswered questions, but they perform a very valuable service in allowing cardiologists to focus on more urgent heart "plumbing" matters. Usually AF patients have access to these Nurses for follow-up after a procedure or appointment by email or phone, but it's a bit "hit and miss" I think. For example, my most recent AF was my most concerning, with 6 of my 9 ecgs over 12.5 hours returning novel determinations on my Kardia 6L (2xUnclassified & 4xTachycardia), but my urgent request to the Arrhythmia Nurse to look at these ecgs for some reassurance that I didn't need to request a new referral to Cardiology was only met with an offer to put my ecgs into my medical record for future reference. Doh!
Anyway, it's an EP (electrophysiologist) you need for "electrical" problems (arrhythmias).
My GP doesn't know much about AF and will always ask the Cardiology/ Arrhythmia Service for advice.
The first 2 of your medical abbreviations refer to cardiologists, and the last 2 are qualified general doctors.
Did I answer your queries?
Thanks ozziebob I had never heard of arrythmia nurses so I am now educated.
It appears though that GPs are less well educated as mine has never mentioned either arrythmia nurses or Electrophysiologists.
Cardio Nurse Practitioners are your first port of call for all things arrhythmia at the hospitals on Tyneside, and in my experience they are brilliant.
I’ve been on bisop 5 mg for a few years and it serves me well. I had a period of increased PAF last year and was prescribed Flecanaide but never took it as PAF settled and when I get it which hasn’t been often, I take 2.5 bisop. Just cut in half. It seems to do the trick. GPs had suggested it so not just off my own bat. Never taken the Flec.
After my paroxysmal atrial fibrillation had finally been identified by paramedics on the way to the main hospital where I then spent possibly the worst night of my life, I was finally allowed to leave the next afternoon with a packet of Bisoprolol 2.5mg to take when I felt an episode (as a Pip) but a silly doc at the surgery wanted me to take it daily! I pointed out that I was very sensitive to drugs so she agreed on the lowest dose of 1.25mg and didn’t even arrange a follow up appointment! But the pharmacist took my phone number and urged me to pop in if I had any concerns before he intended to call in a week. On the third day of feeling more tired than usual I popped in to see him and he took my pulse and told me to stop taking the stuff immediately and a different doc agreed but didn’t come up with anything else. We are all very different and eventually that might be realised by the medical profession. Bisoprolol lowers heart rate but does nothing for the irregularity which is part of our problem. Flecainide does that. I was prescribed it by the EP I found through the AFA and saw privately who prescribed it as a PiP after he’d introduced me to having a smartphone and a Kardia and I’d sent him a reading of my heart going bonkers.
Now that I take it regularly, I have been able to reduce the first dose of the day to 50mg, retaining the evening one at 100mg and it has virtually put an end to episodes. Apologies for the length of my response and good luck finding what works for you.
As Vonnegut I only take Bisoprolol for rate control. 1.25mg per day. Was on Flecanide 2x50mg per day for couple of years as well as the Bisoprolol but taken off Flec by cardiologist (2years ago) and told to only take as PiP.
Since then have used as PiP only once. 300mg over 24 hours. Succeeded in reverting to NSR. Wonder if I could have achieved NSR anyway over 3 or 4 days without the PiP?
Overall have has 3 cardioversions since my first onset of AF in late 2019.
Beta Blockers as a Pill in the pocket
Pill in pocket? 
Pill in Pocket?
