Atrial Fibrillation

[Floholmen]

I notice that in a couple of the chats reference is made to the bisoprolol dosage not being taken at the same time. Is there a reason for this and is it found to be effective

[BobD Volunteer]

Do you mean that some people split it morning and evening rather than all in one go?

[Floholmen in reply to BobD]

Yes, sorry I wasn't very clear.

[pd63]

Bisoprolol is a bit like marmite, love it or hate it.Some people can't tolerate even the lowest dose due to side effects others like me have few problems apart from mild lethargy if I'm sat doin nothing and I can nod off, been on it nearly 5 years

My dose at 5mg in the morning would be classed as medium/high.

I believe some people split the dose to minimise potential side effects

[Jetcat in reply to pd63]

I take 10mg every morning and 1.25 mg before bed if I’m having ectopics in the evening. But it’s usually just the 10 👍

[pusillanimous]

My cardiologist allows me to take my Biso at my own discretion. My choice is to take 1.25mg if my HR reaches 90 Bpm. It quickly lowers to the late sixties, which seems to suits me best. I can go for several days or longer without out it. Same with the BP meds - taking 5mg a day brings my BP down too much, so I take a pill when it goes up. I'm nearly 82, so I think he has given up with me and lets me do my own thing - just makes sure I have the prescription. I can't be doing any harm as at my annuual check the echo shows normality, as does the ECG and so does the BP. I do however, take my Rivaroxaban diligently with my last meal of the day at 5pm.

[Teresa156]

I take mine twice a day now, since a cardiologist increased my dose after being in hospital after my first ablation which failed. It helps to keep me on an even keel throughout the day. I take 1.25 in the morning and 2.5 at night. My episodes before my second ablation, happened at night, so it made sense to do this.

[Kulakman]

I started on 1.25mg then increased to 2.5mg. This made me feel light-headed and just generally very very tired. On the advice of the HF nurse I now split the dose 1.25mg morning and evening and this is working well.

[Scrabblefiend in reply to Kulakman]

Me too, with agreement of cardiologist and GP

[Ewloe]

I take my 5mg daily split 2.5am 2.5 just before bed for 2 reasons.

First it lowers my blood pressure too much in one dose

Second the EP advised it to give a more level 24hr coverage to help dampen the bits of the 3 arrhythmia’s Ive got. To avoid peaks and troughs.

[Ppiman]

The half life of bisoprolol makes it a once-a-day tablet; also, what’s called a “steady state” concentration in the bloodstream is reached after around a day.

This means that it can be taken at any point in the day once every 24 hours and that a split dose won’t be useful. That said, some people do split the dose, which shouldn’t achieve any result - but presumably does.

Steve

[Rosie0202 in reply to Ppiman]

Hello Steve

I don't quite understand the logic of your dosage but I may have misinterpreted. If bisoprolol has a half life then that's only 12 out of 24 hours full life surely. I take mine in a split dose of 3.75 at 9 am then 1.25 at 11pm. My reason for this and which my Cardiologist could not disagree with was that all my AF episodes began, in the early day, at around 4 - 5 am. I figured out that it was therefore better to have some protection during the night time and early hours.

Ulitmately we all react differently so I can't argue with anybody else's regime; only to say what works for me.

Regards Rosie

[Ppiman in reply to Rosie0202]

I based that on what the literature shows, which is that, with a half life of c. 12 hours, bisoprolol remains at active levels that allow once-a-day dosing (and this is the recommended way to take it). After a few days, a steady state concentration in the bloodstream is achieved with once daily dosing, so, technically, there should be no benefit in taking it twice daily or at different times of the day.

I suspect that the majority of users react similarly to bisoprolol in terms of absorption and blood levels - at least, that's what clinical trials show; but, it must be so that some people will have a different response. The excretion of bisoprolol can vary owing to kidney or liver enzyme differences, for example.

If it works best for you to split the dose, then that is useful to have discovered.

Steve

[Auriculaire]

The clinical trials for Bisoprolol were done before 1986 when it was first approved for use ie in an era when neither women nor female lab animals were included in trials so they are not that useful in terms of absorption and blood levels for over one half of the population . Probably why women get on with them worse than men - they are being overdosed on dosages worked out for men. The half life of a drug must surely vary due to individual metabolism and it is now known that there are genetic differences too in rate of metabolism of drugs . Those who are not average can be either underdosed or overdosed by the one size fits all dosing that is standard in medical practice.