I have paroxysmal AF. I take no medication for it, but do have Bisoprolol as a PIP if I should need it. I’m hugely reluctant though, because I felt so ill when taking it, I pretty much lost 3 months of my life!
I take Candesartan for BP (144/84) but my GP would like it a little lower. Bisoprolol made me feel very ill, and I can’t take CCB’s. ACE inhibitors are out (similar to ARBs), so that leaves diuretics as the last commonly prescribed medication for high BP.
I have read numerous times on here that dehydration is a trigger for AF. Is the way diuretics work different from the way that dehydration works? Does anybody know? I really don’t want to risk triggering AF!
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Puckaster
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Furosomide puts me into AF, but I take the potassium sparing diuretic Spironolactone (my Cardiologist only likes his heart patients to be of potassium sparing diurectics - his opinion). because I tend to get swollen feet - not HF! I take 1.25mg Biso as needed (I'm also PAF) but I do take an anti coagulant, in my case Rivaroxaban. But of course we are all different.
Thank you for sharing your post, it is correct that hydration is essential with an arrhythmia such as AF. I am positive the members will offer advice based upon their own experience, please do remember to check with the doctor or pharmacists ahead of taking any over the counter medications.
Why can’t you take CCBs? And have you checked your BP regularly at home? My BP zooms up when taken at the surgery but is lower at home so BP meds made me dizzy and faint!
If it’s any help, my GP is quite happy with that BP for ‘an older person’ as over prescription of BP meds leads to ‘falls’. I gave up on mine after collapsing in the shower….
I was interested to hear that you take bisoprolol as a PIP. When I went into hospital for an operation in 2013 they said I had atrial fibrillation and I was sent home with a box of bisoprolol tablets. Because I was more or less non-symptomatic, I took one of them when I could feel my heart going fast - as I felt it might do some good! Of course, it didn't. I thought, wrongly, that I had ectopics. When the box ran out about three years later, I asked for some more and was somewhat surprised it said I should take two a day on the box. I disregarded this until I had a fall in 2018 and again they said I had atrial fibrillation. After that I took the bisoprolol and it made me feel tired. It wasn't a PIP, it just slowed my heart rate down overall. Because my heart rate is about 62 I thought it was the wrong medicine so when the doctor wanted to increase it I rebelled, asked to see the community cardiologist who said I was an ideal case for an ablation.
I was never offered the actual PIP - flecainide. I don't really know why. If I had, then maybe things would have gone differently.
I have Bisoprolol as a PIP (pill in pocket) in case my heart rate goes so high when I have an episode of AF that I can’t cope with it. As you say, flecainide can also be used as a PIP to control heart rhythm, rather than rate, but I’ve not been prescribed that.
The high heart rate accompanying AF is usually a result of being in AF. Flecainide is used as PIP to restore normal sinus rhythm. If it is effective it should also result in restoration of normal HR. So although Flecainide doesn't directly target HR, it does indirectly.
Is your Candesartan dose very high? Just wondering what your GPs issue is with you taking that if you are controlling your BP on it and can tolerate it.
I’m on 24 mg Candesartan which is keeping my BP at 144/84. GP didn’t suggest increasing that, just wanted to add something else to get it a bit lower. They seem to like lower than 135/85.
The maximum dose of Candesartan for BP is 32 mg , but the GP may want you to have lever room to increase that later and to give you a diuretic instead because the combination of both medications may be more successful.Which diuretic have they suggested?
Did you have a kidney function or liver function test that may have suggested that a diuretic was also a good choice?
Do you have any other conditions or symptoms like water or salt retention or breathlessness that might make taking a diuretic a sensible option?
I’m actually just doing my own research before a phone appointment with the GP. I know they like BP lower than mine, and I wanted as much information as possible before the appointment. I had to take a diuretic called Acetazolamide for just 3 days after cataract surgery recently (I have glaucoma and they were concerned about pressure spiking) and I slept better and my BP was lower, so I was wondering about diuretics, but not if they might trigger an AF episode.
I take beetroot juice first thing every morning plus a good few glasses of distilled water during the day. I find that keeps my bp good. I only need a bisoprolol if I have an AF event.
I take a Spiranalactone and two Bumetanide in the morning plus a Daplifigozin tablet which has a diuretic function. Had a pacemaker fitted and an av node when Flecainide could no longer hold AF. Still happily pottering along at 81!
This is all very confusing for me reading all these comments. I didn't know that Bisoprolol was used as a PIP.
I take it every evening and have done for years now. I had an ablation March 23 and up till then was on Flecainide twice daily. This was stopped, post procedure but my gp just 2 weeks ago has put me back on the Flecainide suggesting I resume taking it as I'm getting constant 'flutters' with tightness and breathlessness. I'm guessing the Ablation hasn't worked completely. Anyhow, she has referred me back to the cardiologist but in the meantime after reading all this about Bisoprolol, I'm beginning to think maybe that's what's causing the issues as I've been taking it every day for a long time and not as a PIP.
It tookseveral months for my heart to calm down after the ablation. The heart has to heal during that time you can get, chest pain, and exhaustion. Next month. It will be a year since I had the ablation which turned out to be successful and I’m delighted.
I never took any drug pip I took flecainide 2x daily and for one month after the ablation. I find magnesium citrate 100 mg twice a day keeps my blood pressure at a good level; by the way magnesium is an antiarrhythmic..
As you can't take medication for Afib have you considered an ablation? It may not completely cure Afib for some people but it improves QoL and may reduce or eliminate your need for medication ( except anti-coagulants).
Thanks Lilypocket. At the moment I’m just seeing how my AF journey progresses. All the while it’s paroxysmal and I can cope, I’d be reluctant to go down that route …..
Would you mind telling me what side effects you had while you were on Bisoprolol please?
I too am on Bisoprolol 1.25mg and have felt really ill since starting them in October. At the moment I am to wean myself off and just take PIP it’s a long journey.
I would be interested to know how they effected you?
Would you mind telling me what side effects you had while you were on Bisoprolol please?
I too am on Bisoprolol 1.25mg and have felt really ill since starting them in October. At the moment I am to wean myself off and just take PIP it’s a long journey.
I would be interested to know how they effected you?
Would you mind telling me what side effects you had while you were on Bisoprolol please?
I too am on Bisoprolol 1.25mg and have felt really ill since starting them in October. At the moment I am to wean myself off and just take PIP it’s a long journey.
I would be interested to know how they effected you?
I found myself completely lacking in energy. Before I was walking from sea level to 75m above without any problems. On Bisoprolol I couldn’t walk up a flight of stairs without a rest. Also I seemed to be unable to think clearly - brain fog. And every half an hour or so I would get a tight feeling in my chest and have to stop whatever I was doing and wait for it to pass. I stopped the 2.5 mg dose after 7 weeks (with my GP’s go ahead) and it took 4 further weeks for those problems to abate. I then had to rebuild my fitness. I am hugely reluctant to take Bisoprolol, even as a pip, and have just got through the one episode (5 days - flu) I’ve had since stopping.
I was diagnosed with AFib in October and put on 1.25mg, they made me feel terrible. I have been reducing very gradually over the past couple of months and now down to under half a tablet. Initially I got down to half and stopped but had to restart after a couple of days due to heart rate . They are not an easy drug to just stop (as you probably already know ). They have also caused me gastric issues and awful anxiety. But shouldn’t take too much longer. I would never have started taking them if I had known.
I’m amazed that you haven’t been given an anticoagulant as sometimes even though diagnosed with paf you can’t always feel as if you are in afib and a blood clot could occur in your heart which if breaks off and spreads could cause a stroke. Sorry not meaning to be frightening, but just surprised your EP hasn’t started you on one. I am on apixaban which I am told is the kindest to brain and stomach.
Regarding the diuretic I was changed to co-amilofruse which does have a little furosemide in it but does not drain potassium and again is kinder to the kidneys
Again I was told a perfect BP is 120/70 but the older we get sometimes the more it rises, but hopefully not more than 135/80
Obviously I am not a doctor but this is what I have been told by hospital consultants
Thanks Tapanac. Yes my GP has prescribed an anticoagulant. I didn’t mention that as I was focused on asking about whether diuretics triggered AF. Sorry.
That’s ok. Glad you’re on anticoagulants. Just to say one of the cardiologists in the hospital told me that diuretics don’t make your skin dry (that’s what I wondered as mine is so dry despite gallons of cream) it helps to stop getting water in the lungs when the heart isn’t functioning properly, or build up of water elsewhere like ankles legs stomach etc just to keep well hydrated
I was put on furosemide and a few weeks later I ended up in A&E after feeling very ill. The first question they asked was "are you on furosemide?" I was put on a potassium drip and switched to spironalactone which has worked well. With all diuretics you do need to drink plenty of fluids and have your kidneys checked from time to time
I have high BP, and then high HR ( but not AFb)as a result of Long Covid over nearly the last 5 years and was on 5 different simultaneous anti hypertensives for most of the time as the combo.didn’t seem to get BP down. Then I got syncope too, had a tilt table test and consultant immediately removed the beta blocker, bisoprolol, as the lowering of HR was not what my body needed before a faint ie brain needed oxygen quickly. One of the 4 drugs I’ve been left on is indapamide, a diuretic, which I find rather odd as postural hypotension is in part caused by low blood volume. I have no confidence that GPs, and for that matter even the cardios who have seen my stats., ecgs, echocardiogram etc but never me, know how these drugs work for all their patients, particularly if numerous taken! I have never been offered a PIP either for hyper or hypo tension…perhaps something to pursue as some days my BP is 150/80 next 95/60….i don’t want to get Afib so trying all I can do to control BP/HR, even swim 50 mins a day 5x a week… Sorry if off message but PIP intriguing.
I am pleased to have discovered PIP. My pharmacist said not many people have heard of it. My understanding is that it refers to any medication that is taken as and when it’s needed rather than all the time. I’m happy to be corrected on this if I’ve got the wrong end of the stick …..
Yes, my daughter in law was just given a PIP in last stages of pregnancy due to high BP a week or two before Caesarian…had no idea they worked that quickly or for that matter quickly removed from body. Problem with PIP for my odd BP is I have now had it so long I cannot feel it, except when very very low, and BP monitor doesn’t work when it’s changing to confirm you need to pop it now!
Mmm not sure about a PIP for blood pressure. I think they are only suited to certain medical conditions, paroxysmal AF in some cases after discussion with one’s doctors, for instance
My EP knew about PIP. It is an approach that has come in in recent years since my diagnosis of P-Afib.. I too an intolerant of Bisoprolol - infact any of the betablockers but I also have Hypothyroidism - beta blockers work by lowering conversion of thyroid hormones..... thats why you feel so tired and struggle with any activity on them. Thry made my heart race too. I was on a CCB for s few years but my Afib progressed to persistant. I had a minimaze - surgical form of ablation but done to the exterior of the heart. Been Afib free since off all meds including anti coag too.
My BP is higher than yours on an Ace inhibitor but my GP is happy as I am older and if my BP is lowered any further I feel dizzy.
Hope you find a way forward. It might be worth a consult with a good EP. They know far more about Afib than general cardiologists.
Hi Puckaster. I take the diuretic Furosemide, 40 mgs. a day. It helps me breathe a bit better, with my AF, along with the HF also caused by the AF. I do get a bit concerned about the effects on kidney function along with potassium levels, it just seems to be another thing to worry about, as if we don't have enough already. Because it's not potassium sparing, I have a morning drink of beet root, pure lemon juice, cherry and carrot, 4 small equal amounts in a 9 ounce cup. I also eat a daily banana along with veggies at dinner. Some days the diuretic works better than others, probably because of sodium found in many foods and drinks. They work better when sodium is kept in check, but you still need some of that also. I also take a magnesium capsule before bed.
They gave risk because they make the kidneys work more so you pee more. But with the pee you lose potassium and magnesium.
So both water and the minerals need to be replaced.
Minerals are in nuts, bananas just a couple.
Like you in ACE meds mine because 'coughing'.
BBs Metopolol breathlessness and 2 sec pauses at night. Without careful monitoring I may have been supplied with a pacemaker. But discovering this the first h/specialist changed me to another BB Bisoprolol. But BBs did not control my H/Rate.
I could not take Losartan as I found protein in my urine.
I can take CCB Diltiazen CD 120mg early morning. Controls my rapid heart rate dramatically.
I'm afraid I would be not be happy on diuretics. But I only have the occasional swelling in ankles. Usually from long hours of driving and in the heat. But if you raise your legs over night prior.
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Reducing Bisoprolol dosage.
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diuretics and dehydration in hot weather
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Diuretics not working anymore
