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British Heart Foundation
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Bisoprolol-night or day?

I have been prescribed Bisoprolol 1.25mg and Cardiologist said to take at night. I have read in the leaflet it says to take in the morning. Do I just continue nighttime? Not due to see cardiologist again for a while. Did anyone else find they have the hands of a 100 year old whilst taking beta blockers or is that just me? Also consultant said heart rate on exercising should be 120 max. I love running but it shoots to 158 with a gentle jog. Should I avoid jogging? Cycling is fine and heart rate 120. I have hypertension, diabetes, MS and some moderate atheroma. I am 49. I was put on beta blockers for some tachycardia on exertion. I also have a reduced lung function (70%). Cause as yet unknown. CT scan in a week. Thanks for any advice re beta blockers. ❤️

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Hey.

I take mine (2.5) in the morning. That's what I was told by the hospital. I wonder if it's because I take atrovastatin at night? Not sure.

Haven't noticed any side affects but have only been on them a few weeks.

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I also take atorvastatin 40mg at night

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Yeah mine's 40. I wonder if you can take the other morning or night then? I haven't had any affects...be interesting to see when others are talking it.

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I understand cholesterol tablet is better at night as that is when the liver produces cholesterol but it can be taken other times

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Atorvastatin is somewhat more effective taken at night. My understanding is that if your levels are in (and stay in) range (total 4 or below, LDL 2 or below) morning is fine.

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I take mine in the morning.

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I take atorvastatin at night and Bisoprolol in the morning.

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Ditto altho I take 5mg of Bisoprolol :)

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You might be one of the lucky ones

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hi mollypet. i was put on 2.5 mg last wk and was told to take at night too. but i’m very symptomatic to lots of medications but so far iv been fine. good luck❤️shiona

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Hello and welcome to the forum! I have Type I diabetes, PAD (peripherial arterial disease) and CVD (had a quadruple bypass last year). Fortunately the answer to your question is quite simple. You are on the lowest dose of Bisoprolol. When first starting on it some people feel dizzy but this usually settles in a few days, so people are started in the evening. If you notice no symptoms move to the morning to derive most benefit. Its half life means its effect is tailing off at the end of the day. The day time when you are up and about is when you need its effect most.

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Thank you Michael. Would I gradually swap to morning- i.e currently take at 10pm. Change to 6pm,2pm,10am?

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This is an area where people become vague. Ideally you should not go without medication for over 24 hours. As you are on such a low dose you should be fine taking it in the evening and then the next morning.

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Thank you.

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Yes this is my worry. I was on propanalol 10mg for two weeks then gp decided to taper me off over a two week period but I had terrible rebound. So I'm wary of overdosing or underdosing by accident.

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IMHO (I am not medically qualified but a physicist) Bisoprolol is the better drug as it is more modern and has a better half life (10 - 12 hours rather than 5 - 7). It is more expensive though.

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Hi, why is Bisoprolol prescribed relative to heart issues?

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It has two main effects; reducing BP and HR thus improving the heart's efficiency. It also has benefits in some types of heart failure.

These days the trend is to use multiple medication as it seems more efficient than a large dose of a single medication, e.g. an ACE inhibitor is often combined with a beta blockers.

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Its the cheapest beta blocker on the market. That's why its prescribed first, that information came from my doctor

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Interesting - I was told Atenolol was cheaper but only by a £1 or £2 per month. Allegedly Bisoprolol is the more effective drug.

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Hi, my husband splits his Bisoprolol into two doses, one mid morning after his other meds and the other at bedtime. His Cardiologist is happy with that.

He was also advised to exercise so that his heart rate is no more then 80% of the normal maximum for his age. Ie 220-age x 80%.

I think that’s fairly standard advice but his condition is different from yours so you might want to check with your Cardiologist/GP/BHF nurse helpline.

All the best.

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Thank you. That's helpful

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I take mine in the morning and statin/ clopidogrel at night

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I was advised by cardiologist and hospital pharmacist to take Bisoprolol in morning and statins at night Like Shar28 rehab nurses said Hr should be 220-age x 80%

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I take 1.25 of bisoprolol in the morning at breakfast and 1.25 at about 7 at night. This works well for me. I was having more AF episodes during the night so doctor split the dose and so far everything is much better.

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Hi I was taking mine in the morning I'm on 10mg ,but found I was feeling tired in the afternoons so my gp said try taking it at night, so I now take it about 6pm with my lisinopril 5mg . Seems to work for me.

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Hello

Heart Nurse and Cardiologist have been trying to get my dose of Bisoprolol optimised over the past few weeks. I have been changing between 7.5 and 10mg of Bisoprolol and switched from Morning to Night back to Morning. The reason for the change was at Night I was going down to as low as 22 bpm and I was getting pauses in my heart beat !! This was all monitored by a Holter and by a Telemetry/recording system whilst spending 24hrs in Hospital. Term used was Nocturnal Bradycardia. I do take a Statin at night along with Entresto.

So the regime at the moment is Morning, Bisoprolol, Aspirin, Omeprazole, Isosorbide.

Mid Morning Furosemide, Eplerenone, Entresto.

Night is 2nd Entresto. With my medication I just follow what I have been told and take it as prescribed !!

Regards

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Bisoprolol will cause you to be unable to exercise, feel tired a d lethargic plus. Dont put up with it, get it changed. Its easy for docs to prescribe these meds they need to try them!! The side effects of bisoprolol are horrible. I came off them and am now on calcium channel blockers which do the same job. My doc said they prescribe bisoprolol first because its the cheapest!!!!! Good luck

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I agree! I felt complete exhaustion for months then got taken off bisoprolol and within a week I was so much better! I was taking it at night on advice of doctor as I take ramipril in morning. I take statin at night. 🙂

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I was on verapamil for over 30 years & my

Cardiologist said bisoprolo is a far safer drug to take it was not available 30 years ago & verapamil has much more serious side effects

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I take all my medicine including 5mg Bisoprolol and 80mg Atorvastatin in the morning when I wake up. I am always tired in the afternoon. After reading the replies I might try taking them at night.

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I also take them I'm on 2mg in the morning used to be at night, now changed to morning as it can affect all other meds x

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Hi. I take mine in the morning. Doubled it to 2.5 and it seems to have settled

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I have taken it in the morning for many years on medical advice. I also take a statin at night.

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I take half of a 1.25 tablet in the morning, doctor halved it as my heart rate was very low. I asked him about running and what heart rate to aim for and he told me not to run as I need to protect my heart! Found that a bit surprising but it just shows that advice is very much dependent on a range of factors.

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Gosh u don't expect to be told not to run.

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I take mine morning.

Some doctors say to take at night because it avoids some of the side effects.

For example Bisoprolol can make u feel tired and exhausted.

Night time at some stage u would be in bed or asleep.

U may also get swollen ankles but in the evening or night u may have feet up or would be lying down.

The Bisoprolol is still in your system doing its job just helping with some side effects it can take 3 weeks plus for it to be completely out of your system.

Also Bisoprolol is at its most potent in the blood 2hours after taking which is when the worst of side effects would be if any.

It's usually well tolerated.

Hope this helps

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Yes, I did find it a bit odd but he did say to keep exercising but just to watch the intensity. He did also remind me that I’m knocking 60 as well!

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I will continue with low intensity then, although it's abit boring

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timestudy.co.uk

I take mine in the morning, I have been taking it for 20 years!

I am also part of this study & they have groups of patients, some of whom take it in the morning & some in the evening. I was asked to take mine in the morning [but also with my Consultants approval]

I believe that the latest thinking, is that taking the anti-hypertensives in the evening has a better outcome for the patients

I think they are currently collating all the information & it will eventually be published.

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Thanks for sharing that

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Hi Mollypet and welcome. After my bypass a year ago I was put on 3.75mg of beta blocker which I took in the morning as advised by the hospital. I soon realised it caused my BP to go so low that I felt completely exhausted and dizzy. My Dr then reduced the dose and now I don't take it at all. I was told by my cardiologist that taking it for the first year protects the heart from the surgery. I now take aspirin, Ramipril (1.25mg) and statin (20mg). Good luck with things xx

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Thank u

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Taking Bisoprolol at night for two years- 2.5 mg - I'm in heart failure - Dilated cardiomyopathy - and despite my heart being at 40% I feel very well. My sleep pattern is not great but I manage my life well so I feel that taking it at night is not negative.

There are prescription helplines so possibly worth investigating them and asking a few questions if you still feel uncertain.

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Hi

I have a genetic heart problem and was prescribed 10mg per day, which I take in the morning. I am always cold. I decided a few months ago to reduce the quantity as I was exhausted all day from the tablets. I now take 2.5mg and some magnesium supplements and I have a lot more energy. You must do what’s right for you. Only you can monitor how these tablets are making you feel. Doctors prescribe them but we all react differently. Try taking them in the morning and evening and see what works. Good luck

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Many thanks

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I take both my bisoprolol and atorvastatin at night, reason being that bisoprolol can make one dizzy. Ive been on this regime for over a year with no bad effects.

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Hi my dad has recently prescribed beta blockers (bisprolol and ramipril). He was feeling dizzy so he's been advised to take them before bed time so he's lay flat and at no risk of fainting. Hope that helps?

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I started taking bisopralol at night but had terrible hallucinations. I would wake up seeing 3 foot long black worms painted all over the walls. It was moved to morning but eventually was stopped as I just couldn't tolerate it. I don't think it matters what time of day you take it but as many people have nightmares ithat's probably why morning is suggested.

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I was also prescribed 1.25mg bisoprolol for tachycardia (after a heart attack). Unfortunately it reduced my already low resting heart rate from 50 to about 44, but it fixed the tachy attacks :-) , my HR used to suddenly jump to 160-180 from 90-100 when just walking quickly.

I take mine in the morning as the levels will be highest during the day, but the blood serum levels should remain relatively stable after a few days.

Cold hands come with beta blockers, but for me it's only really a problem in the winter trying to play golf.

Are you sure your HR is going to 158 when jogging? I wear a HR monitor with a chest band but when I'm jogging the rate is unreliable because of the motion and bouncing around on my chest muscle. It often goes to 180+ but my HR when checked manually is only about 110. At the gym on the X trainer and watt bikes when working just as hard (sweat pouring off me) my rate is 125 max so I tend to ignore my HR monitor when jogging.

I'm 71 and I was also told to keep my HR below 120, but the medics are always conservative.

Good luck

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Thank you. I have noticed my Fitbit heart rate varies quite a bit from the gym ones so I might get a chest one. I tend to go by the gym monitor when exercising. But even with gym monitor it could easily hit 160

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Keep your finger on the pulse as they say.....it's the most reliable.

I suffer from AFIB, fortunately under control for most of the time, but I'm so used to checking my pulse manually I don't really need to use my watch, just a few seconds feeling my wrist and I can tell you what it is within 10%, try it, it's a great confidence booster.

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I’m on the same dose and was told to take them at night

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Following Chest Pains and 5 hours in the Resuscitation Unit in A & E on 31 July last I was put on Bisoporol 7.5 mg and Apixaban 5mg twice a day

I have had recognisable side-effects of fatigue, dizziness, loss of appetite, tinnitus, dry mouth, nausea and so on but either mild or not long-lasting

Then following an angiogram in mid December revealing "serial severe proximal stenosis" 3 more medications were added-nitrates, statins and clopidogrel

Unfortunately I gradually developed diarrhoea which became constant and lasted for 2 months and which I found totally demoralising

A Joint Cardiology Conference recommended a quadruple bypass in January and I am on a 6/8 week waiting list at St Thomas'

A consultant/surgeon at St George's kindly indicated it would be ok to drop the 3 additional medications on 1 March which had an immediate effect on the diarrhoea and I am back on the original prescription

I have had no more chest pain or the supra ventricular tachycardia I realise now I have had intermittently over some years and which stopped when I cut down on and eventually dropped all caffeine

The cardiologists seem to talk to each other and not to me so much and I am left to pick up what I can from their copy correspondence

The gp will see you right away but seem only anxious to refer you elsewhere and talk vaguely about "plumbing and electrics"

I have been to 5 London hospitals for various tests the latest a vein scan at Guy's last week

I was told by one surgeon that I have the option of doing nothing as I am "asymptomatic" on medication

The image of my heart was projected on the wall of the theatre when I had the angiogram but at the time I wasn't really "there" because of the premed

Otherwise I haven't seen any of the scans but I am learning to put my trust in the experts

I am 80 this month and live with my wife and our 3 now adult children (24,20 and 18) so there is plenty of support at home (I hope)

On balance I will go through with the operation and save my energies for the recuperation process-but I must find out about the medication I will be on after the procedure

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Good luck with everything. Yes I find the drs advise something but don't necessarily give you all the information you need. Or leave you with more questions.

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I started taking my Bisoprolol 2.5 mg in the morning. After a series of palpitations and a cardiology review. I was told to take them at night.

I tried taking them at night for three consecutive nights and ended up with an excruciating headache, which woke me from sleep. I reverted back to day time and all seems to have settled.

I take Atorvastatin 80 mg at night .

See how you feel when taking them, your body usually lets you know.

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Although I'm not qualified to comment on when best to take Bisoprolol (I believe it may depend what other meds are taken at night), but just to comment on the exercise/heart rate thing -

I'd humbly recommend shifting the emphasis from running to cycling, my reasoning is there is far less impact stress on joints. I do run, in fact I don't walk anywhere unless running would get me strange looks... but I don't road run any more.

Cycling however is absolutely superb in the control we have over exertion. I cycle for a few minutes to warm up and then do a 20 second sprint in high gear as hard as I can and then rest/cruise for a minute or two then repeat. When my heart pushes against the Bisoprolol limits then I back off.

I'm actually amazed your Bisoprolol allows you to attain 158!! I can't get past 135 no matter how I push.

Oh, and when I was first in cardio rehab I asked the nurse how far I can run - she said simply "you running days are over"... Never did a phrase depress me as much since my diagnosis. Ha, if she could see me now four years on.

Wishing you the best,

Drew

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Thank you for the advice. I am looking to change from the 'runners high' to the cyclists high, if such a thing exists. Unfortunately the older I get the more things I have to give up that I enjoy.

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Hey don't give those things up too easily. it can all come back to an extent. I'm 62 soon (can't believe I'd ever be saying that, grrr), and I'm better than for the last 20 yrs in most respects. Still look like hell but, hey ho.

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I was told that in the run up to my bypass I had looked like Keith Richards on a bad day! Boy, I must have looked rough!

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I wish I knew his secret to longevity though 😁

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In his autobiography (I am a Stones fan) he claims that it is because he could afford to buy the best quality (drugs) and he never took that bit extra. It may be right as they think the death the person I knew was due to cut (contaminated) heroin.

Warning: as they say don't try this at home!

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Yep lifelong Stones fan here too. 'Exile' still leaves me in rock n roll heaven..

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Don't tell anyone, it's controlled insulin levels phcuk.org/nice/

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Absolutely the root cause in my 'umble view. Sugar>Insulin>Insulin Resistance>Inflammation>Pre-diabetes>Type 2 diabetes>CAD/CVD

The perfect storm...

Everyone learns this eventually I suppose, usually a bit late in the day. It'd be handy if it was taught young.

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I take it in the morning first thing when I get up. other wise I would forget to take it

altogether

Take care

C

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drugs.com/drug_interactions...

I meant to suggest that using a drug interactions checker is a good idea. I take so many different drugs that I find this very useful. It is an American site but is the best one I have found.

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Excellent thank u

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I take Bisoprolol in the morning, as per my GP's advice and the instruction leaflet.

I haven't noticed my veins becoming more prominent on Bisoprolol (if that's what you mean by 100 year old hands!).

My experience with pulse rate is the exact opposite of yours. I really struggle to get my pulse much over 115. I'm doing the NHS recommended 150 minutes a week of moderate aerobic exercise (which in my case means a pulse rate around 107), but I could reduce the 150 minutes if I could move up to vigorous aerobic exercise. However, even going like the clappers I'm stuck at 115. I understand that quite a few people have reported a similar effect and believe it's down to a combination of Ramipril and Bisoprolol.

By the way, I had a bypass operation in October last year.

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107 is my pulse just moving round the house. Mad. I also take perindopril .

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Interesting reading on bisoprolol. I had a single bypass last April, and have become progressively tireder over the last few months, even thinking about doing stuff seems like hard work! I take 2.5 mgs am with an aspirin and 40mg pravastatin at night. Couldn't find the energy to run now if my pants caught fire! My average resting BP is 51, it has been as low as 39 and did once hit the giddy heights of 62 when I ran out of meds for a week (pharmacy lost my script)

Shame really, as I am known for my normally high energy levels. I am 63 this year so not exactly old.

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Night! I was taking mine in the morning and by lunch time I was so foggy and tired. Moved it to 7pm and it has made a huge difference. Cheers, Steve

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Hi there,

So sorry to hear of all the negative experiences with the medical staff.

I am so lucky to live half a mile from The Essex Cardiology Unit and I have had excellent communication from the medical staff right the way through.

After never haven taken medication through my life and a quadruple bypass I was given 1.25 mg Bisoprolol, 10 Lercanidipine but start off with 30mg Lansaoprazaole to protect my stomach.

Told to take them in the morning (all before breakfast) and reluctant at first I have surprisingly felt fine as timing is the same every day. I did refuse a statin as not convinced of the efficacy and the effect they had on my mother and sister who both lost their full mobility but of course that is a very personal thing.

I do wish you well and for all those runners my official BHF stage 4 rehab trainer makes us do intermittent runs in the gym! and his advice his push yourself.

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I take in the morning, but yes.. randomly have side effects...get terrible bruising, but all ok when checked with the hospital. Related to the other reply, agree...i only take statins at night.. hope you will be ok!

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Thank you so much to everyone that replied. Very kind and informative. I wish everyone luck in their heart journey ❤️

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I have recently swapped from morning to night and the difference is very noticeable to me. I only have 1.25 as I have naturally low BP but every night on my initial falling asleep I would be jolted awake by a feeling I had forgotten to breathe, I also had odd instances of this during the day. Since swapping to night, after consultation with my GP, it has resolved and I actually sleep better. We are all different but it seems the night/day recommendations are open to what suits each of us best. Good luck

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My skin has been very dry since taking heart meds. It seems to dry up everything! I am drinking more water hoping that will help.

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Interesting. I have dry skin from immunosuppressant treatment

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I was on losartan for six years and then suddenly came up in hives which left awful scars and are still healing. I suppose everything has some side effects! Good luck with your treatment.

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You too. X

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