ATRIAL FIBRILLATION

[Roland_Burdess]

I recently suffered an AF two days following a shoulder operation. A & E stabilised it and prescribed 2.5mg bisoprolol. I was later prescribed 60mg edoxaban. Although my GP assures me that that is the correct dose I'm not sure about this. For one reason I only weigh 63kg and the recommended edoxaban dose for people weighing up 60kg is only 30mg dosage which means a sizeable increase for me to be prescribed 60mg. The 2.5mg of bisoprolol seems excessive as I've never suffered from high blood pressure and I feel extremely lethargic. I've also suffered a slight nose bleed for about a week which the hospital has put down to simply "nose blowing". I have an appointment with a cardiologist but it's not until October. Has anyone got any advice for me, please?

[Hidden]

I copied this from the PDR( physicians Drug Reference) re Endoxaban dose

How Supplied

Dosage & Indications

For reduction in risk of stroke (stroke prophylaxis) and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF).

Oral dosage

Adults

60 mg PO once daily. Do not use in patients with CrCl more than 95 mL/minute due to increased risk of ischemic stroke compared to warfarin.

Bisoprolol is a type of antihypertensive drug called a beta-adrenergic receptor blocking agent (beta-blocker) used to treat hypertension (high blood pressure).

Bisoprolol is available under the following different brand names: Monocor, and Zebeta.

Dosages of Bisoprolol:

Dosage Forms and Strengths

Tablets

5 mg

10 mg

Dosage Considerations – Should be Given as Follows:

Pediatric: Safety and efficacy not established

Hypertension

2.5-5 mg orally once/day; may increase to 10 mg and if necessary to 20 mg orally once/day

It is used for hypertension but also with a fib, a beta blocker is commonly used to keep the heart rate slower, so if a fib shows up again, it will be a slower rate, hopefully easier to stop.

Betablockers can take a few weeks to get used to, so dont give up until you have been on it maybe a month. There are other betablockers too so if this one doesnt feel right, let your doc know. Do not suddenly stop a betablocker. Good luck, Ive had a fib going on 4 yr, it is a process but should get better. Ive gone 14 mo now with no a fib events.. touch wood, lol. Hope I didnt jinx myself.

[RolyB in reply to Hidden]

Many thanks for the information. I guess I'll just have to stick with with it. Thanks again.

[Hidden in reply to Hidden]

Recommendations in the UK are different to this. The BNF (British National Formulary) do differentiate adult dose of endoxaban by weight, as per the OP, which is actually fairly unusual in adult medicine. And bisoprolol is rarely used as a primary treatment for hypertension over here now, it’s primary use is as an anti-arrhythmic.

[Hidden in reply to Hidden]

Beg to differ, but Bisoprolol affects rate not rhythm.

Pat x

[Hidden in reply to Hidden]

I have to beg to differ in return. It is classed in medicine as an anti-arrhythmic, because an abnormal rate is an arrhythmia. Also, the primary effect is on heart rate, but there is a significant effect on the sympathetic nervous symptom, which is part of its anti-arrhythmic profile and one of the reasons it’s favoured in AF/SVT in particular. SVT episodes are almost always triggered by ectopic beats, and bisoprolol reduces the incidence of these beats, which has very little to do with base hr.

[Hidden in reply to Hidden]

Guess I meant it’s primary function is rate control, which is important for those of us whose resting heart rate & BP are low except when in AF. This can result in extreme dizziness and even syncope with Bisoprolol. My cardiologist said it is unsuitable for me & I am maintained on an anti-arrhythmic & an anticoagulant.Some would say this puts me at higher risk of flutter or other arrhythmia without the beta blocker, but so far, so good one year on.

Best wishes

Pat x

[Hidden]

Bisoprolol is primarily used as an anti-arrhythmic these days: it will lower your blood pressure, but it’s no longer favoured as a primary antihypertensive. Where blood pressure needs lowering, ACE inhibitors or calcium channel blockers (or similar) are the first choice. I had the blood pressure of a triathlete according to my gp, but I suffer with SVT and was put on bisoprolol to control my heart rate and rhythm after my first major episode. The knock on to that was that my already excellent blood pressure went even lower, but orthostatic hypotension was a small price to pay for not needing to have my heart stopped to get it back into normal rhythm. A dose of 2.5mg is relatively low (min therapeutic dose is 1.25, max 10mg), and whilst it’s not true for everyone with betablockers, you will hopefully find that the side effects lessen over time and your body adjusts. There are other betablockers (or medication options generally) that some people find are more tolerable than bisoprolol if they have issues with them, so if it persists or is really intolerable, you can always speak to your gp.

With regards, to the endoxaban, the BNF do indeed state 30mg up to 60kg. But the bottom line is you weigh over 60kg: how much over 60kg is irrelevant. Dosing by weight in adults is actually quite rare, but you can trust that the cut off has been set for a reason, and if there was a need to graduate the dose further by weight, they would.

[RolyB in reply to Hidden]

Thanks very much for your reply. The information you have given me

is reassuring. I hope the lethargy decreases as my body adapts to the bisoprolol and the nose bleed ceases eventually; I must remember not to blow my nose.

Thanks again.

[Hidden]

Keep an eye out for dizziness, especially when getting up from lying or sitting as your BP can drop posturally on Bisoprolol. Check your pulse rate as this can be lowered to around 40 which could be an indication to your doc for dose reduction/ change of med.

I’m on Apixaban, a NOAC similar to Edoxaban, and found I had increased gum bleeding when cleaning my teeth, and also found a lot more hair in my hairbrush than usual, but both settled down over a few weeks. As for dose, your age would be taken into consideration as well as your weight - older, lighter patients might be given a lower dose, but your weight alone would mean your dose is correct. There are now at least 5 NOACs and some have side effects on one but not another.

See how you go & ask for a meds review if no improvement.

Pat x

[Hidden]

I meant to say also, never adjust meds yourself, drugs used in cardiology are potent and require expert supervision.

Pat x

[RolyB in reply to Hidden]

Many thanks, Pat.

Roland

[Cazza1953]

Hi I suffered AF at end of May 2018 and was put on edoxaban 60mg but I noticed that was wrong as I was only 8 st so was out down to 30 mg also was prescribed a few beta blockers as I had had about 8 AF attacks between May and October they tried different beta blockers however my cardiologist in November last year put me on Bisoprolol 1.25 mg 1 a day and Flecainide 50 mg twice a day and the edoxaban 30 mg once a day

I feel lethargic all the time and my cardiologist has said to come off Bisoprolol for 7 - 10 days to see if this makes a difference and if not just go back on then and if it does my doctor will contact her and will go back and see her to discuss whether to give me something else

Hope this helps

[Glasgowgirl1947]

I had 2 heart valves repaired on 7th March. I was discharged from hospital a week later and had an appointment with a senior nurse practitioner a week later. I had an ECG and chest Xray and was told I was in AF. My heart had not settled into a rhythm until the Thursday evening, I'd an external pacemaker since the op, I was discharged on Friday. Anyway, the nurse couldn't decide what to do for the best, she first wanted to admit me then decided to prescribe 1.25mg Propranolol and got me an emergency appointment at my local Warfarin clinic on the following day. they can't seem to get the dosage right and I am fed up taking it and having to go every few weeks to get it checked. I saw a consultant a few weeks ago and he said if I have another clear ECG in a month I can come off Warfarin. Yippeee. I'm not keen on any increase in the Bisoprolol dosage as several people on the forum hate the stuff and seem to have side effects, I can't really say I have but I was on Atenolol before my op. so it's possible I was used to Beta-blockers