Dropping beta blocker dose: If you are... - British Heart Fou...

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Dropping beta blocker dose


If you are advised to drop a beta blocker dose in half can you do that straight away without withdrawal? I am on bisoprolol 1.25 once a day for over a year. I have been taking it twice a day on the advise of my dr due to overactive thyroid for the past month. He has now said thyroid is corrected so drop the night dose and go back to once a day (morning). I am scared I will get withdrawal.Heart rate is now back to normal at 60 resting heart rate, compared to 88 back in early May. The tablet is tiny so would be hard to split. Any advice /experience grateful.

37 Replies

You should be fine dropping a 1.25 in one go.

I came off 2.5mg last year because I wanted to row faster in the gym and had no problems.

There was a small and temporary increase in my resting pulse and BP (about 4 or 5 bpm and under 5 points on both BP figure) but they dropped back within a week.

Thank u that’s helpful

Gaz_chops in reply to Caitlyn6

Similarly, due to increased fitness and experiencing dizziness post exercise, I had mine halved a few weeks ago, went from 5mg twice a day to 5mg once a day, I asked pharmacist same question, she said that it only needs to be reduced slowly if stopping all together, I also found my HR increased slightly for a week or so then settled near to what it was.

Noticed a massive difference in tiredness and energy levels, also stopped getting headaches.

Caitlyn6 in reply to Gaz_chops

Did the tiredness improve? Thanks.

Gaz_chops in reply to Caitlyn6

Yes I haven't had a siesta since I halved the dose, energy is much higher, no dizziness post exercise, during exercise i feel i can push more than i was & my HR is peaking slightly lower, which is most probably due to my fitness improving even more.

Caitlyn6 in reply to Gaz_chops

That’s great 😀

Thatwasunexpected so off bisoprolol completely now? Is there a downside to pushing on a bit in the gym whilst on it, or is it just that your heart can’t go as fast as your body needs it too?

Yes, came off it at my first 6 month (after 9 months!) cardiology follow-up.

When I asked the consultant assumed it was a bedroom related request & was surprised when I said it was for the gym :D

The problem being on it is general sluggishness - once you get above a certain work rate it feels like you're fighting through treacle. Obviously, that's a pretty good protective effect but it was getting frustrating!

Once I explained, the consultant was happy to stop it on my bp and HR figures, so I did.

Notwhoyouexpected! I can honestly say i have been working out in the gym 'pumping iron' to put weight on, mountain biking, road cycling, playing squash, badminton, racket ball for over 40 years, didn't think i'd ever get back to a decent level of fitness for the 1st 18 months post SCA! @ 2years post, the biggest dif i would say was finally getting drugs sorted & then a massive step with the reduction of the Bisoprolol, i know i'm not off it completely, but probably never will be!

But, I think you hit the nail on the head with "your heart can’t go as fast as your body needs it too", my HR isn't peaking any higher, yet i am pushing harder, mostly because it feels easier!

Maybe i'll get off them........... hopefully :-)

Gaz I am quite surprised you are still on them, what were the results of your echo? My GP told me that for people who's hearts were in good condition and who can exercise to decent levels they were at best "unhelpful", I found them a huge restriction, similar to thatwasunexpected, and I was only on the lowest dose once a day. Also not very helpful for other types of exercise...

Yes i'm hoping to have a convo with my GP, echo has improved from ~20% soon after arrest to ~30% 6 months after to ~45% at last check, unlikely to improve further but cardiologist said 45 is a result as far as he is concerned.

Been a long slow 2 years to get where I am now. Since they halved Bisop & sorted my Folic a few months ago, I am at a point where I feel I am happy if the way I now feel is my new "normal".

It was suggested by my doctor to take it every other day , but I decided to cut in half and see how it feels , my concern was my resting heart rate had dropped to 49 on occasion !

That's pretty much my normal in the mornings now (without the beta blockers) but that's down to the fitness I've gained and don't have any symptoms or arrhythmias with it so happy for it to stay around there.

As with That was unexpected, I also came straight off 2.5 mg after taking it for 3 months following my heart bypass and had no issues.

Caitlyn6 in reply to Judge_Dredd

Thanks 🙏

I was about to ask something similar. I have only been on them for 8 weeks (2.5mg) and was feeling great, back to running and other exercise, really energetic. Then i ran out last week as forgot to renew my prescription. So I halved my tablets for 4 days and then went without completely for a day before restarting. On days 4 and 5 my chest pain was back, noticeably short of breath and way more tired. I had wondered if this was normal.

Gaz_chops in reply to April_May

I think you have to remember that we are not all on them for the same reasons, so what some will experience is not necessarily the same for everyone.

Regardless, you should not let yourself run out of such an important drug!

8 weeks is still very early on. Stick with them and see how your bp and resting pulse settle over the next few months as you get fitter.

Shopgal67 in reply to April_May

I’m on them because of palpitations which look like were being triggered by caffeine and maybe anxiety !

HI Caitlyn

I have been switched from 7.5mg then up to 10mg back down to 7.5 about 5 times now, and do it over 24 hours I only take Bisoprolol once per day so it can be 10mg around lunchtime for me !! Someone posted earlier we are on this med sometimes for very different reasons !!

Take Care and Stay well

If its advice from your doctor then yes stop. Your heart ratebuscwhetebut should be. He wouldn't of taken you off them otherwise. I gave my bloods done regularly and my blood pressure so don't panic please. Stay with it as my meds took a while to get right. Be strong. Take care.

Love from Wendy xx Greg street.

On the advice of my GP I came off my bisoprolol 8 weeks after my AVR. I was on a daily dose of just 1.25mg. I stopped taking it immediately. It was the best thing I ever did. I still had very slight issues for some 7 to 10 days after stopping the drug. It had been getting my heart rate and BP too low. I didn’t suffer any side effects at all. I would think you should be fine. From what I have read on this site it seems that those on much higher doses need to gradually wean themselves off it.

Some people have side effects like myself and other have no problem coming of it at all. You can buy a pill cutter from the chemist or reduce by shaving a little off every few days.

I weigh mine and shave a little off every time I feel ok after each withdrawal.

I have been warned that when I stop completely I may have rebound symptoms for a few weeks.

Good Luck


I have been adjusting my dose for a few months

Started on 2.5 twice a day then few weeks later 2.5 once a day

Then 1.25 one a day in the evening and when I was still struggling with some of the side effects or could have been anxiety ..😏 consultant then told me to take one every other day for one week and then settle to 1.25 twice a week ... one extra when needed

All seems to not make sense now after reading above 🙃 ...

I take them as I had one episode of AF in February and since then a number of episodes of fast heart rate for short time that they think is ectopic beats. They don’t know as still waiting for post covid app.

When I take the 1.25 it definitely settles / lowers my pulse / anxiety but now wonder if the switching upsets it in the longer term 🤦🏻‍♀️

That's interesting. I have noticed that my heart rate won't go as high as I expect in the gym (well I was noticing that till lockdown). I've always had problems with hills as a cyclist - I just don't seem to be able to push my workrate up to climb faster - and that's definitely true after my operation, even though generally I feel better than before it. But the packet has "Do not stop taking this drug without medical advice" in big, friendly letters on the cover, so I hadn't considered Bisoprolol as something that I could stop. By contrast, my GP has reduced my Atorvastatin.

Hi Caitlyn6, I-was advised by my GP to reduce from 2.5 to 1.25 as he thought my heart rate would drop too low. I started by splitting the 2.5 in half,but was unsure I was breaking it in half so changed the prescription to 1.25 tabs. That is all I take every morning and do not have any obvious side effects. As somebody has said we are not all the same and I find it difficult to recognise a side effect when there are a number of pre med conditions that are not related to my heart condition, but mimic or cause” side effects”.

I played it cautiously when stopping my 1.25mg bisoprolol. I started only taking it 5 times per week, then 4 times per week, then 3 times, 2 times,1 times then none. It seemed to avoid a worsening of ectopics or too much raising of heart rate. I guess that coming off tablets more slowly is not a problem as long as you are not given other tablets to take their place that have a similar function which may lead to problems

Caitlyn6 in reply to Goldfish7

Thank you

Hi Caitlyn6, Last month my cardiologist told me to stop my bisoprolol and double up my ramipril. And stop ticagrelor too all in one go. Its a year since my HA plus 1 stent. Have done all this with no problems. So for some people there us no issue, but its best to go carefully whrn adjusting meds. I made sure i had a box full of bisoprolol just in case!

Cheers and keep well.

When I see comments about 1,25 and 1.5mg doses of Bisoprolol I do get a little worried that I have needed 7.5mg to 10mg to keep my Heart in check. Or is it of little consequence what dose your on as long as it's doing what it's supposed to do !!!

Stay Well Stay Safe

Lezzers in reply to Prada47

I wouldnt worry too much Frank, I think the higher the dosage the more it's protecting your heart. Some people, such as Kevin are on a low dose purely because they can't tolerate a higher dose. The cardiologist wants to get Kevin on a higher dose but his HR is too low. We're at Papworth next week for ICD check and discussion about maybe adjusting his ICD to pace him.

Prada47 in reply to Lezzers

Hello Lesley

Hope Kevin is keeping well Will you drive yourself to Papworth or do you have to use Public transport, if the later take good care of the both of you.

Had a nice trip out yesterday ( our car ) went to Weymouth Bay to look at the P & O cruise ships anchored out in the Bay.

Don't think a Cruise is on our agenda now or in the future a bit dodgy should anything go wrong, and I think the Insurance would be as much as the Cruise !!!

Stay Well Stay Safe

Lezzers in reply to Prada47

Thanks for asking Frank. Kevin isn't doing fabulously well at the moment. He's OK in himself but he's got all sorts of things going wrong! His currently off his candesartan as his potassium has gone high, GP did say any higher & she would have hospitalised him!

We're driving to Papworth, it's safer under present circumstances, we've got out gloves & masks as additional precautions!

How lovely to get out & about, would love to go to the beach. We're not far from a beach that's just one long stretch of beautiful white sand, no shops, arcades etc but most of our times seems to be spent either at GP surgery or waiting for GP to phone! Can't see us getting a holiday any time soon either!

Take care, stay safe.

Gladwyn in reply to Prada47

I'm on 7.5 too and have worried as you have! Most people seem to be on much lower doses. I'm also concerned about coming off or lowering the dose ....should doc tell me to do so ... after reading how hard it is for some to reduce dosage.

Prada47 in reply to Gladwyn

Hi Gladwyn

I think one of the reasons the dose keeps getting put up to the maximum tolerable is because in the NICE guidelines it says something like "only after Maximum meds have been reached" move on to the next treatment possibly a Pacemaker !! but hey I am fine this morning 110/60 HR 60 and that's on 7.5mg Bisoprolol just waiting to see if it changes now I take my 25mg Eplerenone every other day instead of Daily.

Take Care and Stay Safe

Gladwyn in reply to Prada47

Fingers crossed your readings remain stable Prada. Best wishes 🙏

I halved and felt better immediately with no side effects Was like seeing the world in colour again. Didn’t realise how badly impacted I’d been until I reduced the dose. Could suddenly function with enthusiasm through the evening again.

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