Alternative beta blocker to Bisoprolol (due to side effects)

[Warm-heart]

I suffer from atrial fibrillation and a few months ago given Bisoprolol. It has been a nightmare of side effects and I want to switch to something that does not cause eustachian tube fullness/ blockage or total insomnia. Has anyone found an alternative beta blocker to replace Bisoprolol that has fewer side effects for them, and especially if for AF I'd be keen to know. Speaking with my GP later this week about alternatives. Reducing Bisoprolol from 5mg to 1.25mg over the last 3 weeks has finally given me some relief today, so I know Bisoprolol is the problem. Thank you for any suggestions.

[Nathan53]

Hi Warm-heart.

I changed from bisoprolol to nebivolol due to sleep disturbance and fatigue on bisoprolol. Nebivolol suits me much better however I do not have AF.

The attached article describes the differences in different beta blockers and comments that nebivolol does not decrease nocturnal melatonin release which can affect sleep patterns. Maybe read through the document and use as a discussion point with GP.

[Warm-heart in reply to Nathan53]

Hi Nathan, Thank you so much - that is really helpful. The article is also really good and identifies nevibolol as the same category as bisoprolol as far as I can tell - and fewer side effects if any. Plus not lowering melatonin interfering with sleep. This also seems to be the commonist switch for bisoprolol users. Can you tell me how a dose of bisoprolol translates to the amount of nevibolol, ie if currently taking 2.5 mg of bisoprolol daily what would this translate to in amount of nevibolol, would it be the same amount? Thank you!

[Nathan53 in reply to Warm-heart]

Hi Warm-Heart

I was on 5mg bisoprolol and when I changed to nebivolol the Pharmacist working at my GP practice told me there was no 'equivalent dose'. She suggested I start on 5mg nebivolol but I subsequently got it reduced to 2.5mg as the original dose dropped my heart rate into the mid 40's, I already have bradycardia so the opposite to you. I found another research paper on nebivolol in relation to AF pubmed.ncbi.nlm.nih.gov/145...

Hope this helps

[Warm-heart in reply to Nathan53]

Wonderfully helpful, thank you - the reference too I greatly appreciate. Looks like as I'm super sensitive to medication I'd be ok on either 1.25 or 2.5mg. At the moment having reduced bisoprolol my heart rate has dropped to mid 50's bizarrely. Desperate to stop it as even a tiny dose brings back fluid in my eustachian tube. Thank you again!

[Warm-heart in reply to Nathan53]

Hi Nathan, Can I ask if you had any symptoms starting Nebivolol? I tapered my Bisoprolol then began Nebivolol. My congestion in my ear and sinuses has almost gone now & am sleeping better (what relief on both counts). But Nebivolol, even at a tiny dose of 1/4 tablet or 1/8 gives me bad abdomenal pain, and a measure of feeling exhausted/ weak and a bit breathless. I gather these initial side effects pass (hope so but only 2nd day on Nebivolol). Did you or anyone else have side effects on Nebivolol at first?

[Nathan53 in reply to Warm-heart]

Hi Warmheart - sorry to hear of your abdo pain and other symptoms. I was fortunate and had no side effects at all with nebivolol. Hope things improve but again if not get some advice in case it is coincidence and something else is causing those symptoms.

[Warm-heart in reply to Nathan53]

Thank you. I can see these side effects (abdo pain for sure) listed on the leaflet, just hoping it will pass soon and not last!

[Nathan53 in reply to Warm-heart]

I know you probably will but monitor over the next few days and if these symptoms worsen phone a Pharmacist or GP for advice in case you are having an adverse reaction, I mean more than just getting used to it. Hope it resolves as you have noticed benefits.

Take care

[Warm-heart in reply to Nathan53]

Brilliant, will do, thank you very much!

[Nathan53]

Article attached escardio.org/Journals/E-Jou...

[vinixxx]

Talk to your dr. about "nebivolol".

[Warm-heart in reply to vinixxx]

Thank you, this seems to be the most used alternative. Do you find fewer side effects and do you take it for AF? Really appreciate your reply.

[vinixxx]

Actually i drink it for palpitations, extrasystoles and shortness of breath.

But i don't fell pretty much no side effects at all.

Thats why i mentioned it.

[Heyjude31 in reply to vinixxx]

Can you get Nebivolol in liquid form then? Thanks ever so much. Judi

[Warm-heart in reply to Heyjude31]

Hi there, as far as I can tell no: Nebivolol only comes in tablet form. I think when vinixxx said 'drink' perhaps meant 'take'. No liquid form is listed on the online British National Formulary (BNF) which pharmacists and medical professionals use for prescribing.

[Heyjude31 in reply to Warm-heart]

Thank you for replying that’s very kind xx

[Warm-heart in reply to Heyjude31]

You are welcome!

[vinixxx]

Don't worry!

Sometime it tooks a couple of tries to find the right meds.

[kate47780]

It's my first time on here and your question and Nathan response has been very helpful. I have been taking bisoprolol for 6 months and thought I just had to accept side effects like disturbed sleep and my tinnitus has worsened since taking this med. I'm going to ask for an alternative having read this and other posts. Thanks.

[Warm-heart]

Hi Kate, I know it can be a nightmare. I have remained on a very tiny dose of bisoprolol (a small 1/2 of a 2.5mg daily/ mornings so about 1.25mg.) This makes the side effects more bearable but still not good, at least I can sleep a little now. Some days it does not feel enough for my heart though. But I also know withdrawal from it gives side effects, so taking too small a dose can give me a problem with my heart going a bit crazy. Do you take it for AF and what dose are you on? I have been offered nebivolol and metoprolol but the latter I did not like the sound of the side effects, and nebivolol lowered my heart rate a lot the first dose I took it and got a bit scared so did not retry. But I gather nebivolol has the least side effects and suits a lot of people as alternative. I have not found anyone here have trouble on it.

I am waiting for a heart op on my mitral valve, and hoping to come off the drugs afterwards, so am sticking with the bisoprolol for the moment...