Bisoprolol 1/4 tablet taper?

[Caitlyn6]

I have an overactive thyroid and am on two beta blockers a day and a 1/4 tablet before bed. My endocrinologist told me to increase my bisoprolol from 1 a day to 2 a day and I needed the extra quarter to keep heartrate ok overnight. My resting heart rate has been coming down so I have tried to drop the quarter by tapering ( two nights on, one night off) but whenever I do this the resting heartrate goes to high overnight (120 last night) so I just take the 1/4 in the middle of the night. So I guess I will continue with my 2 and a quarter tablets. Any ideas how to taper if my resting heartrate continues to fall as I will need to reduce the beta blocker dose?

[Hidden]

What’s your resting heart rate come down to? Anything above 50 is generally considered fine unless you’re having any symptoms like dizziness or shortness of breath. I also wouldn’t advise lowering the dose without running it by your endo first - they want you on that dose for a reason, so unless it’s making your resting hr problematically low, or you’re getting major side effects, you need to speak to them. The answer regarding tapering, though - if done with medical agreement - would probably be to try reducing the day dose, rather than the night one.

[Caitlyn6]

Ok thanks. Resting heartrate was 78 last week and it’s come down to 72 today. I have been on 1 bisoprolol 1.25 for nearly two years following tachycardia caused by an immunosuppressant. Endo told me to try two bisoprolol a day but as it wasn’t keeping the heartrate down he said I could take more. I just added the extra quarter myself as the heartrate is highest overnight when trying to sleep. But as it’s coming down I thought I could taper it back to two units. I have an appointment with him again end of the month so I can ask. I think I am very sensitive to changes in dosage.

[Hidden in reply to Caitlyn6]

Ah, ok, that makes a bit more sense. Have you thought about taking one and a half in the morning and a half in the evening/nighttime? Beta blockers are relatively short acting, so your hr will gradually go back up over the course of 24 hours, which is why you’re finding not having the quarter in the evening results in your rate going up over night. The doctor is obviously happy for you to split the dose and tweak things, so I think it comes down to as long as however you split it is managing the tachycardia overall, that’s the best regime.

[Caitlyn6 in reply to Hidden]

I had thought of that but I’m scared incase I get used to 1 1/2 morning and then get withdrawal further down the line. I got withdrawal when my Gp stopped my propanalol which is why a cardiologist put me on a single bisoprolol 1.25 to counter the withdrawal. It’s confusing.

[Peony4575 in reply to Caitlyn6]

If you are sensitive to beta blockers , as I am, your heart rate may boomerang back up when you reduce your dose but that does not necessarily mean your problem is returning but may well be a reaction to your dose reduction . My symptoms from reducing bisoprolol from 1.25mg even slowly were more than I could cope with , so I switched to atenolol and weaned slowly and have now been off completely for 7 weeks. Some people can just stop beta blockers without problem but if you are not one of them I would drop an eighth of a tablet a month .

[Caitlyn6 in reply to Peony4575]

How do I drop from a quarter of 1.25? Thank u.

[Peony4575 in reply to Caitlyn6]

Some people buy pill cutters I used a magnifying glass and a Stanley knife blade . Cut a tablet into quarters then eighths . Unfortunately not very precise but as accurate as I could get it. There aren’t any smaller dose tablets. Only cut one tablet at a time my practice pharmacist told me because the active ingredient may not be evenly distributed so in my case when I was taking one eighth a day I did get the whole dose eventually

[Caitlyn6 in reply to Peony4575]

Wow I thought quarters were hard enough. Il give it a go when I restart the tapering. Thank you.

[Peony4575 in reply to Caitlyn6]

Best of luck x

[dembaba in reply to Caitlyn6]

Amazon do really good pill cutters. My son got me two. Give them a go, makes life easier.x

[Surreychica_1 in reply to Caitlyn6]

Would it not be best to crush the tablet up it is a lot easier to measure out a lower dose. I did that with my cats medication. She was on medication which was for humans as well so obviously could not take the full dose just a tiny measure of it.

I crushed up the tablet in a mortar and pestle. Then folded one sheet of A4 paper so that I had a line. I then tipped the crushed tablet onto the paper and with a thin knife and eased it into the line so that it was more or less the same width and with the knife I separated it into whatever amount I needed for example I only wanted one tenth of the tablet so I separated 10 lots and used one and saved the others by putting it into foil for the next day when I needed it again. Just a thought.

[Caitlyn6 in reply to Surreychica_1]

It is a tiny tablet so I don’t think I would be able to do that. Thank you for the advice.

[BC-10]

Honestly, my feeling here is that you could be playing Russian Roulette. You can't mess about with dosages when you have an underlying condition unless youve specifically been advised to cut down by a cardiologist or a trained Heart nurse.

A spike in heart rate - that's what you're actually getting is not a good thing really.

120 bpm is high enough to cause problems if it's left unchecked.

What is your reasoning behind wanting to cut down on them? Just because - or side effects? Or are you scared of being on pills long term?

Bisoprolol have a Half-Life of 12 hours so the fact that you're getting high HR at night is basically down to the fact that your dose is too LOW if anything.

Propranolol are in and out of your system almost completely within a day. The Half-Life is around 3 hours in some cases, hence multiple doses needed of this type.

Bisoprolol is generally a one per day tablet as it stays in your system longer. Split doses sometimes help lower side effects, so they say.

It shouldn't make any difference though really taking it twice or once a day. In theory of course, because the plasma concentration after a couple of days will be the same once it gets taken regularly.

Anyway, back to your original question; IMHO, no, you aren't going to be able to cut them down - not until the thyroid issue gets sorted. Unfortunately.

You need to be at a point where your HR is lowered enough 24/7 so I think your dose is too low for it to be spiking like that. However - because it's happening at a certain time every night - what else are you taking or maybe eating close to the tachycardia happening? Anything?

Hope you feel better soon.Best wishes and kindest regards to you.

[Caitlyn6 in reply to BC-10]

Thank you. I haven’t really been told what dose to take only to take more if I need to so I increased my once a day to twice a day then I was still going high overnight so I added a quarter tablet. Then as my HR was falling I thought I should taper down the half as I am taking a tablet for the overactive thyroid ( carbimazole) which is beginning to work. I have not been told more than that.

[BC-10 in reply to Caitlyn6]

So it's early days yet then? Keep at it, you'll find your dose after a couple of weeks. Are you a generally anxious person? Sorry to pry. If you are then don't worry about taking the bisoprolol. They're safe. Even if you took 4 x 5 mg a day, you'd be ok. I was on that much once myself btw. Now, I'm down to one single 1.25mg every sort of few days. But my condition is different to yours. Your thyroid is basically fighting your beta blocker so the beta blocker must win, lol. Please don't worry. And don't worry about HAVING to take them. Once your system gets used to them, they are probably the best overall with regards to safety, efficacy and side effects.

Best wishes to you.❤

[Caitlyn6 in reply to BC-10]

I have suffered from propanalol withdrawal in the past so I’m just worried that my body will get used to a certain dose, then when my heart rate goes back to normal and I am told to stop the extra beta blockers I will be back in withdrawal/rebound again.

[Petercat1]

Hi.I'm on bisoprolol for palpitations plus it helps lower my BP. I used to take 5mg in the morning and 5mg at night, but I have just reduced the night time one to 2.5mg.

Maybe you could try half your daily dose in the morning and the other half at bedtime. Only a suggestion; but in any case run it by your cardiologist team to see what they think.

Good luck.

Denise

[BC-10 in reply to Petercat1]

The problem with this, is the thyroid issue. It's a different ball game. You and I are on it for a specific Heart related issue but the thyroid - hmmm, different set of rules. Tricky. All these excess hormones rushing out into the system at any one time. A little bit of anxiety triggers it - or even a dream at night and BOOM! Know what i mean? Waking up to a heart rate of maybe 150 and it won't come back down. Frightening.

My feeling about it? Dose is TOO low.

Best wishes to you.

[Cruise1]

My wife had over active thyroid thirty years ago and was treated with one dose of radio active iodine and has been fine since. No heart issues though.