Bisoprolol stopped before one year?

[firstlight40]

I'm on a low dose 1.25mg (in fact none as I've got a treadmill stress test on Monday and the cardiologist told me to stop for the test) My heart rate is now dipping down into the 40's regularly and sits in the 50's when resting and my EF is 60-65%. I know the standard NHS /NICE procedure after an NSTEMI is to keep going on it for a year, maybe longer, but has anyone else just come off it permanently before the year is up as I feel I don't need it anymore? I'm 3 months since my last set of stents and very fortunate to be feeling very well.

[MichaelJH Heart Star]

Hello.. I must admit puzzlement with your post. Typically drugs like Clopidogrel or Ticagrelor are perscribed for a year whilst ones like aspirin, statins and BP medication (like beta ockers or ACE inhibitors) tend to be for life.

[firstlight40 in reply to MichaelJH]

I'm looking at NICE guidance:

nice.org.uk/guidance/ng185/...

1.4.26 Consider continuing a beta-blocker for 12 months after an MI for people without reduced left ventricular ejection fraction. [2020]

and

1.4.30 Do not offer people without reduced left ventricular ejection fraction or heart failure, who have had an MI more than 12 months ago, treatment with a beta-blocker unless there is an additional clinical indication for a beta-blocker. [2013]

So for me (and of course it might not be appropriate for everyone) the guidance seems to be up to a year of betablockers.

I'm very happy to take drugs I need - ticagrelor (for a year) , ramipril, aspirin, atorvastatin but would rather not take those I don't 😀

[MichaelJH Heart Star in reply to firstlight40]

Thank you for some very interesting information. When I had my bypass I had Bisoprolol added and my Atorvastatin max'd out. My Atorvastatin was subsequently dropped to 40mg and my Lisinopril reduced because of hypotension. Lisinopril is an ACE Inhibitor that is frequently described to diabetics as it has a useful side effect of helping protect the kidneys. Currently I am on 1.25mg Bisoprolol and 2.5mg Lisinopril, the minimum dose of each. My diabetes consultant would like my Lisinopril dose increased for enhanced kidney protection. Now I have something to discuss whenever I get my cardiology appointment!

[MEG2020]

Stemi in feb 2020 was on bisoprolol for a few months but it was stopped as bringing heart rate down into low 40s it was replaced with eplerenone after a year prasugrel was stopped so now on atorvastatin aspirin ramipril and eplerenone resting pulse in mid 50s

[Mentdent]

I’m on 1.25mg as well. Same heart rate too. I suspect a bit of a tick box exercise. NICE says we have to have a beta blocker after a NSTEMI and with low resting heart rates 1.25mg is the lowest dose available.

[firstlight40 in reply to Mentdent]

I'll see what the stress test shows today. Cardiologist told me there was no sign of any infarct (dead tissue or scarring) on my latest echo and in my mind if there was damage that would be the key reason for continuing with beta blockers to give the heart time to remodel and recover.

[MountainGoat52]

I had to get my beta blocker reduced as I was almost passing out when I stood up, yet at no stage was there any suggestion of discontinuing it. I still have to be careful on 1.25mg of Bisoprolol, with a resting pulse of 50 - 55 bpm which can dip into the 40s at times.

[richard_jw]

I had a stemi a year ago. In the last few months, the cardiologist has recommended stopping the Bisoprolol. I cut it down from 2.5 to 1.25, but started getting angina, so am still on 2.5. Not taking any anti angina pills because they reduce my BP too much. I think no 2 people are the same. From what you say it sounds like you are in good shape. Beta blockers are meant to reduce the strain on the heart by reducing adrenaline and noradrenaline thus slowing the heart and reducing BP. Could be the cardiologist thinks you really don't need that.

[Marcathon]

similar to others, I was on Bisoprolol to start with after a heart attack in December aged 45, but after 6 months have come off of it as resting HR was around 48-50 and it was having a few other side effects. they reduced it slowly to start with then took me off it completely. a month on I think this has been a good decsion, nothing to suggest otherwise at this stage

[firstlight40 in reply to Marcathon]

Thanks, good to know the treatment depends on the patient.

[Oboemusic]

I had one stent fitted at end of October 2020. On the first day of discharge I fainted after taking bisoprodol, while still in bed, not even from standing up too fast,and had to call 999 and they said that bisoprodol is the likely cause. So I didn't take it again. Had several phone discussions with the cardio nurse who was concerned to titrate my dosage. I continued to decline the bisoprodol, with no ill effects. I am now discharged to the GP and looking forward to discontinuing ticagrelor in Oct. My resting heart rate is around 64.

[Qualipop]

I'm puzzled by your post. The tablets that are usually kept for a year are blood thinners like clopidogrel or ticagrelor. Bisopralol is for blood pressure. Mine was stopped after around 6 months because it was dropping my BP far too low

[firstlight40 in reply to Qualipop]

Hi

Bisoprolol is a beta blocker which reduces strain on the heart by blocking hormones which affect the heart, making the heart beat slower and reducing the speed at which it speeds up as well as dampening any arrhythmias. It has the side effect of reducing blood pressure although there are much better medicines for this nowadays (e.g. ace inhibitors ). Pls. see above earlier comment for the NICE guidance on the use of betablockers after an HA.

[juanitamc]

I was on Bisoprolol 5mg and I had to come off it within a month of starting it..... I had awful side effects, vomiting & diarrhoea, for a whole month, cold feet and hands, headaches, dizzy spells. etc

My Gp told me he could not change the medication because it had to be done by the consultant, well 3 months on and still waiting for the consultant to get in touch with me and this is after my Gp sent an urgent letter 3 months ago to be seen straight away.

I was really lucky that I phone my Gp and told him that I was still waiting for the consultant to get in touch and had no reply from them, and managed to put me on Atenolol 15mg and I'm doing fine with it.

[45sue]

I am surprised by the Nice guidance since every medical person I have seen has stressed that beta blockers are preventative & that I am on them for life. My GP was very reluctant to reduce my Bisoprolol from 2.5 to 1.25 & made a note on my record that it was at my own request. I could not tolerate feeling so feel fuzzy headed on 2.5 & feel much brighter on the lower dose. My EJ is normal following a HA & 2 stents in 2019 . I suppose it is yet another case of one size fits all.

[firstlight40 in reply to 45sue]

I feel much brighter on no dose at all and since I managed to do a cardiac stress test without ecg anomalies reaching 100% heart rate in 12 minutes I think I will stay off it. Assuming you had an NSTEMI HA you could challenge your GP as to why they are not following NICE guidance and get them to put that in your notes too!