Bisoprolol

[footyfeind]

Hello everyone, you’ve probably touched on this subject before but I’ll ask anyway. Is it detrimental to change from taking bisoprolol in the morning after breakfast to in the evening after a meal? I’m on 5mg. Thank you in advance for your help. Stuart

[SheldonC]

You should check with your GP/ cardiologist, it shouldn’t make a difference, but it depends on what other meds you are on and when you take them.

I had to move other meds as my BP was dropping too low.

[footyfeind in reply to SheldonC]

Thank you for your quick reply, much appreciated

[footyfeind]

Thank you, I’ll check with GP but it does sound logical

[Hidden]

Dear footyfeind

Yes the subject has been touched on but its important that as new members ask questions that they realise the subject is new to them, and I for one have no problem repeating myself if it helps someone.

Yes it is possible to change your dose of Bisoprolol from morning to evening, BUT and its a big BUT only after you have discussed it with your Dr/heart team.

I have {along with many} done just that with no ill effects .

Take care and never fear to ask those questions, we are here to help your journey go as smoothly as possible.

[footyfeind in reply to Hidden]

Thank you very much, I will talk to GP first but if it stops me feeling exhausted in the day it will be well worth it!

[Annamay17 in reply to Hidden]

I was advised by GP to take it. Same 5mg at bedtime with 8mg Candasartan. He said it works better when I’m resting. and less side affects, I take Bendroflumethiazide 2.5 in the mornings it works for me.

[sewist22]

Just replied to another post re Biso.I take mine, 1.25mg, at bedtime, I was told to take it in the morning,,but it slowed me down so I changed the time, and never forget to take it. I did mention it to the GP, who said it was ok, I haven't SEEN a cardiologist since 2017 when first diagnosed! I also take 20mg LisinopriI and 60 mg Lixiana at night, and sleep very well.

[footyfeind in reply to sewist22]

Thank you very much, it does help to talk to people who have had or having similar problems

[jerry12953]

If you are having problems with Bisoprolol - many people do - ask your GP /cardiologist to change to an alternative. It seems to be the first line of defence, probabaly because it is the cheapest!

[tommywaits]

Hi Footyfeind,

The reason why it is recommended in the morning is that one's heart rate slows anyway during sleep. Having said that I moved mine to the evening for the same reason as Sewist22. A few months later I asked my cardiologist who explained why morning is recommended, I switched, and found, to my surprise, the lightheadedness did not return.

[Bishop1]

Good morning. I'm on 1.25 Bisoprolol twice a day ,morning and evening. Within an hour of taking morning medication I can be asleep on the settee. Same in evening and miss my programmes. Delayed eve tablet till night time and no more dropping off on the settee. Take care

[Mountwood]

Good morning footyfeind. I have been on 5mgm daily in the morning for some years with no problems, but recently noticed that my blood pressure was high in the morning and gradually dropped to normal by the afternoon. My GP suggested taking the Bisoprolol at night instead of in the morning. So far it hasn't had any great effect.

[mmmb]

I'm only on 2.5mg (reduced from 3.75mg after fortunate strong HF function improvement). I adjusted by splitting it to AM and PM (1.25mg each) which did wonders for me. In that case my HF nurse made the recommendation and the Dr. signed it off. HTH ...

[rupes5]

I've had the time I take my dose altered slightly. I used to take 2.5mg once per day, but felt unwell. Now I take 1.25 twice per day, morning and evening and feel much better. But this was only after discussion with my GP.

[Mrverycross]

I was on 5mg which I took am as advised by GP. When I had a follow up with my cardiologist I mentioned that it left me very tired she changed to 3.75mg, still to take am. I've had no problem since then, some 2 years ago. The default dosage is 5mg (especially with GPs) according to the cardiologist I saw and then they wait and see if the patient reports anything when they will adjust the dosage.

They will prescribe higher or lower initially if they have good reason to do so, but she said 5mg is where they start. So definitely report back to GP/cardiologist.

[Clematis58]

Hi Footyfeind

I spoke to my pharmacist who agreed that it would be OK for me to take my 1.25mg dose of Bisoprolol in the evening ( as long as it was taken at the same time each evening).

This has worked fine for me 👍🏼.

Take care

[Pinky100]

I found it better to split my Bisoprolol I am on 2.5mg I now take 1.25mg in morning and 1.25mg in evening

[Genesini]

Always two sides to a story, following my HA I was told to take Bisoprolol in the morning, not at night in case heart rate dropped too low while sleeping?

[TeresaMay in reply to Genesini]

I agree. Most in morning although I take 2 in the morning 1 in the evening

[LaceyLady in reply to Genesini]

Mine lowers at night and I take bisoprolol in the morning

[spinningjenny]

I was always told to take it in the morning but as my dose increased I was advised to split the dose so I was taking half in the morning and half at night. I was on quite a large dose at the time -12.5mg.

[Cornishbeach]

Hi footyfeindI was so sleepy by 2pm when I was on 5mg bisoprolol in the morning. After talking through with my cardiologist he suggested taking it in the evening and it was so much better.

Post mitral valve repair I am on 2.5mg and have been taking it in the morning without the same issues. I had also been on 32mg of Candesarten which was stopped in hospital.

Talk it through with your cardiologist would be my advice but changing the time worked for me brilliantly at the time.

[EllsBell]

I take all my meds in one go in the morning (plus a second Flecainide and Apixaban twelve hours later). I'm on 10mg of Bisoprolol that I take in one tablet daily, it seems a rather higher dose than many people take... I feel fine with everything but was never spoken to about dosages of Bisoprolol, maybe I should speak with my GP?!

[Tricia7048]

It made me too tired taking it in the morning, bedtime was better for me. On the other side, it made me gain 20kg weight and gave me kidney stones!I am on Ivabradine now , but we are all different! Hope you do well.

[Harefieldfan]

I take it with evening meal. I think it’s ok.

[Engineer46]

You don't say why you are asking about Bisoprolol timing (what issues you are trying to deal with) or whether you are taking other drugs in addition, as are most people with AF.

NHS guidance is that if you have no AF symptoms then the Bisoprolol dose should be whatever is sufficient to bring your resting heart rate down to below 110 bpm (my doctor prefers below 100, but that's not significant). If you have AF symptoms that disturb your daily life and that persist at "below 110 bpm" the dose will probably be increased to bring your HR down to below 80bpm.

Here is some NHS information on AF treatment and Beta Blocker dosage:

handbook.ggcmedicines.org.u...

Bisoprolol has about a 12 hour half life and so, if taken once a day, after a few days it stabilises and will fall to a level of approximately 0.33 x dosage before you take it and 1.33 x dosage soon after taking it. It will therefore be most effective in the daytime when you are most active and heart rate naturally rises. For a 5mg daily dose, these figures would be 1.66mg and 6.66mg.

If you were to take half the dose in the morning and the other half 12 hours later, the equivalent figures would be 2.5mg before taking your tablet and 5mg soon after taking it.

So as you might expect, taking tablets more frequently will smooth out the effect over the 24 hours, but to achieve the required heart rate reduction when you need it (usually during the day) you might then require a higher dosage.

Best wishes,

Paul

[footyfeind in reply to Engineer46]

Thanks Paul, I suppose I’m thinking because I feel tired after taking the 5mg in the morning if taken in the evening I’m tired anyway so doesn’t matter as much. I know it’s not as simple as that but please excuse me I’m new to this 😀Stuart

[Engineer46 in reply to footyfeind]

If you check your heart rate just before you take your 5mg tablet in the morning, then check it again about 2-3 hours later, you'll see the maximum effect that the Bisoprolol has. If it appears to be reducing your heart rate excessively, talk to your doctor about reducing the dose.

What was your heart rate when you were diagnosed with AF? Were you put on 5mg Bisoprolol immediately?

Paul

[footyfeind in reply to Engineer46]

Hi Paul, I believe it was around 85bpm but I think I get more of a flutter in between beats. I was started on 1.25mg then 3.75 then 8mg but that made me feel awful so I went down to 5mg

[Engineer46 in reply to footyfeind]

It sounds as if you may still be in the "titration" stage. That is, trying to establish what dose works best for you. I would check your heart rate before and after taking the tablet then talk to your GP about the dose armed with the facts about your experience.

With AF your heart rate will be "irregularly irregular", that's to say irregular with no repeating pattern, so perhaps you are experiencing that irregularity as fluttering. When you talk to your GP you could ask for an ECG to see what might be going on so that you can be reassured.

The problem that just about everyone on this forum has is that if you are anxious your symptoms get worse, or at least appear to you to get worse.

I am 76 with permanent AF first diagnosed last October but have no symptoms other than the irregular and higher than normal heartbeat. I take 1.25mg Bisoprolol to keep my heart rate under 100 and 5mg Apixaban (anticoagulant) twice daily to reduce stroke risk but no other drugs. I now ignore the irregularity of my pulse, since it does not appear to be a serious condition, judging by the accounts of long-term AF sufferers who contribute to this forum!

Best wishes,

Paul

[richard_jw]

The plasma concentration of Bisoprolol is pretty high for 8 hours after taking a 5mg tablet, then it drops off significantly . That would imply that it has a more potent effect on lowering the heart rate in that time.So taking it in the morning would appear to be better (because the daytime is when you need the heart rate lowering effect of it). Taking it at night might result in heart rate which is significantly lower. For instance at night my heart rate is 55-60, whereas during the day it's over 75.

I don't take Bisoprolol any more. When I did, my heart rate dropped from 75-80 to around 60 during the daytime. That was taking a 2.5mg tablet in the morning.

Don't know what it was at night, since at the time I did not have a Fitbit.

I'm not a doctor, so you should take a doctors advice

Here is a graph of plasma concetrration over time

researchgate.net/figure/Mea...

[footyfeind in reply to richard_jw]

Thanks Richard, very useful information, regards, Stuart

[minchern in reply to richard_jw]

I was taking 5mg in the morning but was making me feel like a zombie during the day. I switched to taking it at night and the only thing I noticed was I get very vivid dreams that can sometime disturb my sleep. Must admit my heart rate is around 50-60 bpm during the day. I was recently in AF but had Cardioversion last November

[Libra47]

I have.

[Deserrol]

Confirm with your GP but it won't make a jot of a difference.

[Afibflipper]

Agree check with your medics but mine has just halved my dose so I take it morning and night now

[Lau5]

Definitely check with your GP or cardiologist, but I changed from taking them in the morning to in the evening, as that was when the symptoms were at their worst and it helped

[Keith35]

Hi Footyfeind. I changed from morning to evening and it worked for me. In the morning it made me a bit wobbly so in the evening didn't really matter much. After a while the effects wore off and I've been taking the same dose as you for a couple of years. Oh, whilst I remember, I didn't ask my doctor, I just did it.