spoke to gp pharmacist today for yearly Medication review, currently on 3.75mg of bisoprolol my cardio surgeon wants to lower it but gp pharmacist wants to raise it ,she said to get most out of medication bp currently around 125/74 pulse around 65 can't understand why they have different views also on clopidogrel, statin, aspirin, allopurinol, ampolpine,pantoprazole
Thanks
Tricky one! In my experience GPs do not usually contradict what a specialist health professional has prescribed let alone their pharmacists, unless there are immediate issues to deal with like serious side effects. I assume you are still under the care of the cardiologist and not discharged back to the care of the GP so I suggest you revert to your cardiologist and ask for clarification and confirmation of what you should be doing.
I'm now under care of gp no longer under care of cardoigist or cardio nurse
In that case, imo, you should follow what the GP prescribes.
I agree with LowerField and would do as your GP tells you.
Hello 
I think there is nothing worse when you are getting conflicting information like this but I would stick with what your Doctor has told you to do but when I next spoke to the Doctor I would mention what the pharmacist said and how you found it confusing I think they need to know x
In my view (and I am no expert) , the pharmacist should not over ride the instructions of the cardiologist irrespective of whether your are under the care of your GP or not They are not the specialists and should follow the guidance of the consultant who presumably released you to the care of your GP on the understanding he/she follows his/ her instructions. Bisoporol, in my experience, is not a pleasant drug and the lower the dosage the better-obviously if you need it then you should take it but in my case the cardiologist eventually took me off of it completely as my BP/pulse/heart function etc did not warrant it and my GP followed his instructions. Although it is a drug where it should be reduced gradually because of the rebound effect. I would go back to your GP and let them know what the pharmacist is suggesting.
I'm wondering why either of the people advising you want to change the dose. Obviously we don't know your medical history (nor should we) but if we just consider your BP, it looks quite normal to me. You been on 3.75mg since the last medication review a year ago and I guess you are not suffering any symptoms that concern you. So why change? Increasing bisoprolol brings the risk of side effects (eg. postural hypotension, cold extremities etc). Decreasing the dose means it's less effective. If I were in your position I would not change anything until someone has given me a good reason why I should.
I'm with Mart, your bp and pulse rate look normal so what effect is the gp trying to achieve? The optimum dose is the one that achieves the desired effect with minimum side effects so why change?
Mine was where your BP and pulse was and my GP and Cardio both agreed to stop the bisprolol altogether. I had to monitor my BP twice a day for a week and submit that to the GP.They were happy and I have been off it for 8 months now
That's what I had to do and feel so much better
I was told by my heart failure nurse whilst I was titrating that they are the 1st choice of meds and that they would get me as high as I could tolerate as the higher I got the safer I was, it made me feel truly awful they eventually swapped me to candestarten which I tolerate so much better. There’s always going to be differences of opinion with medical professionals but if you are under the gp the buck stops with them as you are on their list so the pharmacist can’t over ride him anyway.
It could be that Bisoprolol is the first choice because it is the cheapest.
also true
The pharmacist is not doctor and does not know all your medical history do what your gp says
I am on a 2.5 dose raised from 1.25 immediately after my bypasses in May 2022. My pulse and BP are identical to yours which is termed as 'high normal.'
I am also on ramipril intended to bring down my BP and increased a month ago. I think there is an 'ideal' that cardiologists or your GP may be trying to aim for, rather than a real world acceptable one, whereby the daily doses might cause more daily problems than the small percentage of the likelihood of a different problem they are intended to prevent.
So my first question to your medical people would be what BP and pulse rates are you aiming for me to get to? They might have different ideas, which is why they are in conflict with each other. I suspect one is happy with 'high normal' whilst the other is seeking a theoretical 'Normal'
I had a similar issue to you. I was on 3.75mg of Bisoprolol and my GP wanted to increase it in increments to 10mg. I was having serious issues with dizziness when standing up and I wanted the GP to prescribe a lower dose. After some rather blunt words from me to the effect that I would cut the pill in half, he reluctantly lowered the dose to 2.5mg and referred me to the pharmacist at the practice. I met with her to discuss the matter as I was still having issues when standing up and a further reduction to 1.25mg was agreed. On this my pulse is generally upper 50s in the morning and lower 50s in the evening.
If you are okay on 3.75mg, my question would be "what is driving the need to change?".
Sometimes the views on medication by various people in the medical profession are just bizarre. At my last scheduled check-up I told the cardiologist that I felt my angina was getting worse. Without any knowledge of my cholesterol levels she said I should double my dose of statins. What was that all about? I asked for a second opinion and a more senior cardio gave me a completely different recommendation, which, I'm glad to say, seems to be working.
A BP of 125/74 looks perfectly fine to me. I think mine is higher but the GP pharmacist said it was fine.......
Hi, my drs play around with my bisoprolol too. I'm on 2.5 should be on 10 bit it makes me so tired. Even on 2.5 I'm still fatigued most of the time.
I agree with the blood pressure being ok as mine can be from 120/70 to 130/75 and have been told by GP and cardiologist it was fine. I know the views on blood pressure keeps changing and tends to increase as we age but once 130/90 was considered fine now the recommendation is to be below 120/80. Personally I feel 125/74 is fine!.
I think you should speak to GP before changing anything, also try and speak to cardio surgeon or cardio nurse for their opinion. Your BP seems good to me, don't know why you would increase doze except that you could probably tolerate it as I'm guessing your BP has improved since op, but I'm no expert. Also why does cardio surgeon want it lowered? Could your BP have been lower then?I'm on 2.5mg and have to take 1.25mg night and morning as I have low BP and can't tolerate a bigger doze. I'm also on a few other heart drugs which lower BP. I got the impression from my cardiologist that if I could tolerate a bigger doze I would have been given it but it's out of the question for me.
Bottom line get a second or third opinion and find out their reasoning and hope you can have peace of mind about it soon.
I have similar opinion of Mart and Gibson01. You r BP seems OK and a resting pulse of 65 is good going . AS Mart said we don't have to know your medical history etc and it is a refreshing change for someone to show this respect I must add.
Ask yourself are you feeling better,? f you can remember the original discussions re medication and what was the purpose, durations ,intent etc all well and good.
If you haven't already checked:
1) NiCE guidelines are a good place to start for health conditions and treatments. Ensure it's the most upto date version. Look at treatment.
2) Check the BNF, again the most upto date version.
Check all your drug interactions too including time of dosage etc.
FOR EXAMPLE
I've noticed that your tags say clopidogrel and aspirin. They are in the same class of drugs. This doesn't mean they act the same way or intended for same target etc . Aspirin you make take as its over the counter maybe for pain. This may have a synergistic or contra effect for the intention of clopidogrel. To understand what each drug does you could look up the pharmacology. However, THIS is where the Pharmacist comes in as it's their speciality and they can see your prescription history too.
3) Make both parties justify their argument.
4)You could always ask for a medication review under advice and guidance from the cardiologist you saw. Most GPs should not refuse this request in my opinion .
5) Another option is a medication review from a Clinical Biochemist amd or Heamatoligst point of view. This I also mention as from a metabolic, endocrine and haemostasis point of view the integrity of these systems need to be considered in any medication review which a Cardiologist would ultimately make their decision based on your treatment plan.
You may be anxious about this conflict but it does happen and it is important one to bare witness too. It means that people are doing their jobs in their fields of expertise. However as the person in the middle its frustrating and stressful. Ultimately if I have managed to clarify any options , you can decide what you want to do and feel more comfortable with your decision.
I wish you all the best.
I have already commented on your specific question above - but I just want to add a couple of thoughts triggered by the many interesting replies you have had : First, I strongly believe that patients (= us hearties) need to be sufficiently informed and educated about our treatment so we can contribute to our treatment when possible. These things should be joint decisions and a wise clinician will make a recommendation, explain it and check that the patient is OK. Obviously most of us are not medical professionals so we cannot have the depth of understanding or experience of an expert but I will happily read NICE guidelines and medical publications so that I understand a bit more. It is (after all) my body and so I think it's absolutely right that I am involved in deciding what happens to it. Second I am very comfortable with trying a recommended medication change to see if it makes things better or worse - provided it it understood by GP/cardiologist that I will ask to have the change reversed if there is no benefit or it makes things worse. We all know that people react differently to meds, so what's good for someone else may not be good for me.
Well if you find it bordering reportable report so I can see what you find so offensive. I do mind you asking me if I am a Medical Professional as this platform is supposedly anonymous. For your curioisity ,I'm not. Im a Specialist within my own field. IF you are referring as to me trying to be a Net Doctor, read my post again, I'm not giving medical advice nor prescribing anything nor suggesting medication.
Please note it was an EXAMPLE with respect to pharmacology leading to the reason why we have Pharmacists. Furthermore it was with personal reference to the OP' tags not yours. Whether I have a heart condition is of no concern for you
I wouldnt know what is common to prescribe for post stent surgery so would not claim to know nor state without reference to, or which guidelines etc. Im not advising on medication here either. I am.merely trying to show where information can be found from what little I do know. Quite clearly you find it borderng on reportable. This person's post (Charl07), least I remind you is thier post. Taking up space and being confrontational whilst this person is asking for suggestions and ideas for a sense of directions, I find quite frankly disappointing at the very least. IF Charl07 finds my comments upsetting etc they can report me and question me further. Maybe my way of helping. ironically,like my handle name is the perspective from which you have drawn a conclusion. What are you trying to achieve for this person? What are your objectives? What are you contributing to other than hostile behavior. If you have a problem with what I wrote, then kindly ask me to explain. I'm not soliciting anything. Im volunteering options and information from my own experiences. Im not quoting anything with regard to the drug in question. Im not amply informed nor using my professional opinion in anything I write here. I'm not a literary genius, can barely type correctly and have terrible spelling and grammar.
My " look up phmacology" comment was to be suggestive for further understanding which some people incidentally have clearly grasped. That being an understanding of any medications anyone takes. So that one knows what tablet does what specifically. As when adjusting medications maybe for yet another example kidney function would be considered in terms for clearance ; implications on clearance of other drug metabolites may be toxic to liver. Again a GP, Cardiologist and Pharmacist may have professional opinions on these parameters . AGAIN individual consultation with patient history maybe limited to the Pharmacist could be considered hence a suggestion of the Pharmacist increasing doaage .
As you maybe the medical professional "who knows better" as you know what is "common" im not going to argue.
Let it be clear from my point of view, nobody is common and should not be treated on that basis nor thier medications and reasons. Everyone has individual needs and requirements and these should be meet with the Best ONLY. Not ifs, not buts and if not WHY.
It's a individualised picture not a dot on a piece of paper pulled out of the photocopier. Pharmacist has one picture, Dr has another, Cardiologist has is own.
Maybe my grammar or phrasing etc was not ideal for making a point. Im not a wannabe net Dr. I chose my profession and I love it. I can read in a subject I love, learn, help friends and.family when Im needed Ask questions for them and explain answers, I try the best I can. I want my mum to live to 106 like my Great Grandmother, be happy, healthy and fulfilled. She is in her 70's still teaches me, things, colleagues who are half my age teach me things. We should be here tryjng to help each other and sharing knowledge, ideas and support
Not all of us want to know what does what, but when there is something in question that is important like for Charl07 like many have suggested, a third or fourth party should be used We should come together in a respectful way. The bridge between all of us having an understanding of each Professionals view of The Patient Picture is ourselves. They are not living in the our shoes and may not realise that they may be causing undue stress, and in Chalrl07 case openly discussing medication concerns . We are all patients at the end of the day. Each of us, sadly at some point will have to educate ourselves on a condition we have. From what I can see sadly in the world around us we have to , yet should not have to. We need to be aware of what care we are etting and why. Are we a tick box or a person? If we feel our health or treatment plan is under question who will look out for us without budget strings, self promotion or interest.
The answer is no one really apart from oneself, our friends and family. Asking me if im a medical professional irrelevant, asking me if I have heart disease irrelevant. Yet here it was necessary for you to launch a diatribe. I cant see you contributing to Chal07 OP in a constructive way, I might have to put my glasses on if I can remember where I put them.
I can only apologise to Charl07 for this response on thier post. I personally feel attacked by some one who has not assisted you, the original post person Charl07.
I also apologise that I couldn't bend down to such low level insults from them as I haven't taken my back pain medication yet as have to take that in a trough period of another drug , all of which I found out by reading. This explained my cardio issues which incidentally a Consultant and Pharmacist missed the interactions of!!!
Noooo im not above anyone. I could be a Specialist in my deluded reality on eating peanut butter and marmalade on toast lol. Someone once said somewhere, "I know so much about so little and have forgotten more than what I have learnt. " I think we both here for the right reasons and that is what I see ultimately. Your passion shines through and I was myopic to not.have acknowledged it sooner. You have taught me things already for that I am thankful.
Hi all,
I worked out for myself that I was not tolerating Bisoprolol. I spoke to my GP and was not satisfied by his responses and so I asked to be referred back to a cardiologist.
The cardiologist without any prompting from myself stopped the Bisoprolol immediately and informed my GP. I felt so much better with a day of stopping it and have gone on to lead a full life.
My view:
Cardiologists are the experts in this field.
GPs are as the title suggests ‘General’ practitioners with a wide range of knowledge/experience.
Pharmacists are in effect’General’ practitioners in releasing prescribed drugs for a very wide range of conditions.
I will stick with the experts every time
Blood pressure on the up again
Bisoprolol increase 
Bisoprolol
Bisoprolol and Heart Flutter
Down and depressed 
