Could I Be Sensitive to Bisoprolol, Even at HALF the Dose?

[Rhodog2612]

Hi all,

Over a month ago now I was advised by my GP and an A&E doctor that I could cut my Bisoprolol (1.25mg) tablets in half, due to the fact that my heart rate was dropping to the 40s at night and the 50s whilst I was at work sat at my desk.

I've noticed since then that my heart rate is still dropping as low as 42bpm at night whilst I'm asleep, and whilst I'm laid in bed waiting to fall asleep it is still sometimes in the lower 50s, although I don't feel physically ill by this.

I was first put on Bisoprolol due to Ventricular and Atrial ectopic beats (around 1,400 of them in a 24 hour period), and have been taking the medication since October 2022.

The ectopics do seem to happen more when I'm laid in bed, and I cannot lay on my left side, front, or back without them happening - the only position I can lay in that somewhat helps is my right side.

Sometimes, I get just one or two every few seconds, but other times this changes to several of them clustering together for a good few seconds before my heart rate goes back to normal - usually after I blow on my thumb or cough hard, but this is still quite worrying for me.

An ultrasound scan and 24 hour ECG have been done, and the Ultrasound showed no physical abnormalities with my heart itself. I am a 29 year old male who walks around 6,000 to 10,000+ steps per day, does not smoke or do drugs. I have an occasional drink on the weekend (Around 4 or 5 pints of standard 4.5% lager). I am currently overweight for my age but am actively taking steps to reduce this - my weight is 84kg and I am around 5.5 feet tall. My last blood pressure reading which was done yesterday was 128/80, with a pulse of 82bpm, however I had literally just walked down the corridor at my GP surgery to have this checked - hence the higher heart rate than I usually get.

I've booked in to see Dr Sanjay Gupta who specializes in ectopic beats and Gastrocardiac syndrome for which I match all the symptoms, but I wanted to just get some advice from the community on what sorts of experiences other people have had with Bisoprolol and whether or not I could simply be sensitive to the medication, or if this could be something else entirely?

Thanks in advance!

[Captain_Birdseye]

It's a bit of a tricky one, everyone reacts to medication differently and there's ongoing investigation with no clear diagnosis (ectopics being a symptom rather than a syndrome) - and of course we're not medics.

If anyone has direct experience then I'm sure they'll be along, but I imagine you'll need to finish your investigation with the medics before you have a true answer. I can tell you I sometimes have similar issues positionally, but I'm dealing with myo/pericarditis.

I'll just add that we're not supposed to mention any of our health professionals by name... we remain anonymous on this forum, it's only fair we extend that courtesy to them.

[Hidden]

wow. 1400 ectopic beats from about 110,000 in a 24hr period. So about 1%...that seems VERY low and healthy. anything from 10% onwards is more to be of a concern but more so 30-50% is where its more concerning. . I am no doctor but from resources online, I do not see why they have put you on betas for such a small amount of ectopics...if that is the reason. If your heart tests are coming back healthy this shouldn't be a concern.

My last ecg came back with a 36% ectopic burden in a 24hr period!! The doc rang me straight away and was very concerned. He contacted the cardiologist who put the doctor straight and told me not to worry about it. I am on 2.5mg of this med along with all the others.

Onto the drug itself. Yes Bisporol can be a strong drug. You are on a very low starting dose. it can still be overwhelming and people have been known to get palpitations more from taking this med and also people have known to get less palpitations. everyone is different.

[Hidden in reply to Hidden]

topdoctors.co.uk/medical-ar...

[Cliff_G in reply to Hidden]

I think there's a problem with doctors classifying ectopics mainly as dangerous or not dangerous.

I don't have an issue with high burdens being "dangerous". But my own ectopic burden is in numerical terms totally trivial, but in terms of loss of quality of life, massive, mainly due to disturbed sleep from sporadic attempts by my heart to jump out of bed whilst leaving me behind.

Ironically, if they were much more numerous I could ignore them. I have also seen a lot of people on fora such as this also have similar difficulties.

[Aztec632]

Hi I cant Comment on Bisoprolol because I take Atenelol for my Tachycardia, palps and ectopics. Have done for many many years. I only take half of the beta blocker otherwise my heart rate falls on the lower side but I do need to take it.I also have have the same issue with positioning in bed. I lie on my back when I first get into bed and the flip flops happen for a a minute or 2 and then settle. I just put it down to the vagus nerve. As this has been happening for years I have just learnt to live with it. I still wish it would correct itself but deep down I know it won't. I had an episode of AF back in 2011. I was anemic and had cancer at the time so maybe that had something to do with it. All kicking off. I was told I have normal heart structure.

I would be interested to hear how you get on with Sanjay Gupta . I think he is great and so informative.

All the best.

[Kristin1812 Heart Star in reply to Aztec632]

As Captain Birdseye said ‘we're not supposed to mention any of our health professionals by name... we remain anonymous on this forum, it's only fair we extend that courtesy to them.’

Best not to!

[Aztec632 in reply to Kristin1812]

Oops! My apologies

[Cliff_G]

All your symptoms and patterns, as you've worked out, suggest a vagal origin of your ectopics. Beta blockers can be ok at damping down ectopics but due to their rate-reducing effect, they can be less effective at stopping them. In fact BBs are supposed to be contra-indicated in vagal arrhythmias. I would not be surprised that 1.25 or half of one of those causes such rate reductions. 1.25 is the absolute max I can take.

Your situation sounds very like mine when I was 40. Having to lie on the right, as I had to too, is completely normal in such cases.

I take magnesium and potassium supplements (both the citrate) and have found they both help to reduce ectopics. In fact getting my potassium levels up (after 20+years, I've finally found I tend towards the lower figure!) has significantly reduced them, and almost eliminated the night-time ones and I can even lie on my left. Whilst the normal range is 3.5 to 5.3, there is good evidence that having potassium in the upper half of that range ("high normal") helps to reduce ectopics and arrhythmias. Needs careful watching in conjunction with blood tests, as excessively high potassium can be dangerous.

Good luck with the consultant.