pill in pocket for atrial fribullation

[Tadpole16]

I was put on bisoprolol after suffering a heart attack in April but HR very low felt unwell even on very low dose so cardiologist took me off in July.

Told me to use as pill in pocket treatment for atrial fribullation which I’ve developed after my heart attack .

Does anyone use bisoprolol as pull in pocket for AF if so what dosage? I was prescribed 1.25mg I had a bad AF episode on Monday and this dosage didn’t work . Been Waiting for a call back from doctor surgery since Monday to discuss but thought see if anyone on here has advice please .

[Jalia]

Yes, I was given Bisoprolol as pill in pocket to use at start of fast AF episodes.

I normally started with 1.25 or 2.50 if really fast and titrated up to usually 7.5mg at roughly half hour to hourly intervals. I could go up to 10mg which is usually the limit. I didn't find that 1.25mg by itself any use in terminating or reducing my rate. However we all react differently.

I'm a very experienced AF er (!) so know how my body reacts. It would be wise to wait to see what your GP advises. Chase him up!

PS As it happens Bisoprolol has very little effect on me but it is very widely used and indeed seems to be the default drug of choice when presenting at A&E with palpitations.

[Tadpole16 in reply to Jalia]

Thankyou x

[Autumn_Leaves]

Yes, I’ve used bisoprolol as a PIP for AF. You don’t want your heart rate up at 150bpm or so for a prolonged period and you never know how long an episode of AF is going to last. With a history of HA you don’t want to be stressing your heart in this way. Please ring your cardiac or arrhythmia nurse if you have one, or ring the BHF helpline. They can probably give you better information and answer any questions.

[Tadpole16 in reply to Autumn_Leaves]

Thank you

[ILowe]

At several stages in my AF journey I was on PIP. One consultant wanted me to stay on 1.25mg bisoprolol then take 200mg flecainide as PIP. OR, I could come off bisoprolol, and take a combined PIP of 2.5mg bisoprolol + 200mg flecainide.

In the end, it depended on the kind of heart trouble I had. Sometimes I would come in from work and my heart rate was stuck on 100+ despite lying down and was full of trills and runs. In this case the bisoprolol alone kicked in after 50 minutes.

These are all questions to discuss with your medics.

[thecatandus]

Can't help you there I'm afraid, I'm only on the lowest dose and not suffering from AF (hope not anyway!)

[Kespie]

Hey T16 - I’m not familiar with the ‘pill in the pocket’ plan. I’m a twice a day kinda guy @ 5mg each time. It does make me feel shabby for about an hour afterwards but that passes. 1.25mg is the starter dose I believe so you are doing well at that level and have scope to increase if needed. Good luck with the recovery - stay well. K

[AAJJTt]

I was originally on a daily Flecainide (rhythm) and Bisoprolol (rate) combo to manage Afib. The latter was discontinued, as my heart rate is normally very low and with no Afib, it really fell off with beta blocker. Basically just tired all the time and lack of energy.

In addition to my daily medication, I still have Bisoprolol for use as “emergency PiP”. In the event of an Afib episode, I need to take an extra 100mg of Flecainide and 2.5mg of Bisoprolol. The reasoning being it will help me back into NSR before having to present. My Afib is characterised by RVR, so the beta blocker is required to protect the ventricles. Unfortunately, I cannot comment on its effectiveness, as I have yet to use the PiP. So far, “Afib free” for 3 years plus but previous episodes had a HR of 120-150 bpm at rest. Hope 2.5mg would be enough.