Beta blocker morning or evening?? - British Heart Fou...

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Beta blocker morning or evening??

Naka profile image
Naka
29 Replies

Dear friends, I need some advice and input on best time to take Nebivolol. Does it make a difference taking it in the morning or at bedtime? I feel it's causing me insomnia . I'm taking only 1.25mg which is half of the lowest dose of 2.5mg. I have a myocardial bridge. It doesn't bother me apart from a slightly elevated HR. I was prescribe the Nebivolol to slow down my resting HR and not for high BP. My average BP is 110/72.

My resting heart rate runs around 70 to 75. I read that you could take it in the morning. Basically the reason they tell you to take it at night is because most heart attacks happen in the early hours of the morning. Is it true?

I saw my cardiologist this week and I had a little bit of white-coat syndrome as I was scrambling to get a parking place and I just got results back from a zio patch. My blood pressure was okay 125/75 (a little on the high side for my norm) BUT my HR stayed in the 90's while in the cardiologist office. At home it's around 68 at night and the zio patch recorded HR 52 on its lowest.

Thank you for taking the time to read my posting

Naka

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29 Replies
scentedgardener profile image
scentedgardener

Sorry, that's not a medication I have personally taken so I can't make any useful comment.Perhaps you could speak to either your GP or a pharmacist to get informed advice. I think quite a lot depends on your personal circumstances, I have been advised to take my (different) beta blocker at different times of the day, depending on why they were prescribed at that time. Good luck.

Naka profile image
Naka in reply to scentedgardener

Not a medication??? It's a prescription drug.

seniorita profile image
seniorita in reply to Naka

I realise that it is a prescription drug but the term medication is used to describe prescription drugs, just to be sure I checked the dictionary definition.

Naka profile image
Naka in reply to seniorita

Yes it was early in the morning here. Actually it's my mistake. I didn't read your response properly ☺️ Thanks for responding. It was very kind of you

Lowerfield_no_more profile image
Lowerfield_no_more

+1 on a pharmacist (easiest ) or your GP for informed advice

Bluehope81 profile image
Bluehope81

Note, opinions and suggestions only, always check for interactions, and check with your doctor first before embarking on any changes. This is not medical advice.

Before I had to take Beta Blockers, Nebivolol and Metoprolol gave me insomnia, I switched to Atenolol and I was fine.

Naka profile image
Naka in reply to Bluehope81

Was yours prescribe for high BP or HR?

Naka profile image
Naka in reply to Bluehope81

Bluehope also at what dosage did it give you insomnia

Bluehope81 profile image
Bluehope81 in reply to Naka

Note, opinions and suggestions only, always check for interactions, and check with your doctor first before embarking on any changes. This is not medical advice.

The short answer is 2.5 mg.

I was disappointed to not be able to tolerate this medicine, as Nebivolol increases nitric oxide synthesis, this is incredibly important to improve the health of the endothelial layer, its also doesn't carry the small risk of developing diabetes, with earlier generations of Beta blockers.

Same issue with Metoprolol tossing and turning all night, could not drift off.

I think Atenolol is under utilized in the UK, for me 0 side effects and per mg the same affects on HR and BP as metoprolol and I just felt absolutely fine, Atenolol is cardio selective which I find hugely beneficial compared to Propranolol which isn't but UK doctors are much more likely to proscribe.

Pace1308 profile image
Pace1308 in reply to Bluehope81

Hi I am struggling with insomnia. I am on Bisoprolol and previous Nebovolol snd Soltolol. I am interested to see that Atenolol is fine. Do you have any other side effects? I think that I will speak to my cardiologist with a view to change. Jenny

Bluehope81 profile image
Bluehope81 in reply to Pace1308

Note, opinions and suggestions only, always check for interactions, and check with your doctor first before embarking on any changes. This is not medical advice.

If you suspect any medicine maybe causing you insomnia or unwanted side affects it is a good idea to speak to your doctor, without knowing your medical issues its not possible to know if Atenolol will be a good fit, my case was straight forward but I get this hunch that maybe your case is more involved, heart failure?

Best of luck though , keep on striving to get the most suitable medicines out there for yourself. It might be an idea to keep a journal to provide some evidence to why you think medicine a is causing side affect b............

Pace1308 profile image
Pace1308 in reply to Bluehope81

Thank you. I will speak to my cardiologist.

Naka profile image
Naka in reply to Pace1308

Pace - I was told by my cardiologist that Nebivolol is the best for my condition. I remember way back in 2018 been the heart journey first started. I went through a flurry of test starting with an EKG and ending with and angiogram. The angiogram pointed out a myocardinal bridge . My first cardiologist at the time gave me Atenolol. I stopped it very quickly because it was lowering the HR but really slow my blood pressure as well which was not high to begin with. That cardiologist I felt didn't take me serious and decided to go for a second opinion elsewhere.

I was extremely fortunate to see one of the best cardiologists in the world and specialist on myocardial bridges at Stanford. Nebivolol

Doesn't really lower my BP but it works with lowering my HR. Last two days I'm taking it in the morning instead of in the evening. That definitely helps. I have to good nights of sleep ☺️ My insomnia I think is driven by anxiety more than the drug. I do a little meditation at bedtime. Something else that I was told that really help is breathing exercise which puts me back to sleep if I do wake up at night. It's called

4/7/8 method.

sandandkev profile image
sandandkev

Hi I take mine at night,as it makes my pulse quite low,and I get dizzy about 3-4 hours after taking it so nightime suits me

nursenancy53 profile image
nursenancy53

Good morning

I took nebivolol prior to my valve replacement 5 years ago - I always took it after breakfast - after surgery it was changed to bisoprolol which I have been taking after breakfast since then. Good luck

BeeBee79 profile image
BeeBee79

I take 5 mg of Nebovilol and I began to take it in the evening (7pm) so the high levels of fatigue can have most effect during the night but to be honest, it’s not made any difference doing it this way and I’d still have to take an extra dose in the morning to keep my heart rate down. Sorry, not much help 🤦🏼‍♀️

Loobycare profile image
Loobycare

Hi NakaI am prescribed Bisoprolol - also a beta blocker and was advised - quite strongly to take the drug after breakfast each morning.

Not sure if that is at all helpful but insomnia is awful - so definitely worth checking it out with your doctor or you may be able to get a patient information leaflet in the pack or on line.

Take care.

Silvasava profile image
Silvasava

I'm on Nebivolol and have always taken it first thing in the morning with my other meds (the 4 pillars plus Digoxin) I've not particularly noticed fatigue other than my normal level!

polenta profile image
polenta

I take my beta blockers morning and evening plus my ARBS right before bed because of side effects. I also take my 81 mg aspirin at bed time because I heard thats the best time to take it. I also heard that most heart attacks happen in the morning.

Naka profile image
Naka in reply to polenta

Polenta thank you for your input. I really appreciate it. And I move my baby aspirin to evenings rather than mornings 🙏

ClairePap profile image
ClairePap

Like many on here I take a beta blocker (Bisoporol) which is to lower my HR. I would check with a professional- I was told to take mine in the morning by my cardiologist as he wants my HR reducing during the day when I’m active. Your HR is normally lower when you are sleeping and he didn’t not want it going too low at night

Naka profile image
Naka in reply to ClairePap

ClairePap that makes sense. My heart rate is low at night too. I take it before bed and it's usually lower 60's. I took it yesterday morning instead of last night. Last night my heart rate was 65 at bedtime and this morning 61. Changed my baby aspirin from morning to evening as well 😁

Hallane profile image
Hallane

I take Nebivilol 2.5 in the mornings. Doctor advised it wouldn’t matter what time as long as it was similar each day. I get the shortness of breath side/chest tightness side effect.

Barre01 profile image
Barre01

When I had my HA I was prescribed a number of meds, once I had read the enclosed leaflets I drew up a little chart about them - dosage, when to take them etc. I then took it along to my pharmacist to check my understanding

fishonabike profile image
fishonabike

i read some research a while ago which found that the time of day at which you take medication for Hypertension(e.g. beta bockers and ACE inhibitors) makes no difference to its effectiveness, as long as you take it regularly - some people find that betablockers give them disturned sleep, some find it makes them lethargic during the day - so the timing can be chosen to suit your own preference

there is a BHF article which refers to that research: bhf.org.uk/informationsuppo....

Naka profile image
Naka in reply to fishonabike

Thank you! This is very helpful

mesally profile image
mesally

I take bisoprolol, a different beta blocker. One time I went to pick up my prescription (5mg tablets) the Spanish pharmacist on duty that day gave me 2 packs of 2.5mg bisoprolol, with the instructions to take one in the morning and one at night. She said this would spread the dose and so minimise side effects. It worked. Since then I have been given the usual 5mg tablets and so I split them. Suits me better. But we are all different and your tablets are different so have a word with the pharmacist - they are the experts

Bluehope81 profile image
Bluehope81

Note, opinions and suggestions only, always check for interactions, and check with your doctor first before embarking on any changes. This is not medical advice.

The key point here is the half life of nebivolol, this is going to be the key factor that decides if it still affects you when you go to bed, the half life of nebivolol is 10 - 31 hours , quite an extensive range, we could roughly (very roughly) approximate that the dose you take first thing in the morning, would be 50% metabolized before you go to bed.

Interestingly Labetalol has a half life of 5.5 hours

Naka profile image
Naka

Blue that's that's very good information.Thank you!! 🙏🙏

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