Bisoprolol vs Amlodipine

[JSCAPM]

Hi - hoping someone can help.

My partner had a double CABG at the end of June. Prior to the surgery he took Amlodipine 5mg, which controlled his BP very well. After the surgery he was prescribed Bisoprolol 2.5mg and he’s struggling with the side effects, eg. extreme fatigue. His heart rate at the moment is consistently in the low 50s.

Today he’s had a call with his GP, who is reluctant to cease the Bisoprolol because it gives you “heart protection”. To be fair, she’s agreed to write to the cardiologist to get some advice and in the meantime she’ll reduce it to 1.25mg.

What we don’t understand is why Amlodipine, which would control his BP, is seen as less favourable than Bisoprolol. If it’s at all relevant, he had the CABG following a diagnosis of coronary artery disease, not due to having a heart attack.

My partner’s view is that he hasn’t gone through a major operation only to still be unable to leave the house due to feeling so tired.

Many thanks for reading.

[Petitlady]

After OHS for aortic valve replacement I was prescribed both amlodipine and bisoprolol (1.25mg). I was very tired for several months and I was told that I had to take bisoprolol for at least 6 months as it slows the heart giving it time to heal. I stopped bisoprolol after 11 months . I am still more tired than I was before surgery but have seen a steady improvement over the last year My heart rate increased after surgery and bisoprol kept it in low 60s which was normal for me. Since stopping it my heart rate has increased to a resting rate in the low 70s I would say it’s still early days for your partner and he might find things improve as he heals and his body adjusts to the medication.

[JSCAPM in reply to Petitlady]

Thanks Petitlady, it’s helpful to hear your experience with the meds. Good to hear you’re feeling better.

[RF260]

Hi, I had a heart attack in April, angiogram ok ish with one artery to keep an eye on if any further issues..pre heart attack I was on 10mg Amlodopine and 10mg Ramipril which had kept BP under control for 20 years. When I was discharged in April I was put on 2.5mg of Bisoprolol too (aswell as usual statins, blood thinners etc).Having lost a bit of weight my BP has recently fallen to typically 105/60 and RHR in the 40's and even into the 30's overnight and I have been feeling so tired, lightheaded and generally c**p. So in the last few days the GP has reduced my Amlodopine to 5mg and the bisoprolol to 1.25mg, also in the background my cardio rehab nurse (assume your partner has one ?) spoke to the consultant with a view to stopping bisoprolol completely. He is happy to do that given low RHR and fatigue (and looking at my discharge notes too) so I'm just waiting for follow up with GP so that the bisoprolol can go in the bin. Sure we must respect the medics but hopefully yours will work with you to find that happy balance where doses protect your partner but don't make them feel so c**p. Good luck.

[JSCAPM in reply to RF260]

Thanks RF260. I know what you mean about respecting the medics but not all drugs suit everyone. From tomorrow my partner will take 1.25mg of bisoprolol and if that doesn’t help we’ll need to think again. Hope it works out for you too.

[Happyrosie]

it could be that it’s early days, but you might get some insight from the cardiac nurses at the BHF (see their website) or indeed the pharmacist employed at your doctor’s group of surgeries. My experience is that pharmacists know in detail how medicines work and might clear things up,for you.

[JSCAPM in reply to Happyrosie]

Thanks Happyrosie. Prior to the GP ringing yesterday he’d had a call from the practice pharmacist, which may have triggered the GP call. Fingers crossed the new dosage is suitable but I’ll bear in mind the BHF nurses if not.

[mozart27]

Bisoprolol is a betablocker and he might ask his GP about changing to another betablocker, Nebivolol, which is thought not to have as many side effects

[JSCAPM in reply to mozart27]

Thanks mozart27. The GP mentioned trying another beta blocker but we weren’t enthusiastic. If the cardiologist advice is that he must stay on one I’ll ask about Nebivolol as an alternative.

[Thesnowman51]

Before my CABG L was on 10mg of Bisoprolol and also Ramipril (to lower bp) . I had been on Amlodopine as wellbut it was dropped as I was getting light headed. I also just had a heart failure diagnosis, no HA. Post CABG I am still on the same meds, although Bisoprolol reduced to 1.25, my heartrate is usually 55-60.

Don’t forget these meds are doing 2 different things, A is lowering BP, whilst B is reducucing the hearts ability to overwork and put stress on it and the plumbing system. I’ve been told by my consultant that it’s a lifetime drug

[JSCAPM in reply to Thesnowman51]

Thanks Thesnowman51. That explains why the surgeon and the GP were both keen on him staying on bisoprolol, although neither of them explained it as clearly as you have! Hopefully the reduced dosage will work for him.

[Carriefarm]

I had to come off Bisoprorol as it dropped my pulse far too low. Some drugs are not suitable for some people and it’s a case of trial and error to get it right. Quality of life is important. My cardiologist advised me to stop taking Bisoprorol so maybe he should contact his cardiologist or his secretary to ask for advice. Best wishes.

[JSCAPM in reply to Carriefarm]

Thanks Carriefarm. You’re so right about quality of life. The GP said she’d get some advice from the cardiologist and if that isn’t forthcoming we’ll book an appointment to see him. My partner trusts the cardiologist who diagnosed his coronary artery disease, he’s been spot on with everything so far.

[fishonabike]

I won't add to comments on bisoprolol, others have already done so

but recovery after an operation takes time - your husband has experienced a very traumatic procedure: he was anesthetized (enough to leave anyone tired for weeks), his skin was sliced open, his sternum (chest bone) was cut with an power saw, then his ribs were cranked open

I won't take you through the rest, but it involves a lot of damage and repair

Then your body had to focus its resources on repairing the wounds and warding off infection, while the heart is not functioning at full efficiency to supply the materials

a "simple" sprained muscle can take weeks to repair and recover, with a lot of rest involved, then it has to build up its strength - your husband's heart muscle was cut open, interfered with and stitched back together, and still had to keep going 24/7

the sternum also has to heal, which takes weeks, and that is under strain from the ribs and the movement of breathing 24/7

anyone going through this is bound to be exhausted

I hope that begins to explain why your husband still feels tired

[JSCAPM in reply to fishonabike]

Thanks fishonabike. I appreciate you taking the time to clearly outline why my partner might be so tired. I read your reply to him and it’s given him something to think about.

[greenba]

Bisoprolol had a drastic effect on me, I was given them by mistake and 2hours after taking one tab I was like a zombie. For me , never again. Good luck

[dicynth in reply to greenba]

I had the same experience. Never again.

[JSCAPM in reply to dicynth]

Thanks dicynth. It’s obvious the meds don’t agree with quite a few people.

[JSCAPM in reply to greenba]

Thanks greenba. My partner has been taking them quite a few weeks now and feels like he’s going backwards. I’m hoping he can cope better with the reduced dosage and be less zombie like!

[ForestryPine6]

I had hypertension 10 months ago and GP sent me to A&E as I was breathless during the appointment, the consultant after having chest x-ray bloods etc put me on Bisoprolol 2.5mg twice a day totalling 5mg daily and it's the best medication I could possibly have been given, it's stopped the irregular heartbeat so wouldn't be without this as suffered for a number of year's. Hope this helps.

[JSCAPM in reply to ForestryPine6]

Thanks ForestryPine6. I’m glad that bisoprolol is working for you, it’s reassurance that there is a reason they’ve been prescribed. Hopefully the reduced dosage will work for my partner.

[ForestryPine6 in reply to JSCAPM]

I hope the reduced dose is correct for you JSCAPM as personally I don't have any fatigue effects that some have, it's a good medication for hypertension as GP put me on Amlodipine 5mg then onto Ramipril they both took all the strength out of me, Wishing you all the best 👍

[Simba37]

I have had no side effects with amlopidine but I’ve not had a heart attack.

[JSCAPM in reply to Simba37]

Thanks Simba37. That’s my partner’s experience too.