alternatives to bisoprolol

[Plotter]

a month in to taking Bisoprolol 1.25 a day for recently discovered atrial ectopics.

Fatigue, insomnia, some nightmares, feeling flat. Any alternatives? GP seems reluctant and wants to increase dose to 2.5

[TheBesty]

I got switched to Metoprolol 25mg twice a day, they didn't make me feel as crap as Bisoprolol. No idea if they work the same, but as they both and in "lol" worth a punt

[Plotter in reply to TheBesty]

thanks for this, will ask

[phollers]

hi there

I was initially put on 2.5mg bisoprolol and really struggled with it, so I reduced it to 1.25 and still felt rubbish. Over time, I have had to increase the dose and am now on 5mg. It has taken a few months to get used to it, but I’m now settled in with it.

As you know, it’s a beta-blocker and there are quite a lot of them. In some ways it’s better the devil you know, but if it is causing you a lot of grief then ask (firmly) for it to be changed until you find the right drug for you. You have options and have the right to use them.

Peter

[Plotter in reply to phollers]

Thanks for getting back to me with this

[Ennasti]

Why does your doctor want to increase it? Atrial ectopic beats on their own aren’t usually dangerous, and in most cases, no treatment is offered for them—they’re very common in the general population. However, if they occur in excess or are accompanied by other issues, such as structural heart problems, medication might be prescribed.

Beta blockers don’t often control ectopic beats directly. Their main purpose is to reduce the heart’s response to adrenaline, which can help prevent ectopic beats from being triggered, and to lessen the force of each beat to protect the heart walls. This is especially important for people with cardiomyopathy. There are many types of beta blockers.

Over the years, I’ve been on four different ones—atenolol, metoprolol, bisoprolol, and currently carvedilol. I felt slightly different on each, but carvedilol has worked best for me. We’re all different though and will respond differently to various medications. It took me about three months at first before I started to feel more like myself again.

[Plotter in reply to Ennasti]

Thankyou

[Survivor1952]

I came off Bisoprolol a couple of months ago, had dry eye as a side effect. Switched to 3.125mg of Carvedilol twice daily instead of 1.25mg Bisoprolol once a day. GP wanted to increase dose of Carvedilol to the maximum tolerated level, I’ve refused as I don’t want to be slowed down more than I am already, they’ve accepted that.

I took advice from the BHF helpline and a cardio trained physio who works in my local cardiac unit but who also runs exercise classes.

[Plotter in reply to Survivor1952]

Thanks

[Ennasti in reply to Survivor1952]

That would have been a massive increase in carvedilol if you’re only on 1.25mg. I’m on 12.5mg twice a day and I believe the maximum is 25mg twice a day. Did you make a make mistake and maybe meant you’re on 12.5?

[Survivor1952 in reply to Ennasti]

Nope, no mistake, change was from 1.25mg Bisoprolol to 3.125 x 2 of Carvedilol daily.

Carvedilol is not as effective as Bisoprolol in reducing heart rate so the dose will be higher.

[Sb1171]

I asked my GP to switch from Bisoprolol to Nebivolol based on my personal research and he agreed. My reasons were:

Nebivolol is third gen vs second gen beta blocker. It is 3.5 x more cardioselective.

Studies suggest it may have greater efficacy vs Bisoprolol:

All cause mortality 9.8% vs 11.48%

Cardio mortality 5.4% vs 7 %

All cause hospitalisation 14.4% vs 16.3%

Cardio hospitalisation 9.8% vs 12.09%

Nebivolol stimulates nitric oxide production. It is vasodilating which appears to counter the reduction in heart rate in terms of output. Bisoprolol reduces stroke volume and reduces cardiac index by 7.8%. Nebivolol does not.

Bisoprolol reduces night time melatonin production by 44%, potentially reducing sleep quality. Nebivolol does not.

Nebivolol has a smoother delivery profile (more constant effect rather than a peak and trough) peak to trough ratio 91% vs 58%

Sorry, but I didn’t note down all my sources, so you will have to go hunting for the research yourself to verify.

As for a personal anecdote - I was on 3.75 mg Bisoprolol and used to break the tablet and take a third in the evening which appeared to reduce the frequency that I felt eptopic beats. I switched to Nebivolol and GP agreed to prescribe 2.5mg twice a day. I rarely notice ectopics now, resting HR low 50’s and BP in the 100-110/65-75 range. I subjectively feel that I have more “power” available on exercise.

So Nebivolol definitely works for me, but beta blockers seem to work differently for each of us, so there might be a better one for you. Hope you find it.

[Plotter in reply to Sb1171]

Thank you for this

[Lizzy-loo in reply to Sb1171]

I also do much better on Nebivolol than Bisoprolol.I was put on 1.25mg of Bisoprolol for persistent PVCs and this worked well until I contracted Covid and then it all went out of whack.

A&E Drs and local cardiologist insisted on increasing Bisoprolol to try and combat the ever increasing PVCs but it just left me tired, out of breath, low HR and low BP and did nothing for the PVCs.

By the time I saw an arrhythmia specialist in London earlier on this year, I was on 2.5 mg Bisoprolol x2 daily, with a burden rate of 30% ectopics.

He switched me to Nebivolol 2.5mg x2 daily and within a week the low BP, tiredness, breathlessness and chest pains stopped.

The PVCs remain but I'm currently trialling Flecainide while waiting to see an electrophysiologist.

[Plotter in reply to Lizzy-loo]

Thank you for this

[Survivor1952]

Sorry, I think you've got this very wrong, I was on 1.25mg of Bisoprolol a day, I'm now on 3.125mg of Carvedilol twice a day (6.25mg a day). The change was made in July.

Subsequently the Clinical Pharmacist at my GP practise wanted to increase the Carvedilol to the maximum tolerated level over a period by initially doubling the dose to 6.25mg twice daily (12.5mg/day), monitoring my response to the increase and then increasing it again (known as titrating the dosage). I questioned that as my RHR (overnight) is generally in the mid 50's and spot HR readings can fall into the 40's which my GP had previously said prevented an increase in beta blocker and prescribed a calcium channel blocker in addition.

A contraindication for Carvedilol is a heart rate below 55bpm at which point the dosage should be reduced.

As I'm sitting typing this my heart rate is around the 70 bpm mark which is in the normal range.

I had my annual health check with my GP practice about 3 weeks ago and they were delighted with my current stats all of which are well within tolerance and typical of a healthy adult.

[Ennasti in reply to Survivor1952]

Thanks for explaining. I think I might just be getting a bit mixed up on the term “maximum” dose as you’ve applied it. My understanding is that it’s usually 25mg twice a day (and up to 50mg twice a day for those on the heavier side), which seems like quite a jump from 6.25mg twice a day.

Personally, I’m on 12.5mg twice a day, which is already a bit above what you called maximum. But no worries—it’s probably just a difference in applying the terminology!

My heart rate is low (currently 58bpm) but this is normal for me and it can drop lower. As with blood pressure, there really isn’t a definitive ‘low’ reading anymore, and as long as you have no symptoms, then there is no concern. My risk lies in a high rate and arrhythmias.