Withdrawn Bisoprolol

[garyh63]

Hi. I was diagnosed with Afib in August. I've been on a cocktail of medicines since then. I had DC cardioversion in November, and this successfully reset my sinus rhythm. However......my resting heart rate started to come down to what was probably bradycardia levels. My resting heart rate was 40bpm.

I had an MRI scan at the beginning of December and the consultant said I should stop the Bisoprolol immediately. I was taking (and had been since August) 2 x 5mg of Bisoprolol. This wasn't my consultant btw.

Since then, my resting heart rate is up to 70 bpm, but, more alarmingly, I have episodes where my heart races up to 130 bpm whilst I'm in bed.

My hospital have since said to take a dose of Bisoprolol 'as and when' this situation arises.

I'm feeling very uncomfortable about the whole thing. If they need to change my dosage then they should do so, but not leave it up to me when I take it.

Is this something anyone else has experienced? I was not suffering any ill effects from Bisoprolol other than the lower heart rate.

[RF260]

Hi, similar situation, diagnosed with A Fib in September, referred but didn't get seen until mid December. I had a 24 hour holter monitor showing rhr into the 30's overnight and advised to wean off the 2.5mg bisoprolol (but keep it as a pill in pocket) so I reduced to 1.25 until end December then stopped it on 1st January (but started Amiodorone in readiness for Cardioversion due mid Feb). My rhr in bed now goes to mid 40's and averages 53, i don't have the peaks while in bed but I do have some odd higher events like I shaved earlier and went to 125 (I wonder if that just the rapid arm movement when wearing a fit bit). Another factor is anxiety, I am shaky as hell since stopping and just a level walk sends it to around 110. I'm hoping the strange peaks will subside as body gets used to being off it. Good luck with things calming down..

[Popepaul]

Long term bradycardia could become dangerous with fainting head injuries and a path to HF. I think that the right decision was made. I can not take felcainide since I have a history of 2 HAs. The consultant who I recently saw suggested that I take PiP bisoprol to help prevent the tachycardia. I have followed his advice and found it to be helpful.

[Sheffield55]

So sorry about what you are experiencing. With betablockers, the body develops dependence on the drug. When you stop the body struggles to adjust to this new change. I was on 20mg Propranolol once a day for 2 years and have slowly tapered down to 5mg.

I started tapering by taking 10mg twice a day. Then 10mg once a day. Now I am down to 5mg once a day.

With every change in dosage the body will struggle to adjust. Just pay attention to how you feel and give your body the medication when It actually needs it.

All will be fine in no time.

Cheers.

[garyh63 in reply to Sheffield55]

Thanks for replying. The immediate cessation of Bisoprolol has caused some anxiety for me to be honest. Not a tapered reduction, just a 10mg a day to nothing at all. The only reason I now have the PiP option is having to express my anxiety to a heart failure nurse, who, in turn, spoke with my actual cardiologist who suggested I take as an when required. My resting heart rate is now much higher than it ever was. I'm due to see my cardiologist in a couple of weeks, so I guess I'll have to self-medicate for the interim period. It's not a wonderful situation to be in.

[scentedgardener]

I was initially given 2.5 mg bisoprolol, then told to take an extra one at the onset of an episode of AF. As 2.5 mg lowered my HR quite a lot, I asked if I could have 1.25 mg as a PiP.Over time a daily dose of 2.5 mg lowered my HR and BP too much so the daily dose was reduced to 1 25 mg, and I could still take up to 2 more doses when I had an episode of PAF.

It worked quite well for me.

[garyh63 in reply to scentedgardener]

It seems it is very much a medicine that is prescribed uniquely to us all. I was started on 2 x 5mg and have been on that dosage for four months. This was part of a cocktail of drugs to treat my Afib which saw me initially having a pretty constant 140bpm heart rate for a couple of days. I understand that my MRI has shown that I have healed well over that period and the 'pump' is working well again. The removal of Bisoprolol was sudden and I feel that it's having a reverse effect, sending my heart racing at times. This may well be a different issue that the medicine was masking. These are just my thoughts as I have not been given any feedback yet relating to my current heart health.

[AmatureKnitter]

Unless switching to another beta blocker Bisop should be titrated up and down. 10mg/day is a hefty dose. My rhr dipped to 39 on 7.5mg/day. The advice I was given was to slowly lower the dose by halving it every 2 weeks, but I struggled and ended up reducing in 2.5mg decrements. It took a few months to get off it.

I had 4 good months off it then started having problems again. I'm fine if take 1.25-2.5mg for a few days when I get episodes of arrythmia. At that dose my rhr drops from 65 to 55 but I feel OK.

There are several posts on here discussing Bisoprolol withdrawal and a lot mention periods of tachy. I figured its as the beta1 receptors in your heart become sensitive to adrenaline again.

[garyh63 in reply to AmatureKnitter]

That's a really helpful reply. I've seen some people on a dose of up to 20mg a day, but mine is still on the higher side it would seem. The cold turkey approach has not been a very good experience and I have (arguably) done my own thing with the dosage. I was doing well after Cardioversion and it's been 4 months since the first afib period. However, since making a complete withdrawal from Bisoprolol, my feelings are that I should've had a more controlled reduction in the amount I was taking a day.

[DiyChas]

There has been a lot of discussion here on Bisoprolol.Basically, one effect is to reduce your heart rate.

Going from a large dose to none is a major drop.

Consult a Cardiologist for a reduced amount such as 2.5 twice a day.

If heart rate still very low, let cardiologist know and they may increase slightly.

I went thru this process and have now settled on 2.5mg per day (at night).