Steroids and Beta Blockers

[jaycee444]

Not sure if anyone can help with this question but having had a recent heart attack I have been prescribed amongst other drugs a Beta Blocker called Bisoprolol. I am at present down to 6.5 mg Prednisolone and have been stable on that amount for the last couple of months. The information about the Beta Blockers is that they are adrenergic blocking agents and block the release of stress hormones in certain parts of the body.

I am wondering if this in any way affects the situation with being down to a low dose of steroids and in no mans land regarding adrenal insufficiency. Maybe I am daft but I am thinking that blocking stress hormones at this time isn’t such a good idea?? My reactions to even the smallest amounts of stress at present are extreme. Im just wondering if the Beta Blocker is adding to this?

[DorsetLady PMRGCAuk volunteer]

I was on Atenolol for high blood pressure before and during GCA (so initially on high steroid doses) - no adverse effects..... and although adrenals were a bit sluggish for quite a while, only had random bouts of fatigue nothing more...

No longer on Pred, and now on Candesartan for BP - different regime from previously...

[PMRpro Ambassador]

I've been on bisoprolol for the last 10 years at all doses of pred from 20mg down. I have got from 19 to 5 in the last 16 months while on Actemra - no real adrenal problems so far any worse than I would expect after 14 years on pred. I had been reacting to stressful situations - but losing my iPhone for an hour yesterday caused no ructions as a result once I found it down the side of the car seat - whereas even a phone call to the bank left me shaking a few weeks ago!

[Ruthie64 in reply to PMRpro]

Hi, sorry to jump in but can I ask if you take your bisoprolol at the same time as your preds? I've just been prescribed 1.25mg bisoprolol and not sure whether I can take them at the same time as I read that the preds can suppress the effect of bisoprolol? I normally take my preds at 6am and go back to sleep. Would I be better taking the bisoprolol a bit later?

[DorsetLady PMRGCAuk volunteer in reply to Ruthie64]

I took my BP meds same time as Pred when I had GCA - no issues… But if you wake at 6am take Pred and go back to sleep then take your bisoprolol either at breakfast, lunch time or bedtime - whatever suites you best - it doesn’t really matter so long as once you get into a regime you stick to it.

Some studies suggest bedtime is best… which I do now,…

[Ruthie64 in reply to DorsetLady]

Thank you my lovely! I took it with my coffee at 7.30am yesterday and it worked great. Took it at 6am with my preds today and not feeling so great today. My hr is going higher again today too so I think I'll probably go with breakfast at 8.30. My resting hr at night is normal so don't feel I need to take at night and I'm not getting dizzy spells. It's only been the 3rd day though.

[DorsetLady PMRGCAuk volunteer in reply to Ruthie64]

Okay… as I said what suits you best, and sometimes it takes a few weeks to know that….

Good luck - on both counts.. 🌸

[PMRpro Ambassador in reply to Ruthie64]

No - but that is only because I am on a type of pred to be taken at 10pm and it releases at 2am!! Take it when you find you feel best, as long as it is always the same it'll be fine. That is a low dose which they use to start and then they titrate it up to find the right dose for you.

[Ruthie64 in reply to PMRpro]

Thank you so much both DorsetLady and PMRpro 🤗

[Rugger]

I have been on Bisoprolol for as long as I've been on pred (7 years) with no apparent problems. 🤞 I'm in adrenal territory now at 3 / 2.5mg pred. Take care.

[PMR_sufferer1]

The drug you were given are for Heart Failure and AFIts commonly prescribed for stess. Benign Tremours etc.

Even snooker players that get the yips when cueing use it to calm nerve shake.

[calibriel]

Like others above I am on both beta blockers and pred. I was on beta blockers long before I was on pred: I was prescribed atenolol, and then later also enalapril, nearly twenty years ago; my PMR was first diagnosed and treated in 2020. As far as I know there are no problems with taking them together

[PMRnewbie2017]

Don't get hung up on the "adrenergic" description of beta blockers. There are different types of adrenergic receptor in the body and they respond to adrenaline and noradrenaline. Prednisolone and other corticosteroids shut down our production of cortisol which comes from the adrenal gland too but a different part. Adrenaline and cortisol are all part of the fight or flight response but taking bisoprolol will not affect your ability to reduce your Pred dose.

[jaycee444 in reply to PMRnewbie2017]

Thank you - that explanation makes a lot of sense.