Bystolic (Nebivolol) questions

Hello all,

Sorry to bother all of you again since my hubby doesn't have lone afib. We honestly don't know what his situation is. By all reports he has some underlying cause, but not sure what. Nobody has said if he is vagally mediated. In any case, he is being treated with some of the same drugs that are used for lone afib, so I look to all of you for information with that.

He was on warfarin, metoprolol, amlodipine, plavix, aspirin and benicar hct until recently. He feels so weak and tired all the time so I'm sure he is experiencing drug side effects. Our primary Dr told him to stop the amlodipine and cut the beta blocker (metopolol) in half. This made his BP go up. He has also been having bleeding episodes from the blood thinners so a Dr at the clinic that does he INR testing told him not to increase the warfarin anymore to reach target INR. Also, he has low platelets of unknown etiology, but they are keeping the Plavix and aspirin at the same dose anyway until he sees a hematologist.

Yesterday when he saw an EP for the first time, the EP said he could stop the warfarin and take a different beta blocker, Bystolic. He said it lowers BP and also has a blood thinning effect, which I cannot find any references to that, even for off label use. He said the bystolic has less side effects that the other beta blockers. So I turned to the forum again for insight on this and found a post by Hans:

Quote
Hans
Re: New EP and Beta Blocker

An important key to avoiding afib episodes is to have your autonomic nervous system (ANS) in balance. It seems to me that vagal rebound means that the parasympathetic (vagal) arm of the ANS becomes overly dominant. Thus to balance it you would need more sympathetic (adrenergic) influence and taking a beta-blocker would dampen the adrenergic influence. Anyway, I think bisoprolol may be a better choice as it is also cardiac-specific and has a considerably longer "history" than does nebivolol. In any case, please let us know what you decide and how it goes.

Hans

We are hoping the Bystolic works better for his BP control but since we don't know if he is vagally mediated I'm kind of uneasy about all this. If what Hans says is correct, and I don't doubt him, then any beta blockers are contraindicated, if hubby is vagal. And maybe that is what caused his one afib episode, since he was on the beta blocker before it happened. This is sort of like the chicken and egg question. Did the beta blocker trigger the afib if he is vagal? Or did the afib occur on it's own (for other reasons)?

I would like to know if any other posters have experience with Bystolic and if so, what if any side effects has it caused. Has anyone here had an afib episode triggered by beta blockers, if so which one? And what side effects in general do any of you experience from beta blockers?

Thanks again, Rosie

Interesting article regarding Dr's prescribing Bystolic and receiving payments from Drug makers:

[www.propublica.org]

benicar hct - hydrochlorozide diuretic type drugs deplete all electrolytes and especially important for afibbers is the magnesium and potassium. If he's been on a 'thiazide' drug for a long time, it's no wonder he is weak... you need electrolytes to be able to function and repleting those if severely at low levels takes time... especially the magnesium. Potassium and sodium are easier to rebalance, but if he isn't working diligently on magnesium intake, then look to that immediately by supplementing.

For those who tend to be vagal, then yes.. beta blockers make one feel worse. I was mostly vagal and unable to tolerate beta blockers other than used to slow the heart rate down for the PIP conversion when needed.

Bystolic apparently has caused some patient complaints/notations regarding high potassium levels; other reports indicate low potassium so do some careful research and ask questions of the prescribing physician about his symptoms. .

It's better to try to manage hypertension by diet and exercise and eliminating the hidden sources of sodium in all packaged and processed foods that knock out the essential for afibbers.. potassium. But you need to learn what his intracellular levels are first and then consider appropriate electrolyte intake from foods and supplements. Does he eat a 'clean' diet and watch sodium intake?

Jackie

Hi Jackie,

Yes he has been on benicar hct for quite awhile. However he does take high dose time release potassium with it. The only problem there is that regular testing is supposed to be done to check his electrolytes. This is one of my biggest complaints with the Dr who prescribed it and some of the other drugs. This Dr never does any routine tests to monitor any of the drugs effects, that are supposed to be checked. His sodium intake is low. And he has been taking magnesium since his afib episode, and shortly after he started it he went back to NSR.

He was hospitalized October 6th, with the afib episode and other tests done. Turns out he had one blocked artery as well and had a stent put in. That was when the warfarin, plavix, aspirin, and crestor were prescribed. His cholesterol is low end of normal so my Dr told him to stop the crestor since that can make you weak and tired. He was on the other drugs before this and didn't feel as bad prior to the afib attack. So since he was found to have a blocked artery requiring stenting, everyone said he would feel tremendously better after the stenting. He did not. So obviously the blocked artery was not the cause of his malaise.

Upon his discharge from the hospital, I spoke to the internist about all of his tests, questioned him on everything, and he said all of his tests were normal. His records are all accessible online through the hospital and clinic's online chart system. So I looked them up and to see if there were any other abnormalities myself that are common things that many Dr's dismiss. All but one blood test that was done while he was in the hospital were in the system. The ones that were online were normal. I told him he needed to contact someone about their system to find out why that one test was left out. We forgot to mention this to the Cardio/EP that he saw the other day, but he had all his records online in front of him. He didn't notice anything wrong. However, he did insist on regular monitoring of his electrolytes.

Yesterday he saw a hematologist for the low platelets. Finally someone with half a brain and access to all his records picked up on another problem. It turns out that one missing blood test shows elevated bilirubin and liver enzymes. Liver disease makes you extremely tired. So now we finally have something else to go on, 3 months later. He spent 3 hours in this Dr's office while she went over everything and was on the phone to the lab asking questions and demanding answers. She was thorough and demanding. She ordered more blood tests, 7 tubes of blood. Now we wait to see what all she comes up with. Everyone involved in his care has dropped the ball big time with his health problems. The Cardio he was supposed to see 2 weeks after release from the hospital gave him an appt 2 months out instead of 2 weeks. Then her office called to cancel that appt. So we found a different one to go to, which is the Cardio/EP he saw the other day.

This is why I hate the Dr's and entire medical profession in our area. They are bottom of the barrel health care persons.

He did have hep C years ago, which has not been active for over 30 years. However, the drugs he's been taking can damage the liver, and any stress on the liver can make hep C rear it's ugly head. Yet again, no follow up testing has ever been done to monitor the drugs. I'm hoping that's all it is, and not cirrhosis or something equally as bad.

He had no health problems before being put on benicar, metopolol and amlodipine. So I'm convinced the drugs are weakening his liver and possibly more. I just wanted to know what all ill effects others have had from taking beta blockers, and specifically bystolic, so I know what to be on the look out for with it.

Sorry for the rant...

Thanks, Rosie

Hi Rosie,

I've taken Bystolic in a low 2.5mg dose before just post ablation for a year to help keep the heart rate down. After my two ablations the distinction between vagal ( my original defining AFIB triggers were most all vagal) and adrenergic no longer have the same strong cause and effect associations, obviously, with no more AFIB activity, as they once did before my heart was ablated up pretty good by Dr Natale.

It is one of the more cardio-specific beta blockers, though if your husband has much more identifiable vagal triggering attributes then as Hans suggest he might be better off with a calcium channel blocker, assuming he isn't prone to swelling and edema, though those drugs like verapamil and diltiazem aren't too notorious for such edema.

Does he have any of the classical vagal triggers. like laying on his left side, triggering when bending over of even coughing, frequent night time episodes of half and hour to two hours after a big meal, especially the evening meal etc etc??

Shannon