Bisoprolol - behavioural issues/memory loss

Enquiring on behalf of an 86 year old relative.

She had an on-demand pacemaker fitted a couple of years back to stop the heart rate going too low. Problem is since then she has been suffering from quite bad short term memory loss and some behavioral issues.

A bit of research in the Internet suggests that short-term memory loss is a known side-effect of Bisoprol, especially when combined with Ramipril and especially in the elderly. Also from others descriptions the behavioural changes sound like they might be related to this as well.

Her Cardiologist will not allow her to stop either Bisoprolol (1.25mg) nor Ramipril (2.5mg). Question is are there any other alternatives to these that we can ask for instead?

A recent 24hr ECG showed that her max pulse rate was 130bpm therefore cardiologist will not let her stop taking either of these pills. When we looked into the detail the high pulse rate was at a time she was throwing one of her tantrums which is a side-effect of Bisoprolol.

This nightmare has become a self perpetuating situation: Bisoprolol causes temper tantrums, these cause raised heart rate on 24hr ECG, because of high maximum pulse cardiologist insists she keeps taking Bisoprolol, this is madness!

Even the Cardiologist commented that at 1.25mg the Bisoprolol is such a small dose to be unlikely to have much effect, he was referring to memory-loss at the time, but surely the same applies to it's cardiology effects, if such a low dose why insist that she keeps taking it?

Who is in control of care? Your relative, you (with medical power of attorney) or the cardio?

My opinion, for myself, is I am in control of my own care. I am not required to do anything a doctor asks. They work for me and are my consultants. They may fire me as a patient if I don't follow their advice, but that is my choice. I can also fire them.

As to another med for rate control - how about a calcium channel blocker instead of a beta blocker?

Does your relative have high BP issues?

Welcome NickC,

As George noted, the obvious question her cardio should have already addressed, is why stick to the bisoprolol if it is causing her not only to have temper tantrums on cue, but also then the high HR that he is presumably giving her the bisoprolol to control to begin with??! If, indeed, that is the only reason he is prescribing this drug for your elderly relative. Many docs are reticent to prescribe Beta Blockers for more elderly folks because of the fear of falls from an unsteady gate the sedation, or sudden low BP, from a BB can be a risk for. Especially, in older folks whose kidneys and livers are also elderly as well and thus who may not process these drugs efficiently any longer.

Has her doc given a reason for not trying a calcium channel blocker?

Shannon

Another point brought up by Morpheus,

It's possible the bisoprolol may not have a direct causal relationship to your 86 year old relatives temper tantrums, if she is taking the drug regularly every day, then its possible she might be suffering from some age-related .. and possibly AFIB influenced ... dementia as well and the the beta blocker at such a low dose, may at best be a kind of incidental trigger to the underlying tendency for mood swings that often accompany dementia and cognitive decline.

It is certainly worth doing some dose adjustment investigation and work this out with her physician/cardiologist and perhaps a neurologist in an effort to determine how much, if any, of the primary cause of these out burst she is having really is solely the work of such a low dose of bisoprolol (quite questionable I would think) and if she might have a more systemic neurological issue causing a decline in mental function as a result?

Food for thought in any event NickC, and thanks to Morpheus for the suggestion.

Shannon

Apart from Bisoprolol she is also on:

• Ramipril (2.5mg)
• Indapamide (2.5mg)
• Felodipine (10mg)
• Apixaban (2 x 2.5mg)

However, she has now been told to stop taking the Indapamide.

Is blood pressure high, well here are recent morning blood pressure results:
(siting/standing, Systolic, Diastoloc, Pulse)

• sit, 131, 78, 85
• sit, 134, 87, 79
• sit, 114, 92, 58
• standing, 81, 67, 66
• sit, 131, 73, 91
• standing, 126, 72, 85
• sit, 133, 73, 88
• standing, 136, 68, 88
• sit, 133, 68, 83
• standing, 126, 62, 76
• sit, 148, 98, 86
• standing, 120, 62, 79
• sit, 133, 77, 75
• standing, 108, 83, 70
• sit, 103, 79, 78
• standing, 92, 48, 64
• sit, 101, 51, 60
• sit, 107, 68, 79
• standing, 123, 53, 76
• sit, 142, 68, 87
• standing, 121, 83, 82
• sit, 117, 77, 82
• standing, 128, 73, 76
• sit, 128, 73, 86
• standing, 117, 67, 70

She does have a history of falls and T-LOC events (Total Loss of Consciousness) which could be when her blood pressure goes too low when she stands.

3 blood meds, a blood thinner, and you say she was told to stop the Indapamide (diuretic), usually when they take a diuretic they take a potassium supplement as well.

Did the lady have high BP before she was given all these drugs? Her BP readings are good, I really don't know why the docs want older people to take BP meds to have low BP, as one gets older their blood vessels become thicker and a higher BP is probably normal. Years ago doctors believed that older people would have higher BP and were ok with it. I think all of these meds docs put older people on are causing more problems than they help.

Liz

Hi Liz,

But would her BP readings be ok if she wasn't on this cocktail of drugs?

Difficult to know if she had high BP before as we have no history available, much of this medication has been cumulative a bit added here and a bit there.

My biggest concern is the Bisoprolol which we suspect of being the cause of short-term memory loss but her GP won't allow her to stop taking it because it was prescribed by the cardiologist.

Nick

Nick:

Her bP probably wouldn't be as low as she has it now, we don't know. I really don't know why the docs. want older people to have such low BP, what I have read is that those people don't live much longer by having their BP so low. The arteries get stiffer with age so it is only natural that older people would have higher BP.

Why don't you talk with her cardiologist about the Bisoprolol and your concerns about causing short term memory loss and get a change in her meds. I have a cardio who wanted me to take aminodarone, I wouldn't do it, he works with me, if he didn't, I would find another doc.

Liz

Tried that, he remains adamant that she must keep taking the Bisoprolol.

Regarding 1.25mg of Bisoprolol being such a small does, I was prescribed 2.5 but cut my tablets in half to lesson the side effects, nevertheless, 1.25 was enough to slow me down so much that I nearly collapsed from exhaustion at work, the nurse there called an ambulance as she said my pulse was so weak, the ambulance crew reported my pulse being as low as 40bpm.
In contrast, I then stopped taking that tiny dose as I was due to stop in a few days anyway in order to have an electrophysiology study.
After four days off Bisoprolol my heart beat at rest, (which used to be around 60 as an ex-endurance athlete), was 149bpm, my ecg reading was just a scribble, and I spent the weekend in a cardiology ward at St Georges hospital.

Even such a small dose of Bisoprolol that I had taken for less than three months had that much of a hold on me.