Bisoprolol dose & timing

Hello everyone.

I've had ups and downs with the Afib monster for more than a decade, and got a lot of help from this site and forum at the outset, for which I've been really grateful. I've since had long Afib-free spells, thankfully.

Since early last year, and a protracted viral infection - flu or early Covid-19 - my heart has been more agitated / sensitive. I've been getting longer episodes.

Meds wise, I have been on 3-4 x 40mg propranolol for many years. I take a sleeping pill.

Typically, after tipping into Afib my heart would still function seemingly pretty well most of the time - I could still do most things - but it was worrying and the return to NSR a huge relief.

After a couple of recent 5-day bouts, I walked over to the hospital - a few miles. I was admitted and they ran tests inc bloods. Doc on duty confirmed it was definitely Afib not flutter. My HR was 100-180 for a while. I had no idea it got that high!

Tests came back OK. I was started on bisoprolol and ended the propranolol (which I generally liked but had to concede was not preventing episodes nor rate).

After a rocky start, I started to get on fine with the bisoprolol. But then I had a 12hr episode, starting at night, which resolved OK after I took an extra pill and a gentle walk.

Since had another episode which, as is usual for me, started at night. 36 hrs and my heart feels OK, but it's not in NSR and HR is about 75 unlike my usual 60 or so.

(I was told that I had zero score on the stroke risk / anticoagulant assessment scale. The doc in the hospital thought I could probably deal with this without an ablation.)

My own general doctor has not been a great help re dosing and I'm kind of figuring it out myself. I have 1.25mg pills. Hospital doc thought 2.5mg daily dose, and an an extra PIP one if dealing with an episode.

It says on the pack to take in the morning. I can't ever recall having Afib start in daylight hours.

Do you think it would be better to take a higher dose, or split it morning and night, or just take 2.5mg at night? I see much higher bisoprolol doses recommend for other issues, ie heart failure. I'm not a small guy, and I walk miles each day. (I avoid the gym sadly as that kind of exercise is a sure fire Afib trigger.)

I know that bisoprolol is mainly for rate (and it works very well and comfortably for me) but not really for rhythm. Are there any hazards related to it, like making conversion to NSR more difficult?

Thank you very much for any advice!

Bis. was a drug i was P. early on in my Afib journey....it did nothing to stop my Afib attacks but did dramatically slow down my heart rate (from around 65 to 45) in NSR times which knocked the stuffing out of me like no other drug i ever took + in Afib it marginally shortened the length of time i was in Afib by reducing my HR rate which normally makes it easier for your heart to convert.....the lower the HR in Afib the sooner myself anyway converted. The only thing i would suggest to take Bis. is during a crazy Tach. ep. in the high 100's or higher or a part. bad Afib one so to reduce one's heart rate ASAP so to convert naturally....it takes Bis. 4 hours to reach full strength but it worked faster on me + i was taking only 125 mg or a 1/4 of a 5 mg. pill. Other then slowing you heart down during a bad ep. it was by far the worst everyday drug i ever took (after 2 weeks i stopped) + IMOP a worthless bandaid if that for reg. Afib itself but of course nobody is the same.
I would look into getting a real PIP like Flecainide or Propafenone + scrap Bis. + also think strongly about stopping the bandaid route + look into getting on an Ablation path with an EP.

GL



Edited 1 time(s). Last edit at 07/06/2021 02:00PM by vanlith.