Bisoprolol and now Breathlessness!

Hello all, I just started Bisoprolol for Atrial Tachycardia. Am taking 2.5mg once daily. I have been on it for exactly one week. My heart rate is better (although now kind of low at times ). I have been having blocked PACs and such but DO feel better. The trouble is the dizziness. I am so, so dizzy all morning and it seems to be getting worse. I was hoping to wait it out and see if it would get better over time, but each day has been worse than the last and now it is getting bad enough that I feel really nauseated when the dizziness hits. Any suggestions?/Thoughts? I am encouraged be cause something FINALLY has stopped the SVT, but this is terrible..



Edited 1 time(s). Last edit at 03/11/2024 07:57PM by MeganMN.

Question: is it dizziness as in vertigo or lightheadedness like you would get from low blood pressure?

Check your BP and make sure it is not dropping too low. What do you mean by heart rate is low? Is it staying around 60? If so, you are still good. There are a couple of things you can do, if your other vitals are good you ask for meclizine from your doctor. Or you could try Dramamine non-drowsy formula (has to be non-drowsy) to see if it helps.

Thanks for the replies. My heart rate has been in the 50's but I still have atrial bigeminy and am getting some blocked PACs, so it feels crummy. My blood pressure is normally low (100-110/60-80) I haven't checked my blood pressure a ton, but when I have checked, it is generally between 100-110 systolic. The dizziness is worse in the morning and worse when getting up from sitting. It feels sort of like vertigo. I've run into things (like the wall) and almost fallen over a couple times already. It is getting worse each day. Here is my rhythm strip (bradycardia with atrial bigeminy and non-conducted PACs.). I want this to work. It has helped my tachycardia so much and I have finally slept at night. But......

Those are some long pauses after the PACs (1.4 sec). That could be what's making you dizzy. Talk to the doc. Can the pills be split? If so, maybe try a half-dose, and if not maybe try 1 dose every 2 days.

Thanks everyone. I called the office and they are going to have me try to break the pill into quarters. So that way I am getting closer to 1.25 per day. Eek! He agreed, Carey, that it is slowing me down too much and the pauses are a bit too long. He doesn't want to give up on it because it is the first med to actually help.

I believe the rate control medications, or at least in the case of what I know, that being metoprolol, not only is the rate suppressed but the force of contractions is also reduced. If there's a tendency toward bradycardia (<50 BPM technically, although there is such a thing as individual variability), sitting tends to let blood pool if the rate is too low and the force of contractions is low. So, syncope upon standing would be expected.

Im happy that you have a responsive team that actually listens and is open to suggestions to trial partial doses for at least a few days. I hope it works.

I've been on the lower dose of Bisoprolol now for a week. The dizziness is gone, the pauses/slow heart rate are better. It seems that Bisoprolol has an added bonus of breathlessness. Why is that? Is it affecting the Beta receptors in the lungs? Has anyone used Nevebilol? I am encouraged because the Bisprolol has helped the tachycardia and ectopy,.but don't love the breathlessness and extreme fatigue.... Am wondering about Nevebilol or Atenolol as another option.....

Do you have asthma or COPD or has any doctor ever told you that you have reactive airway disease? Beta blockers should be avoided in general in people with reactive airways because they can exacerbate the condition.

Carey, I do have adult onset asthma/reactive airway. I use an inhaler occasionally. I've left a message for the EP.

Yeah, you probably shouldn't be on a beta blocker.

[www.ncbi.nlm.nih.gov]

The literature and research seem to support cardioselective beta blockers. But.... Anecdotal in here seems to suggest otherwise.

Read the conclusion again and think about how it applies to you:

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Cardioselective beta-blockers prescribed to people with asthma and CVD were not associated with a significantly increased risk of moderate or severe asthma exacerbations and potentially could be used more widely when strongly indicated.

Well, they're right. The cardioselective BB didn't cause moderate or severe asthma exacerbations for you. It only caused mild exacerbations; ie, a feeling of breathlessness. I think your choices for right now are you can look for another non-BB solution (or maybe another cardioselective B or choose to live with the breathlessness. I forget, have you already tried diltiazem?

Yes. I have tried so far: Propranolol (didn't work), Metoprolol (stopped working), Bisoprolol (working but seems awful with rate often too slow, other side effects), Diltiazem (too dizzy, sick), Flecainide (headaches, depression/anxiety, breakthrough), Propafenone (worsening SVT), Norpace (horribly worsening SVT), Multaq (nausea, headaches, low BP, pauses).
I tried many of them for weeks/months, feeling awful the entire time. I'm tired. I don't know what I want to put up with as it all seems awful- no arrhythmia and feeling like poo, or arrhythmia and feeling like poo.
My next options, according to EP, are.Verapamil, Tikosyn, Sotolol, or maybe another BB like Atenolol or Nebivolol. I expect, like everything else, they will be awfulol....

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MeganMN
I tried many of them for weeks/months, feeling awful the entire time. I'm tired. I don't know what I want to put up with as it all seems awful- no arrhythmia and feeling like poo, or arrhythmia and feeling like poo.
My next options, according to EP, are.Verapamil, Tikosyn, Sotolol, or maybe another BB like Atenolol or Nebivolol. I expect, like everything else, they will be awfulol....eye rolling smiley

Have you considered getting pharmacogenetic testing? It is now available at many labs and might just be really helpful in trying to find medications that you tolerate and that work. My EP tested me and it was enlightening as there was a quite a list of fairly common medications that were either totally contraindicated or else needed major dose adjustments.

Fantastic, Daisy!! I just had a conversation yesterday with a patient in the ER where I work about this exact same thing. So I contacted the pharmacist today and have a message in to my doctor for a referral to have it done. What a fantastic idea! Thanks so much! Maybe this will help. On a more frustrating note, my EPs office never called me back, so I am stuck trying to wait it out or wean off the Bisoprolol.... Thanks so much for the suggestion!!

Yes, and when I mentioned dose adjustments, with one of my genetic variations those were in the magnitude of reducing the dose by 3/4!

Google pharmacogenomics and you can read more about it. With your reactions, I’d suspect that you have some significant variations. It just makes sense to test. For instance Natale tested his patients and found that 1/4 of them were non-responders to Plavix, one of the anticoagulants often prescribed after Watchman implantation, so he switched patients to a half dose of Eliquis.

“Pharmacogenetic testing offers immense potential for precision medicine across various healthcare specialties. Its accuracy can significantly improve patient outcomes and safety.”

This does seem like a very good idea.

I spoke with the pharmacist today and she was realistic about expectations but she is willing to do the testing. She said it would help us determine if Beta Blockers should be absolutely avoided, and if other drugs, like Flecainide, would be metabolized differently . I am willing to pay for it to get more information. She was concerned about my EP actually using the info, but even if he doesn't take it seriously, it sounds like Natale would appreciate the extra info, as would I. I am going to do it. It will take about two weeks for results. I will share them once I receive them!

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She said it would help us determine if Beta Blockers should be absolutely avoided, and if other drugs, like Flecainide, would be metabolized differently.

It should give you that information. My results showed that Metoprolol should be completely avoided whereas Bystolic and Propranolol are okay and Carvedilol is use with caution. For Flecainide a 50% dose reduction was recommended. Interestingly, I had been prescribed Flecainide at normal dosing and that resulted in complete heart block!