Worsening side effects on bisoprolol

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I was diagnosed on Tuesday night with Bradycardia with episodes of ventricular ectopics. I was taken off the two BB's I have been taking for 17 odd years since I had a stroke and cardiac arrest and prescribed 1.25mg Bisoprolol instead. The palpitations are bad enough but the side effects are worse. Cold feet, dry mouth & throat, persistant tiredness, headache, flatulence and heartburn. I've only had 3 doses and I am worried that the side effects will get worse as the dose builds up inside me? I'm also concerned that I haven't seen any other reference to Bisoprolol being prescribed for bradycardia? Anyone else have any experience?

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  • Posted

    You have been taking 2 Beta blockers for 17 years and now docs told you that you have a bradycardia?

    If so, maybe docs switched from 2 BBs to only 1, to slightly raise your heart rate.

    On the other hand, they don't want to leave you without BBs since you had a cardiac arrest.

    In those cases, docs usually give BBs, and more or less, you will need to take them forever.

    So, maybe in your case this is a story about two evils.

    Cardiac arrest was very dangerous, and bradycardia is dangerous, but less.

    Since the drugs to prevent another cardiac arrest will always cause bradycardia, docs picked a lesser evil.

    About Bisoprolol and bradycardia, Biso will slow down your heart rate, prevent arrhymtias, lower a blood pressure and give protection against other cradiac events.

    If you will ask to quit Biso, you will probably get some other BB (Metoprolol, Atenolol, Nebivolol, Propranolol, Carvedilol etc) since you probably need to take them as a prevention against new cardiac events, which you sadly, already experienced.

    If you want to quit all BBs, you will experience a problem since you won't have a protection anymore, which you had for 17 years.

    Plus, if you have been taking 2 BBs for 17 years, if you quit both of them, you will probably experience extremely hard and long withdrawal.

    And since you already had cardiac arrest, a hard withdrawal could easily (my opinion) cause lots of dangerous arrhytmias, angina, rebound too high blood pressure and heart attacks.

    If you'll want to quit both BBs (and now Bisoprolol), please consider those withdrawal problems also.

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    • Posted

      If you felt better on those previous 2 Beta blockers, maybe you should ask to take only one of them, if possible.

      Since you had less side effects on those two.

      About Bradycardia, for example, if you had a HR 70 before a caridac arrest, with one BB, your HR will drop to let's say 50-60, and with 2 it will drop to 40.

      If you remove only one out of those two BBs, maybe it will be good enough for you since you will have a higher HR (probably 45-60), and maybe you will still get enough of a protection from only 1 Beta blocker which you were taking for 17 years.

      Bisoprolol will do the same thing as those 2 BBs which you have been taking. But if those 2 caused less side effects, maybe it would be better to stick with one of those two.

      Ask your doc about all possible options.

      Good luck

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    • Posted

      Thank you Bob for an excellent explaination as to why my medication was changed, which has also answered my concern as to why I should have Bradycardia now. Ironically I was monitoring my BP/HR weekly until about November time.

      The two drugs I was on were Amlodipine & Atenolol and my discharge notes say I should go back to my GP to go back on Amlodipine at a lower dose if my blood pressure goes back up again.

      I never had any noticable side effects with either of these drugs.

      I had never experienced palpitations before and they are quite frightening for one thing and the side affects I am experiencing with the Bisoprolol are quite another. Getting a blood whooshing sound in my ears is the latest. I am age 58 by the way. Thanks again Bob.

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    • Posted

      No problem.

      But about Amlodipine and Atenolol, only Atenolol is a Beta blocker (even though one of the oldest, which can be both a good and bad thing since it can have more side effects in some people, but on the other hand since docs are using it for 30-40 years, it surely is working well and it is a proven Beta blocker).

      Amlodipine is a Calcium channel blocker. A medicine that also lowers blood pressure and prevent arrhytmias and cardiac events, but it's mechanisms are different than Beta blocker's. Calcium blocker doesn't effect adrenaline and a central nervous system, so they don't mess with our brain, anxiety and other side effects which can occur when you mess with our central nervous system.

      Further, some Beta blockers mess more with our brains (Atenolol doesn't mess that much since it is a hydrophilic drug and it doesn't cross a blood-brain barrier. Bisoprolol is 50:50 lipophilic and it crosses a blood brain barrier to some extent). Nebivolol, Metoprolol and Propranolol mess with a CNS even more (they are 100% lipophilic drugs). For example one scientific study:

      "Previous investigations have suggested that hydrophilic beta-blockers, which appear at low concentrations in brain tissue, are less likely to produce CNS-related side-effects than are lipophilic beta-blockers, which occur at higher concentrations in the brain. The validity of this hypothesis was tested in a double-blind crossover study in which the hydrophilic beta-blocker atenolol was compared with the lipophilic agents metoprolol and propranolol, in 14 patients with a previous history of nightmares or hallucinations when treated with lipophilic beta-blockers. Nightmares or hallucinations were reported by all patients receiving lipophilic beta-blockers but by only three patients receiving atenolol. The total number of episodes was significantly lower (p less than 0.01) for patients receiving atenolol (8) than for those receiving lipophilic beta-blockers. It is concluded that atenolol is significantly less likely to provoke nightmares and hallucinations than are the lipophilic beta-blockers, metoprolol and propranolol. It seems likely that this finding is due to the differences in hydrophilicity amongst these drugs."

      So, you haven't been taking 2 beta blockers, but only one Beta blocker (Atenolol) plus a Calcium channel blocker Amlodipine.

      Amlodipine doesn't affect our brain and Atenolol is a BB which affects the brain in the lowest amount compared with other BBs (even though Atenolol has some other bad things, as every drug).

      So, you have been switched from 2 drugs which don't affect your brain to only BB (Bisoprolol) which is slightly stronger than Atenolol and it affects your brain, so this is one of the reasons why you are feeling different since brain and central nervous system (breathing, anxiety, dreams, memory) are affected different by different BBs.

      I think that I have read a few Months ago that Bisoprolol is strongest out of these BBs in terms of lowering a heart rate and blood pressure compared with the oldest Atenolol (which is weaker) and Nebivolol (the newest BB) which is the weakest in lowering Blood pressure and heart rate.

      So, your doc probably wanted to switch from 2 drugs of a medium strength (Amlodipine and Atenolol) to a one drug which is slightly stronger (Bisoprolol).

      Talk to your doc about all options, and since you probably need one BB, maybe Atenolol alone without Amlodipine or maybe slightly higher dose of Atenolol (since you will take only one drug now) could do a trick in your case to both prevent your heart, to avoid too slow heart rate (when you take 2 drugs) plus to avoid strong side effects (which you have on Bisoprolol).

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    • Posted

      Very very interesting, knowledgeable and so informative.  Useful to me too as I've just been put on amlodipine, and worred as I've only seen negative comments on here.  I'm also on Sotalol and dabigatran, having been taken off bisoprolol 3.75 as it failed and I had 3 A.Fib attacks in a year.  It had worked brilliantly for 7 years, so I guess our bodies get used to these drugs, am I right Bob?  Thank you for all your knowledge.  All the best. 

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    • Posted

      Sorry, I tried Bisoprolol for one year and Nebivolol for one year, plus Metoprolol and Atenolol for a few weeks (all of these four are Beta blockers), so I don't know about other drugs, except basics.

      About AFib, my doctor told me that people with it usually get more and more episodes over the years.

      Maybe your disease worsened, maybe Bisoprolol stopped working in your case, maybe you had random episodes which would occur no matter which drug you would have been using in that moment.

      Sotalol is Beta blocker+antiarrhytmic drug, so it is somewhat similar to Bisoprolol (it is even stronger).

      In your case, maybe one drug (Biso) was not enough, so a doc opted for a combination of 2 antiaarhytmic drugs (Calcium channel blocker Amlodipine and Beta Blocker+antiarrhytmic drug Sotalol) plus anticoagulant Dabigatran.

      For example, my dad is taking 3-4 drugs for a blood pressure.

      He started with only one, but over the years when it wasn't enough, they gave him another one. When that wasn't enough, he was given a 3rd drug on top of these two etc.

      So, you see, they usually start with one drug.

      If you will be better after that drug, that's good.

      But if it is not enough, you will either need a larger dose of that drug or 2 drugs (a current drug plus a new drug, or two new drugs instead of this drug etc.)


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    • Posted

      Thanks again. I wasn't sure about Amlodapine when I said it was a BB and I couldn't easily check. What effect if any do BBs have ectopic beats which are my other worry at the moment?

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    • Posted

      BBs, Calcium channel blockers and all other drugs which regulate heart and heart rhytm are unpredictable.

      You can have a good heart rhytm and take BBs only for Blood pressure and develop an arrhytmia from BBs.

      You can have some arrhytmia, take BBs and even worsen your condition.

      But, in majority of people, BBs will slower down your heart and lower a blood pressure.

      New, unwanted arrhytmias or other cardiac events are side effects. Drug companies didn't want to cause that, but it happens and it is a part of a risk.

      So, about ectopic beats, BBs and all these drugs should in general lower the number of those incidents, but in some people, it can turn into worse than you had before BBs or you can get them even though you didn't have them at all before taking BBs.

      Emis Moderator comment: I have removed the link as users can easily find the information using a search engine for drug induced arrhythmias rather than linking to a specific website. If users want the specific link use the Private Message service to exchange.


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    • Posted

      This post is singularly the most informative and helpful post I've seen, thank you. I have just this week changed from nebivolol to bisoprolol, I take warfarin along with it. I changed because I was getting breakthrough palps from the AF with the low dies of nebivolol I was on (1.25), for 4 years, so I asked for bisoprolol, thinking it's better for heart rate, but yesterday my resting heart rate was 112, do you think it's just the change?  I already have tinnitus, and realise bisoprolol may make it worse, if that possible!!  I'd much appreciate you view on it.  

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    • Posted

      I was taking Nebivolol at first for a few Months and then I was switched to Bisoprolol (1,25 Mg of Nebivolol and 1,25 Mg dose of Bisoprolol). So, it was the same dose and the same change as yours.

      When I have started to take Bisoprolol, I felt strange for the first 2-3 Months, I had some anxiety and some strange feelings in general.

      I thought that it was Bisoprolol, but since those problems disappeared after a few Months, my current opinion is that it was a withdrawal from a Nebivolol.

      They are both Beta blockers, but each one of them works slightly different.

      My opinion is: imagine that you have 100 cells in your heart.

      Now, each BB will block 50 of those cells.

      But, my opinion is that for example Nebivolol will block cells with numbers 1 to 50 (this is just so that you can try to understand a principle).

      And those celles will be under the influence of Nebivolol while you are taking it.

      So, cells from 1-50 are blocked by Nebivolol, and cells with numbers 51-100 are not affected by a drug.

      Now, imagine that Bisoprolol also blocks 50 cells, but for example cells with numbers 2, 4, 6, 8, 10 etc.

      Now, when you switch drugs, cells 2, 4, 6, 8, 10 etc will be protected again.

      But cells with numbers 1, 3, 5, 7, 9 won't be protected anymore with a new drug.

      Also, cells with numbers 52, 54, 56, 58, 60 etc which weren't affected on Nebivolol will be affected now by Bisoprolol.

      So, Bisoprolol will also block 50% of cells in your heart, but slightly different cells and slightly different mechanisms.

      The end result in terms of a lower heart rate and lower blood pressure will be the same.

      But you can experience some sort of withdrawal when switching from a drug to drug.

      Also, Nebivolol enters into our brain more than Bisoprolol, so it is possible that it affected brain, anxiety and dreams stronger than Bisoprolol.

      Now, when you quit Nebivolol, you can have some sort of a withdrawal due to each drugs controlling slightly different mechanisms and since those mechanisms in the brain are now without a drug suddenly.

      On the other hand, it takes a few days until a new drug builds up in your system, so that you can get a protection again.

      So, my opinion, this is either:

      1. Bisoprolol hasn't started working yet in your body

      2. slight withdrawal from Nebivolol which can last a few weeks

      3. or both no1 and no2

      Also, there are options that Bisoprolol is not working for you, or that it causes bad reaction (even higher heart rate etc).

      If possible, wait a few days to see whether it will get better.

      As you can see, these drugs are very strange and very unpredictable.

      Each person has a totally different reaction.

      Good luck

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    • Posted


      I love your informative posts. Am new to taking bbs also so the information you have given to others makes me feel more confident of asking you questions rather than my GP who is a bit dismissive of my worries about side effects. I am taking Bisoprol 1.25. Have done since had bad allergic reaction to a Volterol rub back in August. Left me with very fast heart rate and terrible anxiety and nerves. Am also on Amlodopine and Canderstartin for high blood pressure. My querie is the side effects that blight my every day. I have the most intense itch which is a 24/7 event. Also my nose randomly blocks, making it hard to breathe and panicking me big time as l relate it back to the allergy reaction when l was hospitalised. This happens every day and goes on through the night and am at my wits end on how to deal with it. Can't take any antiinflamatories so no nasel sprays. Am wondering if this is a usual reaction to bbs? Thanking you for any help or advice you can throw on this matter.

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    • Posted


      Each person has a different reaction to each drug.

      In your case, the simplest way to check it is: write down your side effects BEFORE taking a particular drug and then write down side effects after 1-2 Months of taking a drug.

      If you started to have some problems since taking a new drug, there are only a few options:

      1. new problems are caused by a new drug

      2. you suddenly have a new, mysterious disease which started exactly in the same moment when you started to take drugs (highly unlikely)

      3. some anxiety combined with a No1 causing a side effects of a new drug to look even worse (due to anxiety)

      So, majority of us have either No1 (problems are causes by a new drug) or both No1 and No3 (you do have some side effects due to a new drug, but then due to anxiety, we/you make it even worse).

      So, I think that your problems really came from a new drug. But also, always be aware of a point No3 to some extent.

      If Bisoprolol is causing you so many side effects, you can ask your doc for a different Beta blocker, like other popular drugs like Atenolol, Metoprolol or a newer one, Nebivolol. Nebivolol is usually good enough for lowering a high blood pressure, but sometimes too weak for stronger arrhythmias.

      If possible, ask for a lower number of tablets (15 and not 30 or 60), so if you won't like a new drug, you can go back to Bisoprolol or try a new drug in 2 weeks.

      My Gp was open for giving me different versions of Beta blockers a lot of times until I have found the one with the lowest amount of side effects for my body.

      I have personally tried Bisoprolol, Atenolol, Metoprolol and 4-5 different brands of Nebivolol and then I have found 2 versions of Nebivolol which were ok-ish and causing the lowest number of side effects (not the original brand, that one had too strong side effects in my case).

      In general, all Beta blockers have 90% the same effect on your body. There are slight differences since some of them are older, some are newer. Some are water/lipid soluble, some are excreted by kidneys/liver, some enter into our central nervous system more, some enter less.

      So, when you sum it all, they will all lower our heart rate, lower our blood pressure and prevent arrhythmias.

      But each of them has slightly different mechanisms of actions and thus different side effects.

      So, since there are 4-5 popular Beta blockers available, there is always a chance that some other Beta Blocker will suit you better.

      But please, try to write down your current side effects.

      And if you will try a different drug, write a new symptoms also and then compare which one of them causes less side effects for you. Good luck 

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    • Posted


      Thanks very much for your reply. I am definitely going to do what you suggest and whittle my problems down hopefully to whatever is causing the side effects.

      As l write my nose is blocked again. This is the side effect that bothers me the most really. The mad itching is secondary to this although that mostly disturbs my sleep.

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  • Posted

    I'm so happy to say that following a conversation with the hospital pharmacist I have been taken off Bisoprolol and back on Atenolol which I have been on for 15 years without any problems. The side effects of Bisoprolol were ruining my life. I know only two percent of patients suffer but I had three of the worst side affects.

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    • Posted

      I am happy for you David.

      You doc says that only 2% of BB patients suffer.

      But I have read some info that up to 25% of people on BBs eventually ask for a different drug because of bad side effects.

      Anyway, good luck.

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    • Posted

      Hey david can I please ask what your side affects were ? I've been on bisoprolol 2 weeks and the past week I've felt awful - so tired achey pain in my back chest arms cold feet and fingers shakiness inside and generally not with it !!!! I was on atenolol for a few years with no problems so may ask to switch back ......

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    • Posted

      All of the above you mention plus dreadful hallucinations and nightmares.Very dry mouth & throat. Put on them twice while in hospital and I requested to be taken off and other drugs substituted. Home now and back on Atenolol (which has served me well for 15 years) and Ramipril which gives me a dry mouth and funny taste but is not nearly as bad as bisoprolol.

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    • Posted


      I felt tired, too low blood pressure, too slow heartbeat, too slow breathing (as if my lungs were sleeping all the time), feeling tired, feeling as if I have flu all the time, feeling as if a truck has hit me, inability to walk on some days (as if something is holding me down and doesn't allow me to make more than a few steps).

      If you felt better on Atenolol, maybe you should go back on it, since they are both Beta blockers, but each person reacts differently to each drug.

      Good luck


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