What is the difference between bisoprolol and propranolol

Dihydropyridines such as amlodipine and nifedipine control blood pressure or angina. Non-dihydropyridines such as diltiazem and verapamil can also control blood pressure and angina and be used as part of a rate and rhythm control as well. Diltiazem and verapamil work by reducing the movement of calcium into the AV-node and in the arteries and veins.

This causes the force and rate of the heart's contractions to decrease. This relaxes the arteries and then reduces blood pressure BP. They can be used on their own or with other anti-arrhythmic drugs to enhance their effects. This usually means starting diltiazem at a dose of either mg once a day or 90mg twice a day. With verapamil, the starting dose is mg once a day or a split dose of either 40mg twice or three times a day.

Your starting dose will depend on your heart rate and blood pressure. Different preparations of medications will have different names. You need to keep taking the brand of medication as the different preparations will have different effects. If you change brands, you may find that your arrhythmia symptoms return, but check with your pharmacist if you think you have the wrong preparation. This will usually be done one to two weeks after starting the medication.

We will do this one to two weeks after you start your medication. The most common side effects patients who take this kind of medication have are feeling flushed and light-headed. You may also have headaches and swollen ankles.

This medication can cause a drop in BP for some patients, meaning they experience some light-headedness or dizziness. You may find that your ankles become swollen with this medication. This is because they widen your arteries and veins, but this should stop once you have finished taking the medication. If you know that you have severe heart failure known as left ventricular impairment you should not use verapamil or diltiazem.

These medications can reduce the contraction of the heart, which is not safe for those with severe heart failure. If you have mild or moderate heart failure you may be given diltiazem if other antiarrhythmics are not suitable for you.

If you notice any of the following you should contact your GP as soon as possible:. It works by slowing the electrical impulses through the AV-node, helping to control how fast the ventricles contract. Digoxin works best when you are resting, but for active people, it doesn't work as well on its own to control your heart rate whilst you exercise. We may use it in combination with other antiarrhythmics like beta blockers, calcium channel blockers or amiodarone. For those who have severe heart failure, this medication can help your heart beat stronger and improve the symptoms of heart failure.

You would take this medication once a day but may need to take a higher 'loading' dose initially. This can be taken either as a tablet or via intravenous injection. The dose will be between You would only need your Digoxin intake monitored if your doctor feels that the dosage is too low or if you are having side effects.

Side effects can also be related to your dosage being too high. If we need to, we can do a blood test to check the Digoxin levels in the bloodstream. We would check the levels around six to ten hours after you have taken the medication, so if you take it in the morning, we would check the levels in the afternoon. We may also do periodic checks on your kidney function, as digoxin is not removed from the body as well if you have impaired kidney function.

This medication is usually well tolerated by those taking it but if your dose is too high, you may start to show signs of toxicity. This includes:. This strategy for medication means that you would take a tablet as soon as you realise that you are having an AF episode. If you have been diagnosed with paroxysmal AF, your episodes may be infrequent, so you be told to use the 'pill-in-the-pocket' approach.

We will tell you to take a dose of your anti-arrhythmic medication when you have an AF episode to help stop it. These will include either flecainide, a beta blocker or possibly a calcium channel blocker. This approach works well if you are able to identify when an episode starts.

It also works well if you respond well to the medication you have been told to take, and know how much to take and when. If you have an AF episode that lasts for more than 48 hours, you should see your GP or get advice from your arrhythmia specialist. This may be because your treatment needs to change.

If this approach does not work for you, or your AF episodes happen more frequently, we may tell you to start taking the medication daily.

There are a few antiarrhythmics which can be used for the 'pill-in-the-pocket' approach or used regularly. Which medication you use will depend on any underlying heart disease, such as coronary heart disease, heart failure and hypertension. It will also depend on the side effects and how effective the drug may be.

Flecainide is a sodium channel-blocking drug, which slows the conduction carrying the electrical impulses within the heart. Its main purpose is to act on the atria and also slow conduction through the AV-node. It is very effective in treating episodes of AF and is often better tolerated than some of the other anti-arrhythmic medications. Its effect is more obvious with faster heart rates, which makes it very useful to control fast episodes of AF.

When you start taking flecainide, you will start on a low dose 50mg twice a day , with possibly going up to mg twice a day. If you are prescribed flecainide, you may also have to take a beta block or calcium channel blocker.

This is to protect the lower chambers of the heart ventricles from contracting too quickly. For patients with uncomplicated hypertension beta-blockers are generally a fourth-line option as angiotensin converting enzyme ACE inhibitors, angiotensin II receptor blockers ARBs , diuretics or calcium channel blockers are associated with better outcomes.

There is no evidence that one beta-blocker is superior to any other for the management of hypertension. Information on the management of hypertension is available from: bpac.

Beta-blockers are given acutely as first-line treatment post-myocardial infarction to decrease infarct size, increase the threshold for ventricular arrhythmias, and in the long-term, to prevent dysfunctional ventricular remodelling and heart failure. At 6—months post-myocardial infarction prescribers are encouraged to consider withdrawing beta-blockers from patients without atrial fibrillation or heart failure, if re-vascularisation occurred while they were being treated for their myocardial infarction.

If re-vascularisation did not occur the beta-blocker is likely to be required long term to prevent angina or if there is poor ventricular function. This is an evolving area of research and increasingly the evidence appears to support the withdrawal of beta-blockers from patients without other indications for treatment, e. Information on the management of acute coronary syndromes is available from: bpac. There are two reasons why the optimal duration of beta-blocker treatment post-myocardial infarction is uncertain: A systematic review of sixty trials that divided studies into either the reperfusion era or the pre-reperfusion era, found that beta-blockers reduced mortality in patients post-myocardial infarction in the pre-reperfusion era, but not the reperfusion era.

Guidelines support the use of a beta-blocker for one to three years post-myocardial infarction, 18, 19 but in practice they are now being stopped earlier in patients who are otherwise well, with no signs of angina or heart failure. The adverse effect profile varies between beta-blockers according to their properties Table 1. Tolerance to treatment may be improved with a slow upward titration of the beta-blocker until the maintenance dose is established. Table 2 summarises recommended choices of beta-blocker, depending on the indication, patient co-morbidities and adverse effects.

Beta-blockers should be started at a low dose and slowly titrated to maximum tolerated dose when used to treat patients with heart failure. For other conditions, e. Refer to the New Zealand Formulary for individual beta-blocker dosing regimens: www.

Begin treatment with a beta-blocker at a low dose and gradually increase this to the recommended dose or the maximum tolerated dose.

If adverse effects do not resolve, drop back to the previous dose and assess symptom control. Beta-blockers should generally be avoided in patients with asthma.

If a beta-blocker must be used in a patient with asthma, cardioselective beta-blockers, e. There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit to those with co-existing heart failure; 23 cardioselective beta-blockers are preferred. A systematic review which included 15 studies with a follow-up period ranging from one to seven years found that beta-blockers in patients with COPD significantly decreased overall mortality and exacerbation of COPD.

Cardioselective beta-blockers, e. Malaise, vivid dreams, nightmares and in rare cases hallucinations may be caused by lipid-soluble beta-blockers crossing the blood brain barrier. Table 2: Summary of indications, recommendations and considerations for the use of beta-blockers for cardiovascular conditions in New Zealand.

All beta-blockers are considered to be equally effective although bisprolol or metoprolol may be preferred. Celiprolol and pindolol tend not to be used. Celiprolol and pindolol have ISA which may reduce bradycardia or peripheral vasoconstriction. Water soluble beta-blockers, e. Polypharmacy: bisoprolol is less likely to interact with other medicines.

Renal dysfunction: consider dose adjustments for water-soluble beta-blockers, e. Respiratory disease: cardioselective beta-blockers, e. Bisoprolol or metoprolol; consider withdrawal after 6—12 months if re-vascularised and no other indications. Treatment with beta-blockers is generally long-term, but it should not be regarded as indefinite. Occasionally it may be necessary to temporarily withdraw treatment, e.

In the long-term, the emergence of co-morbidities may make management more complex and it is appropriate to periodically review the benefits and risks of treatment with beta-blockers.

Beta-blockers should be withdrawn slowly to prevent the onset of a withdrawal syndrome which in serious cases may include ischaemic cardiac symptoms, e. The risk of myocardial infarction is increased for older patients during the first month of withdrawal from cardioselective beta-blockers and this increased risk continues for six months.

There are no specific guidelines for withdrawing beta-blockers. The dose could be halved every week for patients who needed to withdraw from treatment more rapidly. We have now added the ability to add replies to a comment. Simply click the "Reply to comment" button and complete the form.

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If someone adds a reply to one of your comments or replies you will recieve an email notifying you of this. Most people taking beta blockers have either no or very mild side effects that become less troublesome with time.

Contact your GP if you're having symptoms that bother you or last more than a few days. It happens rarely, but some people have serious side effects when taking beta blockers. These are not all the side effects of beta blockers. For a full list, see the leaflet inside your medicine packet. You can report suspected side effects using the Yellow Card Scheme. For more information on the side effects of beta blockers, read about the specific medicine you take in our Medicines A to Z.

Most beta blockers are taken once a day, apart from certain beta blockers that are used during pregnancy and Sotalol, which is given 2 or 3 times a day. If you forget to take a dose of your beta blocker, take it as soon as you remember, unless it is nearly time for your next dose.

In this case, just leave out the missed dose and take your next dose as normal. Never take 2 doses at the same time. Lancet ; Should Beta-blockers remain first choice in the treatment of arterial hypertension? A meta-analysis. J Hypertension ; 5. PDF Guidelines for the management of arterial hypertension. Eur Heart J ; Agabiti Rosei E, Rizzoni D. Metabolic profile of nebivolol , a beta-adrenoceptor antagonist with unique characteristics.

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