Managing Bisoprolol Discontinuation: Heart Palpitations and Anxiety Concerns

Issues related to discontinuing Bisoprolol?

Due to palpitations and chest tightness, my doctor prescribed propranolol, but since there was no improvement, I was later prescribed Bisoprolol 5mg.
I took one pill a day for over a month, but then my blood pressure dropped to around 90/50.
I subsequently visited a psychiatrist who suggested I might have an anxiety disorder and recommended that I stop the medication.
I began tapering down to 2.5mg for a week before stopping completely.
After discontinuing the medication, I did not feel any discomfort.
However, on the fourth night after stopping, I took an anti-anxiety medication (Oxazolam 10mg) before bed and woke up an hour later with my heart rate jumping from 90 to 120, experiencing tightness in my chest and numbness in my hands (which I had never experienced before).
In response, I took half a pill of Bisoprolol and went to the emergency room, where blood tests, X-rays, and an ECG all came back normal.
In the past few days, my heart rate has been fast (around 85-95) whenever I get up in the morning.
Should I continue taking Bisoprolol?

Xiao Mai, 20~29 year old female. Ask Date: 2022/05/14

Dr. He Dongjin reply Cardiology

Hello, it is recommended to take 0.5 tablets before bedtime and then monitor your condition.
Changhua Hospital cares about you.

Reply Date: 2022/05/14

More Info

Managing the discontinuation of Bisoprolol, especially in the context of experiencing heart palpitations and anxiety, can be quite complex. It’s essential to understand the interplay between medication, physiological responses, and psychological factors.

Bisoprolol is a beta-blocker commonly prescribed for conditions such as hypertension, heart rhythm disorders, and anxiety-related symptoms. It works by blocking the effects of adrenaline on the heart, which can help reduce heart rate and blood pressure. However, discontinuing beta-blockers can sometimes lead to rebound effects, including increased heart rate and anxiety, particularly if the medication is stopped abruptly or if the dosage is reduced too quickly.

In your case, it seems that after discontinuing Bisoprolol, you experienced an increase in heart rate and feelings of tightness in your chest, which can be alarming. The fact that your heart rate increased from 90 to 120 beats per minute after taking Oxazolam, an anti-anxiety medication, suggests that anxiety may be playing a significant role in your symptoms. Anxiety can manifest physically, leading to symptoms such as palpitations, chest tightness, and even numbness in the extremities. These symptoms can be distressing and may mimic or exacerbate underlying cardiac issues.

Given that your recent medical evaluations, including blood tests, X-rays, and an electrocardiogram (ECG), returned normal results, it is reassuring that there are no immediate cardiac concerns. However, the persistent elevated heart rate upon waking and the feelings of anxiety warrant further exploration.
It is important to consider the following points:
1. Re-evaluation of Medication: Since you have experienced significant symptoms after discontinuing Bisoprolol, it may be worth discussing with your healthcare provider the possibility of resuming a lower dose of Bisoprolol or considering alternative medications that can help manage both your heart rate and anxiety. The goal would be to find a balance that alleviates your symptoms without causing significant side effects.

2. Anxiety Management: Since anxiety appears to be a significant factor in your symptoms, it may be beneficial to continue working with a mental health professional. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can be effective in managing anxiety and its physical manifestations. Additionally, medication adjustments, such as optimizing the dosage of Oxazolam or considering other anxiolytics, may be necessary.

3. Lifestyle Modifications: Incorporating lifestyle changes such as regular physical activity, mindfulness practices, and relaxation techniques can help manage anxiety and improve overall cardiovascular health. These strategies can also help mitigate the physiological responses associated with anxiety.

4. Monitoring Symptoms: Keeping a detailed log of your symptoms, including heart rate, triggers, and any associated feelings of anxiety, can provide valuable information for your healthcare provider. This log can help in tailoring your treatment plan more effectively.

5. Follow-Up Care: Regular follow-up appointments with both your cardiologist and mental health provider are crucial. This collaborative approach ensures that both your physical and mental health needs are addressed comprehensively.

In conclusion, while it may be beneficial to consider resuming Bisoprolol or exploring other treatment options, it is essential to do so under the guidance of your healthcare provider. The interplay between anxiety and physical symptoms can be intricate, and a multidisciplinary approach may yield the best outcomes for your health and well-being.

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