How can a patient safely taper off bisoprolol 2.5 mg who used it once daily? What schedule can he follow to taper off gradually? Any reference/paper/textbook for doing this?
In absence of angina or evidence of on going ischsrma , Bisoprolol 2.5 mg can be taperrd over 1 week. Ref: Medical News Today, May 23, 2018.
Can be reduced to 1.25mg at 4th day and discontinue at 7th day.
Dr.Chowdhury, can you elaborate more on taperring over 1 week? You mean she will take the 2.5 mg once daily dose as she already takes for the first 3 days, then on the fourth day, she will start taking the 1.25mg dose, the same goes for the 5th and 6th day, and then discontinue at the 7th day? Is that what you mean? Given that she took Bisoprolol for a month
The schedule I mentioned earlier was for a patient who were deescalting from higher doses.
Depending upon the patients why she was on bisoprolol and her condition is stable for how many days,her dose tapering can be done over 1week. The schedule of tapering has to be individualized .
For example if the patient has been well stabilized (for the ailment she took the drug ) for last 2weeks, then drug can be reduced to 1.25 mg from. day1 and discontinue at day 7 if her condition is still stsble.
Is there any reference or paper I can read that can help me in my decision?
Dear Mostafa Elsersy, I have already given you the reference.
Bottom line is you should reduce the Beta blocker Bisoprolol over atleast 1 week.
In clinical practice some times dose escalation or descaling depends upon individual patients. Generally guide line do not /can not dictate or formulate each dose schedule for individual condition.
It takes 3 days to get wash off of Bisoprolol. So you should not change it before 3 days. On the other hand if you need to reduce much cautiously you can reduce it by two or three instalments (0,625 mg in each instalment) with a gap of atleast 3 days and which may take time longer than 7 days.
Hello
In my opinion, bisoprolol tapering should be done in accordance with drugs in this category that have a long half-life.
For beta blockers with longer half-lives that are administered once daily (eg, atenolol, long acting metoprolol, nadolol), we have patient take one-half their usual dose once daily for one week, then one-half their usual dose every other day for a week, then stop the medication. However, beta blocker withdrawal can be accomplished in less time if necessary, usually by taking one-half the usual dose every other day for a week.
References
WWW.UPToDate 2021.com.
Best wish,
Mousavinasab
Dear Seyed Ruhollah Musavinsab. I fully agree with you. But ocassionally patients need to be individualized.Excepting renal failure, I prefer to give drugs at usual interval.
I need two weeks for this task half the dose for 1st week then every other day for next week
Dear Chowdhury/Chaudhury Meshkat Ahmed. I agree with you. Individual characteristics are important in prescribing and managing medication
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