Possibility of CTS symptoms arising from taking beta blocker bisoprolol fumarate (cardicor)

Elizabeth Rhodes

Good afternoon, Dr Bland.
The background (somewhat long-winded, I'm afraid!) to my question is as follows:
I am a 65 year old woman who has had Type 2 diabetes for the last 7 years, controlled to date by diet and exercise only.
Early in 2012, I was found to have high blood pressure and was prescribed an ace inhibitor - Ramipril tablets which proved to be suitably effective, even at the relatively low dose of 2.5 mg per day. I was also told to reinstate taking an aspirin of 75 mg daily, as previous opinion as to its continued use had now altered. All seemed to be well.

However, at a diabetic clinic appointment later in the year,concerns arose about an irregular pulse, with subsequent ECG's showing that my heart was producing excessive ventricular ectopic beats at the rate of between 12,000 to 15,000 beats in a 24 hour period. I was referred to Dr Kamalvand who performed an angiogram on 1st September, 2012. Thankfully, this procedure revealed no significant heart disease or narrowing of the arteries, so I was told to stop taking the Ramipril and was prescribed the beta blocker Bisoprolol Fumarate at 5 mg per day. I only managed to get to a level of 3.75 mg per day before the blood pressure results were adequately controlled and the ectopic heartbeats were reduced dramatically, so I have been recommended to continue to take this dosage ever since, in addition to the daily aspirin.

Initially, my symptoms were only slight, but they have significantly increased in severity week by week, which I think may be as a result of the accumulative effects of the Bisoprolol medication. I was warned that I could put on weight, and sadly I have gained about 5 kilos to date - I hope only due in part to the excesses of Christmas! Also, I have had a constantly runny nose since day one, which is listed in the notes of side effects as a rare allergic reaction to the tablets. This is unattractive and unpleasant, but bearable.

More disturbing are the problems I have with my hands. This started with a tingling sensation and feeling of numbness, particularly on waking in the night, or on getting up in the morning. This has become progressively worse and now seems to display the classic symptons of CTS. It is centered on the index, middle and ring fingers, along with the thumbs of each hand. It is occurring at all times of day and can be quite painful, especially when I am driving, carrying things or holding a book or a pen. Christmastime was particularly difficult as, with the family home, carrying the extra heavy shopping bags, logs and fuel for the fires and wrapping presents made for very painful, stiff hands!

In the early days, I also noticed that the fleshy part of my palms, at the base of the thumb on each hand, appeared blue or bruised in colour and that they felt sore. My hands are often painful now, depending on how much I have had to use them, and recently the ring finger on my right hand has felt stiff, painful and "locked" inwards on occasion. My GP noticed a negligible thickening of the palm at the base of this finger at our appointment in December. This bump is now much more pronounced, whilst a similar condition is emerging on my left hand too.

My latest concern is that over the last month I have noticed an intermittent vibration/tremor sensation on the left side of my left thigh, midway between the knee and the groin. This seems to occur in the evenings after I have been on my feet for most of the day, but it goes away after I have rested. I don't suppose that this is related in any way to CTS, and I am probably becoming neurotic, but I thought it was worth mentioning!

Apologies for rambling on, but I do hope my observations may be of some help to others experiencing similar problems.
Thank you for your attention.


The hand symptoms sound from the description like a combination of CTS and trigger digits but we will see what we find when I see you. Tingling extremities are in the side effects list for beta blockers but several caveats spring to mind

1) tingling extremities seem to be in the side effects list for 90% of the drugs in the pharmacopoeia if you look hard enough

2) tingling extremities are not equivalent to carpal tunnel syndrome

3) there is not actually any concretely proven link between use of beta blockers and developing CTS (unlike for example exemestane which clearly does cause CTS)

Given that CTS is very common it inevitably co-exists by coincidence with many other life events - including taking drugs of any kind - and it is often difficult to attribute causation. Sometimes it is possible to do trials of stopping and starting a drug to see if it has an effect on the symptoms but even that can be difficult because of the spontaneous variability of CTS. Diabetes is probably a risk factor for both CTS and trigger digits but even then the hard evidence turns out to be not quite as cut and dried as some of the textbooks would have you believe when you try to find original studies supporting the idea.

Finally  - you are right, I can't tie the thigh vibration into this at all. JB

Elizabeth Rhodes

Hello again!
Thank you so much for your prompt and reassuring reply. The overall view is obviously more complicated than my internet research implied and there are several other possible contributing factors to be considered.

It is so easy to get carried away by self diagnosis - I shall turn off my computer and wait for a proper consultation!
Many thanks once again for your advice.

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