The affect of beta blockers on adrenaline and cortisol levels.

I have hypertension but was prescribed metoprolol by a cardiologist for SVT, tachycardia. I will have to look back and see when I started taking this med in comparison to when my pmr was diagnosed.
I have tapered below 5mg a few times. I am at 2 mg right now. I have markers tested the first of every month. The last two months were normal. My crp last Friday was slightly elevated, 5.4. Normal is less than 5.0.

I think beta blockers like metoprolol mostly block the effect of adrenaline rather than decrease the production of adrenaline.

"Beta blockers are medicines that lower blood pressure. They also may be called beta-adrenergic blocking agents. The medicines block the effects of the hormone epinephrine, also known as adrenaline."
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522
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Adrenal insufficiency in the context of taking Prednisone refers to a low cortisol level that is a side effect of prolonged Prednisone use. I don't see how metoprolol will have any effect on our cortisol level after Prednisone has suppressed the production of cortisol by our adrenal glands.

I might be wrong. I only know the endocrine system is extremely complicated.
https://www.ncbi.nlm.nih.gov/books/NBK537260/
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I have a visit with an endocrinoloist in December, If you have any specific questions I can ask my endocrinologist when I see him. I have some endocrine problems from long term Prednisone use that we are still trying to resolve.

My blood pressure shot up to 210/110 when I was on Prednisone. My extremely high blood pressure caused left ventricular hypertrophy (LVH) and some cardiac arrhythmias. I needed 3 blood pressure medications to get my blood pressure under control when I was on Prednisone. Now I'm off Prednisone and I don't take any blood pressure medications anymore.

I have bradycardia but no current symptoms. I was only symptomatic when my cortisol level was too low when I was tapering off of Prednisone.

The language used to describe the affects of certain drugs in my opinion are designed to make the medications sound better than they are. Beta blockers "prevent the release of adrenaline and noradrenaline in certain parts of the body". They highlight the heart as a "certain part" because that's what the med is prescribed for. They can also affect lungs, kidney function and blood sugar levels, so the reduced function and production of adrenaline is more widespread through the body.

As I understand it, cortisol follows the production of adrenaline - adrenaline stimulates the production of ACTH (adrenocorticotropic hormone) which is what stimulates cortisol production.
"The body releases cortisol after adrenaline, when the immediate stress has passed but the body still needs to cope."
(Cleveland Clinic)

Having adrenaline blocked in the heart and sometimes the lungs are significant places for it to be blocked. That's where natural adrenalin is used most, as well as in allergic reactions, so it would make sense that normal adrenaline production would drop with beta blockers.

I mentioned this to my doctor after starting on prednisolone, but as doctors do, she wouldn't discuss the beta blocker, or the dosage, or the possible interaction with prednisone because it was prescribed by a cardiologist years ago. From the general practitioner's bible: never tread on a specialist's toes, right or wrong. So I reduced the beta blocker gradually myself last year to half the dose, then let my doctor know. She said nothing about it but watches my blood pressure which is always still normal or slightly low. I believe the medication reduction was only possible because of a complete overhaul of my diet to low carbohydrate eating and eliminating processed food last year.
NOTE: do not reduce beta blockers yourself. Sudden reductions can be very bad for your health.

I have a new doctor for the next year, so I'll ask him for his thoughts on all this at the next appointment.

After seeing “megzies” post this AM, I queried my cardiologist on the topic during a scheduled appointment.
My PMR has been in remission for about 10 months, I am down to 2.0 prednisone, decreasing 0.5 per month, and I have been on metoprolol ER 25 for about 18 years following a major MI and bypass. My BP today was 124.
Her feeling was that on my low metoprolol dose, there would be no or negligible effect on cortisol production or availability as I continue to taper.

That consult with your cardiologist was quick. I only posted this less than a day ago.

I'm also currently on 25mg of metoprolol, having reduced last year down from 8yrs on 50mg following a heart attack. My BP yesterday was 116/78. I see there are new articles coming out this year calling metoprolol an "older" blood pressure medication which should be reviewed for some people as it affects things other than what's being treated. It also reduces melatonin production, so I take a small dose of melatonin each day to help with sleep, and renin production in the kidneys which affects salt/potassium balance, the same as prednisone does.

Good to hear that you're able to reduce prednisone to 2mg so far while taking 25mg of metoprolol. That gives me hope.

My appt today was scheduled 4 mos ago. Just happened to see your post before leaving for the appt. Fortunate that we could get at least one doc’s thoughts. I also saw the info about metoprolol being “older”, but the newer ones come with their own baggage.
Good luck !

True, I didn't like the look of the newer ones either.
A bit of luck is what we all need. Thanks!

It is difficult to be hopeful when a person is still on prednisone. The following was inspirational to me. Everything was explained to me by a person who had an adrenal crisis. Her only motivation was to spare me the same fate. She said the following to me before she died.

"A person with low cortisol often will experience erratic bursts of adrenaline - anxiety, rapid heart rate, flustered mood. Adrenaline is secreted as a means to compensate for lowering cortisol as the Pituitary/adrenal duo falters. Insomnia is another frequent manifestation of waxing and waning cortisol.

As cortisol is dependent for life, the body will do everything in its power to compensate for a slowly failing Pituitary-adrenal axis. The Pituitary gland does not falter without a good fight. Waxing and waning low cortisol symptoms, feeling OK one day and feeling as though you have been hit by a Mac truck the next day, reflect this insidious downward trajectory.

The body produces about 5 mg of hydrocortisone/cortisol a day. An external/exogenous dose of prednisone in excess of 5 mg a day is where the pituitary suppression and adrenal gland atrophy originates. Anything above 5 mg of exogenous steroid a day (oral prednisone) and the Pituitary gland correctly “reads” that it does not need to tell the adrenal glands to secrete cortisol. The oral dosing is covering (in excess) the body’s daily need."
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First I had to find a way to stay on less than 5 mg of prednisone daily and stay there. My luck came when my rheumatologist wanted me to try Actemra and I was able to taper down to 3 mg. I stayed on 3 mg per day for nearly a year before my cortisol level improved.

It wasn't helpful when another source was telling me to increase my prednisone dose and it was okay to take 5 mg of prednisone for the rest of my life. I resisted the "prednisone fix" that was recommended by the other source and eventually everything started to improve.

The "prednisone fix" as you call it is the only way I can get out of bed and function relatively normally at the moment, so I'm not going to "resist" prednisone for now. Things for me may rapidly deteriorate rather than improve without prednisone, and I currently have no PMR pain and am relatively mobile on a split dose 6mg morn/1.5mg evening. The daily pain, immobility and sleep deprivation pre-prednisolone were intolerable, awful. So I can't be converted to a life-is-better-without-prednisone position till I have a reasonably good chance of that being true. Slowly and (hopefully) surely is the way I'll go with the meds reductions.

While we have active PMR, the body needs more cortisol to control inflammation than the 4-6mg equivalent that is usually produced. Otherwise our own bodies would have been able to fight off the PMR inflammatory auto-immune response without prednisone.

Actemra is probably not for me. I have latent TB (was exposed to tuberculosis as a teen but didn't develop the illness at the time) and a tendency to get digestive fungal infections, both high risk problems with Actemra.

"So I can't be converted to a life-is-better-without-prednisone position till I have a reasonably good chance of that being true."
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The above is really the essence of it all. I wasn't able to resist increasing my prednisone dose either. The treatment for adrenal insufficiency is more prednisone although hydrocortisone is preferred. My endocrinologist said something to me as I was struggling with the idea of stopping prednisone after "decades" of use. She said I "could" and "should" restart prednisone for any reason if I felt the need.

My endocrinologist wouldn't speculate about what "would happen" if I stopped prednisone because she didn't know. She just wanted me to know about things that "could happen" so some safeguards were put in place.

I never converted to the idea that prednisone gave me my life back. I desperately wanted to be off prednisone because my "quality of life" was almost nil when I needed to take prednisone every day.

Prednisone was very hard on my body when I used it "long term" however, "short term" use wasn't so bad. Basically, all the research in the world confirms this. My rheumatologist still prescribes prednisone for trips when I'm away from home just in case a need arises.
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I'm aware of the warnings about the increased risk of serious infections when a person takes Actemra. It is important to weigh those risks before starting Actemra. For me, I weighed the risks against the following: "Infection Risk and Safety of Corticosteroid Use"
https://pmc.ncbi.nlm.nih.gov/articles/PMC4751577/#:~:text=Observational%20studies%20have%20consistently%20demonstrated,risk%20of%20serious%20bacterial%20infections.
My rheumatologist was very concerned about taking Prednisone in combination with any other medication that suppressed my immune system. Fortunately, I was able to taper off Prednisone relatively quickly after Actemra was initiated. There isn't any concern about being unable to stop Actemra abruptly when an infection occurs.