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@vjs003 Well, according to the electrophysiologist I saw a number of years ago, it really isn't necessary to gradually wean off a small dose of metoprolol, ie, 12.5 mg/day would be a small dose. He didn't define what a small dose would be, other than the examples of 12.5 mg or even 25 mg/day. I was stopping metoprolol at the time under his care, and switching over to diltiazem to see if this would improve my bradycardia and still control the tachycardia. I had to taper off gradually from a dose of 150 mg/day, and his instructions were to do this over a three week period, ie, from 150mg to 100 on week 1, 100 to 50mg on week 2, and 50 to 25mg on week 3, then none at all ( though I was switching to dilatiazem, which as it turned out neither controlled the tachycardia or stopped the bradycardia). I did experience some of what I'd consider rebound effects, which included feeling "hyped up and jittery" for about 2 weeks. My blood pressure was still controlled by the other meds I took, and the tachycardia, well, that'd been a part of my life for quite a while anyway, but well controlled by the metoprolol. Without it, well, it wasn't pretty since the diltiazem didn't do much to control it.

I know the metoprolol package insert states pretty much the same thing you've listed in your post, but the package insert does not indicate at what dosage of metoprolol tapering off the medication should occur when it's being discontinued. As it's been often repeated, one shouldn't discontinue a medication without the knowledge, instructions and guidance of the prescriber, and I think guessing at how much to continue tapering off metoprolol ad infinitum is a sure fire way to drive oneself crazy. I've seen comments from people trying to taper off an initial 25 mg/day metoprolol dose by half, then half again, then one more half, and so on till it seems they're trying to cut a salt-grain size pill particle by half yet again and wondering why they can't find that sliver after their pill cutter made short work of it- all the while going on and on about the miserable "side effects" they're still perceiving and complaining that the metoprolol is the worst drug on the planet. That's got to be frustrating for them, and if those "side effects" are real and continue, it'd be better to investigate their real causes and not continue to blame them on a drug that was discontinued some time before.
Seems to me the best way to go about tapering off a drug like metoprolol is to ask for and follow specific instructions from the prescriber, starting with the dose the person is taking, exactly by how much and how long to continue the tapering off process.

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Replies to "@vjs003 Well, according to the electrophysiologist I saw a number of years ago, it really isn't..."

@marybird Hi, I have bradycardia with the metoprolol but that is good I guess cause of the apical aneurysm makes for a less forceful heart beat being warranted. That is the pits that you have that tachycardia when off metoprolol so did the dr put you back on metoprolol cause you mentioned that did control it? Do you get enough calcium and magnesium? Those minerals help heart rhythm I think.