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Metoprolol Extended Release Withdrawal
Hi, I’m new here. First, I suffer from anxiety, esp health and medication anxiety. I’m certain many will roll their eyes at this post, but my concern is real to me. Also, I already know I’ve done a stupid thing by trying to wean off without talking to my doctor. So please don’t lecture me about that. I’ve researched this quite a bit over the last week.
Back in late 2019 I was having heart palps. I’ve always had some here and there but there was a period where they got worse and weren’t going away. I saw a cardiologist who did all the usual, an ECG, echo, stress test, holter monitor. His notes said: ECG-NSR (is that normal sinus rhythm?), Echo-Essentially normal, Holter-SR, frequent APCs associated with reported palpitations, Treadmill Test-Normal at 9:30 minutes. He said everything was fine and they were benign palps. He prescribed 10mg propranolol to take as needed. The palps stopped on their own and I never even tried the medication.
Enter COVID and my health anxiety went through the roof. During the lock downs my BP was spiking to hypertensive crisis levels and scaring me, but when I was able to get calm it was normal or only slightly elevated. I had several phone appointments with the same cardiologist and he ended up prescribing metoprolol extended release. I started at 25mg and immediately cut to 12.5mg, but both doses had my BP going too low. I ended up quartering the 25mg tablet. So I was taking 6.25mg and my cardiologist was aware. His notes say: palps well controlled with low dose metoprolol 1/4 of 25mg pill. In 2021, per a phone appointment he switched me to propranolol 10mg every 4-6 hours as needed for palps. I think it was bc I was concerned the metoprolol was still taking my BP low. I never made the change though and have stayed on the 6.25mg ever since, because I don’t like messing with medication due to my anxiety.
Then my cardiologist moved to another state. I didn’t find a new cardiologist but did find a new primary care Dr bc my old one moved way across town. As my prescription was running out, I provided her with my med records from the cardiologist and she refilled the metoprolol prescription with me quartering the 25mg tablet for a daily dose of 6.25mg. She did also write me the same propanolol 10mg prescription for twice a day (but I remember her saying I could take it only once a day if I wanted) in case I ever wanted to try that instead. She commented that metoprolol is a strong medication. I never did switch and stayed on the 6.25mg of metoprolol.
Last Monday, I took my BP prior to my morning meds and noticed that my HR was in the mid 40s. That triggered my health anxiety and I didn’t take the metoprolol that day and decided I shouldn’t be taking this at all and I started reading about how to wean off it. Yes, I know you should consult your Dr but mine is out of town until April. After much research, I decided that because I really can’t get any lower on this dose (and I suspect a Dr if asked is going to sigh and say just stop it), I decided to cut it in half yet again (now I’m getting around 3.12mg) and take that for a week, then take the 3.12mg every other day for another week, then stop.
I’m on day 6 of the 3.12mg and I’ve noticed a lot of more anxiety (probably a combination of the reduced dose and my medication anxiety) and that my HR walking around the house doing light housework is going up in the low 100s. Frankly, I don’t know what it normally is, but I convinced myself it was too high. It’s hard to say if it’s the reduction, my anxiety, or a combination. My BP is about like it always is with a few spikes when I was super anxious, but they came back down when I calmed down.
So, with this information, I don’t know if I should go back to my usual dose and wait to talk to my Dr when she returns in April, or if I should hold at this new dose and wait to talk to her. I’ve scared myself too much to try to continue the taper.
Thank you for reading all this. I know I’m a mess.
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@plumto66 I've been on metoprolol for roughly 2.5 years. For me, also, it has some adverse side effects. I'm on it because I was sitting peacefully in my PCP's office for a wellness checkup in JAN 2024 and the EKG showed my HR was at 117 and I was in atrial flutter (but I felt just fine). My typical resting HR was closer to 48-52 at that time. Was much lower (high 30's to around 42) when I was much younger; am 75 now and was very athletic my entire life (since around 8 years old); baseball for 12 years, regular racing on my bicycle for timed trials 10-12 years old, miler, x-country varsity, ice hockey, soccer, more bicycle training and some racing, road running and racing including marathons (high weekly mileage volumes starting at 28 years old), regular HIIT added to endurance exercise for ten years prior to the ambulance trip to the hospital from my PCP's office in JAN 2024 and sustained, pretty intense endurance exercise for decades . You may know metoprolol is a beta-blocker. Like you, it suppresses my HR. And when trying to elevate it during exercise, the experience is very unnatural. I used to do 80-95% of max HR during HIIT, but my cardiologist says don't go above 75% because, sporadically, as I push the effort higher to try to get. to even 70% max HR, it will surge to 125, 140 or possibly higher. When I stop, it comes down to around 75 bpm pretty rapidly; my paced HR is 70. So, you might have a conversation with a/your cardiologist to see if switching to a calcium channel blocker such as diltiazem would be better for you; it may be no better. Others might suggest, if possible, to consider an ablation to try to remove the arrhythmia with the goal of getting off anti-arrhythmic drugs like metoprolol (or diltiazem). Or try electro-cardioversion before trying an ablation.
kly2024 I understand the health/medication anxiety completely. Going through that now. Recently started with meds to help interrupted sleep and now considering some anxiety meds (although have tried a couple and it drops my sodium levels) . I have been on Metoprolol ER 25mg for tachycardia since 2019 after noticing a 120 HR when I checked my watch for the time (while sitting in a presentation). I was then diagnosed with afib in 2022 when I had off and on high HR . I also had bouts of bradycardia (low HR). My doctor suggested a pacemaker. I thought the afib might be causing some of that (extremely high HR , then would drop suddenly). I chose to have an ablation in that year and have been doing well. I have asked the doctor about coming off of the metoprolol because I have not noticed any high HR but he thinks I should stay on it. I hope you find what works for you ...but I would consult a doctor/cardiologist about your concerns now and not wait to see your regular cardiologist. (is she is an office with other cardiologists ?)
@miguela24 I would recommend you urge your doctor to consider changing your blood pressure medication, Metoprolol and other similar blood pressure medications are known to have side effects such as swelling of the calves and ankles. Also, some patients react to the medication with getting heart arrythmias or other side effects, such as being allergic to the rxcipents (fillers) in the metoprolol (my sister had that). I was taking metoprolol for quite a few months. I kept taking blood pressure readings each day and results never showed a drop in my blood pressure. I had to switch to hydralazine. So, it's my way of saying that people react differently to certain medications, so do not be surprised if it happens to you. Shortness of breath is truly very troubling.