1. < Heart Rhythm Conditions

How did you wean off Metoprolol?

Posted by kenny48 @kenny48, May 11, 2018

Hi,
I've been taking both flecainide and metoprolol now for eight years, as a prophylactic for Afib. I recently moved to North Carolina and have a new Cardiologist. Have had a lot of PVC's this past two months, and had to wear a heart monitor for an entire month. He said that although I had a lot of PVC's I didn't have even one PAC! He also noted that my BPM was low in the low fifties most of the time. He asked why I was taking metropolol. I told him that the only thing my previous doctor had said was " it makes the flecainide, work better". He suggested I stop taking the metoprolol to see how I do without it. Unfortunately I read a lot of information on the internet. I read that it can be very dangerous to stop taking it. I take 25 mg metoprolol succinate, split in half. Once in the morning with my flecainide, and then again in the evening for a second dose. He wants me to take half in the morning and skip the evening dose for two days, then stop entirely. Has anyone else stopped taking this drug in a similar manner? I'm worried that the cut off is too soon.

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alwayshope1 | @alwayshope1 | Apr 20, 2019
In reply to @afrobin "Hello Always Hope, After a period of AFib where I did not have 3 steady beats..." + (show)
@afrobin

Hello Always Hope,
After a period of AFib where I did not have 3 steady beats in a row all day, every day..to the point where I felt faint all the time and the Holter monitor malfunctioned. I was put on the maximum dose of a beta blocker, Sotalol. I felt like an old lady but I was only 46 years of age. For almost 2 years I took that drug. The cardiologist told me that my heart could stop at such a high dose and to try to reduce it even by a bit. Try as I might, even cutting out 1/2 a tablet of the 4 I was taking daily, sent my heart into a tailspin.
I read that exercise can reduce arrhythmia and palpitations and I joined a gym. I went every day but Sunday for 35 minutes on the treadmill and then strength training for another half hour. I gradually reduced the dose of beta blocker and my heart remained steady. I was elated! At the end of a month, I was completely off the beta blocker.
My cardiologist said it wouldn't last. I kept going to the gym for 4 months. My heart remained strong and steady...and here I am 24 years later and my heart is fine. No issues whatsoever.
But I am sure half the secret is: since that dark period 24 years ago, I have cut out all stimulants; absolutely no coffee, tea, Coke, decongestants, any ephedrine drugs used in dental freezing or supplements that can be stimulating and alcohol. I have a friend with AFib who prefers to take the beta blocker so that he can enjoy his wine and morning coffee. For me...no thank you! I would rather be off those drugs and their horrible side effects.
Whenever you can, go the 'changes to one's lifestyle' route. Exercise and avoiding stimulants. It worked for me and my extreme AFib. So, it stands to reason that it CAN work for others.

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Hi AF Robin, It's taken me a while and a lot of research to understand why I'm feeling this way, And by the grace of God in His wisdom He led me to the Mayo Clinic forum for more help and info. Unfortunately, now my mobility is diminished. I have still been taking the 12.5 mg in the morning. How did you gradually reduce your dosage? Thank you for the great advice and God Bless You.

REPLY
dr010196 | @dr010196 | Apr 21, 2019

I am wondering about how to wean off Metoprolol also. I had panic attacks as a teenager, and they disappeared once I was older. Once I was placed on Metoprolol XL 25mg, I began having more anxiety attacks which seen to be getting worse. I tried getting off of this with my University of Michigan physician but I felt terrible the entire time. I want to wake up late on the weekend. I want to go out of the country without thinking about having to take my pill on time. If not taken without 15 to 20min of the normal time, I begin having palpitations and panic. I want my life back.

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1 reply
healthytoday | @healthytoday | Apr 21, 2019
In reply to @dr010196 "I am wondering about how to wean off Metoprolol also. I had panic attacks as a..." + (show)
@dr010196

I am wondering about how to wean off Metoprolol also. I had panic attacks as a teenager, and they disappeared once I was older. Once I was placed on Metoprolol XL 25mg, I began having more anxiety attacks which seen to be getting worse. I tried getting off of this with my University of Michigan physician but I felt terrible the entire time. I want to wake up late on the weekend. I want to go out of the country without thinking about having to take my pill on time. If not taken without 15 to 20min of the normal time, I begin having palpitations and panic. I want my life back.

Jump to this post

"I want my life back." Yes, me too. Before I developed afib and heart failure two and a half years ago, I was a very active person on a ranch. But this illness took me down. I am lot's better, heart failure corrected etc. and also am on Metoprolol which is taken to slow the heart rate. This is working fairly well but I have little physical energy. Part of Metoprolol's job as I understand it, is to keep the heart rate lower and when I start exercising I am fighting this med not allowing the rate to move much higher. It's a confusing thing for my need for movement and my heart's need to not beat too fast. Yes, I'd also like a normal heart function but at 71 I am where I am. Trying to be at peace with this process, not able to make plans that can't be changed because I might be having a difficult heart day etc. On the other hand, I am grateful I function as well as I do and the illness is being managed.

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1 reply
AFRobin | @afrobin | Apr 21, 2019

My experience was that being physically active allowed me to lower my beta blocker dose. When I kept up the exercising month after month, I was able to get off the beta blocker completely. Of course, I NEVER drank coffee, tea, alcohol, went near smokers, or took any stimulant like decongestants etc.. I know I keep writing the same story but I can't tell who has read about my AFib cure. This happened when I was 46 over a 2 year period. Now I am 70 years old and have had the odd blip and skip but it is usually because I had some chocolate (stimulant) or a sugary meal. That scares me into total compliance with the 'NO stimulating foods or drugs regime'. I wish the same experience for everyone.

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1 reply
Soliloquized | @soliloquized | Apr 22, 2019
In reply to @healthytoday ""I want my life back." Yes, me too. Before I developed afib and heart failure two..." + (show)
@healthytoday

"I want my life back." Yes, me too. Before I developed afib and heart failure two and a half years ago, I was a very active person on a ranch. But this illness took me down. I am lot's better, heart failure corrected etc. and also am on Metoprolol which is taken to slow the heart rate. This is working fairly well but I have little physical energy. Part of Metoprolol's job as I understand it, is to keep the heart rate lower and when I start exercising I am fighting this med not allowing the rate to move much higher. It's a confusing thing for my need for movement and my heart's need to not beat too fast. Yes, I'd also like a normal heart function but at 71 I am where I am. Trying to be at peace with this process, not able to make plans that can't be changed because I might be having a difficult heart day etc. On the other hand, I am grateful I function as well as I do and the illness is being managed.

Jump to this post

We all respond differently to medications, to some degree. But I'm taking, for various ailments:

Phenytoin 500mg as 200mg AM and 300mg PM

Metoprolol Succinate 350mg as 200mg AM and 150mg PM
Metoprolol Tartrate 25mg mid afternoon.

The Metoprolol, my pharmacy had to clear the extra little bit of Metoprolol Tartrate with my doctor. The Max dose of succinate is 400mg, of the tartrate is 450mg. I'm under the Max in both cases, but that little bit, mid afternoon, makes the day smoother heart rate wise for me. And the Max dose can be exceeded under a doctor's instruction for many medications.

Singulair
Xyzal
Zocor
Levothyroxine
Coumadin

If you read the drug monographs individually, you'd think it was impossible I'm still awake, but not uncommonly I'm up by 4:30 AM through 10:00 PM, so they're certainly not having the negative effects that one would think. I'm almost 62, retired, I'm not as active as I used to be.

I'm in afib, I had the opportunity to be electrically cardioverted, but I was to be put on Sotalol. Reading the literature on Sotalol, it says it should only be used in "Highly Symptomatic" patients. I'm not highly symptomatic, no dizziness, no shortness of breath, just those darn flops in my chest and irregular rhythm. Today is bad, I suspect too much salt in Easter Food, or just too much food. On the days when it's calm, I feel I made the right decision in not getting Cardioverted, but days like today, I wish I had.

REPLY
AFRobin | @afrobin | Apr 22, 2019

I am curious; do you drink coffee, tea, alcohol etc.? Do you get out every day for exercise? These can make a huge impact on your conditions as I said above.

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Soliloquized | @soliloquized | Apr 22, 2019
In reply to @afrobin "My experience was that being physically active allowed me to lower my beta blocker dose. When..." + (show)
@afrobin

My experience was that being physically active allowed me to lower my beta blocker dose. When I kept up the exercising month after month, I was able to get off the beta blocker completely. Of course, I NEVER drank coffee, tea, alcohol, went near smokers, or took any stimulant like decongestants etc.. I know I keep writing the same story but I can't tell who has read about my AFib cure. This happened when I was 46 over a 2 year period. Now I am 70 years old and have had the odd blip and skip but it is usually because I had some chocolate (stimulant) or a sugary meal. That scares me into total compliance with the 'NO stimulating foods or drugs regime'. I wish the same experience for everyone.

Jump to this post

The Parasympathetic Nervous System acts as a Brake for heart rate. I never realized how much until the afib started. Metoprolol does a great job controlling rate, but I had an altercation with another driver recently, OMG, what was I thinking. Although the rate probably didn't go above 100, it hasn't been near that at rest in awhile, more like the 70s at rest, 90s after climbing the stairs. It took hours for my heart rate to return to normal. Adrenaline causes a higher rate, the parasympathetic nervous system brings the rate down, but something that upsets it lets the rate go, or remain, high.

Reading a medical article recently, the doctor said when they see heart rates above X amount, it means Parasympathetic Response has been withdrawn entirely.

So, in those approved to exercise, and in those cases exercising commensurate with their doctor's oversight and in ways approved by the doctor, increased conditioning brings increased parasympathetic tone and a naturally lower heart rate.

REPLY
3 replies
sue225 | @sue225 | Apr 22, 2019
In reply to @soliloquized "The Parasympathetic Nervous System acts as a Brake for heart rate. I never realized how much..." + (show)
@soliloquized

The Parasympathetic Nervous System acts as a Brake for heart rate. I never realized how much until the afib started. Metoprolol does a great job controlling rate, but I had an altercation with another driver recently, OMG, what was I thinking. Although the rate probably didn't go above 100, it hasn't been near that at rest in awhile, more like the 70s at rest, 90s after climbing the stairs. It took hours for my heart rate to return to normal. Adrenaline causes a higher rate, the parasympathetic nervous system brings the rate down, but something that upsets it lets the rate go, or remain, high.

Reading a medical article recently, the doctor said when they see heart rates above X amount, it means Parasympathetic Response has been withdrawn entirely.

So, in those approved to exercise, and in those cases exercising commensurate with their doctor's oversight and in ways approved by the doctor, increased conditioning brings increased parasympathetic tone and a naturally lower heart rate.

Jump to this post

So, that's why my cardiologist keeps stressing exercise.

REPLY
1 reply
1943 | @1943 | Apr 22, 2019
In reply to @soliloquized "The Parasympathetic Nervous System acts as a Brake for heart rate. I never realized how much..." + (show)
@soliloquized

The Parasympathetic Nervous System acts as a Brake for heart rate. I never realized how much until the afib started. Metoprolol does a great job controlling rate, but I had an altercation with another driver recently, OMG, what was I thinking. Although the rate probably didn't go above 100, it hasn't been near that at rest in awhile, more like the 70s at rest, 90s after climbing the stairs. It took hours for my heart rate to return to normal. Adrenaline causes a higher rate, the parasympathetic nervous system brings the rate down, but something that upsets it lets the rate go, or remain, high.

Reading a medical article recently, the doctor said when they see heart rates above X amount, it means Parasympathetic Response has been withdrawn entirely.

So, in those approved to exercise, and in those cases exercising commensurate with their doctor's oversight and in ways approved by the doctor, increased conditioning brings increased parasympathetic tone and a naturally lower heart rate.

Jump to this post

What if you can't exercise due shortness of breath due to afi b and metropolol

REPLY
1 reply
dr010196 | @dr010196 | Apr 22, 2019
In reply to @soliloquized "The Parasympathetic Nervous System acts as a Brake for heart rate. I never realized how much..." + (show)
@soliloquized

The Parasympathetic Nervous System acts as a Brake for heart rate. I never realized how much until the afib started. Metoprolol does a great job controlling rate, but I had an altercation with another driver recently, OMG, what was I thinking. Although the rate probably didn't go above 100, it hasn't been near that at rest in awhile, more like the 70s at rest, 90s after climbing the stairs. It took hours for my heart rate to return to normal. Adrenaline causes a higher rate, the parasympathetic nervous system brings the rate down, but something that upsets it lets the rate go, or remain, high.

Reading a medical article recently, the doctor said when they see heart rates above X amount, it means Parasympathetic Response has been withdrawn entirely.

So, in those approved to exercise, and in those cases exercising commensurate with their doctor's oversight and in ways approved by the doctor, increased conditioning brings increased parasympathetic tone and a naturally lower heart rate.

Jump to this post

Thank you for this response. I must admit that I do not exercise at all, eventhough I was once a college athlete. The reason: I am afraid of my heart rate getting low during or after exercise causing an event similar to what I had when I was over medicated: rapid heart rate, feelings of almost passing out. But this is the variable that I DO feel would change this entire scenario.

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