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Propranolol and Heart Rate
Hi everyone, first post.
I've had what I'd call a fast resting heart rate for some time now. Since I got my first Apple Watch many years ago, I've routinely recorded resting heart rates from high 80's when I first wake up, to typically high 90's or low 100's a few hours later. In the last year I've seen it spike past 110 while resting.
Now in the last 2 months, I had some very stressful things come up through work that hasn't let up yet, which has triggered severe anxieties. My psychiatrist prescribed me Propranolol for anxiety cases, as there were times when the anxiety would cause an unpleasant feeling in my chest. Not exactly pain, not exactly pressure, something sort of different, but unpleasant.
I should note this is also on top of Vyvanse that I started about 6 months ago to try and manage ADHD symptoms, and that drug can INCREASE heart rate, although if it was it was by a small amount. Also I use a small Cialis dose for occasional ED, just the smallest 5MG dose, and Cialis can also raise heart rate and also can apparently interact moderately with Propranolol. Another mitigating factor, at least for past readings pre-Vyvanse, is heavy caffeine use, which at the highest might have been something like 3-4 cups of coffee a day, and 2-3 sodas at night. I have since Vyvanse been limiting this to like 1-2 cups of coffee a day, and and sodas are now caffeine free, trying to be more reasonable on caffeine use, hopefully to counter any heart rate boost from Vyvanse.
I stared Propranolol by taking 10MG morning and evening, just for when anxiety was high, and that seemed to at the least help my chest symptoms. Sometimes I will take 20MG but have never taken more.
As expected with Propranolol, this also lowers my resting heart rate. I typically record it while using the drug in the low 80's or even high 70's sometimes, but usually low 80's.
Now my psychiatrist gave it to me for an "as needed" basis for anxiety, but now I'm starting to wonder if this "benefit" or lowering my heart rate is something that I might consider regular use of Propranolol to manage. I'm trying to decide if there is benefit to this, and if it makes sense to see a heart doctor (or even just my GP) to inquire about this possibility.
Anyone know if lowering a slightly (and chronically) high resting heart rate via regular use of Propranolol is worth considering? Are there benefits to this? Anyone know of any concerns to watch for if I do that? Anyone know any questions I should ask my doctor about this?
Thank you for any thoughts.
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I'm not a pharmacist or a physician/nurse, but it's a question they would have to address for you. I have been prescribed metoprolol in the past for two of its intents: lowering heart effort = reduction in BP for those at the high end of normal to just above that, but also to SLOW THE HEART RATE during arrhythmia (I have atrial fibrillation, since put to rest with a radio frequency ablation of the pulmonary vein ostia in the left atrium).
In my limited experience, the body tends to get inured to drugs...it needs more of the drug to achieve the same desired outcomes as time goes on. You are effectively helping that timeline to advance by taking it more frequently for an apparent benefit. At some point, you'll run out of 'head room'. It might be wisest to consult your primary care provider or a specialist about changing to another medication, even if for a few months, so that the primary drug retains its potency for when it becomes the primary drug once more. Make sense?
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2 ReactionsAs usual, I'm not a doctor and not giving out medical advice. Just trying to toss out some ideas for you. Always consult with your primary care doctor for anything mentioned below.
First, in a few articles I've read, there's absolutely no mention of using Propanolol for anxiety. So I have to question why your psychiatrist is prescribing this medication. Here are a couple of articles describing what Propanolol is used for:
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https://www.webmd.com/drugs/2/drug-10404-9168/propranolol-oral/propranolol-oral/details
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https://my.clevelandclinic.org/health/drugs/20231-propranolol-tablets
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My next question is did your psychiatrist ask you anything about meds you were already on or any medical conditions you have???? Take a look at the following article. It provides info about specific medical conditions that may indicate you shouldn't be taking Propranolol. It also lists possible drug interactions and possible side effects. I'm concerned you were prescribed this without consulting a medical doctor first:
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https://my.clevelandclinic.org/health/drugs/20944-propranolol-extended-release-capsules
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You should also try to eliminate all caffeine, at least until you get things under better control.
Have you considered trying meditation or taking a mindfulness class (or watch a few videos on mindfulness)? That "might" help with some of the anxiety and possibly lower your heart rate a little.
Are you able to get out and walk? That's something that could potentially help lower your heart rate and anxiety (if you're healthy enough to do that).
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3 ReactionsThanks for the comments so far everyone.
I have a hard time walking in the summer here, it's currently 101 outside, has been for more than a month, will be for at least one more month, so my cardio is NOT good and would benefit from more exercise.
I've told my GP doctors in the past about my heart rate and they always just nod then offer nothing. I don't see doctors often, but when I do I get the feeling they don't take symptoms like that (which by themselves aren't obviously an issue, as heart rate could be temp high for a lot of reasons) without knowing it's consistently happening and there are no benign reasons why. I did a heart test like 3-4 years ago, wore a thing on my chest for 2 weeks to record data, heart doctor didn't see anything troubling at that time.
My blood pressure is typically high end of normal.
RE: things like meditation and relaxation, I've played around with it a tad, but have never been able to get it to affect heart rate.
With the body getting used to a drug, Propranolol as I understand is typically small dose for anxiety (which is what I've been taken) and many times higher for serious heart conditions. Meaning, I would have a long, long way to go before I hit a wall. Pretty sure I read some people are at as much as 320MG in extreme cases, as opposed to my current 10-20MG for anxiety.
It's amazing how biologically diverse we all are, but frustrating how much that can complicate knowing what to do to address personal issues.
I'm not sure how difficult or not this would be, but do you think you could see a cardiologist if you're not feeling like your GP/PCP is taking you seriously? Or, maybe you could ask for a stress test or some other kind of testing just to make sure everything is okay.
My dad takes metoprolol for high blood pressure and to decrease risk of having a second stroke. We got the most insight from seeing a cardiologist; he was really nice and explained how the medication was meant to work and even ended up lowering his dose because his dose was lowering his blood pressure so much that he was getting headaches and fatigue. He did an EKG in the office. Before that, he was prescribed a 2 week heart rhythm monitor to make sure everything was okay, and it was. It might seem like a bit much, but it was worth it for the peace of mind.
My daughter takes 20mgs per day for fast heart rate. She has POTs. She also has anxiety and is on Vyvance. The Prop seems to help the heart rate. She takes it daily.
Hello @rsilver,
Have you had a chance to consider some of the ideas from @emo, @hikerguy62, and @gloaming? As a few did mention, it is always best to discuss medication dosage and usage with a health care provider. It is very interesting how different we all react to things like medications, foods, and everything else like you said. @emo mentioned a cardiologist, is this something you think you could discuss with your provider about seeing or potentially getting a new test done now that it has been 3 to 4 years?