Metoprolol vs, Propranolol- Pro's & Con's ?

Posted by thankful @thankful, Sep 26, 2023

I've been taking Metoprolol 50 mg. since having a HA back in 2014.
I've tolerated it very well, but I have also been dealing with Essential Tremor which has mostly affected my left hand (I'm LH'd ). The ET was diagnosed almost 25 years ago and it has more recently gotter a bit worse. My Dr. is recommending switching to Propranolol (starting at a dose of 60 mg) because there has shown that this will help minimize my ET condition. Seems like from my brief reading up on Propranolol that I might incur different side effects from it and so it would be easy to stick with what has worked for so many years?
Any Thoughts? @thankful

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nancymulloy | @nancymulloy | Sep 27, 2023

Stick with what has been working!

thankful | @thankful | Sep 28, 2023

Since I reside in OR from the late spring through fall and
then move down to our AZ home for the winter I have cardiologists in both locations. I decided to send each of them a short note on the portals asking if they would support my PC recommendation on switching to prop anolol from metoprolol. my local cardiologist suported that, but my AZ cardiologist sent a short note back.
"Propanolol has not been shown to be safe in people who have ischemic cardiomyopsthies, so I am not confortable in him switching. If his physician wants to add a small dose of propanolol on top of the metoprolol, I would not have a problem with that. But his heart rate is already fairly slow, so I am not sure he would tolerate that."
Always good to get a 2nd opinion!
Jim@thankful

gloaming | @gloaming | Sep 28, 2023

Metoprolol appears to be keeping you skirting 'bradycardia'....I'm guessing? That means a heart rate often found at or under 50 BPM. Some cardiologists and electrophysiologists disagree and place the number closer to 45. If you never get dizzy and have any arrhythmia, then what is working should probably not be tinkered with...in my inexpert thinking. Propranolol is an anti-arrhythmic drug that should not cause further slowing of the heart, but the arrhythmia it is meant to control is not present...and I can understand why an EP might balk at the suggestion that you should be on it. Still, most/many medications can be administered in controlled and adjusted dosages. It might actually be worth trialing, for a couple of weeks, to see if the 'guess' has some merit. As long as the dosage is the minimum recommended by the 'science' or the manufacturer for any therapeutic effect, it might be tolerable, and it might just do the trick. Mebbe... You can stop it as soon as you know that the cure is worse than the condition, if you follow. I'm sure your health care provider would counsel you to self-monitor for a number of well-understood developments and to cease taking the propanolol immediately.

Sue, Volunteer Mentor | @sueinmn | Sep 28, 2023

In reply to @thankful "Since I reside in OR from the late spring through fall and then move down to..." + (show)

If your cardiologist is comfortable with continuing metoprolol, you might consider asking whether it is safe to try primidone for the tremors. I am unable to use beta-blockers, and this is what helps me.
Sue

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