Metoprolol Withdrawal

I would get a second opinion or ask if there is another treatment that could be better suited for you. I sounds you don't feel confident with this physician. I may be wong . It was just a thought. Take care and feel better.

I'm just going by what I understand from a LOT of reading, and from synthesizing that with my own experience. I spend a lot of time on forums reading about what others experience, I try to cross-reference those anecdotes with published research (there's a flood of really great articles at Pub Med, NIH, BMJ, etc).

This is what I know, or think I know:

The heart is an adrenergic muscle. It responds to Vagus nerve impulses and to adrenalin. It reacts to sometimes contradictory signals between the two factors.

The heart, as it ages, grows some electrical node cells in places where they're not meant to be. So, as each of us ages, there's a decent chance we'll eventually develop an arrhythmia. Happened to me.

When we're anxious, have really active minds, don't practice good sleep hygiene, or have unresolved problems we're not dealing with very well...or at all...it will disrupt our sleep. We begin to 'ruminate' at night, repeating and scrolling through long runs of thoughts that keep us from relaxing. We get tired enough to actually begin to cascade into sleep, but the brain wants to run through the thoughts again, and we jerk awake...which is a startle reflex, which activates the adrenal glands, which pumps out a wee gobbit of adrenalin, which makes its way to the heart, which reacts to the chemical. Heart pounds, even if just a few seconds.

Metoprolol has no anti-arrhythmic power. It is strictly a power-stroke regulating chemical. It lengthens the intervals between contractions, and it inhibits the adrenergic response....meaning fewer beats and the contractions are less forceful. This is why metoprolol is often administered as an initial hypertension drug...it reduces blood pressure...some. Just enough for those with incipient hypertension. It is a rate control drug, meaning is reduces the rate when you ARE in arrhythmia. You don't want the heart to beat continuously at over 100 BPM for more than about 24 hours, according to the instructions I was given after my first ablation. Get to an ER if neither metoprolol nor time stop your arrhythmia and it is above 100 BPM for more than 24 hrs.

There is confusion about how to cease taking metoprolol. Some say stop right away, some way to substitute something else, even for a few days while you wean off it, others say to taper over 10 days to two weeks. I think it's poorly understood by many issuing instructions to their patients.

I have done both stopping cold, but with a substitute (it was amiodarone, a highly potent anti-arrhythmic), and self-weaning on the advice of the cath lab outreach nurse who is an expert in dealing with arrhythmic patients pre-op and post-op. She wanted me to get off metoprolol before my Holter monitor test about two weeks after the 'blanking period', a period of eight weeks after getting an ablation. Her reasoning was that my heart should be freely operating as 'it truly is' when the Holter was provided to monitor my heart for 24 hours. There should be no residues of any chemicals that are intended to regulate cardiac function. Sounds reasonable, no? So, about three weeks before I thought the Holter might come, I cut my dosage in half for three days, and then in half again for another three, and then stopped cold after that...no more halving. I was on 50 mg twice a day when I started (long story). I experienced nothing at all...and have been in steady NSR ever since.

I think you need help with your sleep. It might be of short duration if you have to take medication...hopefully yes...but you need to get help. You don't need metoprolol unless a formal assessment by a cardiologist or electrophysiologist shows that you should be taking it. We ALL have palpitations, most often not aware of them because we're busy doing something else. All of us have the odd pause in our heartbeat, several times each hour (!). We all have PACs (premature atrial contractions). What sets those of us who are aware of it apart is that we sense them, and for us it's a distinctly unpleasant experience. We're so highly symptomatic that the experts will literally do something just to shut us up! I'm being a bit facetious here, but you'd be amazed at how much modern medicine is strictly dealing with symptomology...how patients feel, and how it affects their calm and well-being. Arrhythmias are very high on the list, as anyone with symptoms would immediately appreciate.

Last thing...let a cardiologist know of your unease and your symptoms, especially the palpitations. If you don't already have one, get a Kardia Mobile or a smart watch with ECG capability (Galaxy, Apple), and make the device assess you when you are having palpitations. It if says 'undetermined' or unknown arrhythmia, it's almost certainly not AF. They aren't designed to measure other arrhythmias. But you need to be sure if it's AF or not, despite what the device says, and that's why you need a formal assessment. Note that these smart watches and Kardia can upload data files that show what your ECG looks like, and the cardiologist will find that helpful if you can't get in to them early.

Hi
You are young for a BB. There are other meds like ACE another blocker.

I was on Metoprolol 49.75 mg in 2008 for high blood pressure and I was overweight.
With a split with hubby - a short marriage I lost weight dramatically. I was diagnosed with low BP so I came off it. I had a tummy bug at the time and I wasn't leeping it down. I would call it cold turkey.

In 2019 I had a stroke with rapid and persistent AF Heart Rate. Day 4 during a carotid arteries scan a shadow showed up on my thyroid. Yes, papillary carcinoma at the edge of my right lobe. Other surgeons got to see the scan and decided I had bits in my left lobe. Within 4 months full thyroidectomy plus 12 lymphs removed - 2 affected amd bed dissected.

When the Dr on Stroke Ward said she was prescribing Metoprolol, I said NO! When a new Dr in 2009 doubled the 49.75 I could not breathe and there was a risk of being taken by ambulance. But I managed it, missed next days dose and got back to normal.

The Dr was an endocrinologist who ignored my NO.

I was on it but able to reduce it to 23.75mg. At 1 year 5 months I finally got a heart specialist - no Stroke follow up. Who ordered a ECHO, ECG and 24hr holter.

The latter showed a avg heart beat of 186bpm (I couldn't exert) 47bpm avg night with pauses. I was breathless on all doses of Metoprolol.

Changed to Bisoprolol. Monitor showed 156bpm with some exertion, no breathlessness no pauses.

No control of Heart rate to 100 or under. Good control of BP.

I think meds need review regularly.

In the last 2 months I have weaned off Bisoprolol. Why because BP gone low. From December 2021 I was introduced to CCB Calcium Channel Blocker. Dramatically controlled. My Heart Monitor showed @ 1/2 dose 180mg. Within days I was reduced to 120mg by Dr and reduced Bisoprolol to 2.5.

I now remain on Diltiazem 120mg but realise I may need 180mg.

It is important to 1/2 my Bisoprolol to 1.25 mg before giving it up. I also had an ECG at 1/2 pill status.

I will have another ECG sometime.

Stopping Bisoprolol showed that I had to reduce my 125mg to 100 as T4 was too high. Great.

So ny stopping something could affect your supplements etc. My B12 I have to dose up as it was disappearing!

I was always told that I should reduce med slowly. Then ECG to see what effect.

Take care.

Cherio JOY. (Tuckie)

Changed to Bisoprolol directly

I spoke directly to the cardiologist today. I explained what had been going on and expressed my concern that I didn’t have enough time to taper off the medication properly. She dismissed my concerns and asked if I thought I should go back to the full dose of the medication. At that point, I became less friendly with her.

I firmly told her no—I would not be going back on the medication. I explained that I only cut the pill in half for a week, despite having taken this medication for three to four years. I also told her that, at 30 years old, I don’t feel I should be taking a beta blocker unnecessarily, especially since all my EKGs, Holter monitor tests, and echocardiograms have come back normal. She denied that she told me to abruptly stop taking this medication completely when she did. I told her that I find it ridiculous that she told me to stop taking a beta blocker and she didn't even run me through an EKG. She got snippy and asked me what I think an EKG would show. I told her I don't know I'm not the cardiologist probably nothing like it has shown previously. She had no good reason for me to go back on the full dose of this beta blocker and quite frankly at 30 years old I don't want to be on it.

I work in emergency services and this hospital that she is associated is well known for their incompetence. They call emergency services on a daily basis to ship patients out of their hospital because they can't provide the level of care. When I worked on the ambulance they told us to never send someone to this hospital unless they fell down and hurt their knee or something simple.

She advised me not to believe everything I read online and claimed that I shouldn’t be experiencing any withdrawal symptoms. I responded by informing her that I would be transferring my records to another office. However, I can’t get an appointment elsewhere until after February unless I start experiencing more serious side effects.

I feel like the medical system is a joke and it's just a way for people to make money they dont care about you.

I would find another Cardiologist with plenty of experience to treat you. I have been on Metoprolol 100 mg in the morning and 50 mg in the evening and sometimes my heart beat goes low in the mid 40s. The Cardiologist adjusted the dosage and I am still taking it doing fine. Best luck to you.

I would begin to take daily records of a wearable's ECG during periods when you feel you're frequently in tachyarrhythmia or when fibrillating/PACs. It's a few $$, they work like a hot damn (pardon), and almost all EPs and cardiologists will take a look and order further tests or change medications. Costco in Canada has a deal on Galaxy Watch 7's, maybe in the USA as well. They're excellent watches for many reasons (will record your BP, snoring through a phone app, ECG, heart rate, SO2, sleep quality and stages, etc.).

Thanks for the feedback I currently have a galaxy watch ultra with the latest health features. I monitor my heart rate, stress levels, workouts, and blood pressure on a daily basis

Hi @gloaming, thank you for the information. Does the Galaxy Watch 7's work in the USA with all its features ? (sleep apnea detection, blood pressure monitor, ECG, Heart Rate, SO2, sleep quality and stages, etc). I understand the features available is based in the location where you bought the watch not the location where it was made in. I wonder in what location did you buy your watch. In summary, I really need to buy the watch for my severe heart condition that I am sure will help me to monitor better than the ECG. I have severe sleep apnea, heart murmur, 2 heart attacks, Hypertrophic Cardiomyopathy, leaky valve. Any information will be truly appreciated.

Thank you and Happy New Year!

No wearable that I know detects sleep apnea. They can monitor your heart rate and rhythm, and they can monitor your blood pressure, and they can monitor your oxygenation, your 'sat', or O2 saturation levels, including while you sleep. My Galaxy, in Canada, was finally approved to measure for AF via an ECG, and it even had to be approved by Health Canada for measuring the blood pressure (BP). I don't know about how it currently sits in the USA, but a quick search on the www should have an answer for you. Or ask the sellers.

My watch, through a phone app (on and listening while I sleep), will report snoring, which is only a loosely associated indicator of sleep apnea. Some snore and sleep properly, some don't. Those who snore and don't probably, not certainly, have some form or level of sleep apnea. But, the SO@ levels, if they show a marked dip at any point in the previous night's record, you can take that to the bank...it's an indication that you had a apneic event or somehow stopped breathing...which could mean a central apnea , or when the brain forgets to make you breathe. It's worth investigating, especially if it comes about each night, especially more often as time goes on.

Remember, though, that there are other devices such as wearable SO2 meters that keep a record of your sat levels, and there's the Kardia Mobile device, only a few dollars, that gets really strong reviews, a device that also keeps downloadable records for your night's data. The Kardia is only for heart rate and rhythm.

BTW, and I don't know if this is just a Canadian thing, I would think/hope not, but my Galaxy watch must be recalibrated with a suitable sphygmomanometer every 28 days. You'll get a warning that the calibration period is about to lapse, and you have three days to recalibrate. After that, when you go to use the watch to measure your blood pressure, you'll get a flag saying you must recalibrate...or else.

Thank you so much for the information! Very helpful!