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How did you wean off Metoprolol?
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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Anyone who wants to ween off beta blockers should read my story.
I had a heart attack July 2015 and was placed on beta blockers (metoprolol). I was on 25mg to start, half a pill in morning and evening. Over a few months my pulse was dropping to 43 bpm and my BP was very low. My doctor recommended cutting the dose to half to see how I did. It helped a bit. (12.5mg) once a day.
About 2 months later - out of the blue, my heart started racing 155 bpm and my blood pressure spiked to 180/100. I had chest pain, difficulty breathing, sweating, dizzy... was positive I was having another heart attack. Off to the ER. They did ecg and trope, X-ray... all was fine and my symptoms abated over a few hours.
The next attack happened about 3 weeks later. Same thing. They gave me a hotter monitor and nothing. This went on for a year. I had several stress tests that said all was good. They prescribed lorazepam and told me it was anxiety attacks.
Sometimes my heart rate was 170+ and bp 225/130.
I was in hell. Doing vagel exercises and holding my breath in a bowl of ice cold water. The attacks started to get worse and more frequent. Sometimes waking me up at 4am. The lorazepam did nothing to abate - but still 4 cardiologists, a heart specialist and maybe 25 different doctors wrote it off to anxiety attacks. Yet, after almost 3 years of this, I had strong suspicion it was a rebound effect from the beta blocker.
I tried to ween off it very slow for 2 years. Once I was off for 3 1/2 weeks and then BAM, massive attack that actually registered a tiny trope test. So I had to go back on.
Finally, my heart specialist said let’s switch beta blockers- that metoprolol is a twice a day drug and I was only taking a small amount once a day. So we switched to bisoprolol 2.5mg (half a pill) once a day. This was in August 2018.
The attacks stopped completely. What was happening, yet nobody will admit, was the metoprolol was wearing off every evening before I took my next dose, or shortly after... my body started to produce adrenaline again, and since I had developed billions more adrenal receptors (from being on beta blockers - bodies reaction to the drug), my body would flip out and I would have a hypertension/tachycardia attack.
2 weeks later on the bishoprolol and I felt like crap. Dizzy, no energy, insomnia... but no attacks. Bp and pulse were low so we cut dose to 1.25mg. Felt like crap for a month... then started to feel a little better.
This January, I had had enough of feeling dizzy and no energy. One night my pulse went down to 40bpm and my BP was 190/110. Off to emergency I went. They did all the tests and nothing. So we decided to cut my dose to ween off. I was told by several doctors to just go off cuz it was such a small amount. But having read so much, I thought I should ween. So .65mg tiny thing.
It has been 2 weeks now and I’ve been to ER with crazy high BP twice - but it always comes back down after a few hours on its own. I keep having these attacks again and I’m 100% sure it’s caused by the beta blocker.
This time I’m going to power through even if it kills me. This is a nightmare drug and after almost 4 years of pure hell - I have had enough.
My understanding is although I may be off the drug for months at some point- there is still the physical manifestations of the extra adrenal receptors that will eventually deteriorate as my chemistry normals.
Couldn’t imagine doing this without God. Good luck everyone who is fighting this battle.
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7 ReactionsThank you for sharing. Every body is different. Mine has always been different from others. Nothing for me is normal . My body reacts opposite to health situations away from the "norm". Sounds like yours does also. I have been taking Metoprolol 100 gm for about 6 years. In the beginning it helped along with Clonidine started at low doses so naturally when BP kept rising the doses were adjusted higher making the matter worse. I understand the feeling like crap...like a zombie. Mouth so dry you could spit cotton. Gas and walking farts falling asleep not being able to drive...Every heart test and ultrasound, test for blocked arteries all normal. No reason for high BP increase more drugs that will work. NOT I listened to my body. I slowly weaned down on Metoprolol from 100mg 3 times daily over 2 weeks keeping track of BP 3 to 5 times a day. Really need to watch salt intake like poison to me. Life is a journey and how right God is my pilot.
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2 ReactionsHi, Sorry to hear of your problems. Doctors listening, or actually not listening to patients is a problem at times. I had an undiagnosed seizure disorder for 15 years and was thrown out of my neurologist office because he said nothing was wrong. I consulted another doctor, he did a 24 hour EEG, you can't believe the looks you get leaving the hospital with multi-color wires glued to your head. LOL. But it showed seizure activity from the moment it was connected and a 15 year nightmare went away almost over night while on the right medications.
I'm not contradicting you, we each have a somewhat personalized response to medications. Because I didn't experience it, doesn't mean someone else didn't. But I've taken higher doses of Beta Blockers (Now I'm on 350 mg Metoprolol taken as 200 mg in the morning and 150 mg at night), I've taken 240 mg Inderal LA as a migraine preventative in the past. And though I'm on Metoprolol for rate control of afib I'm actively experiencing, at the time the afib started I was taking 600 mg of Acebutolol as 200 mg three times a day. I haven't seen the issues you describe in myself.
I just wanted to convey that readers should not jump at the idea of taking Beta Blockers is unusually harmful, this is not often the case when drugs are prescribed by doctors that know the patient's overall condition, other illnesses the patient has, and prescribes with that knowledge in mind.
I readily agree that we all should be an active participant in our care, and that includes reading on the subject, listening to the experiences of others, conveying this to our doctor, and getting a second opinion if we're not confident in the actions proposed or taken by our doctor.
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1 ReactionGetting off beta blockers abruptly is dangerous. At least that is what my cardiologist warned me not to do when I was suffering from a severe form of A-fib. He wanted me to reduce my dose since it was very high (80mg of Sotalol 4x per day)...but what I needed to keep the wild A-fib steady. Over a month plus daily aerobic exercise (treadmill) at the gym and I was able to gradually reduce the dose to....zero! The cardiologist said that the A-fib would be back since he had never seen such an extreme case as mine. I didn't have 3 steady beats in a row. Well, I proved him wrong. It is 24 years later and I have occasional blips...but no A-fib.
I am a strong believer in taking charge of one's health and so I read everything I can on a condition that affects me. The cardiologist told me to avoid stimulants so I have NEVER drunk coffee or any drink with caffeine including tea. I avoid alcohol...I have none! I do not take decongestants or freezing at the dentist that has ephedrine in it. I avoid chocolate and take only a small amount of sugar if at all. And this keeps my heart steady. What I really credit for my recovery is the exercise. I went religiously to the gym to go on their treadmill every morning. I was actually afraid to stop going and continued for 4 month, 3 months after I was off the beta blockers. Then I went just 2 - 3 times per week.
I have a friend with A-fib who will not give up coffee or alcohol. He prefers to take a beta blocker every day. Lifestyle changes can usually help if not cure many conditions including diabetes, high blood pressure, hives, arrhythmias, food intolerances and many chronic conditions.
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5 ReactionsSotalol is a special Beta Blocker with Anti-Arrhythmic properties at higher doses. It requires, at least in recent times, a hospital stay of 3 days to initiate when used as an Anti-Arrhythmic (i.e. higher doses), since by changing the timing of the heart's electrical signal, as visualized on an EKG, it can create dangerous rhythms.
""Sotalol - Class III antiarrhythmic drug - also exerts beta blocking effect (inhibits beta adrenergic stimulation).
Do not confuse Sotalol with conventional beta blockers (which have no effect on heart rhythm), since Sotalol has profound pro-arrhythmic effects owing to its prolongation of the QT interval.""
In general, Beta Blockers are the first line of drugs tried in Afib, according to the article paraphrased above. Beta Blockers slow the heart rate by acting on the SA Node (where heart beats normally originate from) and the AV Node (the doorway for electrical signals from the top of the heart to the bottom). Athletes, and people that are physically fit, may have natural methods, via the Vagus Nerve (Vagal Tone) that slow the transmission of Atrial Fibrillation signals from the top of the heart to the bottom. Being physically fit is one thing, I read blog entries from an ElectroPhysiologist that says too much exercise can damage the heart, and he discusses his personal experience with it that occurred during a bike race or endurance ride.
I'm happy that you've worked through your afib. Great story. My afib has been quiet for weeks, but started kicking up the last few days. Had my fingers crossed it was going to self correct, but not yet. Keeping my fingers crossed, a term used by seemingly all in England, or all of the YouTube shows we watch from there.
And on YouTube, there are doctors on with information on Afib. I'd advise people to consult their doctors if they'd like to try a different approach, but some of the Doctor based YouTube shows on afib are worth the watch.
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1 ReactionGreat explanation. Thanks! Keeping one's fingers crossed is used here in Canada and in the US...and hopefully it takes more than that to settle the heart down into a natural rhythm. For me, the daily half hour of fast walking/light running on the treadmill that had me sweating did the trick for me.
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2 ReactionsI am taking metoprolol to control my arrythmia (non-sustained ventricular tachycardia). It is a conventional betablocker. Bisoprolol and atenolol are used as well. They do have an effect on the heart rhythm.
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3 Reactions""Beta blockers are competitive antagonists that block the receptor sites for the endogenous catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) on adrenergic beta receptors, of the sympathetic nervous system, which mediates the fight-or-flight response."
Although they effect heart rate largely due to the above, most Beta Blockers don't change the timing of most of the components of the electrical activity as represented on the EKG. Sotalol prolongs as aspect of the EKG that can lead to other arrhythmias, most other Beta Blockers don't have that effect.
The information in my original post was paraphrased from a site on EKG interpretation. My point was that Sotalol isn't just a Beta Blocker, that under many circumstances additional precautions need to be taken with it when first putting a patient on it.
Reading it over again, I'd say the EKG Site and you are both right, just in different ways. They are talking about rhythm in the sense of the elements of the EKG, you're talking about rhythm as associated with rate. Beta Blockers do indeed alter heart rate, and many people benefit from that for various reasons.
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2 ReactionsAll I know is that my NSVT was picked up on a 48hr holter monitor, (which is an ECG). I also have non-serious atrial tachycardia. Anyway, I've bern on it since late 2016 and would not want to go off.
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1 ReactionI agree. I'm on 350mg of Metoprolol Succinate (200 in the morning, 150 mg in the evening), my resting heart rate on good days is finally getting down to the upper 60s. Beta Blockers are generally well tolerated, effective, and comparatively safe. I'm glad to hear of your success. We're fortunate to live in a time in history where these medications are available.
Best regards.
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