Weaning 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.

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article recently, the doctor said when they see heart rates above X amount, it means Parasympathetic Response has been withdrawn entirely.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

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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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@dr010196

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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I'm ambivalent about exercising, but I want to return to the simple walks I did with the dog. It involves hills, but I'm not one to run up them, I'll just go slow and assess.

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@1943

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

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We have to live within our abilities. By no means am I saying all people must exercise, in fact, an Electrophysiologist I read says that too much exercise can cause arrhythmias, but he's talking endurance exercise. Exercise might also not be the solution for everyone, the causes of Afib vary. My comment was about the significance of parasympathetic influence on the heart rate, something I never understood the extent of.

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@sue225

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

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According to your doctor, abilities, and not endurance level. Athletes can have low heart rates, due to enhanced Parasympathetic Tone and good Ejection Fraction.

This individual is an Electrophysiologist:

The Mysterious Athletic Heart
https://www.drjohnm.org/the-mysterious-athletic-heart/
He details how Endurance Level Exercising can cause Afib and dangerous heart rhythms. But overall, in those approved, non-endurance exercise can be good.

The following link, I'll spoil it, he says the best tool to treat afib is education. Since he's a doctor that does ablation, and since, while, essentially endurance exercising on a Bicycle, he went into afib, I figure he knows both the doctor and patient sides. He advocates for restraint in seeking treatment, I'm sure commensurate with the patient's situation. This was a relief to me in reading it. I hope that MayoClinic finds this suitable, I'm not sure of their policy. If questionable, I hope they review the site, it has much to add without advertisement. The doctor was cardioverted, but he said that if still in afib, he couldn't do the ablation that is his profession.

The best tool for treating atrial fibrillation
https://www.drjohnm.org/2011/03/the-best-tool-for-treating-atrial-fibrillation/

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Thanks for the link. I read Dr John's information. #5 stated that AFib cannot be cured. I wrote to him and told him my story of a cure for the most serious case of AFib my cardiologist had ever seen. I still feel strongly that if people afflicted with AFib exercised AND stopped any stimulants like coffee, alcohol etc…MANY could be cured…or at least could lower their beta blocker dose. Of course, the patient would need to be cleared by his or her doctor who could do tests like a 24 hour or longer Holter monitor during exercise and an endurance test at his or her clinic etc..

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@afrobin

Thanks for the link. I read Dr John's information. #5 stated that AFib cannot be cured. I wrote to him and told him my story of a cure for the most serious case of AFib my cardiologist had ever seen. I still feel strongly that if people afflicted with AFib exercised AND stopped any stimulants like coffee, alcohol etc…MANY could be cured…or at least could lower their beta blocker dose. Of course, the patient would need to be cleared by his or her doctor who could do tests like a 24 hour or longer Holter monitor during exercise and an endurance test at his or her clinic etc..

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""#5.Important new work suggests AF is modifiable with lifestyle measures. As in you can help yourself.""

Actually, these apply:

""#9. There is no “cure” for AF. (See #5)

#10 The treatment of AF can be worse than the disease.""

So, I see where you get the "no cure" part, but he emphasizes the treatment can be worse than the disease, which is an important point. Unchecked heart rate, one that is too high because of Afib, can lead to heart failure, and those with Afib, without proven methods of Anticoagulation, are at significantly increased risk of strokes, but more so in people with certain conditions, but as we age, most of us have one or more of the identified conditions, and anticoagulation is required.

But he emphasizes life style changes and that some treatments are worse than some forms of Afib. I'm not symptomatic, my only symptom is that I feel the commotion in my chest when it's acting up, it just isn't warranted jumping into treatments more than adequate rate control using Beta Blockers and taking the Anticoagulant Coumadin. My resting heart rate is in the mid 60s, before afib because of another Beta Blockers I was taking, it was in the mid 50s.

Thanks for the reply. Dr. John or others posting it, is also on YouTube, not sure of how many shows, I've only seen one.

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I admit that I can link my health problems to my (somewhat) overweight and level of inactivity. If I were half as active as my husband who is a 10 mile a day walker and weren't drawn to 'goodies' (although I eat at least 7 servings of fruit & veggies per day) I would not have blood pressure issues that require medication, recurrent bladder infections brought on many times by eating a sugary meal, (Bacteria lives on sugar) and hives that flare up when I eat carbs of any kind. So the LIFESTYLE changes, I get. I have cut out all sugar at least. Now to get off my duff and MOVE! I think we can all blame ourselves to a certain degree for our health problems and therefore take responsibility and eat better, move more, be happier, do for others, take supplements like vitamin D in winter, keep our brains active and lose weight.
My aim as I approached 'old age' was to not be on ANY medications. I am on two and not happy about it. I plan by the end of the summer to have my BP down and be off any and all medications…and to live a long and healthy life. Isn't that what we all wish for?

Liked by Soliloquized

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@alwayshope1

Yes I've been taking Metoprolol succinate. Metoprolol succinate is an extended-release version of metoprolol, so it remains in your bloodstream for a longer time. Metoprolol tartrate is an immediate-release version of metoprolol.

I started 12.5 mg once daily for over a year now for a fast resting heart rate, and yes I am having growing problems with muscle cramps, spasms, stiffness and joint pain which makes no sense to me. It has caused a lot of anxiety and making it difficult to walk. I contacted my cardiologist and PCP and both stated definitely not to quit, reduce the dosage until something else could be prescribed.

Unfortunately, I lost my medical insurance and could not make an office apt to see the cardiologist or PCP for a different prescription naturally they would not prescribe another medication without seeing me.

The muscle spasms, cramps and stiffness are definitely a side effect. On some websites it's considered "less common" but it is listed (also on the Mayo Clinic website)

After significant research I found that metoprolol has an "anti-anxiety" agent which relaxes and lowers the heart rate. This can make it difficult for some people to quit cold turkey because after long term use the body can build a dependence on it so after consulting your doctor, reducing the dosage until another medication is prescribed makes sense for some.

Also, there are some people who are sensitive to Beta Blockers, I'm also one of them. I have searched and searched to understand what specifically in metoprolol causes this condition but can't find anything that explains it.There may possibly be vitamin or supplement that may help?

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I rely on Vitamin C (buffered). 500mg with breakfast, 500mg with mid morning snack, 500mg with lunch. I feel better when I do this.

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@afrobin

I admit that I can link my health problems to my (somewhat) overweight and level of inactivity. If I were half as active as my husband who is a 10 mile a day walker and weren't drawn to 'goodies' (although I eat at least 7 servings of fruit & veggies per day) I would not have blood pressure issues that require medication, recurrent bladder infections brought on many times by eating a sugary meal, (Bacteria lives on sugar) and hives that flare up when I eat carbs of any kind. So the LIFESTYLE changes, I get. I have cut out all sugar at least. Now to get off my duff and MOVE! I think we can all blame ourselves to a certain degree for our health problems and therefore take responsibility and eat better, move more, be happier, do for others, take supplements like vitamin D in winter, keep our brains active and lose weight.
My aim as I approached 'old age' was to not be on ANY medications. I am on two and not happy about it. I plan by the end of the summer to have my BP down and be off any and all medications…and to live a long and healthy life. Isn't that what we all wish for?

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Get some non-sugary cranberry juice from Trader Joes, 1/2 cup of it straight or mixed with water will help with bladder and kidneys. Raw organic (if possible) celery each evening helps eliminate extra water retention.

Liked by Soliloquized

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@healthytoday

Get some non-sugary cranberry juice from Trader Joes, 1/2 cup of it straight or mixed with water will help with bladder and kidneys. Raw organic (if possible) celery each evening helps eliminate extra water retention.

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Be advised that those on Coumadin might have problems with elevated INR values if they drink Cranberry Juice or consume Cranberries.

Interaction between warfarin and cranberry juice
https://www.ncbi.nlm.nih.gov/pubmed/17919554

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@oldertoo

@sue225 I have been on 12.5 mg of Toprol for over 13 years. I have lost so much hair. My doctor says she doesn't believe such a low dosage is the culprit. I don't know. In any event, I am coming off of it. I have reduced to 6.25 mg for 12 days now. My anxiety is out the roof. My dermatologist, on the other hand, says my hair loss could be the Toprol. I'm afraid at this point, after so many years, I won't have any new growth. I'll just be happy if the shedding stops.

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How are you cutting it so small and is that per day or 2x a day? I am on 12.5 metropolol 2x a day to reduce blood pressure lower than regular for an aortic aneurysm. I took a sliver dose this morning (I cut poorly on one pill so it ended up that way). Just curious how you managed it and do you think your coming off time is longer because you have been on it so long?

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Is anyone on here on beta blockers for an aortic aneurysm? My blood pressure normally is 110/60 but doctor wanted to get it lower. He prescribed Metropolol 25 mg succinate but I could not take it (so many issues and side effects after only 2 days). I was switched to Metropolol Tartrate 12.5 2 x per day and told to stay on it for at least 7-14 days. I am on day 21 and the side effects are growing and getting more and more invasive. Leg and foot cramps, insomnia, dizziness, mental fog, anxiety, depression, fatigue, headaches. None of these were happening to me before the meds. I have no other meds being taken right now. Messaged him this morning to ask about side effects and he responded that I must be dehydrated or doing too much. I am otherwise fit, have great bloodwork, no issues healthwise (other than bicuspid aortic valve that has caused aortic aneurysm). I want off the meds and I don't see why I need to suffer the side effects if my blood pressure isn't high to begin with. I have been told I lack the enzyme to properly metabolize medications so this is not new to me when put on medications.

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Aprille, can you not have the aneurysm operated on asap? Living with that in your body must be stressful to say the least. If it bursts, unless you are IN the hospital at that time and they stop the hemorrhaging right away….let's put it this way, it's a dire situation. I know there is a certain limit in the size of the aneurysm that then requires an operation . At some point it must be operated on. It seems to me, the earlier the better.
I wish doctors would be honest about side effects of drugs. But it may be that they just don't know. After all they didn't study pharmacology. You can look them up yourself AND consult with the real experts on drugs and interactions and side effects and that is, of course, your pharmacist.

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@afrobin

Aprille, can you not have the aneurysm operated on asap? Living with that in your body must be stressful to say the least. If it bursts, unless you are IN the hospital at that time and they stop the hemorrhaging right away….let's put it this way, it's a dire situation. I know there is a certain limit in the size of the aneurysm that then requires an operation . At some point it must be operated on. It seems to me, the earlier the better.
I wish doctors would be honest about side effects of drugs. But it may be that they just don't know. After all they didn't study pharmacology. You can look them up yourself AND consult with the real experts on drugs and interactions and side effects and that is, of course, your pharmacist.

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No, unfortunately they will not operate on aneurysms smaller than a certain size due to complications from surgery outweighing benefits. Many people supposedly live with aneurysms for up to 15 years because they stay small. I go in for 6 month evaluation in September to assess growth and size and we move from there. I just started weaning myself off of beta blockers this morning and already feel much better! My pharmacist told me to call my doctor who said my "side effects" Weren't related to meds. He did call back to say go ahead and stop taking meds but no suggestion on how to do that! 😕

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I know from experience, NEVER get off beta blockers abruptly. You must taper off gradually.

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