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Heart Disease  (Expert Forum)
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so disappointed: beta blockers
Answered by
Cleveland Clinic -
Cleveland - OH
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MedHelp Member's Question

so disappointed: beta blockers

by LynnSB, Aug 08, 2003 12:00AM
I've been taking metoprolol for a little over a month for very brief ( seconds) of PSVT, inappropriate sinus tach and lots of PACs and a few PVCs (documented on event monitor). I started out with 25mg. twice a day.. then half of that. I was and am so exhausted i can't believe it. I'm not talking tired -- I'm talking about it being a tremendous effort to do anything. I also feel slightly breathless and i'm still having palps. I talked to my doctor finally and he said just take 1/4 a 50 mg. pill once a day to see if i can tolerate that. I did that yesterday. i woke up still light headed, weak and miserable.

I just had the holter less than one month ago and had blood work done 2 weeks ago and don't seem to have any serious health problems. Questions:



1. Could this horrible fatigue REALLY be from the small amount of beta blockers?(I do have a history of hypersensitivity and actual allergies to a host of meds.. I don't drink because half a glass of wine and i'm sleepy).

2. If so, when can I expect to feel better if I quit taking the beta blockers all together? my doc says i have nothing life threatening. He won't refer me to an EP because there's so much data on my heart and nothing is sustained or dangerous. The beta blockers are for symptoms only and he says i don't need to take them if they don't make me feel better. I was finally exercising a bit and now i'm too pooped to even try.

3. If I quit cold turkey is there any danger?

4. how can these drugs make me feel so bad? BPisn't that low -- 98/55 sitting, heart rate from 64 to 78. Standing 110/75, heart 80-100. THANKS
Doctor's Answer

by Cleveland Clinic, Aug 08, 2003 12:00AM
LynnSB thanks for the post,



Beta-Blockers are a group of medications that block the effects of catecholamines(hormones that give you pep like adrenaline) in the bloodstream. In many cases it is the adverse effects of higher levels of these hormones that prescribing beta blockers help prevent. For example blocking these hormones can decrease the work on the heart after a heart attack.



Unfortunately, in some people beta-blockers can lead to fatige and mental slowing.  Sometimes, there are differences between agents, where a different beta-blocker will not have the same mental/fatiging effects.  What you are experiencing is not a true allergy, but an adverse effect of the medication. While your fatigue may be related, you should make sure your physican has looked for other causes of excessive fatigue like thyroid disease.



What you really need to determine is whether you need the medication at all. If you are truly asymptomatic or just have occasional palpitaions that are not debilitating then the answer is probably no.



There is no good electrophysiologic answer for pacs, pvcs that cause palpitations ther then trying medications like beta blockers. If you are having long runs of PSVT that are causing your symptoms then further evaluation would be in order. This would be determined by holter or event monitoring.



Quitting cold turkey is really only an issue for people at risk of severe complications from taking their beta blockers like after a heart attack or people with blockages in their arteries.  On the dose your on there is no risk.



Again the effects are not from BP or heart rate effects but more from the effects on the hormones in the body.



I hope this helps.
Member Comments (22)

by Dr. Erik, Aug 08, 2003 12:00AM
To: LynnSB
It's possible that with continued use of the Metoprolol the fatigue will subside or you may want to try a different beta blocker. Or you may try a calcium channel blocker. Good luck.

by LynnSB, Aug 08, 2003 12:00AM
To: erikwithouthedoctor
I kept HOPING this would get better but it's been over a month. For some reason on Monday, it just got so much worse I thought I was going to collapse... I can't believe it's not better after taking such a tiny dose the last couple of days. It's really scary to feel so tired.

by goodluckbear, Aug 08, 2003 12:00AM
I've been taking metroprolol for over 3 years. For me, the fatigue has never gone away. My heart surgeon recently told me that "Toprol" (brand name) "will take the wind out of your sails".  A book that I have on the topic of Chronic Fatigue states that Toprol creates all the symptoms of chronic fatigue. I take 100 mg a day and have a great struggle with low energy. Some days I just can't get off the couch.

by LynnSB, Aug 08, 2003 12:00AM
To: to doctor
I have had the worst few hours ---- rapid runs of fast beats and irregular beats and feeling momentarily weak and horrible.. almost went to the ER but I figured they would pull up my records and see i just had an event monitor for a month less than 3 weeks ago and label me neurotic if the arrhythmias aren't going on in the er. I'm so scared.



I wonder if cutting back on the beta blocker dose could do this to someone very sensitive to the stuff.. i just don't know what to do anymore. I can hardly go on.. i tell myself the event monitor caught lots of stuff and none of it was life threatening so the odds that something malignant has developed is very small to nil.. but how does one decided when it IS appropriate to go to the ER with palpitations?



I'm so confused. And scared. and fed up.

by mis123, Aug 08, 2003 12:00AM
I was taking 25 mg of toprol for a year for Fast Heart Rate -

Pat and Av nodal re entry tachy.  I had very vivid nightmares

and was extremely tired.  During this time my heart rate never

really was controlled with the drug.  My doctor changed me to

25 mg of Atenenol.  It's another beta blocker.  The fatigue

isn't as bad and it controls my heart rate better.  Not completely

but better.  Call your doctor and tell him you want to switch

to another beta blocker.  I tried the calium channel blocker but

had a constant headache and that didn't control my heart rate either.  I am sure since you already were prescibed a beta blocker

you probably just call the office and tell them you want to

change to another with out any problems.  All drugs work

differently for everyone.  I'm still tired by not nearly like I

was on Toprol.

by Cleveland Clinic, Aug 08, 2003 12:00AM
Lynn, If you had an event monitor and experienced the symptoms then it would be documented what your heart what doing at the time.



You should ask specifically what the cause was and perhaps seek another opinion to confirm your doctors answers to allay your fears.

by LynnSB, Aug 08, 2003 12:00AM
To: to doctor
I'm not posting my doc's namee on this board  but you'd know it -- nationally known and editor of THE medical textbook on the heart ( hint) so I'm sure he knows his stuff.. and he said my holter showed non-sustained, brief runs of PSVT ( 4 to 11 beats), many, many PACs, rare PVCs, and tachycardia when I was just moving around a bit.. could be due to deconditioning. My internist agrees with the cardiologist .



Neither will refer to an EP because they are both so sure, now especially, that I have nothing life threatening, nothing dangerous.  all I know is, it can NOT be normal to go for hour after hour after hour with my heart beating irregularly. I am so frigging depressed.



Oh, well. Thanks so much for this great board and for your time.



by Anjakarena, Aug 08, 2003 12:00AM
To: Lynn
Hi Lynn,



I can totally understand what you are going through. My doctor put me on Metoprolol 25 mg for PVC's during a stressful recent move. After taking it for about 5 weeks, all over sudden I started to get shaky, felt really weak and nauseated. All I could do was just hold on to the chair I felt so bad. I also kept having this feeling like I couldn't breathe and was freezing all the time.

The doctor tapered me down to 12.5mg for 3 days and then I stopped taking the medication.

I am really glad I stopped, I feel so much better. Yeah my PVC's are back and now I am just going to take Magnesium and try to relax.

I am so sorry you are going through this, I am 34F and have had PVC's since I was 18 and they still drive me crazy.

God bless,

Anja

by jnj, Aug 08, 2003 12:00AM
Hi All,



I will be 35 in Nov this year. When I was 27, I use to have Systolic Hypertention, 150/80+, at one time when I was very at work back then 170/90, only once, 170/90



The Company Doc's were so eger to put me on tablets, I ended up taking Coversil a French drug, quite expensive where I come from, that only brought my bp to 140/90 period.



I was not happy with that, so I changed my life style, diet,spliments light excercise and brought my bp down to 130/80 without any drug, and I felt much better also, like my intrest in girls came back. So when I left that company, I had no choice but to stop that Coversil, and since my b/p was 130/80, I just stopped. I think I took it for a year only





Now I am 34, married with one kid. What I had back then when I was 27 has somehow resurfaced after taking a four year break.

I don't know why, I know how to handel stress, my diet better now.



I guess being married with one kid and all the finance matters, had somehow got into my system, even my Mind and handel all this but my body cannot I guess.



Now I have pulpitation so bad, like a Concord plane ready to take off, or flying at the speed of sound, been to ER once



Just two days back, I was washing my car, just a light and quick wash, not a full wash. I bend down for less then a minute and as I lifted my head up, everything was spinning, that night I could not eat, did not eat dinner, could not sleep only until 1:30am

My b/p was 130/80, but the pulpitaion was bad. The pulpitation makes everything bad like head spining, going to colapse anytime



Done ECG twice now, all OK, blood test all fine, only colestrol is a border line case. Sugar 3.3mlol when fasting is that OK?, anf 5.5 mlol after food.



I am on Nifedpine 10mg once a day, should I take something else?



The funny thing the other day I eat Star Fruit before going to bed, I spelt well that night, meaning pulpitation came down, and my b/p came down together, felt so good. Now I am going to buy more of that and try.



The Doc has given me Valume or Zanax I think to bring down the Pulp, but I have not taken that yet.



All of the time I feel tired and like walking on air now!



Thank you All!



God Bless!

Joseph