Metoprolol vs Atenolol for Heart Rate Control

[Jerry_NJ]

I posted an update to my tread on "living with AFib", that touches on this subject.

I post here as I would like to draw specific attention to the difference I have learned mostly by the help of other patients who contribute to this Community and from web searches.  Strangely, in my mind, my Cardiologist never volunteered consideration of Atenolol even though I have complained to him for years (at least 10) that I suffer from dream problems, I call them trouble mares.  That is a subject for the "sleep disorders" Community to which I also contribute - so I'll I will not go into more detail here on that subject.

Following are my observations on day two of substituting Atenolol 25 mg twice a day for Metoprolol 25 mg twice a day.. both are regular, for Metoprolol it is called Tartrate, I think the Atenolol comes in only one normally longer lasting form.

Today in the early afternoon, following my third 25 mg dose of Atenolol at about 9 AM, I noticed some dizziness when I rose from a time sitting.  This is not unusual for me, but I checked my HR anyway (using my new Oximeter, subject of another post) and found even though I was then on my feet and had walked at least 10 feet my HR was in the mid 50s.  Prior to changing to Atenolol I rarely saw my resting HR below the low 70s.  I also note my resting HR yesterday and in the early hours of this morning were mostly 70s for resting, some 60s.  

I then went outside and did some physical work, spitting some Ash Hardwood for firewood.  Most of this splitting was done with a 4 ton electric splitter for which I had only to lift the rounds (upwards of 40 pounds I estimate) onto the splitter and then pull them splits apart and throw on a stack.  This went on for perhaps 40 minutes with me having to revert to an 8 pound maul (sledge hammer) and Wedge to split some rounds that stopped the light duty electric splitter.  I estimate I made no more than 30 swings with the heavy maul. This fairly strenuous exercise did make me a bit breathless and I found my HR only in the upper 90s.  Before Atenolol I recall a similar workout would have put my HR over 130, or near my maximum allowed rate.

Research on the web says that Atenolol is much longer lasting than Metoprolol and suggests that Metoprolol Tartrate has to be taken twice a day... Atenolol only once !  Strangle, again, my Cardiologist who issued a prescription for Atenolol upon my request to be allowed to try it is for 25 mg twice a day.

Given my unusual low HR I conclude that taking the Atenolol twice a day would be more comparable to taking the Metoprolol (same 25 mg) Slow Release twice a day - thus being equivalent to an increase in BB level, thus the lower HR.

I plan to skip my bedtime does, treating my morning Atenolol as a long lasting once a day. This will also cut my intake of BB from 50 mg a day to 25 mg.  I will keep a close watch on my HR and be sensitive to any unusual heart symptoms, the current unusual low HR going back to upper 60s or lower 70s at rest being considered normal, not unusual.   I look to with some hope that the reduced dose coupled with the lower brain side-effect of Atenolol will reduce the problem dreaming.  I fully expect to wake up in the early AM hours and will check my HR then, I keep my Oximeter (with HR meter) on my nightstand.

[Emily_MHManager]

Hi everyone -

We have a lot of dosing suggestions in this thread. PLEASE do not take any advice without first discussing with your doctor.

Thanks,

Emily

[fast_heart]

"So in 5 days the patient starts each period with approximately twice the level of one dose taken in isolation.  Of course a 6 hour half-life grows more slowly, but I'll suggest (not doing the arithmetic) the 6 hour half-life will hit the double level in less than a month. "

If you do the arithmetic (it's easier in exel) you will see that a 6 hour half-life
only grows to 1.33333.

[pg356]

I have a high heart rate that neither Atenolol nor Metropolol can bring down. One cardiologist switched me to Atenolol and it played havoc with my body. I had six of the "infrequent side effects".  I was dizzy, couldn't walk straight, had purple spots all over my arms, lapses of memory and lost all taste buds. It was horrible. Over the weekend I reached the on-call cardiologist and he put me back on Metorprolol  SUCC ER 100mg 2xdaily. No side affects; however, heart rate still remains between 88 and 93.I have no other symptoms.   I'm on Atorvostatin 20mg once per day; one Lasix 20mg once a day  and a baby aspirin.  That's it.  I exercise at PT
3 x wk and am losing weight, badly needed.  I hope to get off the statins.
No answers for why heart rate won't come down. BP is normal. I am 83,  female and very active.
pg35

[bigkev414]

I take 12.5mg of atenolol each morning, with another 12.5mg in the evening if I have a 'bad day' and need things to settle down. 12.5mg is enough for me, and for many others too. 50mg reduces me to a semi comatose zombie and drops my heart rate to 40bpm or less. They tried that dose when I first started.
We all react differently, and need to do our own adjustments to achieve the right balance. Blanket statements such as '12.5mg' is not sufficient' should ignored.

[Ed_J]

I agree!

[Jerry_NJ]

I've been taking 25 mg twice a day of Atneolol and no problem, but I have dream problems, but I had them on Metoprolol too. Or my dreaming isn't in fat related to my Beta Blocker medication.  Not sure.

[mikenmoly]

i was taking a very small dose (12.5) of atenolol to lower my HR below 80,  in conjunction with cozaar and amlodipine for BP control.  i had to stop bystolic because of the dreaming factor.  however,  recent studies have linked atenolol with actually causing heart incidents, because of central heart pressure issues.  any one familiar with these studies, and would 12.5mg still be detrimental?

[johnnyky]

Thanks, I def think Metroprolol is working far better for me than Propranolol ever did. I feel liberated I can do active things and not worry about my heart racing like it used to. I've been taking it for a week and it's helped me a lot. I'm taking Metroprolol Tartrate 25mg twice a day. I think metroprolol has a shorter half life than atenolol so has to be taken twice a day to stay in the system properly. I hoping that if I keep doing well on it, I can eventually add small bits of caffeine again because I do like a coke or coffee now and then. So far so good.

My doc said Metroprolol is more selective for the heart and Propranolol is more generalized I believe. It seems to have the same anti anxiety properties as propranolol but is keeping my pulse in check with propranolol did not do so well. My mom takes Atenolol for high blood pressure and she likes it.

[Jerry_NJ]

Metoprolol is the more modern and is I believe the generic Toprolol prescribed by cardiologist in recent years.  As said above I wanted to try Atenolol because it has a longer half-life.

Both are selective beta blockers and neither has much penetration through the brain barrier.  Thus, neither is a strong driver of vivid dreaming and nightmares.  I have problems with vivid dreaming trouble-mares, but that is independent of which beta blocker I use.

Good to read you are getting some benefits from beta blockers, I believe they have few long term negatives.  I've been on beta blockers or stronger arrhythmic drugs (Propafenone) for 15 years or more.. and there's nothing wronge *^$%_) with me : )

[johnnyky]

I have a structurally normal heart and normal blod pressure but suffer from rapid pulse & sudden rise in pulse when doing activities. I was on 10mg Propranolol for a couple years as needed for anxiety and rapid pulse symptoms. It helped anxiety but didn't do much even if I doubled the dose to stop the fast pulse.

Recently I saw a cardiologist he again said my heart is normal and that basically it's just a symptomatic thing. I'm 32, slim, in good shape, so he started me on 25mg Metroprolol twice a day. I'm noticing a huge positive difference. I haven't gotten the rapid pulses I used to get, and it's very liberating. I've still gotten a few pvcs and have woken up to fast heartbeat a couple times but I haven't taken the full prescribed dose yet. So far I've been taking 25mg in the morning and 12.5 at night. It's really nipped my fast daytime pulse in the bud and made me more confident about being active without having to worry about my heart racing at random times.

I'm going to start taking 25mg in morning and at night like I was prescribed and I'm quite optimistic about this medication. The doc told me it's much more selective than propranolol and he thinks I'll do very well on it. So far, so good! I can't comment on atenolol because I've never tried it, but so far Metroprolol is working way better for my fast pulse than propranolol ever did. It's great!

[Jerry_NJ]

Well, that was how my body reacted, but over a few months the same dose worked out fine.  I have taken the 25 mg atenolol twice a day, just as I did metoprolol.  

There is no doubt my cardiologist doesn't agree with your evaluation, but what does he know, only an MD degree, a residency in cardiology and I'll guess 20 years as a practicing cardiologist.

[vfletcher]

ummmm atenolol vs metoprolol dosing is not 1:1.  by taking the same mg atenolol as you did metoprolol you doubled your dosage of effective beta blocker.

[Jerry_NJ]

I just take a generic and it has no "brand name" as far as I know.

I'd think there should be no difference between "bands" as far as HR/BP control is concerned.  

[andytse]

Hi Jerry,

Nornal HR at rest has been set to 60 above, so 5x HR is not good at all.   I am trying to 12.5 mg nowadays, see if it can improve.

By the way, there are many brands of Atenolol, does anyone know it has difference in dropping HR rate among them.   I have a query on this.

[Jerry_NJ]

I don't fully understand if you have a question but will comment that a HR of 50 when fully resting - say when in bed and perhaps just awake, or just waked up sounds good to me, I'd be happy with that.  In fact the Atenolol has put my just awake HR in the mid 50s, seems fine to me.

[andytse]

Hi Jerry,

It is nice to see your experience with Atenolol.    I have been taking atenolol over 20 years, I took that becasue of fast heart beat and also bigh blood pressure, in the first 10 years, I only took it occasionally while I am with fast heart beat or High BP.    Starting from 50, due to constant HP, I needed to take atenolol up to now.

Recently at age of 60 I discovered that my heart beat is as low as 50 at rest at night, then I changed my morning one time dose from 50MG to 25 MG, but my heart rate only come up to around 55.   I did worry about this 55 heart rate, I have done a lot of research on finding  a way of suppresing  fast heart rate but should keep heart beat around 6x per minute.    It seems metoprolol and other belta blockers are not a choice, what else I can do.    I did try to cut to 12.5MG in the morning,  but the fast heart beat came back slowly.    Now, even with a HR of 5x, i sometimes can hear my heart beat too, I did not know what to do ?    I had been in hospital for 3 times, all the medical check told me that I have no big issues.

I also found my BP is going high recently, thus i am taking Prazosin and Aprovel to control BP.  I did try Calcium blocker last month, but the side effect  after one month was  too horrible that I dropped it and is now trying Aprovel, it seems it is ok.  

[andytse]

Hi

I am suffering from fast heart beat too, and is controlled by atenolol over 20 years.   I would like to know what is the purpose of taking Potasium Sparing Diuretic ?  anyway are you taking water or Diuretic tablet ?

[Jerry_NJ]

I've been no a beta blocker in one form or another, including full anti-rhythmic drugs including Rhytmol and Propafenone (sp?) for the past 15 years  I have never associated those drugs with causing congestive heart failure, indeed I think they are taken to prevent (postpone) CHF.  

I have enlarged atrium chambers due to a leaking mitral valve that was repaired in 2007, the surgery was done to prevent the continued enlargement of my heart and development of CHF.  In fact when I asked my cardiologist what if I don't go to a surgeon for heart surgery, he said CHF in the next 5 years.  The valve repair has stabilized my heart size.

[Pachi21]

I have been on Atenolol for about 10 years due to fast heart rate after having my thyroid radiated.  It worked really well but I developed Congestive Hearth Disease and my left ventricle does not rest between beats. I was put on metapropol and taken office of Atenolol and have slept most of the last year. I called the doctor monthly and sometimes more.  I finally saw his PA and I asked if she would consider putting me back on atenolol.  She also added 1/2 of a potassium sparing water pill in addition to the Lasix.  I feel like a new person I'm still having some trouble with dizziness but I know that will go away.  Why don't heart doctors listen? Thanks for all the posts I wish I had read this last year.

[Jerry_NJ]

As I commented, maybe in the opening post, Atenolol was more effective, lower dose did more to slow my HR.  As time passed and this thread developed I reported I have adjusted to Atenolol and now find the 25 mg twice a day just does the job, as did Metoprolol, taken at the same mg level.

To your question, if you symptoms begin more than 6 hours (typical half life of Anenolo, I believe) than a booster would make sense to me.  Atenolol is not a true slow release (once per 24 hours being the base line for that definition) and taking it every 12 hours makes for a more "level" dose in the body.  In this thread we/I have discussed how a 1/2 life of medications can build in the body - if that is of concern then one might skip the second dose once a week to "purge the system", if that was done I'd skip the evening dose once a week.  As I've discussed I always forget to take one meds a couple of times a month and that is my "purge".

You are on what I consider a very low dose, 12.5 mg, so the side effects should be minimal, taking twice a day should not change you side effect experience, especially if you take one before going to sleep.

As always:  Discuss With Your Doctor, neither I nor most of the others who post here are qualified to give medical advice to anyone, we can only share our experiences and personal conclusions.

[seaperson]

This is the first time I have read this thread.  Found it very interesting.  I weaned myself off metroprolol 100 mg twice daily, over a 7 month period because I was so fatigued.  I had been taking it for 30 years for high blood pressure.  Sadly I was not able to manage with no beta blocker because I was having episodes of very high heart rate - over 140 per minute.

Now I am taking 12.5 mg of atenolol each morning but by evening I find myself short of breath with exertion with heart rate rising.  Wondering if I should ask my doctor about increasing to 12.5 twice daily as much as I hate the way these drugs make me feel.

[Jerry_NJ]

I have not further comment on the Atenolol verses Metoprolol beyond I now have about the same result.  Seems my body has adjusted to the Antenolol to a degree that makes its effectiveness about the same as Metoprolol.

On the PVCs, I don't suffer but 10,000 is high to my recollection but not unusual for sufferers.  The "normal" range rates must be available on a search for same.

I suffer from trouble mares, not nightmares.  These dreams are every time I sleep, even a nap, and are indeed troubling, more depression than fear.  This has been going on for years, I can't remember how long.  I don't think the beta blocker is the driver, but the BB doesn't help stop them either, of that I am sure.

I was diagnosed with mild obstructive sleep (OSA) apnea and here's the way that diagnosis developed.

First I was troubled by waking up, sometimes from right at the onset of sleep, with the feeling I was suffocating.  I talked with my wife (with whom I still sleep after over 55 years of marriage) and she has enough trouble sleeping to no put up with any unusual kicking or snoring on my part.  She has complained some, but not often and so there was nothing there to suggest OSA.   But, I was concerned enough I purchased a real time (not recording) Oximeter and put it on my night stand.  I had a couple of reasons for the purchase, not expensive about $25, one being concerns about apnea the other about my heart rate.  The device quickly (maybe 2 or 3 seconds) give a oxygen saturation level and hear rate.  In fact one reason I purchased it was the Antenolol - I was concerned about it's affect on my HR being too high - maybe I could reduce the dose level.  That didn't "pan out".

My Oxygen saturation level was normal to good:  95% to 98% most of the time, but I found when I woke up with the suffocation sensation clipping on the meter showed a O2 saturation as low as the mid 80s %.  I had a scheduled physical exam so I mentioned my experiment with my Primary Care doctor.  He prescribed an overnight recording Oximeter test. That was easy, and natural I did it at home, albeit I had to tape a detector on my finger which was wired to a recorder on my night stand.  I woke up a couple of times that night (as usual - have to pee more at night it seems) and looked at the recorder, which had a display.  I saw low readings there too when accompanied by the suffocation sensation.  The results were reported back to my doctor recommending I purchase and use supplemental oxygen - in fact the company tried to get approval form me to send oxygen, my readings were bad enough they said I qualify under Medicare requirements for supplemental O2.  I told them to hold on the O2, I'd talk with my doctor first.  He prescribed a Sleep study. That got me an appointment with a sleep study center and the Pulmonary specialists - wow,  Good news/bad news, the first test were x-ray and physical exams which resulted in a diagnosis that I did NOT have emphysema or other serious lung problems, the bad news (not all that bad) was because I am (now was) Obsess  (come on, 250 pounds yes, but 6' 5" + to put it on) and that had reduced my air passage size in my throat.  I asked would weight loss help that, the answer was YES, what else could they say.  In any case this led to an overnight sleep study at the sleep center in my local hospital.  I did a near normal sleep and the results confirmed "mild" OSA.  It also showed I still got almost the normal required REM sleep (all the dreaming I think) to get rest, and that I can confirm as I did not suffer from day-time sleep problems.  Hey, where am I going?  Hope I haven't lost the question, or made too may typos to be understood.  The doctor suggested I could benefit from a CPAP sleeping aid, and I said how about losing weight? He said it was worth a try.  I lost 25 pounds and I no longer wake up feeling like I am suffocating.  I need to confirm with another overnight recording oximeter test..here's my bottom line for you:  do a recording overnight O2 test at home, and so it until you can do one with what you consider an overnight sleep.

As for the bad dreams, try reading up on Lucid Dreaming, I like the work by Dr. Stephen LaBerge at Stanford.  I checked his book on the subject out of the library and listened to the audio CD many times.  It didn't solve my problem, but I gave/give it only a cursory try as my dreams and not full of terror.  The book also covers night terror I think.  The point is to try to engage you conscious mind in your dreams, take control  My solution to nightmares was similar, and I came up with it at the age of 12 or there about where I trained my mind to wake myself up when the terror scene was just starting to develop... it worked, I have a nightmare that I remember no more that a couple of times a year, it that often.

Good luck, I didn't proof read, already put too much time in.  My typo rate is troubling, but most are easy to figure out.

[mum418]

Hi Jerry.  I have had pvc's for many yrs. but as I get older they seem to be getting worse.  Upon a prep for a colonoscopy they really got bad the day of the procedure, but the doctor decided to go ahead anyway and I guess because of pvcs he did not give me pain med. or anything else.  Had a holter monitor (24 Hr.) which showed 10,000 pvcs in that 1 day period, which is according to my cardiologist is just short of max.  He changed my med. from 25 mg. of atenonol twice a day to 25 mg. of Metoprolol twice a day. Have noticed an increase in heart rate when I wake up to about 80-85 and with Atenonol mid 60's.
I believe I also have sleep apnea but after going in for a sleep study I could not get to sleep so don't know what to do.  I to get nightmares, headaches and shortness of breath.  Do you have any thoughts on this.

[Jerry_NJ]

Yep, I think we've had the discussion of the build up of medication that has an extended half live period (I'll say at least a large percentage of the period between taking doses) such as 6 hrs for Atenolol.  

I am unable to write the series for this accumulation, perhaps it has a "closed form" so one can easily calculate the maximum of the sum.  Unable to do that and to make things simple I offer the follow brief demonstration that the limit over extended periods of time is the doubling of the dose... never gets there, approaches asymptotically

I'll use a dose every 12 hours and a half life of 12 hours (6 hours half live would grow more slowly).  I will normalize to 1 dose, not 25 mg, and calculate for 10 periods (5 days):

Dose 1  (1)
Dose  2  (1.5)
Dose 3  (1.75)
Dose 4  (1.87..)
Dose 5  (1.94..)
Dose 6  (1.97..)
Dose 7  (1.985..)
Dose 8  (1.992..)
Dose 9  (1.996..)
Dose 10 ( 1.998..)

So in 5 days the patient starts each period with approximately twice the level of one dose taken in isolation.  Of course a 6 hour half-life grows more slowly, but I'll suggest (not doing the arithmetic) the 6 hour half-life will hit the double level in less than a month.

As we have also discussed, I manage to forget to take one of my 25 mg doses at least once a month.  That said I have found my body has adjusted to Atenolol sufficiently that I no longer can directly associate taking a does with feeling dizzy or very low HR.  Checking when just lying in bed, after waking from a sleep that usually is fraught with dreams I usually find a HR in the 60s, some upper 50s and some lower 70s.  When I first started Antenolol I had some dizzy periods and low HR and BP... both of these are near normal now, but the low exercise tolerance remains, but then my atrium chambers are non functional.

[tom_h]

Atenolol's plasma half life is approximately 6 hours.  So in 6 hours, half the original dose remains in your blood, in 12 hours, in halves again, but you take another 25mg.  If you work it out on paper, your see this roller coaster effect, hills and valleys if you will, but every day the amount of Alenolol remaining in your blood increases slightly.  Compound this over days, and weeks, and slowly but surely you begin to feel like a zombie.  It come on imperceptibly slow, but it happens.  Personally, I take 75mg daily of Metoprolol.  It too builds slowly.  When I see my BP around 105/60, and I feel that it's taking too long for my heart to get up to speed when I work out, I stop a dose for a day, pehaps take half my normal dose the second day, then I go back on my maintenance dose.  When you stop, the drug is slashed in half after 6 hours, then is slashed in half again in 12 hours, etc.   At one time before my ablation I was on 200mg of Metoprolol for about a month and a half.  The build-up was so great that I couldn't walk up the driveway to get the mail without that cinderblock on the chest feeling.  I was a former athelete, so I knew somethng was wrong.  I called the physician who had me stop for a couple of days, then start again on a 100mg dose.  The results were remarkable.  I guess if you knew the actual plasma level, you could correct it with more precision, but this rough method works for me and quickly puts me back to feeling like myself again.. I often wonder if physicians take this buildup into consideration when prescribing larger quantities of a partiucular drug.