PAC Medication

[windy59]

I am currently taking 50 mg a day Toporol XL for Pac's.  My Primary Care Physcian wants to increase my dosage to 100 mg per day. (double dosage).  I also have Sinus Tachycardia which is under control with medications.
My concern is that doubling my medication could lower the heart rate too much and cause serious problems.  I was told it would have to be doubled since the tablets are 50 mg each.  Is there any other solution or medication that comes in a lower dosage for this problem?

[DodieRosie]

Toprol XL also comes in 25 mg and those can even be split to a 12.5 dosage. I take 37.5 twice a day (one and half pills each dose). I started on 12.5 (half pill) a day and increased slowly until I got to 25 twice a day. I am taking it for sinus tach following open heart surgery. It gets my rate to about 95. I can not take a high dose due to low blood pressure and risk of heart block. I began having frequent PVCs and my docs increased the dose to 37.5 twice a day and it did seems to help. I know a lot of people on betablockers to reduce "skipped beats" Toprol XL is used to help reduce pvcs and pacs but that doesn't mean it always works. I trust this information because I am under the treatment of several cardiologists and electrophysiologists at Cleveland Clinic.

[Bromley]

btw I have read that as the heart rate drops, the background level of automaticity you have can cause increase in occurance of spurious heart beats.  Why this should be I dont know; I am sure the experts must understand the mechanism. In myself, I notice that when my heart rate is low, I seem to get more PVC's.  But this might be because when I run long distances my heart rate drops and physical stress peaks. These changes would cause lower heart rate and maybe greater catecholamine levels??? Anyway I try to reduce stress when the PVC's start kicking in.

[Jerry_NJ]

I take 200 mg of toprol xl (metoprolo er), 100 morning, 100 night.  My tables can be broken in half to make a 50 mg dose, which I have also used.  I'd guess your 50 mg toprol xl can be split in half to give you a 25 mg tablet.  I'm not suggesting what dose you should use, just saying I think you have a way to take 25 mg accurately if that's what is needed.

I take the med to slow down my HR, driven by AFig.  When in sinus I was taking 100 mg and had a rest HR of about 60.  I am in AFig again, so up goes the dose, and the apparent HR, lucky if it is below 80 at rest now.  

[Bromley]

Man that sounds like a lot of TOPROL.  I have PAC, PVC, and short strings of Vtach and SVT.  1/2 of a 25mg tablet and I am set.  I know people say it doesn't do anything for PVC's, but I swear all of my symptoms disappear on a little bit of this drug.

I dont even need to take it regularly, which is another contradiction with what is supposed to happen: this stuff is supposed to build up in the blood stream as you take it consistently. If you miss doses the blood concentration does not rise to where it needs to be. Are you taking your 50mg dose everyday without fail? Also, is your primary care physician aware of what you take for your sinus tachy and how do you be sure that the two drugs do not interact?

[RNRita]

HI there.  I am wondering why he wants to increase your dosage.  If it is controlling your sinus tach, then it is doing its job.  Beta blockers do not stop PACs nor PVCs.  It is a misconception.  They decrease the heart rate. Less heart beats = less PACs/PVCs although the ratio probably stays much the same.  I'm on a beta blocker for fast resting heart rate.  It controls that, but I've had bigeminy, v-tach and other things.  The atenolol that I take comes in 25mg doses.  I've been up to 100 mg a day with no difference.  In fact, I seemed to have more PVCs on the higher dosages.  I currently take 25 mg.  Good luck.