Problems Comming Off Propanalol

I have been on Propanalol for migrane (migraine) associated vertigo since the begining of July. I started on 80mg and built up to 240mg over a number of months. 4 weeks ago I upped my dose to 320mg and the following day collapsed as my heart beat had dropped to 47bpm, this happened again later that day. I was told by my Dr to reduce back to 240mg but again this had the same affect and I collapsed, so I was then told to reduce back again to 160mg, again I was collapsing. Then due to travel with work I stopped taking them and felt good for 3 days with no problems, on the fourth day my heart beat went to 105bpm which I know isn't exceptionally fast however it felt extremely fast to me (I am generally quite fit and visit the gym 3 times a week). Again I visited my Dr who put me back on Propanalol on 80mg which was OK for a couple of days as it slowed my heart beat down to 65bpm which felt normal to me. On the third day I collapsed again with a slow heart beat of less than 50 and so was reduced back to 20mg which was fine for about 5 days when I felt like I was going to collapse again. I was taken off Propanalol completely just over 2 weeks ago and for the first 3 days my heart beat was constantly just over a 100. Since then I have been in A&E twice with bad chest pains and I constantly feel like someone has scared me, my heart rate is fluctuating between 80 and 100 which is fast for me. Whilst in A&E i was checked for everything you could imagine (blood tests, ecg and x-ray). I believe that I am suffering from withdrawal symptoms from stopping the Propanalol as I have never had heart problems before taking them. The Dr at hospital agreed that I was suffering some kind of rebound but thought that I should be comming towards the end of it, were as my GP thinks that the Propanalol was out of my system a while ago and I should not be feeling like this. At the minute I am off work with this condition and under pressure from work as I had a month off a year ago when my balance problem was really bad. Does anybody know how long withdrawal symptoms from stopping Propanalol can last?

[itdood]

It sounds like you are now experiencing anxiety too which isn't surprising after coming off the beta blocker.  This might be part of a larger picture or just due to the rebound effect.

Since this a behavioral response it requires no drugs or other medical issue to occur.  

When your HR speeds up try some anxiety control techniques, like deep breathing or valsalva maneuvers to see if you can lower your HR through biofeedback.  If this helps you are another step closer to controlling it.

I see you realize this but perhaps me saying it will reinforce it, you aren't even getting tachycardia.  If you keep dwelling on it and hyper monitoring your pulse, this will further contribute to the anxiety.

[ptadvoc8]

I'm NOT a medical professional, and I don't know that your symptoms are due to BB w/d, but I would suspect you ARE indeed having BB withdrawal symptoms. I spoke at length about this subject with a pharmacist specializing in cardiac meds and she said most docs are not aware of just how sensitive some patients can be to BB withdrawal and how debilitating w/d can be. Recent studies have shown that the body actually manufactures EXTRA beta receptor sites when BB drugs are given -- the higher your dose (and frankly, that was a pretty high dose!) the more difficulty you may have with w/d symptoms because your body is now extra sensitive to the naturally occurring chemicals the BBs were designed to block so your body is flooded with them.

In addition, Propanolol, because it crosses the blood-brain barrier, is said to be more difficult to w/d from and may be associated with more anxiety type w/d symptoms in addition to heart related symptoms because of this. I have read some recommendations that patients who are especially sensitive may need to reduce their dosage by only 10% - 20% per week for a symptom free taper. Because you were having such bad symptoms with your heart at the dose you were on, that was not possible in your case, but still I would find a good pharmacist and ask to speak with them about this, get their take on it and ask for any recommendations they might have for your symptoms after the BB w/d, then go back to your doc -- or even try another doc if you don't get what you need -- to help you get through this. It's only natural that you would have anxiety in this situation, but it's also entirely possible that much of the anxiety  -- and other symptoms -- are physical in nature and are caused by BB w/d.

While it feels terrible, it is unlikely to cause serious problems, although except in rare occasions, patients are generally told to taper off these drugs and for many this does have to happen s-l-o-w-l-y, especially from higher doses or long-term use. Still, you should not have to feel this way, nor do I think you should be made to believe your symptoms are all due to anxiety -- that can just lead to patients believing it's all in their head and only anxiety and then they actually may develop panic attacks based on these experiences. Meditation and reassurance can help tremendously as you go through this and are valuable adjuncts to treatment, but don't underestimate the reactions some patients can have to BBs. Below is a link to another lengthy discussion about this subject. It may help you to read through it. Also, if you can hang in there, these symptoms will go away as your body readjusts, but until that happens, IMHO, you need much better information and support from your medical team and you may have to help educate them in how to provide this to you since they may be totally unaware of the realities of BB w/d because there are so many drugs to keep up with and each patient is different. Good luck and best wishes with this.  

http://www.medhelp.org/posts/Heart-Rhythm/Weaning-off-of-beta-blockers/show/752126?personal_page_id=871786&post_id=post_5138142