a substitute for nadolol

[leonel]

Hi doctor,

I'm writing from Argentina, I find your advice and the forum to be extremely helpful.
My case is that I've been taking Corgard (nadolol) in the range of 40-80mg for over 10 years to counter for IST, PVCs and mild/moderate hypertension. The med was a lifesaver for me and did manage to lower my heart rate to a range where I could feel confident. I also received treatmente for anxiety, clonazepam and an SSRI.

Now in my country Bristol has discontinued the Corgard and there is no generic nadolol here so I've been switched to bisoprolol. This drug does not seem to be working, in fact my resting heart rate is going up to 90-100 in the evening and then I'm afraid of having an attack. I did resort to clonazepam for anxiety but had a couple of racing heart episodes during these days. I ended up secluded and terrified!

I was wondering if the bisoprolol could be lowering my BP too much to a point where it could trigger reflex tachy or something (I'm on 5mg). Also, I wanted to ask you if there is any other betablocker which is more similar to nadolol, that is to say, which is more 'focused' on heart rate lowering (metoprolol, sotalol?). Finally, is adding ivabradine a possibility here? Because that would bring my sinus rate down without further lowering the BP.

Any thoughts will be greatly appreciated. I feel quite frightened that this whole thing is coming back and the only thing at my disposal to stop it is gone. I had previously tried atenolol without good results. I have an appointment with my doc in a few days, but it'd put my mind at ease to have some reassurance as the day-by-day struggle to stay well continues.

Thanks a lot, all the best, Leonel

[Veritas01]

I too suffer from PVCs, PACs and AFIB.  I was on Corgard for some time then I was switched to Sotalol which did not work that well.  As a matter of fact I was in Buenos Aires 3 years ago and I had a horrible episode of nearly constant PVCs.  When I returned home my doctor switched me to Flecainide and Atenolol and it has worked well.  I wish you the best of luck.

[leonel]

Hi doctor,
Thanks a lot, it's been helpful to learn there are some other options. Atenolol never worked for me, only nadolol did, that's why I grew so attached to it, and stayed on it for over 10 years... Maybe the rebound tachy is something of an abstinence reaction to discontinuing nadolol. Bisoprolol seems to be failing so far, apart from the lack of heart rate reduction, it's causing me to be extremely depressed, I'm having nightmares and feeling out of sorts. I may try sad old propranolol, although we have no sustained release here.

My ventricular fractions are great, valvs are fine, but I'm overweight and out of shape, mildy hypertensive. Would it be safe to combine a beta with verapamil/diltiazem? I really want to get rid of the sinus tachy and get my life back. It's very disturbing for me.

Thanks again for your kind words, Leonel

[Michael J. McWilliams, M.D.]

Sorry to hear they no longer have your beta blocker.  Finding the right beta blocker is often trial and error.  If one doesn't work, sometimes it helps to just another one.  As an example I have seen people take atenolol and be completely wiped out others think it is a miracle drug.  Express your concerns to your doctor that you feel worse with this drug and you can change doses or change medications.

It is doubtful that a beta blocker would cause rebound tachycardia because it blocks the receptor that would cause the tachycardia.

I have never seen ivabradine used before so I can't really comment on that one.  It does slow down heart rate but I have no experience with it.

I hope this helps.