medication change

Thank you for taking my question - Male, 39, parasoxymal a-fib & labile hypertension, overweight (6'5", 300#). It is believed by PCP & cardiologist that my high BP is most likely the catalyst for the a-fib (approx 1 episode lasting 2-45 minutes per 3-6 moths). Always spontaneously converts. Yesterday,  BP reached 180/90 for no apparent reason. EKG taken by cardiologist as precation was normal. Cardiologist is having me drop Cardizem LA (180 mg) for Carvedilol (6.25mg 2x per day). Any reason to think this change could trigger arythmia or something else really kooky? I am told this is an excellent medication and typically very well tolerated. I tried Toprol XL before for several months. Did not tolerate it well, mainly due to severe nightmares. Once removed from the Toprol, nightmares stopped. Is this a different class of beta blocker that is safer and what (if anything) should I be concerned about? Meds are aspirin (81), protonix (40), HCTZ (25), Lisinopril (10-20) sertraline (50) and now the 6.25 carvedilol.

[Jerry_NJ]

Maybe I over looked, but given you've told us you weigh 300 pounds, I say lose at least 60 pounds and I bet the BP goes down and the AFib disappears.

The only serious risk from AFib is the formation of blood clots and given you have few episodes and are on aspirin I think your clot risk isn't much greater than the general population.

You named too many drugs for me to comment beyond my long term experience with Toprol and Metoprolol (generic) and trouble-mares every nigh for the several years I've been on the drug.  Your sharing your return to peaceful sleep after going of Toprolol raises an interest in me to change drugs.  What do you take instead of Toprol ? Thanks.

[ratatat]

The a-fib doesn't scare me too much anymore since I always seem to self convert. Once coming off the Toprol, I went to Cardizam LA, a calcium channel blocker. It did a pretty good job, but because it is a time release I had to juggle the dosage time to ensure delivery. Peak distribution of the medication is 14 hours, and since I had (ironically) all a-fib episodes between 4-5 a.m., I took the Cardizem at 3p.m. which ensured I got peak med delivery within that time range. The only side effect I had from the Cardizem LA (not the generic) was being able to wake up in the mornings. I felt drugged. I guess you could say that the price was also a side effect, but...We are trying the carvedilol (generic for Coreg) to see if it offers me better coverage. It is a 2x per day dosing.

[Jerry_NJ]

Thanks, yes I understood that calcium channel blockers can be a substitute for a beta blocker, and given you got immediate relief from dreaming, I am interested.

I had my 6-month check-up with my cardiologist a couple of days ago and complained about my unpleasant dreaming problem.  He suggested I cut back on the beta blocker.  I was taking 100 mg morning and night.  The Metoprolol is SR.  I'm still having dreams.

I call my dreams trouble-mares not night-mares, as my dreams and not life threatening/scary they are just troubling... I traveled a lot in my profession and some of the dreams relate to travel and reservation screw-ups and complexities.  Strange, I had almost none of these experiences in my many years of heavy travel.   Other dreams relate to phobias I am aware I have even in my waking life.  My subconscious worry center is just having a field-day on beta blockers, it seems.  

[ratatat]

I started the carvedilol as a replacement to the cardizem Friday. So far, so good, no side effects to speak of and no dreams. This is a beta / alpha blocker combination. Since starting it, heart rate and blood pressure has stayed pretty consistent.