PACs and 12.5mg Metoprolol

[PTHII]

After experiencing a combination of 'irregular heartbeats', fatigue and some elevated blood pressure, I was recently tested, and told I was having about 3,000 PACs a day. Otherwise, my Echo and Holtor tests were excellent. My Doctor prescribed taking 12.5mg of metoprolol a day, even though he acknowledges that there is only a moderate chance that it will address and improve the problem. Having heard some of the more extreme cases of the potential side-effects of metoprolol, I was wondering...

a.) Am I likely to experience many side-effects at such a small dosage? (I'm assuming 12.5mg 1x a day is considered a low dose).

b.) What is the likelihood that metoprolol can be helpful for the aforementioned symptoms, especially in such a low dose?

c.) Is 12.5mg minor enough to be able to stop taking fairly easily? Could taking it actually make my conditions worse?

Thanks for any considerations and responses.

[snippygirl50]

Hello from another Marylander!!! I am approx. 1 hr from Ocean City Md. by Salisbury Md............
I was glad to read your post concerning the Toprol XL, I haven't had any nightmares with mine, been on it for approx 6-7 yrs. I first began with these flippy floppy beats after my mom passed away. then my cardiologist prescribed the Toprol Xl, 100 mg ( 1 per day) my PC Dr. prescribed xanax 0.25 for my anxiety. Which he said might be causing it....I also was detected by the cardio to have WPW, but he said it was better every year he did the EKG. ( THANK YOU JESUS) but my worst side effects with the toprol is edema. In hot weather i can barely go outside in the heat. Ankles and hands swell so. I am definately going to ask the Dr about the metoprolol and see what he says...Recently I have had alot of the skippies I called him he will see me next week on the 20th.  Seems like when i read these posts it makes it seem less threatening....but each time I have them it is very frightening. Especially since they seem to be more frequent this time  and are affected by laying down, eating and especially when i get upset...I am praying my cardio visit is okay...thanks again for the info on the post...

[Candleguy]

I too have been following these threads and a fellow Marylander. I have really bad palpitations and I am on 50 mg of metroprolol. It seems to work for the most part yet with any stress it seems to be ineffective. Sometimes after meals or before meals if I am starving I will get palps really badly. Any kind of stress or if I sit in a certain position it will set them off. I am tired of these things because they impact my life negatively. I do believe these are connected to our stomach and digestion. Anyone have any suggestions?

[Vylent_Fyre]

I had an emergency endoscopy and colonoscopy on the 17th. Still waiting for test results on biopsies but started on lialda 2 days ago for Ulcerative Colitis. My heart palpitations is, to me, my worst symptoms. Holter monitor showed 6 episodes of premature heart beats followed by palpitations.  Stress echo and echocardiography showed I have "heart of a teenager" according to cardiologist. No one could confirm if the UC could be causing heart palpitations.  The day before I started taking lialda my heart palpitations suddenly increased considerably throughout the day. I'm not sure if I'm low Potassium, magnesium, dehydrated, etc but these palpitations truly terrifies me. I was waking up every hour from them. Cardiologist just prescribed for me to take metoprolol, half of a 25mg so 12.5mg. I'll be starting on either tonight or tomorrow morning.

I do recommend talking to a gastrointestinal doctor if you think it is food or bm related like I did.  It seems like the palpitations are worse as i feel food moving in my system. Then just before a bm they definitely increase. I'm hoping the metoprolol will help and not cause more symptoms...

Howdy y'all from good ole Texas

[finetilthree]

Dear Paul,
I am in the same catch 22.  Here's what I've found that works for me.  If I'm having a really bad day...lots of palps, high anxiety from it, I will pop a pill.  My cardio says its fine to do it that way and he'd rather me do it that way than take it every day...the pill in the pocket approach.  However, I will tell you this...I hated the Toprol XL due to the severe depression and nightmares.  I switched to the generic form (metoprolol) which wasn't the extended release... more immediate effect and doesn't last as long in the system.  This approach does not cause me nightmares or depression.  I am 36 and mine started suddenly as well... very disconcerting.  Good Luck!

On a side note, we're neighbors!!! Hello from Carroll County MD!!!

[PTHII]

Thanks for your considerate response, ftt. I'm glad that toprol XL helped with your a-fib condition, but I realize PACs are not too enjoyable either. It sounds like you were prescribed toprol XL to treat the a-fib, then developed PACs *after* starting the medication. Is that right? I'm an otherwise healthy, athletic 37 year old male, which makes this sudden onset of these PACs and other symptoms all the more disconcerting.

It seems to be a bit of a catch-22: The PACs, and associated symptoms, are too troublesome to leave untreated, but the treatment involves taking a medication which only has a small chance of improving the condition, which consists of numerous potential side-effects, and which may actually either cause the condition to worsen, or create new symptoms all together. Not much of a choice, eh? :-) I wish there were some milder, more promising, alternatives.

Thanks again for your help, and best wishes on your own recovery.

~ Paul
Annapolis, MD

[finetilthree]

I was prescribed Toprol XL at the same dosage and had horrible nightmares and depression.  It did not improve my symptoms (PAC's) at all.  However, it prevented me from having any more episodes of afib which I had as a result of pregnancy.  I took it for about six months, and have been off of it now for six months.  In answer to your questions:
a)  My cardiologist told me that the dose I was taking was "like peeing in the ocean".  
b)  Did nothing to help my pacs.
c)  My doc told me that it was such a low dose that I didn't even have to bother weaning off of it.  Could taking it make your condition worse?  I don't know the answer to that question... however, I took it to supress a-fib (which it did), but I developed pac's after taking it and they are still here six months after I have stopped taking it.  Could be coincidental...there is no way to tell.  
Good luck!!