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Metoprolol vs Atenolol for Heart Rate Control
I posted an update to my tread on "living with AFib", that touches on this subject.
I post here as I would like to draw specific attention to the difference I have learned mostly by the help of other patients who contribute to this Community and from web searches. Strangely, in my mind, my Cardiologist never volunteered consideration of Atenolol even though I have complained to him for years (at least 10) that I suffer from dream problems, I call them trouble mares. That is a subject for the "sleep disorders" Community to which I also contribute - so I'll I will not go into more detail here on that subject.
Following are my observations on day two of substituting Atenolol 25 mg twice a day for Metoprolol 25 mg twice a day.. both are regular, for Metoprolol it is called Tartrate, I think the Atenolol comes in only one normally longer lasting form.
Today in the early afternoon, following my third 25 mg dose of Atenolol at about 9 AM, I noticed some dizziness when I rose from a time sitting. This is not unusual for me, but I checked my HR anyway (using my new Oximeter, subject of another post) and found even though I was then on my feet and had walked at least 10 feet my HR was in the mid 50s. Prior to changing to Atenolol I rarely saw my resting HR below the low 70s. I also note my resting HR yesterday and in the early hours of this morning were mostly 70s for resting, some 60s.
I then went outside and did some physical work, spitting some Ash Hardwood for firewood. Most of this splitting was done with a 4 ton electric splitter for which I had only to lift the rounds (upwards of 40 pounds I estimate) onto the splitter and then pull them splits apart and throw on a stack. This went on for perhaps 40 minutes with me having to revert to an 8 pound maul (sledge hammer) and Wedge to split some rounds that stopped the light duty electric splitter. I estimate I made no more than 30 swings with the heavy maul. This fairly strenuous exercise did make me a bit breathless and I found my HR only in the upper 90s. Before Atenolol I recall a similar workout would have put my HR over 130, or near my maximum allowed rate.
Research on the web says that Atenolol is much longer lasting than Metoprolol and suggests that Metoprolol Tartrate has to be taken twice a day... Atenolol only once ! Strangle, again, my Cardiologist who issued a prescription for Atenolol upon my request to be allowed to try it is for 25 mg twice a day.
Given my unusual low HR I conclude that taking the Atenolol twice a day would be more comparable to taking the Metoprolol (same 25 mg) Slow Release twice a day - thus being equivalent to an increase in BB level, thus the lower HR.
I plan to skip my bedtime does, treating my morning Atenolol as a long lasting once a day. This will also cut my intake of BB from 50 mg a day to 25 mg. I will keep a close watch on my HR and be sensitive to any unusual heart symptoms, the current unusual low HR going back to upper 60s or lower 70s at rest being considered normal, not unusual. I look to with some hope that the reduced dose coupled with the lower brain side-effect of Atenolol will reduce the problem dreaming. I fully expect to wake up in the early AM hours and will check my HR then, I keep my Oximeter (with HR meter) on my nightstand.
I post here as I would like to draw specific attention to the difference I have learned mostly by the help of other patients who contribute to this Community and from web searches. Strangely, in my mind, my Cardiologist never volunteered consideration of Atenolol even though I have complained to him for years (at least 10) that I suffer from dream problems, I call them trouble mares. That is a subject for the "sleep disorders" Community to which I also contribute - so I'll I will not go into more detail here on that subject.
Following are my observations on day two of substituting Atenolol 25 mg twice a day for Metoprolol 25 mg twice a day.. both are regular, for Metoprolol it is called Tartrate, I think the Atenolol comes in only one normally longer lasting form.
Today in the early afternoon, following my third 25 mg dose of Atenolol at about 9 AM, I noticed some dizziness when I rose from a time sitting. This is not unusual for me, but I checked my HR anyway (using my new Oximeter, subject of another post) and found even though I was then on my feet and had walked at least 10 feet my HR was in the mid 50s. Prior to changing to Atenolol I rarely saw my resting HR below the low 70s. I also note my resting HR yesterday and in the early hours of this morning were mostly 70s for resting, some 60s.
I then went outside and did some physical work, spitting some Ash Hardwood for firewood. Most of this splitting was done with a 4 ton electric splitter for which I had only to lift the rounds (upwards of 40 pounds I estimate) onto the splitter and then pull them splits apart and throw on a stack. This went on for perhaps 40 minutes with me having to revert to an 8 pound maul (sledge hammer) and Wedge to split some rounds that stopped the light duty electric splitter. I estimate I made no more than 30 swings with the heavy maul. This fairly strenuous exercise did make me a bit breathless and I found my HR only in the upper 90s. Before Atenolol I recall a similar workout would have put my HR over 130, or near my maximum allowed rate.
Research on the web says that Atenolol is much longer lasting than Metoprolol and suggests that Metoprolol Tartrate has to be taken twice a day... Atenolol only once ! Strangle, again, my Cardiologist who issued a prescription for Atenolol upon my request to be allowed to try it is for 25 mg twice a day.
Given my unusual low HR I conclude that taking the Atenolol twice a day would be more comparable to taking the Metoprolol (same 25 mg) Slow Release twice a day - thus being equivalent to an increase in BB level, thus the lower HR.
I plan to skip my bedtime does, treating my morning Atenolol as a long lasting once a day. This will also cut my intake of BB from 50 mg a day to 25 mg. I will keep a close watch on my HR and be sensitive to any unusual heart symptoms, the current unusual low HR going back to upper 60s or lower 70s at rest being considered normal, not unusual. I look to with some hope that the reduced dose coupled with the lower brain side-effect of Atenolol will reduce the problem dreaming. I fully expect to wake up in the early AM hours and will check my HR then, I keep my Oximeter (with HR meter) on my nightstand.
Congratulations on taking charge of your own health care. Yes, we need the doctors, but in the end we are the ones who live with and pay for the medications and treatments they prescribe. I hope you are wrong about doctors accepting medicare being scarce. My doctor will surely be retiring soon and he is one in a million. I don't even want to think about having to look for another who may not accept my insurance.
COMMUNITY LEADER
Update, last night (early morning) my HR was a bit higher, no more 50s. Even at 7 AM while still in bed my HR was in the low 70s, still very acceptable. When I got up and had breakfast, up and down a flight of stairs a couple of time, a trip around the house to attend to a bird feeder and dog, and a couple of cups of coffee my HR never measured above 100. I didn't notice much dizziness when I "jumped" up from seated to walk quickly across the room - a good 25 feet, to answer the telephone. Yes, we still use a wire line phone and while the tele instrument is cordless, I never remember to take it with me when I retire to the living room, and this morning a seat before a fire in the fireplace insert.
Early conclusion: 25 mg once a day of Atenolol works, and spares me the dizziness I associate with the lower HR of 25 mg twice a day. I have not taken my blood pressure, an error in this "test" plan, but that's were I am.
Trying to hurry up on the scientific principle that when doing an experiment with several known variables, change only one variable at a time - the assumption here being that the change has stabilized before making any other changes... I am considering two days and trend line on the reduction of Atenolol sufficiently stable to change something else.
Starting this morning I am cutting my Calcium Channel Blocker back to 1/2, my prescribed level of 120 mg twice a day. I broke my 120 mg dose of Diltiazem in half, and took half this morning, other half will be for this evening. I had misstated earlier I took 240 mg twice a day, 240 mg was the total per day, not dose.
My reasoning on safe to try this is the CCB was added to get my Metoprolol down form 100 and more mg a day to lower my HR. The Atenolol is doing such a good job I may be able to ask my Cardiologist to just drop the CCB all together.
It seems I am pretty much on my own here, and while I consider the very helpful input from my friends here on this Community, the decisions are all mine.
My doctor may not be happy when I tell him after the fact I have done a study and from that here are my recommendations for my treatment. Of course I'll have to be much more tactful and say in a way that fully recognizes I am a patient, not a doctor. As noted earlier, as a senior using Medicare, it may be difficult to find a doctor to treat me simply because of the low payment rate. I don't want to offend any doctor willing to treat me, in the final analysis I plan to be on a plan the doctor has at least approved.
Early conclusion: 25 mg once a day of Atenolol works, and spares me the dizziness I associate with the lower HR of 25 mg twice a day. I have not taken my blood pressure, an error in this "test" plan, but that's were I am.
Trying to hurry up on the scientific principle that when doing an experiment with several known variables, change only one variable at a time - the assumption here being that the change has stabilized before making any other changes... I am considering two days and trend line on the reduction of Atenolol sufficiently stable to change something else.
Starting this morning I am cutting my Calcium Channel Blocker back to 1/2, my prescribed level of 120 mg twice a day. I broke my 120 mg dose of Diltiazem in half, and took half this morning, other half will be for this evening. I had misstated earlier I took 240 mg twice a day, 240 mg was the total per day, not dose.
My reasoning on safe to try this is the CCB was added to get my Metoprolol down form 100 and more mg a day to lower my HR. The Atenolol is doing such a good job I may be able to ask my Cardiologist to just drop the CCB all together.
It seems I am pretty much on my own here, and while I consider the very helpful input from my friends here on this Community, the decisions are all mine.
My doctor may not be happy when I tell him after the fact I have done a study and from that here are my recommendations for my treatment. Of course I'll have to be much more tactful and say in a way that fully recognizes I am a patient, not a doctor. As noted earlier, as a senior using Medicare, it may be difficult to find a doctor to treat me simply because of the low payment rate. I don't want to offend any doctor willing to treat me, in the final analysis I plan to be on a plan the doctor has at least approved.
Jerry-I really appreciate your post. I have been on atenolol for about a year.
The MD prescribed 50mg once a day. My HR went to 45. After a couple of days I decided to go to 25 mg twice a day. My PAC's are pretty much gone (reason for the original scrip) and my resting HR is in the low 50's. I am also considering and mentioned this to my Cardio (he isn't the greatest in the world. He originally prescribed flecanide and I thought for 3-4 days that my heart was going to come out of my body) that I would like to cut back to the morning dose only. He said try it (very encouraging). I will be monitoring your posts. Hopefully this will work for both of us. I too drink tea early morning followed by a bit of coffee which doesn't seem to have a negative affect on my heart rate or bp.
The MD prescribed 50mg once a day. My HR went to 45. After a couple of days I decided to go to 25 mg twice a day. My PAC's are pretty much gone (reason for the original scrip) and my resting HR is in the low 50's. I am also considering and mentioned this to my Cardio (he isn't the greatest in the world. He originally prescribed flecanide and I thought for 3-4 days that my heart was going to come out of my body) that I would like to cut back to the morning dose only. He said try it (very encouraging). I will be monitoring your posts. Hopefully this will work for both of us. I too drink tea early morning followed by a bit of coffee which doesn't seem to have a negative affect on my heart rate or bp.
Just read your last post. Does the caffeine have any effect on your heart rate or bp? Or the afib? I use none -- even chocolate, altho my EP says caffeine may be getting a bad rep.
Jerry -- my Atenolol is manufactured by Zydus Pharm and is 1/4" and is not scored, but breaks easily. I did ask the pharmacy to keep ordering from this mfr. and refused a very small tablet as I could not break it. They honored my request. Glad the Atenolol is working well for you. Take care.
COMMUNITY LEADER
Thanks, my situation is driven by permanent AFib and increasing age : )
I will continue to monitor my now one 25 mg in the morning. I still intake some caffeine in the morning, two/three 8 oz (can't convert o ml in my head) and one 12 oz black tea. In fact I'm a bit behind schedule this morning and am now drinking the tea. It is just past 12 noon here.
My 25 mg Atenolol was taken about 10 AM and was seeing a HR in the low 70s, it is now 60 at rest, as at rest one can be trying to type on a small travel laptop (true notebook) while looking through old eyes.
I remain optimistic that the move to Atenolol was the correct decision.
I will continue to monitor my now one 25 mg in the morning. I still intake some caffeine in the morning, two/three 8 oz (can't convert o ml in my head) and one 12 oz black tea. In fact I'm a bit behind schedule this morning and am now drinking the tea. It is just past 12 noon here.
My 25 mg Atenolol was taken about 10 AM and was seeing a HR in the low 70s, it is now 60 at rest, as at rest one can be trying to type on a small travel laptop (true notebook) while looking through old eyes.
I remain optimistic that the move to Atenolol was the correct decision.
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