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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.
I have have been using atenolol (with Tenoblock, Tenoprin or other names) since the eighties. First I was using 50 mg for many years. Later, especially during AF, my daily dose has been the maximum, 100 mg. Some doctors have suggested to use the high dose, and when needed, I was allowed to increase it a bit over 100. I have the feeling that I should not use so high doses, they will decrease my blood pressure and heart rate too much. Recently, I have dropped the dose to 75 mg. Two doctors have agreed with me.
I think that atenolol is usually suggested as one daily dose in the morning. Before my AF episodes I was taking 50 mg in the morning, and it was OK. I took the daily dose 100 mg in two parts, 75 mg in the morning and 25 in the evening, or even in three parts. During AF, atenolol as a single dose was not wery good to keep my heart rate low enough throughout the day. And, possibly a single high dose caused some symptoms in the morning. The evening dose was because of periods of tachycardia at night. But, as early as during the year 2010 AF, I also had some bradycardia and pauses at night.
I think that my heart rate has had a slight tendency to be generally lower nowadays, maybe due to older age or some other, medication or metabolic factor (vitamin D, Thyroid etc). Now ( I have not AF now), I am using 50 mg in the morning and 12,5 mg in the evening. I hope this is enough to prevent a new AF episode.
Since the eighties I have tried to use many beta blockers. Atenolol has been selected as the best. I cannot tolerate eg. bisoprolol. Of calcium channel blockers Verapamil is forbidden, and Dilmin was not good, and maybe the other calcium channel blockers are not suitable either. It has to be noted that different beta blockers are very different in their effect, so their dosages can be very different.
Atenolol allows my heart rate to rise so much that I do not feel dizzy or weak when I am going up a hill or stairs. Other beta blockers cause my heart rate go mad (bisoprolol) or do not effect at all. Intravenous Seloken, in the emergency unit in 2010, had no effect on my heart rate, and Spesicor in this year did not affect either.
I think that atenolol is usually suggested as one daily dose in the morning. Before my AF episodes I was taking 50 mg in the morning, and it was OK. I took the daily dose 100 mg in two parts, 75 mg in the morning and 25 in the evening, or even in three parts. During AF, atenolol as a single dose was not wery good to keep my heart rate low enough throughout the day. And, possibly a single high dose caused some symptoms in the morning. The evening dose was because of periods of tachycardia at night. But, as early as during the year 2010 AF, I also had some bradycardia and pauses at night.
I think that my heart rate has had a slight tendency to be generally lower nowadays, maybe due to older age or some other, medication or metabolic factor (vitamin D, Thyroid etc). Now ( I have not AF now), I am using 50 mg in the morning and 12,5 mg in the evening. I hope this is enough to prevent a new AF episode.
Since the eighties I have tried to use many beta blockers. Atenolol has been selected as the best. I cannot tolerate eg. bisoprolol. Of calcium channel blockers Verapamil is forbidden, and Dilmin was not good, and maybe the other calcium channel blockers are not suitable either. It has to be noted that different beta blockers are very different in their effect, so their dosages can be very different.
Atenolol allows my heart rate to rise so much that I do not feel dizzy or weak when I am going up a hill or stairs. Other beta blockers cause my heart rate go mad (bisoprolol) or do not effect at all. Intravenous Seloken, in the emergency unit in 2010, had no effect on my heart rate, and Spesicor in this year did not affect either.
COMMUNITY LEADER
Thanks for your personal experience with the same drugs, that's what's great about this Community (blog) resource.
HesAPooka:
Your experience with taking 25 mg Atenolol encourages me to continue my experiment with the same.
Tom:
I as mentioned many times, I am disappointed (as are others) with what I consider the Medicare shuffle, in-out in minimum time, in the USA - you'll be there in a couple of years yourself - if Obamacare doesn't replace it with something worse, I believe 2014 is the full-implementation date. In truth I have to confess my Cardiologist is very kind and attentive and never gives me any direct indication he is trying to quickly finish with my check-up, but the fact that he never offers any experimentation to find a better approach leads me to conclude he's trying to minimize the time I take - good business practice in any business is get the job done right and quickly if you want to make some $$$ and I believe as long as my heart is holding up under the current treatment is good enough. Still I believe the lower Medicare rate, which he accepts, plays a role. Bad news, Obama keeps trying to lower the rates - make the doctors "pay their fare share".
I have lived in the same house for about 25 years so most of my doctors go back to when I was on private health insurance, and they all continue to care for me as a Medicare patient (read that to be lower pay than even the negotiated in-network insurance rates) but I believe, intentional or not, that each doctor tries to minimize the amount of time he spends on each (Medicare emphasis) patient. Thus, when I asked (he didn't come up with the good idea, it came from me and my education here on his Community) him to write me a prescription for using Atenolol he wrote it to mirror the Metoprolol. It took me only a day and a half to conclude the two drugs are not equivalent/equal in my body.
Is-Something-Wrong put me on to some important differences:
1) Atenolol is longer lasting, much longer half-life (forget what he gave, but for me it looks like a half-life of at least 12 hours)
2) Atenolol has less affect on brain function - I have complained for years to my Cardiologist about suffering from what I call trouble-mares. I have specifically asked about the dreaming being related to my BB.
Now with two days "under the belt" I will take my morning dose (and only dose) in the next hour. My resting HR is in the low 70s, now 24 hours since the last dose of Atenolol. When checked during the wee hours of the morning (I wake at least 3 times between midnight and 7 AM) my HR and O2 were good, HR in low 60s and O2 over 95%. Thus I plan to continue with one 25 mg dose of Atenolol each morning and to monitor my HR and O2 saturation.
After heart surgery I was up to 100 mg Metoprolol twice a day for a few days, but I took my BP so low the nurses made me rest and get it back up after a work out in the cardio rehab I was taking. It was somewhere along this time that the BB was lowered and CCB added.
DeltaDawn:
You mention cutting your Atenolol into parts. My tablet (assume all are about the same regardless of the manufacturer) are about 1/8th inch in diameter, and would be difficult to cut in half, forget about fourths. How are you cutting such a small tablet? I have considered taking half in morning and have at night, but my experience/test so far suggests just taking it at 25 mg once a day in the morning may work for me. I am keeping a close measure on what is happening to my HR as I pass the 12 hours mark from my morning dose.
-----
I have never had trouble with high blood pressure, and take the beta blocker (in combination with calcium channel blocker) to lower my HR, so called "rate control" treatment of AFib. I will check my BP too, but doubt it will react badly to a lower dose of BB. I take CCB at something like 240 mg twich a day - high dose, but guess at the number), The CCB is also a BP lowering drug.
HesAPooka:
Your experience with taking 25 mg Atenolol encourages me to continue my experiment with the same.
Tom:
I as mentioned many times, I am disappointed (as are others) with what I consider the Medicare shuffle, in-out in minimum time, in the USA - you'll be there in a couple of years yourself - if Obamacare doesn't replace it with something worse, I believe 2014 is the full-implementation date. In truth I have to confess my Cardiologist is very kind and attentive and never gives me any direct indication he is trying to quickly finish with my check-up, but the fact that he never offers any experimentation to find a better approach leads me to conclude he's trying to minimize the time I take - good business practice in any business is get the job done right and quickly if you want to make some $$$ and I believe as long as my heart is holding up under the current treatment is good enough. Still I believe the lower Medicare rate, which he accepts, plays a role. Bad news, Obama keeps trying to lower the rates - make the doctors "pay their fare share".
I have lived in the same house for about 25 years so most of my doctors go back to when I was on private health insurance, and they all continue to care for me as a Medicare patient (read that to be lower pay than even the negotiated in-network insurance rates) but I believe, intentional or not, that each doctor tries to minimize the amount of time he spends on each (Medicare emphasis) patient. Thus, when I asked (he didn't come up with the good idea, it came from me and my education here on his Community) him to write me a prescription for using Atenolol he wrote it to mirror the Metoprolol. It took me only a day and a half to conclude the two drugs are not equivalent/equal in my body.
Is-Something-Wrong put me on to some important differences:
1) Atenolol is longer lasting, much longer half-life (forget what he gave, but for me it looks like a half-life of at least 12 hours)
2) Atenolol has less affect on brain function - I have complained for years to my Cardiologist about suffering from what I call trouble-mares. I have specifically asked about the dreaming being related to my BB.
Now with two days "under the belt" I will take my morning dose (and only dose) in the next hour. My resting HR is in the low 70s, now 24 hours since the last dose of Atenolol. When checked during the wee hours of the morning (I wake at least 3 times between midnight and 7 AM) my HR and O2 were good, HR in low 60s and O2 over 95%. Thus I plan to continue with one 25 mg dose of Atenolol each morning and to monitor my HR and O2 saturation.
After heart surgery I was up to 100 mg Metoprolol twice a day for a few days, but I took my BP so low the nurses made me rest and get it back up after a work out in the cardio rehab I was taking. It was somewhere along this time that the BB was lowered and CCB added.
DeltaDawn:
You mention cutting your Atenolol into parts. My tablet (assume all are about the same regardless of the manufacturer) are about 1/8th inch in diameter, and would be difficult to cut in half, forget about fourths. How are you cutting such a small tablet? I have considered taking half in morning and have at night, but my experience/test so far suggests just taking it at 25 mg once a day in the morning may work for me. I am keeping a close measure on what is happening to my HR as I pass the 12 hours mark from my morning dose.
-----
I have never had trouble with high blood pressure, and take the beta blocker (in combination with calcium channel blocker) to lower my HR, so called "rate control" treatment of AFib. I will check my BP too, but doubt it will react badly to a lower dose of BB. I take CCB at something like 240 mg twich a day - high dose, but guess at the number), The CCB is also a BP lowering drug.
One other thing.... I originally got on Metoprolol Succinate not for my SVT or to control blood pressure, but to use the side effect of slowing the heart rate. I had complained about awakening in the middle of the night with an elevated sinus pulse. Unfortunately, my physician never took into consideration that my elevated heart rate could have been caused by something. It turned out that I had very severe obstructive sleep apnea which was diagnosed several years later by a new physician. I continue to take it today at 75mg/day for bp and arrhythmia control, along with heart attack survivability. At 62, that unpleasant thought must be taken into consideration.
Hi Jerry. As a retired "double E", I imagine you already realize this but it bears mentioning: You must consider that the effect seen for a given weight of Metoprolol Tartrate cannot be compared to the same weight of Atenolol. In other words, I don't think you can freely exchange drugs and use the same weight.
So if you were formerly on 25mg of Metoprolol 2X/day (which I know from experience is a fairly low dose), 25mg of Atenolol 2X/day may be huge in comparison. I had been on Metoprolol dosages as high as 200mg/day (not fun), and my cardiologist said he has prescribed dosages as high as 400mg./day.
By the way, you can compare similar weights of Metoprolol Tartrate and the time release version called Metoprolol Succicate if you consider the longer half life of the latter version.
So if you were formerly on 25mg of Metoprolol 2X/day (which I know from experience is a fairly low dose), 25mg of Atenolol 2X/day may be huge in comparison. I had been on Metoprolol dosages as high as 200mg/day (not fun), and my cardiologist said he has prescribed dosages as high as 400mg./day.
By the way, you can compare similar weights of Metoprolol Tartrate and the time release version called Metoprolol Succicate if you consider the longer half life of the latter version.
I only take 25mg once a day. If I were to take another dose at night it would lower my pulse too much, and I've also read that taking it at night can cause insomnia as well. I find on 25mg my heart rate sits around 60--75 for most of the day which is perfect for me since my heart rate is affected by my IST during the day time, and usually comes back down to a normal rate on its own at night time.
Jerry -- My Rx for Atenolol is 2 25 mg. tablets per day. I have gone from 1 to 1-1/2 per day to 2 tablets per day after my recent cardioversions. I am weaning off of it now and am back to about one tablet a day. I break the tablet in "large 1/4's" or just a bit less than half for each dose, every 8 hours. My EP said I could do it however it wanted. If I took an entire pill, my bp would plummet like a stone. I keep a check on my hr and bp and if they are down too low, I delay my next dose. My heart rates stays in the 50's. If it drops to 55 or so, I delay the dose. A 60 hr feels fast to me now. I am having some fatigue since my Norpace was increased after my last afib episode. My thyroid is low, so that may factor into the tiredness too. You might want to try 1/2 tablet every 12 hours, rather than one tablet every 24. For me, my bp and heart rate would be up if I didn't spread it out over the course of the day. Keep us posted on how you do. I hope it works out better for you. Sounds like it is keeping your hr lower with less meds.
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