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612551 tn?1450025775

Slow release or normal release beta blockers

I have been taking a beta blocker, 50 mg Metoprolol ER (Extended/Slow Release), for several years but have with my cardiologist approval today refilled my BB prescription with Metoprolol Tartrate (normal release) to be taken at 25 mg twice a day (every 12 hours).  My reason is driven mainly by the fact the Tartrate is about 1/6th the cost of the Suc (ER).  That said, I wonder if I will not in fact have a more "level" medication concentration taking the 25 mg twice rather than the 50 mg ER once a day.  I think there is a good possibility that I'll have a more uniform medication concentration (on average) taking the Tartrate twice a day.  Or, I have my doubts about how well a ER holds up over 24 hours.

I doubt that I'll have anything to report, i.e., there will not be any change in my symptoms that I can detect.  So this post is more a question/discussion point.  It seems I have the same opportunity to save money on my CCB by taking a normal release at half the dose twice a day.  I'll discuss this with my cardiologist on my next 6 month regular check up, that assume I'll (hopefully) not have to seem him sooner. :)
7 Responses
612551 tn?1450025775
Wow, no one wants to touch this one.

I must be the only one who "worries" about drug costs, and I have a private insurance plan connected to CVS.  Like many (most) drug plans I have to pay something even with insurance.  The Tartrate I pay the whole cost, still much lower than Suc for me.  Tartrate is generally available from the pharmacies offering a $10, 90 supply, that's 180 tablets.  

I devote some time today/night to searching the web for research on how BB concentration levels look with 1 24 hr pill verses 2 12 hr pills.

As said, my cardiologist thinks either is okay for me, and my the pharmacist offering the $10 package recommends it as equivalent.... and just smiled at my supposition that 25 mg twice may be better than 50 mg ER once, a day.
1569985 tn?1328251082
I did better on the beta blocker Atenolol, which does not come in extended release, than I did on Toprol XR.  The Toprol knocked by blood pressure down, like being hit by a ton of bricks.  I finally, on the advice of a nurse, broke the Toprol in half and took it twice a day and it was somewhat better, but still  an issue.  Went to another cardio, he put me on the Atenolol and I take it in 1/4's up to two 25 mg. tablets a day.  I am now on Norpace XR and I may face the same issue with my medigap policy as far as the difference in cost between XR and regular.  I think the regular tablet can be taken 3 times a day, and the XR 2 times per day.  I, also, will discuss this with my cardio when I see him in a couple of weeks.  Do you actually get to SEE your doctor when you have a problem?  If I don't have a regular appt, made 3 months in advance, I see the nurse practitioner or whatever other doctor is available at the cardiology practice I go to.

1423357 tn?1511089042
I was on Metoprolol Succinate until my insurance company jacked it up to a Tier 3 which forced me to pay the major portion of the frieght.  My physician rewrote it for Metoprolol Tartrate so I now get 90 days for 10 bucks.  The latter formula requires the user to take it twice a day and the physicians are concerned that the patient won't remember to take the dose.  However, I have no problems remembering as I'm one of those types that live by a routine. My cardiologist told me that patent for Toprol XL (Metoprolol Succinate) is about to expire, or has already do so, and the price will drop dramatically.  He also mentioned that the patent on Lipitor is about the expire, and pharmicutical companies are licking their chops for that one.  I'm on Simvastatin, and he plans to switch me as soon as the price drops on Lipitor (Atorvastatin Calcium). as he claims it's a much better drug.

So, no, you're not alone.  I worry too about drug costs, especially as I approach retirement age (4.5 years away (I hope!)).
1423357 tn?1511089042
By the way, Jerry.  My cardiologist told me that Metoprolol has become a secondary drug for treatment of hypertension.  He also said that prior claims to it being a good drug for heart attack survival is overblown.  I'm presently attempting to to stop Metoprolol altogether.  I've been operating at 50mg since my ablation when I was at 100mg.  I dropped to 25mg for 2 weeks, and now at 12mg for another day or so.  I have a stress test next Monday and I'm suppose to entirely off it by then.  Doc says he's "going to hurt me" during the test as he wants to see how well I do under heaving physical loading without Metoprolol.  He's going to discover that that I'm pretty "spry" for an old guy!
967168 tn?1477588089
Oh Jerry you're not the only one who worries about the cost of meds, some of my meds aren't even covered by my health care plan (PCIP program pre-existing insurance plan).  

I was paying $352 a month premiums, which was double what I did on United Health Care.  Finally they lowered the cost of the premiums by about 40% July1st to $211, so I'll be able to afford more meds or change from generic to brand as my dr's have suggested I do.

The pharmacy plan on the PCIP leaves so much to be desired, but hey at least I have health insurance; it's a great diet plan - you choose food or premiums and meds.  On the PCIP program, after the 2nd time you refill a script at a local pharmacy, the cost goes up alot some almost double, but if you order through their Medco program it stays the same price as the beginning, so this almost ensures you have to use their program.

For example:
Brand Inderal $125.80/Generic Propranolol $26.05 for 30 pills. I have to use the brand because generic doesn't work with my system due to something in the fillers.  I take it as needed, so some months it costs alot more depending on how flaky my heart's being.

Dexilant  $180 monthly no generic and PCIP said no coverage - denied
Protonix $162 monthly/Generic Pantoprozole $42 monthly (I tried this one)
Prilosec $140 monthly/Generic Omeprazole $40 monthly (I tried Prilosec)

Brand Lortab $47.52/Generic Hydrocodone $4.66

Brand Midodrine $110 - 30 tablets; taken 2-3 times daily = $220 - $330 monthly, for some reason this is considered an "experimental" drug and can't be given in doses higher than 30 pills at a time so I have to refill it 3 x monthly.  I quit taking it when my BP raised so much they were going to put me on something to lower my bp - I see no reason to spend that much money and have to take something else to counteract the med.

I take as little meds as possible, I've been going through disability since I had surgery in August 2009 and have not worked and rely on my early retirement I get - $491 monthly.

The thing that really bothers me is, unless they find me a cure or new heart I have basically 35-40 more years of going through this...

There are programs available for those of us with no health insurance or pharmacy plans; some mfg's websites have help and if you search enough sometimes you can get free medications through them or pharmacy programs.
612551 tn?1450025775
DD:  My cardiologist is booked at least 3 month into the future, but if I am flexible (and lucky) I can put my self on a stand-by list for any cancellations.  I live about 3 miles of easy traffic from my cardiologist, so if I am home I can get there in 15 minutes.  Or, like you, I can get an appointment with a second-tier medical person... I like one woman he has as she spends more time and will discuss +/- aspects of my questions.

Tom: I believe, don't remember the details (I'm older than you), that both the Statin drugs and BB have some additional beneficial side effects - I too take Simvastatin, I was on Lipator and asked for a change when my private insurance (I still have that coverage, and believe it is better than the Medicare Part D - or whatever it is called) made me pick up a large portion of the high cost of Lipator.  Lipator got me down to about 150 from a history of 240 for my total cholesterol.  When I changed to the low cost generic I measured the same or better, I now get a number like 130.  I do not have any plans to go to a generic lipator if it becomes available.

I don't "hate" the drug companies for the high cost of patent medicine - I believe in the private sector market and believe the high return is why capital is put into the research needed to develop new and effective medicine.  Now I wish this confidence would result in a medication that would cure AFib and all other health problems... boy would that ever put a strain on the US (and other) entitlement systems.
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