Testing a reduction in dose of beta blocker... maybe stop.

[Jerry_NJ]

I have been on beta blockers or stronger anti-arrhythmic drugs for about 20 years.  I have been in permanent AFib for about 10 years following open heart surgery to repair a mitral valve.  About two weeks ago at my 6 mo check up with my cardiologist I asked if beta blockers, or any of my other medications, could cause sexual problems in a senior male (heck being senior is surely the main issue, no med for that however).  He suggested I try stopping my beta blocker, Antenolol 25 mg every12 hours.  I have to watch for too high heart rate (suppose that means 100 bpm at rest and under 130 when exercising) and restart beta blockers if HR problems surface.  Blood pressure could also be a problem to watch for.  So far I think I in general feel better, much less dizziness when I stand from a long period of sitting... and maybe in general I feel better.  My HR is still in the low 80s when at full rest and general 100 to 115 when up and just moving around on level surfaces.  I do not feel any hammering or even any notice of higher HR other than reduced sensitivity to change in activity level.  I now wonder if trying (in fact I am testing) lower dose of beta blocker to see if there is some happy ground that gives both benefits, lower HR and no dizziness, and maybe better performance when engaged in physical activities... the details of which may be a subject for another community.    

I'm now starting on going to 25 mg once a day, first with Atenolol regular release, ant then maybe try Metoprolol at 25 mg slow release, I have both on hand.  

Question?  Looking for any experience or knowledge on the value of reducing beta blocker dosage and when is the dose so low as be useless, too low for the body to even notice.

[Jerry_NJ]

Hi tom, good to see some of the "old gang" are still active here.  I am just now returning to half my past 50 mg of Atenolol .. now taking just 25 mg before bedtime.  My resting HR, true resting, when awaking for sleep, was in the 80s.  With the 25 mg I am again seeing even low 60s when checking after awaking and still in bed.  I like that better and while will I discuss with my Cardiologist I plan to go forward with just 25 mg a day, maybe I should take the slow release version.. albeit I went on Atenolol to get the long half-life of about 12 hours.  I'm not sure about a long term build up.  I haven't done "the math" lately but I think a dose X per 24 hours with a half life Y less than 12 hours the long term build up level at is 2X at the time a does down to is taken to X when the next does is due.  That's what I remember, a mathematic series that is asymptotic to 2X.  In any case, I think I am okay with a lower does so long as my HR is tolerable, to me way under 100 when at rest.  Keep up the good work and faith.  Try to enjoy each minute.  

[tom_h]

HI Jerry.  This post is very timely, because I've begun doing the same thing.  Ive been on 100mg of Metoprolol daily for years now.  Recently, I've been having problems with a particular arrhythmia.  Beat-skip-beat-skip-beat-skip, almost like a gallop.  In addition, I've had periods of extremely low heart rate; rates as low as 40 but usually around 58 to 60 at rest.  Interesting, when I bring my respiration up to working levels, my heart responds smoothly and there's no arrhythmia.  I can only assume that in taking my dose day after day, that I had acquired an excessive amount in my blood.  I cut back to 75mg, then to 50mg.  The difference was felt within a day.  The arrhythmia is still there but is very seldom now, and my energy level has jumped.  I plan to talk to cardiologist when I see him next month.  But for now, I'm staying at this reduced level.  I hope it works for you, but given you permanent AFib, do it with caution.

[Jerry_NJ]

So far I'm doing okay with the stop of beta blocker, but the HR was higher than I'd like, in the 80s when just awaking from sleep.  I have gone back to taking beta blocker (Atenolol) 25 mg once a day, before bedtime.  Result give me a lower HR when sleeping.. or at least when I wake up and check.  Also much less dizziness during my awake period when I stand from a long sitting session.  This is 1/2 my usual dosage, I may discuss with my Cardiologist and see if he agrees it is okay for me to use BB at half my long time past level.  I have been in permanent AFib for 9+ years and assume the atria are in fibrosis by now.  Not likely to ever revert to Normal Sinus Rhythm and thus I continue "rate control" as my only treatment.  Also take a calcium channel blocker and of course warfarin (anticoagulant) .