What time do you take BB and CCB?

[Jerry_NJ]

I have a follow up visit with my Cardiologist's Physician Assistant (PA) concerning my change about 3 weeks ago from 100 (or more) Metoprolol a day to taking 50 mg Metoprolol and 240 mg Diltiazem XR (Diltia XT) a day.  The former is Beta Blocker (BB) and the latter a Calcium Channel Blocker (CCB).   Both are long/extended/slow (whatever) release and are often prescribed for taking once every 24 hours.  Well having my doubts about how even the does is over a 24 hour period, I decided to take the BB in the morning and the CCB in the afternoon.

Well the good news is I got a good bit of time to talk about my evaluation of the prescription change, generally a positive evaluation as I had posted here earlier this month.  My Cardiologist doesn't really rush me, but I somehow felt time was less of an issue when talking with the PA.  

To the point of my subject line, the PA asked that I take the BB and the CCB both before bedtime.  The theory, as I understood it, is that this will minimize my HR (maximize my heart's rest) during my sleeping period and this will result in an improvement in my energy level during the day.  So, no BB this morning, I'll take both tonight.

Anyone get a similar prognosis on when to take BB/CCB?

[Jerry_NJ]

Well, one week of taking both before bed time and I am going back to the morning for the 50 mg of Metoprolol.  I am pretty sure the night time BB causes more dreaming problems, the dreams seem to be more vivid and lasting.   This is hard to get a good measure on as my mind tries to forget dreams as soon as I wake up... I think this is normal.  I also don't feel any more energy and I think my HR is a bit higher both during the day and when first getting out of bed... I always check my resting rate when I get up in the morning.  

Keep in mind, I am still taking a stiff CCB before bed time.  For me the day on BB and night on CCB (both are 24 hour medications) works better.  I will talk more with my PA, but have decided to go back to my original regiment for time to take.  I may call and leave a message saying I have I've decided to go back to taking the BB in the morning.

[rilesnic]

Jerry, I was told to take my BB at night.  Started off with Toprol in AM and I was completely drained.  I've been on atenolol for about 6 years now and was told to take at bedtime.  I don't have the lack of energy like I did taking the Toprol in the AM.

[Jerry_NJ]

I see I opened my post with a typo, "I have" it should have been "I had" as the rest of the message does imply.

The PA was quite confident that resting the heart at night is more productive than slowing it down during the day.  Of course the meds are extended release and should still have strength throughout a 24 hour period.  Given BB are well known to cause some fatigue problems, morning isn't the best time.. however I was concerned that BB were causing me some troubling dreams.  But, even at 50 mg in the morning, the dreams go on.  I'll try to measure the dream trouble-index tonight to see if it is up or down, given I just took my BB on the new night schedule.

As I said in an earlier post, I have a very positive reaction to the CCB medications over BB.  It has so far lowered my HR and I think I have less fatigue... from cutting BB form 100 mg to 50 mg.  I also asked about the potential benefits of going CCB all the way, no BB.  I think the doctor has to be consulted, and I agreed to give the current medication regiment a few weeks longer before trying to change it again.  I have another PA appointment in about 8 weeks, and will see my Cardiologist in October for my 6 month check-up. That may be the first time to really consider further reduction (maybe to zero) in my BB.

[Nurse2b1982]

Hmmmm...I havent heard of this either unfortunately.

[LindaTX]

Sorry, Jerry, I don't have a clue.... but it will be interesting to find out!  :)  I do know that even the small amt of ToprolXL iused to take would cause me fatigue if I took it in the morning.

[ksig]

Interesting point, Jerry.  I take Diltiazem XR as well as atenolol and diovan.  I  take all three in the morning.  It has never been a recurring topic of discussion.  I am going into the hospital on Wednesday for a pacer change out, so I will bring it up when I am discharged that afternoon.

Your argument makes sense.
ksig