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Old 05-20-2007, 01:53 PM   #1
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Beta Blockers and Edema

Hi all,

I was wondering if anyone here had ever had a problem with using beta blockers or had some knowledge regarding beta blockers and severe edema. I'm not talking the swollen ankle thingy but dependent pitting edema to the tune of 4-5 lbs on a 100 lb frame.

Could this be the result of beta blockers? I've been on beta blockers for my hyperthyroidism since 1991 and not had any problems with more than slightly swollen ankles on a hot day until this last february. Since last September, I've had my beta blocker changed several times from 160mg inderal to 250mg atenolol to 240mg inderal to 100mg toprol and am currently taking 100mg atenolol. This current lower dose is not doing anything for the water, isn't controlling the weird heart thingys and isn't making my thyroid very happy either.

My pcp seems to want to deal with the problem by throwing lasix at me.

Any input would be appreciated.

 
Old 05-20-2007, 04:16 PM   #2
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Re: Beta Blockers and Edema

I take 3 different meds for BP - 50 mg. atenolol, 5 mg. norvasc and 80 mg. Micardis Plus (water pill is the plus). So far, my BP is good and I don't feel poorly. A friend of mine has edema and is not taking a water pill, because he is allergic to the sulfa that some meds contain. I don't think lasix has any sulfa, but I told him to check with his doctor and get started on a diuretic. My Mom has been taking Lasix for years and is doing well on it. If your doctor is perscribing it, you can always start with a lower dose and see if your edema improves.

 
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Old 05-20-2007, 08:34 PM   #3
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Re: Beta Blockers and Edema

I have thyroid problems and gained 60+lbs of water. Caused by my thyroid making my heart have to work to hard- i have an enlarged heart now, with other problems, please make sure your doctor is sure that your heart is ok-- thats more important than pills to loose the water. Also the doc should make sure your thyroid is ok, as that can be part of the problem to.

 
Old 05-20-2007, 09:19 PM   #4
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Re: Beta Blockers and Edema

Can somebody please tell me what EDEMA is, I'm starting to suspect it could be swollen feet and ankles from this thread. I've been on 50mg morning and night of Metoprolol for five years since my Triple bypass and assumed my swollen feet each night were from bad circulation. If I'm correct in my assumption, should I worry about my swollen feet or just carry on?

 
Old 05-21-2007, 02:33 AM   #5
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Re: Beta Blockers and Edema

Thanks. I really appreciated the responses.

arlmon - lasix does contain sulfa but everything I read said it is not likely to cause an allergic reaction in someone who is allergic to sulfa. I checked cause I'm allergic to sulfa too and that kinda bothered me when I saw it. I have been taking the lasix since the end of march and not run into an allergy problem.

admace - Hypo or hyper? I'm a hyper with normal tsh and elevated hormones. Most likely secondary hyper but the docs don't seem to want to find out why. Been dealing with it for 48 years. Was put on betas and left to pretty much handle it on my own in 1994. The docs take one look at my labs and run. Was diagnosed with a heart murmur (he thought it was probably mvp) in 1983 and an ecg at the er in 1991 showed an enlarged right atrium. That's the closest I've ever had my heart looked at. I know neither of those was terribly significant at the time but having been hung out to dry on the thyroid issue, I'm not terribly fond of the idea of them ignoring this too. The thyroid is not ok. It's been acting terribly naughty for the last year. 3 endos later, and all they can do is shake their head and send me back to my pcp. He's clueless but he did run a creatinine clearance and since that came back "ok", I'm fine. I am to force fluids, take the lasix and call if the edema gets worse. He hasn't seen it.

Jay Ar - Edema is the abnormal accumulation of fluid either under the skin or in a body organ. From what I've read Metoprolol is more likely to cause it than some of the other betas and swollen feet and ankles isn't real unusual. You should tell your doctor about it but in most cases, it's harmless. Mines quite a bit more than swollen feet and ankles.

 
Old 05-21-2007, 06:45 AM   #6
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Re: Beta Blockers and Edema

access,

Your doctor is wise...LASIX is a VERY good idea.

Generally speaking, people who retain water and have hypertension are in the salt-sensitive minority...I consider myself squarely at the top of this pyramid.

We salt-sensitives respond beautifully to diuretics for our hypertension and almost not at all to ARB's or ACE inhibitors and only modestly to beta blockers (although they DO have some diuretic properties and thus are of some benefit.)

Mark my words, if your water retention bothers you, you will LOVE your furosemide (Lasix.) I have tried the last 3 days without it and ate Indian last evening and I am up 6 pounds, all my joints hurt, and I can barely make a filst. I am waiting til I eat something to take my 40 mg. Lasix and pee all this out...it works for about 3 hours. I will probably need tomorrow's dose to complete the job although I COULD take a second dose today///but that would cause me to be thirsty all night long.

AND it's cheap.

Honestly, with Lasix, you might find you are able to do without the 100mg. atenolol, which would be a blessing.
Give Lasix a try at 40 mg. (You MIGHT need a potassium supplement...I don't!)

Nicest drug I've ever taken...oh well, maybe after Demerol and Valium!

Last edited by Lenin; 05-21-2007 at 06:47 AM.

 
Old 05-21-2007, 08:38 AM   #7
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Re: Beta Blockers and Edema

Hi lenin,

I don't have hypertension. I've always pretty much sat square on the perfect 120/80 except when the thyroid kicks into high gear and then I get the normal wide pulse pressure of a hyperthyroider at about 130/70 or something along those lines. My thyroid causes tachycardia, arrythmias and an increased cardiac output. Causes a lot of other problems with the increased metabolism for the rest of my body but the beta blockers pretty much control a lot of the symptoms.

I most likely will have to take beta blockers for the rest of my life. I don't have much choice there. The thyroid almost killed me once and I don't wish to ever go back there again.

Since I have succesfully taken beta blockers for 18 years, I can't understand why I am currently having this problem. My bp's been staying stable. Pulse is staying under 100 but I have been feeling quite ill ever since I started bloating last february. Nobody will look for the root of the problem. And besides, this lasix makes me wanna puke. Every day I've taken it, I spend the rest of the day trying to keep from losing my cookies and it also seems to be dropping my bp down to a max of 110/70. This is only 10mg, mind you.

I have trouble believing that after all this time that the betas may be the problem so that's why I asked if anyone else had problems with betas and this much water. I've got a strong feeling that it's something else going on entirely and I'm going to have to start jumping up and down on the pcp's head in order for him to take this seriously or to get him to do anything about it.

I'd very much like to hear that other's have had this same problem with betas. I really don't like some of the alternative possibilities very much.

 
Old 05-21-2007, 10:07 AM   #8
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Re: Beta Blockers and Edema

To answer your question square on:
I really REALLY doubt that your beta-blocker is contributing to your edema. That would be antithetical to the way beta-blockers work.

 
Old 05-21-2007, 10:44 AM   #9
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Re: Beta Blockers and Edema

Not exactly what I wanted to hear but pretty much what I expected. My pcp doesn't seem to know a whole bunch about betas. I've been trying to learn as much as I can about them after a little incident last september when he switched me from 160mg/day of inderal to 25mg atenolol and landed me in the er where I was told I could go as high as 400mg if needed. I went as high as 250mg. This 100mg just isn't doing it.

I gather I'd be pretty safe going back up again and not have to worry that it is contributing to the waterworks problem especially since dropping the dose doesn't seem to have any impact on it anyway?

Can't tell you how much I appreciate the input.

 
Old 05-22-2007, 05:17 AM   #10
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Re: Beta Blockers and Edema

I feel that if a person isn.t responding well to a beta-blocker for any reason, then it's unlikely raising the dosage to sky-high limits is going to do much good, and probably a LOT of bad.
If 100 mg. atenolol, a very HIGH dose, doesn't deliver then I think the answer is to find another drug.


Quote:
This current lower dose is not doing anything for the water, isn't controlling the weird heart thingys and isn't making my thyroid very happy either.
And of course, the perfect drug class for edema is a diuretic.

Quote:
And besides, this lasix makes me wanna puke.
There are several other diuretics you can choose but that sounds like a funny reaction to Lasix. Have you ever tried taking 40 mg? Try it for 2 days and check out the effect on your edema.


Anyhoo,
It sounds like it might be time to tackle your thyroid directly. If it is furiously overactive then perhaps surgical or radioactive iodine reduction should be considered. A lifetime of megadosing with beta-blockers may not be the answer becasue of the all-over body effects. There are drugs that work directly to suppress the thyroid: check out methimazole and propylthiouracil (PTU).

What is your blood pressure now with the 100 mg. atenolol per day. What was it BEFORE you started beta-blockade? Why do they keep changing your beta blocker?

edit:

Let me correct my past statements...further research informs me that beta-blockers CAN INDEED cause edema. Live and learn!

So accessn, it seems time to find another treatment regimen...DO check the radioactive iodine because it is the most common treatment and safer than surgery.
Whatever you do, DON'T up to 200 or 400 mg. atenolol.

Last edited by Lenin; 05-22-2007 at 05:40 AM.

 
Old 05-22-2007, 07:30 AM   #11
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Re: Beta Blockers and Edema

Hi lenin,

My frustration level is maxed out. It's a long, long story which I will not go into a lot of detail here. I have a very rare form of hyperthyroidism which is not caused by the thyroid itself. It is a form of inappropriate tsh secretion that simply put, just means that my pituitary is mucked up and doesn't know when to stop telling the thyroid to keep putting out.

I have done anti-thyroid meds in the past. PTU, methimazole and block and replace. 3 solid years of hell. Surgery is not an option. If they cut out the thyroid, it will grow back because it will not stop the excess tsh production. There have been people with this problem that have had their thyroid removed 5 times. I have been waiting since 1994 for rai when one brilliant endo diagnosed me as having "some form of atypical antibody negative graves". RAI is not supposed to be performed unless tsh levels are below normal. My tsh level never goes below normal. I have been shuffled from doctor to doctor and no one has ever been able to help much. I've been dealing with this for my entire life. Sometimes it doesn't bother me much, other times it's a real pain in the butt.

The treatment of choice is beta blockers to control symptoms. The root of the problem is not fixable.

People who are hyperthyroid are also blessed with many more beta receptors than a normal person and also have a tendency to metobolize drugs very fast. Therefore, higher doses and more frequent dosing is necessary.

I did pretty well for 12 years on the 80mg inderal la bid. Something unbalanced me last may (coincidently at the same time that I came down with shingles) and I've been having trouble ever since. Me and my thyroid hormones have been bouncing all over the place ever since.

I live in a very remote rural area. We have one doctor. I have been as far as 300 miles away to see 3 different endos since last september. They pretty much just shake their head and send me back to my pcp. Nobody ever checks to see if and what this is doing to the rest of my body. I get a cursory exam. A look at the labs, a feel of the thyroid, a quick listen to the heart and if I'm lucky, they check my reflexes. I haven't been lucky enough to have one stand right in front of me on that one yet. Came close on one of em though. Then I'm sent on my way with a different beta script to cope with it on my own.

But never mind me. I'm just an hysterical 48 year old female whose probably just going thru menopause that just isn't showing up in the labs yet.

Thanks for listening.

Helen

 
Old 05-22-2007, 05:22 PM   #12
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Re: Beta Blockers and Edema

Ooops. I think I was a little cranky this morning. Sorry.

Any idea by what mechanism the betas do cause edema and whether or not it's dose dependent?

The main reason I ask is that I went so long without problems that it kinda scares me to just chalk it up to them without looking further for any other explanation. Especially since a reduction in dose doesn't seem to have any impact on the situation.

Thanks,
Helen

 
Old 05-23-2007, 05:23 AM   #13
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Re: Beta Blockers and Edema

access,

I'm pretty sure the effect would be dosage dependent.
Basically beta blockers are vasodilators which process always causes some fluid leakage...have you developed a cough?

Your heart might be beating so weakly that you are chemically mimicing the effects of heart failure...and its attendant edema.

Why not go back to the 160 mg. propranolol and see what the effect is. There are big differences between a non-seelective like Inderal (propranolol)and a selective like Tenormin (atenolol.)

It sounds like IF you are going to continue the high beta-blockade route and you continue to get edematous, you really have no alternative but to couple it with a diuretic.

Have you had an MRI of your pituitary?...PAGING DOCTOR HOUSE!

<I have an underlying gut feeling that going to 200 or 400 mg. atenolol would be a DESPERATELY bad choice.>

What would your life be like if you went completely without a beta-blocker and let your "hyperthyroid" run full out? What symptoms would you expect? WHich did you have back in '94?

I found an interesting study: with selective beta-blockers the effect of adrenaline is "pure pressor" that is both systolic and diastolic rise, but with atenolol (selective) adrenaline cause systolic to rise and diastolic to fall: this lowered diastolic MIGHT mean more fluid leakage...not sure.

These mechanism are really tough to figure out though because the effects of thse hormones are so multivariate and effect almost every bodily function.

Last edited by Lenin; 05-23-2007 at 05:42 AM.

 
Old 05-23-2007, 06:38 AM   #14
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Re: Beta Blockers and Edema

Yeah, developed a cough. Also got post nasal drip so I was kinda hoping it was that. Not keeping me awake or anything but the hubby's mentioned that I took up snoring in the last couple months.

Wouldn't a weak heart cause a drop in bp? I been running between 110/70 and 130/80 when I don't take the lasix. I took the lasix today cause I haven't for a couple days and a lot of the water is back.

I did find quite a difference between the selective and non-selective and to be perfectly honest and frank, I was enjoying the non-selective better cause it doesn't muck with the sex life so much. I also noticed that when I originally switched from the inderal to the atenolol back in September, the slight puffiness that I had always had around my ankles disappeared. That made me think that the atenolol was less likely than the inderal to cause it. At some point in all this switching around I did go back to the 160mg inderal and didn't see any difference in the edema after a couple weeks. I do realize that a diuretic may be the only solution. I just wish someone would tell me why it's all of a sudden happening. I'm being brushed off and that makes me nervous.

Had a ct scan of the pituitary in 1991. No tumor. They did an mri of my neck the next day. Do not ask me why. I have never figured that one out. But it is typical of the medical care that I have received regarding this whole mess for the last 25 years.

Ok. I won't go up on the dose. I will ride this out for a little while and see what happens. Then if things don't get better I will try going back to the inderal.

Let me see. Without betas, I can expect my pulse to exceed 180. My metabolism shoots thru the roof and it really can be quite spectacular. It plays havoc with my head and my body. It has resulted in thyroid storm on two occassions. One real bad that required nine days hospitalization followed by home nursing care. The next one was following surgery but I felt it coming and got an increase in betas before it hit full force. My body runs itself into the ground until I collapse.

It wasn't difficult to deal with when I was young. Seems the older I get, the harder it gets. It's beginning to worry me about what it's done to me over all these years. Oh, did I mention I also have high cholesterol that does not respond to dietary measures? The docs have known about it for 25 years. Been told that since I'm a hyper, I don't have to worry about it. rotflol

 
Old 05-24-2007, 04:35 AM   #15
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Re: Beta Blockers and Edema

Quote:
I can expect my pulse to exceed 180.
I guess that quite effectively rules out the no medication route.
Try 40 mg. Lasix/day in a single dose and see what it does for your edema.
If you gag, you GAG...How's THAT for bedside manner. (Take it with food, it is better/faster absorbed in an alkaline environment.)

Ask your doctor point blank if he has any reason to suspect any heart remodelling or falling ejection fraction, or heart failure. What is your ejection fraction? Don't let him off the hook on this...you want PLAIN answers. Heck, you've paid them enough so far.

Quote:
They did an mri of my neck the next day. Do not ask me why. I have never figured that one out.
Probably to ascertain thyroid size and look for any nodules.

Last edited by Lenin; 05-24-2007 at 04:42 AM.

 
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