taking Beta Blockers as needed for tachycardia?

11-02-2006, 06:38 AM

Hi, I just registered and had a question for you guys. I posted this yesterday on the anxiety boards and realized it was more of a heart issue (when my problem first started I thought it might be anxiety, now I don't think it's the cause, but probably is worsened by anxiety).

I am taking a beta blocker, Toprol XL 25 mg once a day for sinus tachycardia. I would have ST episodes, at first rarely (every 6 months) then becoming a little more frequent (every couple of months), then when I went to the Dr I had had 3 episodes in 2 weeks. They were often just out of the blue for no reason, but sometimes due to caffeine, which I know I shouldn't have, and then I would get scared and panic/anxiety would prolong it and make it worse. My resting heart rate was fairly high, usually around 90, but ranging from 85-100. During the ST episodes it would range from 120-150.

So they ran the whole battery of tests, blood work for thyroid, EKG, echo, holter monitor, and just found sinus tachycardia- everything was normal, rhythm, valves, etc, just fast. So first they prescribed regular metoprolol 25 mg twice a day. It worked great for my heart rate, but I started having insomnia and started cutting my pills down, first to 3/4, then to 1/2 and taking melatonin and it helped. They went ahead and switched me to Toprol XL (25 mg), which is extended release, that they thought might help with the insomnia (Yesterday was my first day on it so we'll see! I still took the melatonin and slept fine).

Anyway, enough of the long background story! My real question was, although the BB is working well and I am happy with it for the most part, I just have this weird aversion to taking medicine and would kind of like to get off of it. Part of me likes the "security blanket" of not having to worry about ST, but I would like to have the option to quit if I wanted. I asked my Dr. if the BB could be taken on an "as-needed" basis, just when I felt an attack coming on and he said no. But I don't really understand why not. I know people take it for stage fright, so it can be taken on a one-time basis, it doesn't need to build up or anything, and also when I took my first dose, it slowed my heart down within a half hour, so it seems like it would work, when I have an attack of ST, to take a BB to stop it. Would it not stop tachycardia once it had started? Do any of you guys have any insight? I feel like this would work and since I generally didn't have the ST very often, I didn't know if it was worth it to take meds every day for something that happens once every few months. But the doctors don't seem to like that idea. Also a related question- I guess if I was to try that, the regular metoprolol would be better because it is released immediately, rather than the Toprol XL that is extended release?

Thanks, and sorry this was so long! I appreciate any advice anyone has.

11-02-2006, 07:27 AM

Beta blockers work best on a consistent basis. They are not made to be taken intermittently. Your heart needs a constant dose. The rapid increase in heart rate is not healthy. You definitely do not want to just drop your heart rate suddenly either. The sudden increase and decrease can be very stressing on the heart. Listen to your cardiologist, what they are telling you is correct. No one likes to take medicine (at least most). Sometimes our bodies just need a little something to maintain homeostasis (a constant maintaining of stability).

Amy

11-02-2006, 07:41 AM

Hi stargazer,

When one has an episode of ST there is no assurance that the disorder will only be an event of little or no significance. It could very quickly rise to a serious level causing clots and heart arrest. Post medication has a lag time and could/would be ineffective. If serious it would require shock therapy not oral medication.

There is autonomic control of the heat beat and BB helps block the over generation of parasympathic impulses and maintain equilibrium over the long term.

I just read Amy's response, I agree, and I will add don't discontinue medication abruptly as that in itself can cause a medical problem. The body system adjusts.

11-02-2006, 10:18 AM

Thanks for the advice and info. What you all are saying makes sense. I will continue on it for now and if I ever want to get off it I will discuss it with the Dr. first. I did know not to just stop taking it suddenly, I was going to gradually lower the dose if I ever did want to stop. I'm sure it is good for my heart to stay at a more constant level. One thing that concerned me about staying on it long-term was I read that by blocking whatever it is it blocks, it causes your body to make more receptors, so if/when you go off the BBs things can be worse. I don't know if then after awhile your body decreases the number of receptors or not.?? The side effects aren't bad, just the trouble sleeping, but the melatonin works for that. I have read that BBs can decrease your level of melatonin (FYI in case anyone else has that problem). Thanks again for the help!

11-03-2006, 05:50 AM

stargazer,

I get HORRIBLE insomnia from beta-blockers.
I am almost CERTAIN that the XL version of the metoprolol (Toprol) will be even WORSE for insomnia than the faster acting version.

Let me know.

It probably takes a larger dose of metoprolol to STOP an attack than to prevent it this you might need MORE if you take it after symptoms have started...but yes, the instant version is better for this than the XL.

Have you tried propranolol?

11-03-2006, 05:19 PM

Hi Lenin,
I haven't seen much difference between the Toprol Xl and immediate release metoprolol so far. I have tried the last couple of nights to go to sleep without taking melatonin and it does seem like I still have insomnia. But I don't lay there for long, if I don't go to sleep within a half hour to an hour I go ahead and take the melatonin, then I get a good night's sleep. I do feel more sleepy at bedtime at least, on the immediate release I felt alert and wide awake. It might have more to do with it being a lower dosage (25mg XL 1x a day vs 25mg twice a day) than being extended release though. I think if I don't see any difference in the next few days I will probably ask to go back to the original metoprolol though, and take 1/2 a pill in the am and 1/2 in the pm for a total of 25 mg/day, the lower dose seems to have less side effects. They seem pretty much the same to me and I know the Toprol will be more expensive since there isn't a generic. They also suggested I take my pm dose earlier in the evening (I was taking it with dinner at about 7pm)

Do you (or anyone else) know of any differences between the XL and immediate release (besides the obvious)? Like in how your body reacts to it, is the XL better because it stays at a more stable level throughout the day or anything like that? Just trying to figure out if there is any reason to keep taking the XL if it doesn't help with the insomnia. I will ask the dr. this too, I just thought I would give it a few more days before I switch back.

They haven't tried me on propranolol. I will see what my dr. suggests when I call them. I might also get a second opinion, I don't see a cardiologist except they did my holter and echo, but they just sent the reports to my GP, I never actually saw the cardio dr. And, I hope I don't sound critical, but the person I see is a PA, not an MD, (no disrespect to PAs), and a lot of people I know don't think she is very good. I hope that doesn't sound mean, she is a nice lady, and usually seems to know what she is talking about, but I know a lot of people who haven't been very satisfied with her. I may go to a dr. I grew up seeing in my hometown over the holidays, he is an older guy and has pretty much seen and heard it all, so it might be good to get a 2nd opinion from someone with a lot of experience.

Thanks for the help!

11-06-2006, 04:54 PM

How long have you been taking Toprol? In my experience with it I did have insomnia for about two weeks in the beginning but I made it through. I got a kick out of the warning label that says may cause drowsiness, yeah right! I hope you can work through this issue. Good luck.

11-07-2006, 05:39 AM

stargazer,

Just try taking the metoprolol 25 mg. in the morning and NOTHING in the evening. Or else take one at 6 AM and the other at 3 PM.
It' the EVENING dose of the med that's keeping you awake.

You MAY have developed a dependency in the melatonin?

taking Beta Blockers as needed for tachycardia?

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