If Metropolol made you tired, alternatives?

I came across this comment which hit home with me as I've had the same problems, side effects with Metoprolol:

"When I was first diagnosed I was given Metoprolol. I too felt like I was in a fog, and was extremely sleepy and out of it. Asked my Dr to switch me to something else ...eventually settled on Bystolic which was much, much better for me personally. Everyone reacts differently to these drugs so work with your Dr to find what is right for you".

(Looking at the Wiki page on Bystolic, [en.wikipedia.org] , I see it has some potential rough side-effects as well...)

Any good experiences to suggest, alternatives to what Metoprolol does? (Beta Blocker, rate control).

Bystolic is a "Cardioselective" Beta-Blocker. These should cause less sedation/legarthy than Metropolol, because they target the Heart, and at least at lower Doses, have less effect on the rest of the Body.
The other type of Drug we use for Rate Control, is a Calcium Channel Blocker, like Diltiazem. These usually are less Sedative than Regular Beta-Blockers.

Metoprolol has a wide dosing range depending on the patient. Minimum dosages can be 25mg/day and maximum dosages 200mg/day.

How much were you on when you noticed the fatigue and did you try titrating down?

Thank you Anti-Fib, and good question Wolfpack, I was put on 25mg (twice a day, with 50 mg Flec, twice a day), and actually just this morning I decided to cut the Metoprolol pills in half on exactly your reasoning, so, I'm trying 12.5 and 12.5, but I think I will seek as well a different option than Metoprolol, but yes, lets see how this goes at a lower amount, and thanks -

Yes, you can cut the metoprolol pills in half, but only if they are the metoprolol tartrate. The metoprolol succinate is the extended-release formulation and should not be cut in half.

Thanks Wolfpack, I see that mine is Metropolol Tartrate (so not time release then), and about 10 hours in from my last dose where I started the "cut in half", my heartrate as expected is up a bit (but was low before actually), and, so far, no disruption to Afib being controlled, no random scratchy patterns (yet LOL) on my pulse with waveform display meter.

Side Effects survey, question, for the Metoprolol alternatives:

I know anything has its potential side-effects, and different people have different reactions, but among the good suggestions so far, Bystolic or Atenolol as targeted / more selective beta blockers, and a "selective" calcium channel blocker like Diltiazem;

It seems, with an initial read-through, that Bystolic "may be the least of the bad side-effect potentials"... If anyone has feedback on Metoprolol alternatives (mentioned, or not yet mentioned here) and side-effects you've had or know about, I'd love to hear about it. I'll probably be switching to "something" else in two days, when I next see my cardiologist.

And, would Flecainide still be "probably the best thing to partner with it", re: rhythm control... the Meto/Flec combo "controls my Afib", but, I'm foggy and exhaused, actually could function better "in" Afib... which wasn't good LOL.



Edited 2 time(s). Last edit at 05/09/2018 07:10PM by FrankInFlorida.

Frank - one problem with beta blockers... and in my case... the metropolol when I took it full time... was the potential for a negative influence on insulin release. I was not and am not diabetic, but for some reason, the metoprolol made me feel tired and weak. After complaining to my holistic MD at the time, he suggested the insulin resistance potential and we did testing that confirmed the problem.

Note this:

Beta-blockers

Beta-blockers are the other major class of blood-pressure-lowering drugs that have been implicated in causing diabetes or worsening diabetes control. The several large studies that have looked at the risk of diabetes associated with beta-blockers include the Nurses Health Studies I and II and the ongoing ARIC (Atherosclerosis Risk in Communities) study. In these two studies, the risk of developing diabetes in people originally without it who took beta-blockers was approximately 20% to 28% greater than in those who did not take beta-blockers.

This may seem counterintuitive since people with diabetes are often warned that beta-blockers can cause problems with low blood glucose, not high blood glucose. Beta-blockers cause these two problems in distinct ways. First, they may harm a person’s ability to recognize and respond to low blood glucose, mainly by keeping the heart rate slow, which can dampen symptoms of hypoglycemia. They may also inhibit the release of glucose from the liver. But beta-blockers also block the release of insulin by interacting with nerve signals to the pancreas and can thus lower insulin levels even when blood glucose is high.

There is some evidence that not all beta-blockers affect insulin secretion. Beta-blockers work by interacting with proteins in the body called beta receptors. There are several distinct types of beta receptors in the body. Beta-1 receptors are predominantly in the heart, while beta-2 receptors are in the heart as well as the arteries, muscles, liver, and pancreatic beta cells. This means that beta-1–selective drugs are less likely to interfere with the secretion and regulation of insulin.

Several studies have shown that a combination of beta-blockers and thiazide diuretics, as expected, also produces an increase in the risk of developing diabetes, by approximately 20%. The National Institute for Health and Clinical Excellence in the United Kingdom, an advisory group that develops national health policy, has placed a limited caution against the combined use of beta-blockers and thiazide diuretics for people at high risk for diabetes (because of family history, impaired glucose tolerance, or obesity, for example). While the risk of diabetes-related complications for the population as a whole is relatively low, these drugs may be a source of preventable diabetes or of diminished blood glucose control in individual cases.

Of note, ACE inhibitors and calcium channel blockers have not been strongly linked to diabetes.
Source: [www.diabetesselfmanagement.com]

Jackie

Thanks Jackie, man these drugs are like shaking around a house of cards! What a path we must weave...