beta-blocker side effects

First I would like to thank all those who responded to my posts in regards to metoprolol.. What a thoughtful group!!!

What I am wondering is if anyone out there on beta-blockers has experienced side effects like sluggishness, slight head-ache, and a foggy feeling? I can tollerate these, if the reward is staying out of a-fib. However, I am going to ask my doc. about atenolol.. When i experienced my first a-fib 25 years ago, I was put on atenolol, and don't seem to recall feeling the way I do on metoprolol... As a reminder, I had been a-fib free for those 25 years...All in all, I have been in a-fib a total of about 15 hours in my life.. I know i should consider myself lucky...I wonder if I have over-reacted in asking my doc. to put me on these beta-blockers... This second episide just really scared me, and cost me a fortune at the hospital... I am considering going off of these drugs alltogether, and instead, try to control it with diet..

Any thoughts, Jim

Just as a matter of interest, I have been on Metoprolol 25mg b.i.d. since Summer 2009 (about 18 months) since being in hospital with acute bacterial pneumonia subsequent to H1N1. I was on life support in lala land for almost a month and awakened to discover I was on Metoprolol (is this when AFib started?).

In any event, in the 18 months, up until November, my pulse was regular and 'in range'. Nobody was willing to take me off the Metroprolol and nobody knew why I was put ON Metroprolol while in hospital. I was in about as bad shape as it gets and at one point my wife was asked how long she wanted me to be kept on life support. Then I woke up. Go figure. Perhaps some MD's don't know everything. Remember that.

As to the side effects of Metroprolol I do not believe that I have been experiencing ANY. I do feel sluggish and short of breath often but attribute that to the AFib itself and not the med.

Having said that, there is always the interaction between meds that comes into play and I experienced the worst of those when meds were changed in November past against my better judgement. I returned to my original meds three weeks later but appear to have been left with persistent or permanent/chronic AFib as a result of a plummet in BP and all the other nice things the new meds did at the time. It is the only event I can specifically associate to my pulse starting to look like a kid drawing a circle on an etch-a-sketch. That pulse has not changed since and I am looking at an attempt at electrocardioversion in the next month (I have been stabilizing my INR via Warfarin/Coumidin).

Everyone is different; what I experienced may not be what you experience as I have learned the hard way. I would certainly speak with my doctors (ALL OF THEM) as well as my pharmacist about the meds and the side effects and I would do it sooner than later.

Just my experience and two cents worth. I am still learning.

Jim - I've probably responded numerous times on the side effects I experienced with metoprolol. Sluggishness is an understatement. I also developed insulin resistance, which I later learned was common. I weaned off that drug and felt much better. It took a couple of years to reverse the insulin problem and fortunately, my glucose tolerance and Hemoglobin A1C remains good.

However, Metoprolol is in my PIP protocol and I have used it successfully when needed to slow the heart rate prior to adding flecainide to convert on those intermittant occasions when I have breakthrough AF. I only use 25 mg, but it still manages to make me feel tired and sluggish for the day after. Still, I'm grateful that it works well as the companion to the anti-arrhythmic when I need it.

Have you taken the time to chart out a log of your daily intake of sodium and potassium from food sources? ... so that you can attempt to calculate what your intake ratio might be...keeping in mind that at 4:1 potassium to sodium is the goal which should help keep you in NSR. This could be a good project for you while you're waiting for the CV so that you can make adjustments if needed and hopefully then maintain NSR.

Good luck with your CV.

Jackie

Jackie- Thanks for the input on metoprolol.... I think I need to get off of it... Been on it for about 3 months, and just don't feel up to par.. How long did it take you to get off of it??...Did you start by cutting the pills in half?? I currently take 25mg daily... I will be seeing my doc. soon, and talking about this...

I have been really trying to reduce my sodium, while increasing my potassium.. I am lucky in that I love the low-sodium v-8... I drink around 6 cans per day..

What do a-fibbers do when they go into a-fib on an airplane... I am very concerned about this, and will be traveling soon? Is there any agreement on the best medication to take upon onset?

Thanks, Jim

Jim
I was on metoprolol for about eight weeks when I noticed a light-headed strange feeling. I took my pulse and counted 30 beats per minute. Got up and walked around a bit and the rate went up again. This happened again about a week later, and I phoned my cardiologist, who had prescribed the drug. He would not phone back and I was told to phone my GP. She phoned right back and told me to get off the metoprolol right away, that I was being overblocked. I said, "But they say you have to wean off it" and she said, "ok, take half doses for two days, and then stop." I took half doses for one day, and they made me feel so sluggish by that time that even a half-dose was too much, so I just stopped. No ill effects for me from stopping so quickly, but as we all know, we are all different.

Marg

Jim - My doctor told me to shave off a bit of the pill each time I took it. I did this over about a month's time. When I commented to the EP nurse on one visit that I was taking 12.5 mg or half the 25 mg pill... she said I may as well not be taking any at all as that was a 'trivial' amount. So, I just stopped and had no problem. I had been using 50 mg morning and night.

Now, for the PIP approach, I still take 25 mg at the onset to slow the HR down and then in 30 minutes add 100 mg flecainide. If I don't convert in 1 hour, I'm to take another 100. It usually works in about an hour.

For flying, I'd be sure you have a Plan B in place. That reassurance, alone, goes a long way to keeping your "calm." Carry with you whatever drugs you do use to help convert. I'd use the metoprolol just as I've mentioned if your HR starts to climb because of anxiety. I would also take Theanine before, during and after your flight... if you are anxious the day before, then use it. I'd carry a stash of magnesium and potassium supplements with you in case of delays and if you have an event. Buy bottled water to carry on the plane once you pass security and hydrate well during your flight. Carry some type of food, nuts or something in case of delays.
I'm not a anxious flyer, but I always carry with me anything I might need if I would have an event or if there is a big delay. That way I can remain calm. I have had AF events while flying and one just as I boarded years ago. Fortunately, my stash has always helped me. The main thing is staying calm and knowing that you'll be okay, just as you always are at home...just ride it out if necessary. I rely heavily on theanine anytime I anticipate stress or if I get into an unexpected stressful situation.

Here's the dosing information from Michael Murray, ND, article on theanine:

L-theanine has been approved for use in Japan as an aid to conquer stress and promote relaxation. It is a very is a popular ingredient in function foods and beverages as well as dietary supplements designed to produce mental and physical relaxation, without inducing drowsiness.

L-theanine is fast-acting. Generally, the effects are felt within the first 30 minutes, and have been shown to last up to 8 to 12 hours. Based on the results of clinical studies, it has been established that L-theanine is effective in the range of 50 - 200 mg.

If a person has higher levels of stress it is often recommended that they take at least 100 to 200 mg one to three times daily. Although L-theanine is completely safe and without any known adverse drug interaction, as a general guideline it is recommended to take no more than 600 mg within a 6 hour period and no more than 1,200 mg within a 24 hour period.

At typical dosages, e.g., 100-200 mg L-theanine does not act as a sedative, but it does significantly improve sleep quality. It is also an excellent synergist to melatonin and 5-HTP (5-hydroxytryptophan) in promoting sleep. On its own, L-theanine at a dosage of 200 mg was shown in a double-blind trial to produce statistically significant improvements in sleep efficiency, an index of actual sleep time enjoyed between the time of falling asleep and nighttime awakenings.

Read the whole article [integrative-energetics.com]

Good luck.

Jackie

Thanks Jackie, great information... I am currently only taking 25mg. of the metoprolol daily,,, I also carry the faster acting tartrate version in 25mg, and was told to take one of these upon onset.... I am wondering why nobody mentioned the flecainide that you use.. I will mention it to my doc. next fri. when i see him... I have never been a nervous flyer before.. The afib changed that... I also have some ativan i can take if i get very anxious...

Thanks again for your input.....Jim

Jackie,
I'm also taking Metoprolol Succc ER 25 mg once a day, guess this is the time release version. My doctor told me this is low dose and should not effect insulin. I also just started Flec 50mg twice daily where I read you need to stay on a beta blocker in the rare event of tachycardia? Flec seems to working well for me, hoping this is a miracle drug for me right now like others have said. Is 50mg twice a day low dose? Thanks

I currently take 25 mg of atenolol a day. My main problem with beta blockers has been cold hands and feet. I didn't notice it so much early on as I had a very strong heart from regular workouts. But now, it is a real problem, especially in the winter months.

I also take a small amount of flecainide. Last year, for about six months, I dropped the atenolol altogether. My hands and feet got better but my heart got worse. My EP said it was unwise to take flecainide without rate control. It could result in a very high HR as the Flecainide tries to keep the atria and ventricles in sync. That is, high atria rate may lead to higher ventricle rate.

One good thing about a beta blocker. It totally eliminated my migraine headaches. Also takes the edge off. Many pro golfers use beta blockers to improve putting.

McHale - originally, I was hospitalized for the induction of flecainide and Toprol XL. That was the initial dosing. Because of the symptoms and the feeling of being in hybernation 24/7, and after reading here, that beta blockers weren't appropriate for vagals, I decided to stop. I told my cardiologist why I was doing it. He didn't object or give me any cautions about inducing flutter.

As far as affecting insulin, it's well known that beta blockers can cause insulin resistance....it's probably an individual biochemistry thing. All drugs deplete magnesium so making sure you have plenty of magnesium daily is a good start for avoiding insulin resistance. As I recall, back then, I was not taking nearly as much magnesium as I did in later years. Even my holistic MD at the time ('99) was not knowledgeable on the nutritional aspect of AF. We here on this forum are light years ahead in that regard.

Jackie

I have been taking atenolol for 25+ years. Started at a low dose, 12.5mg, then upped to 25, then upped to 50, then 75, then 100, now back down to 75. I think that my body is telling me that 75 is too much. My resting HR is below 50 and for the past few weeks I have had lots of ectopic episodes that last off and on for most of the day subsiding at night and mostly when I'm at rest. Also, I notice a problem when I exercise at moderate levels, like hiking hills, and riding my bike. The feeling is very heavy legs when hiking with a HR that never goes above 105. If I push myself any harder, the lactic acid buildup in my legs forces me to slow down. Now, with all these ectopics that have been happening lately, I don't know if I'm taking too much atenolol or not enough. I don't like the heavy feeling when hiking up hill or when I push myself a bit on the bike. So, I blame it on the atenolol and low HR at rest and at moderate exercise. Probably not pumping enough blood to the extremities. The main reason I take atenolol is for pressure control. Normally it runs between 115-125 over 60-75. I should probably take my pressure while hiking up my favorite hill at 105 bpm. Should I be asking my cardio to wean me off the beta blocker and onto something else for pressure control? I feel as though if my HR is above 55-60 in NSR I don't have any ectopics or afib. (I am mostly vagal). And finally, today and yesterday while I was having a lot of ectopics and a low HR, I drank a cup of regular coffee to see if the caffeine would boost my HR. It did slightly and also the ectopics went away for a while. Go figure. Going on a 7 day cruise soon and it would be nice to not have any afib or ectopics. (In my dreams) Ha...
cheers,
Ralph

Hi just wanted to say that upon my first AF episode last year I was prescribed 40mgs Nadalol! No wonder I could hardly walk! I weaned off after a couple of weeks. But then had a repeat AF a few months later so I used one of the left over Nadalols and converted myself. My cardiologist insisted I should take it daily and agreed to a lower dose which I did but still felt lousy. I was also worried when I researched it that it can screw up thyroid metabolism which was certainly not something I wanted as I am on meds for low thyroid. Then I met two different people who hadn't had an episode for a long time and were told by their cardiologist just to take a BB at onset of AF and use it as a PIP (along with 4 baby aspirin under the tongue). So I decided to go that route instead of poisoning myself with a drug that I didn't seem to need. That was last October and I am doing fine. I do follow the supplement protocol mentioned here on the forum and I carry my BB and aspirin with me as a PIP.