6 Months out and considering a medication change

[Oilman]

Well I visited my Cardiologist today and reviewed my echo and rehab results. Everything is looking good he says, and we should schedule my next echo and visit for a year. Im feeling pretty darn good these days. I started riding my road bike 20km per day in 52min, for the last two weeks now. I find myself pushing harder each time I go out, and feeling very well doing it. I do ride with my Garmin 310 st so I can keep an eye on my HR. I'm really interested in getting into the best shape I can this summer, but doing it safely too.

I have my alarms set for 140 bpm, which I set off on the hills and once in awhile when I just initiate exercise. So I have been thinking about switching from Metropolol to Bisiprolol solely for the convenience of only taking meds once a day. My Cardio expressed the, if its not broke, don't fix it theory, but is willing to go down this road with me. It's just a lot easier with the type of work I do, in my opinion.

So now that I have his blessing and the prescription for the bisiprolol, im getting a little cold feet. Just wondering if anyone has done this and what was the experience. My resting heart rate is at 60 bpm at rest now. When I ride my average HR is 120-130 bpm. Like I mentioned before, I do experience a few spikes in HR. I also get PVC when not exercising, but nothing that last anytime.

I spoke to the Cardio a few months ago about this and he had said my current dose of metropolol was 150 mg per day, so the equivalent in bisiprolol would be 7.5 mg once per day. But now that I told him about my heart rate spiking a few times, he wants me to start at 10 mg first, and if I feel off we will drop to the 7.5mg a day. My Bp has been good, avg 115/75 most always. I just don't like the comment about not feeling well, especially if I'm out cycling by myself.

So just wondering if anyone has been down this road, and what your thoughts are...

Thanks
Doug

 

[epstns]

Doug - If I remember correctly, metoprolol is a timed-release version of the drug, so why the point about only wanting to take meds once a day? I have been taking metoprolol once daily since my AVR over 2 years ago. The one thing we did was to gradually reduce my dosage from 100 mg/day to 50, then to its current 25 mg/day. As long as my statistics stay under control, the 25 is where I stay. When reducing my dosage, I noticed major improvement in exercise tolerance - especially the last reduction to 25 mg. When I was taking the full 100 mg/day, I felt as if I was towing a sled full of rocks when I worked out. Now I feel better than I did during the couple of years prior to valve surgery (even with a pacemaker since surgery). Why not discuss a reduction in your metoprolol dosage with your cardio as a first try?

 

[Oilman]

Steve,

I was not aware that Metropolol can be taken once a day and control the PVC's and arrythmia's. When I left the hospital I was placed on Metropolol 75mg twice a day, I was told this was generic. I started to have a little dizziness when getting up to fast, so at my visit at 4 weeks out to show surgeon my leaking from scar, which was normal. He mention that we should cut back that Metropolol to 50 mg twice a day. It seem to help the dizziness, but maybe allowed more PVC's. when I went to see my Cardio at 8 weeks, we did a stress test and found that my HR shot up to 168 bpm, which he had concerns about being so early from surgery. He decided we needed to increase the Metropolol to keep the HR under control. So that is where I went back until now, 75mg twice a day.

I notice that about a couple of hours before its time for the meds, my PVC can be more frequent, possibly from me paying to much attention to them, sitting at rest. I believe he called my fast heart rate increases while exercising, SVT's. i can get it to drop off right away if i stop the intensity of exercise for 30 seconds, then get back to it. The cardio mentioned that if and when my Hr and arrhythmia's starts to stay under control, we will start to decrease the dose. Really not sure what I should try at this point. I could call him back and ask about taking the Metropolol once a day. But I was just wondering if anyone has the experience with the switch of these two drugs. I seem to be fine with the Metropolol. I can't compare my condition to before surgery, as I let my condition go for the last 3 years leading up to Surgery. I have dropped 35 lbs since last sept, and am eating a lot better, so I feel way better now.

I'm pretty sure if we decrease the drug now, I may experience more PVC & SVT. I did suffer a Afib event back in Sept that provoked my valve replacement. I only have had it that once, would be nice to keep it that way too. With the meds not bothering me too much now, I'm ok with staying at a higher dose for now. One thing the Cardio mentioned is the difference in the two drugs is that Metropolol blocks two signals, one from the heart and one at the brain. He claims the Bisoprolol only blocks the signal from the heart and that is really all I require now. Sometimes it's a little to much to take in on a 30 minute visit...lol..

Thanks for the insight

 

[epstns]

Oilman - I re-checked the label on my metoprolol last evening. Mine is "metoprolol ER succinate." I believe that the ER means extended release. So, there really may be two versions of metoprolol and if you prefer to take meds only once per day, maybe you can be switched to the ER version.

 

[Oilman]

I think your right, my bottle says Pms-Metropolol-L Tartrate, so I'm thinking this stuff has a quick release, he did mention this Metropolol is out of my system within the day. So I can get right to the Bisoprolol. He also felt that cause I'm not having problems with the Metropolol that most likely I will have the same result with this Bisiprolol, but also said not always the case. So I'm going to try it on Sunday, because I'm attending my oldest sons high school grad today & tomorrow and don't want to feel unwell on his big day. I will let you know how it goes next week.

Thanks

 

[Oilman]

Well today was the 5th day with the change of meds from a twice a day Metropolol (150 mg total) to the once a day Bisoprolol (10 mg). I found that at day 2 the PVC's seemed to increase a bit, but most of all I noticed that it was making me feel heavy and not want to do anything. Also a little dizzy when getting up and down too fast. The Bisoprolol 10 mg is a little stronger than what I was taking of Metropolol, equal to 200 mg, and I was on 150 mg. The cardio wanted to increase the dose cause of the discussion about while riding my bike lately I would experience a little SVT. I found that the increase of this med didn't effect my blood pressure at all, but did lower my resting HR by 8 bpm, sitting at 54 bpm. A little to low for me I think, I felt good at 62 or so.

I rode my bike the last couple days the usual 20 km and notice my max Hr was Down about 20 bpm, so I was at 125 bpm max today, which didn't feel to bad. Over all, I feel the meds are slowing me down tho, so I called my cardio and discussed my situation with him and he agreed to lower the dose to 7.5 mg of Bisoprolol today and see if things get better as far as energy and the PVC action. This would be close to my original dose strength of Metropolol, so I hope the side effects smooth out and I don't see any SVT's while introducing exercise, and all would be good. My main reason for the switch, is that I only would have to take meds once a day.

The next plan would be to start weaning down off the heart protection, if it will behave after a good remodelling period has taken place. Time will tell. I'm just glad that I can achieve riding 100 km per week for the last three weeks now, and not feel like I'm over doing anything. We will see how this lower dose of 7.5mg per day feels.

 

[Jkm7]

Metoprolol is generic for Toprol XL and and be taken once a day.

 

[Terry45]

Oilman, I just had a checkup with my surgeon and cardio. I'm at 9 months since my surgery. Both said no restrictions and I also talked to my cardio about cutting my metroprolol in half to help with running and exercise. I was taking 25mg twice a day and he gave me the okay to lower it to 25 per day. He told me to cut my one pill a day in half and take it twice a day. I will have to ask my pharmacy about the time release thing. My first runn on the new 25m dosage will be tomorrow morning. I'm looking forward to seeing if it has made a difference. I'll let you know how it goes.

 

[Oilman]

Jkm7,

I guess there is two types of Metropolol, the "succinate or the tartrate. The succinate being the extended release and taken once a day, the tartrate being taken twice a day. Both brands having similarities and some differences. My surgeon was the one to suggest switching to the Bisoprolol for a once a day application. He must of felt it was the best for my case. Not sure why either one of them never suggested extended release Metropolol since I was on the same kind, oh well.

Terry45- that sound like your doing very well at 9 months now. You must be on the tartrate brand of Metropolol, also being taken twice a day. Your dose is very small and with any luck you will be weaned off of it altogether when it's time. When I was released from hospital they had me on 75mg twice a day and I'm still kind of there today, but once I get this stable, I hope to start to wean down. I find while I'm busy most of the day my PVC's don't act up as much. When I sit quiet and read, and listen to the valve close, lol, it gets them going. Also the part that scares the docs is while I start my work out, I get a few spikes in heart rate. Goog luck on your run, let me know if you find any differences.

 

[kimcdougc]

I appreciate you guys educating me. I am just starting this Metropolol medicine. I am taking 25 mg in the am and the pm right now. I get to watch and see what you guys do. Thanks again for educating me.
____________________________________________________________________________________________________Congenital BAV - discovered at my AVR. Replaced with On-X valve 21mm at 53 years of age. Swedish Hospital, Cherry Hill location, Seattle, Dr. Barnhart. May 23, 2013.

 

[Terry45]

JKM7, I am on the tartrate brand. I would love to come off of it completely. I never had bp or heart rate issues prior. I have the same issues with PVC's and will get a few at night when I finally wind things down and will feel the heart when i go to bed and lay on my left side. Always goes away and doesnt cause any problems or pain. I will also get PVCs when i first start excercising hard and first start running. doesnt last long but does get my attention. Cardio is not worried about them and said it is normal as long as it is not an over abundance of them. One thing I have noticed especially when I was going to cardiac rehab was that I need to do a good warm up before hard excercise and running. A great example was doing 10 minutes on the elipto before running on the treadmill. I wouldnt have any PVCs at all on the elipto and very few when I started running. Doing a good quality warm up is harder than you think!

 

[Oilman]

Well so far so good with the change to Bisoprolol , it's been 72 hours on the lower dose and I feel pretty good, not any dizzy spells and feel the same energy level prior to the medication change. I rode 20km yesterday and again today, the first ride was pretty smooth and beat my old times, weather conditions just perfect lol. Today's ride was also good, but did experience a 10 second SVT, heart rate went from 125 to 160 , then dropped right back to the 125 bpm as per most of the ride. My vitals at rest are good once again in the low 60's bpm, BP at 115/75. I can't belief how quick the meds make a difference, but I do remember in the hospital my resting HR after surgery was 100 bpm until they gave me the Metropolol in the morning of day 6, and it idled down to about 85 by the evening, and was sent home.

I did like how my HR stayed so low while riding with the 10 mg of Bisoprolol, but found the side effects too strong. So going forward I feel better on 7.5mg. I will just have to be aware of it while exercising. I will take your advise and try to also warm up better before getting on bike. My SVT for some reason happened today at the end of the ride.

 

[Ovie]

I got off the beta blockers and it was the best move I've ever made. They messed with my vision, I had no energy, and was sluggish, I switched to Losartan and it's such a difference.