Discontinuing Metoprolol

[mikestorm]

Hey everyone, 40 YO male diagnosed with BAV at birth, and two years ago had an ON-X valve & graft to correct abdominal aortic aneurysm. Immediately after surgery was put on Metoprolol, with a gradual stepping down to 50 mg. Doctor hinted it could be cut down/eliminated further in the future, but nine months later noticed PVCs so Doctor upped dosage to 100 mg (50 mg twice a day).

I stopped noticing the PVCs all right, but the side effects (overall lack of energy and extreme exhaustion after 7 pm) took their toll physically and mentally. I decided that feeling the PVCs beat being on Metoprolol, so at my request Doc lowered dosage back to 50 mg once a day. My energy level has returned and I'm much happier. He again is suggesting that, if I feel comfortable, it can go down to 25 mg and we can play it by ear from there.

My question is, are there many folks here aren't on Metoprolol? My recovery has been pretty typical. No issues beyond the PVCs, which I'm at peace with, so to speak. Are there any downsides I'm not considering?

I would also like to take an informal poll, if folks with a replacement valve could respond with their dosage, and how they feel, that would be great. I'm feeling like 50 mg a day seems to be the mode, but would also like to see if a critical mass of people aren't on it at all.

 

[Paleowoman]

I'm not on Metoprolol nor on any other beta blocker. I had my BAV replaced nearly 18 months ago. I was put on 25 mg Atenolol (a beta blocker like Metroprolol) immediately post surgery and was on that dose for four weeks post surgery, then reduced to 12.5 mg at that point, and stopped completely 12 weeks post surgery. I had a few PVCs some weeks post surgery but they were deemed 'normal'.

 

[Boomanchu]

I'm on 50mg twice a day and energy is a struggle. In the evenings it's tough to stay awake. I have never worried about weight but now I fight to keep belly fat at bay. It was worse before when I was on 100mg twice a day.......I could sleep all day, go to bed early then wake up exhausted. I was kept on it because I had some afib a week after surgery but really can't wait to have it cut down more.

 

[MrsBray]

43, OnX valve March 2015. I was on 12.5 mg metoprolol 2X/day for 6 months. I didn't lose any weight while I was on it. On the upside, I could drive a busload of 8th graders and not give a flip about anything. I kinda miss that.

 

[Fundy]

I also wondered the same thing about metoprolol after surgery as my blood pressure was always good both before and after. I was taking 25mg twice a day and my family doctor felt I should probably take it for life anyway as he thought it would definitely be beneficial to me long term. But soon afterwards I had a cardiologist appointment and she said that with everything going well that I should actually stop taking it as there was no benefit to me, and if anything it could be the cause of problems.

Soon afterwards a lingering throat soreness, my endurance, and some feeling issues within my hands also disappeared. So stopping it may have been beneficial, but then again maybe it was just more the passage of time.

Is the doctor your mentioning a cardioloigist? If not his/her opinion may differ. But from my memory of reading these boards it seems that some stop taking it, while others have a definite need for it. Some also seem to try other similar solutions but I'm not familiar myself with what those drugs would be.

 

[epstns]

I'm now about 4 years out from valve replacement, and am 67 years old. At the time of my surgery, I had afib, bradycardia and a host of other rhythm disturbances all of which combined to leave me with a pacemaker (for the bradycardia and pauses) and metoprolol for the afib. I started out with 100 mg/day of the extended release metoprolol for some months. I felt like I was dragging a sled full of rocks around all day. I discussed it with my cardio and we decided to try reducing my metoprolol to 50 mg/day. That helped, but still left me wiped out by the end of the day. We finally reduced my metoprolol to 25 mg/day, where it now stands, and I do feel much better. I still cannot get my heart rate up as high as I used to (used to hit the mid-160's when running, knees won't let me run and I don't get above mid-140's anyway) but otherwise feel pretty good. My cardio feels that I will probably need the beta blocker for life, to help my heart beat as fully as possible with my bovine aortic valve. Since I feel pretty good, I am not arguing with him. . .

 

[Boomanchu]

I would love to get to 25/day at some point but even stepping to 50/day soon would be great. I know it was needed at first as I had a 4 day bout with afib but my ass is dragging and work is tough. Working out seems to help but doing that after a day at work is a challenge as I just wanna nap

 

[T in YVR]

I had surgery 2 yrs ago this October and have been on Metoprolol since immediately post op. I take Metoprolol + an ACE Inhibitor drug (Coversyl) to help my left ventricle reshape and remodel itself to hopefully get back to a normal size (I was moderately enlarged pre op). I have no other complications, but could swear I have felt the odd PVC, but nothing major. I used to task 50 mg daily but had incredibly bad dizziness, especially if I got up too quick. I blacked out once due to the drug, fell & hit my head/got knocked out and had a severe concussion and was off work for 3 months. So, we cut it back to 25 mg daily and it's more manageable (12.5 mg 2x per day). We (me and cardiologist) also dropped the dosage to see what/if any effect it would have on my LV recovery) and if I could could eventually get off it. I have an echo July 6 and am hoping my LV returns to a normal range (it's dropped 9 mm in size so far and is on the high edge of normal). It's not my favorite drug, but a necessary evil or sorts I couldn't handle 100mg daily of it....that would be a major challenge.

 

[coffeelover]

Mike, Have you considered taking the beta blocker at a different time of the day? I take my small dose 25mg. of Atenolol at bedtime and I seldom really notice any side effects. But, on occasion when I have instead taken the dose in the morning, I then did notice the side effects of feeling low on energy.

 

[epstns]

Mike, Have you considered taking the beta blocker at a different time of the day? I take my small dose 25mg. of Atenolol at bedtime and I seldom really notice any side effects. But, on occasion when I have instead taken the dose in the morning, I then did notice the side effects of feeling low on energy.

This may work, or may not. It depends upon the variety of the beta blocker you are taking. If it is the timed-release version, the drug slowly passes through your system, until the next dose. In this case, the meds will reach a "saturation" level in your bloodstream, and will pretty much stay there, regardless of what time of day you take it.

If yours is not the timed-release version of the beta blocker, then by all means, experiment with different timing, as in your case it will make a difference.

 

[cldlhd]

I was on a beta blocker from the time of my diagnosis until my surgery 11 months later in February of this year . I had my BAV repaired and my ascending aneurysm replaced with a graft ( was your aneurysm abdominal or ascending?) . After surgery my surgeon said I didn't need them as my blood pressure was fine and he said the problem was fixed. He might be I'm the minority but I'm glad that's his viewpoint, I had a few pvcs during the early part of my recovery but they went away. My cardiologist said she might want me back on them because my resting heart rate is 72 to 75 and before surgery it was in the 60's. I declined as I'm only 5 months out and right after surgery my rate was in the mid 90's so it's dropped a lot and I think it's ridiculous to go on them to get it down a few beats. Some people need them but I think some drs are too drug happy.

 

[AZ Don]

I've seen several people comment that they don't tolerate metoprolol well. The only problem that I've ever had with it was insomnia when I took it at night when recovering from surgery. Think I was on 50mg twice a day at the time. Now, 2 years later, I take 25mg twice a day, first thing in the morning and again mid afternoon. No problems.

 

[epstns]

I never had insomnia from metoprolol, but at high doses I had some really vivid and weird dreams. I remember when I first got home from the surgery I would think "It is about bed time. I wonder what's playing tonight."

Once my dosage was reduced the first time (from 100 mg/day to 50), the dreams went away. Guess I'll never see what's playing next. . .

 

[dornole]

I was on metoprolol post-repair, felt near comatose and sometimes dizzy on standing. My blood pressure is naturally very low, very often 90/60 at the doctor's office. My cardiologist did agree to take me off it pretty quickly, thank goodness. I don't know all the reasons they prescribe it but definitely not a fan of the side effects.

 

[epstns]

My cardio says that if my BP gets too low, he will reduce my HCTZ (diuretic) before he stops the beta blocker. Something about the B/B slowing the heart and helping to ensure that it more fully empties the ventricle each cycle. Oh, well. . . I'm used to it now.

 

[Paleowoman]

I discovered prior to surgery that it's usual to discontinue the post surgical beta blockers at around 6 to 8 weeks, at least in the UK - that is if there are no problems neccisitating continuing with it. My cardiologist took me off them at 12 weeks.

You are still taking a diuretic Steve ?

I was taken off the post surgery diuretic 10 days after surgery.

 

[epstns]

Anne - I have been taking a diuretic for blood pressure control since before my valve surgery. I was also taking an angiotensin receptor blocker. Now I continue the diuretic, along with the beta blocker. My blood pressure is usually around 12X/7X by mid-day (higher in the early AM, before meds), and my cardio says it may be good for me to have it just a bit higher, to allow best blood flow through my prosthetic valve, which he says is stiffer than a native valve.

 

[cldlhd]

My cardiologist seems to like the idea of slowing the heart down ,even though my HR is in the low 70's. It's almost as if she thinks that will make it last longer. Under that line of thinking I guess 90% of people should be on them. Don't get me wrong I know some people really should be on them but I'm not going on them unless something shows up in my next echo, 1st one since I was in for my surgery, that makes a case for me really needing them.

 

[Paleowoman]

Anne - I have been taking a diuretic for blood pressure control since before my valve surgery. I was also taking an angiotensin receptor blocker. Now I continue the diuretic, along with the beta blocker. My blood pressure is usually around 12X/7X by mid-day (higher in the early AM, before meds), and my cardio says it may be good for me to have it just a bit higher, to allow best blood flow through my prosthetic valve, which he says is stiffer than a native valve.

Oh I see, the BP med is not specifically to do with your replacement valve then. That's interesting that your cardio says that the tissue valve is "stiffer" than a native valve……….but surely not stiffer than our old stenotic bicuspid valves ?

 

[epstns]

Oh I see, the BP med is not specifically to do with your replacement valve then. That's interesting that your cardio says that the tissue valve is "stiffer" than a native valve……….but surely not stiffer than our old stenotic bicuspid valves ?

No, not stiffer than THAT. Before my valve replacement, my BP (without meds) was usually around 150/100 - too high for the active life I lead. Now, with meds, it stays well behaved - but I don't.:Face-Angel: