Medication question!

[pellicle]

Unsure how long succinate stays in your system, I thought I saw something about 24 hours but will see.

So lets look at an interesting (and a bit complex) graph.

We see here presented in time with each other

• the nanoMoles per Liter (upper half)
• the suppression of the HR that occurs over time

I'll first note that there seems to be something very interesting which occurs there which I will not outright assume is an error but I'll discuss that soon.

The (presumably measured from blood serum) nM/L of blood serum does not seem to follow what is suggested in the various references for half life for Metoprolol that it is between 3 and 7 hours. Now lets just leave that alone for a sec and keep driving through the main points.

pay close attention to the graphs and the table of meaning:

note

• that 100mg tartrate is administered once a day, and
• the 50mg tartrate is administered twice.
• the succinate once

This is not insignificant as we know also from sources that bioavailability goes up on a second administration from 50% to 70% - this is not insignificant.

With the tartrate form we see that the results are a much shorter lag between taking and a significant influence on both heart rate reduction and blood plasma.

If you are just post surgery and lying in bed with a racing heart rate (recently discussed and asked here by @Nesphito for instance) you may totally want that and benefit from that.

But what if you're a walking and functioning back in normal life person? Do you want / need / benefit from that durable and lengthy suppression of your HR? Conversations I've had with members here (waves at @christopherj ) would suggest that such a thing just gets in the way.

I've mentioned here many times that I prefer the way that the tartrate (tartaric acid) and I'm not entirely sure I want to have additional succinate in my diet regularly (because that is not without consequences). The way I personally look at it is that I don't have a need for a drug which constrains my heart 24/7. In my case (and perhaps others) we desire "training wheels" on your heart to steer it (and we don't encourage kids to ride along leaning on the training wheels, but to learn to ride on the main wheel).

What if (as a walking functioning re-entered normal life) we have situations where spikes of something (say adrenaline or exersize) trigger something (perhaps even commonly) and we just want something to reach out and quell the bell that's been struck so that ringing can be brought under control?

I believe that this is my usage case with tachycardia and It is in that instance that I'm very glad I'm on Tartrate not succinate.

I take 25mg twice daily (~12 hourly) and at first I found I totally needed that. Now a few years after the acute onset of tachycardia (which btw was not 100% every minute but would be triggered by things like heat / exersize / stress) I find that sometimes I totally forget my morning dose (no alarm for that one) and while a year ago it would be clear to me by 9am I'd forgotten my dose (whereupon I took it) now I've found that I've gone the whole day until evening when I see "oh, look I didn't take it" (and haven't needed it).

On Succinate you'd never know that you were getting better.

Sometimes one needs to be on a drug permanently (warfarin comes to mind) but other times the drug is like a "plaster cast" that's there for a reason for a period.

HTH

 

[slipkid]

...makes me wonder if I'm just starting to feel the effects and have night terrors and other issues waiting around the corner.

I don't remember all the details about other folks that experienced the awful nightmares but I know for myself it started right away rather than kicked in after a couple days/week/months. It might be that your body just isn't affected that way period. Also I wondered if my being on a proton pump inhibitor (PPI) which has a known adverse effect of vivid dreams already then adding metoprolol on top of that made my nightmares off the chart dives into Nightmare on Elm Street territory...

 

[Joseph]

Sometimes one needs to be on a drug permanently (warfarin comes to mind) but other times the drug is like a "plaster cast" that's there for a reason for a period.

HTH

That's essentially the approach I'm taking based on the way metoprolol affects me personally. My bi-annual bouts of tachycardia do not seem to have a trigger, or at least not one we've been able to identify, and have occurred when I've been both sedate and very active. Although I'm sure tachy will become more common as I age for now I plan to take the "plaster cast" approach. Certainly the tartrate would (likely) give me more immediate relief but my previous experience with it was living in a brain fog. That would leave me with a choice of tachycardia, brain fog, zero energy and feeling like someone is sitting on my chest, or cardioversion (or an alternate beta-blocker but I don't want to experiment). Come'on science, where's that fully-functional bionic heart!

 

[pellicle]

my previous experience with it was living in a brain fog

Could have been dose related , cold be your don't get along with it.

Finding the right drug and dose is fine too be trial and error.

 

[Eva]

I had an episode of afib/tachy prior to vacation last month (gory details in another thread) and doctors prescribed 25mg metoprolol succinate twice per day. I definitely felt some negative effects (sluggishness, low HR, cold feet) but it was not as bad as the tartare I had been on a few years back. After returning home and meeting with my cardiologist and EP they agreed to cut my dose to 25mg once per day and then 12.5mg once per day.

Last night my HR was floating around 50-55bpm even during exercise. I emailed my EP about weaning off of the drug and am waiting for a response. I don't like the idea of slipping into afib/tachy but I also don't like my heart underperforming and my pacemaker having to step in constantly to keep my rate up.

I haven't read the literature (or many posts) on the impact of discontinuing metoprolol but it sounds like there are varied experiences (@slipkid, @Eva, @Superman, and @pellicle reported different results of being on or off). Reading some posts makes me wonder if I'm just starting to feel the effects and have night terrors and other issues waiting around the corner.

I’m one of those who love my Metoprolol succinate…it’s a life savior for me and will never get off it again.
One year after stopping it in 2014, with the approval of a new cardio in a new town we moved to, I had my first A-Fib and stayed 5 days in the hospital. Then was put back on it after electro Cardioversion and my dose was lowered to 25 mg twice a day after I recovered completely.
One year and a half later, I had another A-fib and another Cardioversion and again stayed on 25 mg twice/day.

This past March, I had a third visit to the emergency with Atrial flutter. I stayed in the hospital for three days. Luckily my heart rhythm was fixed with cardizipam drip at the hospital and an increased dose of Metoprolol twice a day! I was discharged with 50 mg Metoprolol twice a day. I’m managing ok and re-started exercising at the gym to beat my lethargy. No night mares…never had nightmares before jut pleasant vivid dreams sometimes! I always eat a small bite when I take my Metropolol in the evening.