To metoprolol or not to metoprolol

[csigabiga]

Hi,

I'm 4(!) months post op after a Bental w/mechanical valve. Had a visit with cardiologist and one topic that came up was whether to continue with metoprolol. I had a bit of Afib post-op, but otherwise I am a healthy 39 year old individual.

Since release from surgery, I have been taking 25mg of metoprolol tartrate in the morning and another 25mg before bed. Now at my 4 month follow up, cardio and I agreed to half my dose to 12.5 in the morning and 12.5 at night.

I'm curious as to everyone's thoughts on the drug, pros and cons, and if you continued or discontinued.

My reason for considering discontinuation is that I feel great and would simply rather deal with one less drug. I have gained a bit of weight and get dizzy when I get out of bed / off the couch, but these are minor complaints. Overall, I don't think the metoprolol affects me that much. I'm not overly tired, and have no issues getting my heart rate up to 130-140 in rehab.

Curious to hear about others' experiences / opinions on the drug.

 

[LondonAndy]

I had my heart surgery 10 years ago now, and have been on a betablocker ever since. They started me on Metoprolol, but I found it interfered with the blood flow to my legs (I am also diabetic), and so after trying several others I have been on Nebivolol mostly. However, I have what they have described as a fairly consistent low level of a-fib, so that is why the drug is ongoing. If you can safely get off it, I would - it has quite a dulling effect.

 

[csigabiga]

it has quite a dulling effect.

What do you mean by dulling ?

 

[pellicle]

Hi

I'm 4(!) months post op after a Bental w/mechanical valve

Only 4 months...

My reason for considering discontinuation is that I feel great and would simply rather deal with one less drug

Sometimes drugs are about other more "nothing you can feel" things, like promoting healing and preventing damage. However I'd take it up with your cardio.

Myself i discontinued after about 6 months.

to hear about others' experiences / opinions on the drug.

Never really felt it did much, but now it's controlling my tachycardia. I'm of the view that without that and warfarin I'd be dead.

The one less drug thing sounds like its about psychology not practicalitly, I've got friends who juggle quite a lot more than that, and by juggle I mean one interacts with another so they have to be taken 12 hours apart, then there's food interactions.

Make sure that your reasons are not "I want to go back to how I was" , because yesterday is gone and tomorrow yet to happen. Nobody adult likes change, but as kids we loved it. You got bigger and stronger every year. I believe many people look in the mirror and want to covet up wrinkles and dye grey hairs because they don't want to accept changes.

I was off metoprolol for 11 years, then tachycardia set in over a period of months and I thought it best to try it because I already knew it had minimal side effects for me and no interaction with warfarin.

HTH

 

[LondonAndy]

What do you mean by dulling ?

Beta blockers lower blood pressure and can cause tiredness, among a range of side effects.

 

[thomas999]

For me, beta blockers did more harm than good. They made me very irritable, which in turn made my blood pressure go up. Lisinopril, at .5mg does all I need. I took my bp yesterday 105/51 pulse at 60. It's a bit low, but I think it is residual of sleeping medicine I take. I have to watch that sleeping medicine because it has a tendency to add to the lisinopril effect.

 

[Eva]

If your cardiologist prefers you stay on it, then I encourage you to stay on it especially that you’re tolerating it well and the good caring cardiologist know our hearts better!
In my case, after surgery my cardiologist kept advising me to stay on it every time I asked him if I could stop it. I was happy when another cardiologist gave me the ok to stop it, and the result was not ok. I was happy taking “less medication” and I thought I enjoyed some extra energy after stopping it, but that extra energy was not worth stopping it! Little by little, without it, my heart couldn’t/didn’t stay well for a long time. I had AFibs and had to take it again and other additional medications !
Now, I’ll never stop it and with good supervised physical training, I have the energy I need!
Good luck with your decision.

 

[Mister_James]

I love my Metoprolol.
Let's see I take Fish Oils, Niacin, Red Yeast Rice, L-Citrulline, Warfarin, K2, Vitamin D, Coq 10, Statins....
I usually have a handful of pills to swallow so I have morning and evening mouthfuls.

BP 107/75
Total Cholesterol 110 (65 HDL)
Heartbeat under 60 (I have seen 38 at night)

 

[pellicle]

I usually have a handful of pills to swallow so I have morning and evening mouthfuls.

I've got the munchies already ;-)

 

[pellicle]

I wanted to add something I said which occurred to me after reading this point:

If your cardiologist prefers you stay on it, then I encourage you to stay on it especially that you’re tolerating it well

when I said:

Myself i discontinued after about 6 months.

that was in discussion with and agreement of my cardiologist and surgeon.

 

[thomas999]

I love my Metoprolol.
Let's see I take Fish Oils, Niacin, Red Yeast Rice, L-Citrulline, Warfarin, K2, Vitamin D, Coq 10, Statins....
I usually have a handful of pills to swallow so I have morning and evening mouthfuls.

BP 107/75
Total Cholesterol 110 (65 HDL)
Heartbeat under 60 (I have seen 38 at night)

38 is is quite low, although I have seen mine in the low '50s on occasion. My systolic and diastolic blood pressure was 86 / 48 in one of my last 10 readings. I try not to get it that low because it can be dangerous on other parts of the body.

 

[neo]

My cardiologist switched me from Metoprolol (1st gen beta blocker) to Bystolic (3rd gen beta blocker), also known as Nebivolol. In my opinion, a much better beta blocker doing all the same things for my heart just without any of the side effects I experienced on Metoprolol.

 

[Lynn]

I decided, after discussion with my surgeon, to try recovery without beta blocker after surgery. The reason for this is as London Andy said, I have found they have a dulling effective. Which make sense as they work by blocking adrenaline. I would note a couple of things here, firstly that even though I had not had any episodes of AFIB, my medical team still wanted me to take a beta blocker, at least for a few months. Secondly, we came to an agreement, that should I have any issues or episodes of AFIB, I would start taking one.

It was my previous experience of feeling like crap (low blood pressure, poor exercise performance, head ache, tired, grumpy and lack of energy) on a beta blocker that lead me to push back on this, and for me it worked. I am in no way advocating this for others, many people do need to take them post surgery and do not have the side effects I had.

i would also say though, that it may be worth having a discussion with your team about the continued need to take a beta blocker. Would it be safe for you to try discontinuing It and see if you feel better off of it?

 

[slipkid]

I've talked about this in another thread or two.

I cannot function on Metoprolol. Will NEVER take it again if I have any say in it.

Was given it after some stents put in in 2019. Not because of high blood pressure but because they give you to prevent your heart from overworking, want it to heal, .or something like that.

I had to be admitted to hospital after the stent procedure to monitor my bleeding since was on warfarin/bridging with lovenox (long story in itself). Had to lie still on my back something like 4-5 hours after the procedure and not allowed to move.

When eventually allowed to get up I spent the evening roaming the halls and flirting with the nurses. Found a freezer where they kept ice cream for the patients & I raided that. I felt great. Next morning I was up at 6am, ordered breakfast, and was waiting to be discharged & for a friend to come by to pick me up. Again I felt GREAT and was full of energy, couldn't wait to get out of there and the plan was to go back to work 3 days later (I had the next 2 days off).

At about 7:00 or so a nurse came in and gave me 2 pills to take (one was metoprolol). Within like 15-20 minutes I felt like my body (& mind) had been transported to Jupiter (or some other planet with a gravitational field hundreds of times that of planet earth). I had no energy whatsoever and felt really really odd. Then got really really sleepy. Crawled back into the hospital bed and fell asleep. My friend came to pick me up but I was out of it, did not even know he was in the room.

The next day I had to see my primary physician to go over things with plan being going back to work in 2 days (although at that point the incision point for the tube thing used in the procedure, which had some kind of plug in it, ahd massively swelled up due to bleeding). With the swelling and the total lack of energy I was in NO shape to go back to work. I don't even know how I drove to the Dr's office. Got lost/had to pull over on the way, not sure where I was. Memory is hazy now trying to recall it all.

Meeting with him he decided to hold me out a week & come back in the next week to see how I was doing. This of course meant dealing with all kinds of bs FMLA and short term disability forms that needed to be filled out for my factory job from hell that I had (which I just quit last month, could not take it any longer).

At the end of the appt I was too tired to even leave. He let me stay in the exam room and I fell asleep in there for I don't know how long. More to that story I won't go into....

That week off I could do nothing other than lie in bed, watch TV, and sleep all the time. Most of what I watched was the congressional hearings about Trump and the Ukraine weirdness going on at that time. How wonderful...anyways...

Going into see him the next week I complained about my condition, said something must be wrong, I was not myself and I was not getting any better. The Dr's attitude was that I was a wimp, that I needed to get out of bed and go for a walk. So I tried that when I got home - couldn't go more than a block. Had to sit on the curb, fight off falling asleep, somehow eventually was able to get up and stumble back home. Collapsed on living room couch then crawled into bed and fell asleep. Spent another week trying to "live" like that.

Then had to see the cardiologist (very long story). I could not mentally retain much of anything we talked about and had to have him write things down. He had me shift my 25 mg metoprolol dose to the evening instead of the morning but I still could not function.

Both he and my GP then ganged up on me and said I needed to go on Prozac. WTF? No thanks.

Finally after another week of this horror my GP called and said he and the cardio Dr thinks I should cut the meto dose pills in half (from 25mg to12.5mg).

Finally I after doing that I was almost normal but still had some problems on it. I couldn't stand it. My pecker was not itself and that was a big reason to get the hell off that drug right there. So I weaned myself off it.


Point is, it is not for everybody. Everyone reacts differently. Unfortunately most (all?) Drs I have ever had simply go by a one size fits all guideline regarding drugs especially and do not want to disclose, listen to, or even acknowledge adverse effects. Instead they just want to give you Prozac & treat your adverse effect complaints as a mental condition.


Another story that I've told up here about beta-blockers concerns a friend where I used to work (name of Danny). We were at a factory safety meeting first thing in the morning and had just broken up into smaller groups. I was in a group of 4 people including Danny. Danny went to point out a safety concern he had and while he was talked he fainted and fell to the ground. I caught him luckily b4 he almost killed himself on the concrete floor. Lifted him up. He then continued what he was saying with no apparent concept that he had passed out. We were asking if he was OK and it happened again. Two of us caught him this time. I thought he was having a stroke but oddly he was SNORING at the time. Two of the other guys held him up at that point and I ran over to my nearby work area where I had a chair and brought that over, we put him in that. An ambulance was called which took him away. Later we found out the issue. His Dr had just increased his blood pressure med/beta blocker (was probably metoprolol but I don't recall). He took his first higher dose that morning b4 work. Luckily it didn't hit him hard enough until he got to work. He could have fallen asleep at the wheel driving in and killed himself or other people. Of course his Dr gave him no guidelines/caution about what to look out for when increasing the dosage or suggest he try it on a day off rather than immediately going to work on a higher dose.

The OP sounds like he is tolerating it OK (unlike what happened to me), although I wonder if it is responsible for his weight gain.

 

[csigabiga]

Thank you everyone for the thoughtful comments

Myself i discontinued after about 6 months.

Why did you want to discontinue at 6 months?

blood pressure and can cause tiredness

I seem to be tolerating well. BP is perfect, and in general I don't feel too tired. No worse than usually

If your cardiologist prefers you stay on it, then I encourage you to stay on it

When I asked him if I could go off because I also don't feel it doing anything (for better or worse) He told me it's controversial and we agreed to half the dose from 50 a day to 25. Since then I've had flutter once maybe twice, but overall seems to be OK still thankfully. Also, thank you for the cautionary tale that eventually your heart didn't stay well. What happened? Did you go into Afib? How often did it happen, and how long after you went off the beta blocker before it started happening?

Would it be safe for you to try discontinuing It and see if you feel better off of it?

Yeah we agreed to half the dose and go back to full dose if I start experiencing Afib. Also we agreed to reevaluate in 5 months.

like he is tolerating it OK

Thankfully I am. Your story sounds insane though

 

[pellicle]

Why did you want to discontinue at 6 months?

I didn't specifically seek it. We just didn't see a need and it had served its purpose. Like removing bandages or dressings I suppose. My heart had no arrhythmia at that time.

 

[Eva]

Thank you everyone for the thoughtful comments

You’re welcome and wish you best of wisdom to guide you to the right choice.

When I asked him if I could go off because I also don't feel it doing anything (for better or worse) He told me it's controversial and we agreed to half the dose from 50 a day to 25. Since then I've had flutter once maybe twice, but overall seems to be OK still thankfully. Also, thank you for the cautionary tale that eventually your heart didn't stay well. What happened? Did you go into Afib? How often did it happen, and how long after you went off the beta blocker before it started happening?

In brief: four years without it, I had AFib twice since then plus other heart deteriorations. But this could be me and doesn’t necessarily mean it may happen to others.

In more details: My cardiologist after my surgery, who wanted me to stay on it by telling me how it *saved/saves* other hearts/patients by keeping the extra workload off the heart, was a distant relative who genuinely cared! So, I stayed on it since my surgery in September 2008 until April 2014.
All my yearly echoes during those years were consistently impressive and pleasing to him, to my Family doctor, and to me… [I always asked for copies of the echocardiogram results], and every year’s figures were consistently the same as the year before!.

In April 2014 we moved to Northern California area for a year where I saw one of the top-notch doctors who, after the impressive echocardiogram, agreed to stop the metoprolol. I enjoyed “more energy” though my energy was ok when I was on it. I “tolerated it”!

2015 (one year later) without the Metoprolol I started mild left atrium enlargement and trace pulmonic regurgitation!

2017 still without the Metoprolol I started trace tricuspid regurgitation, and the trace pulmonic regurgitation became mild,
3/2019 severe left atrium enlargement
4/2019 emergency trip to hospital due to AFib. Plus widening of the aorta 3.5. Then back to metoprolol!
4/2020 dilation of aorta became 4.2
12/2022 another Afib and another Cardioversion and lower EF.

 

[slipkid]

Thankfully I am. Your story sounds insane though

You want to hear insane? I didn't even mention the insane part! Ha!

Metoprolol gave me the worst nightmares I've ever had in my life. Very very frightening and the first two were "waking nightmares" in that in the dreams I was in bed and woke up - to the nightmare part. I didn't make the connection with nightmares and that drug but discovered later that that was a commonly reported adverse effect later. I think I relayed those 2 dreams elsewhere up here already if yer curious...

Be well!

 

[LondonAndy]

Ah yes! Beta blockers are great for powerful dreams! I regularly wake up in the morning quite angry that something I was quite passionate about has been interrupted by waking up ... but no idea what it was!

 

[Superman]

I’ve been on the same 25mg am and pm since my second surgery over 13 years ago. Never noticed anything with it. But I’m a bigger person at 6’4” and a bit over 200lbs. So maybe the dose isn’t much for my size? I still exercise regularly and function just fine. Blood pressure is normal.

I know had had more irregular heart beat episodes in the past, including being cardioverted back into rhythm a couple times. Haven’t had any of those episodes in years. So I hesitate to experiment with going off it.