Toprol XL (Metaprolol) Withdrawal

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pem

Well-known member
Joined
Mar 5, 2011
Messages
301
Location
Virginia
Hi. I'm about 9 months post-surgery and doing great. I continue to feel so very grateful to this community on the forum. You have all been a tremendous source of support and continue to be. I try to post any findings that might be relevant to others, and it is in this spirit that I am posting my experiences with Toprol here.

As with many post-AVR surgeries (and probably other heart surgeries), they put my on Toprol (a beta blocker) to reduce the strain on my heart during recovery by lowering my blood pressure and heart rate. A few months following surgery I had a bout of PVCs or PACs, so they increased my dosage from 25mg/day to 50mg/day, which I was told is still a relatively low dosage. In retrospect, I think the PVCs were situational (stress) and I know from past experience they can be episodic, but I think they recommended the increase just to manage the benign symptoms for quality of life. I continued to take the 50mg/day for months. In general, though, I prefer not to take medication that I don't need. So at a certain point I asked my cardiologist if I could wean myself. She suggested a protocol of reducing the Toprol to 25mg/day for two weeks, then to 25mg/every other day for two weeks, and then to none. She said if at each step, I didn't get a recurrence of the PVCs, I could proceed to the next step.

It turns out the PVCs never really increased beyond what I consider normal (a few each day), so I followed the weaning regimen all the way through. As it turns out, Toprol has an anxiolytic effect (anti-anxiety), which I never explicitly noticed while I was taking it. But when I reduced from 50 to 25mg/day, I experienced a few uncomfortable days of anxiety. Then when I reduced again from 25mg/day to every other day, I experienced yet another day or two of anxiety, which passed. The final transition, however, to no Toprol, was the most difficult. It left me with a fairly constant generalized anxiety. I think explored the Internet to discover that many people experience this to such a degree that they are never able to completely wean themselves and remain on Toprol for life. I endured this discomfort for over a month and was almost at the point of resuming toprol (with the cardiologist's consent), but I decided to wait another day or two to explore alternatives, and during that time period the discomfort finally abated. In other words, I'm off Toprol, I no longer feel anxious, and any bounce-back effect seems to have subsided.

My main reason for posting this is to give hope to anyone else who is trying to wean off Toprol and has a similar experience. At least in my case, with enough patience to endure the emotional discomfort, I am finally back to normal. I will also mention that reducing caffeine intake (which was higher while on Toprol) seems to have helped as well.

Toprol seems to be a very effective drug for its intended use, but anyone considering taking it should know about the possibility of withdrawal effects. As always, caveat emptor.

I suppose drugs like Toprol and their withdrawal or "bounce-back" effects vary from person to person, but I hope this can be useful to others and wonder if anyone else has had similar experiences.

My very best,
pem
 
I found that metoprolol exasurbated my insomnia and heightened the nightmares, so my family doctor dropped it and returned me to daily doses of 150mg of irbesartin. That seems to keep my blood pressure under control and offers kidney protection too.
 
I found that metoprolol exasurbated my insomnia and heightened the nightmares, so my family doctor dropped it and returned me to daily doses of 150mg of irbesartin. That seems to keep my blood pressure under control and offers kidney protection too.

Thanks for the reply. It sounds like you had trouble *while* you were taking metaprolol, but no difficulties when you stopped it.

Best,
pem
 
Pem - Thanks for bringing this to everyone's attention. I seem to be one of the lucky ones who has never really experienced any problems with Toprol XL, so while I'm on board for long term use, this will be good to keep in mind should I ever discontinue in the future. I generally don't pay much attention to things that are working well for me, so had never really researched Toprol, but your post inspired me to learn a little more. Little did I know, there is actually a "black box warning" for Toprol specifically about suddenly stopping therapy: http://www1.astrazeneca-us.com/pi/toprol-xl.pdf. While it's even more pertinent for those with ischemic heart disease (angina and MI), it does apply to everyone. Anyway, always good to learn more, particularly about medicines such as these that are so common for valve patients.

By the way, you almost have to laugh at some of the warnings for Toprol: "Until you know how you will react to Toprol-XL, avoid activities that require alertness"! :confused2: So, it seems I've found my perfect excuse for next time my wife tells me I'm not listening to her... :biggrin2:
 
By the way, you almost have to laugh at some of the warnings for Toprol: "Until you know how you will react to Toprol-XL, avoid activities that require alertness"! :confused2: So, it seems I've found my perfect excuse for next time my wife tells me I'm not listening to her... :biggrin2:

Exactly :) And think twice before you climb into that front-loader or any other heavy machinery.

pem
 
I started having panic attacks about 15 years ago (I was going through a personal crisis at the time) and my doctor put me on xanax and toprol xl. He said the toprol really helps with the physical symptoms of anxiety and I only took the xanax if I felt my anxiety was heading towards a panic attack. Eventually I stopped the xanax altogether and only carried a few with me "just in case". After a couple of years I was weaned off of the toprol with little discomfort but a bit slower than what you were (I believe it was 50, 25, 12.5, 12.5 every other day, and at 4 week intervals). Now with a tissue valve and dacron aortic root / ascending aorta I believe I am destined to be on metoprolol indefinitely. I started taking it 2 years before my 2nd surgery (50mg twice a day) and have been on that same dose to this day. I also have mild hypertension and I seem to tolerate beta blockers ok so I guess I can accept that I will probably be a "lifer" lol.
 
My cardio tells me that I'm on metoprolol for the long term, too. He recommends it for control of my hypertension and for general heart "protection" after all the junk I went through post-op. We did, though, reduce my dosage from 100mg/day to 50.
 
Oh, man, I've always wanted a big front-end loader to drive through Chicago's rush hour traffic. . .

Especially since they took away my rocket launcher.

You've gotta get that rocket launcher back. They're so picky these days.
 
I seem to tolerate beta blockers ok so I guess I can accept that I will probably be a "lifer" lol.

From what I understand, there are few side effects and no serious long-term effects, so if you have to be on a drug for life, it ain't a bad one :)

Best,
pem
 
Thanks for sharing, Pem

I hope to get off it one day! :)

Maybe you will, Eva! I guess the first step is to ask your cardiologist if you can try reducing the dosage by a little and then see what the effect is.
 
My cardio tells me that I'm on metoprolol for the long term, too. He recommends it for control of my hypertension and for general heart "protection" after all the junk I went through post-op. We did, though, reduce my dosage from 100mg/day to 50.

Seems to make sense! I wonder how you'd do on 25mg, though probably not a big deal either way.
 
I was placed on metoprolol a few weeks ago for PVC's and AVC's and just to calm things down. My cardio. said to start with 1/2 a pill ( 25 mg) at bed time since I am small build. I did that for a week then increased to the full 25 mg at bed time. A few days later felt terrible. So tired and dizzy, I could not function. Checked my blood pressure and it had dropped to 88/66. I am back to 1/2 the 25 mg pill once a day. I am really scared about how I will react to medicines when it is time for my AVR. I just don't tolerate anything and am also worried about tolerating Warfarin. Has anyone else had these fears? Thanks for the help.
 
Per "I was told that beta blockers can affect your sex life in younger male patients. " This is true for any man, not just youngs. There are different beta blockers that can be tried. Metoprolol is one of the few where it is listed. It depends upon the person, but metoprolol can be considerably phsycoactive in some people. I sure noticed it. I was Mr. Mellow which was good for rehab :)
 
I was told that beta blockers can affect your sex life in younger male patients. I'm glad I'm not on it!

I've heard rumors about this, but the studies I've seen do not seem consistent with this. Nonetheless, you have to ask who is funding the studies :)

pem
 
I was placed on metoprolol a few weeks ago for PVC's and AVC's and just to calm things down. My cardio. said to start with 1/2 a pill ( 25 mg) at bed time since I am small build. I did that for a week then increased to the full 25 mg at bed time. A few days later felt terrible. So tired and dizzy, I could not function. Checked my blood pressure and it had dropped to 88/66. I am back to 1/2 the 25 mg pill once a day. I am really scared about how I will react to medicines when it is time for my AVR. I just don't tolerate anything and am also worried about tolerating Warfarin. Has anyone else had these fears? Thanks for the help.

When is your surgery? In light of your concerns you might discuss with your cardiologist trying Warfarin for a few weeks well in advance of your surgery to figure out how well you tolerate it and how stable your INR is on it. It might buy you peace of mind. Sorry about your trouble with Metaprolol. Sometimes less is more :)

pem
 
pem-

Thanks for posting your experience. I am in almost the same boat you were - left the hospital on the "recovery" 50mg daily dosage. Recovery was going well and then I had a bout of PVCs and some A-Fib. In hindsight I think these were mostly caused by me doing a little too much too early and anxiety/stress. BUt it was enough for the doctor to recommend an increase in my Metoprolol dosage to 100mg a day. Even when he wrote the prescription, we were already talking about getting off the stuff in coming months. So far, the increased dosage has resolved the irregular beats and lowered my HR without much in the way of side effects. We are planning on starting to wean me back to 50mg a day when I have an echo in July. Hope I can repeat your success in eliminating the med.
 
I left the hospital on metoprolol as well. I just got off of it on Monday at six weeks post op. My cardio put me on attenolol instead. I do like it better. I seem to have more energy and think a little clearer. I didn't experience any issues as far as stopping metoprolol.

Gary
 
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