Propralolol

[NorincoKid]

Was admitted to the hospital yesterday for testing. They didn't see anything physically wrong with the heart but the numbers they were producing (heart rate) were very high.

Normal resting rate 68-78. Lower when very relaxed and sleeping (high 50's).

Sitting was between 75-100 variable. Standing was fluctuating between 130-160.

They're sending me to a specialist, which I'm very happy about. The last two times to the hospital were disappointing, one doctor insisting I was "on something".


They gave a script for propranolol (Beta Blocker) 10mg (break in half, take twice daily so 2x 5mg)

I understand that this a low dose, but I've never taken a medication besides a pain killer or antibiotic.

How much would a dose like this lower someone's heart rate? I'm a little concerned about it as my heart rate is mostly appropriate when sitting/laying down and sleeping.  

Would it be a bad idea to just take the 5mg when I get up in the morning? I have mixed feelings about taking it before I go to sleep.

I apologize if it's a stupid question, but this all new to me, and I've never been a fan of "better living through chemistry" but at the same don't want to disobey any doctor suggestions.

[NorincoKid]

Well....trying the metoprolol today. Halft (25) in AM and other half around dinner. Hope it's better that the low dose propranolol

[fast_heart]

Actually I find this not to be true with me, maybe just the opposite.
I'm taking a low does of atenolol 12.5 mg per day, and my resting (sitting)
heart rate which used to be around 75 (sometimes much higher), is now 55
all day. My exercise heart rate seems to go up about as much as before,
however it seems to drop down much more quickly than it used to.
,

[NorincoKid]

So....is this better than Propranolol for keeping heart rate in check?

Id have thought theyd have me up the dosage on that (maybe 10mg 3x daily) before theyd try something else.

Also, i have the non-slow release version of metopropol, so wouldnt the 50mg in the morning wear off pretty quickly?

[is_something_wrong]

There has to be a generic form of Toprol XL. Here, the generic form has been around for ages. I remember my dad was taking it for angina for years. It was always the generic version, as far as I can remember. Now, after surgery he is only taking 25 mg, but it's still generic.

In my honest opinion, Metoprolol is not the best medication. It crosses the blood-brain barrier and may have side effects like lethargy and tiredness, as well as sleeplessness at night. So you'll get all the "fun" side effects without having any true effect on anxiety. For anxiety and palpitations in combination, I think Propranolol is way better. I'm considering switching to Atenolol for my palpitations (as I get high blood pressure from Propranolol). It's on a molecular basis only half as potent as Metoprolol but it's instant release with longer half-life, so the exposure will be higher.

[tom_h]

...if I had to pay for the entire cost of the extended release version of Metoprolol, Toprol XL, it would cost as much as $136.00 for a bottle of 100 from an online source in the US.  Crazy, huh....?

[tom_h]

Yes it is.  As I mentioned above:

"The problem is the cost.  It's much higher than Metoprolol Tartrate which is literally pennies per dose."

If haven't investigated if Metoprolol Succinate aka. Toprol XL is available as a generic form or not.  I know my insurance provider considers Toprol XL as a higher "tier" drug, and passes the expense on to the insured.

[is_something_wrong]

Is Metoprolol extended release also expensive in United States?

I find your healthcare system amazing, the problem is the cost. In Norway, Metoprolol extended release 100 mg costs $6.50 for a bottle of 100, on an ordinary prescription (not co-paid by the government).

[tom_h]

Metoprolol Tartrate is meant to be taken USUALLY twice daily, or every 12 hours.  It has a fairly short half life so you need to take as such.  You could take 25mg every six hours, and it would probably benefit you by smoothing out the amount in your blood.  The problem is that we're prone to forgetting to take the dose when scheduled.  I supposed you could put an alarm on your phone to ring you every six hours as a reminder.  Physicians seem to be ok with dosing every 12 hours.

You could take Metoprolol Succinate with is the timed release version.  Dosages are the same, except for you, you'd take a 100mg once a day.  The problem is the cost.  It's much higher than Metoprolol Tartrate which is literally pennies per dose.

100mg should have a significant impact with lowered BP as well as a slower pulse.  I'm on 75mg and have been so for 10 years.  It's a good med.  If you run, exercise or workout, you will probably need a little longer to warm up as it does throttle back on the pulse and the heart seems a little slower to react to demands.  But once up to speed you should be fine.

Also... if a physician ever questions you about being on any substance, and you know that you aren't, demand...DEMAND an immediate blood test.  Tell them to put up of shut up!  This happened to me a many years ago when I saw a cardiologist about my life long supraventricular tachycardia.  This guy ask me repeatedly if I used cocaine.  I finally had enough, and stood to leave.  He sensed my anger and asked me to sit back down.  I told him to either take my blood or stop questioning me, or I'd report him.  He shut up real quick.  I never went back to the quack.  He still practices today.  Meanwhile, I'm now cured of my SVT after seeing another cardiologist who understood what I had.  Man... that riles me up!  You take care.

[NorincoKid]

So I went in for a follow up. Usual stuff, nice resting heart rate.

Got an EKG @68BPM they tell me there is a 1st Degree Heart Block.

They also say to stop taking the Propranolol (5mg 2x daily) and they want me to take Metoprolol (50mg 1x daily)

Ive read that one of the reasons/causes for this "heart block" thing is from taking beta blockers. Will this new drug/higer dose make it WORSE? Would this be best to split 25mg x2 daily? or does this work all day. Any help/input appreciated

[NorincoKid]

Haven't really noticed anything, although at such a small dose I don't know if I would.

Does this drug a couple of days of taking to work properly or is it a "in-and-out" sort of thing?

[NorincoKid]

Thanks! I think I have a better understanding. I'm going to start them tommorow.

[is_something_wrong]

Q:How much would a dose like this lower someone's heart rate?
A: Almost nothing. It's an extremely low dose. What you might notice is that your heart rate when standing will drop somewhat, partly because the major adrenaline surge you obviously get while standing will be blocked, partly because propranolol will prevent your blood pressure from dropping too low when standing because the medication can help your arteries/veins contracting as they should while standing.

Q: Would it be a bad idea to just take the 5mg when I get up in the morning?
A: I think you should take it as your doctor told you to do. Of course it's not dangerous to take it only in the morning, but there really is no need to, as it's not dangerous to take it at night. I would take half in the morning and half late afternoon/early evening if I were you.

Beta blockers don't reduce the heart rate at rest so much, as your heart isn't very exposed to adrenaline during rest anyway, so there really isn't very much to block.