beta blocker (metoprolol) weaning

[spartangator]

Hi VR community,
Quick question from a frequent lurker and rare poster: what timetables have worked for weaning off beta blockers?

I searched the forums and found a few posts, but I'm sure more people than that have been down this road. The cardiologist made an offhand suggestion during my belated 6-month follow-up today, but it obviously wasn't his top concern (I'm only taking 25 mg twice a day).

Considering everything I've read about the importance of coming off these pills slowly, I was curious how everyone else has handled it. I am absolutely thrilled to be off my last heart medicine, though, as I hope this helps with some of the fatigue and other issues.

Thank you for all the information throughout the VR.com site.

 

[Duff Man]

I have weened off beta blockers at one time. I was on 100 mg of tenormin a day, i did it by cutting back 1/4 every 3-4 days, or when I felt comfortable with it. 25 mg is a pretty small dose. But for me, there was a serious difference between being on them even a little at 25mg and not being on them at all. I definitely felt worse, so I got back on the full dosage.

Good luck my friend. That was the steps I took from my doc.

 

[tcopel]

I dont believe there is a hard and fast time table for the withdrawal of beta blockers. There are too many variables. Mostly, it is per the expertise of your doc as to have fast or slow, and this is probably a reflection of how you are doing post operatively in general. Some, like myself, have been on it for years for PVCs. Some here on VR seem to be sensitive to even gradual withdrawal and others seem to do well when low dose beta's are just stopped. Perhaps others can chime in and give their experiences.

 

[Freddie]

I too was on 25mg of metoprolol a day - 1/2 table twice a day.
If I remember correctly, I decreased my dosage by 1/2 table for 4 days, then miss a day, take another half, miss one more day, take the other half. Then I was done!!!
Check with your doctor or cardiologist to be sure. Everyone is different.

Take Care.

 

[ruth]

I was given the ok by my cardio to wean off atenol/tenormin and I took slowly decreasing doses, from 2/day to 1.5/day to 1 per day, etc until none. I waited a week between decreasing doses.

Now, I will say I was not as comfortable off tenormin as I was on. My PVCs were obnoxious and I just didn't feel "right". I'm as anti-drug as they come but even with my stiff bent towards taking nothing I don't absolutely need I voluntarily chose to take 25mg/day of tenormin. My cardio was fine with it after we discussed that it was just enough to keep the nasty arrhythmias at bay.

I guess for me the moral is that as much as I wanted to be off them, they were benefiting me in ways I didn't realize.

Peace,
Ruth

 

[PairoDocs]

I agree that the "weaning" depends on the patient, but the general rule is a gradual decline in the dosage over 2 weeks, at least. And some of the dosages can be pretty teeny. And metoprolol seems to be one of the ones you have to do more slowly. My husband came out of the hospital on 100mg twice a day of extended-release metoprolol, and it took us several months!

Smoky in Idaho,
-Laura

 

[aussigal]

I have come down gradually from 100mg twice a day to 75mg to 50mg in 6 monthly intervals...this was done as my BP settled and kept creeping lower and lower...its now sitting @110/60....My Cardio likes his AVR patients to stay on Metoprolol forever even if its only a teeny dose because it slows the forcefullness of the heartbeat down amongst other things.

 

[MaryC]

This is a sore subject with me right now. I am on 100mg of metoprolol. I had bout with a-flutter 3 weeks after my surgery. I have been on as much as 200mg. I had my surgery Feb '07 but hadn't seen the cardiologist in 6 months.......I was hoping I would get my dosage lowered. No such luck. My cardio is keeping me on the 100mg for now and I don't see him for another 3 months. My bout with a-flutter has marked me as a person with heart rhythm probs. I hope you have better luck getting the ok to lower or wein yourself off of this med.....but yes, Dr Berk, I understand this is a life saving drug....

 

[Bina]

Post op I was on 75mg Meto, after almost 2 yrs I got down to 50 mg per day.
Since my BP can get low I tried to cut down a bit.
I lowered it by 6 mg per day and my tachy episodes came back along with headaches. I guess I am stuck with 50 mg.

 

[Marguerite53]

Tapering down as suggested was my route. I went very very slowly, several days at each stage with finally only a quarter tab every day, then every other day, etc.

But I was on another BP med and upped that one slightly to appease the cardio. My only reason for being on the beta blocker were the PVC's. I hated the beta blockers enough that I decided to put up with the PVC's for awhile when they mildly returned once the beta blocker was stopped. I really jsut thought my heart could get back to a good rhythm. So I also stopped all caffeine, all hotly spicy foods, and all chocolate (known to cause PVC's !!) for a few months. Gradually, (and knock on wood) I"ve re-introduced those stimulants to my diet and the PVC's have not returned at all.

Now, a year later, the cardio is letting me half dose the remaining bp med since my bp is under control. Once I lose another 25 pounds I'm hoping to get off them altogether. But I decided to be very patient and let my heart heal and my body adjust to the new and perfect heart. Patience has worked well for me.

Good luck!

Marguerite

 

[Jim P]

I am 16 months post-op and still taking one 25mg tablet of Metoprolol twice per day -- the same amount I was taking the first day I left the hospital.

My cardiologist said that I should continue this dosage forever -- for some of the same reasons mentioned by others earlier ("prolongs the life of valves"). I did not have high BP before surgery and do not have high BP now. But, I am willing to go along with the advice, as I have not noticed any bad side effects.

 

[spartangator]

weaning

weaning

Wow, thank you for the helpful information. I knew the smartest thing I could do was ask you all .

After reading through this, I called the surgeon again to get his take on things since there are some solid reasons to keep on a small dose. I don't have any heartbeat/blood-pressure issues that would merit it, but avoiding or delaying another surgery is all the motivation I need. He's not going to be back in the office until Tuesday, though, so the topic is on hold.

In any case, I will certainly be extra vigilant about how I handle it after hearing the stories here. That's exactly the type of feedback I needed.

MaryC, sorry to hear about the frustrating times. Hope things turn around at your next visit in three months.

Marguerite53, best of luck adding the foods back and keeping the rhythm under control. You're 100% right about patience being a required ingredient--I'm trying to take that lesson to heart (no pun intended). One's attitude is a much larger part of this process than I was prepared for so that's where my focus lies now.

 

[spartangator]

Just for the sake of being complete in case anyone searches for this thread in the future, my surgeon wants me to stay on the metropolol (as other posters have mentioned above). The surgeon is happy with my current blood pressure and doesn't want to mess with things. I'm hoping this'll change in a few months more, but we'll see.

 

[Superbob]

I'll just add that nearly 3 1/2 years after surgery, I am still on 25MG of metoprolol twice a day, and I gather it is for the duration, no weaning off it. My BP is great and I notice with interest here what others have said about their docs contending it may help their valves last longer. I am all for that. Having no ill effects of meto that I am aware of.

 

[ctyguy]

I was given 100mg Toporol once a day and that is the scrib Im still on at 4 months post op. I asked my PCP and my Cardiologist about a lower dose or weaning off and they both said Im on Toporol for the forseeable future. My Cardio said we will talk at my annual visit next year and that may only be a reduction. Not a big deal really, Im down to three meds a day (Coumadin, Toporol, and a baby aspirin). The one I'd like to get rid of is the Coumadin but thats not in the cards so I don't really worry about it.

 

[ruth]

My surgeon had indicated to me that I would likely be on BB's forever, if only the 'baby 12.5's' as she called it. The reasoning was that clinical studies had shown that reducing the forcefullness of the heart's beat took less of a toll on the heart's valves. Considering that my bout of rheumatic fever left me with damage to my aortic, tricuspid and mitral valves (only 1 bad enough to need surgery at the time, the others were still minor leakage) the logic was that even post op I would still be walking around with damaged valves that are obviously in my interest to protect. So why on earth would I want to be off BB's? Sigh, I don't know, I'm just anti-drug, I worry that the side effects might be worse than the benefits. Yet, I will say, I've gotten quite good at listening to my heart, it's beats, flops (pvc's) and rate and I genuinely feel like 25mg of tenormin is a real sweet spot for me personally right now.

MaryC - I am also labeled as a 'rhythm problem' person since I spent 6 weeks in AFib post op. I hate it. I've been in NSR for almost 16 months now and the cardio still holds it over my head. The doc is quite possibly right that it will haunt me again someday but it irritates me, I know how you feel.

Peace all,
Ruth

 

[mrwjd]

I'm down to 12.5 mg of toporol xl a day and my great surgeon said to keep taking it forever as it prolongs the life of my valves and I'm all for that.

This is interesting to me, as I don't understand (a) whether a permanent beta blocker is indicated in all AVR cases, or only if there are collateral symptoms like Afib or tachy; and (b) what are the physical symptoms/sensations you have had with withdrawal?

 

[ponygirlmom]

This might be a good place to mention that I, personally, have had much better results on Hawthorn (an herbal supplement) than on metoprolol, which not only didn't control my afib, but gave me migraines and anxiety attacks.

My cardio is perfectly happy with hawthorn; my surgeon was very suspicious. I think my surgeon was really shocked when, after surgery, I did just fine on hawthorn and he didn't need to prescribe a beta-blocker. He had an amazed sound to his voice.

What I don't know if is if I will need the hawthorn in the future. New valve, new aorta portion.... same heart though.

 

[Dina]

I am weaning off metoprolol also as my BP gets low(90/60-110-70)and I
havent been on a set schedule per se, but just weaning slowly from 25mg
bid and now at 3 weeks later Im on 12.5mg qd. Im being very careful not
only checking my BP frequently ,but since I had A.Flutter pre-surgery my
cardio seemed ambivalent about me doing it at all.So in my belief its best to take it pretty slow,Lotsaluck

Ponygirlmom-I also took Hawthorn for awhile,but my doctors wanted me
to stop taking it when I began having arrhythmias. I also tried researching herbs for anticoagulation therapy , but could find no conclusive studies in
relation to ACT for arrhythmia or OHS patients .I did find alot of good candidates though.
With my first arrhythmia and subsequent ablation, I was put on a high dose of metoprolol(100mgbid), 2 months later , I end up with another arrhythmia
(also A.Flutter),so I dont know if the beta blockers were just not effective
on my type of arrhythmia or if it was just THAT extreme and nothing could have prevented it.
Hope you are doing Well-Dina