Cough and Beta Blockers

[cday]

My husband has been on Metoprolol 25mg once a day since his AVR, but was feeling faint when getting up from sitting. His BP would be in the 95/70 range. He also had a light cough.

Today he went to the cardio and the doc is changing to Carvedilol 6.25 mg 2x a day to see if these two issues will clear up.

Any one have any side effects to look for with this new drug?

 

[Duff Man]

The switch from metoprolol to carvedilol is kinda weird, but there's been some encouraging studies that show carvedilol is more effective. Maybe that's why the doc did it.

As far as the difference, Carvedilol is a non-selective beta blocker, which means it blocks both beta1 and beta2 receptors. Metoprolol is a selective beta blocker that blocks only the beta1 receptors. At higher doses even the selective beta1 blockers will block beta2, which is attributed to keeping the air passages open. So my assumption is IF the cough was a side effect of the beta blocker, it very well could become worse from the carvedilol because it's not beta1 specific (it will also block beta2 receptors).

I would definitely not tell your husband about the possibility of the cough thing because of the power of suggestion. I would take a wait and see approach, because ultimately carvedilol is a newer and supposedly more effective drug, despite not being cardioselective. There's a lot of technical reasons why carvedilol might be superior to metoprolol, but really the jury is still out.

 

[cday]

Thanks, Aaron. One of your posts was the reason I became aware of the cough being a possible side effect.

I really think that the doc changed the drug solely because of the faintness, but thought that the cough might be metoprolol specific.

But, I will definitely keep an ear out for the coughing and I know my husband will be more attune to it now. He now says he noticed some slight wheezing, but didn't know that was something to look for.

There are so many changes after surgery. It is hard to know which ones are side effects and which ones are just your body healing and adjusting.

Again, thanks.

 

[Duff Man]

The other thing I was wondering is, maybe he was recently put on an ACE Inhibitor like lisinopril, enalapril, etc. Ace Inhibitors are notorious for giving people an annoying but usually harmless little cough/tickle.

If he was just put on an ACE Inhibitor and it doesn't go away, you might want to look in to changing that to something like an ARB, such as losartan potassium.

These are all just guesses. I'm just "thinking outloud" so to speak.

Upchurch also talked about an annoying cough post surgery. He was also put on a beta blocker.

 

[SHEEPDOG]

My mom had a cough too.

My mom had a cough too.

She was on Zestril for years and developed a really annoying cough. Now she has changed meds but the damage is done. She coughs a lot. I have been on Lisinopril (which i think is generic for Zestril) for 6 years and have no problems. They put me on a Beta Blocker post op but I hope to go back soon.

 

[cday]

No ACE inhibitors here. Just beta blocker, niacin, simvastatin, and asprin.

I asked him if was a throat tickle, or diaphragm irritation (as some on this site had listed that), or heart skipping issues (he had that urge pre-AVR), but he says it is upper chest. And it is mainly in the evening.

Switched drugs today -- I'll update if I notice anything one way or another.

 

[cday]

update

update

After 1 week on Carvedilol I think his cough has lessened, but he has some edema (retaining fluids) which is making him feel horrible during rehab.

He did lose over 3 lbs of water weight since yesterday so that may be correcting itself, but it is listed as a common side effect of Carvedilol.

Last rehab he felt as though the work out was much more difficult (but none of the exercises were increased) and he was never able to get his HR above 100.

He just wants to be OFF of the drugs. If this keeps up he doesn't see any way he could return to his previous activity level.

 

[Superbob]

Uncanny to find this discussion here tonight. In recent months, I have noticed I have a mild cough when eating, esp at suppertime. I have been on metoprolol and lisinopril for years, so if it is a side-effect, it wouldn't just start now, would it?

I have a regular GP appointment next Monday, so I could ask him, I guess. Almost afraid to. Already got knee surgery Sept. 23 preceded by heart checkup and echo on Sept. 12. I really am getting my fill of tests.

It is a rather mild cough -- never occurred to me it could possibly be the meds. Guess I should read all that fine print about possible side-effects more closely. If they want to screen for some kind of throat problem (I quit smoking 42 years ago), I think I'd rather wait. Guess they could x-ray the lungs though.

 

[Mary]

After 1 week on Carvedilol I think his cough has lessened, but he has some edema (retaining fluids) which is making him feel horrible during rehab.

He did lose over 3 lbs of water weight since yesterday so that may be correcting itself, but it is listed as a common side effect of Carvedilol.

Last rehab he felt as though the work out was much more difficult (but none of the exercises were increased) and he was never able to get his HR above 100.

He just wants to be OFF of the drugs. If this keeps up he doesn't see any way he could return to his previous activity level.

It's still early, so tell him not to lose hope.
I was on Toprol sometime after surgery, and I had the cough. I tried several different medications trying to reduce my heart rate, but eventually I told the cardio I wanted off everything and he obliged.
I don't mean to suggest that Chris should do the same; just that it takes some time to discover what works, what doesn't, and how much tolerance you have for the side effects.

 

[aussigal]

This is the first time I have heard of metoprolol being linked to a cough. I previously was on an ace inhibitor and that gave me a cough,. it was also something the doctor told me to look out for.

I hope you have success with the change of meds.

 

[cday]

It's still early, so tell him not to lose hope.
I was on Toprol sometime after surgery, and I had the cough. I tried several different medications trying to reduce my heart rate, but eventually I told the cardio I wanted off everything and he obliged.
I don't mean to suggest that Chris should do the same; just that it takes some time to discover what works, what doesn't, and how much tolerance you have for the side effects.

Thanks Mary,

He, of course, wants to do all he can to protect that cow valve, but he feels worse than he did even a month ago. He has now tried two beta blockers. I just wonder how well people tolerate BB, etc when they are trying to exercise. If it is holding his HR at 100 he can't get enough oxygen to his muscles and begins to get lactic acid buildup.

He should have time to talk to the Cardio today. I am trying to help him really analyze his problems on this new drug: edema, lactic acid build up at rehab, feeling sluggish during any exercise.

 

[cday]

It is a rather mild cough -- never occurred to me it could possibly be the meds.

Chris' was a mild cough, but not something he had ever had before. It is listed as bronchospasms on the side effects.

 

[Superbob]

Thanks, I hope this problem clears up for Chris. Thanks for this informative thread.

 

[Jim P]

Superbob:

I was having similar symptoms to yours -- a mild cough, almost choking when eating, and it seemed to be getting worse. I was worried that it was related to the aorta so went to my cardiologist. After an MRI showed that not to be a problem, he sent me to a gastroenterologist. She performed an EGD (esophagogastroduodenoscopy) --most times referred to as an endoscopy -- and found an "esophageal ring" which was narrowing the passageway.

About a month ago, the gastroenterologist performed a procedure similar to the endoscopy where she used a device called a dilator to stretch the ring wider open. This, of course, is done in the hospital, under general anesthesia.

This had an immediate positive effect and all has been great since then. One disadvantage is that the treatment may need to be repeated occasionally.

 

[Superbob]

Superbob:

I was having similar symptoms to yours -- a mild cough, almost choking when eating, and it seemed to be getting worse. I was worried that it was related to the aorta so went to my cardiologist. After an MRI showed that not to be a problem, he sent me to a gastroenterologist. She performed an EGD (esophagogastroduodenoscopy) --most times referred to as an endoscopy -- and found an "esophageal ring" which was narrowing the passageway.

About a month ago, the gastroenterologist performed a procedure similar to the endoscopy where she used a device called a dilator to stretch the ring wider open. This, of course, is done in the hospital, under general anesthesia.

This had an immediate positive effect and all has been great since then. One disadvantage is that the treatment may need to be repeated occasionally.

Thanks, Jim. I will start monitoring it more carefully. Just noticed during breakfast didn't have the mild cough. Seems to be more at suppertime. Hope it's just a nuisance thing. After all, isn't there supposed to be a cap on the number of things that can go wrong at the same time? I find it hard to think of dealing with anything else right now but I guess we don't get to pick and choose.

 

[Duff Man]

Thanks Mary,

He, of course, wants to do all he can to protect that cow valve, but he feels worse than he did even a month ago. He has now tried two beta blockers. I just wonder how well people tolerate BB, etc when they are trying to exercise. If it is holding his HR at 100 he can't get enough oxygen to his muscles and begins to get lactic acid buildup.

He should have time to talk to the Cardio today. I am trying to help him really analyze his problems on this new drug: edema, lactic acid build up at rehab, feeling sluggish during any exercise.

You could try a calcium channel blocker, seems like a smarter move for him... or give another "cardioselective" BB a try, like Tenormin. Actually, the BB change probably won't help him not feel sluggish. BB's are famous for it.

Not sure why cardiologists hesitate so much to put someone on a calcium channel blocker.

 

[cday]

Actually, the BB change probably won't help him not feel sluggish. BB's are famous for it.

He feels more sluggish especially during exercise on the Carvedilol than on the metoprolol -- possibly the edema adding to the normal BB sluggishness.

 

[hensylee]

Jim, it will have to be repeated. Mother had this for years and she got stretched every now and then. It was brutal for me to watch but decided it might happen to me, too, since I have hiatal hernia like her. All they did to her was to numb the throat area - she hated it. But it helped a lot. Lots of folks have hiatal hernias, according to my dr. Not too many have this problem, tho.

 

[mmarshall]

side effects

side effects

carvedilol is a "new" drug under name. it is the generic drug for coreg. i was put on 10mg lisinopril right before surgery and then put on 25mg 2x daily of coreg after surgery. i have been taking both of those along with 81mg asprin and now 20mg of pravastatin since i like taking pills.

i have the dry cough every now and then but it is something i just deal with...not really annoying. i feel the slight muscle pain in my feet but i think that has to do with the pravastatin since that is the generic of lipitor. although the 3 miles a day that i jog and weekend golf has a lot to do with the muscle aches too.

once a cardio puts you on a med that is "benefical" to you, don't look forward to the cardio ever taking you off of it. when i was adjusting to the coreg, i use to get really light headed and an awesome head rush when getting up from a lying or sitting position...have the scar under my chin from the kitchen table to prove it...i told my cardio about it and his advice was to get up slower and be careful. i still get them every now and then but i kinda like it, yes i know, i'm not right in the head.

 

[Superbob]

once a cardio puts you on a med that is "benefical" to you, don't look forward to the cardio ever taking you off of it. when i was adjusting to the coreg, i use to get really light headed and an awesome head rush when getting up from a lying or sitting position...have the scar under my chin from the kitchen table to prove it...i told my cardio about it and his advice was to get up slower and be careful. i still get them every now and then but i kinda like it, yes i know, i'm not right in the head.

Man, is that ever true -- both a cardio and a GP, in my case. I gather as long as my numbers are good, they will keep me on them for the duration. I just keep wondering, what if I went off all these meds? Suppose we had a national emergency and I couldn't get refills? Are these meds really keeping me alive? (I'm not suggesting to anyone that you just quit on your own; just wondering.)