Weaned and off Meds

Per last doctor's visit, after complaining about abdominal distress over the past year from probable Metoprolol, the doctor had me weaned off the medication. For the year I was on 12.5 mg of the medication daily along with aspirin (81mg). For one week the doctor had me take the half tab once every other day and then stop for a 3 week period. I had my last administration metoprolol on a Wednesday evening. That Friday and Saturday I had some chest discomfort primarily in the form of pressure.. I do not seem to have it today (Monday). I wanted to cut back on meds because the abdominal distress interfered with my morning distant run. It's different but not quite better. Prehaps over the next few days there will be improvement. My heart seems to maintain regulation with my PM. I hope it remains regulated. For the past 2 or 3 days I have experienced more sleepiness. I felt sleepy and tired during my very very slow run this morning cutting it from 7 miles down to a slower 3.66 miles of slow jog and walk. I must have napped two hours afterward and feel sleepy as I write. Is this a common phenomen from withdrawing from the med? This whole thing is an experiment. My medication cardiologist wanted me to see how I reacted to the one week weaning off med (fine) and 3 weeks without med until I see him after a month had passed. 


Weaning off metoprolol

by AgentX86 - 2021-02-15 21:50:39

I've never heard of the need to be weaned off metoprolol.  I haven't heard of digestive issues either.  OTOH, aspirin is well known to cause stomach, somtimes serious, problems.  Chest pressure on discontinuing metoprolol is possible, I suppose, but 12.5mg is a very small dose to begin with.


Digestive issues with metoprolol

by Persephone - 2021-02-15 23:45:04

I have also experienced digestive issues with low dose metoprolol. In theory it would usually be a short term side effect that would eventually go away for most people. If you need it, however, is there any reason you couldn't change up the time of day you're taking it, if it's interfering with your a.m. workout?

How are you now Runpacer?

by Gemita - 2021-02-16 07:11:48

Do you feel you might be making some progress albeit slowly?  I do hope so.

Unlike Persephone, I haven't tried Metoprolol but I am on a similar action beta blocker called Bisoprolol.  Beta blockers are often used to quieten everything down and can also be used for anxiety as well because of their "calming" effect on the heart and other organs.  Metoprolol like Bisoprolol is very selective though at targeting the heart especially at low doses, so your dose of 12.5 mg daily I believe shouldn't have had a major impact on your bowel unless it slowed you down too much causing constipation leading to abdominal discomfort?  Are you drinking sufficient fluids ?  I can get very very dry on Bisoprolol and I think Metoprolol can do this as well.

Like AgentX86, I believe baby Aspirin 81 mg though is more likely to cause bowel distress.  Are you still taking Aspirin? I was told long term Aspirin for arrhythmia stroke protection (if that is why you are on it?) is not effective and can even make us more susceptible to a bleed, especially a gastric bleed, than one of the newer novel direct oral anticoagulants like Apixaban.  This surprised me because I know so many take a baby Aspirin a day since they feel is has protective properties and is very safe.  Both my late parents had a gastric bleed while on long term baby Aspirin, so please be careful.

Withdrawal symptoms from a beta blocker are possible like with many meds for arrhythmia control but I would imagine you would be more likely to have renewed energy if your Metoprolol was really slowing you down and causing the fatigue.  Hopefully you will be able to exercise again soon without being held back.  Some of us can be very very sensitive to a beta blocker, even at low doses, so you have nothing to lose by experimenting.  

I recall when I exercise, especially with any heart rhythm disturbances, I have increased chest pressure/discomfort.  Weaning off Metoprolol may increase potential to develop ectopics or other arrhythmias again (for which you were originally given Metoprolol) and with exercise this could be causing any chest discomfort.  Maybe check your neck pulse on running to see how it feels - does it feel regular or irregular?  Get to know what feels normal for you when running.  Maybe get some monitoring again or another stress echocardiogram to see what happens when you exercise in case you have developed another troublesome arrhythmia as a cause for your continuing fatigue?

I think though you have other reasons for your fatigue too including, if I recall, cardiomyopathy which may still require an upgrade to CRT sometime in the future?    You sound as though you are doing your very best to help yourself and I feel sure you will succeed.  You don't seem the type to give up easily.  I recall too you have sadly lost your EP/cardiologist and this cannot be helping.  I do hope your new doctor is supportive and you feel comfortable with him/her.  Finally, please listen to your body and if you feel tired, perhaps ease off the running, pace yourself more, until your symptoms improve.  Don't push through them.  It may set you back, especially with cardiomyopathy.

Good luck Runpacer.  


by Marybird - 2021-02-16 10:34:40

I feel like the Metoprolol Queen here, LOL, having taken it for 20 yrs or so and counting. I recall feeling tired and a little lightheaded with the drug when I first started taking it ( in 2001), but no stomach or GI issues, and those side effects disappeared within a month or so. 

The black box warnings that come with this drug state that it shouldn't be stopped suddenly, but should be discontinued gradually, tapering off the drug over a couple weeks or so. I was told that this depended on the dosage of the metoprolol, with low doses ( around 25 mg/ day or so), tapering off would not be needed.

I  was up to 150mg/ day to control my atrial tachycardias when I had to wean off the metoprolol to see if it could be replaced with diltiazem ( calcium channel blocker) for control of the tachycardia without the bradycardia I had developed which we speculated might be due to the metoprolol ( at least partly). The EP said tapering off metoprolol was needed at that dosage, and I decreased it over a two week period. 

Well, as my metoprolol levels decreased, my tachycardia increased, and with even a small amount of stimulants such as a cup of coffee, a square of dark chocolate, or something similar I began to feel as though I was on speed, and that feeling would last for hours. That would have been due to the old body missing the effect of the beta-1 receptor blockers, with what felt like surges of adrenaline taking over. And the dumb thing was, even with almost no metoprolol, the bradycardia still snuck in there in between the other miseries. I felt so bad I couldn't exercise most of the time.

The diltiazem controlled the tachycardia- marginally, but not very well. And I still had bradycardia in between the tachy, so I got the pacemaker, and the EP called it SSS. 

After the pacemaker, I stayed on the diltiazem, and started again on a low dose of metoprolol ( 50 mg/day). The hopes were that both these meds would work together to control the tachycardia, so a lower dose of each than either one alone could be used for that. And I think it did for a while. I felt much better after the metoprolol was resumed. They increased the diltiazem to 360 mg/ day for better blood pressure control after that, and I hoped it would also work to control the tachycardia.

Seems it hasn't done so, not much anyway. My last two remote pacemaker reports have showed short runs of afib, and the cardiologist has once more increased the metoprolol to try and stomp out the afib. I'm back up to the 150 mg/ day I was taking before the pacemaker, with what they've told me will likely be 200 mg/ day around the corner. I must admit though, it seems to work for me, with no side effects I can tell. 

One week weaned; 1 1/2 weeks without med

by runpacer - 2021-02-20 15:11:57

Good morning to PM Club members! I am sitting in front of the computer, 45 minutes post 7 mile run. Everything is about the same. My gut is the same. The struggle with the strange pressure on my chest during a run is about the same.... So it wasn't the Metoprolol. I will wait until I see my doc and ask about taking a break from the aspirin. Perhaps it will help. I think the first few days I felt several short episodes of atrial flutter but I may not have remained in flutter long enough to give it that label. I don't know if I will remain off meds but for now I seem to be doing ok... When I ran today, like all other days since surgery, it does not matter how fast or slow I run.... I take a limited number of steps and I feel this pressure build and then I can be short of breath and reduced to a walk. I wonder if the location of the PM may intrude in a way that limits the ability for the heart to function correctly or perhaps the "leads" restrict heart or lung function? I want to push through or pass the injury but it seems as if there is a low ceiling. As if my Vo2 max has been greatly reduced. The new electrical physiological cardiologist was fairly dismissive. He said there were symptoms but there is no evidence recorded from the home monitor or when I am in the doctors office. Next appointment with him is one year from now. My medication doc was more sympathetic. Hence, the experiment to be without medication. No change leaves me to test aspirin, question the doc about the location of the PM as a possible cause, same for the Leads and after that I may surrender to the possibility that is the new norm for me. But i haven't surrendered yet. 

You know you're wired when...

You trust technology more than your heart.

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My eight year old son had a pacemaker since he was 6 months old. He does very well, plays soccer, baseball, and rides his bike. I am so glad he is not ashamed of his pacemaker. He will proudly show his "battery" to anyone.