Switching Beta Blockers

So pleased to have an update

by Gemita - 2023-10-03 13:40:40

Hayden, I know it is not easy when our heart is out of rhythm and I am glad you are feeling better.  Both hubby and I have changed beta blockers in the past.  We always started a new beta blocker at an initial lower dose and build it up very slowly.  We have never had withdrawal problems from our meds because the med we discontinued, we did so slowly too so that our body didn’t miss the medication. 

I believe the problem you have had with Nebivolol has more to do with the fact that Nebivolol has a different mode of action from Nadolol.  It is a beta blocker which is also a vasodilating medication.  In our experience a vasodilating medication can cause dizziness, heart palpitation or a rapid heartbeat, headaches, fatigue, nausea and other symptoms until you get used to the medication.  Nebivolol contains nitrous oxide which activates specific chemicals that help open your blood vessels.  It will take time to get used to this medication.  It fact I think you have done really well with this new med.

I hope this continues but if you start getting symptoms again, you know you can always ask to go back to your old beta blocker at a reduced dose since you have been told by your cardiologist that a beta blocker isn't really necessary and that Nadolol 80 mg dose was too high for you in any event?  I appreciate the GP may not want to change a new medication prescribed by your cardiologist but in the event of not being able to speak to your cardiologist, your GP is still responsible for your day to day care and that involves changing your meds should this become necessary.  Our GPs don't like to do it without consulting the cardiologist.  However in my experience, many consultants are of the opinion that the GP knows the patient best and is more than capable of making minor changes to our prescribed medication in an emergency situation when the patient would otherwise need to attend A&E to get relief for their acute symptoms.

I would contact your cardiologist and ask if you could perhaps restart your old beta blocker should you ever experience similar worrying symptoms.  You could specifically ask how you could safely do this?  I wouldn't wait until you experience symptoms again.

Good luck Hayden and I am so glad you are feeling better

Stopping beta blockers

by Selwyn - 2023-10-03 14:57:01

Rebound is well recognised by prescribers of beta blockers ( or should be!).

https://pubmed.ncbi.nlm.nih.gov/32382156/

Changes should always be gradual. 

I am pleased to hear you have weathered the change.  As you can see from the enclosed reference, others may run into more serious difficulties.

Gradual Changes ?

by Penguin - 2023-10-03 15:27:51

Selwyn's comment above that ' changes should always be gradual' seems very important to me, although as stated previously I have no direct experience of beta blockers. 

Piglet recently posted a link from New Zealand re: Beta Blocker withdrawal and it referred to 3 - 4 months of tapering to avoid symptoms I believe. 

If I was stopping a beta blocker I'd want to know how gradual is gradual and does this apply when swapping from one drug to another or only when stopping altogether?   

I'm pleased that you're feeling better Hayden, but I think that the question that needs to be raised here is whether or not the guidelines are clear.  ' Gradual' is open to interpretation.