What's been your experience with beta blockers?

I took various beta blockers between 1973 when I had increasing angina until 2007. It certainly helped the angina, although I also used nitroglycerin for acute attacks. For decades after I started taking them, my resting pulse was always 48/min. But then in the early 2000s, it started dropping, eventually into the low 30s. First they stopped the beta blocker (gradually, don’t ever stop suddenly) and that didn’t help. Then they put a Halter device on me–a 24 hour cardiogram–and found that during the night I once went 7 seconds without a heartbeat. I was outfitted immediately with a pacemaker and now beat a steady 60.

As I said, it is important not to stop suddenly. If I forgot a pill one morning, then by that evening my heart was pounding and I took a pill immediately (I carried a couple in a pillbox at all times). There was no harm in taking my regular pill the next morning. You can’t really OD on them. What they really do is stop adrenalin from being released. I wonder if this prevents the damage that stress does.

My wife also started beta blockers a few years when she was experiencing angina and it seems to have (mostly) stopped it. She does use nitro occasionally.

I’ve used a version of metoprolol for years with good results. My issues are a combination of BP and heart; for actual incidents I have to pack nitro and clonopin as well. (I guess the latter is so I don’t panic that I could be croaking if the former doesn’t work :slight_smile: )

About 20 years ago: Used metoprolol (forgot the dose) to control blood pressure. No problems for about 6 months. Then, I began to feel shaky and jittery. This started mild and got progressively worse. I didn’t associate it with the metoprolol because I had already used it about 6 months with no bad effects.

I also began to have some cognitive problems. One evening, driving home after dark, I parked in an unlighted spot outside the post office, and discovered that in the dark, I couldn’t remember how to open the car door from the inside! More particularly, the door had one of those recessed handles on the inside, and I couldn’t remember where it was. I felt all around the door and couldn’t find it.

I was both alarmed and fascinated. I knew exactly how to open the door another way (roll down the window, reach out, and open it from the outside), but I refused to do that for a while. I took it as a challenge to figure out how to open that door! I realized that this was a “mechanical memory” failure (whatever may be the proper term for that). I wondered if my “left brain” would know how to open the right-side door even if my “right brain” couldn’t remember how to open the left-side door – so I reached across the seat with my right hand and tried that. Fail.

I don’t remember if I ever thought to turn on the inside light, or if I did but refused to try it. Eventually, I gave up and reached out the window. Next day, I called the doctor.

When I went to the doctor, I had to park about a block away. Walking to the office, I felt so weak and wobbly that I felt like I was going to literally collapse in a heap on the sidewalk at any moment. I didn’t, but I told the doctor that.

He took me off the metoprolol (cold-turkey, IIRC) and told me that it could take a week or two for it to get all out of my system. Be that as it may, I felt 50% better in 24 hours and 90% better in another 24 hours.

I had been having sporadic symptomatic palpitations (like, several times a day) for years which I never mentioned to a doctor. A few years after the above events, I began having them frequently – like every 30 seconds, for about six weeks. Saw cardiologist; wore monitor all day for a week; got diagnosed as Premature Atrial Contractions (PAC); cardiologist put me on atenolol.

On the fourth day of atenolol, in a staff meeting at work, I suddenly felt faint. I went back to my office and lay down on the floor and fainted. I’m not aware of ever having fainted before that (and only once since). I have no idea really if the atenolol did that, but I suspected (and still suspect) that it did. I quit using the atenolol. The PAC’s subsided anyway, although I still have them sporadically. Various doctors have told me that they’re nothing to worry about as long as they are infrequent. Now I have a note in my medical record to not use any beta blockers.

I’m sure you can still exercise beneficially. But I couldn’t do aerobic exercise–just couldn’t do the high intensity. It’s not just that my heart beat more slowly; my aerobic capacity was crap while on a beta blocker.

My husband’s been on Metoprolol for years. It keeps his heart rate in the high 60s and 70s, which is still faster than they like, but better than the 120s-140s it goes to without it. (He also has atrial fibrillation, which makes counting a pulse a little tricky - his heartbeat is irregular, so we have to remind medical pros to actually count it for a full minute if they want a real number. Counting for 10 or 15 seconds and multiplying just doesn’t work.)

He likes metoprolol just fine. His only problem is when he has to go to the hospital and they make him NPO (no food or water) and put him on Carvedilol* by IV instead. Carvedilol only works for him for 24 hours, then no amount of it will slow his heart rate. So that gets him an extra 2 days in the hospital on a heart monitor while they ignore us saying that this happens every time, and once they give him his oral metoprolol, he’ll be fine. Eventually, they decide to humor us and give him his oral metoprolol, and an hour later…he’s fine. It would be comical, if staying in the hospital for another two days for no reason was at all fun.

The last time they did this, he was getting a test as an outpatient that he couldn’t take his morning meds for. They came out to find me, told me his heart was racing and he needed to be admitted but wanted to leave AMA. They brought me back to talk him into staying. I walked in and said, “Ready to go?” and they about lost their shit. I told them if they weren’t going to read his chart and use their heads that he didn’t need to be under their care. I handed him his bottle of metoprolol and we were gone an hour later, heart rate of 68.

So, um, moral of the story: despite what the books say, your body may have one beta blocker that it prefers to all others. They are not interchangeable in reality, although the doctors will tell you they are. So if this one doesn’t agree with you, tell your doctor, and get her to try another.

*What I really do not understand is why they don’t try metoprolol by IV instead. They tell me it doesn’t exist in IV formulation. Novartis might be surprised to hear that.

You still get the benefits of aerobic exercise on beta blockers. You just can’t use your old target heart rate as your cue that you’re doing it right. You can get a stress test done and your doctor can tell you your target heart rate under the influence of beta blockers, or you can exercise “to tolerance” - to the point where you’re tired but can still speak. American Heart Association | To be a relentless force for a world of longer, healthier lives