Dosage Metropolol/Bisoprolol how low?

[OzJames]

I recently visited my cardiologist and everything going ok, I advised him that I’d reduced my Metoprolol from 12.5mg morning and night to about 8mg. The equivalent in Bisoprolol is about .8mg. I asked if it still does something or should I stop taking. His answer was that its very small amount but it could still contribute to tamping down adrenaline and keep things in check.

Is anyone else on such a low dose as just wondering if I should reduce again or stop taking it as I’m not sure if long term use will cause other problems

[Threecats]

Hi OzJames

When I was on Bisoprolol I gradually reduced that to 0.6mg per day due to side-effects. I was told repeatedly that a dose that low was doing nothing and I should increase it but it was still working for me. Unfortunately it continued to cause side-effects, too, so now switched onto a CCB . I guess that when they come up with dosing guidelines for these drugs, they’re basing it on averages but we’re all so very individual in our responses I don’t think an average really exists!

I suppose you would maybe need to factor in whether the drug is helping in other ways, such as keeping your blood pressure in check if that’s an issue for you, or countering some of the effects of anxiety on the heart, which was certainly an issue for me. Good luck in whatever you decide to do. TC

[OzJames in reply to Threecats]

interesting as I really feel that it tamps down my resting HR by a few beats when I was on initial dose of 25mg my resting HR was sometimes in the high 40’s now it’s in the mid to high 50’s. I’m ok with blood pressure never had any issues except when I go to the doctor! 😁

[Glenlyon]

I take a similar amount in the mornings and it seems to lower my heart rate though not as profoundly as 12.5bd that I was taking after a couple of bouts of avert landed me in e.

The second bout, that lead to the diagnosis required a dose of adenosine to correct things and although I was given the choice of taking Metoprolol regularly or as a pip ... I went for the regular dose without doing any research ... I've since read that it is mostly metabolised via cyp4d6 (mine is negligible, though I'm sure that is only one aspect of a complex process)... I cut back very slowly as side effects were difficult ... doctor and gp both said I was on such a low dose initially it would be fine to just stop and keep it as a pip, with going back on it regularly as a back up plan if I am needing a pip too often. All very clearcut also scary. I'm learning on my feet atm but was reassured reading you are also finding a low dose does the trick. I am unsure if I fit the diagnosis of Afib yet, will see my cardiologist in a few weeks with the letter from the ed. Hoping I am not overstepping being here without knowing but I figure the avnrt is in the same family and I am learning so much from everyone here. Thanks for your posts.

[OzJames in reply to Glenlyon]

Everyone has different reactions as you said I feel the little dose that I have does take my resting HR down a bit. Mind you it could also be the lifestyle changes diet and supplements I started some months ago

[Glenlyon in reply to OzJames]

Yes James, in the end, those are the things matter the most! I’ve just been looking at “Magnesium: Reversing Disease”, I can’t vouch for the book in its entirety but I found the kindle sample is very interesting. Wishing you all the best

[OzJames in reply to Glenlyon]

Thanks, I’ll have a read. My go to book that’s helped is Breath by James Nestor.

Be well

James

[Bodydoctor12]

hi James,

I’ve been slowly slowly reducing my Biso since my DCCV last Feb - I was on 3.75 beforehand. I’m now down to .625 and am continuing the reduction for the same reason as you - terrible side effects. I’ve managed somehow to take half that .625 (pin head) and now it’s every second day. My heart reacts slightly each time I reduce it and then normalises again. So far so good, should be clear of it this month - inshaAllah 🙏

[OzJames in reply to Bodydoctor12]

Yes I did same last time I went off it years back. Slowly reduced as your doing then stopped. I was AF free after that for 5 years until late last year. I guess I forgot my triggers were alcohol and vigorous exercise and AF came back!

[LJjr]

After my initial diagnosis of AF I slowly reduced my dose to 6.25 mg of Metoprolol once a day. I did this while physically conditioning for a hiking vacation that was coming up. So, in a sense, it was done with a home version of stress testing taking place. I had originally been put on 25 mg twice a day. During my annual cardiologist check-up the doc said why bother at that (6.25 mg) dose and advised me to use it as a PIP only. I tried that but had an uptick in episodes. Went back to the 6.25 once a day and have found it definitely helps. Sometimes I will take a second dose at night if I find my anxiety is up. So far that is managing my particular version of A-fib fairly well while minimizing the undesirable effects of the beta-blocker. I do sense it is progressing, albeit slowly. I am happy to stick with this regimen for now.

[OzJames in reply to LJjr]

Sounds like a fair plan I think I’ll cut back to once a day soon. I did the same some years ago then went off it altogether for 5 years until it came back late last year. Too much wine the night before then went to a cardio fitness session in the morning and it came back!

[OzJames in reply to LJjr]

I forgot to ask how do you get your measure down that low or is it just an estimate? I’m trying a jeweller scale I got from Amazon

[LJjr in reply to OzJames]

I use a pill cutter and quarter the tab. It is "more or less" 6.25 mg.

[OzJames in reply to LJjr]

Thanks for that, our smallest Metropolol in Australia is 50mg so I cut down a lot more so hence the need for a jewellery scale!

[mav7]

I’m not sure if long term use will cause other problems

Metoprolol is known to be a less toxic medication to the system (thyroid, kidneys, etc). But you should take annual blood tests at minimum to determine if any effect.

What is your afib status, paroxysmal, persistent, in normal rhythm ? Would take the doctor's advice since he is familiar with your history.

[OzJames in reply to mav7]

I have PAF and seemed to get it every 4-5 years since 1993 until late last year it hit me in August and December. Yes the GP has me on annual blood tests. Thanks for your thoughts

[JOY2THEWORLD49 in reply to mav7]

Hi

Metoprolol less toxic???

Not for me pauses, breathlessness and fatigued with no energy.

The public H/Specialist said Bisoprolol is suited better AFers she said.

It is my list of no nos. I was also coughing on ACE blocker.

cheri JOY. 74 (NZ)

[mav7 in reply to JOY2THEWORLD49]

Toxic meaning affecting the system (kidneys, thyroid, liver)not side effects.

Bisoprolol is probably equal and equally prescribed.

Point to the OP was it is generally a safe drug.

[JOY2THEWORLD49]

Hi

I'm confused metropolol? or bisoprolol? These are both beta blockers.

Metoprolol made me breathless, fatigued and 2 pauses x 2 seconds at night.

AFers the preference is Bisoprolol.

cheers JOY. 74. (NZ)

[das1234]

I am taking metoprolol 25 XL since February 2023 once in the morning. Before that I was taking Ivabradine 5 mg twice daily since 2019. After routine check up doctor advised me to take Metoprolol. He told me that Ivabradine cannot be continued further. Beside this I am also taking Telmisartan 40 in the evening. Metoprolol is given for rate control. But I don't know whether this medicine is making me so tired and causing slow movement. Feels dizzy whenever I want to speed my walk. In the last 2 months I have to stop walking activity. I am 60+ . this metoprolol was prescribed 15 years ago as antihypertensive, at that time I didn't have any AF episode. But it caused Sinus pause for over 2 seconds, Cardiologist stopped it.

[OzJames in reply to das1234]

Are you saying the 15 years ago your cardiologist stopped as it was causing you issues then why are you on it now? In any case my initial dose was 25mg and I felt lethargic and seemed even vague sometimes. The cardiologist halved the dose straight away and the symptoms disappeared. Best to talk to your cardiologist again

[BaileyC57 in reply to das1234]

Get back with your doctor and have them see what meds make you feel like that!

[BaileyC57]

I am on Metoprolol 12.5 mg in the morning and the other half at night! But you are taking two different beta blockers , that would make my blood pressure go too low!