Looking for an alternative to propranolol to relieve symptoms.

[CSK1]

Hello I have recently been diagnosed with hyperthyroidism, I am taking 40mg propranolol to manage the symptoms but am asthmatic, my consultant has doubled the dose of carbimazole after the 2nd blood test and wants to get me off the propranolol as I am struggling with my asthma, just wondered if anyone has found an alternative to beta blockers to help manage the symptoms of hyperthyroidism, I was walking 5 miles a day and now need inhaler to climb the stairs.

[SeasideSusie Remembering]

You could ask for a cardio-selective second generation beta blocker.

bnf.nice.org.uk/treatment-s...

"Beta-blockers can precipitate bronchospasm and should therefore usually be avoided in patients with a history of asthma. When there is no suitable alternative, it may be necessary for a patient with well-controlled asthma, or chronic obstructive pulmonary disease (without significant reversible airways obstruction), to receive treatment with a beta-blocker for a co-existing condition (e.g. heart failure or following myocardial infarction). In this situation, a cardioselective beta-blocker should be selected and initiated at a low dose by a specialist; the patient should be closely monitored for adverse effects. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol, have less effect on the beta2 (bronchial) receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance but are not free of this side-effect."

medscape.com/viewarticle/46...

[CSK1 in reply to SeasideSusie]

Thank you for your reply, I will discuss these with my consultant, having successfully managed my asthma for several years I was surprised that I had been given a medication and not monitored more closely, the original dose was 80mg.

[Angelic69 in reply to SeasideSusie]

My Gp said Bisoprolol is not for hyper only hypo

[SeasideSusie Remembering in reply to Angelic69]

The OP is talking about the effect of her beta-blocker on her asthma. I pointed out that NICE says second generation cardioselective betablockers have a lesser effect on the bronchial receptors.

[Angelic69 in reply to SeasideSusie]

Just thought that she was hyper, that's all. Great subject as ive noticed that my son has developed breathing difficulties and he takes propranolol. At first when he had a racing heart beat I gave him a bisoprol and the dr said he needed one but mine were for and opposite issue and I shouldn't have given him one. Thanks I will raise this issue with my sons GP and see if we can get those. Do you have the link so I can send onto sons Gp in case she goes narky and refuses. Are they more expensive.

[SeasideSusie Remembering in reply to Angelic69]

Link is in my first reply to the OP. I've no idea how much any of them cost the NHS.

[Angelic69 in reply to SeasideSusie]

Thanks, am comprehending correctly, patients that have asthma and ongoing airway issues will only have them available or does it mean if a breathing issue arises they should be swopped to one of those second generation versions. My sons GP never sees him and probably doesn't know he has now got breathing issues and he can not seem to get past the obstacles to see for a check.

[SeasideSusie Remembering in reply to Angelic69]

I can't answer your question, I only know what is in that article and I read it that people who already have airway disease can be affected by betablockers, and if they must have them then the second generation ones would be better because they are cardioselective with less chance of causing bronchospasm. I have no idea if a patient develops breathing difficulties with a first generation beta blocker then they should change to a second generation one.

I am looking into this because it's an issue that may very well affect me due to serious tachycardia episodes awaiting investigation and the fact that I have COPD and bronchiectasis.

[Angelic69 in reply to SeasideSusie]

So sorry to hear that sad news, tachycardia is very frightening. Don't want to sound silly but at what level is your blood glucose.

[SeasideSusie Remembering in reply to Angelic69]

I have tested that recently and Fasting Blood Glucose was 5.06 (3.5-5.8) and HBA1C 34 (20-42)

[Angelic69 in reply to SeasideSusie]

Sugar can start my heart off along with caffeine, i can only tolerate very low doses of either. I had heart ablation op via key hole surgery for tachycardia a couple of years back made a huge difference, rarely have to take beta blockers now just aspirin and be really careful what i eat.

[SeasideSusie Remembering in reply to Angelic69]

I only have one decaff coffee daily (cardiac nurse says that's no problem), no tea, don't have much sugar particularly. The heart history in the family is horrendous and it looks like it's my turn, I'm the last one apart from my, and my brother's, children. I've been expecting it! Had discussion with nurse practioner and he says it most likely due to history rather than anything to do with my hypothyroidism even though TSH is suppressed and it doesn't rise unless I reduce thyroid meds to a level where free Ts hit the floor and I can't function.

[Angelic69 in reply to SeasideSusie]

Do you take any meds for copd or have you checked to see whether blood glucose goes up after meds which may be something or nothing in relation to your tachycardia seein that your sugar and caffeine intake is not the issue. Not sure if theres brands that do not increase blood sugar or know of any links for increased insulin intolerance and certain medications. I heard they do a lactose free T3. This may sound stupid but you are drinking plenty of plain fresh water. Oh and do you smoke as there are at least 200 chemicals in cigarettes that will most certainly give you tachycardia.

[SeasideSusie Remembering in reply to Angelic69]

Don't smoke.

Apart from 1 decaff coffee, small amount of OJ, other drinks are plain water.

Both inhalers I take have tachycardia and palps as possible side effects, no problems for 4 years until December and around the time one was changed to a different brand (same active ingredient) so I discussed this with nurse practitioner who has put me back on the old brand to see if it settles down.

Haven't tested blood glucose after inhalers, I don't have the wherewithal at home to do that. I think it would have shown up sometime previously as I've been on then since 2013.

[Angelic69 in reply to SeasideSusie]

Have you moved recently to an area that has traffic congestion or greater amounts of pollution. Low pressure atmospheric.

[SeasideSusie Remembering in reply to Angelic69]

Ah, bless you Angelica, trying to find reasons/solutions for me

Not moved for 24 years, I live on the North West Welsh coast, in a tiny seaside town with one road in/out, and I am tucked away in a pedestrian area with no traffic passing. It does get busy at holiday time, traffic wise, but I keep well away.

I don't normally know about the atmospheric pressure but have just checked with the daily forecast online and it is said to be 996/997mb all day.

[Angelic69 in reply to SeasideSusie]

Not sure to what degree atmospheric pressure can effect breathing or the numbers they measure by, just noticed that on certain days air quality is poor and can probably alter gaseous exchange thus increase blood toxicity which may cause heart irregularities. They say an accumulation of ingested pesticides contain within food may also have this effect. Hope you feel better soon.

[mw2304]

Hi CSK1,

I was diagnosed with Graves (hyperthyroid) in October last year. I was given propranolol 20mg to take 3 times a day but stopped taking it after 4 days. It made me want to just curl up and die - I felt absolutely awful. I would rather put up with the symptoms than the side effects of taking it - I really felt that bad!

I'd read that acupuncture could help relieve the symptoms so I thought I'd give that a try. I live in Manchester so wanted to see a 'proper' Chinese doctor and ended up having 4 sessions (once a week) in Chinatown. I did feel better after each session, it felt like a weight had been lifted.

THEN... WOW!

The Chinese doctor recommended I start taking Chinese herbal medicine, which I agreed to. He made a special mix up to help with all my symptoms. I have to say that I was very sceptical and wondered whether it would work but thought I'd give a go for a few weeks and just 'see what happens'.

It sounds hard to believe (and I admit I was very skeptical) but within 2 weeks pretty much all my symptoms over being overactive, apart from the tiredness, had gone.

Palpitations 90% gone. Insomnia gone completely - I was sleeping like a baby! Feeling hot all the time almost gone. Very bad tremors, my whole body was shaking, 90% gone. They are just the main symptoms that I really suffered with in the early days but they all pretty much disappeared within the first 2 weeks.

Traditional Chinese medicine. Amazing!

The cost approx. £50 per week so it wasn't cheap, but was very effective.

** Thought I'd better add that I was also taking 20-30mg Carbimazole daily as well. I only used the Chinese medicine to help with the symptoms, i.e. instead of taking the Propananol **

[ling in reply to mw2304]

Just amazing!

What are the herbs used?

Thank you

[mw2304 in reply to ling]

Hi ling,

He sent me this list after my first appointment but he tweaked it each week depending on what was going on with the symptoms:

These are all the English names...

-

Creeping lily-turt tuber

-Prince ginseng root

-Northern schisandra fruit

-Fresh Chinese foxglove root

-Chinese wild yam root

-Dogwood fruit

-White atractylodes rhizome

-White peony root

-Fragrant solomon’s seal rhizome

-Sour jujube seed

-Arbour-vitae seed

-Hoelen tuckahow spirit

-Anemarrhena root

-Sichuan lovaage root.

All ground up, boiled, then drank while still warm.

[ling in reply to mw2304]

Thank you very much mw2304 for the list!

Definitely require a specialist to concoct such a brew. Really envy your having found a natural solution : ) God bless you well : ) Thank you again for taking the trouble to put up the list

[CSK1 in reply to mw2304]

Hi mw2304, thank you for your reply, I had acupuncture 25 years ago when I was expecting twins and suffered severe morning sickness, it was almost instantly cured, I hadn’t thought of trying that, my old GP recommended one. I don’t live near Manchester and had a negative experience with my local Chinese herbalist when I was trying to find triggers for my asthma and food allergies, do you think your herbalist would recommend someone in London? I am on 40mg Carbimazole and reduced my propranolol from 80 to 40 after speaking to my pharmacist who was quite alarmed at the amount I was prescribed with my asthma history. Thank you again for your reply it really helped.

[Fruitandnutcase]

Not surprised your pharmacist was shocked. When I was first diagnosed with Graves I was told I couldn’t be given beta blockers because I had asthma and my asthma is very mild and seasonal.

I started on 20mcg carb and after four weeks it hadn’t made much difference so I doubled it to 40mcg daily which I stayed on for a year, I added levothyroxine after three months and my carbimazole stayed at 40mcg while my levo increased over the year until I was taking 75/100mcg a day.

The point I am aiming for is that I don’t think you have to take beta blockers at all or I didn’t and I was fine. they just calm things down a bit faster (I think), once the carb has worked its magic the pounding heart - and boy did mine pound, it was a miracle I hadn’t had a heart attack - and other awful hyper symptoms ought to sort themselves out.

I would skip the propranolol and wait for your carb to kick in, from the sound of it you couldn’t feel any worse than you do at present. It takes time for your body to get back to normal.

[Valarian]

I was prescribed a calcium channel blocker, as I had high blood pressure and was over 55. It seems to have had much the same effect. Carbimazole typically takes a couple of weeks to kick in fully, as it inhibits future production of thyroid hormones, but does not destroy whatever you already have stored.

I guess it depends how bad your symptoms are. It’s amazing how much better you can feel if the heart pounding, breathlessness and tremor are reduced even a bit.

[Espisnowwoman]

Do u know of metoprolol its also a beta blockers. I have taken this med for 22 years for hyper/graves.

[SeasideSusie Remembering in reply to Espisnowwoman]

Have you not checked the Patient Information Leaflet?

medicines.org.uk/emc/produc...

[Espisnowwoman]

I have no side effects from taking that med. I take 200 mgs a day.

[MissFG]

After 6 years propranolol just didn’t help anymore and stopped working for me. A year ago I was put on gabapentin which has been a huge help. I’m gradually increased my dose and don’t have any noticeable side affects however I know some can’t tolerate it.

I

[Kari55]

Melissa tea (lemon balm) helped my husband for palpitations before he was prescribed propranolol.

[CSK1]

Thank you everyone who has replied to my post, it’s been really helpful...