Beta Blocker Vs Calcium Channel Blocker

[lauralulu]

So, I finally got diagnosed with pots on 9th April and was given a 25mg dose of atenolol to try.

I've been feeling incredibly wiped out and fatigued, and upon measuring my bp, realised it's gotten lower than is usual for me (around 80 something over 50 something).

I tried halving the dosage and then even went to taking the half dose every other day. On the days when I DIDN'T take it (in the evening btw, prior to going to bed), I had a lot more energy.

What I like about the bb is on it, I feel more comfortable when standing. I don't get that weird sort of 'hyped up/can't relax' feeling and the symptom that I really hated, the muscle jerks and feeling of needing to constantly fidget when trying to relax, was gone. But the cost is feeling constantly tired and dopey, which I don't like.

My pots dr wrote to me and my Dr saying if I don't tolerate the bb, the next med to try is a calcium channel blocker, extended release.

I'm just wondering, why these tablets first when both lower BP? And aren't calcium channel blockers usually poorly tolerated in people with pots?? I have my reservations about changing medation if it's only going to make me feel bad in a different way. Maybe I should be more optimistic and think, it could be the one to make me feel better! I just seem to be sensitive to meds and often the side effects seem to outweigh the benefits. I think overall, despite many unwanted symptoms, I was doing better without medication... BUT I'm kind of reluctant to have back all those other symptoms I've been enjoying doing without.

I don't really know what I'm asking here, as no one can tell me what's going to help and I suppose if I want to have some symptoms controlled/masked or whatever, I've got to be willing to go through the trial and error... I just feel very wary as I hadn't expected a calcium channel blocker to be one of the things for me to try. I'm not really sure how that's suppose to help, so if anyone more clued up can enlighten me...?

[DizzyMe]

Just wanted to say well done on reaching a diagnosis.

I have just started on Atenolol too 12.5mg too, I,m sure I have seen doses as low as 6.25mg daily mentioned on here as being beneficial as we tend to be sensitive to meds and need less.

Melanie.

[summer]

Hi! Yes, the trial and error phase can be very frustrating. Have you been trying the BB since April 9 or more recently. I know that when I first tried the BB, it wiped me out, but in other ways I felt better. I did find it took a good 2 weeks of taking it every day to build up to it a bit. I'm still fatigued, but not as much as I was off the BB.

Also, I was not able to take the BB alone. When I started florinef along with it (to keep my BP up), the combination of the two worked much better. Good luck trying to find something that works for you!

Summer

[lauralulu]

Summer- I have been taking it since April 9th. I had wondered about possibility of taking florinef too, as I know it helps with retention of fluid and thus blood pressure. I'm just waiting on some blood tests because I'd asked about DDAVP, due to my constant feeling of dehydration, thirst and urinary frequency. I think they are testing me for diabetes insipidus, but can't be sure, the nurse had never ran those tests before. If I can take the DDAVP I believe it will have a similar effect as florinef in helping with retention of fluid and thus raising bp, so just waiting. If I can't take that then I'll email my pots dr and ask about florinef.

As an aside, does anyone else get really nervous about actually SUGGESTING meds to your dr? It's like you're saying 'hey, I know better than you, I want medication x, write me a script!' lol.

Dizzy me- wow those are very low dosages, I'm going to ask if I can try a smaller dose like that as half of a 25mg pill is too much for me at the moment. It's good to know they can come that small! :-)

[Angelika_23]

Hi, Atenolol did not work for me. Eventually they found that Toprol XL was the best choice. They did try me on a calcium channel blocker first, and it made my POTS ever so much worse.

Good luck,

Angela

[lauralulu]

Thanks Angelika.

I might just stick with being unmedicated and managing that way. I did it for 9 years and have been okay. I'm overall just not entirely comfortable with taking medication that could have negative long term effects when I don't strictly NEED to. I CAN manage without. Am disappointed though, the first couple of weeks I felt a lot better, until the fatiguey doped up feeling kicked in. As for the CCB, well I just don't like the sound of what it does, and how it can affect the liver. Just puts me right off even trying it.

[Angelika_23]

Have you thought about maybe trying Toprol? That is what works best for me. I don't have any side effects from it.

[green]

I have been on Calan (verapamil) all this week. 80 X 3 daily. This is a beta-blocker. I am noticing no side effects, but no benefits either.

Have you thought about maybe trying Toprol? That is what works best for me. I don't have any side effects from it.

[green]

I have been on Calan (verapamil) all this week. 80 X 3 daily. This is a beta-blocker. I am noticing no side effects, but no benefits either.

Sorry. I meant to say "calcium-channel blocker" Verapamil is not a beta-blocker.

I am reluctant to try BBs because I read 1) they tend to stop working over time, and, 2) they increase one's risk for diabetes.

[Simmy]

I tried Metoprolol and Fludrocortisone and didn't tolerate them very well. My doctor and I finally settled on (for now) a calcium channel blocker - Verapamil. According to my doctor, although it's often used to lower blood pressure (bad for me) it's also good at lessening the quick heartrate spikes.

To combat the blood pressure dropping effects of Verapamil, he also put me on Midodrine - a vasoconstrictor, Desmopressin (DDAVP) to retain fluid, and Mestinon, which also boosts blood pressure but turns me into a nauseous zombie.

Although I've gotten worse, overall I think the meds are helping. Without them I doubt I'd have the energy (or will) to even type this on my phone.

[lauralulu]

I tried Metoprolol and Fludrocortisone and didn't tolerate them very well. My doctor and I finally settled on (for now) a calcium channel blocker - Verapamil. According to my doctor, although it's often used to lower blood pressure (bad for me) it's also good at lessening the quick heartrate spikes.

To combat the blood pressure dropping effects of Verapamil, he also put me on Midodrine - a vasoconstrictor, Desmopressin (DDAVP) to retain fluid, and Mestinon, which also boosts blood pressure but turns me into a nauseous zombie.

Although I've gotten worse, overall I think the meds are helping. Without them I doubt I'd have the energy (or will) to even type this on my phone.

I want to be able to take DDAVP to retain fluid as I believe that's my biggest problem, with my overactive bladder I just pee it straight out. Unfortunately though my Dr wasn't sure about the licensing laws over here, I might only be able to take it if I actually have diabetes insipidus. I've just had some blood tests and am waiting to see what they say, if anything.

I'm also reluctant to take beta blockers now after reading about how they can increase the risk of diabetes. I've already got one complicated health issue, I do not want to risk getting another!

Thanks for the responses. It's good to have the diagnosis now and know the CCB is available to try, but as long as I'm doing okay without, I'll just keep it as a possible option. I'm afraid of taking meds when I'm not doing that badly and then if things were to get worse, the meds wouldn't work. I'd rather save them for if I really, really need them! Right now I am lucky that I can cope with my symptoms.

I do hope I can have DDAVP though because I really think this would help, I'm thirsty and feel dehydrated all the time, so I drink anything from 2 to 4 litres every day and still never feel like my thirst is quenched!

[janiedelite]

A vascular doc suggested I try a CCB for my Raynaud's, but the Mayo neuro and my cardiologist said the CCB would only aggravate my POTS by causing more peripheral vasodilation and lowering BP. It would also raise heartrate.

[flop]

Hi, beta-blocker vs calcium channel blocker is a good question.

They are both mainly used to treat high BP, but they both work by slowing down the HR.

The physiology looks complicated but it is actually a fairly simple equation

Cardiac output (liters/minute) = heart rate (beats/minute) x stroke volume (litres/heart beat)

Basically when our hearts beat really fast the heart chambers don't have time to get full between beats. This means that the amount of blood pumped out of the heart (stroke volume) is low. By slowing down the tachycardia the heart can fill properly so each beat pumps more blood. This means that over-all the heart becomes more efficient and cardiac output is increased (ie better blood flow to our brains and generally higher BP).

In people with a normal heart rate but high BP (the majority of people prescribed these meds), slowing the heart rate from normal to low-normal doesn't change the stroke volume so the overall effect is to reduce cardiac output (ie reduce BP).

It is because of the inter-relationship between heart rate and stroke volume that these meds can have such different effects on different conditions. Many doctors don't realise how meds will have different effects on people with POTS. That is not to say that a BB or CCB won't cause low BP in people with POTs but many of us find them very helpful medications.

I've got to dash now but will try to remember to come back and write more later....

Flop

[lauralulu]

It is because of the inter-relationship between heart rate and stroke volume that these meds can have such different effects on different conditions. Many doctors don't realise how meds will have different effects on people with POTS. That is not to say that a BB or CCB won't cause low BP in people with POTs but many of us find them very helpful medications.

I've got to dash now but will try to remember to come back and write more later....

Flop

Thank you flop, that is most interesting and helpful! I like to understand how these things work. Unfortunately the bb was making me feel terrible, so tired, dizzy and nauseous. My bp was down in the 80s/50s, so I think perhaps I'll have to try the CCB next.