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Is My Beta Blocker Working?


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I know this sounds crazy but my cardiologist started me on 25 mg Metoprolol and I started by taking half of half (1/4 of it) then increased to 12 mg ( which is half ) but I dobt think I noticed anything different. Still dizzy still light headed .. Still good days and bad .. I do notice not as a huge jump in HR though .. Is that possible?

Thank you

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For what it's worth, I've had a very similar experience....like you, I'm on half the dose of what the doctor suggested for a beta blocker (I'm on a tiny 5mg of Nadolol...tried the 10 mg dose they suggested for several days and concluded the side effects at that dosage outweighed the benefits). Like you too, I notice that I get fewer jumps in heart rate and in my case, fewer bp jumps as well, so it helped with the discomfort that came along with those, but it didn't help the dizziness and other symptoms at all. I'm no expert on beta blockers, but I'm assuming that's because beta blockers are only designed to lower your heart rate and blood pressure, not treat whatever causes the dysautonomia itself. Our bodies presumably still have troubles regulating blood flow to our heads and all the other places that need blood, and that means we still have symptoms.

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One thing worth noting is that Metoprolol DOES cross the blood-brain-barrier. In a similar fashion to Propranolol, though it is Beta-1 receptor selective, which means that its action does differ somewhat.

I've only tried propranolol and Eucommia bark (a non-selective herbal Beta blocker) so far, but it seems like it sometimes takes trial an error from what I've read to find the right one. I've found that the propranolol has helped a bit with some of my symptoms, but I think it is giving me issues with insomnia/sleep cycle, as I seem to easily have issues there.

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I'm on 100mg of toprol XR (the extended release form of metoprolol). Actually, I was on 150mg for a year or two before I (at the recommendation of my then-new POTS doc) dropped it down. 100mg was as low as I could go without feeling cruddy again, with tachycardia and the palps. Some people (even us notoriously med-sensitive POTS people lol) just need higher doses of certain meds.

I know a lot of the current research indicates low-dose bb to be the way to go, but if you're not seeing a real difference, why not see if a higher does will help? If I were you, I would keep upping the dosage (w/ your doc) until I either felt a significant amount better or side effects popped up. You can always drop it back down. Some people can't tolerate certain betas (you'll know when you hit one - propranolol knocked me out completely), but from what you've said I'd guess that you just haven't reached a dose which will help you yet.

My beta blocker turned out to be a godsend, but it definitely took a while to get to a dose where my tachycardia was controlled.

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