Beta Blockers With Midodrine

[davecom]

Seems counter intuitive - one is vasoconstricting and one is vasodilating, yet this is the new regimen I am to start. Anyone find both together helpful? What has your experience been? I am supposed to be starting 12.5 mg atenolol with the 10 mg 3x a day midodrine I'm on although I'm thinking about holding off since I didn't take midodrine for most of the day today for the first time since i started and my head felt much better but I had two extreme sudden tachycardia events 200 bpm+ out of nowhere (that quickly went away) and I had never had anything like that before. Could my body have gotten so used to midodrine? I thought it was short acting.

[Chaos]

Yes it does seem counter intuitive but I've been on both for several years. Docs who don't know POTS always look at me funny and ask why I'm on both. But, the combo does seem to work well for me anyway. I need the beta blocker to control heart rate as well as a bunch of other symptoms and the midodrine seems to help with HR control as well as keeping my BP from tanking.

[Relax86]

In my first bout of POTs I was prescribed both of those drugs. I recovered fairly quickly from round 1 (which was in 2009) WITHOUT using the drugs. At that time finding out that I was pretty anemic and VIT D deficient, and fixing those things seemed to get me better. The flare of 2012 I was diagnosed with low BP and I chose to only take the Midrodine. Once my BP came up then my HR mostly seemed to come down. I felt better, and my body seemed to re-train itself over time. It is worth to mention that I was on/off Hydrocortisone for most of 2012 as well. I used HC because I was dx with adrenal fatigue which is a controversial theory. My symptoms fit quite a bit of the criteria and I don't think I could have gotten better without using hydrocortisone. So my point which I seemed to get away from is that once the Midrodine raised my BP my tachy episodes improved.

[hholmes13]

I did the Midrodrine beta blocker (nadolol) combo for a little over a year. It seemed to work okay for me, but my problem was the beta blockers seemed to work too well. Even just taking a 1/4th of a pill (~5mg) my hr would go down to 38. We finally took me off the beta blocker last summer when I started Mestinon.

[Hope]

I take Midodrine and Metoprolol. I always monitor my blood pressure and heart rate before I take either because some days I need both, some days I only need a 1/2 dose and the more I am recovering, some days I don't need either at all. Interestingly, even when my blood pressure and heart rate are under control, I can still have an array of symptoms that do along with POTS.

[E246]

I may also try this combo so am interested in your experience. I also have the hr jumps - these then cause the pots symptoms and give me hours of chest pains. I have managed to control them as i have got better to about 1 a week. You are the first person i have noticed gets these as well. Mine are just sinus node tachys. Sometimes the beta blockers cause these initially when they enter my system half and hour after taking them. But i have found the beta blockers stabilises them. I take them as and when needed.

[YolaInBlue]

I take a small dose of Midodrine and Pindolol in the morning. Usually 2.5 mg both, but, like Hope, I check my blood pressure first. When it's low I take only a quarter pill of Pindolol instead of half. These are small doses but they lower my heart rate by about 20 bpm. That's all I need. My heart rates are much better nowdays, only in the morning they are 100-115 standing. I manage to keep my blood pressure in the 95-115/50-70 range, so this combo seems to work. I also take 0.05 of Florinef daily.

[Guest Alex]

A year or so ago, shortly after being dx with POTS I was on a combo of midodrine and propranolol for about a month (plus florinef) but I was unable to tolerate the BP spikes the meds were causing, so my dr had me stop the midodrine.

Alex

[davecom]

My heart rate has been extremely low - low 50s in the morning and at night and even sometimes during the day. Even seen 40s at some times. I am on 12.5 mg atenolol and now 7.5 mg 3x a day midodrine. Apparently there IS a serious interaction between the two. I am going to gradually try lowering my midodrine a bit. I've strated by lowering my last dose to 5 mg.

atenolol ↔ midodrine

Applies to: atenolol, midodrine

MONITOR: Midodrine, an alpha-1 adrenergic agent may lead to bradycardia if administered concomitantly with any agent that directly or indirectly reduces heart rate. This may be most important for beta blockers and tricyclic antidepressants.

MANAGEMENT: Patients should be advised to discontinue midodrine if they experience signs or symptoms of decreased heart rate (i.e., slow pulse, dizziness, syncope, cardiac awareness) and to contact their provider for reevaluation.

[seattle chris]

I started Midodrine about a month ago (5mg) and I have been taking Atenolol for years (now at 50mg). The Mididrone has moderately to slightly helped my symptoms and I would like to take a higher dose of Midodrine but my hr has been as low as 39 so I am kind of stuck with the current dose. One thing both meds have in common is that they can lower your heart rate.

[davecom]

Chris if you read the known drug interaction above... You should be careful increasing midodrine, especially when you're at 39 while awake.