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RecipeForDisaster

Pounding heart... what has worked?

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I was prescribed metoprolol succinate 25mg ER and I found that it helped my pounding heart to lessen and therefore let me sleep. However, the effect wore off after about 8 hours even though it's a 24 hour formulation. Odd!! It didn't affect my heart rate or BP at all. My rate isn't always terrible, but even 90-100 and HARD while you're trying to sleep is too fast for comfort. I had no problems with the metoprolol other than the fact that it didn't last long. I slept much better than without it but never past 3am. Last night I didn't sleep at all and that's not too uncommon. Nothing helps me sleep "through it" when the pounding is bad... just the metoprolol because it lessens the force.

When I told my cardiologist how fast the effect wore off, because I would wake up at 3am every morning with the severe pounding and could not get back to sleep, he switched me to diltiazem, starting with 30mg twice daily last night. Strangely, it hasn't affected my rate or BP either (I know it's a tiny dose to start with) but it hasn't helped the pounding, either. I did feel a little more lousy (lightheaded, weak) for a few hours after taking the first two doses, but after multiple checks I found that my BP was the same it had been.

My BP has been quite low recently even before either of these meds, so we are being careful with dosages. I collapsed while walking yesterday and had to lie on the floor for a while the day before. I feel grateful that the doctor will even give me anything for this symptom given my blood pressure. He does want my rate reduced if it can be done safely.

I'll get my TTT results in a couple of weeks. I didn't pass out but I felt pretty woozy during the tilt. I know the BP alarm went off a few times as well. I don't think my rate was terribly fast, though.

 

 

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Have you talked to the doctor about possibly taking the short acting version of metoprolol so you can take it more often? 

Also, there is pharmacogenetic testing available that helps people to understand if they are slow or rapid metabolizers of certain medications. I had mine done through YouScript/Genelex. I am a rapid metabolizer of some medications and they therefore have no effect on me or only work for a very short time before they are cleared from my system.  Knowing this can allow a doctor to help find a more effective drug. It is no longer considered experimental science but it is newer so a lot of docs haven't used it, but, it's worth the question. 

 

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My doctor wants me to have the steady, extended effect of metoprolol, because I asked about the short acting twice a day. He said my heart could have issues with bouncing back and forth. That's really interesting about the metabolism research! I will ask about that-it honestly seems like it's gone after 3am (I take it at 6pm since it should be with a meal). I was also thinking of taking it right at bedtime without food so it would work for the entire night. It seems like if I took the long acting 12.5mg 3 times daily at a tiny dose it would work well, but it would "look" crazy. On the other hand, it makes me a little sleepy, so I'm not sure if I really want to take it in the morning.

He wants to bridge me over to long acting diltiazem once we find the right dose, but I just don't feel as good on it, so far. I guess I'll give it a total of 4 days?

Is there anything else that people have had success with for pounding heart? Sometimes my rate and pressure are even decent, heart rate fast for sleeping at about 90-100, when it's very bothersome but I have not gotten to check my pressure in the wee hours when I wake.

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Hello! I have the same problem with long-acting medications, they always wear off in about a 4-6hour period. My doctor told me I metabolize medications quickly, I tested positive as a rapid metabolizer in bloodwork. He also said that certain medications and vitamins can counteract and cause an absorption issue - he asked me if I was still taking iron (which I have been on for almost 2 years now) he said iron can decrease your body's ability to absorb the medication. Are you taking any supplements/vitamins? I would check with your dr or pharmacist about splitting the metaprolol er, it's not typically advised to break those forms of drugs.

There may be a couple medication options to talk to your doctor about. Sometimes one type of beta blocker works better than another. There are many BB options, however, Propranolol in low dose is recommended for POTS patients. http://circ.ahajournals.org/content/120/9/725 , http://www.neurology.org/content/early/2013/04/24/WNL.0b013e318293e310.abstract  Another option is a drug that was just recently approved, Ivabradine (corlanor) I'm on both of these medications, Ivabradine changed my life.  I had refractory tachycardia and palpatations for years, on mass doses of bp meds until ivabradine was added. https://www.verywell.com/ivabradine-corlanor-1746411 

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Hi again, I just remembered more of that convo about drug metabolizing with my doctor. He said the iron has a form of metal in it which is the reason for not absorbing well, also said that antacid's have that as well. I was trialing a med, Provigil, which is a weaker form of a med like Ritalin, but he said that type of medication can cause a metabolizing issue if taking it close to a dose of another medication.

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Interestingly, I normally take iron but I have missed a week or two lately because I am not eating much. I didn't take it when I was on the metoprolol. I don't take antacids but I do take magnesium at night, hmmm. That, vitamin D, folate, and B12 are my only vitamins.

 

i have pretty bad asthma so they want me to be on a specific beta blocker that doesn't affect breathing as much. I also have low blood pressures, so I don't think we can really bump up the dose.

 

It's okay to break metoprolol ER cleanly down the scored mark as it's actually divided there. If you crush it, that's not okay. 

 

I was wondering about ivrabidine... I am afraid it's "too new" for the doctor to be comfortable with, but it sounds really good. Thanks!

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I had this to the point I was in hospital for a month, it was UNBEARABLE. Improved with propanolol and mirtazapine. You may also want to look at ivabradine, magnesium, light (specifically red) and cold.

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14 hours ago, RecipeForDisaster said:

I'm going to ask about ivrabidine. Please tell me more about light! I do take 500mg magnesium nightly. What is the cold about?

Basically we need a lot of sun light , unfortunately at high latitudes it's hard to get. I benefit from vielight 810, reptile lights and natural light. I highly recommend reading jack kruses work.

Cold thermogenesis provided benefits and negatives.

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I'm outside a lot and I have a sunlight lamp for vitamin D (I supplement it too). I'm cold a lot, and keep the house at 60f. I will check out Jack Kruse.

I feel better without the diltiazem, for better or worse. I still woke up hot and tachycardic at 3am, but metoprolol gave me a few hours of sleep before that, at least. I skipped magnesium just to see if it changed how metoprolol worked, but no.  

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21 hours ago, RecipeForDisaster said:

I'm outside a lot and I have a sunlight lamp for vitamin D (I supplement it too). I'm cold a lot, and keep the house at 60f. I will check out Jack Kruse.

I feel better without the diltiazem, for better or worse. I still woke up hot and tachycardic at 3am, but metoprolol gave me a few hours of sleep before that, at least. I skipped magnesium just to see if it changed how metoprolol worked, but no.  

You seem to be doing alot good but I would still recommend checking out kruse

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I take propranolol, not extended release. So for it to be effective all day I have to take it 3x, which is 9 pills a day lol. I've heard a lot of different stories and reactions to medications and was recently prescribed ibdredine? I'm paranoid about medications and I'm hesitant to take it.  Also I find it interesting what people say about sunlight because I avoid the sunlight like I'm a vampire. It makes my skin hurt and my veins swell and I get pooling in my extremities, I do take a vitamin D supplement though.

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