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Beta Blocker Blues


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Which beta blocker to you all use? I've been on Metoprolol since May. Now that i'm finally up to a dosage that helps my POTS, I've been having major insomnia issues. I've heard that metoprolol can cause insomnia, but atenolol doesn't have any side effects like this....does it have other side effects that i don't know about? I'd really like to switch, but i want to know what that may entail. Have any of you switched beta blockers before for different reasons? What are your experiences?

Thanks for your help!


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Bisoprolol for me, but only with midodrine. otherwise my pulse seems to crsh through the floor for days afterwards.

Interesting you mention insomnia= I get really cold and sleepy.

but we're all different, and god knows our ANS's are wired differently at the best of times :P

Good luck with it all- there are loads of different ones you can try :P

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Everyone is different so it is certainly worth talking to your Dr about.

I took atenolol for a long time but then it kinda stopped working for me. I definately had a lot more bradycardia issues on atenolol but again; we are all different. Atenolol also made me extremely tired.

I've had the insomnia issue with metoprolol as well.

For me, I do better on metoprolol because it is shorter acting. Atenolol is long acting. So, I take small doses of metoprolol during the day but I don't take any dose after 4pm (unless I have a huge spell of tachycadia). This works for me..I take a very small dose which is just enough to get me some relief but I don't have so much of it in my system where I'm up all night.

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i have been on a ton!!!!!! of BB's in the past 3-4 yrs.. and I honestly dont remeber what ones they were..

a few made me very fatigued.. though..atenolol.. LA toperolol? (SP ? --i may have gotten the name totally wrong!!.. potsy moment! :P )

right now I am on propranolol.. it does not make me tired.. how ever after about afew months the dose does not work well for me and I have to increase it.. but all in all it works good..

Like I said I have been on many many BB's.. and had to change them because they didnt work.. or they stopped working..

sometimes you have to "tweak" the dosages.. in some cases the dose was too high.. and it slowed the old ticker down too much.. or it wasnt enough.. and didnt slow things down..

i would recommend starting at a small dose.. and work your way up.. if you dont tolerate the med. well then talk to the doc about it..and see what else you can try.. there are alot of BB's.. it just might take some time to findthe right one for you.. and the right dose..

good luck to you!



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A very low dose of Toprol XL (half of 25 mg tablet)seems to work well for me. I think the extended release is key because it seems to last all day without a major surge at the beginning.

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kristen -

despite my extensive med history, i don't have a lot of wisdom to add on the beta blocker front. when i was first diagnosed with NCS in 97 i was put on toprol (can't recall the dose) and it was a disaster. i got worse, was blacking out left & right, etc. whether it was b/c of the med or b/c i was simply getting worse i'm not sure, but i was taken off of it b/c of my BP being so low.

b/c of that no one bothered to try me on a BB for years in between....not sure why when my tachy was so bad (which wasn't my primary issue at diagnosis the years before) but likely b/c of the hypotension fear.

fast forward to this year...

i've taken inderal/propranolol since my stay at vanderbilt in may. it was one of the meds in the drug trial for the research there. alone it was NOT good for me. even on a tiny dose i was out cold as my BP went crazy low. but combined with mestinon (which was also bad for me on its own) it was my best med combo of all. on that day of the trial i felt better than i had in months. day to day my BP was still dropping so we added midodrine back in too which has been the best for me. not magic, but has me functioning to a better degree than in quite a few months...

i take 10mg (along with 30mg mestinon & 10mg midodrine) every 4.5hrs while i'm awake, including before i can get out of bed in the morning....

i haven't noticed a change in sleep patterns with the beta blocker...was having problems before, still having them after.

hope you find something that works magic!

:huh: melissa

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Thanks for the helpful replies.

Poohbear, i didn't know that atenolol was long acting. That helps me understand better why i may be on metoprolol. I have been on it along with florinef...melissa i think that's why it worked for me...it seems like a beta blocker works well when it's coupled with something else. I really have felt relief for the first time on my increased dose of metoprolol...dizzygirl, i have been tweaking the dosages and i finally found one that feels right (either that or i've just had enough time to recover from my last spell) But the insomnia set in right after this increase. I'm thinking that maybe if i just don't take it at night that it might alleviate the wide open eyes at 6am....and 7am...and 8am... not sure.

Do you guys feel immediate relief from POTS symptoms with BB and/or other meds? Melissa, it sounded like you got immediate relief from some of your meds at Vanderbilt. For me it seems to take weeks and weeks to feel just a little better. I'm just not at a really stable place yet. I feel like i'm balanced very very carefully at the tip of a pin....hopefully my first cardiac rehab session tomorrow won't push me off! :huh:

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I was put on Toprol, but it lowered my B/P too much. I am now on Lappressor and Levsin

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