Propranolol

[Knellie]

Hey Guys--

 My doctor recently started me on propranolol, just a higher dose than before. Is it supposed to help with palpitations, because it isn't helping me? Does it have to have time to build up in your body? Also has anyone had any bad side effects from it? Thanks!!

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[MTRJ75]

What's the dosage? I'm on 10 mg of PPL once a day early (mostly for high blood pressure), but then 2.5 mg of Ivabradine in the evening. Feel like my heart rate has been better controlled with Ivabradine. I think there's also some literature on lower doses of beta blockers being more beneficial than higher doses in POTS. 

[Knellie]

I am on 20 mg twice a day of propranolol. But none of my other medications should affect my heart I don't think. The only other prescription med I'm on is Omeprazole and then I am on loads of supplements. I just wish the palpitations would go away! They are very obnoxious. But it is interesting to know that a lower dosage may be more beneficial.

[MTRJ75]

There is literature out there to that effect, though I can't remember if it was ever posted here or not. You may want to google. That said, the dosage you're on is still very small. less than a standard single dose. If you don't have blood pressure issues (mostly high), you can also consider looking into Ivabradine (though I hear it's difficult to get covered). 

[Pistol]

11 hours ago, MTRJ75 said:

I think there's also some literature on lower doses of beta blockers being more beneficial than higher doses in POTS. 

I agree, I have also read this in studies and heard it mentioned by physicians. I tried several betablockers early on in my POTS journey and found that the only one that controlled my palpitations was Carvelidol. This BB has alpha and beta blocking properties and therefore may be more effective in certain cases. 

[MikeO]

@KnellieI don't know for sure if a lower dose would help but i would ask your Dr to trial it and see what you get. You can always go back. My Daughter is suspected of having POTS  and was put on a low dose beta-blocker.

I have also read that not all beta-blockers are equally effective. I have tried a few of them and none of them have prevented palpitations 100% of the time especially during a flare.

I did have good luck with Metoprolol Succinate extended release but it would not last the entire 24hrs so timing in taking was helpful to reduce symptoms. Recently i was switched to Carvelidol like @Pistolis taking. My only complaint is that i have to take it twice daily and there are times when i feel stronger contractions of the heart even though i have a normal hr when they happen. 

[Pistol]

12 minutes ago, MikeO said:

My only complaint is that i have to take it twice daily and there are times when i feel stronger contractions of the heart even though i have a normal hr when they happen. 

@MikeO - I have that happen too! But I just stash that One away with the rest of my "uncomfortable but inconsequential symptoms". This happened to me during my ILR years as well and it was never anything serious, so I think it is just one of those things that I learned to live with. 

[MikeO]

11 minutes ago, Pistol said:

But I just stash that One away with the rest of my "uncomfortable but inconsequential symptoms"

@pistol I agree it is not a show stopper for sure.

[Knellie]

Thank you guys! It is interesting to know that different beta blockers work for different people. I was worried that I may not have POTS because the propranolol isn't working and that I would have to try for forever to find out what is wrong again, but it is good to know that I can't rule POTS out until I have tried more beta blockers.

[cmep37]

 

14 hours ago, Knellie said:

I may not have POTS because the propranolol isn't working

 If you have a positive TTT you have POTS - BBs don't help every POTS patient!  I found 20mg of propranolol did reduce my HR - not a great deal, just about 10-15 BPM and as my normal standing HR is 140BPM+ it didn't make that much of an impact. My main problem with BBs was that they dropped my BP too low - my cardiologist tried me on a 10mg dose of propranolol but I was still greying out/fainting a lot due to low BP so we decided to stop.  The lower dose of propranolol was just as effective at reducing my HR though.   Ivabradine did control my HR better (reduced by 20-30BPM) but I got really bad bradycardia in the afternoons and evenings on it so that was another drug that I tried and failed. However it is a great drug for lots of POTS people and definitely one worth trying if your cardiologist would agree.  There is also Florinef and Midodrine - have you tried either of those yet?

[Knellie]

@cmep37 - I have not tried either of those medications. I think my doc said that if this doesn't work he would try me on something else. I was just worried because my TTT was borderline - I hit the threshold right at the end of the test, although my HR shot up 30 beats at the beginning and stayed that high. I hit the 40 right at the end. I hope I can find a medication that works!!

[Pistol]

8 hours ago, Knellie said:

I hit the threshold right at the end of the test, although my HR shot up 30 beats at the beginning and stayed that high.

@Knellie - an increase of 30 BPM within the first 10 minutes of upright TTT is positive for POTS. 

[cmep37]

@PistolI think some doctors in the UK like to see a 40 BPM rise if you are aged between 12-19 - I am not sure if that applies to you @Knellie ? 

[Knellie]

@cmep37 - yes, I am in that range. My doctor said that we were going to treat this like POTS though, because it technically is.

[cmep37]

Of course it is POTS, I'm not sure why they make that distinction for age!  If the rise in HR is sustained, it's clearly not normal.  I assume as well as meds you got the usual advice on increased fluids (electrolytes are better than plain water), increased salt, compression tights (waist high are best, they are the least sexy things you ever saw but do help) and as much exercise as you can tolerate - things like swimming and recumbent cycling are good.