Anyone taking Atenolol AND an SSRI?

[MomtoGiuliana]

I am mostly writing this to soothe the concerns of my mother!

I have POTS and my 25-year old sister has just been diagnosed with POTS. She lives in Savannah, GA, btw. She found a cardiologist with some knowledge of it, but he's not nearly as knowledgable as my doctor unfortunately. Anyway, I take a beta blocker and an SSRI and it has really helped me tremendously. Her doctor started her on atenolol a month or so ago. Although this helped the tachycardia, she still has many other symptoms, some of which are getting markedly worse, including anxiety, depression, jitteriness, fatigue, weakness. Her POTS doctor says he is not qualified to prescribe an SSRI and is sending her to a neurologist for that.

Anyway, my mother is concerned that it might not be safe to take both atenolol and an SSRI and for some reason she doesn't trust the neurologist or the cardiologist. SO, I thought I'd ask if anyone on this forum is on this combination, just to ease her mind a bit.

Also, if you take or took atenolol alone, did you have any significant side effects, and what dose did you take?

What dosage of the SSRI do you take and which one?

In advance, I deeply appreciate the time you take to respond!

Katherine

[hilfgirl33]

I have taken SSRI's along with a beta blocker and my doctor is an expert in POTS and he said it was safe.

As for Atenolol, I took it first at 50 mg daily with side effects of extreme dizziness, nausea, especially in the morning and excessive fatigue. I could not tolerate this even at 25 mg daily. I was switched to Toprol and I cut the 25 mg dose in half and take 1/2 in the morning and 1/2 in the evening and I am able to tolerate the lower dose better this way.

Hope this helps. It is so hard to know who to trust and what to take. I literally think I have post traumatic stress about taking new meds because of the # of bad reactions I've had.

[briarrose]

Ok back when I took Atenolol, Dr. Grubb tried me on Lexapro which I couldn't tolerate.

When I first started on Atenolol I took 12.5 mg a day and eventually ended up on 6.25. I took Atenolol for over a year (I believe, I'm tired this morning and my memory isn't great right now.) I started taking Lexapro and I think I stopped taking it because of the intense headaches I got with it.

I eventually had to switch from Atenolol because I couldn't breathe well upon awakening in the morning to Betaxolol. I take 5 mg of Betaxolol. I was then started on Zoloft and I take 12.5 mg of that SSRI.

steph

[pamyla]

I have been taking atenolol and zoloft together for over 5 years now. I take 12.5 mg atenolol 2x a day. And I take 25 mg zoloft once a day. No big issues to report, and it definitely helps me function I had some trouble adjusting to the zoloft at first, but from what I hear side effects are pretty common at the beginning.

hth, Pam

[MightyMouse]

I've not heard any warnings about taking both classes of drugs at the same time. Many ANS docs think that the SSRI's help the CNS, which in turn, is believed to have a "mediating effect on the ANS". That quote is taken from a letter to my doctor from Dr. Grubb.

Nina

[RunnerGirl]

I, too, have been prescribed both a beta blocker and an SSRI for symptoms that mimic POTS. (I still do not have an official diagnosis, but have many of the symptoms of autonomic dysfunction, though blessedly they have been mild for the last several months.) My cardiologist says both are suitable treatments and while some people try one or the other first (I'm currently only trying the SSRI for now, holding off on the beta blocker), there should be no problem with taking both together for most people.

For Briarrose: How are you doing with the 5 mg of Betaxolol? This is the one my doc suggested for me, and also recommended a 5 mg dose. Said I might even want to quarter the pill at try 2.5 mg for starters. I'm very sensitive to meds and my HR at rest is very low (when I'm not having symptoms) because I'm an endurance athlete.

Thanks!

[Jackie]

I've very interested to find out that there is a lower dose of atenolol than 25 mg. I take 25 mg once a day in the morning and frankly I think it is too much and would probably do better on 12.5. I have never known it comes in 12.5 and was told 25 was the lowest dose. I will defin. put this on the list of things to ask the new doctor next Tuesday. Thanks for bringing this subject up. (Oh and for me, I also take Xanax because I couldn't tolerate Ativan or 1 dose of Lexapro and now am afraid of everything even the Xanax yet I keep taking it for now) so I can defin. relate also to the posttraumatic thing mentioned below to med. side effects. From everything I've heard, many people take both and there shouldn't be any problems...I would start one at a time though maybe so as to know what is causing what if there are side effects....just my opinion though. I wish you sister luck and keep us updated.

[briarrose]

RunnerGirl

I think this is my 4th or 5th beta blocker. I've been on it since last summer and I'm doing very well with the low dosage.

Ive been struggling with orthostatic hypotension for many months now, unrelated to the beta blocker. I have also taken beta blockers that have dropped my heart rate down into the 40's but not Betaxolol, I haven't really suffered any problems yet do to this beta blocker.

I'm very chemically sensitive, you can probably tell by the low dosage of medications that I take.

It's always worth a try. Good luck.

steph

[goldicedance]

I had been on atenolol and Zoloft together along with high dose of neurontin.

Atenolol in 25 was too much for me as well. My doc had an easy solution--take 12.5 by breaking the atenolol in half. The generic was too small to break so I had to use the name brand. I also take 3600 mg of Neurontin to help control migraines as well as some POTS symptoms.

[futurehope]

I just want to let you know that when I took Tenormin (atenolol), it made me depressed. Beta blockers can do that and they can also make you fatigued. If your sister is worse with the medication than without, maybe she should reconsider. On the other hand, if it is helping her POTS, then maybe she will need to take an anti-depressant so that the beta blocker can be continued.

[RunnerGirl]

Briarrose - Thanks so much for your response. I'm very glad to hear the Betaxolol seems to be working well for you, without any noticeable side effects. Yes, it does sound like you're a lot like me - being very sensitive to medications - given those low doses you're on. I know it will sound strange, but I'm on 5 mg of Prozac right now (I think the lowest therapeutic dose for depression is 20 mg!) - and I honestly think it's helped "reset" my system a bit. Granted I've only been on it for a month or so - but if there really is something related to brain chemistry causing my strange bouts of tachycardia (they've ruled out just about every other organic cause), perhaps the slightest "tweak" of the seratonin levels and other neurotransmitters could make a difference. Time will tell, as I've had 'remission periods' before, without medication. Hard to say if the Prozac is responsible for this latest string of good days!

Jackie - I noticed your comment about beta blocker dosing. Yes, definitely talk to your doc about taking down your dose, if you feel a little sluggish. The smallest pill for atenolol is 25 mg (I think) - but you can get a device at your pharmacy to cut your pills in half, or even in quarters. (I helps if the pills are scored, of course.) As I noted above, my doctor suggested I should quarter a pill to get to the right dosing. Apparently, particularly for people who have the hyperadrenergic forms of dysautonomia, just a very small dose can inhibit the effect of adrenaline and mellow things out for us.

Also, I remember you have some significant anxiety symptoms. I know the Lexapro didn't work for you, but have you tried another SSRI? This might really help. I think the key is to start with a very low dose and SLOWLY work your way up to where you want to be. I know I tried Prozac a few years ago - and my doctor started me out on 20mg. By day four, I was absolutely beside myself with anxiety and jitters - and I had a splitting migraine-type headache that was unbearable. I discontinued the medication and threw the unused pills down the toilet. I decided to try it again just recently - and this time I was smart - I stared on 2.5 mg (again, quartering a 10 mg pill) and have worked my way up to 5mg. I feel a positive difference already and didn't suffer any negative side effects.

Good luck to everyone!

[mome22]

I am also taking Atenolol 25 mg(soon to be 50 mg) and Lexapro together. So far so good on them for me. The Dx I have right now is tachycardia(I have gone into SVT). Im usually on here for my daughter who has NCS, but thought I might be able to help:)

[Jackie]

Thansk Runnergirl for the suggestion. Darn scared of SSRIs I am but we will see what the new doctor says next week. I'm really hoping for a positive change.

I still have hand/feet sweating periodically and/or cold hands feet sometimes even while they are sweating. I still have some anxiety and panic-type symptoms but today my BP was running low again about 80s/50s (it is that time of the month though so I think that is complicating things too). I just feel blicky (is that a work?!).

So far as I know, cutting an unscored tablet in half will not definitively give you half the dose as the medicine is not evenly distributed in each half but if it works for you guys then why not I say! I have a pill cutter myself for my scored medicine. I wrote down the name of that beta blocker betaxolol and am going to bring that up to the dr. too.

I wish I could get brave enough to try the SSRIs again. I think I need something more balancing and I hate to say it but I feel like such a pill popper having to cut these darn Xanax tablets and take them 5 times a day...it's really hard to space them out without feeling too relaxed but I've tried going down to 4 and ended up going back to 5 (.25 mg). It honestly doesn't change any of my other symptoms though (maybe helps with the IBS) but I still have a bunch of other symptoms. So much for it is all anxiety huh?! If that were true, this should be the wonder drug...unfortunately not. Please keep me updated those of you on SSRIs...I'm just so afraid of going through those reactions again but we will see.

[RunnerGirl]

Jackie: I TOTALLY understand your concerns about the SSRIs. After my horrible experience with Prozac, I was very resistant to trying again - even though my doc assured me that most of the side effects could be mitigated by starting with a much lower dose. But I finally gave in.

Like you, I'd been using xanax to try to manage the anxiety-related symptoms - with very little effect. And I, too, used this as ammunition in my 'war' to convince my endocrinologist and my first cardiologist that my tachycardia was not anxiety related and I wasn't having classic panic attacks! (Amazingly, out of the literally dozens of docs I've seen since all of this junk starting happening to me, ONLY ONE - my psychiatrist - never had any doubts that I had something physiological going on, not psychological! He finally called my endo and discussed my case with her, and dissuaded her of the opinion that I needed to be treated for an anxiety disorder.) The Xanax will take the edge off - just barely - but it does nothing for my tachycardia, bp spikes, sweats, etc.

I have to say I feel better than I've felt in a long while on the Prozac - and I'm now down to just one .25 mg Xanax, which I take at night to help me sleep. My anxiety is much diminished and my episodes of tachycardia and ectopic beats have become less frequent. Coincidence? Perhaps - but I'm going to stick with this regime for a while and pray things continue to go well!

Good luck, Jackie, and let us know how the doc visit goes. And if you decide to try another SSRI, just take it slow and know that we'll be here for support!

[goldicedance]

Re: Cutting Atenolol pill down

The doctor that told me to do this is not only an EP with POTs experience but also a clinical pharmacologist. I think that's a pretty good reference for pill cutting.

Moreover, I've read that some people try to get their doctors to prescribe a higher dose of the medication even when they know they need to cut it in half since frequently double the strength costs less than if one we're to buy 2 lower doses. Therefore, by cutting the dose in half, they can save money. AARP even suggests that. With drug prices what they are, every little bit helps.

[RunnerGirl]

I second what Goldicedance says. The doctors who have told me to cut pills are include: 1) a hyptension expert at Cornell U. with lots of experience in finding the right mix and dose of meds to controll BP and 2) an excellent EP with experience in both IST and dysautonmia. Apparently, he has several pediatric cases who MUST have the lower dose and it's common to split pills to achieve a 'pediatric dose.'

Jackie, of course run it by your doctor first - but it's a fairly common practice to cut pills, not just for dose tweaking but also, as Goldicedance says, for cost savings purposes.

Good luck!

[MomtoGiuliana]

Thank you everyone for your responses. It has helped to put my family's minds at ease and has included some other information and ideas that will be helpful when my sister sees her doctor.

We appreciate it.

Katherine

[Jackie]

I didn't mean to offend anybody about the pill-cutting issue. I don't say your doctors are wrong. I was just saying what I've been taught (i.e. if not scored, there is not an equal amount of active med in each half...you could get all of it or most of it or none of it in one half or anywhere in between and for me I'd rather be on a set dose). But, I also said if it works doing that, then it works. I will run it by the doctor myself like I said because I would desire a lower dose of the BB and if cutting an unscored tablet is how to do it then I'll be lining up for sure! I was going to ask about it anyway because I was curious how they got a pediatric dose for children (i.e. liquid or what?) anway so thanks for mentioning how you guys are doing it.

Thanks Runner Girl for your additional support and information about the SSRI. Believe me if I try one again I'll be looking for you!

[Jackie]

Runnergirl, would you mind if I sent you e-mail? I get I'm nervous about my appointment tomorrow. I've been looking forward to it so much but now I guess I'm just scared because I know I want to try something different to see if it will help more and well fear of the uknown I guess and thought depending on what she recommends to try I might want to get more information from you regarding your experience with SSRIs to build my confidence. Thanks!

[RunnerGirl]

Jackie: ABSOLUTELY no problem to e-mail me directly - anytime. I'm at dlademan@comcast.net.

BTW, I wasn't offended on the pill-cutting issue, not in the slightest. I understand your concerns about not getting consistent dosing. I think Goldicedance and I were just trying to reassure you that it was something you could reasonably do with an doctor's OK. (Unfortunately, e-mail isn't always the greatest medium for communicating and things can come across as terse or defensive or whatnot when it was never intended to be that way!) I, too, hope I didn't offend with my response. :-)

Again, feel free to write me direct any time!

Best to you!

[Marg]

My daughter started taking Propanalol on 2/26 and by 3/22 her cardiologist decided it wasn't worth her taking. While it was helping (+/-) with her heart rate and blood pressure, it was making her feel worse physically. Also, she was switched from Prozac to Lexapro and became severly depressed. SSRIs can be very dangerous if you don't get the one that is right for you. Anytime you feel more depressed than you did prior to an anti-depressant, it's time to be re-evaluated.

She's back on Prozac now and the depression is gone.

Margaret

[calypso]

Re" the pill cutting issue: I know Toprol XL makes a 25 mg extended release pill, for those not wanting to cut the halves in half. Of course, it costs $40 more on my insurance, so likewise it may be more for you also. I've been cutting my clonazepam in half for years, though, with no problems. I suppose beta blockers should be more accurate, though.

[danelle]

I take 50-62.5mg of atenolol(tenormin) per day-depending on my tachy. I also take clonazepam .5mg up to 4 times a day as needed for anxiety. I have been on the atenolol for 15 yrs now. I started out at 6.25 and gradually had to move up to keep the tachy down. It keeps the fastest stuff away but even still, i get spells up to 160 with lots of other arrythymias as well. I do stay tired but I could NOT survive without the tenormin. Yes, my BP usually runs pretty low. Danelle