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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Vincent_QC on May 19, 2013, at 21:09:00
Hi,
I saw my Doc and since I can't see my cardiologist before the end of summer, we both talk about how I feel on the propranolol.I take 30 mg day, since my dose was increase by the cardio Doc 4 months ago, I start feeling more depress, have more difficulty to fall asleep, my heart rate is higher ( first reason to be on a beta-blocker med was to make my heart beat slower and reduce my anxiety), I explain that I start also to have muscle weakness and pain, I'm also a lot tired all the time, can't sleep but feel like I always need to nap, have more chest pain, heartburn, have more cognitive problems and very bad short term memory, also it's harder to breath and I can feel and hear weird noises from my lungs (I'm don't have asthma but I do smoke).
My Doc RX another beta blocker, it's the atenolol. He said its a hydrophilic beta-blocker and have less central nervous system side effects.
The main problem is that it's long half, with the propranolol it's easier to dose because when I feel that my heart rate is normal I don't take more and can take less than the 30 mg a day but with the atenolol it's a 1 dose a day in the morning so if the heart rate and blood pressure fall to low, you have to wait until the side effects fade away...
I explain that to my Doc but he said that 25 mg day of atenolol is a very low dose and not worry. He said that if its not working, I just have to call him and we will try another one, his next choice is the bisoprolol...
I took the atenolol for 2 days now, took 25 mg in the morning yesterday but my blood pressure drop too low and my heart rate was higher in the 100 sit... So today I took only 12.5 mg, the blood pressure was a little bit higher but it's doing nothing for the fast heart rate...also the extreme tiredness and muscle pain is worse... Have to mention that my cardio Doc say that I have pots and dysautonomia...
Anyway, I think I will call my Doc this week and ask to try another one.
I want some help from posters here who take beta-blocker.
Since I already try the bisoprolol back in 2011 and it didn't help me and I know it will be the next choice of my Doc, I want to find another one who will be better for my symptoms.
The beta-blocker I didn't try are the nadolol, pindolol, the bystolic just to name a few.
I need a beta-blocker who is hydropholic, selective ones don't seem to be better for me, had bad side effects from the metoprolol and bisoprolol... Also I don't need a beta-blocker who also act on the a1 adrenergic receptor since my blood pressure is already normal and can fall on the low side.
I wonder if someone here took nadolol? Apparently it's a good one? Similar to the propranolol but don't enter into the brain and with a long half-life. If the fact that its not entering in the brain can reduce the central nervous system side effects I think it can be a good choice no?
Well if someone have any idea of a beta-blocker who can help me to lower the heart rate with less side effects I will really appreciate it!!!
Thanks everyone -:)
Ps: did try the florinef for pots and dysautonomia, well try the florinef to reduce the orthostaric hypotension I had from the Parnate, it lead to huge increase of blood pressure and bad headaches!!! The dysautonomia part seem to be from an over active sympathetic nervous system and bad parasympathetic function... Did try also the clonidine for the tachycardia, but it did nothing for the fast heart rate, just make me very sleepy...
Posted by SLS on May 20, 2013, at 7:23:54
In reply to Doc change my propranolol for atenolol, posted by Vincent_QC on May 19, 2013, at 21:09:00
I know this doesn't apply to you, but I thought I would mention that atenolol can produce a paradoxical increase in blood pressure at first. Perhaps doctors should recommend a more gradual titration for this drug. I don't know.
Pindolol is a beta-blocker that is thought to have antidepressant activity when combined with SSRIs. It blocks serotonin autoreceptors (somato-dendritic). I imagine the same is true when pindolol is combined with SNRIs.
Carvedilol is a beta-blocker drug that has additional blocking activity at peripheral NE alpha-1a receptors. It thus acts as an after-load reducer and places less pressure on the heart to pump blood into the muscles, and can mitigate insulin resistance. Carvedilol is particularly good when treating congestive heart failure (CHF).
- Scott
Posted by Vincent_QC on May 20, 2013, at 8:48:55
In reply to Re: Doc change my propranolol for atenolol » Vincent_QC, posted by SLS on May 20, 2013, at 7:23:54
> I know this doesn't apply to you, but I thought I would mention that atenolol can produce a paradoxical increase in blood pressure at first. Perhaps doctors should recommend a more gradual titration for this drug. I don't know.
>
> Pindolol is a beta-blocker that is thought to have antidepressant activity when combined with SSRIs. It blocks serotonin autoreceptors (somato-dendritic). I imagine the same is true when pindolol is combined with SNRIs.
>
> Carvedilol is a beta-blocker drug that has additional blocking activity at peripheral NE alpha-1a receptors. It thus acts as an after-load reducer and places less pressure on the heart to pump blood into the muscles, and can mitigate insulin resistance. Carvedilol is particularly good when treating congestive heart failure (CHF).
>
>
> - ScottThanks Scott!
My cardio Doc almost RX the carvedilol (Coreg) the last time I saw him but he said that since I don't have heart failure and high blood pressure, it will be too strong for me.
This is a very good beta blocker and know some people's on it, they all had cardiac arrest and some stents... They all said that it was a hard drug to be on, making them feeling very tired and also lowering sometimes too much the blood pressure...
The pindolol is used as an augmentation treatment for major depression not responsive to usual AD alone, one problem is that it have ISA (intrinsic sympathomimetic activity) and don't decrease the heart rate at rest, who is my main problem. I tried the acebutolol who also have iSA activity and it didn't lower my heart rate...
I didn't know for the atenolol and the increase blood pressure when you start it. My Doc should have mention this to me!!! I don't like it at all and will not take it again and wait until I call my Doc and see what he think about the nadolol...
I order some nadolol online, very cheap price since its an old drug, I think I will stay on the propranolol for now and when I will receive the nadolol I will try it.... If that fail then I will call my Doc...
I think I should maybe ask for the newer beta blocker call bystolic? One of is effect is to cause vasodilatation because it activate the NO... Side effects seem to not be the same as the older beta blockers... More headache... Probably cause of the vasodilatation of the blood vessels in the brain???
Well thanks again for your answer and help!!!
I appreciate it -:)
Posted by vbs on May 20, 2013, at 11:35:23
In reply to Re: Doc change my propranolol for atenolol » SLS, posted by Vincent_QC on May 20, 2013, at 8:48:55
Yeah I take carvedilol (Coreg) 12.5 mg bid. It works alright at lowering my systolic blood pressure. I also take lisinopril 20 mg bid and HCTZ 25 mg. Blood pressure still runs high w/ meds. Heart rate is usually a little elevated. It hovers around 75-90 bpm. No side effects from the bp meds otherwise.
I've taken atenolol and metoprolol in the past w/ success. Clonidine too but I had to discontinue it b/c it made me too drowsy.
I hope you find a med that works w/o side effects.
Posted by Vincent_QC on May 20, 2013, at 12:02:25
In reply to Re: Doc change my propranolol for atenolol » Vincent_QC, posted by vbs on May 20, 2013, at 11:35:23
> Yeah I take carvedilol (Coreg) 12.5 mg bid. It works alright at lowering my systolic blood pressure. I also take lisinopril 20 mg bid and HCTZ 25 mg. Blood pressure still runs high w/ meds. Heart rate is usually a little elevated. It hovers around 75-90 bpm. No side effects from the bp meds otherwise.
>
> I've taken atenolol and metoprolol in the past w/ success. Clonidine too but I had to discontinue it b/c it made me too drowsy.
>
> I hope you find a med that works w/o side effects.Did you have high blood pressure cause you are on a TCA??? Or you had it before?
3 blood pressure meds, wow!!! I'm glad you feel good on them and help you!!!
Usual people's will worry about high blood pressure, me I worry only about the fast pulse rate... I know that when I'm not expose to a stressful events my blood pressure is running on the normal to low side but when I have to get out of the house it's on the high side (140/90) but its linked to the anxiety and when I return home the blood pressure return on the normal to low side... So taking high blood pressure meds who don't decrease the heart rate is not the goal or something I need , so the beta blocker are what I need cause they lower the heart rate, my heart rate without the beta blocker run in the 100 sit at rest and up to 140-150 only by walking in the house... Taking a shower bring it into the 160 and more range...
Just have to find the good beta blocker for me, the one who will not make me feel so tired all the time, the lower dose and the one who will decrease my heart rate who don't seem to be links to high adrenaline... Had a 24 h urinary tests for the adrenal glands 2 years ago, at the time I had the rapid heart rate only in the morning and wasn't on a beta blocker, results show low cortisol, no adrenaline it was so low that they wasn't able to measure it, and low noradrenaline, normal dopamine...
Anyway thanks again for your help!!! For the Coreg, did you had a lot of side effects when you first start it? They start it at 3.25 mg day no? Did it cause the extreme fatigue like the other beta blocker? Just wondering cause I may order some and try it also... If I wait for my Doc to RX it I will wait forever, he will only want to put me on the bisoprolol and I don't like it at all... My cardiologist is more open minded for the cardio meds but have to do a 24 h blood pressure monitoring test and a 24 h holter test before I will be able to see him again; both tests are schedule in the summer so will not see him before fall...
Posted by vbs on May 20, 2013, at 13:57:03
In reply to Re: Doc change my propranolol for atenolol » vbs, posted by Vincent_QC on May 20, 2013, at 12:02:25
Wow, your pulse really gets up there. I've had high blood pressure since it was discovered when I was 16 yo. I'm not taking a TCA unless trazodone is considered one. I don't think it is. As far as Coreg is concerned, I was started on 12.5 mg bid. I didn't experience any side effects upon starting it. FYI I also take Cymbalta 60 mg, Saphris 10 mg, Zyprexa 20 mg and Invega Sustenna injection. That's right, three APs! I'm lucky that I don't have serious or bothersome side effects.
Posted by vbs on May 20, 2013, at 14:04:06
In reply to Re: Doc change my propranolol for atenolol » Vincent_QC, posted by vbs on May 20, 2013, at 13:57:03
Just thought I'd mention that I take trazodone 50 mg at night for insomnia.
Posted by Vincent_QC on May 20, 2013, at 15:44:43
In reply to Re: Doc change my propranolol for atenolol » Vincent_QC, posted by vbs on May 20, 2013, at 13:57:03
> Wow, your pulse really gets up there. I've had high blood pressure since it was discovered when I was 16 yo. I'm not taking a TCA unless trazodone is considered one. I don't think it is. As far as Coreg is concerned, I was started on 12.5 mg bid. I didn't experience any side effects upon starting it. FYI I also take Cymbalta 60 mg, Saphris 10 mg, Zyprexa 20 mg and Invega Sustenna injection. That's right, three APs! I'm lucky that I don't have serious or bothersome side effects.
Yeah, my pulse rate get high for sure...even if I didn't had the usual tests for a diagnostic of dysautonomia and pots, my cardiologist think that it's what I have...those tests are done on a tilt table at different position to reproduce the fainting and high pulse rate but where I live no hospital have a tilt table and I can't travel for those test...can't be in a car even if I don't drive, I will have powerful panic attacks...Can be in a car on small roads as a passenger but for very short car ride...
Hummm I was mixing you with the other poster SLS...didn't realize that your poster name was VBS...sorry that's why I talk about the TCA...
3 AP, wow!!! You are not meds sensitive like me...you don't have side effects from them? What is your diagnostic?
I did try the saphris back in last October, the pills taste horrible and you have to let it dissolve under your tongue since swallow it will not work... My Doc heard from another one PDoc that it was somewhat helping for the anxiety. I took only 2 doses and it was 1/4 of the lower dose pills, I react badly from it, more bad than the seroquel or Zyprexa... One thing is sure, the AP are not for me, they never help with the kind of anxiety I have...
Do you have problem with sugar level? The beta blocker and the AP can both cause some metabolic problems no?
Humm the Tradozone (desyrel) is not a TCA for sure...took it for insomnia but had horrible anxiety the next morning cause if one of its metabolite. Never toutch it again...was on low dose of seroquel for the insomnia back in 2009 but had to increase the dose from 25mg to 100 mg in 6 months and even at 100 mg I had insomnia...Also start having panic attacks again when I increase the seroquel to 100 mg, I stop it and panic don't stop...since then I deal with very debilating anxiety...and I'm med sensitive, a Tylenol will give bad side effects... That's something new for me since I was used to take all the meds especially the AD in high dose with no real bothersome side effects with exception of lack of energy, sexual side effects and weight gain...
Anyway thanks for your time, I appreciate it -:)
Posted by Phillipa on May 20, 2013, at 19:09:47
In reply to Re: Doc change my propranolol for atenolol » vbs, posted by Vincent_QC on May 20, 2013, at 15:44:43
Lopressor 25mg decrease anxiety for me when first was going to start an SSRI. Phillips
Posted by Vincent_QC on May 20, 2013, at 22:31:09
In reply to Re: Doc change my propranolol for atenolol » Vincent_QC, posted by Phillipa on May 20, 2013, at 19:09:47
> Lopressor 25mg decrease anxiety for me when first was going to start an SSRI. Phillips
Hummm ok Phillipa, that's not when you hit the mailbox with the car because you had a lower blood pressure? Lol
I tried the lopressor, generic name is metoprolol, last October, lower too much my blood pressure and no effect on the heart rate... Even with 12.5 mg dose who is half a pill...
Will wait to receive the nadolo, a not selective beta blocker with a long half life, apparently it's the same as propranolol but less side effects cause it's not entering in the brain... I order from an online pharmacy, a reliable one since I order often from them, but can take 1 month before I receive it... Will hope the custom will not keep it, last time I had to order the same product again, free of charge, but took around 1 1/2 months before I receive it...
For now will continue with the propranolol... If the nadolol is not better than I will call my Doc... Too bad I can't call my cardio Doc, I trust him better when it come to cardio meds...but it's impossible to talk or see him before my holter monitor and blood pressure machine tests will be done... And if I call him this week he will not phone me back as usual... Very hard to reach him by phone...
Posted by vbs on May 21, 2013, at 6:55:06
In reply to Re: Doc change my propranolol for atenolol » vbs, posted by Vincent_QC on May 20, 2013, at 15:44:43
I'm definitely not med sensitive. Sometimes I get shortness of breath. I don't know if it's related to the meds. I was at the hospital a couple of weeks ago b/c I felt like I was having trouble breathing. The hospital discharged me with a script for Ativan and a diagnosis of anxiety. My primary diagnosis is schizo-affective disorder. I hear voices a lot. You would think that with 3 APs on board I'd be symptom-free. Blood sugar tests? I had blood work done about 3 months ago & my blood sugar was in the normal range. I hope it stays that way. Invega Sustenna is a new med being added about a month ago. I know about the diabetes risk that comes with these meds so hopefully I will continue to be okay as far as diabetes is concerned.
Posted by Vincent_QC on May 21, 2013, at 10:02:58
In reply to Re: Doc change my propranolol for atenolol » Vincent_QC, posted by vbs on May 21, 2013, at 6:55:06
> I'm definitely not med sensitive. Sometimes I get shortness of breath. I don't know if it's related to the meds. I was at the hospital a couple of weeks ago b/c I felt like I was having trouble breathing. The hospital discharged me with a script for Ativan and a diagnosis of anxiety. My primary diagnosis is schizo-affective disorder. I hear voices a lot. You would think that with 3 APs on board I'd be symptom-free. Blood sugar tests? I had blood work done about 3 months ago & my blood sugar was in the normal range. I hope it stays that way. Invega Sustenna is a new med being added about a month ago. I know about the diabetes risk that comes with these meds so hopefully I will continue to be okay as far as diabetes is concerned.
Hey that's ok to be on 3 AP, I mean the goal is that you feel better and I do hope your meds work for you. hearing voices should be disturbing... I guess it's adding a lot of anxiety on you?
All the meds have side-effects, some of them are more dangerous than others... but if you have blood work done often for the diabčtes and cholesterol, then you are ok and safe. Weight gain is normal, I always gain weight on all the AD and the AP I was on... exercises or reduce calories intake didn't help with that issue for me BUT I think it's better to be 20-30 pounds heavier than stay sick... that's my point of view of course...and if diabčtes become a problem, then meds for diabčtes can be had with no problem...my point of view again...
I also get shorness of breath often everyday... it's worse since my Cardio Doc increase my beta-blocker dose. I try to reduce my dose to 10 mg a day and the breathless continue so I guess it's anxiety related and not related to the beta-blocker? I have health anxiety, they call it somatisation disorder, so every little physical sensations that I feel in my body make me anxious and trigger panic... I'm a smooker, I smoke 1 pack of cigarettes a day and I fear to have lungs cancer since it's a very common cancer in my family and some peoples in my family died Young from that disease. So each day I telling to myself that I will stop but I can't!!! The scary part of this is that smoking cigarette trigger panic attack on me now, and the more I smoke and the more breathless period I have in a day. Same for the pain, if I have small pain I feel it like it's 1 000 000 worse, I don't know why exactly, my Doc think I may have fibromyalgia, but again having a diagnostic is almost impossible...
Well, enough about my problems...
You seem to be a nice person, I do hope you feel better ;-) Remember to not give up!!!
Posted by vbs on May 21, 2013, at 12:28:13
In reply to Re: Doc change my propranolol for atenolol » vbs, posted by Vincent_QC on May 21, 2013, at 10:02:58
Yes, hearing voices can make me anxious. The shortness of breath really sucks. But oh well, it is what it is. I don't smoke but I use smokeless tobacco (dip) all the time. I worry about getting mouth cancer.
Thanks for your kind words. I wish you all the best as well. Never give up! :-)
Posted by Vincent_QC on May 21, 2013, at 12:55:21
In reply to Re: Doc change my propranolol for atenolol » Vincent_QC, posted by vbs on May 21, 2013, at 12:28:13
> Yes, hearing voices can make me anxious. The shortness of breath really sucks. But oh well, it is what it is. I don't smoke but I use smokeless tobacco (dip) all the time. I worry about getting mouth cancer.
>
> Thanks for your kind words. I wish you all the best as well. Never give up! :-)Yes, being out of breath suck for sure, it's make me very anxious and I can't exercise...
At least you don't smoke, only use smokeless tabacco is far less dangerous than smoking, I agree that you can get mouth cancer but its a rare cancer if you compare the rate of mouth cancer vs lungs cancer... Half of people's who smoke will die from it. Also high % of people's with a psychiatrist disorder smoke, my Doc always told me that smoking is a natural AD, kinda of a mild MAOi increasing dopamine, serotonin and noradrenaline to name a few...but it's a bad habit, far worse than drug addiction, alcohol addiction or all kind of other addictions... Even if most of the time my first cigarette in the morning lead to powerful panic attack, I still smoke, even if I have difficulty to breath and have wheezing noise from my lungs I still smoke, even if I have chest and back pain especially with deep breathing and lungs pain I still smoke, even if my heart rate goes crazy when I smoke I still smoke... the only one addiction that I can't fight... I stop street drugs cold turkey years ago, stop drinking alcohol cold turkey, never had drug or drink alcohol again since many years, and never had withdrawal symptoms and never crave for drugs or alcohol after I quit... But cigarette smoking is very different, each time I had surgery and had to stay at the hospital for weeks, even with nicotine patch and nicotine lozenge I had intense craving, short temper, withdrawal symptoms and had only 1 idea in the head and it was to smoke a cigarette!!! That's crazy... Recently I spend a lot of money on an electronic cigarette and nicotine juice... Even if its doing smoke and taste good and deliver nicotine like regular cigarettes, I can't feel satisfied and need to smoke a real cigarette... I hate it!!! Everyone in my family stop smoking, my dad smoked for more than 50 years and he stop cold turkey, no patch or nicotine lozenges or gum... Same for my brother and 2 sisters... One of my sister had a relapse of depression after she stop smoking but she start again her cymbalta and she's mostly ok now... Me I can't stop and I feel so guilty cause each day I continue to smoke I know I destroy my healh, and what I want the most is to be in good health physically and mentally... We can't reverse the damages done from cigarettes smoking... Have no energy and no patience at all to enter into a withdrawal process of nicotine with the amount of anxiety I live right now in my life, I'm already lucky to not be suicidal since what I fear he most is death!!! The unknow!!!
Anyway... Can't wait to feel better and return to school and work... 6 years now that im on disabality... Don't want to end my days in that state with no money or income to live...
Well thanks again and sorry if I wrote long message... Have a nice day and take care of you ok -:)
Posted by vbs on May 21, 2013, at 13:49:59
In reply to Re: Doc change my propranolol for atenolol » vbs, posted by Vincent_QC on May 21, 2013, at 12:55:21
Yeah, kicking the habit of smoking is one of the hardest things to do. They say it's as hard if not harder to quit smoking than quitting a heroin addiction. I used to smoke cigarretes like you do. I switched from smoke to smokeless. Smooth transition for me. I'm on disability too, been on it now for about 1.5 yrs. If it weren't for disability I'd probably just another statistic, homeless & mentally ill. Anyway, good luck with your nadolol trial. I don't know much about it but if it doesn't cross the blood-brain barrier then hopefully it will resolve your symptoms w/o the same side effects as other beta-blockers.
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