Metoprolol Side Effects

That’s really unfortunate. I was in hospital when I was prescribed both bisoprolol and propranolol for the first time (on separate occasions), and in both cases, the fact that I had asthma was definitely a consideration. In both cases, it was decided I really needed the medication. I wonder, if you’ve been taking it for eight years, it might also be worth evaluating if it’s still necessary to take a beta blocker (discuss with your doctors first, of course!). There are also other medications that can be used to lower heart rate if you are using it to treat tachycardia.

I have seen about eight different doctors/practitioners since I started on propranolol eight years ago. Since I’ve reported shortness of breath symptoms, I’ve visited the emergency room doctor, probably a resident, as well as the attending physician that night. Then I consulted with my primary care provider, a physician’s assistant. I then saw my cardiologist and an endocrinologist. They are all connected to the care network I use and have access to all my records, including my ER records, blood tests, list of current medications.

My primary care PA continued the propranolol Rx from my previous doctor. I saw him within a week of the ER event. He prescribed some Albuterol, an inhaler to alleviate the air hunger. He also ordered a pulmonary function test, the same one that I use for Afrezza eligibility, FEV-1. My endo gave that event a passing glance but she had no comment on my use of a nonselective class of beta-blocker. She was obviously unaware of the association with asthma. The cardiologist was so distracted with my LDL numbers and continuing statin denials that I don’t think he even noticed that I was in the ER with shortness of breath recently.

So that’s four providers who could have alerted me but didn’t. I think this should have been grist for a discussion in years past. You just don’t know what you don’t know! I have been given a glimpse of asthma and it is frightening – an existential threat. I will concentrate on my good fortune to avoid a much more intense case of it.

About a year ago, I quit both my ARB blood pressure med and the propranolol. I followed my blood pressure and heart rate daily and was able to maintain good numbers for a few months. But my blood pressure and pulse both climbed to unacceptable levels and I had to restart the meds. I’m thinking that might have been a trigger but several months went by in the interim, so I don’t really know.

I’m still taking my daily dose of propranolol and have not had any serious asthma events. I take the Albuterol about once per week at the slightest hint of breathing difficulty. When my pulse gets over the mid-90s, I don’t feel well.

You are using the word “asthma” I notice. Usually a diagnosis of asthma involves identification of one or more allergic triggers. Correct me if I’m wrong, but you’re probably talking about some chest tightness, shortness of breath, and the horrible-sounding air hunger, right?

I will be interested to hear more about this, and I’m sure you will be pressing for answers. What I’m curious about is that period you stopped the propranolol and then re-started it. If you really are having asthma, then what I wonder about is, and it is going to sound crazy - if you developed an allergy to propranolol which itself can cause things like bronchospasm and sob, as you know. A double whammy so to speak. I say that because often it takes a second exposure to something to trigger a reaction, and you had a chance to clear it out of your system before re-introducing it.I certainly hope it’s not that, and it probably isn’t.

But anyway, if you truly do have asthma (what were the results of those PFTs btw, and what did the PULMONOLOGIST have to say?? - yikes - or did you go back to your PCP after the PFTs?), then take a look at those contraindications to propranolol - asthma.

ETA:" I’m thinking that might have been a trigger but several months went by in the interim, so I don’t really know" – ah ok, ignore my development of an allergy idea then.

I’ve not been given a formal diagnosis of asthma but the positive effect of albuterol might be seen as indicative of asthma. I don’t really know what designates any shortness of breath as asthma. I had no wheezing or sounds of airway passage restriction.

I made an appointment with a pulmonologist – first available appointment is for the middle of April. I’m hoping that a change of beta-blocker meds will extinguish all asthma symptoms. The pulmonary function test was the same as previous PFTs that I’ve done annually for the last three years or so; it produces an FEV-1 number. I had one done in January 2019 with similar results.

Terry,

Not all breathing difficulties are asthma, even if albuterol is shown to help. It could be bronchitis, for instance. A relative was just given an alb inhaler for bronchitis. (Not saying that’s what occurred in your case.) A hallmark of asthma is inflammation.

From what we know now, and according to the Asthma and Allergy Foundation, asthma is defined as a chronic inflammatory disease of the airways. The tissues lining the airways become swollen, large amounts of mucus may be secreted, and the smooth muscle surrounding the airways tightens - a process known as bronchospasm. Furthermore, the airways become hyperresponsive, meaning that they are irritable or “twitchy.” All of these effects contribute to narrowing or obstruction of the airways.

Usually that hyperresponsiveness is caused by a trigger, or an allergen. Or indeed exercise or stress (which are also triggers but not technically allergens).

So when you say the recent PFT is the same as the past, I’m assuming that you mean no change and all is well, and you don’t, for instance, have COPD - bc if you did and you were getting Rx’ed propranolol, well that would really be something.

Good luck with your new practitioner.

I think this is missing in my case. When my shortness of breath caused me to go to the ER, I had no airway passage narrowing, no wheezing. Is the inflammation that you refer to chronic or only elevated when asthma episodes occur? I had a hsCRP test run recently and my number was normal.

My understanding is that my FEV-1 numbers are lower than normal but still within normal function and not indicative of COPD. They are also unchanged over the last three years. I’ve been getting these tests every year since they are required for continued use of the inhaled insulin, Afrezza.

It’s nice to know that not all breathing difficulties are asthma, even given the positive response to albuterol.

Whenever I see a new medical provider I try to stay positive and give the relationship the best chance of starting well. I think an informed patient like me presents a challenging setting for medical providers. I must admit, however, that my expectations are much lower these days. I take comfort in the fact that peer groups like this have immeasurably improved my health and quality of life.

Did you ever smoke Terry, and if so, how much / how long?

Yes, I did. I smoked a pack of cigarettes/day for 12 years over a 16 year period and quit in 1986.

I don’t think asthma can be diagnosed with just a simple PFT. When I’ve had PFTs, they did one FPT, then administered salbutamol, and then 15 minutes later did another PFT to see how well I responded. My results were borderline because my asthma is mild and the test was done on a day my lungs were doing great, but I did have some response to the salbutamol. My asthma has improved significantly recently so I have another PFT with salbutamol to do and it’ll be interesting to see the results.

Asthma doesn’t always involve wheezing, it sometimes involves coughing or just tight, irritated lungs (in my experience). But as mentioned in other comments, it may well have just been an infection or virus, especially since we’re in the middle of cold and flu season. Hopefully you can get some clarification and hopefully you’re not dealing with a new chronic condition like asthma.

I forgot that you are on Afrezza, but I know asthma is a contraindication for that as well as it can trigger breathing difficulties or coughing. So that may also be something to be careful of while your lungs are recovering.

Perhaps smoking might be what’s causing your breathing issues?

COPD presents itself in many different ways, and I know several people who’s COPD developed 20-30 years after they quit.

Or perhaps you’re developing something unrelated to asthma that is only manifesting itself now? It can happen - just look at me.

@Jimi63 – Yeah, my smoking history definitely raises the possibility of COPD.

@Jen – I hope that asthma does not become another diagnosis to manage. COPD would be no picnic either. Aging is definitely not for the faint of heart! Thanks for adding your knowledge of asthma to the discussion.

@PedsRN1 – I apologize for the significant diversion from your original topic. I hope your return to your original metoprolol dose continues to give you relief. Your thread opened up new information that I think will benefit me.

Jim, I am taking propranolol and yes, I did quit cold turkey – in retrospect, not a good move. After two months I restarted propranolol at my former dose and that’s where I’m at today.

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PedsRN1

While I’m sorry you’re having issues, I’m thrilled to read your post this morning. I saw a new PCP yesterday due to a move, and he mentioned concern I started taking Metoprolol four months ago and wondered if it was an issue in symptoms for hypos. That’s another issue altogether for me, but I’m on my way to see my Endo today and will be asking about this. I’ve been having significant issues with hyper spikes since starting it. I found correlation re study data on bg control and this particular beta blocker online this morning and decided to discontinue Metoprolol. It’s not the only BP med I’m taking. Will discuss with both endo & cardiologist today. I’m convinced this might be my problem! Can’t wait to learn more.

What happened if you quit cold turkey? We’re you on it for a high heart rate?

I’d really like to get off beta blockers, but I always have the same experience as @Terry4: things are fine for a few days, weeks, or months, and then suddenly not fine.

Bisoprolol is extremely effective for me (I’ve tried a calcium channel blocker, which had no effect), and even just a quarter of a 5 mg pill a day keeps things under control (my heart rate averages about 50 bpm slower).

I attempted to discontinue it again this past Friday. Things were fine until this morning. This morning my heart rate has been 140-150 bpm just getting ready for work, and right now just sitting for the past 15 minutes is 115-125 bpm, and all the unpleasant symptoms that come with having a constantly fast heart rate. So this is probably another failure, because of my heart rate stays fast all day, I’ll resume bisoprolol tonight.

Your comment is the first I’ve ever heard about weaning a beta blocker. I’ll ask my cardiologist about it when I go later this month.

Terry, is there any possibility that your breathing problems could be brought on by stress?

@Jen I found out first hand that when you stop taking bisoprolol cold turkey, it causes angina plus other unwanted heart effects including myocardial infarction.

On discontinuation, bisoprolol should be tapered off slowly over at least a week, and in some longterm users considerably longer.

No, I don’t think stress has played a role. I’m getting good sleep every night, meditating regularly, and doing breathing exercises daily. In fact, during the last year I would say my stress has gone down, even though I’m dealing with these health issues.

I find myself smiling more than I used to and I try to remind myself that I have much to be grateful for. I do get impatient with medical incompetence but I always try to take concrete positive action when dissatisfied.

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Good for you Terry! My terrific naturopathic doctor in Portland raised my thyroid, something which my GP in ID was afraid to do, and I am feeling so much better. It is amazing what thyroid can do. I have another cancer test on Thursday and I am not stressed. I love this doctor if you ever feel like you need a terrific naturopathic doctor. She is now studying to be a endocrinologist.

Beta blockers reduce sympathetic nervous system activity (fight or flight activation, such as elevated heart rate, sweating, getting shaky etc). Sound familiar? That same system gets activated when you’re hypo, and it’s a major part of how most of us detect hypos if we are able to. So for some people, being on beta blockers can cause or exacerbate hypo unawareness. They should not have any direct effects on blood sugar control though.

Of note, for someone like myself (and I’m guessing @Terry4 may be similar) who has tachycardia off of a beta blocker, I tend to feel low when I’m not actually if I’m unmedicated. When on a beta blocker, my resting HR is lower and less reactive, and a result, my hypo awareness is actually better, since unexplained spikes in SNS activation are much more likely to be valid indicators of hypos.

Also, this past year, environmental allergies have been exceptionally bad in many places, causing worse or new problems for many people, so not surprising to me that someone might get tipped over their threshold into new difficulties. This is likely the new normal thanks to climate change… I know my immune condition (mast cell activation syndrome) worsened considerably over the past year or so resulting in some cough-variant asthma for the first time in my life (among other symptoms), which I managed to get mostly under control by adding singulair to my meds.