Question: Hi, I'm on propranolol for an acute hyperadrenic crisis in which I have tachycardia and high blood pressure. I've been on the propranolol for a week now and I'm still noticing fluctuations in blood pressure and heart rate, although my blood pressure is now within normal limits. I've been prescribed 10mg taken up to 3 times a day as needed. Since my bp and heart rate are fluctuating. I'm taking a half pill if my heart rate is below 80 and my bp is near 100 and I'm taking a tablet and a half if my heart rate is around 110 and my blood pressure is near 120. Sometimes, even after taking 1.5 tablets, my heart rate does not go down much. I even had to skip a dose one time when my bp was below 100 systolic and heart rate was 76. Is this an okay way to take Propranolol? Based on my blood pressure and heart rate? My primary care doctor is okay with it, but I want to ask a cardiologist if adjusting doses this way is normal, or if it is absolutely necessary to take the same amount at each dose.Thank you.

Hi, I've decided to write a brief history. I have an acute problem with tachycardia, weakness, and elevated cortisol that started 3 weeks ago. I also have vertigo and an ENT evaluated me and concluded it was not inner related, but may be vascular in nature.

3 weeks ago, I went to St. XXXXXXX and had a "DMPS challenge test" done by an integrative MD in which I was given a DMPS IV and gave a urine sample before and after to see if any levels of heavy metals were excreted. I did perfectly fine with the infusion, but the next day (20 hours later) when I returned to get a routine Vitamin IV from the same doctor, I felt lightheaded and faint, my blood pressure XXXXXXX and heart rate elevated to 135. The next two days after returning to XXXXXXX I felt very weak, although my blood pressure was low (92 systolic).

Two days later, the weakness continued, although my heart rate elevated. My heart rate remained elevated from a range of 100-120 for the next two weeks, and my blood pressure was 140/80 in a bedridden state. My normal blood pressure is 115-120 (systolic)My endocrinologist did a thorough blood workup and the only abnormality was elevated cortisol, which she said could cause tachycardia but would not cause the profound weakness. During this entire time, I was so weak that I was unable to walk to the bathroom at my home. The tachycardia was preventing me from sleeping, so my primary care doctor put me on Popranolol 10mg – 3X/Day to decrease my heart rate and Clonazepan to help me sleep.

Since that time (a week ago) I’ve regained a small amount of strength, although I am still very weak to where it is difficult to walk, and I still struggle with vertigo. My heart rate remains in the range of 85-100, although it is sporadic, and sometimes will be 111 when it is time for a dose, or as low as 74 when it is time for a dose. My blood pressure has come down to normal levels.

I had a cardiology work-up in 2012 at St. Francis Heart Hospital. Everything was normal. However, because of the sporadic nature of my heart rate and now that beta blockers are involved, I wanted to consult you.

I should also tell you that 2 episodes of weakness similar to this, without tachycardia, have happened in the past 10 years. Also, I have a small (2mm) pituitary lesion that my neurologist has been keeping an eye on for 3 years that may be a factor.

The six main symptoms are:

1) Profound Weakness
2) Tachycardia
3) Vertigo when I turn my head
4) Elevated Cortisol
5) frequent urination
6) Lightheadness

Two questions:

1) Could the vertigo/lightheadedness be a vascular problem that I should see a cardiologist for?
2) When taking Propranolol - If I take a dose (1.5 tablets of 10mg) and within an hour my heart rate has not gone below 95, can I then take another .5 tablets? In other words, how long is my "window" of a dose to see if I can get my heart rate down before I should just wait until my next dose 6-8 hours later?


Also, here are the labs I've had done so far - only 2 were abnormal - are there any more I should ask of my primary care doctor? thank you!


Labs Completed


Component
WBC
RBC
Hgb
Hct
Abnormal 44.9 Ref Range 34.5-42.8 %     

MCV
MCHC
RDW
Plt
MPV
nRBCs
Neutrophil (%)
Lymph (%)
Mono (%)
Eos (%)
Baso (%)
Absolute Segmented Neutrophils
Absolute Lymphocytes
Absolute Monocytes
Absolute Eosinophils
Absolute Basophils
ESR
Metanephrone
Normetanephrine
FOLLICLE STIMULATING HORMONE
LUTEINIZING HORMONE
INSULIN LIKE GROWTH FACTOR
PROLACTIN
ALDOSTERONE/RENIN ACTIVITY RATIO
CORTISOL

ACTH XXXXXXX R Prabhala, MD     Final result
T4 FREE XXXXXXX R Prabhala, MD     Final result
TSH XXXXXXX R Prabhala, MD     Final result
METANEPHERINE,URINE 24 HOUR XXXXXXX R Prabhala, MD     Final result
ALDOSTERONE, URINE 24 HOUR XXXXXXX R Prabhala, MD     Final result
CORTISOL,URINE Abnormal 72 Ref. Range 45 XXXXXXX R Prabhala, MD     Final result
METANEPHRINES,URINE XXXXXXX R Prabhala, MD     Final result
ALDOSTERONE,URINE XXXXXXX R Prabhala, MD     Final result
CoRTISOL,URINE XXXXXXX R Prabhala, MD     Final result

Hi Dr. Iliri,
I've been taking the propranolol at 1.5 tablets 3 times a day, and the last two days, I've been getting a little stronger and getting up and walking to the bathroom and trying to walk more even though I'm very weak. Because of this, I've noticed by blood pressure returning to lower levels, and half the time I take my blood pressure it's now in the lower 100's for systolic. This morning, my blood pressure is in the 90's, my pulse is 83, and it's been 12 hours since my last dose, so it's overdue for a another dose. I've only been on propranolol for 2 weeks. Should I skip this dose since my bp is so low? I thought it was dangerous to skip a dose. Thanks.