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Dr. Andrew Rynne

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Can Metoprolol be discontinued cold turkey?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5894 Questions

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Posted on Mon, 27 Mar 2017 in Hypertension and Heart Disease
Question: 6 months back a cardiologist suggested that stop taking my 25 mg am and pm dose of metoprolol. He told me my heart is good. I was absolutely fine until then. I tried to quit, but could only stop 1 25 mg, and not the other.
After a moth i noticed, getting heart skips. Mostly in am and pm. I mentioned this to the cardiologist, and he did not say any thing. When i asked my family physician, she said i can just stop it. I also told her about the skips, which i am still getting (not all day), but mostly when i don't sleep). She had nothing to suuggest. I asked my Family dr. can i get a Holter Moniter test. I got it on XXXXXXX 17, 18, 19 . After 2 weeks the cardiologist office called to say, that if i have stopped taking Metoprolol, i should re-start. I told his receptionist, i never stopped taking it. I defiitely got axnious, because i was to write every time i felt some thing. So since then my condition aggravated. I thought i was to go back to my old dose, so i took 25 mg am pm, but the 2nd day, i got excessive skips. My family Dr. suggested, to stick on the 25mg that i have been taking (12.5 am and 12.5 pm) My condition has improved a lot, but the skips are still there. I will be very greatful to you, if there is a SOLUTION to this.
God Bless. YYYY@YYYY
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Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM1

I passed carefully through your concern and would like to explain that when starting and stopping a beta-blocker it is important not to do it cold turkey, but to progressively escalate the subsequent dose in order to avoid what is called rebound phenomenon.

So, if you hadn't skipped beats when on 25 mg Metoprolol, but they appeared immediately after you decreased the daily dose, probably the previous dose fits better to you (it is well tolerated, considering the average daily heart rate).

For a better understanding of those ectopic beats occurrences, it is necessary to review the performed medical tests and recommend additional ones:

- cardiac ultrasound,
- Holter monitoring,
- complete blood count (for possible anemia),
- thyroid hormones level (possible thyroid dysfunction),
- blood electrolytes level (possible imbalance),
- fasting blood glucose level

Could you upload the already performed tests here for a direct review and a second professional opinion?

Also, it is necessary to better manage excessive anxiety by engaging in frequent daily activities; walking outdoors, avoiding caffeinated drinks, optimizing sleeping regimen.

Hope to have been helpful to you!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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