Suggest ways to deal with addiction to Metoprolol

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Posted on Mon, 15 Jun 2015 in Hypertension and Heart Disease
Question: I am taking metoprolol 12.5 mg once a day. it makes me groggy starting about 16 hrs later and continuing for some hours until I go to bed. If I don't take it, I have chest pains which I never had. I think I have become addicted to or dependent on the metoprolol. Is there a way to get off it.
ADDED- I was given metoprolol after a valve replacement- blood pressuer is 140-150/80-90. Except for problems of grogginess, I am in reasonable shape and have an exercise trainer and can do mild exercise readily
doctor
Answered by Dr. Prakash H Muddegowda 4 hours later
Brief Answer:
Metoprolol should not be stopped immediately.

Detailed Answer:
Hi,
Thanks for asking.
I am Dr. Prakash HM and I will be answering your query.
Based on your query, my opinion is as follows:

1. Metoprolol is known to cause grogginess as a side effect. However, the grogginess effect starting 16 hours later is difficult to understand. Its known to be start being active 1-2 hours after intake.
2. Possibility of hypoglycemia or dehydration requires evaluation. Metoprolol or other beta blockers, block the symptoms of hypoglycemia, hence grogginess could be a major manifestation.
3. You are not addicted to metoprolol, however, it should not be stopped immediately. Post cardiac surgery, beta blockers are necessary. If stopped, they can give rise to cardiac symptoms, which you are experiencing. It should never be stopped immediately, and it should be stopped slowly, if necessary, which switching over to other medication.
4. Blood pressure, is mildly high, and losartan can be helpful. Do discuss with your doctor. Maintain adequate hydration. Do get your blood sugar levels and blood pressure levels at the time of grogginess evaluated. Based on the results, further opinion possible.
5. During periods of unsteadiness, move around slowly. Changing positions should be done very slowly for blood pressure to adjust. Avoid any risk of falling.

Hope it helps.
Any further queries, here to help again.

Dr. Prakash HM
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prakash H Muddegowda 11 hours later
I thank you for your useful comments. Here I am trying to add whatever might be useful.Metoprolol is useful and makes me feel better in the first hours after taking it, usually at 10 pm. By 4 the next afternoon I fall asleep for 1-2 hours and wake up into a groggy state and cant do anything useful until 10-12 pm when I take another
and go to sleep. To me, this suggests it has 2 effects, the first beneficial and the second disastrous. Best would be to wean myself from it completely. However when I do not take any at all, I have chest pains, last time for several hours after getting up in the morning which were relieved by another metoprolol in the afternoon (2 losartans did not prevent these pains)
Valve replacement was in Feb 2014 and they prescribed 50 mg metop 2x/day-
which was too much and cut to 25 which was ok for a while and then cut to 12.5 twice a day annd next to 12.5 once a day. However when I stopped the met
totally, inthe last few weeks, I started having heart pains. I believe that the metoprolol was never needed, but how to get off it?
It seems to me that besides the insulin I should be taking enalapril, which I tolerated well in the past for about 12 years, and lasix and potassium, aspirin and synthroid, and lipitor- and that's it
but how to get to that-
blood sugar and blood pressure are both ok even when groggy- hydration isok too. I checkkblood sugar 5 or 6 times a day.

In short, the grogginess that follows metropolol makes life difficulot to live-
how can I get off it

with thanks XXXX
doctor
Answered by Dr. Prakash H Muddegowda 6 hours later
Brief Answer:
Metoprolol - discontinue slowly - it appears to be the cause.

Detailed Answer:
Hi XXXX
Thanks for replying.

Good to know that blood sugar and blood pressure are within normal range.

You are on the lowest possible dose of metoprolol. However, as you are having adverse effects, it needs to be slowly tapered and stopped.

You need to taper it over one to two months. You should never discontinue immediately, as it increases heart problems or increase risk of heart attacks.

You would need to slowly reduce dosage schedule, initially alternate days, then 3,4,5,6 and finally weekly once. You need to do it twice, each of them. You may experience anxiety, increased heart rate, chest pain and dizziness due to cardiac effects and also rebound hypertension. Do watch your blood pressure and heart rate at different times, every day. Once, it becomes, more than a week, you can probably stop it altogether. Physician/ cardiologist would be able to advise and monitor you better during this phase to rule out any adverse events. If necessary, they will adjust the withdrawal, still further to reduce any adverse symptoms feeling.

Do meet your doctor, to put you on a schedule for weaning. Stopping it abruptly can give rise to various symptoms, and can be life threatening.

Hope it helps.
Any further queries, here to help again.

Dr. Prakash HM


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Prakash H Muddegowda

Geriatrics Specialist

Practicing since :2004

Answered : 2138 Questions

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