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What Causes Memory Loss And Confusion While On Metoprolol?

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Posted on Wed, 24 Dec 2014
Question: My wife is taking Metoprolol 25 MG after having 4 stents placed 1 and half years ago. She is experiencing memory loss, and confusion . She is 81 years old. She has never had high blood pressure. Why does she need to take this beta-blocker to reduce blood pressure? Is this medication along with Clopidogrel, Losartan and Atorvastatin can seriously decrease her cognitive ability, confusion and halucination?? Sorry not decrease, INCREASE !!
doctor
Answered by Dr. Panagiotis Zografakis (38 minutes later)
Brief Answer:
I would advice against stopping the beta blocker

Detailed Answer:
Hello,

I understand your concerns and I'd like to present some facts to you, so that you could make an informed decision.
Metoprolol is a beta blocker drug that reduces the blood pressure. It also helps reduce heart's oxygen requirements. This makes it necessary for coronary artery disease treatment. I would advice against stopping it!
Clopidogrel is essential as well and shouldn't be stopped as well. It helps reduce thrombosis risk which could lead to an acute coronary event.
Losartan helps in more than one way and unless her blood pressure it too low (systolic blood pressure less than 120-130 mmHg) then I suggest you don't stop it either.
Atorvastatin helps reduce cardiovascular risk. Most cardiologists would aim for an LDL cholesterol below 70mg/dL.
Beta blockers can cause cognitive disorders, confusion, hallucinations, bad dreams but metoprolol is supposed to cause less. Atorvastatin may also cause some problems but you've likely been right about putting the blame on metoprolol. I don't believe that any of the other drugs causes the symptoms to her.
Since beta blockers are very useful to patients with coronary artery disease, I suggest you discuss with your cardiologist the possibility of either reducing the dose or changing to another beta blocker. Please note that stopping the beta blocker abruptly may cause problems to her heart.
I hope I've helped!
If you'd like more information, please let me know and I'll be glad to help more...

Kind Regards!
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Panagiotis Zografakis (18 hours later)
Dear Dr. Zografakis, I understand your reply and kind of agree with that. You cannot provide else then the "regular understanding" of a medication. I like better when you mentioning that Metoprolol can be blamed more than the other medication. Pls allow me to make some comments or more precisely ask some further questions: It is suggested and obviously I like to believe that our problem is caused by deteriorated vascular problem than Alzheimer. (Tests, MRI etc) Here are my questions; 1. Although metoprolol is a necessary medication in those cases and it is a well known and good medicine, but there are better new medicines like Bisoprolol (Concor cor i.e. 1.25 MG) that are causing much less negative side-effects and better control blood pressure and arrythmias. What would you be your view on changing the medication to this?? 2. It is also mentioned in the literature that Calcium-channel blockers (i.e. Verpamil) can have less side-effect and what is more it is better tolarated by elderly persons. 3. It is well know that Atorvastatin is replaced by Rosuvastatin that can be administered in smaller dose and expected to create much less negative side-effect. Can atorvastatin be replaced by rosuvastatin, with careful and continuous monitoring?
Since , it is believed that the mentioned changes in the patient's mental and cognitive and health herbivore most probably caused by vascular deterioration, in this case the blood circulation and oxygen transfer in the brain and heart would be required to be increased by well known medication or supplements that cause no or very little negative side-effect? It is known, that for example the Cavinton forte ( the alkaloid of vinca minor, i.e.Vinpocetine) can be a very effective supplement/medication. The other very well praised medicine the Trental (pentoxifyllin in 400 or 600 MG ) cannot be or should not be prescribed for the patients taking metoprolol or even bisoprolol ?? It is not a vasodilator, but positiv way effects on the red blood cells, that after treating them with pentoxifyllin they regain their ability to deform , and consequently they become able to move through tighter and more ridged or twisting/winding blood vessels and carry the oxygen to the brain cells. The effect of the Cavinton forte and Trental can further be enhanced by Neuromultivitamine that contains the necessary B vitamin in larger dose that are vital for the brain's nerve cells. Such vitamin like the Thiamin in 10MG suggested to be quite effective.
Dear Doctor! I have many questions for you and I hope that you will be kind enough to provide me the necessary help and information to evaluate the value and necessity of the mentioned new and old medications . Your research and literature review would be a great help and I am extremely shameful for asking so many questions and information, but probably it is needless to say how important this can be for us and perhaps many more elderly patients. Thank you. Sincerely, XXXX PS: I am not a medical doctor or physician, and all what I am communicating to you is learned from the appropriate sources, internet and from some of my foreign physicians. The state and information of the US health professional is obviously most important for establishing the best locally available and approved treatment system.
doctor
Answered by Dr. Panagiotis Zografakis (1 hour later)
Brief Answer:
Many questions, please find the answers below...

Detailed Answer:
Hello,

regarding the metoprolol vs bisoprolol issue: metoprolol is a well established drug in the treatment of coronary artery disease. It is actually considered a beta-blocker/6535?iL=true" >beta blocker with a low potential for nervous system side-effects (compared to the others of course). Whether it carries a low risk or a high risk for side-effects, any particular patient that does experience the side-effects, is entitled to ask for alternatives. I'm not practicing in the USA but as far as I know bisoprolol is indicated only for hypertension there. Please also check my answer on CCB. Carvedilol could used instead, although I'm not so sure it will provide a better side-effects profile. Nonetheless it's worth a try.

Regarding the CCB (verapamil): b-blockers have documented postinfarct protection and mortality reduction in heart failure. Not many drugs can prove such reductions. For patients that have recovered after a myocardial infarction, beta-blocker use is a level A indication, which means that it should be used!

Regarding the statin issue: I don't believe it's well-known! Rosuvastatin is definitely the most potent statin in the market but the side-effects are not less (for a similar result on the LDL). The higher the anti-LDL effect, the higher the side-effects risk. Of course if other (more likely) possibilities have been investigated or excluded then a trial of rosuvastatin could be helpful.

And finally regarding the other drugs or supplements you've mentioned: The drugs you've mentioned have not proven their efficacy over the years (at least not without doubt) so that using them (and expecting good results) would probably prove futile. And this is why you won't find level A evidence in treatment guidelines.
Some of them (like vitamin B of any kind) can be used without any risk for her health though, and although I wouldn't expect a visible result, I wouldn't recommend against its use either.

I do understand your concern and I've tried to provide my best for your query, although the issues you've mentioned cannot be addressed with a simple and guarantied to work answer. I would give another beta blocker a chance, although the prescribing physician is the most appropriate person to decide that. I don't believe that atorvastatin or rosuvastatin would make any difference but you can try it if all else fails.

I hope I've not missed any of your questions! Your follow-up question was a long read indeed!
If you'd like more clarifications, please ask for them!

Kind Regards!
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3809 Questions

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What Causes Memory Loss And Confusion While On Metoprolol?

Brief Answer: I would advice against stopping the beta blocker Detailed Answer: Hello, I understand your concerns and I'd like to present some facts to you, so that you could make an informed decision. Metoprolol is a beta blocker drug that reduces the blood pressure. It also helps reduce heart's oxygen requirements. This makes it necessary for coronary artery disease treatment. I would advice against stopping it! Clopidogrel is essential as well and shouldn't be stopped as well. It helps reduce thrombosis risk which could lead to an acute coronary event. Losartan helps in more than one way and unless her blood pressure it too low (systolic blood pressure less than 120-130 mmHg) then I suggest you don't stop it either. Atorvastatin helps reduce cardiovascular risk. Most cardiologists would aim for an LDL cholesterol below 70mg/dL. Beta blockers can cause cognitive disorders, confusion, hallucinations, bad dreams but metoprolol is supposed to cause less. Atorvastatin may also cause some problems but you've likely been right about putting the blame on metoprolol. I don't believe that any of the other drugs causes the symptoms to her. Since beta blockers are very useful to patients with coronary artery disease, I suggest you discuss with your cardiologist the possibility of either reducing the dose or changing to another beta blocker. Please note that stopping the beta blocker abruptly may cause problems to her heart. I hope I've helped! If you'd like more information, please let me know and I'll be glad to help more... Kind Regards!