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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can Metoprolol be stopped abruptly or should it be gradually tapered?

My mother had a center brain bleed stroke 6 months ago. She’s been on metoprolol.25mg for about 6 years but she said she only took it when she had heart palpitations because a previous cardiologist said she had afib. The new cardiologist said she does not have afib. He did say that she needs a pacemaker because her heart rate is so low. I informed him that at the time she was also taking keppra and clonazapam which also lower her heart rate. He then changed his mind about the pacemaker. Her BP has been high at night and the valsartan is long acting and takes a while to work. After I did extensive research I talked with her primary about stopping metoprolol and adding something faster for the extremely high nightly BP. After I checked all interactions I found that clonodine has the least side effects and will work faster than the valsartan. Can the metoprolol be stopped immediately or does it need to be tapered? Her heart rate is usually in the mid 50’s while her BP at night and early morning can reach up to 210/110 and has required multiple trips to the ER.
Wed, 5 Sep 2018
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Internal Medicine Specialist 's  Response

Metoprolol is a drug which reduces the heart rate so it should be used with extreme caution with slow heart rate. First of all, an ECG should be done to rule out heart blocks. If there is a heart block on ECG diagnosis, or sinus bradycardia with heart rate of less than 45, Metoprolol should be stopped.

As you mentioned, the heart rate to be in mid 50s, I would suggest to still stop taking this drug and switch over to another drug like Amlodipine or Nifedipine, in combination with Valsartan, which is very safe and effective combination in controlling blood pressure.

To stop Metoprolol, it should be gradually reduced over 1-2 weeks with careful monitoring. However, any change in drug should be done under the guidance of your doctor.

Hope I have answered your query. Let me know if I can assist you further.
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