Please help/advise beta blocker withdrawal

[Moxxi]

Has anyone ever successfully come off beta blockers? I'm starting my journey now and I'm scared of the rebound tachycardia. Does it go?

Hi there. Can you define “your journey”? I hope you mean a slow decrease. The fact is that they’ve shown cardiac hypersensitivity is worse if you just quit propranolol abruptly (and that no one should quit beta blockers abruptly anyway) VS if you quit it slowly, by tapering. If you start to experience tachycardia, I would talk to your doctor about slowing the taper even more, if necessary. I wouldn’t necessarily assume that you have to suffer this as I know people who have stopped taking propranolol without experiencing the rebound tachycardia.

@RightYesButNo I was taking 5mg of Bisoprolol.

I'm now taking 2.5 in the morning and 1.25 at night. It's only been 1 day and my HR is already higher in the morning than usual. It's all still very early days. I'm going to come off them very slowly.lbas recommended by my GP. After a week of this I will take 2.5 morning and then 0.6 at night for a week. Drop the 0.6 for a week, and so on, just drop it slowly each week. Before I started beta blockers my resting heart rate was 90, on them it's 80 but my hair is all falling out from them.

I'm scared the withdrawals with never go

Was your 5mg split before (2.5 morning and 2.5 night)? Cutting it to 2.5 and 1.25 is an immediate drop of 1.75 mg. I would only be considering a drop of 0.5mg a week for someone who is anxious about their heart rate. I can completely understand being concerned about your hair (I’ve suffered medication-related hair loss and seeing it come out in the shower was just too much), but at this point it may be that the “damage” is done and now healthy hair will need to come through, so it’s bit a good reason to rush your withdrawal. If you have another too personal reason, I understand.

If you’re already experiencing some discomfort, you can try:
WEEK 1: 2.25 in the morning and 2.25 at night
WEEK 2: 2 in the morning and 2 at night
WEEK 3: 1.75 in the morning and 1.75 at night
WEEK 4: 1.5 in the morning and 1.5 at night
WEEK 5: 1.25 in the morning and 1.25 at night

Doctors (and medications reactions) are only concerned if you try to withdraw more quickly, since that can speed up side effects. There’s nothing wrong with withdrawing more slowly, like the schedule I’ve laid out. But yes, your current schedule is a week 1 drop of 1.75mg snd week 2 drop of 0.65. In two weeks, that’s a drop of 1.9mg in the first two weeks, almost 2/5 of your bisoprolol. Maybe try the 2.25 tonight, 2.25 tomorrow morning, see how you feel, and then determine if you want to try the slower schedule?

@RightYesButNo that's an absolute fantastic idea. I was on beta blockers for inappropriate sinus tachycardia, caused my anxiety. I am going through CBT now and my therapist and GP have decided that actually I may be able to do without.

My Resting HR before beta blockers was 90
On them its 80
I can cope with an increase of 10. My mum has a naturally fast heart rate, so I could have inherited mine from her. I have had numerous tests done and my heart is apparently healthy.

Only issue I'm going to have is. How am I going to know the exact amount, for example I have 2.5mg tablets, how will I lower that to 2mg? Is that a silly question?

Also, have you been through withdrawal at some point? It's all very scary for me.

@RightYesButNo sorry another silly question I have is, why do people experience these withdrawal and rebound tachycardia? I don't fully understand it :(

Argh. I had foolishly assumed they’d have logical pills amounts like 1mg, but I see it’s 1.5mg then 2.5mg then 5, for tablets. So let me do some math and get back on that one (might take me a bit). Some will be “easy” (ll, you’ll just use a 1.25 tablet. In order to get 1/4 of a 2,5 tablet, you’ll probably need a pill cutter that can cut in 1/2, 1/4, and even 1/8 (they’re about £5 on Amazon UK).

While your fast heart rate may be scary and uncomfortable (as I’m sure it is!), tachycardia is usually a resting heart rate over 100 beats per minute. And even then, it can be perfectly safe if there’s nothing electrically wrong with your heart. I think it’s very hard to believe that when you can feel your heart beating quickly when you’re just sitting still, but yes, as long as you’ve had the proper studies (and it sounds like you have), you’re safe. I know it’s hard to believe sometimes.

ABOUT REBOUND: It’s both complex and really simple. Beta blockers actively block certain chemicals that raise the heart rate, like adrenaline. If you abruptly stop the beta blockers, those chemicals suddenly are “back,” can cause the problems you had before, or maybe maybe even worse, beclaii you may be even more sensitive to them than before. But there’s still a lot we don’t know about beta blocker rebound phenomenon (how often it happens, how long on average, etc) lthat they’re studying right now.

@RightYesButNo I will definitely get a pill cutter. My heart scan was perfect and my ECG just showed a fast heart. Sinus tachycardia.

I have heard from a few people you can eventually go back to how you were before beta blockers. Is that true? Just takes time.

I don't think I have heard of permanent damage from beta blockers?

Again, thanks so much.

Think about quitting your beta blockers exactly like starting to exercise. So when you start, it’s very obvious that you’re new to exercising. And if you try to push yourself and do too much exercise too quickly (just like quitting beta blockers too quickly), it will be very obvious that your body is not dealing with it as well because it is too much too handle. If you exercise too much too quickly, you could hurt yourself. Likewise, if you flood your system with chemicals too quickly from just quitting your beta blockers, you could hurt yourself. Yeah But if you slowly start exercising, your body can get used to it and you don’t hurt yourself; just like if you taper off the beta blockers, your body can get used to those chemicals again and hopefully will only experience minimal symptoms.

I will not lie; there are probably some reports of permanent damage from beta blockers. But those will be people who had heart problems or heart damage already and are on much larger doses than you (you are on the second smallest doses) and quit abruptly.

Wow ok, thank you again. When you say permanent damage, what is the damage exactly?

Damage to the heart? Or damages to the nervous system? I'm 26 and already at my age I'm thinking this is going to kill me, it's very scary. @RightYesButNo

Ok, I was hoping my second paragraph would help you realize that if such damage exists it’s

1. Very rare and
2. Only going to happen to people who aren’t like you. You have a perfectly clear ECG and heart scan.

But I see the parts that hit you were “reports” and “damage.” And believe me, I do understand that’s how health anxiety works. So…

Beta blockers work by binding to two receptors, those for adrenaline and noradrenaline (fight or flight, basically). They’re meant to help smooth irregular muscle contractions from your heart OR slow them down if they’re too fast. The only people who have suffered what I would say are serious problems are those who have overdosed. (And in case you’re worried, you are VERY, very far from an overdose amount). In fact, the problem has been the opposite - in 2012, a large study discovered they weren’t effective enough, that by themselves they didn’t cut down on the risk of death (and if you have heart problems, you also likely take an lanticoagulant, statin, antihypertensives, and all of those will protect you). Actually, the people at some risk are people who have the OPPOSITE condition than you: bradycardia, or a heart slowness. Which you just don’t have.

What was your heart rate when they told you that you had sinus tachycardia? (sinus means that it’s still in a normal rhythm so you shouldn’t be in danger, though you may have discomfort and obviously you have fear). As I said, as of right now, your resting heart rate is high, but it’s not tachycardia and it’s not even abnormal. I mean, Fitbit reports that the normal heartbeat range for its adult users is 50-90.
blog.fitbit.com/what-your-resting-heart-rate-can-reveal-about-your-health/
I know it probably feels quite scary, but you are not in danger.

I hope this helps. I’m still working on the math. Unfortunately, since we’re trying to make these numbers out of only 2.5 mg pills (who came up with that? It limits you to only decrases by 1.25 or 0.625, requiring math), it’s probably going to require cutting the pills in 4 and 8. While waiting for the pill cutter, if you’re starting to have issues, instead of your 1.25 dose, which I assume you’re getting by cutting your 2.5mg pill in half, do this.

1. Cut the pill in half for your 1.25mg dose.
2. For the other half, take a knife and engrave s line near the middle of it, like a scoring mark that would already exist on a pill. Then take a sharp knife and press down while “sawing” along that kindly. If it’s not exactly half of the 1.25mg half, that’s fine. You will be taking the other “half” tomorrow night and you will not overdose since you were already taking 2.5mg before.

As I said, I hope this helps, sincerely. We’re at the limits of my knowledge, sorry. I’ll keep trying to do the math and post when I figure it out, probably tomorrow.

You are absolutely amazing and I wish I could hug you!! Seriously wow!

On my 24 ECG my average was 101 low of 88 and high of 160.
I had terrible anxiety at this point.

My usual resting heart rate before beta blockers was 85-90 and 110-120 when active. 150+ whilst exercising. I appreciate you so much. Is there anyway we can personal message? So that I can keep you posted ❤️

No problem. I’m PMing you now. I’m going to go ahead and put the public disclaimer here, just in case, that I’m not your doctor and don’t know your case, so if you ever feel unsure or especially if you ever start feeling badly, please do consult your doctor. None of us on Mumsnet can help you as much or as thoroughly as your own doctor. Take care!