Beta Blocker Switch

Hello All, 

Yesterday I experienced a strange ordeal and need some advice please. 

I was told by my cardiologist to change my beta blocker that I had been on for 2 years, to a lower dose of a beta blocker. The change is from 80mg Nadolol OD to 2.5mg Nebivolol OD. 

I changed yesterdsy and the effect was almost immediate. I felt extremely dizzy, sick and light headed all day, and my heart rate, which is usually 60 ish, was fluctuating randomly from 60-110. I felt extremely dizzy and sick to the point where I couldnt sleep. At 2am I felt my HR going extremely fast, and I felt very ill, I decided to call the medical number for my university, and was sent to hospital. 

The Drs performed an ECG, and some blood tests. The blood tests and ECG came back fine, they said the ecg looked a bit abnormal, but nothing of concern, and it may be normal for me, but they had nothing to compare too. The on call cardiologist suggested that the random fluctuations in heart rate where due to the change of medication, and nothing of concern. 

It was extremely distressing, and still now I am feeling a fast resting heart rate and it still randomly get fast heart rates, and some dizziness. I feel like my heart rate increases a lot more than usual after movement and exertion. 

I was wondering if anyone else has expericned anything like this? And is there anything I can do? 

If anyone has any advice that would be amazing, 

Thank you so much and I hope you are all well, 

Hayden x

7 Comments

Time?

by USMC-Pacer - 2023-10-01 15:36:02

Maybe you just need to get used to the new medication. I can't tell from your profile why you are prescribed a beta-blocker, (assume BP) but these two beta-blockers go about their job differently:

Nadolol is non-cardio selective

Nebivolol is cardio selective

I think your DR. would be the best person to ask why they were switched. 

Sorry I'm not more helpful, but I'm sure others will be along shortly with more experience with these BBs

Confused

by Penguin - 2023-10-01 16:10:02

Hi Hayden, 

I'm a bit confused by your message. 

You've clearly started university now and have accessed university medical advice and local emergency help for these symptoms.  That's not the confusing part.

I am confused as to who told you to change your BP medication? You posted about an EP appointment before you left for university and didn't mention any advice to change meds from this appointment.  Has something happened to prompt a meds change since and if so did it come from your usual team or a new doctor in your university town / city? 

In the first instance I would go back to the prescribing doctor for advice on these new symptoms.

Prescribing doctor

by PacerPrice - 2023-10-01 17:25:33

Hello,

At my consultaton in september i was told to change my medication from nadolol to nebivolol, as my dr said i was on too much of a high dose drug for an issue that didnt really need treatment, asymptomatic nsvt. I have only just changed the drug now as I had to finish the course of nadolol i had before i started nebivolol. 

I hope this makes sense. Thank you 

My Mistake

by Penguin - 2023-10-01 17:34:39

Apologies Hayden, I think that's my error for not reading your last post accurately.  It does make sense. 

In that case I'd contact the doctor who provided the advice to change meds and explain your reaction to the change and what happened to you.  There may be some pertinent advice that could be provided regarding how to discontinue one medication and transition onto another without inducing further symptoms. 

 

 

Thank you so much penguin

by PacerPrice - 2023-10-01 17:53:30

Thank you for your help, i was just wondering if this is a common or normal reaction to coming off or switching beta blockers? 

Nebivolol

by Gemita - 2023-10-01 18:06:49

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1993984/#:~:text=Nebivolol%20is%20a%20racemic%20mixture,rate%20normally%20seen%20with%20exercise.

Nebivolol is unique among beta-blockers in that, at doses <10 mg, it does not inhibit the increase in heart rate normally seen with exercise.  I wonder if this is why you have been given this med?  It has a different mode of action to your old beta blocker.  Have a read of the link above Hayden. 

I have sent you a private message 

Beta blockers

by Penguin - 2023-10-01 18:26:23

I haven't taken a beta blocker and therefore I'm not very familiar with cardio selective / non cardio selective types and how changing type might affect you.   Tapering the dose may or may not be advisable. 

I would hope that your doctor could draw on their own clinical experience with these drugs and advise you accordingly.  

In my experience (with other drug types which can cause withdrawal reactions), individual responses can be unpredictable and may vary. Some people seem to transition from one drug to another without significant symptoms whilst others may struggle and need to taper the original drug carefully and reduce the original drug very very slowly.  

I'd only rely on peers who have experienced something similar and are very familiar with the drug types that you are dealing with. I am not that person! Peers can help with validation that your symptoms may relate to the drug and may be able to explain what helped them when they faced similar symptoms. 

However, it really would be very wise to consult your doctor in the first instance as the prescriber has responsibility for safe de-prescribing and change over advice and if you have struggled whilst adhering to their advice and ended up in A&E, you really need to let your doctor know so that they can adjust their advice accordingly. 

Perhaps try this first and let us know how you get on. 

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