How to safely come off beta blockers

A lot of people have contacted me and asked me as to how to safely stop beta blockers and therefore I thought I would do a quick video around this subject.

Before I start it is important to say that please do not try and alter your dosage without speaking with you health care provider as he will know about your unique clinical situation and all I am doing in this video is just giving general information.

Beta Blockers are one of the commonest classes of medications that we use in cardiology and often serves as a jack of all trades. They basically blunt sympathetic activity and by doing so, have a multitude of potentially beneficial effects such as reducing heart rate, reducing blood pressure, making the heart less irritable, reducing the demands on the heart and increasing the time for the heart to fill with blood do that the heart is able to contract more effectively. In some situations they make people feel better I.e improve quality of life. In other situations, they may actually have a prognosis modifying role.

Let me give you some examples.

Beta blockers can be used to control blood pressure. Here they don’t necessarily make patients feel better may have a prognosis modifying role (albeit a weak one).

Beta blockers can be used as a treatment for heart failure. Here they make people feel better and have a very significant impact on improving lifespan

Beta blockers can be used for heart rhythm disturbances (ectopics/AF/SVT/VT) and her they may make the patient feel better and in some heart rhythm disturbances may also have a prognosis modifying role

Beta blockers can be used to treat angina and prolong life after a heart attack so against they may improve quality and quantity of life.

Sometimes beta blockers are used in a purely symptom control role such as for controlling anxiety or benign ectopics in people with normal hearts

So if you are taking beta blockers it is always worth asking why you take them. Is it because they make you feel better or is it because they in some way are being used for their prognosis modifying effects? This is important because if they have a prognosis modifying role you may decide you just want to remain on them

Acute, abrupt withdrawal of beta blockers has been shown in many case reports to be associated with an increased risk of morbidity and mortality. This is mainly seen in patients who were taking the beta blocker for angina due to significant coronary disease and in a few of these patients, stopping the beta blocker was associated with more angina and even development of heart attacks. Similarly there have been case reports of patients who were taking beta blockers to control dangerous heart rhythm disturbncaces and when the beta blocker was abruptly stopped it led to precipitation of ventricular dysrhythmias and even in some cases death. There have also been reports of heart failure status worsening and blood pressure going up excessively. This is termed as Acute beta blocker withdrawal syndrome.

Why does it happen?
It is believed that withdrawal effects happen because if increased sympathetic activity which is probably because of Beta receptor up regulation during the period of beta blockade. Upregulation is a well recognised phenomenon where the receptors that are being blocked become more sensitive and responsive to circulating adrenaline. It is believed that receptors take 24-36 hours to down regulate when the blockade is removed. So if you stop the beta blocker abruptly and it doesn’t stay in the body long (and how long it hangs around in the body depends on that beta blockers half life) then there may be a period where you have receptors which are significantly more sensitive to the effects of the adrenaline and this can then trigger this withdrawal syndrome. What this means is that the withdrawal syndrome is far more likely with short acting beta blockers or those beta blockers where you have to take 2 or 3 doses in day because they will have a much shorter half life. Beta blockers that have a lon half life will stay in the body for much longer and therefore will allow that time that is needed for the beta receipts to down regulate.

So if you are taking a short acting beta blocker I.e propranolol, metoprolol, carvedilol etc, it is best to be more cautious about reducing the dose.In such cases I would suggest taking the usual dose once daily for a week, then every other day for a week and then stop.

If you are taking a long acting beta blocker eg Atenolol, Bisoprolol etc , then take half the usual dose for a week, then half the the usual dose every other day for a week and then stop.

As I say it is very important that you only alter your dosages if sanctioned and supervised by your own doctor as it may in some patients have dangerous consequences.

[samuelmachoka]

Best video of the heart meds. Have been taking htcz, atenolol 100gm, nivedipine and aspirin 75 gm for 20 years. Recently adopted keto reduced weight and bp kept reducing. Have stopped htcz and nivedipine and now remaining aspirin 1/3 and atenolol 121/2. All these without dr supervision. Have now the last to drop. Withdrawal symptoms of a throbbing heart beat are there but I check my pressure in my house. Average is 118/68. Thanks. . Fast forward after 5 days of completely stopping the meds I feel like liberated a new. The heart is thumping but l Will win. My diet is mainly a avocado, banana, potatoes, sweet potatoes, whole grains, olive oil, ginger, tumeric, oranges, watermelon, spinach, cabbage, peanuts, sardines, garlic, kales and eggs. These have assisted to overcome the transition. My ED of 20 years has reversed in just 5 days. It is hallelujah to my God. God bless Dr Gupta who gave me the final push. Dr Berg is the contemporary. Best wishes from Kenya.

[paulinefriend]

Thank you so much. My aunt had Prednisone for a week, she had to stop it when it is finished because this medication was given for only one week - She almost died, not the doctor and not the pharmacist advised her about its withdraw symptoms or how to lower its dose and come out slowly and safely. Since then, whole family checks every medication given on the Internet before even using them!!!

[judylee]

I have been far more conservative coming off the heart meds than the doctor or the pharmacist recommended. This video is BRILLIANT, in so many ways, because now I understand why I’m still trapped on the Metoprolol and why I still “need” it. I am strengthening my heart through minerals and exercise but am not trouble by the small amount of Metoprolol I’m now taking. Before this adjustment the dosage was such that it left my muscles therefore myself feeling like crap. It seems hard to help a doctor understand. Thanks Dr Gupta. What a blessing you are.

[glgartman]

Thank you so much for this important information. I wish all doctors were so informative. And thanks for using your "down time" to keep helping patients! So many patients would be more medication compliant if doctors would explain things and not just give orders.

[DavidChristieCareerCafe]

My experience is that the Cardiologists dispense it (and other pharmacopeia favourites ) as a standard panacea after any and all cardiac events without thinking it through and have no methodology where they are happy to take the patient off-ever. I have never had any counselling on food based alternatives, just vague entreaties to modify my lifestyle. What has been effective has been my fundamental approach to mental health via several professionals and I feel damn good, thanks.

[vleiratfilms]

Very useful. I was warned when I was prescribed beta blockers that the side effect was to lower my existing low blood pressure. After a recent full test with my cardiologist I was told I was fit as a fiddle, and could gradually reduce and eventually stop taking them. At 79 I am very active around the home, up and down ladders, maintaining everything. But sleep becomes difficult after a few hard days work, as the thumping when I lie down takes forever to quieten. This video certainly has made me feel much better about reducing and eventually stopping the atenolol drug. ❤ will check out your other videos.. have subscribed 🌈🇿🇦

[cathydavis]

At this point in my life i am taking no medications. I had open heart surgery at 16. quit taking those meds. at 22. So glad I did, recent studies are not good.. was on blood pressure meds. for over 20 years. My poor legs got so weak.. Asked my doctor to change one instead she put me on another, so i was taking more. My legs got so weak, I would almost fall down just trying to go get the prescriptions.. So I got pissed. Quit taking all meds. 4 months ago. I have cleaned my sons house from top to bottom, repacked every box. Came to my cottage. Have cleaned and cleared that out, Cleaned out my new RV. The old one is next, then the barn. I have never felt so good. I don't want to put things off, I want to get them done. If i die tomorrow at least I will die doing something. Not laying around just waiting to die.. I just turned 67. i appreciate what the doctors do do, because they are necessary. But pissing prescriptions has got to stop. Cant they just say you need to go home and quite smoking, or drinking, or eating to much sugar or drinking too much coffee. All these things have an effect on our health. This is a stressful world and not getting better. Stress its self is a killer. Balance is the answer. Everything in moderation. Canada food guide... We are what we eat. If you eat only dead food then expect to die.

[marleneholik-lswr]

My prescriber finally put me on a beta blocker as a comfort measure after I asked for help from benzodiazepine withdrawal . A few months later I was diagnosed with diabetes type 2. I researched it and the American Diabetes Association confirmed the fact that there is a relationship between them and hyperglycemia!

[JeremyRemele]

Dr, I took Nebivolol to reduce cardiomegaly. My heart grew due to poor lifestyle choices, it has since returned to its normal size through major lifestyle improvements, nutrition, exercise, and the employment of Nebivolol.

My cardiologist shook my hand.

I have your videos to thank for the lifestyle improvement sir. At the rate I was going, I would’ve died before 40 years old.

[bozzikevin]

Thanks so much for the thorough and comprehensive review. Completely understand all aspects of my beta blocker, half life, the receptor sensitivity, and what types of conditions they are used for. The prognosis vs symptoms (making you feel better) was really informative! You’re a fantastic teacher.

[tomborn]

Most informative, a solid comprehensive discussion on Beta-blockers that will be most useful to many people!
Thank you..

[alpha]

Thank you Dr Gupta. You are appreciated. You help me to understand exactly what is what in regards to my heart. The doctors here just do not have the time to talk to you like they should. You are a blessing!

[jenniferbate]

Thank you so much Dr Sanjay. I realise you have had some recent sadness in your life and I wish you peace and healing. You are a great blessing to many people, including me, and your explanation and compassion bring much understanding and calm. Thank you again and God bless you.

[sonnyreddevil]

So it takes a GP less than 10 mins to put you on them but getting yourself off them could possibly kill you. Incredible

[traleyton]

Useful information. I am trying to get off beta blockers. If the General medical practitioners were good, one would not need to look for these videos. NHS is in a chaos. Several cardiologists only talk to patients on phone and some have never met the patients. That includes the flagship Barts at Barbican London. I am envious of animals who get a lot better health care.

[pearlhall]

You probably won't see this, but I love your videos. I always considered myself healthy, as I've never been on any medications, & just use peppermint oil for headaches. But on Dec 4th I had a heart attack. The doctor said the heart attack I had was called, "broken heart syndrome", which is exactly what I felt, when it hit me. I was put on a machine, where they put dye in your wrist, & they discovered that I had no blockage, whatsoever. I don't smoke, drink, or do drugs, & I had quit gluten, & sugar 11 months prior to the attack. But, what I did have was stress. And because of that, I had also gained an unhealthy amount of weight. I had slowly lost 20 pounds, prior to the heart attack. I just want people to know what I didn't know. And that is, just how dangerous depression & stress are to your heart, & health. I was released to go home on Dec.10th, with 2 prescriptions, plus aspirin. The aspirin was because I refused to go on blood thinner. The two prescriptions were Lisinopril & Metoprolol. I had begun coughing in the hospital. I thought it was a cold coming on. But, as time went on, I discovered it was a reaction to one of the medications. I left a message for the primary care doctor the hospital gave me. Five days later, I got a return call, & she thought it was the Lisinopril. I told her I thought it was the Metoprolol, because it felt like when I had bronchitis a few years ago, & I heard that Metoprolol can have that effect. She told me I could stop taking the Lisinopril, & see what happens. And I might add, she was rather uncaring & rude. I would have just stopped, had my sister not told me that her doctor weaned her off it. So, I weaned myself off it. I was off it for10 days, but the cough was as terrible as ever. I can't sleep at night, due to coughing so much, & it makes you have to pee, so then I'd have to go downstairs to relieve myself. This is every 2 - 3 hours. I called my doctors office again, & they told me they would let the doctor know that the cough had not gone away. Four days later, which is today, I finally heard from her office. They told me that she said I could go off the Metoprolol, & see what happens. They said to call them back when the coughing stops. I don't feel good about this, because they did not tell me to wean myself off that either. If it wasn't for you educating people, about the dangers of that, who would know? So, I finished watching this video again to learn how to wean myself off the Metoprolol. Thank you for your informative videos. You seem so kind & understanding, treating patients like people, not just numbers. I feel like the doctors just want to check you off, & get you over with. Or push the pills on you. When i told her I need therapy, to help me with the stress, & that the hospital hadn't found a therapist for me yet, her response was to put me on another pill for that. I told her that I'm already stressed out by the ones I'm on now. I don't want to add to it. They are ignoring that stress caused my heart attack & that should be an important element in healing too, I'm in the process of finding a different primary care doctor. I have an echo scheduled for March 8th. I just wanted to let you know how helpful your videos are, even 1 year after you put them out there, they are doing people good. Maybe someday you can do one on depression & stress. Maybe you have, & I haven't noticed it yet. Have a great day. :) You're my hero! Otherwise, I would be even more stress out. Thanks again.

[littlestation]

I took metoprolol succinate 25mg daily for 20 days and my PVC was gone, My doctor told me I can stop any time . I stopped take it without proper withdraw, my pvc came back you for the information.

[goldenera]

such a great guy - he is in quarantine yet has so much passion to help people- hats off to you doc. one question: if any side effects appear what should a patient do? go back on beta blocker or continue to build natural resistance or something else?

[peggymicsky]

This video was really helpful because I've been considering stopping my medications due to side effects. As usual, Dr. Gupta gave me food for thought and good common sense advice. That's why these videos are so valuable. I trust him and thank him for taking the time. 💖

[gregvedder]

Such important information. Thank you for all you do and especially these timely videos. You do more good for people than you realize.