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  • Atenolol Question

    Hi All,

    Has anyone noticed that when you first start taking Atenolol, you felt great for quite a while, then for no apparent reason had to start increasing your dose to control your symptoms?

    When i first started taking the stuff, i thought it was a miracle drug. I went for almost six months with virtually no symptoms. I could barely feel my heart beating in my chest, much less the pounding that i was used to. Now all of the sudden i've had to double my dose, and find that my gradient is slipping back up toward the 100mm mark.

    Am i just developing a tolerance to the drug, and down the road may have to switch to another one entirely? Or possibly just the result of external stresses and influences not related to the drug at all?

    Thanks for any advice or similar experiences anyone has,

    Jim
    "Some days you're the dog... some days you're the hydrant."

  • #2
    Re: Atenolol Question

    Hi Jim,
    I was on Atenolol 50 mg / day and was cut to 25 mg / day due to other medical problems. Then I was cut to zero – then I was increased to 25 mg / day to see if I could tolerate it. Then I was diagnosed with HCM and was increased back to 50 mg / day.

    Frankly, with everything going on at once, I could not distinguish any difference between not taking the medication, or the various dosages I was on. That doesn’t mean there weren’t any differences, only that I couldn’t distinguish one situation for another, and did not ascribe anything to this drug in particular.

    Let’s face it. Life is not a static situation, and various things are in play all the time. The important thing is that you take the right dosage for the situation you find yourself in now, and let tomorrow take care of itself tomorrow.

    OK, now where’s my rum cake?
    Burt

    Comment


    • #3
      Re: Atenolol Question

      Jim - I started out (before I had my ICD/pacer) only able to tolerate 12.5 mg of atenolol twice a day for a total of 25 mg. I was ok for awhile, and then I started having presyncope and it was recommended that since my gradient was still going up to about 80 with exertion (resting was about 40) that I should get an ICD/pacer so that my bradycardia could be controlled and that I could tolerate higher beta blocker doses. I was then moved to 50 mg./day, and was ok again for awhile, until I started having presyncope again. My gradient was found to be over 100 with severe mitral regurg. Then I went up gradually to 100 mg. a day (50 am and 50 pm), and after a few months again up to 125 a day. I get echos done every few months, and my gradient was down to 40 or so the next time, but last time it was back up to 80 or so (resting), so I am now up to 150 a day, 75 am and 75 pm. My doc eventually wants me on 200 a day, but wants to do it gradually, like over a year.

      I don't know why its always moving, I think its highly individual, and is affected by hydration, etc. Anyway, until you have maxed out your dose on whatever has worked for you, they will probably increase until you can't anymore, and then they switch.

      I have also had problems with arrythmias, but they never want to put me on another drug...only to increase the atenolol.

      I have inquired about surgery or ablation to my HCM expert doctor, but he really feels, as I told you before, that it should be a last resort, and that it isn't a miracle solution. You will still have problems....they just may be different ones. He therefore wants to try me on every dose and med. before we start thinking about surgery.

      Hang in there,

      Cynthia
      Daughter of Father with HCM
      Diagnosed with HCM 1999.
      Full term pregnancy - Son born 11/01
      ICD implanted 2/03; generator replaced 2/2005 and 2/2012
      Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

      Comment


      • #4
        Re: Atenolol Question

        When I was first diagnosed with HOCM my doctor started me on atenolol, 25mg per day. This made me feel soo much better but by evening all my symptoms returned ( sob, chest pain, racing heart beat). They increased me to 50mg per day but I still had trouble in the evening. What really helped finally was taking 25mg in the morning and 25mg in the evening (around 5-6 pm). This worked for about a year. I am now taking 50mg in the morning and another 25mg in the evening. They want me to try to increase the 25mg evening dose to 50mg but I am reluctant to do this because like you I am trying to stay on this lower dose as long as possible. I feel that after time you do work up a resistance to the medicine and I really like the atenolol and would like to stay on it as long as possible. Once they tried to lower my dose of atenolol (25mg) and added another drug called DiltiazemCD 120 mg per day and that DID NOT work. I felt terrible! So I called they went back to just the increased dosage of atnenolo. I have to day I really don't like trying new drugs so I am keeping my fingers crossed that the atenolol keeps working. I know that I can go as high as 200mg per day but I would really like to keep it where it is. On occasion, if I feel really bad in the evenings I have taken 50mg instead of the 25mg and this was okayed by Dr. Asher at Cleveland. I now see Dr. Lever since Dr. Asher has left the clinic to go to Florida. My gradient also varies from 25 (resting) to 100 when given amyl. Surgery was mentioned to me by Dr. Asher last year but right now I feel like that will be by last last resort. I am scared to death even thinking about heart surgery! I have just rearranged my whole lifestyle to accomodate this disease and just pray that it gets no worse.

        Comment


        • #5
          Re: Atenolol Question

          Thanks for all the responses,

          I started out at 100mg for my initial dose last may, felt great, and was on that until november when it was increased to 150mg. Now i'm on 200mg (100 in the am, 100 in the pm) and i'm still not getting any relief. Like the rest of you, i want surgery to be a last resort only, but i'm not sure where to go from here. The atenolol was working so good, i don't know what's happened.

          Thanks again,

          Jim
          "Some days you're the dog... some days you're the hydrant."

          Comment


          • #6
            Re: Atenolol Question

            Hi Jim. I was on 50mg for years. I did not feel a lot of changes, except that I had lots of pappatations and especially at night I had a pounding heartbeat.

            Hopefully they will be able to find something to control your symptoms soon.

            Peace,

            Leon
            God Squad co-moderator
            Nothing is as gentle as strength and nothing is as strong as gentleness

            Comment


            • #7
              Re: Atenolol Question

              Hi All,

              Is 200mg the highest you can go on atenolol? Most of the literature i've read states that no additional benefit is received at dosages above 100mg, but us HCM'ers always seem to be the exception to the rule as far as dosage limits are concerned. Nevertheless, even with HCM, i've never heard of anybody going above 200mg?

              My absent cardiologist has been relaying messages through his nurses regarding the dosage increases. Who knows what he is actually telling them or if they are relaying his messages properly. I finally get to see the man on thursday. I had to beg and plead with them to give me an audience with his majesty. After blowing me off for so many months, i hope this guy has enough time set aside for me to ask him a whole lot of questions

              I'm going to try not to go into the appointment with an attitude, because that's really not going to help anything, but the fact is that i've been out here with a whole lot of issues going on and the man has been nowhere to be found. At the very least, i'm going to ask him for the names of at least three other cardio's who have experience with HCM.

              Oh, the joys of being in an HMO. I honestly think i was healthier before i had this crappy insurance

              Thanks for all your input,

              Jim
              "Some days you're the dog... some days you're the hydrant."

              Comment


              • #8
                Re: Atenolol Question

                HI Jim , I can't speak for anyone else but it certainly is possible to be on higher doses of Atenolol. Yes 200mgs is considered max but, the literature also says push the betas beyond max if necessary for HCM and control of the symptoms. I don't know if you remember but that is why I left one doctor at one Boston Hospital and then went for a second opinion at NEMC. At that time I had been at 200mgs daily divided am and pm. One of the first things tried was titrating me up all the way to 400mgs. At that dose my head was in a constant funk and I felt very depressed and weepy. Lowering to 300mgs qd attained the same effect as 400 but my head and mood cleared. The rationale for the psych symptoms is that beta blockers can be used for depression and mood disorders but the effect is very dose related ; I was going the oposite way. It was good for me that the 300mgs worked fine for my HCM symptoms. I stayed at 300mgs untill my myectomy last Oct. . I am now at 100mgs and being titrated up on Verapamil for the reccurrent chest pain post surgery. If that does not work they will start to increase the atenolol like before cause it often works to relieve chest pain if calcium channel blockers don't do the trick. I just know about the beta blocker thing because I ran a psych assessment clinic in the past. Hope the info helped. Pam
                Dx @ 47 with HOCM & HF:11/00
                Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
                Lead failure,replaced 12/06.
                SF lead recall:07,extracted leads and new device 2012
                [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
                Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
                Genetic mutation 4/09, mother(d), brother, son, gene+
                Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

                Comment


                • #9
                  Re: Atenolol Question

                  Hey Jim,
                  From the posts it appears that different folks require different dosages, and the limit is higher then either of us was aware.

                  I am in an HMO also, and I would like to make a suggestion if I may. I got a list of participating doctors from the insurance company. While I just lucked out in finding this cardiologist when he treated me in the hospital, you can use the list provided by the HMO to find one. Call the doctors on the list and ask at their office if the doctor treats HCM patients, and if so, how many. You will then have a shorter list from which to choose. I really don’t think your current doctor will be very helpful to you in finding his replacement.

                  When you see him I would also suggest talking to him about his unavailability. Tell him you want a doctor who will answer your questions and one that will see you if and when you have a problem. Maybe you can actually get him to perform to your requirements – otherwise - - - Happy Hunting. There is nothing as useless as a doctor who won’t treat you.
                  Burt

                  Comment


                  • #10
                    Re: Atenolol Question

                    I'm just curious. If those of you on atenelol have high normal /high Blood pressures. I have a very high resting heart rate so we decided to try 12.5 mg. of atenelol and I felt icky bp dropped around 80/50. My heart rate wasn't quite what they wanted and so I was increased to 25mg and I circled the toilet with 60/16 for a bp. Is this a normal outcome on such a low dose?

                    Mary S.

                    Comment


                    • #11
                      Re: Atenolol Question

                      Mary

                      you have those tiny blood vessels, which makes you a special case. bb's will lower your bp, certainly, but i don't think there are any averages in the literature.

                      me, for example, i'm taking 50mg of atenolol 3x a day now and my bp is totally normal.

                      jim --everyone is right about HCMers having to go their own way on dosing. the literature is almost never including HCMers in the info unless it specifically says so. i wouldn't put too much stock in the "no benefit" over 100mg. if a higher dose makes you feel better, that is the point.

                      as for not feeling better on a higher dose, then you have to try higher or go sideways to a different medication.

                      i've taken about five different betablockers in my life. it is not out of the ordinary to need more after a while. switching around isn't a bad thing, either. i am actually going back to atenolol after refusing to take it for 20 years. and now i like it much better than my old nadolol, which i liked better than metoprolol. whew! i'm tired just typing this.

                      try not to worry so much about the dose. just concentrate on feeling better.

                      s

                      Comment


                      • #12
                        Re: Atenolol Question

                        Hi All,

                        Mary, i've always had low/normal blood pressure, like most of us with HCM i think. The nice thing about the atenolol for me, was that it lowered my heartrate without lowering my blood pressure much... usually around 110/80 or so. I was pleasantly surprised with it.

                        I guess i was a bit naive about the atenolol. I figured since i was doing so well on the 100mg, that i would just take that for the rest of my life and be fine. And it's just so darn cheap... for those of us without prescription coverage, the ten or twelve bucks a month it costs to take atenolol is a godsend

                        I'll see what the doc says. There could be a dozen reasons why the atenolol just might not be working very well now... physical stress, illness, or any number of other things which might be temporary.

                        Thanks again,

                        Jim
                        "Some days you're the dog... some days you're the hydrant."

                        Comment


                        • #13
                          Re: Atenolol Question

                          Originally posted by Toogoofy317
                          I'm just curious. If those of you on atenelol have high normal /high Blood pressures. I have a very high resting heart rate so we decided to try 12.5 mg. of atenelol and I felt icky bp dropped around 80/50. My heart rate wasn't quite what they wanted and so I was increased to 25mg and I circled the toilet with 60/16 for a bp. Is this a normal outcome on such a low dose?

                          Mary S.
                          Mary,
                          Come Wednesday, I know just the person to ask. . . I'll bet you do too.
                          Burt

                          Comment


                          • #14
                            Re: Atenolol Question

                            Such a smart man you are Burt .

                            That is just one of a ton of questions they are going to get tomorrow! I'm one of the weird HCMers! Many times the meds I've been on are contraindicated but they worked for me because as Sarah said I've got those tiny vessels. It really does complicate things sometimes. I'm just hoping this last echo and cath are wrong lets put it that way!

                            Mary S.

                            Comment


                            • #15
                              Re: Atenolol Question

                              Started 18 years ago on 50 mg of Atenelol, upped it and felt crummy, moved me to Toprol, ended up at 150 mg. and feeling worse and worse...what we did not know was that I also had an arterial blockage...the combination of the 150 Toprol, reduced blood flow to my brain, etc...dropped my bp to 90/60...had a stent in Sept., alcohol ablation in January and now able to run up stairs, jog, stay awake most of the day! and down to 100 mg. Toprol XL. Still twinges of pain when I am either bent over or emotionally stressed. But, am delighted with the results of Ablation.
                              Alcohol ablation January, 2004. Stent placed, September, 2003. Now...at age 53...working out, building a cabin, sober and clean. A 2nd chance at life. There is hope, there is a future. Have faith.

                              Comment

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