Expert: David Richardson - 8/21/2007

Question
I just started taking Toprol XL 2 weeks ago.  I am feeling very tired and somewhat drowsy.  I have what may be some complicating factors- 1- i had sydenham's chorea/rheumatic fever which caused RHD, mitral valve replace in 95- so this is why at 56 I have A-fib..?  Had perfece BP, Pulse, Chol until after 95- between age and diet restrictions all became higher.  Had severe asthma as a child, and have had several bouts with Pneumonia- some wheezing.. So-
I take coumadin already cause of valve, take Lisinip...HCTZ for high bld press, take Crestor for Hi cholesterol... and now Toprol XL 50.  Will my body adjust to the Toprol?  I'm trying to lose weight, and my pulse monitor shows that when I'm resting I'm at 55-65, when exercising at no higher than 89....
Any advice will be greatly appreciated.  I thought I was done dealing with heart problems and just on 'maintenance'-- and now this!

Answer
Dear Mary,

Toprol makes some people feel tired and drowsy and wheezy.  Another class drug (called calcium channel blockers) lowers blood pressure without causing fatigue or drowsiness or wheezing.   Amlodipine (Norvasc) and diltiazem are examples.  My suggestion is stop the Toprol and see if your crumby feelings clear up and what your blood pressure does  If BP is too high, add amlodipine.  Remember that beta blockers like Toprol should not be stopped abruptly, but take half your current dose for a week, and if the dose during that week is more than 12.5 mg, decrease the dose weekly by half till you get to 12.5 mg., then stop.  Yes, the mitral valve disease enlarged the left atrium and that causes atria fib when we get older.

Please write back if this note doesn't answer all your questions.

David Richardson