About William J. Walker, Pharm.D. Expertise Homeopathic, alternative, herbal, natural, adverse drug reactions, side effects, risks, outcomes, research, medication, rational therapeutics, infectious diseases, cardiology, pain management, nutrition, psychopharmacology, oncology, pediatrics, sleep disorders, tropical diseases, HIV, drug interactions, substance abuse, illicit drugs of abuse, geriatrics
Experience
Past/Present clients State of California Department of Youth Authority
State of California Department of Mental Health
County of San Luis Obispo Public Defenders Office
County of San Luis Obispo District Attorney Office
TenetHealth Corporation
Boy Scouts of America
Better Life Institute
Campus Crusade for Christ
Volunteers in Medical Evangelism
His Healing Hands, Inc.
AskMe.com
Kiwanis International
Question Hi doctor: My mom has hypertension, glaucoma, and bipolar, she takes 10mg of norvasc/day lithium 750mg/day, navane 2mg day/ and timoptic drops and pilopine gel for glaucoma, her bp is still a little high but what concerns me is her pulse is a little high all the time, about 90-100 bpm, granted she is sedentary and about 30-40 lbs overweight, which i read can make a pulse higher, i was going to ask her doctor if toprol 50 would be a good choice and dose not only for the slightly elevated bp but more so for the heart rate, along with the above mentioned med's and conditions i wanted to ensure no major problems. Her thyroid level are normal by the way, creatine a little elevated possibly due to chronic hypertension? or lithium use for 10 years her age is 64 thanks so much for your input
Answer By all means consult with her physician accordingly. He might be able to help you rest at ease with her condition or he might be able to work with you in fine tuning her regimen or both. Your suggestion is actually a good one. You have selected one of the best agents for slowing the heart rate and you have properly chosen a nice sustained release version. Additionally metoprolol carries the benefit of a profound reduction in cardiovascular mortality and prevention of myocardial ischemia. This is a drug that is hard to argue against for almost anyone in advancing years. Quite properly you have also selected an agent that is actually therapeutic for glaucoma too. Not so effective unless in eye drops but the point is well made just the same.
All things considered this makes sense except for one thing. Beta blockers are quite prone to causing depression. Slightly less often they cause mood lability. Your mother is already managing bipolar disease so this should be closely watched. It is manageable though as I have many patients who successfully combine a beta blocker in the midst of managed mood disorders. It can safely be done but just be aware. From what I know of the case I would endorse the choice but I would start at a low dose and go very slow. You thought Toprol 50. I recommend Toprol 25 instead. In fact, I would even begin with 1/2 tablet. Toprol 12.5 daily for one week then re-evaluate. There is no rush to push the dose nor is there one to get the desired effect either. Have her take her time getting there so as to not upset the balance in her mood. Involve her physician so that all the proper monitoring is done.
