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Doctors' Answers to "Frequently Asked Questions" - Metaprolol

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Metoprolol as opposed to Digoxin
Question: I would like some information on the drugs metoprolol and digoxin. I have read very specific information on both on the internet but I would like some response to my questions in connection to my mother. She is 79 years of age and since 1994 has been taking the drug digoxin for heart arrhythmia. At a very early age she developed rheumatic fever which has left her with narrowing of the mitro valve and some heart enlargement. The drug digoxin, although its purpose was to regulate, did not do the job. Just this past weekend her family doctor admitted her to hospital and prescribed the beta blocker metoprolol. Her response thus far to her children has not been positive. Her heart rate is staying between 40 and 50 when in bed. The last blood pressure taken was 92 over 50. She is not on warfarin but it is being suggested to her. When I read the information on metoprolol the side affects were numerous. I am very concerned. Is there no other drug alternative?

Answer: Metoprolol is a beta-blocker. This is a class of drugs used for many purposes since they clinically block the effect of adrenaline on different organs. They always slow the pulse and lower blood pressure. The pulse lowering is the effect desired by your grandmother's physicians. I'm not clear whether she is in atrial fibrillation or not. Many patients with rate problems are, especially with her drugs. A drug called amiodarone is also occasionally used to control atrial fibrillation and will not lower blood pressure. If she is not in atrial fibrillation there are some other alternatives. These are mainly calcium channel blockers which slow the pulse like verapamil, but, they; will also lower blood pressure. Common side effects of beta blockers are fatigue, low pulse, nausea, nightmares, occasionally shortness of breath, depression, etc. There are others, but these are the most common. Elderly people don't tolerate beta-blockers well, but they don't tolerate any medication well and her heart condition is clearly disabling. This is often a tough problem.
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