Beta Blockers withdrawal

Treatment and medication
1

Hi am 67, last year I had throat cancer managed to get it treated immediately and during radiotherapy treatment because I was unable to eat or hold anything down for three weeks I became dehydrated my blood pressure dropped to 62 ! heart rate 200bpm called 999 had 3 litres of saline + and everything corrected itself stayed overnight and was prescribed BBs 1.25mg and aspirin plus cylacine which helped me to start eating again. My GP kept me on BBs even though she put a letter on my file stating she was happy for me to stop them, I was going to India for three months so she doubled my dose to 2.5mg. I had a FULL heart scan which was Normal just before I left.

When I arrived in India my BP went up to 185/100 saw doctor in India went onto BP tabs. But after increased exercise after spending the last 12 months fairly doormant because of my cancer my BP started to correct itself so I had the opposite affect so after 2 months I stopped BP tabs and felt Ok.

I have been fairly active since but started to feel weak and unwell, so decided to look at what the BBs were doing to me, checked BP before taking BBs to find BP was raised but after BP shot up 160/90 Heart rate dropped to 55bpm, I Halfed my dose and found I felt better BP was raised just after taking BBs kept on 1,25mg  and meanwhile arranged an appt at docs, told her my findings and she told me Just to STOP taking them 5 days after reducing my dose !

Went Glamping the following week felt good until the last day of our holiday whilst tidying up to leave for home my heart went into a rythem all of its own !

I have since had two similar episodes and had paramedics out, they said my heart was fine my BP was their main concern as it was 193/110 and said anxiety had pushed up the BP. He asked me what I was frightened of and I said that I was frightened of my Heart Stopping !

Spoke to a doctor 3 days later as they could not see me for a week, after having another episode during a shopping trip and she said to go back on the smaller dose and stay on that ! I said no way am I going onto a drug for the rest of my life that I should not have been on in the first place, they seem to be unaware of how dangerous this drug is !

Anyhow after reading this forum I feel that following my own instincts and quitting these BBs is critical to my future health, I can now understand why ERs are full ! Most of them are people like us on BBs !

Still feeling Lousy but I am full of hope after reading these articles, just want to say thanks to you all for taking the time to let us know what has happened to you, so much so I had to tell you my story, will keep you posted I am only in my third week of ditching the BBs......

 

2

Philip, I have wrote this on some other topics, so I'll copy/paste some key things about BBs in our bodies:

Beta blockers slow down our Heart rate, like from 70-80 in resting to 60-ish, but also heart pumps weaker in each second when we are taking BBs. Instead of usual number (let's say 100%) it pumps only, let's say 80% of blood in each second (so, a heart pumps lower amount of blood in each second when we take BBs, compared to levels before Beta blockers. Let's say 0,80 litres now under Beta blockers, and 1,0 litres before BBs). Because of that, a heart as a muscle gets weaker (since it is working slower and pumps lower amount of blood). That is good in terms that we are "saving" our hearts and it's workload is lower, but in general, a heart is just weaker and weaker as a muscle.)

Now, when we drop BBs, our heart suddenly needs to pump 100% of blood again, in each second, like as it was programmed by default when we were born. And if we were taking BBs for 1-2-5-20 years, heart (as a muscle) got used to that 80% of pumping-level.

It is a huge shock for the heart, since it suddenly needs to beat much faster and pump much more blood in each second. You know that feeling when you didn't do any activity for years and then you start running/biking and similar for 1 hour per day, and then your legs and muscles hurt every day after that activity - Well, imo, now we are experiencing the same problem with hearts.

Plus, the problem is, when your legs hurt and when you are running too much, you can just stop for a few days and get some rest until they get better. But a heart can't get a rest, since it needs to beat all the time. You can't stop when you are tired...

So, more or less, a heart is under a huge stress currently and it is deconditioned. And it takes a few weeks/months until it gets somewhat conditioned and until it will be again, strong enough to pump 100% of blood in each second with 70-80 HR without any problems.

If your resting HR without BBs is slowly dropping from 100 to 90, 85 and 80, it means that your heart is slowly getting stronger and more conditioned. But, the longer you have taken BBs and the weaker your heart was due to BBs=the longer it will take to finish the withdrawal (or, to get your heart back in a normal shape).

This is why a longer tapering may lower the strength of withdrawal and stress to our hearts/whole body. That way, heart will be forced to go from 80% of blood pumped to 85%, then 85% to 90%, then 90% to 95% and 95% to 100% in the end. (When you drop for example, from 5 Mg to 4 Mg, then to 2 Mg and in the end to 1 Mg, then 0,50 and 0,25 Mgs for a few weeks.) But when you quit cold turkey or when you wean off for only 1-2-3 weeks, your heart will need to readjust from 80% to 100%, which is a huge stress, as you can see.

I am weaning off for the last 5-6 Months slowly, and it still hurts like hell and a heart still has lots of problems to adjust to these new 85%, 90% and 95% levels of pumped blood...

I was taking 1,25 of Biso for a year and a half. A few months ago, I tried to quit them and lowered the dose from 1,25Mg to 0,90, then 0,60 and 0,30 Mg in the end, and then I quit them completely (from 0,30 to 0,0 Mg).

I didn't "survive" it, I had too high pulse all the time for 2 Months and had to go back on BBs.

A few Months later, I tried to wean again, this time I lowered the dose like: 1,25 then 0,90, then 0,60, but this time: 0,50, then 0,40 for 1 Month, then 0,30 for a Month, then 0,20 for a Month, and now I am already 2 Months on 0,10 Mg (since I wasn't feeling well, even a drop from 0,20 to 0,10 took some time until my body readjusted).

Also, it seems that when we take BBs, we get less blood and oxygen into our organs and muscles and thus all muscles in our body atrophy to some extent.

So, when you quit BBs: 1. your heart will be under a lot of stress and it will take Months until it will readjust into a normal (slower) rhytm. 2. your all muscles will need months to get back into a shape and they may hurt you a lot (like lungs, abdomen and similar) once you start walking again, it will be extremely strange feeling. For example, when I lowered Bisoprolol, my lungs started to work better and I was able to take deep breaths again, and when I started to walk again after BBs, on first days, my lungs and the whole upper abdomen would hurt for 2-4 hours after walking as if I was lifting some heavy weight for 24 hours (lungs and muscles around lungs would hurt as if I worked way too hard and as if they will stop breathing out of tiredness in each moment. Very strange and scary feeling in the beginning. But it disappears once you get into a better shape and once your lungs start with deep breaths on a regular base again). 3rd, you will have problems with anxiety, there was a talk about it yesterday on another topic:

"Imagine that you have 100% of adrenaline in your body as a normal person.

When you are scared or extremely happy, it jumps to 120% and then your heart starts to beat faster, you breathe faster etc.

Now, when we take Beta blockers, Beta blockers don't allow to all adrenaline to affect your heart and brain. So, instead of 100% of adrenaline, only 80% of adrenaline affects your heart and brain.

That means that your heart beats slower and even when you are scared or happy, it doesn't beat as fast as in normal person.

So, for example, when you take Beta blockers, your heart will be affected by only 80% of total adrenaline, and when you are scared it will be affected by 100% of adrenaline.

While in a normal person, who doesn't take drugs, they will be affected by 100% of adrenaline all the time, and when they are scared (for short periods of time), they will be affected by 120% of adrenaline.

Now, our bodies are always re-adjusting to new circumstances. And so, when we take Beta blockers, our heart, brain and body start to think that 80% of adrenaline is "a normal state of our body".

And then, when you lower a dose of Beta blockers, let's say from 10Mg ro 5Mg, there will be less of a drug in your body, so the drug won't be able to block all the adrenaline anymore. For example, you won't be affected by only 80% adrenaline (on 10 Mg of Beta blockers), but with 90% of adrenaline (on 5 Mg of Beta blockers). If you quit them completely, you won't have any "protection" against adrenaline anymore, and your body will be affected by 100% of adrenaline again.

BUT, the problem is that a normal person, who never took Beta blockers is used to 100% of adrenaline, since it is a normal state of his body for him. While for us who were taking this drug for months or years, our body is now readjusted to only 80% of adrenaline.

So, when you lower the dose of a medicine or when you quit them, our body is in a huge shock. You are more or less under a huge stress all the time. More or less, when you quit beta blockers it is the same as when a normal person is scared to death or something. The problem is that a normal person is scared only for a few hours or days, while we, who quit beta blockers, are in that state of stress for 2-3-4-5 Months constantly until your body readjusts.

In that period after quitting Beta blockers, you will experience huge anxiety and being nervous and scared all the time for no apparent reason. You aren't crazy. This is happening because your body now has to cope with too high levels of adrenaline (and adrenaline is now free in our blood stream, because Beta blockers aren't blocking it anymore).

Because of all that, you will be nervous and have some anxiety.

And physical symptoms of anxiety will usually be: scared, short breath, dizziness, a lump in the throat, as if you are chocking from time to time, heartburn, burning sensation in abdomen from time to time etc

Plus, some classice symptoms of anxiety like:

Surge of overwhelming panic, Feeling of losing control or going crazy, Heart palpitations or chest pain, Feeling like you’re going to pass out, Trouble breathing or choking sensation, Hyperventilation, Hot flashes or chills, Trembling or shaking, Nausea or stomach cramps, Feeling detached or unreal.

And now, your body will again try to re-adjust to these new circumstances. But it will take some time (2-3-6 Months) until your body re-learns how to cope with adrenaline again. That means that the symptoms will usually be the strongest in the first 1-2 Months after quitting BBs and then later they will be weaker and weaker in majority of people.

One of the problems is that a lot of people feel very sick when they stop taking Beta blockers and due to horrible pains, anxiety, too high Blood pressure (due to a withdrawal) and some tachycardia or arrhytmia (due to a withdrawal) they think they need Beta blockers again and they are back in hell with Beta blockers.

So, the problem is: on beta blockers you will have 2-3-4-5 side effects due to drugs and then if you quit them, you will experience even worse side effects from a withdrawal (which can last for Months).

But then, if you can survive through a hell of a withdrawal, maybe you'll find luck with some other medicines with less side effects for you.

About anxiety from a withdrawal, my docs told me that I can take small doses of Valium daily for 1-2-3 Months until my body will re-adjust to 100% of adrenaline."

So, Philip, you will experience now:

1. too high heart rate and possibly dangerous arrhytmias for a few weeks/months

2. jump in a BP from time to time

3. problems with all muscles in your body

4. surely some anxiety due to free adrenaline in your system now, and then anxiety will again cause even higher heart rate and blood pressure

Imo, it would be better if you haev weaned slowlier.

If you still have some Bisoprolol at home, maybe you should cut the tablets into smaller pieces, like 0,30, 0,20 and 0,10 Mg. It seems as a low amount, but if you'll stay on that level for 1-2 Months, your body will readjust more easily to these lower levels, and then when you'll finally feel fine on 0,10 Mg, you can drop it completely (or take it every other day for some time and then drop them completely).

Good luck with a withdrawal, but for a lots of people, it can be extremely tough and dangerous.

3

Hi Bob, Thanks for replying so Quickly, as you know all we really want is some guidance as to what to do when we feel so ill. I whole heartedly agree with your conclusions (forgive the Pun) After managing to treat my Cancer promptly and controlling it, to be dropped by doctors into this trap that I am now in struggling to get out of. I starting spitting blood when I was in India and Walked into one of their Hospitals of the street with no appt, within 20mins I was on an intravenous drip ! Returned home and went to see a GP with all my notes from the Indian ENT specialist and a Visible tumour on my tonsil and he told me to come back in a week !  The last thing I feel I want to do is listen to GPs giving me advice.

Your information makes complete sense and I have started the doses you recommend and feel better already, I have always taken my health as my responsibilty, but after going through the cancer treatment which, once I was in the sytem I could not fault, I let my guard down and ignored my instincts.....

Once again thanks for your Help, I will keep you up to date with my progress.

Phil.

 

4

No, problem Philip

I am younger, I am 30-ish, but I also had some problems, and was put on BBs and they made me feel 10 times worse and more sick than before BBs.

All I can say, this is my experience (I was taking them for SPVT which occured once-twice in a year for a few minutes):

I was taking Bisoprolol for 1 year, dose 1,25. My problems on Bisoprolol were: troubles with breathing, as if I was breathing too shallow or too slow all the time (as if my brain is sleeping/drugged and it is not sending signals to lungs to take a breathe. A strange feeling). Further, my BP dropped from a usual 120-130 to 90-100. I was feeling tired and dizzy all the time. Before BBs, I used to walk one hour every day, and on BBs I barely managed to walk 10 minutes, I was dead tired after 10 minutes and lungs felt as if they don't want to breathe anymore. And on some days, I felt as if my heart beats too slow and if I tried to walk or something, I felt as if heart hurts (it is hard to explain, I just felt wrong and sick all the time on BBs, as if I have 80 years and not 30). Also, legs and body in general on some days felt as if I am carrying tons of weight on my shoulders. It just felt wrong all the time.

After 1 year of that hell, I figured out that I felt way better before BBs. So I tried to quit them, but as I have wrote, I dropped from 1,25 to 0,30 or 0,40 in 2 Months (maybe too fast since I wasn't filling well while lowering the dose) and then I dropped to 0,00.

While I was lowering the dose from 1,25 to 0,30, I felt much worse than on 1,25 Mg. Back then I thought that I am feeling bad because of BB's side effects, but now I know that I was feeling worse because it was a withdrawal from 1,25 to 0,30 Mgs (pain in the abdomen, pain in lungs after walking, feeling ill all day long, nausea etc)

Maybe I should have waiting for a little longer before quitting.

When I tried to quit them for the first time, I felt the same as on BBs for the first 2 weeks after quitting (imo, my blood was still filled with Beta blockers) and I thought: well, I don't have any withdrawal, nice!

But then, after 2-3 weeks after quitting, one morning, my heart rate just jumped from 70 to 100 (while sitting) for no reason, and it stayed that way for hours. If I moved, tried to walk or tried to go to bathroom, it would jump to 120-130, and it felt as if my heart really hurts.

HR stayed elevated for the next few weeks (it was getting better slowly), but still from time to time, for no reason, HR would jump to 100-120 for a few hours on some days.

During one of those episodes, a doc told me to go back on BBs.

After that I was taking only 0,60 Mg (half dose) for a few Months, but side effects of BBs were the same as on 1,25.

After 2-3 Months, I decided to quit them again, but waaaay more slowly this time, since I suspected that BB's withdrawal caused those problems when I have quit them for the first time (docs will tell you: no, it's not a withdrawal, you need drugs. Even though, I never had a heart rate 100-120 while resting before BBs, in all my life. My HR while resting was always 70-75).

Anyway, as I explained, I dropped slowly: from 0,60Mg to 0,50Mg, then wait for 1 Month. Then 0,40 and wait one Month, then 0,30 and 0,20, and 0,10.

Currently I am at around 0,10 or lower.

(If you don't know how to cut exact pieces of 0,50 or 0,40, don't worry.

Just take the knife and split the 5,00 Mg tablets into 10 pieces. Each piece will be around 0,50 Mg.

Do that with 3 tablets and you will have 30 pieces of 0,50 Mg.

Now, since some pieces will be bigger, take those bigger pieces in the first 1-2 weeks, and in the next 2 weeks take dose smaller pieces.

That way you will actually take 0,55 then 0,54 then 0,52 then 0,50 Mgs (roughly), if you get me.

So, don't worry if pieces are not exactly the same, nothing will happen.

Just take them from the biggest to the lowest and you will have even slowlier weaning that way each day.

Then after one month, just split the 5,00 Mg tablet into 12 pieces, that will around 0,40 Mgs. And split 3 tablets that way, to create 36 pieces.

Anyway, you will understand the principle...

Imo, the docs think that we will wean off too fast. They always say: take 1 week 2,50, then one week 1,25, then one week 0,60, then take 0,60 every other day, then quit.

Well, it is not that simple for majority of us.

Weaning off for me was painful even this way, but it was way more manageable.

Since I tried both ways: quitting fast and quitting slowly, I would tell to everyone: please, do it slowly, it is much less painful and you will have a lower BP and less scary heart rate all the time, you won't need to go to ER this way probably.

Again, even this way there were a few weeks with elevated HR, but this time, it was 90-100 while resting, and not 100-120. And later only HR 85 on some bad days.

There was some nausea, dizziness, pain in abdomen, headaches.

But after 4-5 Months of slow weaning, lately I have been able to walk again for 15 minutes in the morning and 15 minutes in the evening, which I wasn't able for 2 years (since when I started to take BBs).

So, I am slowly feeling like my old self (before BBs).

I still have to quit the last 0,10 Mgs of BB, plus there is still some anxiety left and some days when a HR jumps to 90-95 for an hour or two, for no reason (you are watching Tv for example).

But I will do it slowly, there is no rush for me anymore.

About you, since you dropped from 2,50 and 1,25 Mgs, you will surely have some problems now (even on 0,30 Mg), since still it is a huge drop.

Maybe you can even stay on 0,60 Mg for a week or two.

Then when you'll fell better and without high HR, BP and anxiety, you can drop to 0,50 for 1-2 weeks.

When you'll feel ok-ish again, drop to 0,40 etc

On one hand, if you'll go back to 0,60 Mg, you will think: oh, no. Not that hell again.

But this is only to "beat this devil" and so that you can wean from the drug. So, you'll sacrifice 2 weeks for a better long term future. If you will feel bad, just tell to yourself: ok, in 3-4 Months I will be at 0,20 or 0,10 or maybe 0,00 Mgs. I will be almost like my old self then...

Imo, if you'll quit too fast, you'll end on ER a few times, docs will give you new drugs etc.

So, please, listen to your gut feeling, listen to your body and try to titrate your dose, and listen to people who have been through the same.

Good luck

 

5

Hi Bob

​I concur with all that you have written here, particularly about reducing the dosage very gradually.

​I got down to 1.25 mg, than I started to cut them in half giving me 0.625mg. I stayed on this does for about two months. Than I cut the 1.25 mg tablets to quater, giving me 0.3125mg. This requires some skill and help of a "pill cutter".

That's as far as I have reached.

​Please tell me how I can get down to 0.2mg and 0.1mg? Cutting them into quater is a challenge in itself.

many thanks

6

Bob has got me thinking about reducing the Bisoprolol dose right down to 0.1mg per day.

Please tell me how I can get down to 0.2mg and 0.1mg? Cutting them into quater is a challenge in itself.

many thanks for your help

sean

7

Hi. I have 5 Mg pills of Bisoprolol (heart shaped).

If you split it in half with a hand, that's 2,50+2,50 Mgs.

If you split each half again, these are quorters or 1,25+1,25.

I do this with a kitchen knife (just like when you cut vegetables). Sit down, relax, take 5-6 pills and cut a lot of tiny pieces. Don't hurry, try to cut very, very tiny pieces. (Or if you can't cut tiny pieces, ask your wife, a son, a grandson, or someone who can help you, someone who has steady hands and some free time).

When you'll cut 2,50 in 4 pieces, that will be 0,60+0,60+0,60+0,60.

Now, try to cut those with a knife into a smaller pieces, you will get 0,30 Mg then.

But as a I have explained, it is hard to get exactly the same pieces, plus you don't even need exactly the same pieces.

If you cut 5,00 pill into 16 parts (or each of 2,50 Mg part inot 8 parts), they will be around 0,30 Mgs.

Now, take one box/container for pills (a new one/empty one) for these pills, and just try to cut 4-5 pills (of 5,00 Mg) into 16 or more pieces each.

You will get 64-80 or more pieces now.

If you have 7 parts in that container (Monday, Tuesday, Wednesday etc), just put around 10 of the biggest pieces into a Monday's part.

10 pieces which are the 2nd biggest=put them in a Tuesday's area.

Etc. The tiniest pieces should be in Sunday's container.

So, in Monday's box, you will have the biggest pieces, and in Sunday you will have the tiniest pieces.

Now, you should first use ALL pieces from the biggest area (Monday). So, you should take: Monday, Monday, Monday, Monday, Monday, Monday etc. When that container will be empty, move on to Tuesady, Tuesday, Tuesday, Tuesday etc.

Then on Wednesday, Wednesday, Wednesday etc.

More or less, it is totally irrelevant whether these pieces have 0,35 or 0,25 Mgs and whether you are able to count exactly how big they are.

The point is that the doses are very small, plus, you will be tappering off again since you will be taking tinier and tinier doses each 10 days (from this container).

When you come to a part where you'll want to take only 0,15 or 0,10 Mgs, you will have to cut your pieces into very tiny pieces (if you had a 5,00 Mg pill), you will need to cut 5,00 Mg pill into 40-50-60 pieces, or 2,50Mg into 20-25-30 pieces.

My current doses of around 0,10 Mgs are big somewhere around as a grain of salt.

It seems that it is a tiny piece already and someone may say: just drop it, you don't need them anymore.

But again, the last time, I dropped from 0,30 Mg to 0,00 and I had horrible 2 Months, it was a too huge drop for my body.

And that 0,30Mg dose already seemed as a very tiny.

But it was still too strong for my body, it seems.

So, I am currently at 0,10 Mg (a grain of salt pieces), plus, I have already cut around 30-50 new pieces who are even smaller (their range is from a grain of salt to almost tiny pieces like a grain of sand or dust). Those tiny pieces are around 0,03-0,04-0,05 Mg in my estimation.

When I'll come to a tiniest pieces of sand/dust (pills), I will then start to take those tiny pieces on every second day for a few weeks (to extent weaning off even further), and then after some time I will take those pieces of dust/sand on every 3rd day and then I will eventually quit.

If you are not in a hurry, if you have some and time and patience, and you want to this as slow as possible, you can try the same.

Again, from my experience=it hurst way less than when you try to quit this drug in a month or two.

Also, each person is different. If I need one month to readjust from 0,30Mg to 0,20Mg, it doesn't mean that you will need the same period of time. Maybe you will be fine on 0,20 even after 2-3 weeks. But also, maybe you'll need 7-8 weeks to readjust on each new dose.

Don't worry and don't rush, listen to your body.

So, please, just listen to your body and listen to how do you feel.

If you feel good and if you think that your HR, BP and anxiety is stable for more than 7-10 already at a new dose, feel free to lower the dose for another 0,10 Mg in that moment.

(But wait until you will feel good for 7-10 days in a row, because in this withdrawal, your health will go up and down. You will feel good for 3 days, then you will have 2 bad days, then you will have 5 good days, then 2 bad days again. So, wait until you can have 7-10 good days in a row. It means that you are more or less quite stable now.)

If you don't feel good and you are on the same dose, don't worry, take some time, it will get better.

For example, my last drop, from 0,20Mg to 0,10Mg had hit me the hardest, and I had to stay on this level for 3 Months and now I am finally ready to continue with slightly tinier pieces.

On the other hand, when I look back, maybe I was lowering too fast on some levels (0,50 to 0,40 only 2-3 weeks, then 0,30 only 2-3 weeks), and maybe I haven't fully readjusted to a new dose, but only partially, and yet I have moved on to a new dose right away, so I actually had a double-blow: still some readjustment left from a previous dose-lowering and a now I have added a new readjustment from a newly lowered dose (if you get me, my 0,50Mg to 0,40Mg drop was only partially over, and yet I lowered right away again from 0,40Mg to 0,30Mg. And then I had 50% of readjustment left in my body from 0,50 to 0,40 drop, plus a full 100% of a new readjustment from 0,40 to 0,30. And then this 2nd drop will hit you very hard, because you weren't ready yet for a new drop since you weren't stable on a previous dose yet).

I have said to myself on when I dropped from 0,20 Mg to 0,10Mg: I will wait now even for 6 Months if needed, until I will feel 100% fine.

So, I can't tell whether some lowered doses will hit you harder, or I had this effect of 2 accumulated readjustments in one time (from 0,50 to 0,40 which wasn't finished completely and then I moved too fast to a new one from 0,40 to 0,30).

I hope this will help to some people.

Please, if you have time, do it as slow as possible, and just cut your pills into 50-100 on tiny pieces and don't worry exactly whether they are 0,10 or 0,13 or 0,15 Mg.

Just use your eyes, try to estimate which pieces are the biggest, and take those 100 tiny pieces from the biggest to a tiniest one, and imo, you should be fine eventually, with manageable withdrawal.

Good luck to everyone, people

8

Hi Bob.

Many thanks for the detailed explanation on how to get to 0.1 mg.

Currently I am using 1.25 mg tablets, and I have been able to cut them into four but unfortunate Haven't been able to get any lower.

So, I am taking a quarter of 1.25mg every other day. On average, I am probably getting between .15 and 0.2 mg. daily

after few weeks I will take a quarter of 1.25 mg every third day.

I am wondering if bisoprolol is soluble in water? Than we can dissolve the tablets in water and take the reducing volume of water. That would be more accurate?

Thanks again for your help