Case 2 Ask Dr. Bill: I Stopped Metoprolol
That Put Me in the Hospital
This is a real case. Someone that I know well took metoprolol for high blood pressure. He was having some fatigue. Metoprolol can cause fatigue, so his doctor told him to stop it without further instruction. He stopped the medication. His blood pressure surged to a high level. That caused a nosebleed from an artery and that led to a three day hospitalization. This was a direct result of suddenly stopping metoprolol. Our AI Medical Assistant functions like a chat.
Hello, I'm Dr. Bill. It's a pleasure to connect with you. How can I help you today?
Patient question to medical assistant: Can I stop my metoprolol?
Medical Assistant Answer: Stopping metoprolol suddenly can be risky and potentially dangerous. It's essential to discuss any changes to your medication regimen with your primary care physician or the prescribing doctor. Abruptly discontinuing metoprolol can lead to a rebound effect, causing your heart rate and blood pressure to increase, potentially leading to serious complications like chest pain, heart attack, or irregular heart rhythms.
I strongly recommend consulting with your primary care physician before making any changes to your metoprolol prescription. They can assess your individual situation and advise on the safest way to adjust or discontinue the medication if necessary. A gradual tapering under their supervision is typically the recommended approach.
Follow-up question: What if my primary care physician recommended that I stop metoprolol without supervision?
It's highly unusual for a primary care physician to recommend stopping a beta-blocker like metoprolol abruptly and without supervision, especially given the potential risks involved. While I can't speak to the specific reasons your physician might have suggested this, I would strongly advise seeking a second opinion from a cardiologist or another qualified healthcare professional.
Here's why unsupervised discontinuation of metoprolol is generally discouraged:
Rebound Hypertension: Metoprolol controls blood pressure and heart rate. Stopping suddenly can cause a rapid increase in both, sometimes to levels higher than before you started the medication. This is known as rebound hypertension.
Worsening Angina: In patients with angina (chest pain), abruptly stopping metoprolol can exacerbate or trigger angina attacks due to the increased demand on the heart.
Heart Attack or Stroke Risk: Though less common, there is a potential for more severe consequences like heart attack or stroke in some patients, particularly those with pre-existing heart conditions.
Withdrawal Symptoms: Some individuals experience withdrawal symptoms like anxiety, tremors, and insomnia when stopping beta-blockers abruptly.
If your primary care physician has specific reasons for recommending this unusual course of action, it's crucial that they thoroughly explain the rationale and address your concerns about the potential risks. Documenting this conversation is advisable. If you remain uncomfortable, seeking a second opinion is a prudent step to ensure your safety and well-being.”
The AI Medical Assistant nailed it. It can help individuals who are changing their medications know how to do that safely. It can increase your understanding of your medicines. That is another way to use the tool.
Have there been cases where switching from one beta blocker (Sotalol) to Metoprolol has triggered an autoimmune reaction? I believe that this happened to me almost six years ago and triggered a case of lichen planus in my gums that I am still dealing with after four laser treatments.
Hi, Bill. I love the example about discontinuing a beta blocker. It's in plain English and could have been useful to a great many patients. I'd like to add an historical note to this discussion. From roughly 2000 through 20076 I was the Director of the Center for Health Informatics at the American Academy of Family Physicians, my job being to encourage, support, and lead the adoption by family physicians in the country to adopt Electronic Health Record (EHR) technology in their practices. It was a successful campaign leading to the majority of AAFP members across the country using EHRs by the end of this period. One important aspect of this campaign, an important strategy, was that over time the data from these EHRs could be used to develop and sustain "best practices." The idea was that data aggregated from many hundreds of patient care records on many dozens of important diagnoses would lead to the intelligence needed for in-the-moment consultations with patients and to a national effort to establish evidence-based guidelines. THIS NEVER HAPPENED, although there were some notable attempts at several places around the country. There were several reasons why this never happened, and I won't describe them all in detail. However, it is worth noting, I believe, that the biggest roadblock to the development of artificial intelligence based on best practices and outcomes gathered from physician practices was that the HMO movement disintegrated, leaving the EHR technology to be taken over by hospitals and used to support billing, accounting, and collection of $$ rather than becoming a tool for accountable care.