Can't take propranolol anymore due to low heart rate

Hi there everyone,

I recently had an EKG, due to a previous abnormal one, which showed that I am severely bradycardic; in other words, my heart rate is very low. Low, but still within normal range, is 60 beats per minute, and mine is 44 beats per minute. I also get very low blood pressure at times and get dizzy and/or faint occasionally when standing from a seated position.

My PCP says that because propranolol is a beta blocker (at least at higher doses, prescribed for high blood pressure), I need to cut down my dose or stop taking it altogether (I'm not sure, will find out on Tuesday), in order to bring up my heart rate and blood pressure to normal levels.

The thing is, I take propranolol for the tremors I experience due to Abilify. When I was taking only 1 a day, the tremors were improved, but I still had them. I'm now taking 2 a day. I'm so afraid of reducing the dose, much less stopping taking it altogether, as my tremors will likely come back.

I'm going to ask my pdoc, but meanwhile I was wondering if anyone was taking something other than propranolol that is effective for tremors due to taking antipsychotics?

Thanks!

I'm glad you've got the reason identified and are taking measures to reduce/stop the bradycardia.

Are you a runner or swimmer or cyclist?

I imagine there must be some other options. Where and how bad are your tremors? Are they something that you could maybe tolerate? Is your job, passion, or appearance very affected?

I had hand tremors from Lithium, but it didn't affect my life in any significant way. I'm sorry if yours do.

I take propranolol, but for tachycardia. I didn't take it during one period of past tremors.

I had to quit because it dropped my blood pressure too low. I switched to guanfacine which is also a blood pressure Med that didn’t drop me so low.

Well, I am still interested in what your athletic life is like, because some aerobic athletes (runners, for example) not uncommonly have resting heart rates in the forties or even high thirties. For them, this is no danger, cardiac-wise. It's just a sign of their level of fitness. It's actually a good thing, not a bad thing.

Even someone who just walks a lot could potentially have a resting heart rate in the fifties pretty easily. So, take that into consideration while you are evaluating all this. If you're an athlete, I personally would not give up the beta blocker--unless you are symptomatic (ie, dizzy or fainting, etc). I was running ultramarathons when I was on propranolol and my rate at rest was in the low forties. But I didn't have any kind of AV block, so we didn't worry about it. It was fine.

If you do decide to d/c the propranolol, you might look into gabapentin, which worked pretty well for my tremor when I was on Abilify. Ultimately, I developed tardive dyskinesia-like issues and so we had to stop the Abilify altogether. My tremor went almost entirely away, even though I am still on lithium.

Sending you positive vibes. Hang in there. You will figure it out.

Thanks so much for the replies.

Yes, I exercise. I do intense, very fast walking for 60-70 mins on a treadmill most days. And, in fact, it's after doing exercise that I tend to get dizzy when getting up from a seated position, so, it seems, that it is especially after having done exercise that my blood pressure, and/or hr drop.

It sounds like you may be really on to something, BPCyclist and thanks for your thoughtful reply. It may well be that my resting hr is so low because I'm in such good shape. Though perhaps the propranolol exacerbates it, who knows.

I'm going to talk to my PCP on Tuesday and ask her about that. As far as I know, there were no other abnormalities on the EKG, only Bradycardia. I'd REALLY rather not change my meds around, I desperately don't want side effects, of some sort, from another medication; I've been so stable and without side effects on the regimen I'm on now.

I take 2 propranolol a day, so maybe going down to 1 will protect me from the tremors (they're in my hands and do really bother me). I'm starting with that, and then we'll see what happens. But I will DEFINITELY bring up the exercise with my PCP; I think I'm in very good shape and, as you say, that may be playing a big role in my blood pressure (which isn't always so low) and heart rate.

I'll ask my doc about that medication, thanks!

I beleieve that Cogentin is the most commonly prescribed med for extrapyramidal side effects. I take it and it helps quite a bit with tremors. I would take a higher dose (I take only .5), but my mouth, nose, and eyes get very dry from it.

my doctor lowered my abilify from 20 to 15, and the tremor in my right hand is all but gone. i was also prescribed cogentin, but...i never took it, i don't like the way anticholinergics make me feel. blah.

not to scare you, but my psych told me that having tremors and such indicates a higher likelihood of eventually developing TD than if one can take a given tranquilizer without tremors or other EPS. TD is also more likely with higher doses, even with the atypicals. after the dosage was lowered, i consulted The Google, and found out that Abilify is well studied...at 10-15 mgs/day. beyond that, the data gets weak. true story.