I’ve had POTs for several years now. Only one of those years was it untreated. Beta blockers were a game changer for me. I was able to have a lot of success with them. I have been on two different beta blockers, metoprolol and propranolol. Both of these had different effects and different results. One thing to keep in mind while reading is that I get both tachycardic, as well as bradycardic. This fact is really important for me in dosing and management. It changes my experience because of my significant highs and significant lows. Let me dive into the specifics of both and my experience.
I am on 10mg of propranolol three times a day. I am currently using propranolol as my beta blocker. I was started on this originally in 2018. Previous to being on propranolol my heart rate ranged from 40-200+ daily. Obviously, that is a very unsafe range. I was unable to exercise. Anything more than sitting (and even sitting) would cause spikes in my heart rate. Propranolol was an almost instant game changer. I was less dizzy and symptomatic within a day. It allowed me to complete physical therapy and regain my ability to walk normally. It also allowed me to start exercising regularly. The downsides of propranolol were lower lows. I dip into the 30s every once and a while and that poses a lot of challenges for my body. The important thing to note with that is that it was my normal beforehand. I would get done with a workout after my heart rate spiked to 240 and it would drop to 50 instantly. So although 30 is too low, it’s not out of the range of what I was experiencing prior. I say this because if you aren’t bradycardic before propranolol, I doubt you’d have that issue. That said, I am not a doctor and if you are concerned consult your prescriber. I don’t have many side effects with propranolol, I didn’t gain weight or anything in that regard. The most difficult component to deal with is how high my heart rate still goes while exercising. It still goes into the 200’s frequently when faced with heavy activity. I can’t up my dose because of the bradycardia so I just have to be mindful of exercise.
When I took metoprolol, I was taking 12.5 mg twice daily. That’s half the lowest pill size. I did gain weight almost immediately with metoprolol. I personally didn’t have a bad experience with metoprolol overall but it didn’t work for me. I tried it because my neurologist suggested switching things up for a bit. He wanted to see if I wouldn’t have better results when exercising. I didn’t. I still had a 200+ range when exercising and dips into the 30s. I was also much more symptomatic on metoprolol. I would get dizzy when standing. I’d feel blood pressure drops and heart rate drops much more significantly. It didn’t fit with what I needed. I think if I would’ve started with metoprolol I would’ve been happy with the symptom improvement. For me propranolol was by far the better choice.
Another thing to keep in mind is that I’m on fludrocortisone to control my blood pressure. I have orthostatic hypotension, as well as general low blood pressure. Being on these medications without blood pressure medications can make me more symptomatic. It took them a while to add in the fludrocortisone. The combo of fludrocortisone and propranolol has been the most successful. I’m not 100% better. I am still tachy daily and still symptomatic. The thing I am most grateful for is how much improvement I’ve made. I’ve had so much success. I can exercise again. I hope that you give medication a try if it is right for you. Keep in mind that medication is a process and it likely won’t be a miracle the first time around. Keep in touch with your doctor and don’t be afraid to speak up. The dosing has to work for you and your lifestyle. I hope that you’re having a wonderful day that is filled with gratitude, positivity, and laughter.