Verapamil, Crestor and Beta Blockers

[Leigh Ann]

I am so encouraged by the many responses given already. While I do plan to give a call to HCMA, we have another question. My friend is taking verapamil and Crestor.The doctor now wants to put my friend on Bystolic. He is so afraid that it will slow him down greatly. He is an very outgoing energetic person whose life is always on the go. Does anyone have alternative suggestions without having to go with beta blocker? Anyone have success with th meds they are on?
My friend again has HCM, and mitral valve/v fib. He recently had a TIA in June 09.

[gfox42]

Hi Leigh Ann,
I don't have any personal experience with these particular drugs. But really, beta blockers are the usual first-line treatment for HCM. For various reasons, some people are given calcium channel blockers instead. Both classes of drug will reduce the heart rate -- that's actually the point, to give the stiff left ventricle a chance to fill properly.

Will the drugs slow your friend down? Probably, but it may not slow him down much; that really depends on the particular drug, the dose, and how his body responds. It's possible that the beta blockers won't slow him down any more than the verapamil that he's currently taking. It does often take a while, and some experimentation, to find the appropriate drugs and doses for a patient.

Everyone with HCM needs to put some limits on their activity -- but what those limits are vary to some extent among people. I say "to some extent" because some activities are always a bad idea for people with HCM -- stop/start sports like football and basketball, and serious weight lifting, to name a couple. Not doing so can lead to serious damage to the heart.

It's important to realize that I'm not saying that your friend needs to spend the rest of his life sitting in a chair. Generally speaking, exercise is good -- but we need to consult the HCM docs as to what's safe.

This is a hard thing for people to adjust to, especially active people. One thing that may help is to discuss it with others on this board; there are a lot of people on this board who've had to deal with this issue.

I'm glad to hear that you're going to call Lisa.

Gordon

[angel-a]

As with all meds, side effects vary from person to person. I think it's important to remember that each person is different and in order to see how an individual will react, first they must try them. Just a little background on me, my 4 year has HCM and I am only gene positive at this time (no hypertrophy yet) BUT I have had high blood pressure since I was 26. I tried Bystolic last spring when I needed to go back on meds and I had a terrible time on it with headaches. So I was switched back to another med I was on years earlier for my blood pressure, Hyzaar and have no troubles with that. After I went in for my annual appointment with an HCM specialist he wanted to put me on a beta blocker to control my high (resting) heart rate. So I have been on 100 ml of Toprol XL since December and have been doing great on it. I haven't noticed any difference with my energy levels or fatigue. I do get cold hands at times but not that often. But it's nice not to feel my heart racing all the time.

Meds can be changed and adjusted if need be, but if the doctor is recommending it . . . it would be a good idea to give it a try. Remember to keep in touch with the doctor and report and side effects. If your friend feels the need to stop the meds, consult the doctor first. He may need to be weaned off of them (which was the case for me with the Bystolic).

[MariaB]

Speaking of meds.....I work at a pharmacy. My Brother in law is a pharmacist and Ive used the same pharmacist for 20 yrs. All three of those sources reassure me that toprol XL and metorpolol are one in the same. When I tell them my HCM specialist says "No they are not " they tell me that he is wrong. I told them that when I called his office and spoke to the receptionist , she told me that there was a recall on the met. My clan of pharmacists said it was a recall on marketing...not the drug. So for now..Im still doing the toprol...just wish it wasnt so expensive !!!:(

[gfox42]

The general story about generic vs brand-name drugs is this. Generics have the same "active ingredients" as the brand-name drugs. That makes it sound as though they're the same, but that's not necessarily true. Think about it this way: if the "inactive" ingredients didn't matter, why would the manufacturers put them there? These other ingredients can have big effects on the way a drug is absorbed into the blood stream or cells, and on how long it is maintained in the body.

Some manufacturers of generic drugs use sets of "inactive" ingredients that make them differ substantially in their effectiveness. There has been some history of some manufacturers producing versions of metoprolol that were problematic. I don't know if those versions are still being marketed. I take a generic long-acting metoprolol and seem to be doing ok with it, but it's not at all impossible that some people will handle these different "identical" drugs differently.

What complicates things is that manufacturers of both brand-name and generic drugs do things that make it harder to figure out what's going on. Some brand-name manufacturers, as their patent protection is expiring, market new long-acting versions of their drugs under new patents, to try to preserve their sales. Some generic manufacturers produce drugs that have problems precisely because of the "inert" ingredients but then insist that the drugs really are the same. It's really not easy to know what to do!

Gordon

P.S. More or less the same comments are true about things like pesticides. The "active ingredients" aren't the only important content, and in fact the "inert" ingredients are sometimes more important in determining how many insects, fungi, or weeds are killed. If this makes you want to scream, you just passed the test for being human.

[crystal]

The big selling point of bystolic has been that it is supposed to have a much better side effect profile than other beta blockers, but I have personally never tried it.

I think some insurance companies require patients to fail another beta blocker first.