Stopping propranolol and moving on to amitriptyline

Hi guys n gals,

My neuro told me today to immediately stop propranolol and start amitryptlin. (10mg once at night)

The thing is, he definitely said to abruptly stop it but on the packet and online it says it’s important to wean off! Does anyone have any advice please?

I have only been on propranolol 1 month- the first 5 days I took 40mg once a day. Then I went up to 40mg twice a day for a week and a half. Then I went up to 40mg three times a day for just over a week.
Maybe that’s not considered long enough to need to wean off?? I know my heart rate is down as is blood pressure so I’m worried about the effectsvof suddenly stopping

Thanks guys xx

I’ve always heard it said that you need to cut it down gradually. I would speak to your local pharmacist, as they’re really knowledgable about this, and you will be able to speak to someone tomorrow rather than having to wait until Mon to see a doctor.

Did ur dr say why he wanted you to stop? You can take both meds so you can start ami and see if the two work well together, and if not then take the propranolol down at your comfort level. The only reason to stop abruptly would be if you were having bad side effects. I doubt most doctors take these meds so I like to talk to users and/or pharmacists.
Kelley

Thanks guys… I went to the pharmiscist who said it shud be ok to stop as I didn’t have heart disease but to keep eye on blood pressure…

Ironically, I felt really good last night, I felt normal!! But then when I went to bed I took amitryptiline, and no propranolol and woke up feeling so terrible - dizzier than iv ever been in 9 wks. Will this stop? I also have crushing headache. Doc told me to stop propranolol as I didn’t think it was helping- I hadn’t seen a change. But now I feel awful is it a coincidence? Can the first few doses of ami make you feel this bad?? Please help guys, I’m really struggling with this

These are the two meds I did one after another a few years ago. I did Propanalol for 3 months, I was on 40 mg most days, I tried a few days on and off at 80 mg but it gave me insomnia and loose bowels at that amount. After 3 months I stopped it dead and went straight on to Amitryptiline but started on half a 10 mg pill. Even that, made me sleep heavy and wake with a hangover type head. I stayed on the Amitryptiline for 3 months but I couldnt get above three quarter of 10 mg tablet without being hungover till late in the day.

It would have been more interesting if I had done the two together, the propanalol at 40mg and the Ami, but I dont think I would have been able to increase the Ami as for me, I still had the hangover heads even after 3 months, but, I do remember the propanalol decreased the daily headaches and the Ami after a couple of weeks decreased the dizziness in the morning.

Christine

Yes, absolutely the Ami could be making you feel the way you are. It is a bit challenging for you because you are changing two meds at the same time so it may be hard to know what might be causing side effects.

But for sure the Ami could be making you feel off. I had side effects after the first dose of all my new meds. Hang in there!

I have felt worse on the ami since I have started it 2 weeks ago. I am hoping that it will eventually calm things down and will continue to take it for atleast another 2 weeks. My doc wants me to up to 20 mg after 2 weeks, but I am away on vaca and I can’t risk feeling worse! Hang in there!
Jen

MIssmoss,
I def think the changes of both meds are affecting you. The brain of a migraineur is so overly sensitive, it’s important to make changes low and slow…my doc says “sneak up on the brain so it doesn’t see what’s happening”… lol
You could try adding back a little propranolol and see if it helps…if so, then maybe a slower titration would be in order.
Also, take the Ami early in the night…like 6:00 to prevent feeling poorly/overly tired in the mornings. It takes a while before it makes you tired. FOr me, it didn’t make me too tired at all up to 20mg, at which point I came off as I didn’t notice it doing too much.
Kelley

I agree with kelley totally. Take it around 6 or 7 pm and see if it makes you tired. the 1st day was the worst but after that I havent felt tired or anything. I could even prob take in am with no effect. My doctor friend told me to split me beta blocker dose and give the ami some time to work. I tried that but felt worse so I continued my Nadolol at usual dose. I def think the 2 meds together have dropped me BP a little, but have found now that I dont feel that way anymore. I drink LOTS of water! I am hoping that the ami will kick in 1 of these days. I felt my best on just the nadolol, but ami was added just to see if I could get rid of most of my symptoms. It is hard to keep an open mind and stay positive, as my life feels so far from normal right now!

Hi everyone, thank you for all your advice and thoughts.

Bit if an update since I posted this…

The last propranolol I took was Friday morning 40mg.

I took the first ami dose fri night while I was having avfew hours where I felt completely cured, like a miracle had happened! Sat morning… Felt horrendous. Ten times dizzier and fuzzy headed. Spent all day wondering round in a daze or sleeping. Sunday morning, I woke up with palpitations. I felt like my whole body was shaking. It was constant. I had palpitations on fri but only a few. I felt so bad I visited the nhs walk in centre. They did an ECG which turned out ti be abnormal. Something to do with sinus tacky whatever that is. My blood pressure had also gone up to 150/100 and pulse 105. This is in contrast to last mon when it was 130/85 and pulse around 70 I think.

The gp said it’s prob because I didn’t taper off the propranolol. She said usually if you have been on them under a month you should b ok abruptly stopping if you dont have heart disease. But I’d been on them a month and like Kelley pointed out, perhaps migraine brain is sensitive… Anyway… She consulted another doc and they decided I should go back on propranolol! I should take 1 x 40mg a day and go and see my regular gp to discuss how I taper off or if I should stay on. I’m worried at what the neuro will say! She also said I need an outpatient cardiologist appointment to investigate the weirdness in the ECG. But added it could have been causes by my being anxious about the whole situation, as could my reaction to it, true… Fair point. I feel better palpitation wise now but dizziness is still elevated, ear symptoms still elevated and head and face pain is high. Di you think the neuro will let me keep 40mg of propranolol? I want it for anxiety and slightly high bp. Even if it wasn’t working on the migraines.

Cmoc- dud you not experience any side effects when coming off propranolol abruptly? Did you ever manage to find something that didn’t produce the hangover feeling? I feel hangover every day without the pills… Urgh

Anne- your exactly right- it’s confusing because I’m coming off one and starting another. sigh

Kelley- I took what you said on board about our brains being overly sensitive… It really makesvsense. Your idea of addingbsome back makes sense ti me.

Jen- when you say split the beta blocker do you mean take half in am half in pm type thing? How long were you on nadolol before feeling better? It really is hard to keep positive- I’m really hoping the ami starts to work for you.

Ps… I hear you on taking the ami earlier… I’ll try that too thank you!!
X

Hi Missmoss,

I am sorry you have had such a bad time of it. I have had loads of side effects from taking preventatives, but I didnt experience any side effects when coming off the propanalol. I do believe that Amy can cause some heart arrythmus (is that how its spelt?) as I found out when I was going to take it again and was told that I couldnt take it with Stemetil (which I use now and again) as Amy can cause heart arrythmus (dont think that is the spelling :shock: ) and the stemetil can make it worse. I wasnt told this in the past and took amy with the stemetil as needed with no problems.

What dose of Ami did you take the first night? I started on half a 10 mg tablet and even that knocked me out, I could never get past three quarter of a 10 mg tablet as I stayed with that drugged heavy head till around 3 in the afternoon (even if I took it early evening the night before). I tried to get beyond that but after 3 months gave up. I am very sensitive to most meds so that might just be me.

I am surprised they didnt repeat the ECG as I had a weird one once and they repeated it again and it was fine.

Christine

I’m wondering if it was all anxiety and psychosomatic… If so, I really am an idiot :frowning: I didn’t know that about ami… That chucks a different spin on it, although I did have flutters on Friday before taking the ami…, hmmm.

I took 10mg that first night… I was told that’s a low dose but perhaps I’m not noticing the knock out effect as iv been feeling knocked out every day now for over 3 months. I’m surprised that 5mg can affect so much- but it’s good to know.

They did repeat the ECG but got the same result! :frowning:

Have you found a med that works well for you?

missmoss,
Have you taken any benzos? That might help you with your heart palpitations in case a lot of this stuff is anxiety related. 40 is a really low dose for Propanolol…I think it ends up that you take as much as your weight…unless I"m confusing it with verapamil…have to check into that.
I don’tsee why your neuro would be against taking the Prop…along with ami…I’m fairly certain that these meds can be used together. Have you checked out Dr. Hain’s website? He lists preventatives in order of what ones he likes best and says you can use 2 classes of meds (and sometimes 3) to get results if you don’t get enough on just one class.
HOpefully your doctors let you have a say so in your own health care since you’re the one going through it.
I kind of wonder if you were just getting good results with the propranolol before adding Ami? hhmmmmm…
Kelley

Hi Kelley

No- I haven’t taken any benzos but I was thinking about asking for one… I had a look at different ones, the thing is, do they really take away the dizziness and also, do they sedate you too much? I am so tired, was chronically fatigued before this started, and now worse esp on the ami…

Thanks for all the info. I will check out Hain’s website… definately.

I also, was wondering whether Prop was starting to work as I’d only been on 120mg for a week (after buildig it up) I’m definately in more pain and more dizzy since the ami.

SIGH

Bloody juggling act isnt it!

xx

Wow, I am sorry to hear about whats going on… Anxiety can do a lot to your body. Sinus tachycardia in and of itself is not dangerous. How fast was your heart actually going? I think the stress of what is going on may have caused you some issues. I would have thought being on propanolol, even cutting back cold turkey would’ve actually kept your heart rate on the slower side. Cardiac pts who take large doses of beta blockers are sometime stopped abruptly if they have too slow heart rates, so I would not imagine stopping it completely would have caused this. (I work in a cardiac electrophysiology lab where we treat fast and slow arrhythmias!) I have great doctors to consult with on cardiac issues! When I was afraid to start a beta blocker with a heart rate in 50’s, they laughed at me…saying it wont do anything at the dose I was on.
Make sure you are drinking tons of fluid too, dehydration can cause you to become tachycardic as well.

I am still in the same boat (literally). I havent been able to drive this week becasue of the way it makes my head feel. I seem to feel worse as the sun goes down, as my vision gets real blurry. I am tired of feeling this way! May have to consider not returning to work on the 5th as planned. Who knows. I keep taking the ami thinking it might actually do something one of these days.

Hang in there! If you continue to take 40mg of propanolol with the ami you will be fine. I am on both.

1 Like

The low dose I take of klonopin diesnt make me tired. If I take more, I get tired. It has a kong half life so you can take it once daily at night to avoid excess sedation. And yes, it is a mild anticonvulsant (all benzos are) and calms the brain. I would pick either Valium ir klonopin as they are the longest acting.
Good luck!!
Kelley

It all depends on the dose and how long you’ve been taking it, and your own body’s sensitivity. I don’t know much about the cellular-level physiology but I do know that sinus tachy is not unusual after abruptly stopping a moderate to high dose. I had to come off of 40 mg/day of nadolol a few years ago for a stress test. Even though I weaned myself off gradually, I had some runs of ectopy the day before the test, when I was completely off of it, and my heart rate was faster than normal and a little irregular. I’m sure that if I had just stopped it suddenly, my heart would have been racing, skipping, and thumping.

— Begin quote from "jenh21"

Wow, I am sorry to hear about whats going on… Anxiety can do a lot to your body. Sinus tachycardia in and of itself is not dangerous. How fast was your heart actually going? I think the stress of what is going on may have caused you some issues. I would have thought being on propanolol, even cutting back cold turkey would’ve actually kept your heart rate on the slower side. Cardiac pts who take large doses of beta blockers are sometime stopped abruptly if they have too slow heart rates, so I would not imagine stopping it completely would have caused this. (I work in a cardiac electrophysiology lab where we treat fast and slow arrhythmias!) I have great doctors to consult with on cardiac issues! When I was afraid to start a beta blocker with a heart rate in 50’s, they laughed at me…saying it wont do anything at the dose I was on.
Make sure you are drinking tons of fluid too, dehydration can cause you to become tachycardic as well.

I am still in the same boat (literally). I havent been able to drive this week becasue of the way it makes my head feel. I seem to feel worse as the sun goes down, as my vision gets real blurry. I am tired of feeling this way! May have to consider not returning to work on the 5th as planned. Who knows. I keep taking the ami thinking it might actually do something one of these days.

Hang in there! If you continue to take 40mg of propanolol with the ami you will be fine. I am on both.

— End quote

It was 105beats… But that was quite fast compared to my 50bpm a few wks ago… My acupuncturist whose also doc said she could see why I felt uncomfortable and suggested an EChocardiogram, but my gp said it was nothing to worry about, I don’t need any more tests and also, that I didn’t really need to wean off the propranalol- a few conflicting views there, but I’m pleased there’s no alarm bells… But I’d prefer to get the heart checked out as my mums mum died of heart failure at 50.

Thanks for ur inside cardiac knowledge- that’s really interesting. And the ami can cause sinus tachy too? Is it ok to stay on it do you think? Jeeze, this anxiety is hard to keep under control I didn’t know that about dehydration either… Gulping down the water now :slight_smile:

I’m sorry you feel how you do- I also have had the swim my feeling so haven’t driven this week.I have the opposite to you though in that I feel better when the sun goes down! Do you find your vision and swim my head is worse or better outside as opposed to inside your house or a building?

I have a sick note til July 2nd…I hope we can both say that we feel better enough to go back to work in early July. Let’s cross fingers that little miss ami gets her butt into gear in our brains!

Thank you for your invaluable replies… It’s good to talk as this can make me feel so isolated xx

— Begin quote from "rockyksmom"

The low dose I take of klonopin diesnt make me tired. If I take more, I get tired. It has a kong half life so you can take it once daily at night to avoid excess sedation. And yes, it is a mild anticonvulsant (all benzos are) and calms the brain. I would pick either Valium ir klonopin as they are the longest acting.
Good luck!!
Kelley

— End quote

Thanks as ever Kelley :slight_smile: