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DrThomasMd, Board Certified Physician
Category: Cardiology
Satisfied Customers: 63937
Experience:  Classical homeopath also board certified in integrative and holistic medicine. Many years of practice, also all of medicine.
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My mother was recently diagnosed with afib. She also has dialostic

Customer Question

My mother was recently diagnosed with afib. She also has dialostic heart disease. Before this occurred, she was on 25mg toporol succ er once a day and 5 mg lisinopril. Now they want her to take the metoporol that is not extended release 50 mg twice a day. However, i did not realize that they had changed it to this and since she had extras of the 25 mg, she was taking (2) 25 mg twice a day. The extended release seemed to be wking for her, but her dr wants her to take the other. What is the main difference between the two and is one better for afib than the other? Also is one better for dialostic heart disease and enlarged heart?
Also, they have her on blood thinners and want to shock her heart in six weeks. Is there anything that can be done to avoid this like maybe a different medicine or other alternative? If her heart rate and pressure are under control with current medication, can someone live with afib without any consequences?
Submitted: 1 year ago.
Category: Cardiology
Expert:  DrThomasMd replied 1 year ago.
HelloThere is no specific advantage, it is which one gives better control.This is an educated guess based on experience, and clearly her doctor has made that decision, felling that the twice a day dosing is better.There is no way to effectively cardiovert her with the certainty of cardioversion, which is a standard procedure.That is what they are planning. Trying alternatives is relatively unreliable.
Customer: replied 1 year ago.
She was taking the 25 mg er two tablets twice a day isnt this eqivalent to the 50 mg regular release twice a day. If her heart rate has been high sixties low seventies and blood pressure has been normal to borderline low ( low hundreds high ninties), is one better than the other? In other words, do not want her bp to go too low. Also
Read the extended release is better for people with heart failure, is this accurate? Also, what happens if one opts to have afib as long as blood pressure and heart rate stays under control?
Expert:  DrThomasMd replied 1 year ago.
None of that is accurate.The medication that brings her heart rate down and keeps it down is the best.If she opts to keep the a fib, then she must stay on anticoagulation. Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 1 year ago.
What i am trying to figure out, is what is the main difference between extended release and.the other. Would the extended release decrease her bp and heart rate faster than the other or vis versa? If not, then if the extended release is wking, what would be the reasoning in changing it?
Expert:  DrThomasMd replied 1 year ago.
NO, the dose is set to be equivalent. The only difference is that one is longer acting before taking another dose...that is it. That difference is negated after 6 doses of either, ad blood levels reach a steady state.there is no specific advantage. It is a matter of drug individualization. You simply have to ask her doctor what his specific reason was. This will not apply to all patients....OK?I can not read her doctors mind, you have to ask. If she was well controlled, I would not have changed.The doctor probably felt he would avoid the troph [low blood level] that can occur before the redosing with the extended release...but that is a guess. Please click a positive rating.
Customer: replied 1 year ago.
I did ask but i did not understand the reasoning. All i gathered was that one would decrease heart rate faster ( i think) but if it is already under control dont know why that would be necessary. Thats why i wanted to see if u had an idea. Dr told us to complete whatever was left of extended release then start the other.
Expert:  DrThomasMd replied 1 year ago.
It sounds like the first preparation is not bringing the heart rate as low as the doctor wants, or that it does not lower it consistently enough or fast enough after the dose.Those are the possibilities. Other than that, you will have to clarify with here doctor.The fact is that some preparations work better on some patients than others, and that is the bot***** *****ne. Please click a positive rating.