Brief Answer: Why was this dose doubled? Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about this muscle pain and the unsteadiness that you have reported. It would be very strange to hear that beta blockers cause muscle pain. This is very atypical and not commonly described with this class of medications. However, because you have used two different formulations and the symptoms seem to be almost identical, I have reasons to suspect that you may have a problem with Beta blockers. Muscle pain is more common with statins! Beta blockers are a must in heart disease especially after a heart attack or if you are having angina. I don't know for what reasons you were prescribed this drug? Was it just for the management of high blood pressure or a heart related disease? If the indication is not a direct heart disease, then switching this medication may be an option to be considered. Metoprolol prevents the normal response that occurs when we stand upright from a sitting position to prevent decreased blood flow to the brain that can cause dizziness, blur vision, lost of balance, etc. It would be nice to also check your blood pressure numbers in the sitting and immediate upright position to see what the change is and what the baseline is. If it is too low, it may be the reason for the unsteadiness but all the same does not explain why you have the muscle pain. In all, it sounds likely that you have a problem with Beta blockers. If it were okay with 12.5mg, please return to this initial dose. If the indication is not absolute like in heart disease/heart attack, consider switching to a different class of medication. I hope this helps. I wish you well. Feel free to ask for more information and clarification if need be. Thank you so much for using our services. Dr. Ditah, MD.

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Brief Answer: Thanks for this follow up Detailed Answer: Hi and thanks for the follow up precision. There is no harm in playing around with drugs for diagnostic purposes especially when the patient is complaining of side effects that may be attributed to the drug. There is no point for your doctor to insist on the 25mg dose if the side effects make you stop using it. A drug is only effective when it is correctly prescribed, accepted by the patient and compliant to it. When you mention a worry, he should seek addressing this else you would not take the drug. This make all the efforts useless. I will not advice you directly to change the dose of your drug without talking to your doctor. Confront him on this and make sure he does something to make you feel better. If he is so sure that this drug is not a possible cause, then he should be so sure of the cause and treat it. How you feel after the treatment would tell whether he got it right or not. Also, ask him why Diovan was stopped(maybe because it doesn't work on fibrillation). Fibrillation should not be suspected but diagnosed. It is either there or not and nothing should guessing should stop. An ECG or a 24Hr monitoring would make the diagnosis. There is no point in suspecting and treating without confirmation when it is very easy to confirm. Is he a cardiologist? I am so sorry to hear about the passing away of your wife. Accept my sincere condolence. I hope yo have been able to accept it as one of the pailful finite experiences that we cannot do anything to reverse what has happened. Any lube is okay so long as it does not cause any reactions and the satisfaction is okay. Otherwise, there is no reason to change it. I wish you well. Dr. Ditah, MD.

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Brief Answer: Thanks for following up! Detailed Answer: Hi and thanks for following up with me. I am happy to know you are feeling better having returned to the initial 1/2tablet. I however encourage you to inform your doctor of any changes you have made. Remember I said it would not be a good idea unilaterally changing tour drugs dosages. My role was is principally to provide an honest advice that you can act on after talking to your doctor. Because if the benefits of metoprolol on irregular heart rhythm, it may not be the best reason to drop this drug totally. Also, was it a one time high blood value or repeated higher values that prompted this increase in the dose of metoprolol? Too change the dose of a medication, we need to have persistently high values before we can justify such a decision. I hope that this procedure was followed through. Beside, what was this blood pressure value that necessitated this increase on dose of metoprolol? Has your doctor ever told you what his treatment goal is to you? There also seems to be so much that I cannot understand with the Diovan. If a drug drops the blood pressure that low, the immediate reflex is to decrease the dose and not switch over the therapy. It does not sound very right to me. You blood pressure number is quite encouraging at 130/70mmHg. I will suggest that you measure values over three days and provide to me so that I can look at the trend and tell whether you need more medication for this blood pressure or not. I hope this helps and I wish you the best of health. Provide me with this more information so that I can be able to see what the best drug or combination is to recommend for you. Thanks. Dr. Ditah, MD.

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