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High Blood Pressure

Sinus Tachycardia and Toprol-XL

06/30/2008

Question:

I have been taking Toprol-XL 200mg daily for the past ten years to treat sinus tachycardia and mild hypertension. The medicine works well at controlling both the sinus tach and hypertension. My doc wants me to get allergy tested and the testing center basically stated they could not test me while on Toprol-XL because it can cause complications in the rare event that I would go into shock while skin testing. My doc stated that they could change my Toprol-XL so I could be tested. I remember once in the past they tried switching me to Procardia. It worked good for the hypertension but was not effective in treating the sinus tachycardia. I told my doc I would rather have nontreated allergies than go through the awful withdrawal symptoms of going off Toprol-XL again. Are there any other meds you can think of that I can discuss with my doctor that will control my sinus tachycardia and mild hypertension and still allow me to be allergy tested and treated? Thanks.

Answer:

You can consider switching from Toprol XL to diltiazem (Cardizem).  Diltiazem is a calcium channel blocker, similar to Procardia, but is slows the heart rate, while Procardia does not.  Given your current dose of Toprol XL, the required dose of diltiazem would probably be 360 to 480 mg of a long acting formulation a day.

Diltiazem is a good substitute for patients who cannot tolerate a beta blocker.  Be careful not to combine Toprol XL and diltiazem,  The combination could cause your heart rate to slow down too much.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati