Q. Can Metpure-XL be taken by a sinus bradycardia patient?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
Published on May 15, 2018 and last reviewed on: Dec 26, 2018

Hello doctor,

I have been a high BP and sinus bradycardia (heart rate of 52) patient for the last four years. I used to take Metpure-XL 25 mg after breakfast based on my cardiologist's advice.

For the last six months, I was having headache and confusion plus slightly increased urination. Last week, I visited another cardiologist who checked my BP. My BP was very high i.e. 175/105.

He asked me to start with Telma 40 mg and Metpure-XL 50 mg after breakfast. I did all types of blood tests. My uric acid is slightly elevated at 7.8. Vitamin D is deficient at 10. All the other tests like the lipid profile, renal tests, LFTs, sodium, potassium, and blood sugar are alright.

My headache is gone after taking new medicines. However, I am feeling bloated most of the time.

My questions are

1. Is bloating a side effect of Telma 40 mg? Can you advise another medicine?

2. Is Metpure-XL 50 mg advisable in sinus bradycardia (a heart rate of 52)? Please assist me with next course of action.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

  • Firstly, it is better to avoid Metpure (Metoprolol) if the heart rate is on the lower side at least resting heart rate should be above 55 to 60 per minute.
  • Also, we have other options available for blood pressure control. So, it is better to reduce the dose to 25 mg, and check if the heart rate remains below 60 then stop. If needed we can add Amlodipine 5 mg once a day if the blood pressure remains high.
  • I suggest you have low salt diet and monitor blood pressure regularly thrice a day for one week then once or twice a week. If blood pressure is persistently more than 140/90 mmHg then we need to add medicines.
  • Regular exercises like brisk walking, jogging according to your capacity for at least 30 minutes a day five days a week will help. Lots of green leafy vegetables, fruits, fish once or twice a week, avoid meat. Weight loss will also help in both bloating and blood pressure control.
  • You can have some walk after having food instead of taking rest. Have multiple small meals instead of heavy meals. Have regular sleep habits and avoid stress. Lots of green leafy vegetables, fruits. Avoid smoking and alcohol if any.
  • I suggest you take tablet Pantodac DSR (Pantoprazole and Domperidone) 40 mg or Esomeprazole and Domperidone combination before breakfast once a day for a week and then if needed. Consult your specialist doctor, discuss with him or her and with their consent take the medicines.

Hope this helps you and you can get back if you have any doubts.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Thank you doctor,

So your recommendation is to take Pantodac DSR 40 mg before breakfast for a week, Telma 40 mg after breakfast and Amlodipine 5 mg?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

Firstly, you need to decrease the dose of Metpure (Metoprolol) to 25 mg as we cannot stop it suddenly. If the heart rate is still below 60 then we will stop completely.

So, I suggest you the following. Consult your specialist doctor, discuss with him or her and with their consent take the following medicines.

  1. Telma CT (Telmisartan and Chlorthalidone) 40/12.5 mg once a day. It is better to have a combination of Telmisartan and Chlorthalidone, so from next time I suggest you buy this.
  2. Tablet Pantodac DSR (Domperidone and Pantoprazole) 40 mg before breakfast once a day for a week.
  3. Tablet Amlodipine 5 mg once a day in the morning only if the blood pressure is persistently more than 140/90. So you let me know your blood pressure readings before starting this.

All the best.

For more information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Thank you doctor,

I will get back to you after 15 days and will follow your advice.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
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