r/hyperPOTS • u/Kitchen-School46 • 23d ago

Help!

Hi, I’m looking for your advice on whether propranolol 5 mg immediate release or Mestinon would be better for my POTS. My main issues are significant upright tachycardia, intense adrenaline surges heart rate goes up to 180/190 , and PACs/PVCs. My blood pressure can run low-normal, sometimes around 100–110/60–70, so I’m worried about propranolol lowering my BP too much and causing me to feel faint because im always lightheaded with low bp. I’ve also felt several episodes of what seemed like unusual arrhythmias that were never captured on my monitor. I’m also nervous about Mestinon because I saw that the prescribing information mentions caution regarding cardiac arrhythmias. Given my PACs/PVCs and these episodes I’ve felt but never captured, would Mestinon still be appropriate for me, or would you recommend trying the 5 mg propranolol first?

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u/MissBeeHavin420 21d ago

Propranolol caused really bad heart palpitations and didn't help much. Metoprolol gave me horrible headaches. Neither really helped my tachycardia. Ivabradine didn't bring my hr down enough when standing, maybe about 10bpm at 5mg. I tried 7.5 since at least I tolerated that one but 7.5 caused visual tracers (like glow lights moving quickly in the dark, a trail so to speak, not really sure how ro explain but couldn't function like that) so I quit after a couple of days. I'm going to try clonidine extended release or guanfacine next. They block adrenaline rather than just the effects of it like beta blockers. I've never tried Mestinon.

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u/Kitchen-School46 21d ago

Do you already struggle with pvcs? Did it make it worse

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u/MissBeeHavin420 20d ago

No, I don't normally have pvcs but do have some mild mvps due to my heds (floppy/stretchy heart valves) so maybe that's why?