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Forum Name: Hypertension

Question: switching from beta blocker to ace inhibitor


 cmvm - Tue May 05, 2009 1:01 pm

My 42 yo husband has been on atenolol 100mg daily for over a year. His Md has switched him to lisinopril 10mg daily. The Md did not say anything about tapering off the beta blocker. Can he stop the beta blocker one day and start the ace inhibitor the next day?
 John Kenyon, CNA - Mon May 11, 2009 10:40 pm

User avatar Hello --

First your husband has been on a very high dose of atenolol. Second, it is not the same class of drug as lisinopril. While the lisinopril can be started as prescribed, with such a high dose of atenolol it should be reduced some first, and in any event it needs to be tapered off carefully over a period of 10-14 days to avoid potentially very serious side (rebound) effects such as heart attack, blood pressure spike, chest pain, cardiac arrhythmias, etc. Since the dose is so high, it should be tapered to at least 1/2 before the lisinopril is begun in order to avoid wild fluctuations in blood pressure (first likely very low, then possibly spiking a little later). This should have been carefully explained by your husband's doctor. If the doctor is not a cardiologist then perhaps before this changeover is done your husband should have a consult with a cardiologist who can supervise this drug switch. Again, the current dose of atenolol is very large, so I'm assuming the effectiveness was being lost over time and now the doctor wants to try something new. Beta blockers cannot be stopped abruptly, even if one is being replaced by a different sort of drug for the same problem, because other side effects can still take place as outlined above.

I hope this is helfpul to you. Good luck to you and your husband with this. He's lucky to have you watching out for him. Please follow up with us here as needed.

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