Coreg vs. Toprol in post PPCM preg

[miachic]

Hi Dr. Fett I think I've asked this question before but I'm not sure. I go see my cardio on Tuesday for my next FU appt and to get final clearance on a post PPCM pregnancy. He said in January that he feels comfortable caring for me and feels that I'll do fine (of course also cautioned me of the risks). I go for an echo and am going to request baseline electrolyte studies and blood work as well as baseline CRP and BNP.

I am getting ready to start a list of questions to ask him and wondered what I can ask or mention about the efficacy of Coreg vs. Toprol in a post PPCM preg. I know that Toprol has had more studies and is documented as safe and Coreg is unknown thus far but what's your opinion on them? I know you've said either one is fine but if you were prescribing one in a post PPCM preg, what would you recommend? BTW, I'm not currently on either. Also, I think I've asked this too but do BB have any effect on thyroid meds? I'm currently on Synthroid for hypoT at 75 mcg per day.

Thanks in advance!

[JAMESFETT]

the easy one first: While beta blockers are used to also block symptoms of over active or hyperthyroid condition, they do not interfere with replacement thyroid medication, nor with the ability to monitor effective treatment using thyroid stimulating hormone (TSH) blood test measurement.

It appears there are new reports about carvedilol (Coreg) being potentially harmful to the fetus, so on that basis, if it turns out to be true, best not to use in early pregnancy or if trying to become pregnant. In that case metoprolol long-acting would be best choice and safe.

JDF

[JAMESFETT]

P.S. Hopefully in a post PPCM pregnancy, assuming return of normal function prior to a subsequent pregnancy, there would be no need for a beta-blocker and no heart failure (meaning a relapse). So I assume you are asking in the event there were a relapse, which beta-blocker would I prefer. The answer is metoprolol long-acting, plus hydralizine and nitrate as being safe to use in place of an ACE-inhibitor.

JDF

[sfekke]

Do you have any more information on the harmful effects of Coreg on the fetus? What types of problems?

[JAMESFETT]

Sorry, can't put my finger on other info. Best to check that with your pharmacist and cardiologist.

JDF

[miachic]

P.S. Hopefully in a post PPCM pregnancy, assuming return of normal function prior to a subsequent pregnancy, there would be no need for a beta-blocker and no heart failure (meaning a relapse). So I assume you are asking in the event there were a relapse, which beta-blocker would I prefer. The answer is metoprolol long-acting, plus hydralizine and nitrate as being safe to use in place of an ACE-inhibitor.

JDF

I've had return of normal function but he would put me on a BB at 14 weeks for preventative therapy (in the hopes of that is). He said back in January he would want to do that to give my heart the extra boost from the BB so that hopefully we won't have to go through everything we did before. I would then continue on it until I'm out of the "danger" zone at 6 months and then reevaluate. I'm guessing this would still be his plan of action but that's what I have to figure out and ask him on Tuesday when I go for my FU appt and echo.

Thanks for the info Dr. Fett! :D