3 Months after taking methoprolol

I have been taking Metoprolol 12.5mg twice a day (morning and noon) for three months now.
I developed orthostatic tachycardia as a side effect of a vaccine, and I was extremely anxious about taking medication for it.
When I first started taking the medication, I found courage by reading various posts on this channel.
Now, after more than three months, I want to write a review for people who, like my past self, are afraid of starting medication.

I’ve had POTS for about 4 years but had never taken any medication.
This is because my heart rate increase symptoms only occurred for the first one or two months after the onset, and then disappeared.
However, after a year of preparing for employment, I lost muscle mass rapidly, and starting from August last year (during the very hot summer), my heart rate started frequently reaching 130-150 bpm about 3-4 times a week.

As a result, I visited the most well-known doctor in Korea for POTS in March of this year.
He prescribed Bisoprolol 1.25mg and Pyridostigmine.
I also requested Midodrine since I have significant morning hypotension (vagal imbalance), but the doctor advised against using Midodrine, saying it can sometimes paradoxically increase heart rate.
He did not elaborate further on why, but he mentioned that in general, Midodrine is not commonly prescribed for POTS.

He emphasized the importance of beta-blockers, referencing a study he conducted himself where 250 patients were followed for 3 months on beta-blockers and pyridostigmine.
According to him (and I’ve read the paper myself), 100% of patients— all 250 — showed improvement.
He even stated that including a placebo control group would be unethical because the medication is so effective.

He explained that once the adrenaline “switch” is turned on, it’s critical to turn it off — and medication is the best way to do that.
This convinced me to try beta-blockers.

I was hesitant to take Bisoprolol because of its long half-life (8-12 hours).
If I were to experience side effects, they would last for a long time.
So instead, I visited a local clinic and was prescribed Metoprolol 12.5mg.

After taking the medication, my condition improved dramatically.
Before medication, my heart rate would often spike to 140 bpm 4-5 times a week.
Since starting Metoprolol, my heart rate rarely exceeds 120 bpm, and even when it does, it calms down within a minute — even during times when the drug’s effect should have worn off.
Since Metoprolol has a short half-life (3-5 hours), it may be a good starting point for people who are anxious about trying medication.

Over these 3 months, the only side effect I’ve experienced is occasional lightheadedness when going to the bathroom in the morning.
However, I believe this is due more to vagal imbalance than hypotension itself.
Since beta-blockers are sometimes used to treat vagal imbalance, I suspect the dizziness may actually be a result of my heart rate not rising as much as it used to (staying at 100-110 bpm instead of shooting up to 140-150).

If you're hesitant to try beta-blockers because of low blood pressure, consult your doctor about other supportive treatments such as Midodrine, Fludrocortisone, electrolyte drinks, etc., and consider trying beta-blockers carefully.

Lastly, I’m attaching a research paper comparing the blood pressure-lowering effects of various beta-blockers.
According to the paper, at the lowest doses, the blood pressure lowering effect doesn’t seem to be very significant:
https://pmc.ncbi.nlm.nih.gov/articles/PMC6486283/