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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by mike99 on February 28, 2006, at 20:20:57
Would anyone care to share any experiences with Coreg?Has anyone taken Coreg with Provigil?
Posted by sdb on March 1, 2006, at 12:11:17
In reply to Coreg (carvedilol), posted by mike99 on February 28, 2006, at 20:20:57
carvedilol is a beta1/2 and alpha1 antagonist.
its an effective antihypertensive med indicated for heart failure. If you're not hypertensive I am sure you will have some orthostatic syncopes (seeing black and dizziness after standing up fastly). If you intend to use a betablocker for psych reasons there are better options.~sdb
Posted by ed_uk on March 3, 2006, at 17:14:52
In reply to Coreg (carvedilol), posted by mike99 on February 28, 2006, at 20:20:57
Hi Mike
I assume you're considering taking carvedilol to reduce the cardiovascular toxicity which you've previously experienced on amphetamines and methylphenidate.
I'm not sure carvedilol would be the best option. You might want to consider taking a beta blocker (eg atenolol or bisoprolol) in combination with an alpha blocker (eg doxazosin) instead. This way, you could adjust the dosage of the beta blocker according to your heart rate and the alpha blocker according to your BP etc. This is an oversimplification but I'm sure you understand what I'm getting at. With carvedilol, you wouldn't have as much 'flexibility'.
Ed
Posted by mike99 on March 4, 2006, at 15:54:11
In reply to Re: Coreg (carvedilol), posted by ed_uk on March 3, 2006, at 17:14:52
> Hi Mike
>
> I assume you're considering taking carvedilol to reduce the cardiovascular toxicity which you've previously experienced on amphetamines and methylphenidate.Exactly...I'm actually considering a trial of Provigil, and despite it's reduced cardiovascular activation I'm pretty confident I'd also need an alpha/beta blocker on board.
> I'm not sure carvedilol would be the best option. You might want to consider taking a beta blocker (eg atenolol or bisoprolol) in combination with an alpha blocker (eg doxazosin) instead. This way, you could adjust the dosage of the beta blocker according to your heart rate and the alpha blocker according to your BP etc. This is an oversimplification but I'm sure you understand what I'm getting at. With carvedilol, you wouldn't have as much 'flexibility'.
...I get your point right on--that's a great idea. Thanks for the suggestion. In addition to the 'flexibility' you mention, it would also allow me to use a cardioselective beta blocker like atenolol as you suggest. One thing I really don't like about carvedilol is it's non-selectivity of beta blockade.
I'll run this by my doc and post if it works out. Thanks again for your response and input.
Mike
Posted by ed_uk on March 4, 2006, at 18:05:17
In reply to Re: Coreg (carvedilol) » ed_uk, posted by mike99 on March 4, 2006, at 15:54:11
Hi Mike :)
I doubt you'll need an alpha/beta blocker with Provigil but I suppose it's possible. If you do, you might respond well to atenolol alone, without an alpha blocker.
Kind regards
Ed
Posted by mike99 on March 4, 2006, at 19:24:26
In reply to Re: Coreg (carvedilol) » mike99, posted by ed_uk on March 4, 2006, at 18:05:17
> Hi Mike :)
>
> I doubt you'll need an alpha/beta blocker with Provigil but I suppose it's possible. If you do, you might respond well to atenolol alone, without an alpha blocker.
>
> Kind regards
>
> EdThanks Ed. I always appreciate your input, it is extremely helpful.
The reason I'm concerned about only using a beta blocker w/Provigil is that I've read in the physicians desk reference that beta blockers "increase pressor effects of sympathomimetics"-- and also a previous thread by rphstudent cautioned that combining a sympathomimetic and beta blocker can lead to a dangerous phenomenon called "unopposed beta blockade"--where beta receptors are blocked out of proportion with alpha receptors.
For example, based on this premise I believe the protocol for cocaine/amphetamine toxicity in the ER is to never give a beta blocker alone but a mixed alpha/beta antagonist. Perhaps I don't understand this fully, it is more theoretical than practical or only applies to severe acute toxicity because several babblers claim to use beta blockers alone with stimulants/sympathomimetics.
Also, I realize Provigil is not technically a sympathomimetic but it definitely does have sympathomimetic properties (don't know if you caught this in a recent thread under "provigil discussion") and that I might tolerate it without any cardiac meds. However, despite my good health, my physiology is such that I'm probably one of the small minority that would be extremely sensitive to provigil from a cardiovascular standpoint.
I've read of 2 babblers having to go to the ER due to the cardiovascular effects of provigil. Been there, done that (w/ amphetamine), got the t-shirt, don't want to visit again ;) That's why I'm being so cautious and meticulous in my research (and of course always proceed under physician supervision).
Might you have any thoughts on this? And are you aware if atenolol has any benefits (or drawbacks) compared to say toprol?
Regards,
Mike
Thanks Ed. Do you know if atenolol has any advantages over toprol?
>
>
Posted by ed_uk on March 5, 2006, at 14:05:14
In reply to provigil+-alpha/beta blocker? » ed_uk, posted by mike99 on March 4, 2006, at 19:24:26
Hi Mike
>The reason I'm concerned about only using a beta blocker w/Provigil is that I've read in the physicians desk reference that beta blockers "increase pressor effects of sympathomimetics"
Beta-1 selective antagonists such as atenolol do not increase the pressor effect of sympathomimetics, the caution applies to non-selective beta blockers such as propranolol.
>For example, based on this premise I believe the protocol for cocaine/amphetamine toxicity in the ER is to never give a beta blocker alone but a mixed alpha/beta antagonist.
That's right. Alpha blockers are needed for the hypertension. Propranolol alone could be risky. A beta-1 selective antagonist (alone) would be safer but wouldn't be adequately effective if severe hypertension was present.
>Do you know if atenolol has any advantages over Toprol?
In the UK, atenolol is cheaper than metoprolol.
Atenolol has a longer duration of action than metoprolol and can be given once or twice daily. Metoprolol often needs to be given several times per day unless it's given as the more expensive Toprol XR.
Very little atenolol enters the brain. Metoprolol, on the other hand, enters the brain more readily. Potential CNS side effects such as sleep disturbances can be a problem.
Kind regards
Ed
Posted by mike99 on March 5, 2006, at 16:25:47
In reply to Re: provigil+-alpha/beta blocker? » mike99, posted by ed_uk on March 5, 2006, at 14:05:14
Thank you kindly Ed,That's exactly the information I was looking for. It is very much appreciated.
Mike
Posted by sdb on March 5, 2006, at 17:06:07
In reply to Re: provigil+-alpha/beta blocker? » ed_uk, posted by mike99 on March 5, 2006, at 16:25:47
if you use sympathomimetics combined with betablockers I would be cautious stopping the betablocker isolated and fastly. Atenolol and metoprolol are not very beta1-selective. A and M cause beta receptor upregulation by time thus increased sensitivity for sympathic stimuli if you stop taking the betablocker.
~sdb
Posted by mike99 on March 5, 2006, at 17:37:22
In reply to Re: provigil+-alpha/beta blocker? }} mike99, posted by sdb on March 5, 2006, at 17:06:07
> if you use sympathomimetics combined with betablockers I would be cautious stopping the betablocker isolated and fastly. Atenolol and metoprolol are not very beta1-selective. A and M cause beta receptor upregulation by time thus increased sensitivity for sympathic stimuli if you stop taking the betablocker.
>
> ~sdbThanks for the info. I realize the dangers of abruptly stopping a betablocker.
I thought atenolol and metoprolol are quite beta-1 selective (although none are completely selective)?
Posted by sdb on March 5, 2006, at 18:28:55
In reply to Re: provigil+-alpha/beta blocker? }} mike99 » sdb, posted by mike99 on March 5, 2006, at 17:37:22
>>although none are completely selective
Yes. The most selective betablocker for beta1-receptors is nebivolol. But nebivolol has weak affinity. It's more likely that nebivolol acts antihypertensive through NO release.
Most betablockers elevate LDL but laboratory research has shown that there is no increase in (intima/media) thickness of blood vessels. This is postulated due to antioxidative properties, stabilizing heart rate, more smooth pulsus improving haemodynamics.
~sdb
Posted by mike99 on March 5, 2006, at 18:34:12
In reply to Re: provigil+-alpha/beta blocker? }} mike99, posted by sdb on March 5, 2006, at 18:28:55
Posted by sdb on March 6, 2006, at 21:43:19
In reply to thanks (nm) » sdb, posted by mike99 on March 5, 2006, at 18:34:12
I am glad if I can help you in the presumably right direction and not help you the wrong direction.
~sdb
Posted by Chairman_MAO on March 7, 2006, at 15:19:27
In reply to Re: Coreg (carvedilol) » ed_uk, posted by mike99 on March 4, 2006, at 15:54:11
The best strategy for mitigating cardiovascular toxicity is to use equivalent doses of methamphetamine which has a much higher ratio of CNS:peripheral effects. That is, you can produce significant CNS effects with d-methamphetamine (not dl-meth, which is what most street speed is at best!) with negligable cardiovascular effects. This is not usually possible with d-amphetamine (though d-amphetamine is better than the racemic or Adderall).
A more direct solution to this problem would be low-dose clonidine--this directly reduces sympathetic outflow.
Posted by ed_uk on March 7, 2006, at 16:13:19
In reply to Re: Coreg (carvedilol) » mike99, posted by Chairman_MAO on March 7, 2006, at 15:19:27
But how does one aquire a prescription for Desoxyn? ;-) Not an easy task.
Ed
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