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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by linkadge on December 12, 2006, at 17:07:37
Hi, I have normal BP, but my doctor prescribed propranolol for what he calles symtoms of excess adrenalin or something.
Is propranolol safe to use in a patient without high blood pressure for extended periods of time??
Linkadge
Posted by madeline on December 12, 2006, at 17:18:17
In reply to Propranolol safe for long term use with normal BP?, posted by linkadge on December 12, 2006, at 17:07:37
In my opinion, it is.
If I had chronic anxiety, the beta blockers would be my drug of choice.
What dose are you on?
Maddie
Posted by linkadge on December 12, 2006, at 19:31:18
In reply to Re: Propranolol safe for long term use with normal BP? » linkadge, posted by madeline on December 12, 2006, at 17:18:17
20-40mg to start, but I don't know, the drug is kinda making me feel low. I'm already really depressed, my psychiatrist doesn't even ask me about that.
(I told him I'm suicidal and he told me to tell it to go away.)
Linkadge
Posted by sdb on December 12, 2006, at 19:45:51
In reply to Re: Propranolol safe for long term use with normal BP? » linkadge, posted by madeline on December 12, 2006, at 17:18:17
> In my opinion, it is.
>
> If I had chronic anxiety, the beta blockers would be my drug of choice.
>
> What dose are you on?
>
> MaddiePropranolol crosses the blood-brain barrier much more easily than nadolol and it has a short half-life. Because it can block many central beta-receptors it can make you sedated, probably more depressed. Unfortunately propranolol increases ldl but interestingly lowers intima/media thickness of a blood vessel, like nadolol does. Nadolol has very similar beta1/beta2-blocking properties, the substance itself a long-half life (one pill lasts for 24h) and is <not> metabolized by the liver.
Nadolol is not that effective to lower blood pressure in moderate dosages. But it is proven by
many studies to be very effective in blocking adrenaline. Nadolol is approved for long-term usage, propranolol can probably mess more because it is too cardiodepressant if you take that for a longer time.If you take nadolol only once you should take probably 40mg and 3-4 hours before an event because of its long half life.
I am sure that there is a cheap APO generic available in CA.
I have a lot of copied stuff in pdf-file format from many studies eg. effectiveness to block adreneline, heart-failure, hyptertension and what's probably more interesting for you betablockers effectiveness and comparison in performance anxiety (adrenaline rush).
Take care if you have asthma or known heart problems.
If you want I will send it to you per e-mail (some Mbytes)
kind regards
sdb
ps. sjw is a drug that can work and it's definitely not a placebo!
http://www.rxlist.com/cgi/generic3/nadolol_cp.htm
some abstracts; the lipworth study compares some betablockers efficacy in blocking adrenaline (isoprenaline is used for tests because of adrenaline's short half-life but it does more or less the same)
Am Heart J. 1984 Oct;108(4 Pt 2):1150-5. Links
Beneficial effect of nadolol on anxiety-induced disturbances of performance in musicians: a comparison with diazepam and placebo.* James I,
* Savage I.The effects of 40 mg nadolol versus 2 mg diazepam on performance anxiety of 33 young music students were determined. The study had a double-blind, crossover design and was placebo controlled. Nadolol attenuated the rise in pulse rate caused by anxiety and improved those aspects of string playing that can be adversely affected by tremor. There was also a tendency for other functions requiring coordination and judgment to improve. No effect on anxiety was noted for nadolol or for 2 mg diazepam. Diazepam, however, did cause some minor deterioration of performance that was not related to anxiety change. These findings, taken with others, suggest that beta-adrenoceptor-blocking drugs such as nadolol have an important role in the correction of anxiety-induced disturbances of performance. Indeed, their use under such circumstances probably is preferable to that of the benzodiazepines.
PMID: 6148877 [PubMed - indexed for MEDLINE]
A dose-ranging study to evaluate the beta 1-adrenoceptor selectivity of bisoprolol.
* Lipworth BJ,
* Irvine NA,
* McDevitt DG.Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee, UK.
A dose-ranging study was performed to compare the beta 1-adrenoceptor selectivity of bisoprolol with that of atenolol and nadolol. Seven normal subjects (mean age 26 y) were given single oral doses of bisoprolol 5 mg (B5), 10 mg (B10), 20 mg (B20); atenolol 50 mg (A50), 100 mg (A100); nadolol 40 mg (N40); and placebo (PL), in a single blind randomised cross-over design. Beta 2-adrenoceptor responses were assessed by attenuation of finger tremor and cardiovascular responses to graded isoprenaline infusions. Dose-response curves were constructed, and doses of isoprenaline required to increase finger tremor by 100% (IT100), heart rate by 25 beats/min (IH25), SBP by 25 mmHg (IS25), cardiac output by 35% (IC35), and decrease DBP by 10 mmHg (ID10), after each treatment were calculated. These indices were compared with placebo response and expressed as dose-ratios. Exercise heart rate (EHR) was used to assess beta 1-adrenoceptor blockade. There were dose-related increases in plasma concentrations of bisoprolol and atenolol. Reduction of EHR was significantly less with B5 (16.8%) in comparison with all other treatments: B10 21.9%, B20 23.1%; A50 22.5%, A100 22.6%; N40 22.9%. There were small but significant reductions in isoprenaline-induced tachycardia with bisoprolol and atenolol, although mean dose-ratios were considerably less in comparison with N40 (IH25 dose-ratios): B5 2.55, B10 3.18, B20 3.93, A50 2.91, A100 4.89, N40 17.23. There were similar patterns for the other isoprenaline responses. These results show that conventional doses of bisoprolol (10 mg) and atenolol (50 mg) produced equal antagonism of beta 1 and beta 2-adrenoceptors, and therefore possess equal degrees of beta 1-adrenoceptor selectivity.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 1676675 [PubMed - indexed for MEDLINE]
Posted by sdb on December 12, 2006, at 20:01:01
In reply to Re: Propranolol safe for long term use }} linkadge, posted by sdb on December 12, 2006, at 19:45:51
addendum,
for long-term nadolol usage you could even go with 25mg (d) because there is some accumulation.
Propranolol causes beta-receptor upregulation which can diminish its efficacy and make handling, withdrawal more dangerous. Nadolol's evidence is that is doesn't do upregulation of beta-receptors which is a clear positive thing.~S
Posted by Phillipa on December 12, 2006, at 20:48:16
In reply to Re: Propranolol safe for long term use }} linkadge, posted by sdb on December 12, 2006, at 20:01:01
I know you can't take inderal with autoimmune diseases too. I was once put on 25mg of lopressor to (per the doc) my body for an antidepressant paxil at l0mg as I was so anxious. But it made me very tired. Love Phillipa
Posted by sdb on December 12, 2006, at 20:56:21
In reply to Re: Propranolol safe for long term use }} linkadge, posted by Phillipa on December 12, 2006, at 20:48:16
> I know you can't take inderal with autoimmune diseases too. I was once put on 25mg of lopressor to (per the doc) my body for an antidepressant paxil at l0mg as I was so anxious. But it made me very tired. Love Phillipa
lopressor is lipophil thus can go into the brain and it slows heart rate, makes you more tired.
Love sdb
ps. an ecg sometimes could be good (check heart, vascular things) if you have autoimmune, lymes
Posted by Phillipa on December 12, 2006, at 21:56:27
In reply to Re: Propranolol safe for long term use }} Phillipa, posted by sdb on December 12, 2006, at 20:56:21
Been done. Was treated for around three years for chronic lymes. My ANA is l:l80 now. Very good for me. They say it's the hasimotos thyroiditis. Negative for lupus, sjournes, liver, but lost my taste 3 years ago and saw loss of taste is autoimmune. Love Phillipa
Posted by yxibow on December 13, 2006, at 0:01:53
In reply to Re: Propranolol safe for long term use }} linkadge, posted by Phillipa on December 12, 2006, at 20:48:16
> I know you can't take inderal with autoimmune diseases too. I was once put on 25mg of lopressor to (per the doc) my body for an antidepressant paxil at l0mg as I was so anxious. But it made me very tired. Love Phillipa
Lopressor is metoprolol, a cardioselective beta blocker with somewhat different properties than noncardioselective beta blockers. But in the whole, they can may make you tired, at least to start with. That's part of the anxiolytic use of them, especially with doctors who are benzophobic.
One should be careful though that since propranolol is a beta blocker that one monitors one's blood pressure occasionally as fainting is a possibility. It is given PRN for stage fright and people have occasionally fainted as a result as of not being terribly educated by their doctor. Nothing though that should worry you if you have a normal healthy heart and blood pressure.
But just like benzodiazepines, beta blockers once used in a regular routine and not PRN, must be withdrawn from in a cautious fashion or rebound blood pressure could occur. Probably not as dangerous for propranolol as rebound from clonidine (alpha blockers.)
But yes, they're safe for long term use with occasional prudent cuff monitoring and/or EKGs at a physical and have been around not quite as long as benzodiazepines but many years.-- Jay
Posted by madeline on December 13, 2006, at 4:09:43
In reply to Propranolol safe for long term use with normal BP?, posted by linkadge on December 12, 2006, at 17:07:37
Okay, what else are you taking?
Was this a routine visit with your pdoc or an emergent one?
When did you start to feel suicidal?
Do you think this is related to your earlier post about object in your head?
I don't know why people (especially doctors) tell people to just make their symptoms go away.
Like that helps?However, I do not think that the propanolol will push you down so far that you develop a plan, but if you do - get help okay? and tell your doc that you couldn't tolerate it.
Hang in there linkadge, this time of year can just make everything worse.
Maddie
Posted by dessbee on December 13, 2006, at 6:04:32
In reply to Propranolol safe for long term use with normal BP?, posted by linkadge on December 12, 2006, at 17:07:37
I think Propranolol may be helpful.
"The most striking findings of this study were the pronounced activation of the central noradrenergic system in patients with melancholic depression and the data indicating that cortisol is likely to play several roles in producing and sustaining the depressive syndrome. Several implications for future therapeutic intervention in major depression with melancholic features emerge from these findings. First, the potential efficacy of an alpha-noradrenergic blocker should be investigated. Second, given the positive correlation between plasma cortisol and NE levels and the capacity of glucocorticoids to also potentiate the activity of the descending hypothalamic and amygdala CRH pathways, further trials of glucocorticoid antagonism should be conducted in patients with major depression with melancholic features. "
Posted by linkadge on December 13, 2006, at 10:05:07
In reply to Re: Propranolol safe for long term use with normal BP? » linkadge, posted by dessbee on December 13, 2006, at 6:04:32
I don't know if beta blockers actually block HPA axis fucntion. Ie do they have any effect on stress induced cortisol rise?
Linkadge
Posted by linkadge on December 13, 2006, at 10:08:04
In reply to Re: Propranolol safe for long term use with normal BP?, posted by madeline on December 13, 2006, at 4:09:43
When did I start feeling suicidal ? Maybe 13 years of age.
Anyhow, I can't really talk about it here.
(I also have to add the statement that I am not in any immediate danger to myself, so that nobody contacts anybody)Linkadge
Posted by sdb on December 13, 2006, at 17:14:37
In reply to Propranolol safe for long term use with normal BP?, posted by linkadge on December 12, 2006, at 17:07:37
> Hi, I have normal BP, but my doctor prescribed propranolol for what he calles symtoms of excess adrenalin or something.
>
> Is propranolol safe to use in a patient without high blood pressure for extended periods of time??
>
> LinkadgeHi linkadge,
There are much more people dying because of not taking a betablocker than because of taking a betablocker.
I don't think a low dosage propranolol will hurt you. But it can definitely be depressogenic, make you lazy, tired. IMO you would probably go better with a low dosage of approx. nadolol 25mg in the longterm.
Betablocker can change levels of sugar (glucose) concentration in the blood especially in the beginning of a treatment. But there's no direct influence on crh, cortisol known. Nevertheless there are many questions not answered. Nadolol works for migraine in spite of that it does not cross the blood brain barrier easily.
I wish you well
sdb
Posted by sdb on December 13, 2006, at 21:13:28
In reply to Re: Propranolol safe for long term use }} linkadge, posted by sdb on December 13, 2006, at 17:14:37
Linkadge,
Bye the way, I am very thankful that you gave me your St. john's wort informations and experiences.
Thankfully
sdb
Posted by bipolarspectrum on December 15, 2006, at 23:57:33
In reply to Propranolol safe for long term use with normal BP?, posted by linkadge on December 12, 2006, at 17:07:37
Hi Link,
My understanding is that many many many people are on propanolol long term... no issues whatsoever.. its part (or was, im not sure) of the so called cardiovascular combo for high blood pressure routinely given out...
bps
Posted by sdb on December 18, 2006, at 14:14:11
In reply to Re: Propranolol safe for long term use with normal, posted by bipolarspectrum on December 15, 2006, at 23:57:33
IMO bopindolol is one of the best betablockers available for some therapeutic treatments . It has affinity to 5ht1a receptors. Some say that it even possess antidepressant effects itself.
Nippon Yakurigaku Zasshi. 1997 Jan;109(1):1-12. Links
[Pharmacological characteristics of the long-acting beta-blocker "bopindolol"]
[Article in Japanese]* Nagatomo T,
* Hosohata Y,
* Ohnuki T,
* Suzuki J.Department of Pharmacology, Niigata College of Pharmacy, Japan.
The non-selective beta-blocker bopindolol, which was developed as a pro-drug, possessed 50-60 times more potent long-acting hypotensive effects on the blood pressure than those of atenolol or propranolol. Because this drug has only a mild partial agonist activity, it did not cause the rapid decrease in heart rate observed with atenolol or propranolol or the increase in heart rate induced by pindolol. These hypotensive effects are due to beta 1-antagonistic effects, not effects on beta 2- or beta 3-adrenoceptors. In addition to these effects, benefits of this drug include the following: slow dissociation rate from beta-adrenoceptors in tissues, high affinity to 5-HT1A subtypes, less clinical effects on lipid metabolism and the inhibition of renin release. It is possible that this drug possesses different pharmacological characteristics from other beta-blockers.
PMID: 9067994 [PubMed - indexed for MEDLINE]
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