Dr. Bob's Psychopharmacology Tips

Beta-blockers for aggression

Date: 14 Aug 95 23:00:02 EDT
From: Troy Caldwell <75112.1676@compuserve.com>
Subject: Propranolol for aggression

The author prominent in aggression pharmacology I mentioned is Stuart Yudofsky, M.D., Chair of Psychiatry at the Baylor College of Medicine in Houston, Texas. Refer to Psychiatric Annals 17:6, June 1987. Since you may not have this, I am including his 12-Step Guide to Clinical Use of Propranolol from that article.

A 12-Step Guide to Clinical Use of Propranolol

1. Conduct a thorough medical evaluation.

2. Exclude patients with the following disorders:
   • bronchial asthma;
   • chronic obstructive pulmonary disease;
   • insulin-dependent diabetes;
   • diabetes mellitus;
   • congestive heart failure;
   • persistent angina;
   • significant peripheral vascular disease;
   • hyperthyroidism.

3. In patients for whom there are clinical concerns about hypotension or bradycardia, begin with a single test-dose of 20 mg per day. Increase the dose of propranolol by 20 mg per day every three days.

4. For patients without cardiovascular or cardiopulmonary disorder, initiate propranolol on a 20 mg tid schedule. Increase the dose of propranolol by 60 mg per day every three days.

5. Increase the propranolol until the pulse rate is reduced below 50 bpm or the systolic blood pressure is less than 90 mm Hg.

6. Hold the medication dose if severe dizziness, ataxia, or wheezing occurs. Reduce or discontinue the propranolol if such symptoms persist.

7. Increase the dose to 12 mg/kg or until aggressive behavior is under control. Doses of greater than 800 mg are not usually required to control aggressive behavior.

8. Maintain the patient on the highest dose of propranolol for at least eight weeks prior to determining that the patient is not responding to the medication. Some patients, however, may respond rapidly to propranolol.

9. Utilize concurrent medications with caution. Monitor plasma levels of all antipsychotic and anticonvulsant medications. Propranolol has been shown to increase plasma levels of chlorpromazine and thioridizine.

10. Avoid sudden discontinuation of propranolol, particularly in patients with hypertension.

11. Tapering should be accomplished by reducing a patient's dose of propranolol by 60 mg per day until such time as the patient is on a total daily dose of 60 mg per day. At that point, taper the medication at a rate of 20 mg every other day (or more gradually in patients with hypertension) to avoid rebound hypertension.

Date: Wed, 17 Jan 1996 05:46:09 -0500
From: "Robert A. Katz, M.D." <trp.fish@ix.netcom.com>
Subject: Pindolol for aggression

I've used pindolol with a 21 y.o. retarded male with a hx of depression and assaultive behavior along with cruelty to animals. He responded well and now is on paroxetine 20 mg qd with pindolol 2.5 mg bid.

From: "Jonathan Silver" <SILVERJ@cpmail-nz.cis.columbia.edu>
Date: Wed, 17 Jan 1996 10:30:01 EST
Subject: Pindolol for aggression

For a reference on the use of pindolol: Greendyke RM, Kanter DR: Therapeutic effects of pindolol on behavioral disturbances associated with organic brain disease: a double-blind study, J Clin Psychiatry 47:423-426, 1986.

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