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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by CareBear04 on January 12, 2005, at 2:56:03
hi, i have some questions about these drugs.
i've been on propranolol on and off for tremors mostly from lithium. one doctor prescribed it at 20mg 4x a day. other doctors have been really reluctant to prescribe it. i guess the main reason is that i have really low blood pressure (systolic in the 70s). i don't know if the concern is more that the drug will lower my BP more or that it will slow my heart enough that it won't be able to compensate as well for the low BP. i've sometimes taken it for that reason too-- i feel my heart beating too fast (way over 100bpm) or i feel palpitations. does anyone know to what degree propranolol lowers your blood pressure and slows your heart?how much is too much propranolol? a few times, i've taken as much as 200-300mg at one time and haven't even felt tired. i have such bad tremors and muscle spasms that the propranolol saved energy by blocking those things. how much can one take at a time without running into toxicity? is the dose based on size or condition or what?
i'd appreciate any advice or knowledge! thanks so much!
Posted by med_empowered on January 12, 2005, at 13:26:53
In reply to propranolol/beta blockers, posted by CareBear04 on January 12, 2005, at 2:56:03
hey! I've taken propranolol in high-ish doses as well, and I have normal blood pressure. Anyway, for high BP, propranolol can be RX'd in the hundreds of mgs-I think the ceiling is around 700mgs total, so for most people that'd be in or approaching 200mgs a dose, depending on how the total is divided by the prescriber. There are a few problems, though; higher dose prescribing can push the total amount provided to you when the Rx is filled up to and beyond the amount needed for suicide, some people develop abnormally low BP, tapering can be a pain (risk of irregular heart beat, heart attack in some), etc. Personally I found that, at most, propranolol pushed my BP down maybe 10pts...significant, but not dangerous, if your BP is at or around the normal range. Although i can understand some reluctance on the part of prescribers in your case, I hope that would just result in cautious RXing (monitoring, etc.) to make sure everything's cool with your BP, rather than outright refusal to prescribe. That said, some docs will flat out refuse, in my experience, without even taking checking BP...one of my former shrinks said he "didn't like" propranolol...however, he felt fine RXing a benzo for the same condition. Go figure. At any rate, I wish you luck with your condition...is there anything you can get easily that helps? Or anything else you've ever wanted to try?
Posted by CareBear04 on January 12, 2005, at 13:35:42
In reply to Re: propranolol/beta blockers, posted by med_empowered on January 12, 2005, at 13:26:53
hey med_empowered! thanks for responding!
what dose of propranolol were you on? is 80mg/day pretty typical to calm jitteriness and tremors?
that's kind of scary to think about people taking close to a gram a day of propranolol. i think i've read that propranolol is more toxic than other meds in this class. i don't know if you know anything about that. there was something about it being implicated in a lot of suicides and being more likely to cause seizures than the others.have you tried or do you know about other beta blockers like atenolol? i don't know the names of any others; atenolol was the only other suggested by one doctor. i do like propranolol a lot. it doesn't make me tired, and i think it's pretty clean in what it does for me-- just taking care of tremors and calming me in a different way than benzos.
do you know if the decrease in blood pressure is dose-dependent? i guess from what you said, it probably would be if the high BP people are taking 700mg a day.
thanks again!
Posted by med_empowered on January 12, 2005, at 16:45:54
In reply to Re: propranolol/beta blockers » med_empowered, posted by CareBear04 on January 12, 2005, at 13:35:42
hi! I think your dose of propranolol is pretty typical...mine was 60mgs/daily for akithisia/anxiety. Given the huge differences in dosage, I would say that propranolol's effects are dosage-dependent. I've also taken higher dosages, and there seems, subjectively, to be a difference; at 160mgs or so, its almost like taking an ativan, except it has the added benefit of slowing down the pulse and lowering the blood pressure a bit. I've never taken any other beta blockers, but I here a lot of people take pindolol (sp?) for purposes similar to propranolol, though propranolol seems to be a classic remedy...its even mentioned in layman's books on some forms of mental illness.
Posted by yxibow on January 12, 2005, at 18:43:19
In reply to Re: propranolol/beta blockers, posted by med_empowered on January 12, 2005, at 16:45:54
There are definite differences between the beta blockers... they belong either to a class called cardioselective (acting primarily on Beta-1) or noncardioselective (acting to degrees of extent both at Beta-1 and Beta-2). (roughly so).
Cardioselective ones tend to be slightly newer agents intended for cardiac use and related conditions. Non-cardioselective drugs, while also affecting Beta-1, your heart, are used for anti-tremor and the modulation of muscular
effects.
These include propranolol, carteolol, labetalol , nadolol , penbutolol, pindolol, sotolol, and timolol. Others, such as metropolol are cardioselective (Beta-1).
The reasoning behind using non-cardioselective agents is that they dont act primarily on your heart, but they also act as noted before on peripheral areas of the body.In either case, there are several cautions; since they do act on your heart, should not take them if your heart rate is already around 60 or so, or you may end up with out much of a pulse especially if you take a large dose. The other thing to note is longer term use requires a withdrawal period because your body will adjust to the agent in the heart rate - blood pressure equilibrium; I don't believe you can just drop it. And they affect serotonin levels on a very mild level so they can also increase depression. But as for an anti-tremor agent, propranolol is probably used the most widely up to the 200s in mg per day. 600 is more reserved for heart patients.
(disclaimer, void where prohibited, etc... :)Tidings
Posted by CareBear04 on January 12, 2005, at 20:32:15
In reply to Re: propranolol/beta blockers, posted by yxibow on January 12, 2005, at 18:43:19
thanks, tidings! that was really helpful. i guess i'll stick with the propranolol, as long as i can get it prescribed. my pulse is too fast if anything, though BP is low. propranolol makes a huge difference, though, in just being able to write or put on chapstick or do simple things like that. thanks for the info!
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