[pshrinkery, med] Q re propranolol (Inderal) for anxiety

[siderea]

MDs, pharmacists, other Rx'ers, and medicine geeks: Is there some reason that propranolol is not more widely prescribed for anxiety? Like, in my reality, at all?I have a patient who is elderly, had a bad reaction to benzodiazepines such that nobody sane will ever prescribe them to her, and raging agoraphobia. Her psychiatrist has only offered her

Comments

[therck]

A little bit of Google searching seems to indicate that there are two sub-groups of beta blockers. There's some indication that cardioselective beta blockers may be safe, possibly even beneficial, for folks with asthma or COPD, but the other type are potentially quite dangerous.

These two papers give some information:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709648/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC482795/

The first one specifically excludes any studies done before 1985, and the second one was done in 1979.

I'm not certain of the reliability of this site, but here's a bit of what they say. It's in much clearer language than the NIH papers.

"The rationale for this makes a lot of sense on the surface. Beta blockers target beta receptors and stop them from sending messages to various parts of the body. In the cardiovascular system, this is beneficial for people with high blood pressure and heart problems because a lot of beta receptors are both on blood vessels and in the heart itself. Blocking these “cardiovascular beta receptors” relaxes blood vessels, slows down the heart, and leads to an overall decrease in blood pressure and in the amount of work the heart has to do.

"However, a lot of beta receptors are in the lungs and “airway structures” ( bronchi, bronchioles -- both are small passages that conduct air through the lungs). In these locations, active beta receptors help keep air passages relaxed and loose, which improves breathing. Blocking beta receptors here causes these airway structures to become more tense and constricted, which is dangerous for people with asthma, COPD, or other types of reversible airway disease.

"The important point, though, is that cardiovascular and airway beta receptors are actually a little bit different. Beta blockers aren’t very good at telling the two types apart and generally block both types about the same, which is bad."

[siderea]

HUH! Fascinating. I'm glad I asked.

good to know

[merashmita]

hmm good to know this