پروپرانولول به عنوان گزینه‌ای برای درمان اضطراب

So welcome back! In today's video we're going to be talking about propranolol or inderol for the treatment of anxiety. And this is actually as a result of a question that came up during my first live session on YouTube. And the question actually was what are some alternatives to benzodiazepines? And you know that I am NOT a proponent for benzodiazepines and I have a couple of videos on those medications. So if you've missed those, go ahead and check them out so you can understand that I hesitate to prescribe those medications to my patients. And so perpanolol happens to be one of three alternatives to benzodiazepines that I will use. use. And the other two medications are hydroxyzine and clonidine. And so I'll be making videos on those two medications. So make sure you're subscribed so you don't miss out. And without further ado, let's get into the video on propanolol starting now. So number one, what is perpanolol? Well, perpanolol is a non-selective beta-adrenergic blocker. So it blocks B1 and B2. So blocking the beta-adrenergic receptors actually help to decrease autonomic excitability. And autonomic excitability is present in a lot of patients who have anxiety where the sympathetic nervous system is overactive. And so you have a lot of those symptoms of increased heart rate, muscle tension, maybe grinding your teeth, or just having that restlessness or fidgety feeling, that oftentimes is coming from the overactivation of the sympathetic nervous system. And so propranolol helps to decrease that or block those receptors that activate that response. Now, theoretically, the B1 or beta-1 adrenergic blockers may prevent fear conditioning or fear reconsolidation. And this is very important for patients who have PTSD. PTSD because what this means is that it allows the patient to be able to be more open in therapy, to have less fear reactions during their therapy sessions when they're discussing a traumatic event. And this then allows them to reprocess the traumatic event and allows the person to heal and reprocess the fear and even the emotional responses related to the traumatic event or traumatic memory. And so that's where this medication can be very effective for those types of patients. And so that leads us... into what is propranolol used for. Well, propranolol was FDA approved in 1967, and it has many FDA approvals, such as migraine prophylaxis or migraine prevention, the essential tremor or tremor in the hands, hypertension or high blood pressure, cardiac arrhythmias or irregular heartbeats, angina pectoris or chest pain, myocardial infarction, so to be used after someone has had a myocardial infarction or heart attack. hypertrophic subaortic stenosis, and femochromocytoma. And as you can see, a lot of these conditions are related to heart health or cardiovascular illnesses. However, propranolol's psychiatric uses are noted in the off-label uses. So after it was marketed and FDA approved, these other uses were found for propranolol. And that's where the psychiatric uses come in. And they are generalized anxiety disorder, social anxiety disorder, PTSD or post-traumatic stress disorder, akathisia, which is a side effect of many of the psychiatric medications, as well as helping with aggression and violence. And so how long does propranolol take to work? Well, there are two forms of propranolol. You have your extended release and your immediate release. And when we're using it for anxiety, we're usually using the immediate release because we're trying to just gain a short-term benefit to help reduce symptoms of panic or anxiety very quickly. And so effects of that are going to be be 30 minutes to one hour. And so 30 minutes are going to be seen for the immediate release and an hour or more for the extended release. And the doses that are used for anxiety, like generalized anxiety or social anxiety are going to be typically 40 milligram doses once daily or up to three times a day. And now when you're talking about PTSD and helping with the fear reconditioning or the fear response, it can actually be used in doses up to 240 milligrams total for the day. And that's in divided doses. And so it... Is propanolol addicting? No, propanolol is not addicting. It doesn't cause any cravings or any urges to use it. And you won't abuse it or use it more than you need to. However, it can cause rebound symptoms if you abruptly take it away. And this is true for a lot of medications, not just the psychiatric medications. And so when I'm talking about rebound symptoms, these are things like rebound hypertension. So your blood pressure can spike abruptly and also arrhythmia. or cardiac arrhythmias can occur. So if you're taking them, for those causes, then you abruptly stop it. It can actually trigger a hypertensive crisis or even a heart attack. Now, if you're just taking it sparingly for anxiety, which is how it's typically prescribed for psychiatric or mental health. purposes, then if you're not taking it pretty regularly, you won't have any of those rebound symptoms. And so now let's move on to side effects. What are the side effects of perpana law? Well, the common side effects that we see in practice are sedation, headaches, dizziness, feeling weak, which can be attributed to it lowering your blood pressure or lowering your heart rate, as well as having cold fingers or cold toes, nausea, vomiting, and diarrhea can occur, as well as stomach pain, and then weight gain can also be a factor. Now some other notable side effects of propranolol include things like bronchospasm or spasms of the lungs or the bronchioles in the lungs, sexual dysfunction can occur with propranolol, urinary retention, has been seen and also low blood sugar and even joint pain can occur. Rare but dangerous side effects to look out for with propranolol include things like Steven Johnson syndrome, which is a very nasty rash that I've talked about in other medication videos. Also the development of ANA antibodies, which can lead to immune conditions. And an immune condition that has been associated with long-term use of propranolol has been systemic lupus erythematosus or lupus. Another rare but dangerous side effect is it can actually worsen my myasthenia gravis, which is another type of autoimmune condition. And with myasthenia gravis, patients probably should not be using propranolol because it can worsen those effects. It can also increase your BUN or your blood urea nitrogen, which is a kidney marker. And it can also elevate various liver enzymes as well as lactate dehydrogenase or LDH, which is a type of inflammatory marker. And so that's why it's important to make sure you're getting your labs checked and looking for those specifically, but also looking for other markers. markers of poor health. And because it can elevate those liver enzymes and the kidney function, the BUN marker, it needs to be used with caution in patients who have kidney or liver disease. And so what are some drug interactions of propranolol? Well, propranolol is primarily metabolized through the liver using the CYP2D6. So we want to be cautious with inhibitors and inducers of that enzyme. And there are more inhibitors than there are inducers. And there are many more inhibitors of CYP2D6. YP2D6. These are just the ones that I commonly see. So always make sure you're doing your drug interaction checks. So other drug interactions or other drugs that can affect propranolol levels include these medications, which can actually increase propranolol levels and propranolol side effects. And then you have calcium channel blockers, which can potentiate the antihypertensive effects of propranolol. So you have to be careful with calcium channel blockers as well as other blood pressure medications. And then these medications... can actually decrease the effects of beta blockers as a whole and decrease the effectiveness of those drugs. And then prostaglandin inhibitors can actually inhibit the antihypertensive activity of propranolol. So if you're taking it for high blood pressure and you're taking an NSAID or aspirin or something like that, you may actually inhibit that antihypertensive effect or activity. Now, propranolol itself can actually increase adverse effects of gabapentin and even benzodiazepines. And this is true. with the side effects, specifically with sedation or dizziness. So if you're having those side effects while taking gabapentin or benzodiazepines, and then you take propranolol, you can actually increase those side effects. Propanolol can actually also increase the levels of lidocaine, and that can lead to lidocaine toxicity if you're taking lidocaine or if it's used in an emergency for a patient and they're on propranolol. So that should actually be avoided. And propranolol can actually also increase anticoagulant effects. of warfarin or coumadin. So therefore it's going to be very important to have your PT and INR checked if you're on propranolol and also taking coumadin or warfarin. And now some cautions and considerations with propranolol. Well first of all propranolol can cause bradycardia or very low or slow heart rate and so it's definitely contraindicated in patients who have second or third degree heart block as well as those in cardiogenic shock. It's also not advised to be used for bronchial asthma or COPD because it's a non-selective beta blocker and it can actually inhibit the catecholamines. Like if you take your epinephrine or inhaler, if you're having an asthma attack and you're on propanolol, propanolol can actually block the effects of that. And so therefore, you would end up having an asthma attack and not be able to treat it properly if you're using propanolol. And that's why it's not advised to use propanolol in patients who have COPD or asthma. Perpenolol can also be used to treat Also lower intraocular pressure and so this is important because it can interfere with glycoma screening tests and so talk to your ophthalmologist if you're taking propanolol and getting ready to have an eye exam. Also it should be used with caution with the elder. because with the elderly they have an increased risk of stroke and also increased risk of side effects with dropping blood pressure too quickly or even heart rate too quickly. And so what are my final thoughts on propanolol? Well as As I mentioned in the very beginning, it's actually one of those effective medications that can be used as an alternative to benzodiazepines. And if you know anything about benzodiazepines, then you know that benzodiazepines can cause tolerance, dependence, and many patients will have a very difficult time coming off of them. And benzodiazepines are not to be used long term. And so something like propranolol can be an alternative to the use of benzodiazepines, but I want to state that it's not going to be as effective or as strong as you're used to if you've been taking a benzodiazepine because benzodiazepines work differently on those GABA receptors and have a very strong effect. So it's going to take some adjusting there if you're going to be switching from a benzodiazepine to propranolol. And another thing that I want to mention is that as my philosophy goes, skills before pills. And so you want to make sure that if you're having anxiety or having symptoms of PTSD, that you do the skills and you do the work. to work in therapy to help you regulate your anxiety and regulate your emotions and your fear responses and those symptoms as that ultimately is the long-term goal with therapy is that you improve. And with these medications, whether it be propranolol or benzodiazepines or any other anxiolytics should only be used short-term or very sparingly. And so that's for the skills before pills come in. Now, sometimes you need pills to build those skills. And that's why... it would be okay to use it first initially when you're having an acute stress response or acute reaction, but learning those skills in therapy will help you to regulate your own emotions and anxiety so that way you're not depending on the pills so much. So that wraps up my video on propanolol and its use in anxiety. Do you have experience with taking propanolol for anxiety? If so, drop it down in the comment section and let us know as we learn from sharing each other's mistakes. experiences. And as always, I thank you for watching and wish you well on your mental health care journey and look forward to seeing you all next time. many uses okay i'll go into sorry sorry sorry sorry lactate dehydrogenate uh sorry lactate lactate

So if you've missed those, go ahead and check them out so you can understand that I hesitate to prescribe those medications to my patients. And so perpanolol happens to be one of three alternatives to benzodiazepines that I will use. use.

And the other two medications are hydroxyzine and clonidine. And so I'll be making videos on those two medications. So make sure you're subscribed so you don't miss out. And without further ado, let's get into the video on propanolol starting now. So number one, what is perpanolol?

Well, perpanolol is a non-selective beta-adrenergic blocker. So it blocks B1 and B2. So blocking the beta-adrenergic receptors actually help to decrease autonomic excitability.

And autonomic excitability is present in a lot of patients who have anxiety where the sympathetic nervous system is overactive. And so you have a lot of those symptoms of increased heart rate, muscle tension, maybe grinding your teeth, or just having that restlessness or fidgety feeling, that oftentimes is coming from the overactivation of the sympathetic nervous system. And so propranolol helps to decrease that or block those receptors that activate that response. Now, theoretically, the B1 or beta-1 adrenergic blockers may prevent fear conditioning or fear reconsolidation. And this is very important for patients who have PTSD.

PTSD because what this means is that it allows the patient to be able to be more open in therapy, to have less fear reactions during their therapy sessions when they're discussing a traumatic event. And this then allows them to reprocess the traumatic event and allows the person to heal and reprocess the fear and even the emotional responses related to the traumatic event or traumatic memory. And so that's where this medication can be very effective for those types of patients. And so that leads us...

into what is propranolol used for. Well, propranolol was FDA approved in 1967, and it has many FDA approvals, such as migraine prophylaxis or migraine prevention, the essential tremor or tremor in the hands, hypertension or high blood pressure, cardiac arrhythmias or irregular heartbeats, angina pectoris or chest pain, myocardial infarction, so to be used after someone has had a myocardial infarction or heart attack. hypertrophic subaortic stenosis, and femochromocytoma.

And as you can see, a lot of these conditions are related to heart health or cardiovascular illnesses. However, propranolol's psychiatric uses are noted in the off-label uses. So after it was marketed and FDA approved, these other uses were found for propranolol. And that's where the psychiatric uses come in.

And they are generalized anxiety disorder, social anxiety disorder, PTSD or post-traumatic stress disorder, akathisia, which is a side effect of many of the psychiatric medications, as well as helping with aggression and violence. And so how long does propranolol take to work? Well, there are two forms of propranolol.

You have your extended release and your immediate release. And when we're using it for anxiety, we're usually using the immediate release because we're trying to just gain a short-term benefit to help reduce symptoms of panic or anxiety very quickly. And so effects of that are going to be be 30 minutes to one hour.

And so 30 minutes are going to be seen for the immediate release and an hour or more for the extended release. And the doses that are used for anxiety, like generalized anxiety or social anxiety are going to be typically 40 milligram doses once daily or up to three times a day. And now when you're talking about PTSD and helping with the fear reconditioning or the fear response, it can actually be used in doses up to 240 milligrams total for the day. And that's in divided doses.

And so it... Is propanolol addicting? No, propanolol is not addicting.

It doesn't cause any cravings or any urges to use it. And you won't abuse it or use it more than you need to. However, it can cause rebound symptoms if you abruptly take it away.

And this is true for a lot of medications, not just the psychiatric medications. And so when I'm talking about rebound symptoms, these are things like rebound hypertension. So your blood pressure can spike abruptly and also arrhythmia. or cardiac arrhythmias can occur.

So if you're taking them, for those causes, then you abruptly stop it. It can actually trigger a hypertensive crisis or even a heart attack. Now, if you're just taking it sparingly for anxiety, which is how it's typically prescribed for psychiatric or mental health. purposes, then if you're not taking it pretty regularly, you won't have any of those rebound symptoms.

And so now let's move on to side effects. What are the side effects of perpana law? Well, the common side effects that we see in practice are sedation, headaches, dizziness, feeling weak, which can be attributed to it lowering your blood pressure or lowering your heart rate, as well as having cold fingers or cold toes, nausea, vomiting, and diarrhea can occur, as well as stomach pain, and then weight gain can also be a factor.

Now some other notable side effects of propranolol include things like bronchospasm or spasms of the lungs or the bronchioles in the lungs, sexual dysfunction can occur with propranolol, urinary retention, has been seen and also low blood sugar and even joint pain can occur. Rare but dangerous side effects to look out for with propranolol include things like Steven Johnson syndrome, which is a very nasty rash that I've talked about in other medication videos. Also the development of ANA antibodies, which can lead to immune conditions. And an immune condition that has been associated with long-term use of propranolol has been systemic lupus erythematosus or lupus. Another rare but dangerous side effect is it can actually worsen my myasthenia gravis, which is another type of autoimmune condition.

And with myasthenia gravis, patients probably should not be using propranolol because it can worsen those effects. It can also increase your BUN or your blood urea nitrogen, which is a kidney marker. And it can also elevate various liver enzymes as well as lactate dehydrogenase or LDH, which is a type of inflammatory marker.

And so that's why it's important to make sure you're getting your labs checked and looking for those specifically, but also looking for other markers. markers of poor health. And because it can elevate those liver enzymes and the kidney function, the BUN marker, it needs to be used with caution in patients who have kidney or liver disease. And so what are some drug interactions of propranolol? Well, propranolol is primarily metabolized through the liver using the CYP2D6.

So we want to be cautious with inhibitors and inducers of that enzyme. And there are more inhibitors than there are inducers. And there are many more inhibitors of CYP2D6. YP2D6.

These are just the ones that I commonly see. So always make sure you're doing your drug interaction checks. So other drug interactions or other drugs that can affect propranolol levels include these medications, which can actually increase propranolol levels and propranolol side effects.

And then you have calcium channel blockers, which can potentiate the antihypertensive effects of propranolol. So you have to be careful with calcium channel blockers as well as other blood pressure medications. And then these medications...

can actually decrease the effects of beta blockers as a whole and decrease the effectiveness of those drugs. And then prostaglandin inhibitors can actually inhibit the antihypertensive activity of propranolol. So if you're taking it for high blood pressure and you're taking an NSAID or aspirin or something like that, you may actually inhibit that antihypertensive effect or activity. Now, propranolol itself can actually increase adverse effects of gabapentin and even benzodiazepines.

And this is true. with the side effects, specifically with sedation or dizziness. So if you're having those side effects while taking gabapentin or benzodiazepines, and then you take propranolol, you can actually increase those side effects.

Propanolol can actually also increase the levels of lidocaine, and that can lead to lidocaine toxicity if you're taking lidocaine or if it's used in an emergency for a patient and they're on propranolol. So that should actually be avoided. And propranolol can actually also increase anticoagulant effects.

of warfarin or coumadin. So therefore it's going to be very important to have your PT and INR checked if you're on propranolol and also taking coumadin or warfarin. And now some cautions and considerations with propranolol. Well first of all propranolol can cause bradycardia or very low or slow heart rate and so it's definitely contraindicated in patients who have second or third degree heart block as well as those in cardiogenic shock.

It's also not advised to be used for bronchial asthma or COPD because it's a non-selective beta blocker and it can actually inhibit the catecholamines. Like if you take your epinephrine or inhaler, if you're having an asthma attack and you're on propanolol, propanolol can actually block the effects of that. And so therefore, you would end up having an asthma attack and not be able to treat it properly if you're using propanolol. And that's why it's not advised to use propanolol in patients who have COPD or asthma. Perpenolol can also be used to treat Also lower intraocular pressure and so this is important because it can interfere with glycoma screening tests and so talk to your ophthalmologist if you're taking propanolol and getting ready to have an eye exam.

Also it should be used with caution with the elder. because with the elderly they have an increased risk of stroke and also increased risk of side effects with dropping blood pressure too quickly or even heart rate too quickly. And so what are my final thoughts on propanolol? Well as As I mentioned in the very beginning, it's actually one of those effective medications that can be used as an alternative to benzodiazepines. And if you know anything about benzodiazepines, then you know that benzodiazepines can cause tolerance, dependence, and many patients will have a very difficult time coming off of them.

And benzodiazepines are not to be used long term. And so something like propranolol can be an alternative to the use of benzodiazepines, but I want to state that it's not going to be as effective or as strong as you're used to if you've been taking a benzodiazepine because benzodiazepines work differently on those GABA receptors and have a very strong effect. So it's going to take some adjusting there if you're going to be switching from a benzodiazepine to propranolol.

And another thing that I want to mention is that as my philosophy goes, skills before pills. And so you want to make sure that if you're having anxiety or having symptoms of PTSD, that you do the skills and you do the work. to work in therapy to help you regulate your anxiety and regulate your emotions and your fear responses and those symptoms as that ultimately is the long-term goal with therapy is that you improve.

And with these medications, whether it be propranolol or benzodiazepines or any other anxiolytics should only be used short-term or very sparingly. And so that's for the skills before pills come in. Now, sometimes you need pills to build those skills.

And that's why... it would be okay to use it first initially when you're having an acute stress response or acute reaction, but learning those skills in therapy will help you to regulate your own emotions and anxiety so that way you're not depending on the pills so much. So that wraps up my video on propanolol and its use in anxiety.

Do you have experience with taking propanolol for anxiety? If so, drop it down in the comment section and let us know as we learn from sharing each other's mistakes. experiences. And as always, I thank you for watching and wish you well on your mental health care journey and look forward to seeing you all next time.

many uses okay i'll go into sorry sorry sorry sorry lactate dehydrogenate uh sorry lactate lactate

Transcript for:پروپرانولول به عنوان گزینه‌ای برای درمان اضطراب

Transcript for:
پروپرانولول به عنوان گزینه‌ای برای درمان اضطراب