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Reducing dose of Propranalol/Inderal for anxiety.
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Reducing dose of Propranalol/Inderal for anxiety.

Hi, just need to ask if anyones knows the best way to reduce a daily dose of 80mg of Propranalol?  I take 40mg in the morning and 40mg before bed, but i am beginning to think that this drug, after 6 months of taking it, is starting to play havoc with my circulation.  I am constantly feeling dizzy, breathless when try to stand up or move about, simple things cause me to feel unsteady and i often feel like im gona pass out and then have a panic attack.  I want to see if it is indeed the Propranalol that is causing it.  

I want to reduce to 20mg x 2 daily and see if this helps with the symptoms but dont want to do it too quickly causing more side effects.

Thanks
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Avatar_m_tn
If I found myself in this situation, I'd consider the following facts...

An elevated sedimentation rate of 33 is indicative of inflammation, or an autoimmune response. Beta blockers (particularly Propranolol) are associated with the development of anti-nuclear antibodies, which, in turn, may lead to an autoimmune response - whereby the body produces auto-antibodies against itself. This may occur acutely or over some "X" period of time. Certainly, the development of an elevated sedimentation rate should have raised a red flag and warrants further investigation/intervention. Propranolol is the most probable source for your symptomatology.

Additionally, Propranolol is a highly lipophilic, non-selective beta-blocker. Given its lack of specificity, it targets both beta-1 (cardiac) and beta-2 (bronchial) receptors. Given the high affinity for beta-2, it would not be uncommon to experience severe shortness of breath or bronchospasm on this drug if one has a sensitivity towards it. Since Propranolol is highly lipophilic (highly bound to plasma proteins), it readily crosses the blood-brain barrier. This may result in lethargy, heightened anxiety, confusion, depression, hallucinations and other neuropsychiatric side effects.

Would suggest discontinuing the drug slowly under medical supervision. 10 mg, b.i.d. (10 mg, twice daily) per week at the maximum, as to prevent catecholamine surge/rebound hypertension or tachycardia. The drug must never be abruptly discontinued. An additional (and far superior) option to run past your M.D. is to transfer directly to a cardio-selective beta-blocker such as Atenolol. This will likely resolve your current symptomatology that you are experiencing with Propranolol. Dosage equivalency for Atenolol to your current Propranolol dosage is 50 milligrams once daily.

In the interim (until you can visit a physician), I would suggest heading for the emergency department if you feel the situation warrants it. Such symptomatology is generally progressive with this drug. Everything you have described suggests intolerance. A dosage reduction generally will not resolve the symptoms, given their degree of severity. However, transferring to a cardio-selective beta-blocker (Atenolol, Metoprolol) generally will. I believe that you'd find tapering the Propranolol to be intolerable, as the symptoms would likely persist regardless of the dosage. And given the severity of your symptoms, I believe that it would be hazardous to remain on it. There are far better options available to you.

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Avatar_f_tn
I have never taken that particular med., but I think that might be moving too fast if you are trying to avoid withdrawals. Personally, I would only cut 1 dose down at a time and see if there is an improvement in the dizziness. I would wait 5-7 days and see how you feel before cutting down the other dose. I can only cut down doses maybe 5 mg at a time. I'm just too sensitive. I guess the main thing is to pay close attention to how you are feeling! Be blessed and keep us posted! Studchick
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968908_tn?1274874715
Thanks Studchick, yeah i totally forgot to take it last night, woke feeling a little anxious but not dizzy, actaully felt quite clear headed then took 30mg instead of 40mg and half an hour after taking it came over so tired and then started to get the unsteadiness, dizziness feeling upon moving about.  

Im not sure if it anything to do with it but im shaking alot and feel very anxious but yesterday on my ususal dose i was having alot of panic attacks, so i dont know.

Anyway if anyone out there has withdrawn off propranalol/inderal id love to hear from ya and to know your experience.  Thanks.
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Avatar_f_tn
Hi Julie, I take propanolol, and from talking with you, it appears you may be having some of the side effects of the medication. I would talk to your doctor about this and see what alternatives there are.  I was prescribed it for a hand tremor 20mg 2 x a day, but I didn't like how it made me feel when taking it in the morning, extremely tired, so I just take it at night.  I did this on my own but it was very early in the game, I had only been on it for a couple of weeks.  Contact your doctor about reducing the amount you take, to be on the safe side.
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968908_tn?1274874715
To be honest my doctors dont seem to give a dam, i was mean't to have an appointment with a Dr at my surgery this morning but got a phone call 5 mins before the appointment time and told me that doctor wasnt going to be in today, so instead of offering me an appointment with another doctor, and there are several others, or putting me on the emergency list they offered me another appointment for NEXT Monday.... can you believe it.  I told them bascially to shove it up their behinds.  So, im gona do this on my own, i'm on 80mg, i'll reduce it to 60mg and see if this helps.  I took 30mg this morning and have felt a little bit better, not sure too early to tell yet, but i'll continue to take 30mg over the next couple of days and see.

Just wana get to the bottom of all this c.r.a.p.
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Avatar_f_tn
Five minutes notice, how nice of them!  I think you know enough to do this on your own.  Hope you do feel better as a result.  Take care..
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480448_tn?1403547723
Sincerely, while I don't discount that a lot of people are quite knowledgeable about their meds and conditions...it still isn't adviseable to adjust med doses on their own.  I'm a registered nurse and STILL consult with my doc before making any changes.  It would be absolutely irresponsible of us to suggest that it was okay for you to do this without consulting your doc.  I know doctors aren't always easy to get a hold of or deal with, but please....do this the right way.  Your are messing with a beta blocker that if dropped too quickly may have some significant adverse effects.  The process should really be done moderately gradually....and to go from 80mg BID to 20 mg BID, that is a very significant drop.

WAIT until you can get a hold of your doctor, in the very least, contact the Pharmacist for some advice (even though they will likely tell you to also call the doc).  There is no hurry here, you don't HAVE to do this today.  This IS  a cardiac med and really, you can never be TOO cautious in these cases.
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480448_tn?1403547723
To all posters:

Just a general note....please do not post "taper" info or give specific info on how to dose medications...it not only isn't permitted on our site, but it can be dangerous.  While I understand that people are not supposed to follow the advice of any poster here, that doesn't mean that someone won't....and we don't want to be responsible for something bad.

I know doctors aren't the easiest people to deal with (trust me...I deal with them every day and all day for work)....but there really IS a reason they go to med school for 8-10 years and why THEY are the ones with the prescription pad.

I want nothing but for everyone to be safe while they muddle through this stuff. ALWAYS BETTER TO BE SAFE THAN SORRY!  Also, as anxiety sufferers, we want to do everything "right now", which predisposes us to possible adverse effects thinking we can make med changes on our own.

Thanks.....

Your Anxiety Co-CL's
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968908_tn?1274874715
Hiya, just to let you know i actually feel there is an urgent need to reduce this med, i am fully aware of the need to do this slowly, but i just can't cope with this vertigo type dizziness, breathlessness on SLIGHT exsertion, drunk, confused feeling i get all the time.  I have been taking this drug for the last 6 months at this dose and have had some level of problem from the begginning, first tiredness, cold hands/feet then that passed, then i start to get hallucinations when i briefly woke in the night, (which i have discussed and asked advice about on here), numbness of limbs and finally 6 weeks ago i woke in the night gasping for air with a crushing sensation in my chest, since then the breathlessness/dizziness has been getting progressivly worse to the point now my agoraphobia is worse than ever, cause im finding it soooo hard to even walk 1 min to the shop next door to my house without feeling like im about to fall flat on my face.  My social phobia is worse as i become more anxious in the presence of even my kids cause i keep feeling so off balance and im scared im gona have a bad dizzy spell in front of them, the last couple i have had in front of them scared them as i was all over the place.  All i can say is this is ruining my life, actually right now i dont have a life.  Im spending most of the day in my bed, and only getting up to do essential stuff like cook food.  This anit no way to live, so yes i need to reduce this med NOW and hopefully in the next few days or weeks i will feel alot better.

I have discussed this with my psychiatrist and two GP's at my practice and all they do is take my blood pressure say its ok and send me packing saying its anxiety related..... thats all i get from them, anxiety related.  Yes i agree to a point cause i am anxious far more of lately but that is simply because of how all the dizziness, breathlessness is making me feel.  I feel like im dying.

Tell me, i was doing some light housework the other day, i bent down to take out a load of washing from the machine, stood up and flet like someone had puunched me in the diaphram, i just couldnt catch my breath,felt winded and a intense pressure, i came over dizzy, drunk and felt like i was gona hit the floor, i had to sit down and try to get some sense of normality ended up having a panic attack because it scared me so badly.  And this happens every time i get up to do something.  Would you be able to cope??

I have had two ecg's and numerous bp checks which all show normal, but get this i was in the hospital scared out of my mind felt so anxious but the ecg read normal sinus rythum and my blood pressure was 100/70 pulse 70 and the An E doc said the propranalol is doing a brilliant job on your heart its nice and slow but not too slow, i didnt register what he said at the time but once i thought about it i was like HOLD ON if i am bloody scared out of my mind and its reading like that then what is happening when im nice and relaxed???? or deeply relaxed in bed sleeping???  Anyway blood test came back fine apart fom it showed an elvevated ESR of 33, but my GP said because everything was ok it isnt indicitive of anything serious.  So, now what else do i do, the only other thing it has to be is the Propranalol.  I and another kind person has researched the side effects of it and everything fits with the drug.  

I do thank-you for being concerned but as you might of worked out im not a silly or careless person, tomorrow i will call the psychiatrist and have a chat to her about it again and see what she says but the bottom line is i need to know if its this drug and i have already reduced it to 60mg instead of 80mg from today.  
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480448_tn?1403547723
Julie...I only read a bit of your last post...but I wanted to comment....BECAUSE of your severe symptoms I most certainly agree that you need to start tapering off the Inderal, HOWEVER the severity of the symptoms are even MORE reason to get to your doc ASAP.  Seriously...I dont want you to mess around here.

PLEASE call your doc NOW even if you have to page the on call doctor.  Back to read the whole deal...
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480448_tn?1403547723
Julie....what you're going through is horrendous.  Why have you put up with it for so long, if you've had these symptoms since starting the Inderal?  While I sympathize with what you're going through and your urgent need to get some relief, please just consult with one of the doctors you trust and who wont dismiss you.  Like I said...there will always be a doctor available on call if you need them.  Just trust me when I say that this med (ESPECIALLY at high doses) really needs to be carefully tapered.  I want you to get relief...but i want you to do so safely...and without making new (and possibly worse) problems for yourself.

By no means was I implying that you weren't smart or able to figure this out on your own....I certainly know that...but I also know as a fellow anxious person what it is like when we want relief NOW.....

If you dont get a hold of your doc tonight, PLEASE call and INSIST on being SEEN in the office tomorrow.  Those side effects are severe and warrant more than a phone call.

Hoping the best for you.
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370181_tn?1408130715
Here is what you recommended to Julie.......................

" I think you know enough to do this on your own.  Hope you do feel better as a result."

If that's not giving the go ahead for someone to alter their dose, what would you call it?

And if you did not have both nursegirl and myself blocked from communicating with you, we could have worked this out privately.

  

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Avatar_m_tn
If I found myself in this situation, I'd consider the following facts...

An elevated sedimentation rate of 33 is indicative of inflammation, or an autoimmune response. Beta blockers (particularly Propranolol) are associated with the development of anti-nuclear antibodies, which, in turn, may lead to an autoimmune response - whereby the body produces auto-antibodies against itself. This may occur acutely or over some "X" period of time. Certainly, the development of an elevated sedimentation rate should have raised a red flag and warrants further investigation/intervention. Propranolol is the most probable source for your symptomatology.

Additionally, Propranolol is a highly lipophilic, non-selective beta-blocker. Given its lack of specificity, it targets both beta-1 (cardiac) and beta-2 (bronchial) receptors. Given the high affinity for beta-2, it would not be uncommon to experience severe shortness of breath or bronchospasm on this drug if one has a sensitivity towards it. Since Propranolol is highly lipophilic (highly bound to plasma proteins), it readily crosses the blood-brain barrier. This may result in lethargy, heightened anxiety, confusion, depression, hallucinations and other neuropsychiatric side effects.

Would suggest discontinuing the drug slowly under medical supervision. 10 mg, b.i.d. (10 mg, twice daily) per week at the maximum, as to prevent catecholamine surge/rebound hypertension or tachycardia. The drug must never be abruptly discontinued. An additional (and far superior) option to run past your M.D. is to transfer directly to a cardio-selective beta-blocker such as Atenolol. This will likely resolve your current symptomatology that you are experiencing with Propranolol. Dosage equivalency for Atenolol to your current Propranolol dosage is 50 milligrams once daily.

In the interim (until you can visit a physician), I would suggest heading for the emergency department if you feel the situation warrants it. Such symptomatology is generally progressive with this drug. Everything you have described suggests intolerance. A dosage reduction generally will not resolve the symptoms, given their degree of severity. However, transferring to a cardio-selective beta-blocker (Atenolol, Metoprolol) generally will. I believe that you'd find tapering the Propranolol to be intolerable, as the symptoms would likely persist regardless of the dosage. And given the severity of your symptoms, I believe that it would be hazardous to remain on it. There are far better options available to you.

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Avatar_f_tn
I totally agree with you and this is why I told Julie that I felt she was having some side effects of the drug, and to speak to her doctor about alternatives. Thanks for your input.
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968908_tn?1274874715
Thank you so much for your input, this is excellent advice, im actually gob smacked by your knowledge.  However i will def put your suggestion to my paychiatrist tomorrow when i speak to her, she was not in the office today and i seriously can not even think about talking to one of the doc's at my surgery, they look upon me as a hypercondriac, everything is all anxiety related and they either throw another anti-d at me or i walk out empty handed with no advice, no help.  

Spoke to my psychologist today and she feels that i should chat to my shrink about the Propranalol but she did kinda defend the GP's saying that how can they treat something they cant find.....LOL, i said well maybe they just anit doing the right tests or they are just plain blind to the fact of the side effects of the propranalol, even though only 1 doctor has acknowlegded that the halunications were more than likely sue to it, but never said to reduce the dose.  

Im gona ask my shrink if she can suggest a CT scan of my head and spine and see what she says.  I'll cry and beg if i have to, i just want someone to listen.  Strange huh, cause people can understand my suffering on here so why the hell anit any of the bloody doctors listening??????????

Thanks again.
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968908_tn?1274874715
OMG... i am a serious b.u.t.t munch, i phoned the sugery and asked to speak to a doctor, she said i had to ring back in the morning as the telephone advice was done for the day.  I told her i think the Propranalol is causing bad side effects, she said to come to the surgery and i'll have to sit and wait to see someone, anyway, i then got in a cab and i was just 2 sec's from the surgery when i cam over seriously panicky, felt like i couldnt cope and asked the cab to tun around and take me home.  As soon as he did i calmed down and i should of gone back but ive only had 4 hours sleep last night and just am dead and lack of sleep dont help one to handle stress.  I'm sure all the comments frightened me more than i thought cause last night i didnt sleep til 1am and this morning i woke at 5am feeling extremely anxious and havent been able to eat much all day, have felt sick to my stomach.......

  
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968908_tn?1274874715
Just thought is let ya's know i spoke to one of the better doc's at the surgery today, she agreed that yes it could be the Propranalol, i did tell her i had reduced it to 60mg, she has made me an appointment in just over a weeks time to give the effects of the reduction a chance to kick in, she said that if i still am feeling no change at the appointment she will give me a thorough examination.  I poored my heart out to her regarding how i felt no one was listening to me and how i have rang and been seen numerous times but all i get is the anxiety talk and so she said she'll keep an eye on me and if at the exam she feels i need to have a CT scan or be referred she shall do so.  
So i guess thats a step in the right direction, maybe i should of seen her from the beginning instead of being past from pillor to post.  Anyway thank's for your support, means much.
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Avatar_f_tn
That's great news Julie!  I'm happy you found someone to listen and take you seriously.
Hopefully, now you can look forward to feeling better.  Take care...
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Avatar_m_tn
WOW First I wanna thank you for posting this question because I am having the exact same problems on the exact same dose, my doctors also do not give a ****! I've been having these issues on and off for almost a year, recently my second cardiologist recommended reducing my dose to 20mg b.i.d., I've been doing so by the rate of 5mg once a day, my own idea because I have been experiencing a great deal of sensitivity to anything it seems. So Im currently at a dose of 25mg b.i.d. and in the last couple of days my blood pressure has consistently been under 119, sometimes as low as 105 systolic, my diastolic numbers have been around mid 60s to high 50s for months now which Im told is good. Anyways the comment by "Brazil66" made more sense to me then any medical advise id received on the matter. About 6 months ago my first cardiologist had switched my prescription based on 'our' symptoms, but because of a personal issue with the secretary in his office 'my ex' I had to discontinue my visits to that particular cardiologist.
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Avatar_m_tn
WOW First I wanna thank you for posting this question because I am having the exact same problems on the exact same dose, my doctors also do not give a ****! I've been having these issues on and off for almost a year, recently my second cardiologist recommended reducing my dose to 20mg b.i.d., I've been doing so by the rate of 5mg once a day, my own idea because I have been experiencing a great deal of sensitivity to anything it seems. So Im currently at a dose of 25mg b.i.d. and in the last couple of days my blood pressure has consistently been under 119, sometimes as low as 105 systolic, my diastolic numbers have been around mid 60s to high 50s for months now which Im told is good. Anyways the comment by "Brazil66" made more sense to me then any medical advise id received on the matter. About 6 months ago my first cardiologist had switched my prescription based on 'our' symptoms, but because of a personal issue with the secretary in his office 'my ex' I had to discontinue my visits to that particular cardiologist.
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Avatar_m_tn
To continue... I believe that cardiologist may have prescribed a substitute like 'Brazil66' had suggested but because I was not going to be able to see him again and it would take some time until I was reffered to another cardiologist I didnt want to start taking something new without the educated support/observation of a cardiologist, I continued with the Propranolol not actually thinking this was causing my problems. Now yu might say to yourself how come this idiot did not just follow the doctors orders, and the reason is that like I mentioned earlier my experience with medical professionals recently is that they ******** around while your trying to figure out important details about your health and then just throw a script in your face without actually explaining why you may be experiencing such symptoms and what this new medication is and how its going to help you. So I continued with the Inderall and things where up and down. When I read 'Brazil66" post It finally made sense to me what might actually be taking place. Anyways I do apologize for the lengthy post but just wanted to show some gratitude first to you 'Julie...' for sharing and secondly to you 'Brazil66' for your knowledge. THANX
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