Essential tremor: Inderal vs. Topral XL

[BigPapaDave]

I suffered a "nervous breakdown" in 1975.  I experienced a high state of anxiety, agoraphobia, depression, panic attacks, and tremor in my dominant hand/wrist.  Due to the tremor, I was unable to write or eat in social situations.  Being a part-time musician, my first acute panic attack was experienced at the beginning of a performance and was accompanied by (or triggered by?) the tremor.  I was teaching, selling insurance, going to graduate school, starting a family - under much stress.  I had to quit my job, but was never hospitalized, and eventually went back to teaching and music, although very difficult most of the time.  My only medication, prescribed by my GP, was Valium, and I have taken 2.5 to 20 mg/day ever since - usually about 5 mg/day now since retired.  In 1987, my depression became severe -no sleep, suicidal thoughts, etc. and I consulted a psychiatrist and have been under his care ever since.  I underwent individual psychotherapy, goup therapy, and prescribed 225 mg of Tofranil at night, 120 mg of Inderal in the morning, and Valium "as needed".  I was able to function well at work, moving into administrative positions and able to perform comfortably enough to enjoy playing music more.  Since retiring, I have been interested in possible alternatives to the Inderal because of side effects - becoming totally exhausted at times (several times a month), sexual side effects, etc.  Although I discussed trying 50 mg of Topral XL with my Psychiatrist and cardiologist (no major heart problem, but I do take 5 mg of Norvasc and 10 mg of Lipitor at night) and they both suggested giving it a try since "any beta blocker should work with the tremor".  I am concerned that, after taking the Topral XL for 4 or 5 days that I am experienced more exagerrated tremors (also developed tremor in my neck 8 or 9 years ago), and have wondered if the 50 mg of Topral is equivalent in strength to the 120 mg of Inderal.  I have asked both doctors and a pharmacist, and did not feel I received an explicit answer.  Could the time-release factor be involved?  Any information concerning the use of the Topral XL verses Inderal will be greatly appreciated.

[Roger Gould, M.D.]

I do not prescribe Topral, so do not have the direct experience to answer this very important question.  I do know that both are beta blockers, and you are taking the highest recommended dose of Inderal, so you might ask your doctors if 50mg is the equivalent, that is,is it the highest recommended therapeutic dose.  That answer will give you the information you need.

[chadster]

Dave, I have experience with Toprol XL 50mg.  My cardiologist diagnosed me with having PVC's(this is a fairly common problem with the heart and is usually harmless).  PVC's are pre-ventricular contractions.  Most people that have them never even notice them.  But, of course, I was one of those few people that felt every damn one of them.  It felt like my heart was skipping beats and it scared the hell out of me.  My internist kept telling me that I was having panic attacks and prescribed xanax.  After taking xanax without relief from the PVC's, I finally insisted that he refer me to a cardiologist.  After wearing a Holter monitor for a month, the cardiologist finally found the PVC's (bless him because I was beginning to think I was losing my mind).  Anyway, after trying many meds, the Toprol gave me relief (I read so much literature about PVC's and asked him for Toprol).  He was more than willing to let me try it.  I thanked him for everything and he also reminded me to stay on the xanax.  The PVC's obviously send me into a panic attack and we all know how awful those are.

So there's my long-winded story.  Taking Toprol XL and Xanax XR have made my life worth living again.  They both make me a little drowsy during the day but that is JUST FINE.  I'd rather be a little drowsy than going through what I was.

Good luck & take care.   chad