Beta blockers can be helpful in the treatment of the physical symptoms of anxiety, especially social anxiety. Physicians prescribe them to control rapid heartbeat, shaking, trembling, and blushing in anxious situations for several hours. Often social anxiety symptoms are so strong that beta blockers, while helpful, cannot reduce enough of the symptoms to provide relief. Because they can lower blood pressure and slow heart rate, people diagnosed with low blood pressure or heart conditions may not be able to take them. May reduce some peripheral symptoms of anxiety, such as tachycardia and sweating, and general tension, can help control symptoms of stage fright and public-speaking fears, has few side effects. Taken occasionally, propranolol has almost no side effects. Atenolol is longer acting than propranolol and generally has fewer side effects. If taken daily, abrupt withdrawal can cause very high blood pressure. If there is no response, increase to two 50 mg tablets, taken together or divided. Not recommended for patients with asthma or any other respiratory illness that causes wheezing, or for patients with diabetes. Some people may feel a little light-headed, sleepy, short-term memory loss, unusually slow pulse, lethargy, insomnia, diarrhea, cold hands and feet, numbness and/or tingling of fingers and toes. It has less of a tendency to produce wheezing than other beta blockers. Use alcohol with caution, since alcohol can increase the sedative effect and exaggerate this drug's ability to lower blood pressure. After two weeks of 100 mg the patient should notice a marked decrease in the racing heart, trembling, blushing, and/or sweating in social situations. Initial dose: Immediate-release: 40 mg orally 2 times a day Sustained-release: 80 mg orally once a day XL sustained-release: 80 mg orally once a day at bedtime Maintenance dose: Immediate-release: 120 to 240 mg orally per day Sustained-release: 120 to 160 mg orally per day XL sustained-release: 80 to 120 mg orally once a day at bedtime Maximum dose: IR/SR: 640 mg orally per day XR: 120 mg orally per day Comments: -The XL sustained-release formulation should be administered once daily at bedtime (approximately 10 PM) and should be taken consistently either on an empty stomach or with food. -Dose titration should be done gradually until adequate blood pressure control is achieved. -The recommended dosing is the same whether used alone or added to a diuretic. -The time needed for full hypertensive response to a given dosage is variable and may range from a few days to several weeks. -While twice daily dosing of the immediate release formulation is effective and can maintain a reduction in blood pressure throughout the day, some patients, especially when lower doses are used, may experience a modest rise in blood pressure toward the end of the 12 hour dosing interval. This can be evaluated by measuring blood pressure near the end of the dosing interval to determine whether satisfactory control is being maintained throughout the day. If control is not adequate, a larger dose, or 3 times daily therapy may achieve better control.
Prophylaxis 80 mg/day PO divided q6-8hr initially; may be increased by 20-40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided q6-8hr Inderal LA: 80 mg/day PO; maintenance: 160-240 mg/day Withdraw therapy if satisfactory response not seen after 6 weeks Hemangeol: Indicated for treatment of proliferating hemangioma requiring systemic therapy Initiate treatment at aged 5 weeks to 5 months Starting dose: 0.6 mg/kg (0.15 m L/kg) PO BID for 1 week, THEN increase dose to 1.1 mg/kg (0.3 m L/kg) BID; after 2 more weeks, increase to maintenance dose of 1.7 mg/kg (0.4 m L/kg) BID PO: 0.5-1 mg/kg/day divided q6-8hr; may be increased every 3-7 days; usual range: 2-6 mg/kg/day; not to exceed 16 mg/kg/day or 60 mg/day IV: 0.01-0.1 mg/kg over 10 minutes; repeat q6-8hr PRN; not to exceed 1 mg for infants or 3 mg for children PO: 1 mg/kg/day divided q6hr; after 1 week, may be increased by 1 mg/kg/day to maximum of 10-15 mg/kg/day if patient refractory; allow 24 hours between dosing changes IV: 0.01-0.2 mg/kg over 10 minutes; not to exceed 5 mg Immediate-release: 40 mg PO q12hr initially, increased every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day Inderal LA: 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day Inno Pran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO Consider lower initial dose PO: 10 mg q6-8hr; may be increased every 3-7 days IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg Once response or maximum dose achieved, do not give additional dose for at least 4 hours Aggravated congestive heart failure Bradycardia Hypotension Arthropathy Raynaud phenomenon Hyper/hypoglycemia Depression Fatigue Insomnia Paresthesia Psychotic disorder Pruritus Nausea Vomiting Hyperlipidemia Hyperkalemia Cramping Bronchospasm Dyspnea Pulmonary edema Respiratory distress Wheezing Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid; agranulocytosis, erythematous rash, fever with sore throat Skin: Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, urticaria Musculoskeletal: Myopathy, myotonia May exacerbate ischemic heart disease after abrupt withdrawal Hypersensitivity to catecholamines has been observed during withdrawal Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuance When discontinuing long-term administration of beta blockers (particularly with ischemic heart disease), gradually reduce dose over 1-2 weeks and carefully monitor If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina) Warn patients against interruption or discontinuance of beta-blocker therapy without physician advice Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension Asthma, COPD Severe sinus bradycardia or 2°/3° heart block (except in patients with functioning artificial pacemaker) Cardiogenic shock Uncompensated congestive heart failure Hypersensitivity Overt heart failure Sick sinus syndrome without permanent pacemaker Do not use Inno Pran XL in pediatric patients Long-term beta blocker therapy should not be routinely discontinued before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures Use caution in bronchospastic disease, cerebrovascular insufficiency, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions Sudden discontinuance can exacerbate angina and lead to myocardial infarction Use in pheochromocytoma Increased risk of stroke after surgery Hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, have been reported Cutaneous reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported Exacerbation of myopathy and myotonia has been reported Less effective than thiazide diuretics in black and geriatric patients May worsen bradycardia or hypotension; monitor HR and BP Avoid beta blockers without alpha1-adrenergic receptor blocking activity in patients with prinzmetal variant angina; unopposed alpha-1 adrenergic receptors may worsen anginal symptoms May induce or exacerbate psoriasis; cause and effect not established Prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations, and sweating May cause or worsen bradycardia or hypotension Pregnancy category: C; intrauterine growth retardation, small placentas, and congenital abnormalities reported, but no adequate and well-controlled studies conducted Lactation: Use is controversial; an insignificant amount is excreted in breast milk Nonselective beta adrenergic receptor blocker; competitive beta1 and beta2 receptor inhibition results in decreases in heart rate, myocardial contractility, myocardial oxygen demand, and blood pressure Class 2 antidysrhythmic Bioavailability: 30-70% (food increases bioavailability) Onset: Hypertension, 2-3 wk; beta blockade, 2-10 min (IV) or 1-2 hr (PO) Duration: 6-12 hr (immediate release); 24-27 hr (extended release) Peak plasma time: 1-4 hr (immediate release); 6-14 hr (extended release) Solution: Most common solvents Additive: Dobutamine, verapamil Syringe: Inamrinone, milrinone Y-site: Alteplase, fenoldopam, gatifloxacin, heparin, hydrocortisone, sodium succinate, inamrinone, linezolid, meperidine, milrinone, morphine, potassium chloride, propofol, tacrolimus, tirofiban, vitamins B and C IV administration rate should not exceed 1 mg/min IV dose is much smaller than oral dose Give by direct injection into large vessel or into tubing of free-flowing compatible IV solution Continuous IV infusion generally is not recommended The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. In addition to its effect on the heart, betaxolol reduces the pressure within the eye (intraocular pressure). Food and Drug Administration (FDA) for ocular use as a 0.5% solution (Betoptic) in 1985 and as a 0.25% solution (Betoptic S) in 1989. This effect is thought to be caused by reducing the production of the liquid (which is called the aqueous humor) within the eye. The reduction in intraocular pressure reduces the risk of damage to the optic nerve and loss of vision in patients with elevated intraocular pressure due to glaucoma.
Dosages Recommended By Investigators. You can take a 20 to 40 mg dose of propranolol as needed about one hour before a stressful situation. If necessary. Your dose may need to be changed several times in order to find out what works. Propranolol extended-release capsules should be taken at bedtime 10 p.m.