Propranolol

[가라사대]

Propranolol

Propranolol is a medication of the beta blocker type.^[1] It is used to treat high blood pressure, a number of types of irregular heart rate, thyrotoxicosis, capillary hemangiomas, performance anxiety, and essential tremors.^[1][2][3] It is used to prevent migraine headaches, and to prevent further heart problems in those with angina or previous heart attacks.^[1] It can be taken by mouth or by injection into a vein. The formulation that is taken by mouth comes in short acting and long acting versions. Propranolol appears in the blood after 30 minutes and has a maximum (peak) effect between 60 and 90 minutes when taken by mouth.^[1][4]

Common side effects include nausea, abdominal pain, and constipation. It should not be used in those with an already slow heart rate and most of those with heart failure. Quickly stopping the medication in those with coronary artery disease may worsen symptoms. It may worsen the symptoms of asthma. Greater care is recommended in those with liver or kidney problems.^[1] Propranolol may possibly causeharmful effects in the baby if taken during pregnancy.^[5] Its use during breastfeeding is likely okay but the baby should be monitored for side effects.^[6] It is a non-selective beta blocker which works by blocking β-adrenergic receptors.^[1]

Propranolol was discovered in 1964.^[7][8] It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.^[9] Propranolol is available as a generic medication.^[1] The wholesale cost is between 0.24 and 2.16 USD per month.^[10] In the United States it costs about 15 USD per month at a typical dose.^[1]

Medical uses[edit]

An 80 mg capsule of extended-release propranolol

A mixture of 20 mg and 10 mg propranolol tablets

Propranolol is used for treating various conditions, including:

Cardiovascular[edit]

• Hypertension
• Angina pectoris (with the exception of variant angina)
• Tachyarrhythmia
• Myocardial infarction
• Tachycardia (and other sympathetic nervous system symptoms, such as muscle tremor) associated with various conditions, including anxiety, panic, hyperthyroidism, and lithium therapy
• Portal hypertension, to lower portal vein pressure
• Prevention of esophageal variceal bleeding and ascites

While once a first-line treatment for hypertension, the role for beta blockers was downgraded in June 2006 in the United Kingdom to fourth-line, as they do not perform as well as other drugs, particularly in the elderly, and evidence is increasing that the most frequently used beta blockers at usual doses carry an unacceptable risk of provoking type 2 diabetes.^[11]

Propranolol is not recommended for the treatment of hypertension by the Eighth Joint National Committee (JNC 8) because a higher rate of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to an angiotensin receptor blocker was noted in one study.^[12]

Psychiatric

It is occasionally used to treat performance anxiety.^[2] Evidence to support the use in other anxiety disorders is poor.^[13] Some experimentation has been conducted in other psychiatric areas:^[14]

• Post-traumatic stress disorder (PTSD) and specific phobias (see subsection below)
• Improvement of social communication skills in people with autism spectrum disorder^[15]
• Aggressive behavior of patients with brain injuries^[16]
• Treating the excessive drinking of fluids in psychogenic polydipsia^[17][18]

PTSD and phobias[edit]

Propranolol is being investigated as a potential treatment for PTSD.^[19][20] Propranolol works to inhibit the actions of norepinephrine, a neurotransmitter that enhances memory consolidation. Individuals given propranolol immediately after trauma experienced fewer stress-related symptoms and lower rates of PTSD than respective control groups who did not receive the drug.^[21] Due to the fact that memories and their emotional content are reconsolidated in the hours after they are recalled/re-experienced, propranolol can also diminish the emotional impact of already formed memories; for this reason, it is also being studied in the treatment of specific phobias, such as arachnophobia, dental fear, and social phobia.^[22]

Ethical and legal questions have been raised surrounding the use of propranolol-based medications for use as a "memory damper", including: altering memory-recalled evidence during an investigation, modifying behavioral response to past (albeit traumatic) experiences, the regulation of these drugs, and others.^[23] However, Hall and Carter have argued that many such objections are "based on wildly exaggerated and unrealistic scenarios that ignore the limited action of propranolol in affecting memory, underplay the debilitating impact that PTSD has on those who suffer from it, and fail to acknowledge the extent to which drugs like alcohol are already used for this purpose."^[24]

Others[edit]

• Essential tremor. Evidence for use for akathisia however is insufficient^[25]
• Migraine and cluster headache prevention^[26][27] and in primary exertional headache^[28]
• Hyperhidrosis (excessive sweating)
• Proliferating infantile hemangioma
• Glaucoma
• Thyrotoxicosis by deiodinase inhibition

Propranolol may be used to treat severe infantile hemangiomas (IHs). This treatment shows promise as being superior to corticosteroids when treating IHs. Extensive clinical case evidence and a small controlled trial support its efficacy.^[29]

Adverse effects[edit]

See also: Beta blocker § Adverse_effects

Due to the high penetration across the blood-brain barrier, lipophilic beta blockers such as propranolol and metoprolol are more likely than other less lipophilic beta blockers to cause sleep disturbances such as insomnia and vivid dreams, and nightmares.^[30] Dreaming (rapid eye movement sleep, REM) was reduced and increased awakening.^[31]

Adverse drug reactions associated with propranolol therapy are similar to other lipophilic beta blockers.

Precautions and contraindications[edit]

Propranolol should be used with caution in people with:^[32]

• Diabetes mellitus or hyperthyroidism, since signs and symptoms of hypoglycaemia may be masked
• Peripheral vascular disease and Raynaud's syndrome, which may be exacerbated
• Phaeochromocytoma, as hypertension may be aggravated without prior alpha blocker therapy
• Myasthenia gravis, which may be worsened
• Other drugs with bradycardic effects

Propranolol is contraindicated in patients with:^[32]

• Reversible airways diseases, particularly asthma or chronic obstructive pulmonary disease (COPD)
• Bradycardia (<60 beats/minute)
• Sick sinus syndrome
• Atrioventricular block (second- or third-degree)
• Shock
• Severe hypotension
• Cocaine toxicity [per American Heart Association guidelines, 2005]

Pregnancy and lactation[edit]

Propranolol, like other beta blockers, is classified as pregnancy category C in the United States and ADEC category C in Australia. β-blocking agents in general reduce perfusion of the placenta which may lead to adverse outcomes for the neonate, including pulmonary or cardiac complications, or premature birth. The newborn may experience additional adverse effects such as hypoglycemia and bradycardia.^[33]

Most β-blocking agents appear in the milk of lactating women. However, propranolol is highly bound to proteins in the bloodstream and is distributed into breast milk at very low levels.^[34] These low levels are not expected to pose any risk to the breastfeeding infant, and the American Academy of Pediatrics considers propranolol therapy "generally compatible with breastfeeding".^{[33][34][35][36]}

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Pharmacotherapy of social anxiety disorder: what does the evidence tell us?

Davidson JR1.

Author information

Abstract

The treatment goals for social anxiety disorder (SAD) are to reduce fear, avoidance, physical distress, disability, and comorbidity. This review illustrates some of the primary studies used to eval‎uate efficacy of treatments for SAD. The selective serotonin reuptake inhibitors (SSRIs) paroxetine, sertraline, fluoxetine, fluvoxamine, and escitalopram and the serotonin-norepinephrine reuptake inhibitor venlafaxine are effective treatments. They have the additional benefit of being able to treat comorbid conditions. For people who do not respond to serotonin reuptake inhibitors, treatment options include benzodiazepines (clonazepam, alprazolam, and bromazepam), alpha2delta calcium-channel blockers (gabapentin and pregabalin), reversible inhibitors of monoamine oxidase A (moclobemide, although agents in this class are not available in the United States), antiepileptics (levetiracetam), and atypical antipsychotics (olanzapine). The irreversible monoamine oxidase inhibitor phenelzine can be considered an effective third-line therapy. Combination treatments may be beneficial, but more research is needed. Benefits of beta-blockers (propranolol and atenolol) are limited to performance anxiety. Botulinum toxin A may be an effective augmentation treatment option for severe axillary hyperhidrosis in patients with SAD. Studies show that patients with SAD who are maintained on paroxetine, sertraline, or clonazepam have a low relapse rate.

[가라사대]

결국 정신과적으로 사용할 수 있는 Propranolol 은
performance anxiety (=Stage fright) 에 한정하여 응용해야 한다는....
다른 anxiety에는 사용 안 함.

외상후 스트레스장애 (Post-traumatic stress disorder (PTSD) 때도 응용해 볼 수 있고.


*performance anxiety : 수행불안

[탁구왕김제빵]

무대공포증 같은거는 누구나한테 있는건데..정도차이지만..
어느정도까지 가야 수행불안이라고 하고 약을 써야 하는건지.. 진단기준이 있나?

[가라사대]

약을 먹어야하는 진단기준은 없는 듯 하고
자신이 결정할 문제 같은데?
너무 떨려서 의사의 도움이 필요하다고 느낄 때.

[우크조크]

인데놀 같이 주 사용 목적외에
다른 증상 완화에도 도움이 되는 약들을
Off Label 약품이라고 하더라구요
체험적 효과~~~ 적응증과 효과, 부작용등의
경계선상에서 상용이 되고 있으므로 더 주의가 필요
인터넷 보면 일반인들이 긴장될때 인데놀 효과있다고 입소문이
나서 암암리에 거래도 되는걸로~~~
어찌됐든 약은 의사가 환자를 보고 충분한 검토 후 처방 하는게~~~
무작위로 긴장 완화를 위해서 이런 약을 복용 하는건 반대합니다

[탁구왕김제빵]

수행불안은 결국 스스로 극복해야할 문제이지만 정 안될때는 약물의 도움을 받을 수도 있겠지요..
하지만 의사의 관리감독이 필요하고 결국 의사의 성향과 판단에 따라 처방되겠네요..
단 우리나라같은 의료환경에서 환자가 개원의한테 와서 처방해달라고 하면 거부하기는 힘든 현실..ㅠ.ㅠ
미국같으면 조금 꺼림직하면 단번에 처방 거부할수도 있는데 말이지...

[우크조크]

저는 단호히 거부 하는데~ ㅋㅋㅋ
여기는 슈퍼마켓이 아니니 약 처방 결정권은 나한테 있으며
그게 싫으면 그냥 처방 해주는 의사 찾아 가라고~~

[탁구왕김제빵]

나도 처음엔 대쪽같은 의사였다고~ ㅋㅋㅋ

[도룡동영화배우]

나도 한번 체험해 볼 예정

[가라사대]

수술할 때?

[가라사대]

복지부 고시