TG98: Introduction & Stopping Propranolol

[TG98]

Hi everyone, hope you're well.

 

Background on me: anxiety and depression, some trauma stuff that initially led me to seek antidepressant treatment. I never stuck with taking them (Sertraline) for more than days at a time (my reading up on them scared me out of it) so don't have much of a story there. Have been working hard in therapy and managing better now. Otherwise healthy. Looking for work at the moment. This has been the worst year of my life but I'm hoping it's an upward trend from here 

 

Why I'm here: I was prescribed Propranolol 80mg ER (extended release) in May 2021, originally to help me stop panicking while boarding Sertraline. I have been taking it daily ever since. Has small benefits but want to see how I do off them. I first found this site months ago when looking for AD withdrawal information to help inform my treatment choices.

 

Help/tapering: My doctor told me to cold turkey my propranolol. I'm sure it won't be as bad as cold turkeying other meds, but this advice goes against everything I have read. He wrote me a script for 40mg IR (immediate release) tablets to take as needed if I feel bad after ceasing treatment but he said no harm will be caused and I can just stop. I'm confused about this and feeling uneasy as I'm already an anxious person around medication. I don't know where to begin trying to schedule a taper myself (I have read through the propranolol threads I've found here but it's hard when most are on IR to begin with) so am feeling pretty scared. I have about 28 of my ER pills left and a small supply of the IR that I'm picking up today that can be cut in half to 20mg, so not a lot to work with. I'm only used to the once daily ER dose and don't know how it translates to IR dosing. I'm hoping my doctor is right and I'll be okay, but if anyone has advice I'm more than ready to listen (I understand this is not medical advice). I struggle with anxiety attacks so a rebound of physical symptoms will probably mess me up a bit.

 

Hoping things go smoothly for me — and you all!

 

 

[DataGuy]

Hi @TG98,

 

Thanks for your questions. Your doctor sounds as if he is as ignorant about withdrawal as most other doctors. You're right to be skeptical. You should not stop propranolol suddenly, as this has been known to elevate the risk for cardiac events including heart attacks. My best advice would be to schedule a taper of around 10% per month, reducing from 10% of your last dose. So if you are starting at 80mg, you would go to 72mg, then 64.8 (10% reduction from 72mg) etc. 

 

Chouinard notes problems with stopping propranolol and other beta-adrenergic drugs in this article: "The early recognition of supersensitivity rebound with β-adrenergic drugs helped to identify its underlying receptor supersensitivity mechanism through catecholamine stimulation by isoprenaline (isoproterenol), a nonselective β-adrenergic receptor agonist in patients [99,124,125], and later identify persistent postwithdrawal disorders consisting of an increased risk of myocardial infarction and mortality following their discontinuation [96]. Houston and Hodge [102], in their review of β-adrenergic blocker withdrawal syndromes, described 7 studies showing rebound and persistent withdrawal with 80 mg/day propranolol and a study showing these withdrawal syndromes after only 7 days of propranolol use. Doses below 80 mg propranolol/day appear safe to use in psychiatric clinical practice, but gradual dose reduction of low-dose propranolol is also recommended especially in patients at risks of myocardial infarction and essential hypertension."

 

Here is our guide on stopping propranolol.

 

Some drugs and supplements can interfere with metabolism and can also have psychotropic effects (antibiotics, steroids, some supplements, coffee, nicotine etc.). Withdrawal can also alter the response you have to medications you are already taking. It would be very helpful if you could create a drug history in your signature like this one. This link will take you directly to the signature. Signatures generally look like this: 

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

This will allow any moderator or member to quickly see your history and where you are in your taper, and thus be able to help more easily without too much reading (most people here are volunteers and have other jobs).

 

Thanks, and please let me know if you have any questions : )

[TG98]

Thanks for the detailed response. I have some reading to do! 

 

As for the signature, I have entered it on my profile and it's definitely saved there (followed the instructions on the post for new members) so I'm not sure why it's not appearing.

[DataGuy]

"May 2021 - Started Propranolol ER 80mg "

 

This is what I'm seeing in your signature, @TG98. Is that right?