Kanwaldeep, 2008 Watch for nonpsychotropics causing psychiatric side effects

[btdt]

non psych drugs causing psych symptoms 

 

https://www.mdedge.com/psychiatry/article/63080/watch-nonpsychotropics-causing-psychiatric-side-effects

 

Past Issue

EVIDENCE-BASED REVIEWS

Watch for nonpsychotropics causing psychiatric side effects

Look behind the scenes for drugs that play a supporting role in new mood symptoms

Vol. 7, No. 4 / April 2008

Kanwaldeep S. Sidhu, MD
Third-year resident, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI
Richard Balon, MD
Professor, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI

....

Recognizing a medication as the possible cause of your patient’s psychiatric symptoms can avoid inaccurate diagnosis and nonindicated psychiatric treatment. Diligently evaluating patients for drug-related psychiatric side effects is critical because complications usually are reversed when the offending drug is discontinued. Unfortunately, a thin line separates available evidence from anecdotal myths about psychiatric complications of nonpsychotropics.

 

Almost two-thirds (65%) of drugs included in the Physicians’ Desk Reference list potential psychiatric side effects, according to a random sample review.1 In some patients, such as Mr. J, these effects can exacerbate mood symptoms and result in perceptual, cognitive, or behavioral disturbances.

 

A wide range of drugs can cause psychosis, agitation, anxiety, depression, delirium, or insomnia (Table). On the other hand, certain psychiatric side effects of nonpsychotropics can be beneficial (Box 1).

Clinical Point

Beta blockers such as metoprolol and propranolol can cause delirium and psychosis

Improve your assessments by examining the evidence linking psychiatric side effects to commonly prescribed and over-the-counter (OTC) compounds, including:

• cardiovascular medications
• steroids (prescription and illegal)
• hormones
• interferons
• antimicrobials.

Table

New-onset psychiatric symptoms? Check patient’s drug list

Symptom

Documented as a possible cause

Psychosis/agitation

Anabolic androgenic steroids, antihistamines, clonidine, corticosteroids, decongestants, didanosine, ethionamide, H2 blockers, isoniazid, nitrates, NSAIDs, opioids, proton pump inhibitors, quinolones, salbutamol, skeletal muscle relaxants, sulfonamides/trimethoprim

Anxiety

Acyclovir, anabolic androgenic steroids, clonidine, corticosteroids, cyclosporine, decongestants, didanosine, serotonin 5-HT1 agonists such as sumatriptan, foscarnet, ganciclovir, nitrates, ondansetron, penicillins, skeletal muscle relaxants

Depression

Anabolic androgenic steroids, beta blockers, chloramphenicol, clonidine, corticosteroids, didanosine, digoxin, efavirenz, foscarnet, GnRH agonists, H2blockers, interferons, isoniazid, isotretinoin, NSAIDs, quinolones, statins, tetracyclines

Delirium

ACE inhibitors, anabolic androgenic steroids, antibiotics (most), anticholinergics, beta blockers, centrally acting antihypertensives such as methyldopa and reserpine, cimetidine, clonidine, corticosteroids, didanosine, digoxin, H2 blockers, lidocaine, naltrexone, nitrates, NSAIDs, opioids

Insomnia

Aminophylline, anabolic androgenic steroids, clonidine, corticosteroids, decongestants, didanosine, opioid antagonists, proton pump inhibitors, quinolone antibiotics, salbutamol, skeletal muscle relaxants, tetracyclines

NSAIDs: nonsteroidal anti-inflammatory drugs; ACE: angiotensin-converting enzyme; GnRH: gonadotropin-releasing hormone

Source: Prepared for Current Psychiatry by Drs. Sidhu and Balon from references cited in this article

Cardiovascular medications

Beta blockers have CNS effects—some of which cause psychiatric syndromes—that might depend on an ancillary property such as lipophilicity.2 Unlike hydrophilic agents such as atenolol that are excreted unchanged by the kidneys, lipophilic drugs such as metoprolol and propranolol are metabolized by the liver and are believed to enter the brain. Metoprolol has a brain/plasma concentration ratio about 20 times higher than that of atenolol.3

Metoprolol and propranolol can induce delirium and psychosis.4,5 Psychiatric side effects with metoprolol are frequent,4 and propranolol has been associated with:

• sedation (affecting >10% of patients)
• nightmares
• visual impairment
• hallucinations
• delirium
• depression.5

In 1967, it was reported that up to 50% of patients taking propranolol may experience dysphoria and at times severe depression.6 These effects may occur acutely or develop gradually. 5

The relationship between depressive symptoms and beta blockers has been increasingly questioned, however. One study did not find a higher prevalence of depression in patients receiving beta blockers vs those receiving other medications, although this trial had major methodologic limitations.7 One large study found no significant association between beta-blocker use and major depression, regardless of patient age, gender, or race.8

These studies stress the importance of carefully assessing the individual patient before assigning neurotoxicity to beta blockers, as these drugs have considerable benefits for cardiovascular disease.9

Angiotensin-converting enzyme (ACE) inhibitors also affect the CNS. About 4% to 8% of patients taking an ACE inhibitor experience altered mental status—typically increased arousal and psychomotor activity—although <2% discontinue the medication because of neuropsychiatric side effects. These include:

• anxiety
• mania
• insomnia
• fatigue
• paresthesias
• hallucinations.5

Clinical Point

Mood changes are the most common psychiatric symptoms caused by corticosteroids

Sedation occurs in about 5% of patients taking ACE inhibitors. Depression and suicide ideation as a result of ACE inhibition have been reported;13 however, ACE inhibitors have also been known to improve depression. Episodes of frank delirium have been reported.5

Clonidine is a centrally acting alpha-agonist. The alpha-adrenergic system regulates arousal and has an important role in major depression, anxiety states, and other arousal disorders.

More than one-third (35%) of patients taking clonidine experience sedation or lethargy; less commonly, the drug causes anxiety (3%), agitation (3%), depression (1%), and insomnia (1%).5 Acute confusion, delirium, hypomania, and psychosis related to clonidine use have long been recognized, occurring in <1% of patients—primarily those with preexisting cerebrovascular disease.5

Box 1

Not all psychiatric side effects are harmful

In some instances, mood-elevating side effects of nonpsychotropic medications might be beneficial. This might be the case if your patient experiences a sudden, otherwise unexplainable improvement.

CASE Helped by corticosteroids

Ms. Q, age 44, has a history of asthma and major depressive disorder and is being treated by a resident psychiatrist with a combination of paroxetine, 60 mg/d, mirtazapine, 15 mg at night, and cognitive-behavioral therapy. Her treatment has been challenging, and the psychiatrist has tried multiple medications and psychotherapy modalities.

At a recent psychotherapy session, Ms. Q says she has been feeling much better, with improved mood and greater energy. Upon further questioning, she reports having an asthma exacerbation a week before that resulted in hospitalization. During her stay, Ms. Q was started on a tapering dose of prednisone, which elevated her mood. Depressive symptoms returned when the effects of the prednisone wore off.

Prednisone is not indicated for depression and has harmful effects when used long term. The psychiatrist adds bupropion, 300 mg/d, to Ms. Q’s regimen, and her symptoms improve.

Other cardiovascular drugs. Side effects of nitrates/nitrites include delirium, psychosis (including delusions), anxiety, restlessness, agitation, and hypomania.5 Digoxin can cause cardiac glycoside-induced encephalopathy, which may present as sedation, apathy, depression, and psychosis. Patients may develop delirium, even when digoxin/digitoxin serum levels are within a therapeutic range.

Cholesterol-lowering statins might be linked to an increased risk of depression and suicide, but the evidence is inconclusive. Some studies have supported this link,10,11 whereas others have strongly refuted it12,13 or had mixed results.14 A recent review15 recommends being vigilant for psychiatric side effects in patients taking these drugs.

Steroids: prescription and illegal

Corticosteroids are prescribed for a variety of immune system-related diseases, including asthma, allergic rhinitis, rheumatoid arthritis, inflammatory bowel disease, and dermatologic disorders. Mood changes are the most common psychiatric symptoms caused by corticosteroid use; delirium is less common. Psychiatric side effects include:

• lethargy
• insomnia
• euphoria
• depression
• psychosis
• “personality changes”
• anxiety
• agitation.5

Multiple studies have linked corticosteroids and mood symptoms. The Boston Collaborative Drug Surveillance Program16 confirmed a direct relationship between corticosteroid dosage and psychiatric effects. More than 18% of patients had severe psychiatric symptoms at corticosteroid dosages >80 mg/d.

Clinical Point

Some studies suggest a link between estrogen and depression but in others estrogen had a positive effect on mood

A prospective study of asthma patients found statistically significant changes in mood—primarily manic symptoms—during brief corticosteroid courses at modest dosages. Depressed persons did not become more depressed during prednisone therapy, however; in fact, some improved. Some patients with posttraumatic stress disorder reported increased depression and memories of the traumatic event during prednisone therapy.17

 

In a study of 50 ophthalmologic patients who did not have psychiatric illness receiving prednisolone (mean starting dose 119 mg/d) for 8 days, 26% developed mania and 10% depression.18 None reported psychotic symptoms.

 

The most common adverse effects of short-term corticosteroid therapy are euphoria and hypomania. Long-term therapy tends to induce depressive symptoms.19 A review of 79 cases of psychiatric syndromes induced by corticosteroids found that 41% reported depression, 28% mania, 6% mixed symptoms, and 14% psychosis.20

 

A group of 16 healthy volunteers receiving 80 mg/d of prednisone over 5 days exhibited depressed or elevated mood, irritability, lability, increased energy, anxiety, and depersonalization.21 Numerous case studies have reported anxiety, agitation, mania, and psychotic symptoms in children and adults taking inhaled corticosteroids.

 

In general, psychiatric side effects of corticosteroids occur within 2 weeks of starting therapy and resolve with dosage reduction or discontinuation. In severe cases or situations in which the dosage cannot be reduced, the patient may require antipsychotics or mood stabilizers.19

 

Female gender and past psychiatric history might be risk factors for developing psychiatric symptoms with corticosteroids,22 although not all studies have confirmed these findings.18

 

Anabolic androgenic steroids (AAS) have limited therapeutic benefits but are used illegally by some bodybuilders, wrestlers, and other amateur and professional athletes to increase muscle mass, enhance performance, and gain a competitive edge. AAS can cause acute paranoia, delirium, mania or hypomania, homicidal rage, aggression, and extreme mood swings, as well as a marked increase in libido, irritability, agitation, and anger.

 

In a large observational cohort study of 320 bodybuilding amateur and recreational athletes,23 AAS use induced many of these psychiatric side effects. The extent intensified as the abuse escalated. A study that used the Structured Clinical Interview for DSM-III-R to compare 88 athletes using steroids with 68 nonusers found that 23% of the AAS users reported major mood syndromes, including mania, hypomania, and major depression.24

 

In a 2-week, double-blind, fixed-order, placebo-controlled, crossover study of healthy male inpatient volunteers, AAS had both:

• mood-elevating effects—euphoria (“steroid rush”), increased energy, and increased sexual arousal and drive
• mood-dysphoric effects, such as irritability, mood swings, increasingly violent feelings, increased hostility, and cognitive impairments.25

 

As with corticosteroids, psychiatric symptoms from AAS become more prevalent and severe as dosage increases. They usually resolve within a few weeks after users discontinue steroids but may persist for up to 1 month, even if adequately treated with antipsychotic medication.

 

Hormones

Gonadotropin-releasing hormone (GnRH) agonists such as leuprolide and nafarelin are approved for treating endometriosis, advanced prostate cancer, precocious puberty, and uterine leiomyomata. Some studies and case reports suggest that these agents cause depressive symptoms.26

Clinical Point

Watch for depressive symptoms in patients taking interferon, especially in those with a family history of mood disorders

Progestins have complex and variable psychiatric effects. Clinical trials have investigated the antidepressant effects of exogenous estrogens on psychiatric patients, but results have been inconsistent—possibly because of small numbers of subjects and design flaws.26 Some studies suggest a link between estrogen and depression in premenopausal and menopausal women with and without psychiatric illness, but findings remain controversial because other studies have found that estrogens have positive effects on mood.26,27

 

Interferon

Various forms of interferon are used to treat hepatitis C, melanoma, multiple sclerosis, chronic myelogenous leukemia, and other illnesses. Psychiatric complications—particularly depression—are the most frequent side effect of interferon therapy and mainly occur within the first 12 weeks of therapy.28

In a prospective observational study of veterans undergoing interferon-alfa/ribavirin treatment for chronic hepatitis 😄

• 48% of patients not receiving psychiatric care at baseline required treatment for neuropsychiatric side effects
• 23% developed symptoms of major depression.29

Treatment with a selective serotonin reuptake inhibitor stabilized these symptoms and allowed patients to continue hepatitis treatment.

Because patients who receive interferon are far more likely to require psychiatric intervention if they have a family history of mood disorders, closely monitor them for depressive symptoms and treat such symptoms aggressively. Also closely monitor patients with multiple psychiatric diagnoses receiving interferon-alfa therapy.30

Vol. 7, No. 4 / April 2008

Jeungling et al31 speculated that hypometabolism in the prefrontal cortex may predispose patients to interferon-associated neuropsychological syndromes. Neuropsychiatric symptoms may be a characteristic of hepatitis C, interferon treatment, or both.32

 

Antimicrobial agents

Antibiotic and antiviral drugs can cause psychiatric side effects:

• directly by affecting neuronal functions
• indirectly by entering the brain rapidly, taking advantage of the compromised blood-brain barrier during sepsis or infection.

Delirium is the most common psychiatric complication associated with these agents.5

Antibiotics. Penicillin and its analogues are associated with sedation, anxiety, and hallucinations. Delirium has been reported as a side effect of most cephalosporins, especially in patients with compromised renal function. Quinolones such as ciprofloxacin and ofloxacin rarely cause restlessness, irritability, lethargy, tremors, insomnia, mania, depression, psychosis, delirium, seizures, or catatonia (incidence ≤1%).5 Though not commonly used, chloramphenicol may cause depression, confusion, and delirium. Many case reports have strongly associated clarithromycin with delirium.33

Isoniazid is one of the most commonly used antibiotics that can cause psychiatric side effects; it has been linked to delirium, mania, depression, and psychosis. Ethionamide is associated with sedation, irritability, depression, restlessness, and psychosis. Tetracyclines have been known to cause depression, insomnia, and irritability at high dosages.

Sulfonamides can cause delirium. Psychosis and confusion also have been reported, especially when sulfa drugs are combined with trimethoprim.5

Antivirals. When used intravenously and at high doses, acyclovir and ganciclovir can cause lethargy, anxiety, hallucinations, and frank delirium.5 Foscarnet—an antiviral used to treat herpes viruses—can cause depression, anxiety, hallucinations, and aggressive irritability.

Didanosine—an antiretroviral agent to treat HIV infections—can cause lethargy (5% to 7% of patients), depression (2%), anxiety (2%), emotional lability (25%), delirium (2%), insomnia (1%), and psychotic delusions (1%).5 Efavirenz treatment may be associated with major depression and severe suicidal ideation.34 Tenofovir, a nucleotide reverse transcriptase inhibitor, has not been associated with psychiatric side effects.27

Antifungals. Psychiatric side effects are rare.

 

OTC and other agents

Many common nonprescription agents can cause psychiatric symptoms. The most frequently used classes include cold and allergy preparations, reflux medications, and analgesics (Box 2).5,35

Cold preparations. Combined antihistamines and decongestants—such as phenylpropanolamine, azatadine, loratadine, ephedrine, phenylephrine, pseudoephedrine, and naphazoline—can cause an atropine-like psychosis that typically manifests as confusion, disorientation, agitation, hallucinations, and memory problems. Decongestants can cause dangerously high levels of norepinephrine when combined with monoamine oxidase inhibitors (MAOIs) and are contraindicated in patients taking MAOIs. Ephedrine can induce restlessness, dysphoria, irritability, anxiety, and insomnia.

Clinical Point

Combined antihistamines and decongestants can cause psychosis

Reflux medications. Two primary classes of reflux medications are proton pump inhibitors (omeprazole and lansoprazole) and H2 receptor antagonists (famotidine, nizatidine, ranitidine, and cimetidine). Although generally considered to have a benign side-effect profile, these medications have been reported to cause serious neuropsychiatric complications—including mental confusion, agitation, depression, and hallucinations—mainly in geriatric patients with impaired hepatic-renal function.36 These occur in only <0.2% of outpatients but are much more common among patients who are hospitalized, elderly, or have hepatic or renal failure.37

 

Time to onset of psychiatric side effects from H2 antagonists varies. Ranitidine can cause depression 4 to 8 weeks after treatment begins. Cimetidine has been reported to cause adverse events within 2 to 3 weeks and delirium within 24 to 48 hours.38 These effects usually resolve within 3 days of discontinuing the drug. Cimetidine is also associated with sexual dysfunction.

Clinical Point

The acne drug isotretinoin can cause severe depression and suicidal behavior

Discontinuing ranitidine or cimetidine can induce a withdrawal syndrome that includes anxiety, insomnia, and irritability.39 Cimetidine can increase the blood level and action of tricyclic antidepressants. Blood levels of these antidepressants can become toxic, resulting in tachycardia and other adverse effects.

 

Other medications. Ondansetron is a 5-hydroxytryptamine subclass 3 (5-HT3) antagonist used for antiemetic therapy. In case reports, it has been strongly associated with anxiety.40 This association is complex, however, and studies are evaluating 5-HT3 receptor antagonists for the treatment of anxiety, depression, phobia, and schizophrenia.

 

Isotretinoin—a retinoid used for severe acne—can cause severe depression and suicidal behavior.41

Aminophylline and salbutamol are associated with agitation, insomnia, euphoria, and delirium. Methotrexate is known to cause personality changes, irritability, and delirium.27

Box 2

Psychiatric effects of OTC and prescription analgesics

Up to 70% of persons in Western countries use analgesics regularly, primarily for headaches, other specific pains, and febrile illness. Nonsteroidal anti-inflammatory drugs (NSAIDs)—including aspirin, naproxen, ibuprofen, and indomethacin—are efficacious and have a wide safety margin, but potentially serious psychiatric side effects can occur even when these drugs are taken in recommended doses.

Salicylate intoxication, which can present as frank delirium, often goes unrecognized. Any NSAID can produce delirium in the elderly. Case reports have also implicated NSAIDs in mania, psychosis, and depressive disorders with suicidal ideation.35

Opioids may cause sedation, psychic slowing, dysphoria, mood changes, psychosis, and delirium. Epidural administration of morphine may induce hallucinations and catatonia. Opioid antagonists—such as naloxone and, particularly, naltrexone—can induce dysphoria, fatigue, sleep disturbances, suicidality, hallucinations, and delirium. The serotonin 5-HT1 agonist sumatriptan (an antimigraine medication) has been associated with fatigue, anxiety, and panic disorder.5

Skeletal muscle relaxants such as baclofen and dantrolene may induce sleep disturbances, anxiety, agitation, mood disturbances, hallucinations, and delirium.

Treating drug-related mood effects

If you suspect a nonpsychotropic medication is causing your patient’s psychiatric symptoms, discuss this with the patient and the prescribing physician. Switching to another similar agent may be an option. If this is not possible:

• work closely with the patient’s primary physician
• treat mood symptoms with appropriate psychotropics.

Related resources

• Turjanski N, Lloyd GG. Psychiatric side-effects of medications: recent developments.Advances in Psychiatric Treatment 2005;11:58-70.
• Brown TM, Stoudemire A. Psychiatric side effects of prescription and over-the-counter medications. Recognition and management. Washington, DC: American Psychiatric Publishing; 1998.
• Physicians’ Desk Reference. www.pdr.net.

Drug brand name

• Acyclovir • Zovirax
• Aminophylline • Phyllocontin, Truphylline
• Atenolol • Tenormin
• Azatadine • Optimine
• Baclofen • Lioresal
• Chloramphenicol • Chloromycetin
• Cimetidine • Tagamet
• Ciprofloxacin • Cipro
• Clarithromycin • Biaxin
• Clonidine • Catapres
• Cyclosporine • Neoral, Sandimmune, others
• Dantrolene • Dantrium
• Didanosine • Videx
• Efavirenz • Sustiva
• Ethionamide • Trecator
• Famotidine • Pepcid
• Foscarnet • Foscavir
• Ganciclovir • Cytovene
• Indomethacin • Indocin
• Interferon alfa • Intron, Roferon
• Isoniazid • Nydrazid
• Isotretinoin • Accutane
• Lansoprazole • Prevacid
• Leuprolide • Lupron
• Lidocaine • Xylocaine, Xylocard
• Loratadine • Claritin
• Methotrexate • Rheumatrex, Trexall
• Methyldopa • Aldomet
• Metoprolol • Lopressor
• Mirtazapine • Remeron
• Nafarelin • Synarel
• Naloxone • Suboxone
• Naltrexone • Vivitrol
• Naphazoline • Naphcon-A, Clearine
• Naproxen • Aleve, others
• Nizatidine • Axid
• Ofloxacin • Floxin
• Omeprazole • Prilosec
• Ondansetron • Zofran
• Paroxetine • Paxil
• Peginterferon alfa • PEG-Intron, Pegasys
• Phenylephrine • Neo-Synephrine
• Prednisolone • Blephamide, Pred Forte, others
• Propranolol • Inderal
• Pseudoephedrine • Actifed, Sudafed
• Ranitidine • Zantac
• Reserpine • Serpasi
• Ribavirin • Copegus, Rebetol
• Salbutamol • Aerolin, Airomir, others
• Sertraline • Zoloft
• Sumatriptan • Imitrex
• Tenofovir • Viread
• Trimethoprim • Proloprim

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

 

Edited June 14, 2018 by Altostrata
moved to Journals

[btdt]

from what I can tell it is old likely more drugs now...

[compsports]

The ENT that was initially going to do my septoplasty would have prescribed steroids after the surgery as a precautionary measure against inflamation.   I found that more scary than the antibiotics I would have had to take.

 

I also found this section interesting:

 

 

Treating drug-related mood effects

If you suspect a nonpsychotropic medication is causing your patient’s psychiatric symptoms, discuss this with the patient and the prescribing physician. Switching to another similar agent may be an option. If this is not possible:

• work closely with the patient’s primary physician
• treat mood symptoms with appropriate psychotropics

 

Great, so the game of piling on drugs to treat side effects begins.   That is how someone ends with a multicocktail of several meds.

 

CS

[Nikki]

Thanks bt.....

 

Compsports  I get very intense anxiety from steroids and HBP.  But I understand this is a common side effect and it did go away once I stopped medication.

 

I was sensitive to meds all my life, BUT AD's increased my sensitivity.

[btdt]

I do not know if I was sensitive to drugs all my life as in before Ads as I did not take drugs I was healthy as a horse all my life had never been to hosp except to have a child.  I had a bad reaction to birth control pills as in a small stoke when I was 18 that is the only drug reaction I had prior to Ad.  Seems most everything reacts on my now I need to be very careful. Even puffers for a lung infection react on me. I am using them now as I need them and can't wait to be done with them. I also react to vitamins many of them D and many Bs. 

[compsports]

Thanks bt.....

 

Compsports  I get very intense anxiety from steroids and HBP.  But I understand this is a common side effect and it did go away once I stopped medication.

 

I was sensitive to meds all my life, BUT AD's increased my sensitivity.

Nikki,

 

When I had surgery way before I ever started psych meds, I breezed through it.  I don't remember having any med complications.

 

Ads are the gift that keeps on giving.

[lundeliz]

Wow. I just started taking an ARB for my high bp. I'm taking half of a 20mg Benicar.

 

Can't notice any se's yet. Keeping my fingers crossed.

[Altostrata]

May I move this topic to the Symptoms forum?

[btdt]

Sure Alto I never know where to put things put it wherever you like.

[btdt]

Put Atenolol on this list it is bugger of a trickster. 

[UnfoldingSky]

Put Atenolol on this list it is bugger of a trickster. 

 

It's a beta-blocker isn't it?

 

I took Propranolol..what a nightmare.  Causes "reversible amnesia".  

[btdt]

yes it is and it caused a lot more than that for me

[btdt]

 

Put Atenolol on this list it is bugger of a trickster. 

 

It's a beta-blocker isn't it?

 

I took Propranolol..what a nightmare.  Causes "reversible amnesia".  

 

were you taking any other drugs with it... I happened upon a interaction with these drugs while I was searching 

 

http://www.ehealthme.com/drug_interactions_side_effects/Lamictal-2538498

 Adverse Event, Amnesia, Anxiety, Aortic Dilatation, Atenolol,Blindness, Dizziness, Epilepsy, Hypertension, Lamictal, Nausea, Rash, Skin Chapped, Skin Exfoliation, Skin Haemorrhage, Withdrawal Syndrome

 

only three people in this but all had these symptoms

 

Comparison with this patient's adverse outcomes among males aged 45 (±5): Interaction Number of reports Adverse Event 3 (100.00%) Amnesia (deficit in memory caused by brain damage, disease, or psychological trauma) 3 (100.00%) Anxiety 3 (100.00%) Aortic Dilatation 3 (100.00%) Blindness 3 (100.00%) Dizziness 3 (100.00%) Drug Interaction 3 (100.00%) Nausea (feeling of having an urge to vomit) 3 (100.00%) Rash (redness) 3 (100.00%) Skin Chapped 3 (100.00%) Skin Exfoliation (removal of the oldest dead skin cells) 3 (100.00%) Skin Haemorrhage (bleeding into skin) 3 (100.00%) Withdrawal Syndrome (a discontinuation syndrome is a set of symptoms occurred due to discontinuation of substance) 3 (100.00%)

[Altostrata]

This is valuable information.

 

bdtd, please do not post entire copyrighted articles. To conform to fair use, you can post selections.

[btdt]

Then I took a look at drug induced aortic ruptures and dissections....

no real reason why just nosey...It just sounds so DEADLY

 

http://www.intechopen.com/books/etiology-pathogenesis-and-pathophysiology-of-aortic-aneurysms-and-aneurysm-rupture/drug-induced-aortic-aneurysms-ruptures-and-dissections#T1

 

 

 

[btdt]

 

 Conclusions

The only drug group for which relatively clear-cut evidence of involvement in the formation and rupture of aortic aneurysms exists, is the glucocorticoids. In addition, there is inconsistent evidence from epidemiological studies regarding whether the various antihypertensive drug classes protect against or in fact may precipitate growth and ruptures of aortic aneurysms. Prospective controlled clinical trials in this area are urgently needed to elucidate this issue.

Drug groups implicated in aortic dissection include those known to increase systemic blood pressure, such as phosphodiesterase-5 inhibitors like sildenafil, and vascular endothelial growth factor inhibitors like sorafenib, sunitinib and bevacizumab. Moreover, abrupt discontinuation of antihypertensive drugs known to cause rebound hypertension after cessation of therapy, such as beta-blockers, may also cause aortic dissection. In addition, single case reports exist for a few other drugs. Finally, illicit drugs such as cocaine, amphetamine, methamphetamine and ecstasy are associated with acute aortic dissections, with relative risk increases in the order of magnitude of about 2-3. Thus, the increased risk of aortic dissection for these substances is presumably considerably higher than for legal medicines.

 

[UnfoldingSky]

yes it is and it caused a lot more than that for me

 

What did it do to you?

 

I also had other problems from Propranolol, but the worst had to be the amnesia. 

[UnfoldingSky]

 

 

were you taking any other drugs with it... I happened upon a interaction with these drugs while I was searching 

 

 

 

No, none of those, though I was on Valium.  Benzos also cause memory loss so I was really hit hard.

 

Somewhere I also read (probably on Rx List) that Valium potentiates Propranolol.  You know when I found that out?  The absolute very last day I stopped taking Propranolol.  I had no idea there was that sort of interaction between the two.  Go figure I found out on the last day of my taper, pretty well by accident.

[Altostrata]

See the Drug Interactions Checker at http://www.drugs.com/drug_interactions.html

[btdt]

 

Then I took a look at drug induced aortic ruptures and dissections....

no real reason why just nosey...It just sounds so DEADLY

 

http://www.intechopen.com/books/etiology-pathogenesis-and-pathophysiology-of-aortic-aneurysms-and-aneurysm-rupture/drug-induced-aortic-aneurysms-ruptures-and-dissections#T1

 

 

 

Very odd that this did not come up in the original search but just for the heck of it I did a specific search with aortic problems and ssri... Guess what showed up 

 

PAXIL

 

• Pain in the chest that may resonate to the back
• Cough, hoarseness
• Difficulty breathing
• Pain in the jaw, arms, or neck

One of the causes of aortic aneurysm is hypertension, which is, unfortunately, sometimes the result of taking Paxil. Learn more about how to fight for justice and compensation if you have been harmed by this medication by speaking with one of our knowledgeable and reliable lawyers from the National Injury Law Center. You can reach us by calling 888-273-6041 today.

Paxil

on a law site no less... as for symptoms I seem to have all of those... is it in my head who knows.

[btdt]

I can breath now but I am on steriod puffers and antibiotics....still same doc put my on the bp drug as the others.

seems it has to do with the accident I was in awhile back but the treatment with the bp drug was hellish for me felt like a near death experience with psych treats cognitive ...lobotomy

[UnfoldingSky]

Sounds a bit like my experience too. 

[btdt]

I will be avoiding them in the future.

[btdt]

What I found about atenolol that explains my reaction to it.

 

 

Central Nervous System: Reversible mental depression progressing to catatonia; an acute reversible syndrome characterized by disorientation of time and place; short-term memory loss; emotional lability with slightly clouded sensorium; and, decreased performance on neuropsychometrics.

 

at RX list... will be my good to site for drug info from now on.

notice it says ACUTE I can vouch for that .. and it is not nearly as benign as it sounds.

[UnfoldingSky]

I swear I answered your post yesterday but my answer is not here...hmm.

 

What I found about atenolol that explains my reaction to it.

 

 

Central Nervous System: Reversible mental depression progressing to catatonia; an acute reversible syndrome characterized by disorientation of time and place; short-term memory loss; emotional lability with slightly clouded sensorium; and, decreased performance on neuropsychometrics.

 

at RX list... will be my good to site for drug info from now on.

notice it says ACUTE I can vouch for that .. and it is not nearly as benign as it sounds.

 

No it isn't as benign as it sounds.  I had the disorientation really badly as well.  I remember going out to a local forest with someone, somewhere I had been many times before and should know quite well and I was so confused as to where we were and worried I would get lost that the whole time all I could think was "if you get lost just follow the river". 

 

They have no idea just how dangerous these drugs are...

[lundeliz]

Can anyone tell me what kind of beta blocker withdrawal symptoms they had?  I know I can expect

 

some blood pressure and heart rate rebound symptoms.  But what kind of mental symptoms can I

 

expect from withdrawal?  Will I feel like I'm losing my mind like Cymbalta wd?  I have tapered down

 

to 14mg of Atenolol, and I'm getting really nervous about coming off completely.  I have a few more

 

weeks of tapering left.  If anyone could share their wd experience, I would really appreciate it.

[UnfoldingSky]

lundeliz, I withdrew slowly from a small dose I had been on while on benzos.  It would be hard to say what was causing what at the time as I had just come off benzos, but, to be honest I don't recall noticing anything significantly different coming off beta-blockers, meaning I didn't notice withdrawal symptoms.  It went fairly well actually.

 

Of course you may have different experiences, depending on why you took them.  I was not on them for BP, it was for a drug reaction.  They had however made my BP too low and it did normalize after I stopped taking them.

 

Also it caused Raynaud's which did improve after I got off them. 

[lundeliz]

Thank you for telling me of your experience, Unfolding Sky. It sounds like your

 

taper off the beta blocker went well. Mine has been a little tough, but like you

 

said it's hard to tell what is causing what. It's good to know it can be done

 

without too much difficulty.

[UnfoldingSky]

Sorry to hear it's been rough for you lundeliz.

 

I had really severe on-drug effects so it could be that the benefits I saw coming off were more obvious than any possible withdrawal.  It would have been hard for things to get much worse for me at the time (though not impossible) so when I did taper and found out that my BP was going back to normal and that the Raynaud's was improving I looked at it as overall beneficial.  I was so very worried that when I stopped it or benzos finally that all hell would break loose, but that thankfully never happened. 

 

 

[lundeliz]

Oh, good, thank you, that is good to hear. I also have bad side effects from the

 

med, and I can see some benefits already by lowering the dose. Your experience

 

gives me hope. Thanks!

[UnfoldingSky]

No problem, hope things continue to improve!

[lundeliz]

I came looking for this topic to ask about beta blocker wd. Hmmm, I didn't even remember

 

that I had already asked about it. Wow. I'm still not sure if bb wd can affect moods.

 

I do know that wd from bb can cause rebound anxiety, but could it also cause the feeling

 

of fear and dread? This has really kicked in for me the last couple of days big time. Has

 

anyone experienced this as a symptom of bb wd?

[UnfoldingSky]

Hi lundeliz,

 

I have the same problem, I sometimes go back and find I have left a comment on a thread I can't recall having left.  It's a bit disconcerting.

 

About the BBs, I don't know what to tell you re the doom and gloom.  My situation is too messed up from other drugs to say for sure that it might have caused some of that for me.  Hopefully someone else has more info to help you sort this out.

[btdt]

I came looking for this topic to ask about beta blocker wd. Hmmm, I didn't even remember

 

that I had already asked about it. Wow. I'm still not sure if bb wd can affect moods.

 

I do know that wd from bb can cause rebound anxiety, but could it also cause the feeling

 

of fear and dread? This has really kicked in for me the last couple of days big time. Has

 

anyone experienced this as a symptom of bb wd?

 

• How do you safely reduce propranolol dosage without ...

  www.drugs.com › Q & A › Questions

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  Nov 27, 2012 - My doctor seems to believe that going off of these beta-blockers are no big deal and ... my body, focus-level and just managing with the withdrawals. .... chest pain, feet feeling hot and cold, trembling muscles, feeling of dread.

 

And this definition of anxiety includes fear and dread... 

anxiety

anxiety A mood disorder characterised by somatic, emotional, cognitive and behavioral components encompassing chronic fear, dread, worry and panic attacks.

 

Clinical findings

Insomnia, recurring negative thoughts are common, as well as nausea, palpitations, dizziness and dyspnoea.

 

Management

Anxiolytics (benzodiazepines), serotonin-selective reuptake inhibitors (SSRIs), 5-HT1A receptor agonists (azapirones), barbiturates; somatic symptoms of anxiety may respond to beta-receptor blockers, e.g., propranolol.

 

Beta-blockers are medications that work by blocking the body's reaction to the stress hormones that are released during the fight-or-flight reaction. They include drugs like propranolol (Inderal) or atenolol (Tenormin). Beta-blockers are sometimes given to patients with post-traumatic anxiety symptoms. More commonly, the beta-blockers are given to patients with a mild form of social phobic anxiety, such as fear of public speaking.

http://medical-dictionary.thefreedictionary.com/anxiety

 

It would make sense to me that stopping a drug that "blocks the bodies reaction to stress" could cause anxiety.  

 

• Anxiety - Medical Dictionary - The Free Dictionary

  medical-dictionary.thefreedictionary.com/anxiety

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  Withdrawal from certain prescription drugs, primarily beta blockers and ..... anticipation of impending danger and dread accompanied by restlessness, tension, ...

looks like google says yes

[lundeliz]

Thank you so much for this good information.  It definitely answered my questions.  This anxiety

 

feels different to what I have been having, so I bet it is due to the tapering of the beta blocker. I

 

really appreciate you finding these articles for me. Exactly what I was looking for. Thanks again!

[btdt]

Your welcome.