In this video, we are going to be talking about the medication Propranolol.
It's a medication that's been around for a while and has a lot of different uses.
We'll go over the different most common uses, what side effects you need to watch out for
and the big black box warning that everybody taking this medication needs to be aware of.
Hi, I'm Dr. Erik Richardson a board certified Family Practice physician.
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On today's episode we are going to be talking about propranolol.
It's a medication that was first patented back in the 1960's so it's been around for
a long time.
And throughout all those years, we have found a lot of uses for it.
It belongs to a class of medications called beta blocker's.
These are a group of medications that work on specific part's of the body, including
the heart and blood vessels, that among other things, decrease how fast and strong the heart
is beating and help blood vessels to relax.
It's through these different mechanisms that it is able to help in so many ways.
So we are going to go over some of those common uses and then after will talk about the side
effects as well as other issues you need to watch out for with this medication.
So the first area that propranolol was originally desined to help with is the cardiovascular
or heart system.
It is used to treat high blood pressure and conditions where you get an irregular heart
beat like atrial fibrillation.
It can be used to treat certain kinds of chest pain caused by heart disease or even at the
onset of a heart attack to help prevent further damage or sometime after a heart attack to
prevent further events.
By slowing down some of the stimulus that is going to the heart and blood vessels this
medication is able to decrease how hard it is working and allows blood vessels to relax.
This can have a lot of protective effects on these conditions.
Now, there are a lot of different medications that we use that are a bit better for these
conditions, so we don't use them quite as often as in the past, but they still can be
a good option in certain situations.
That same effect carries over for another condition that we use this medication for.
That is to treat something called esophageal varices.
These are blood vessels that dilate in the esophagus.
They are basically like varicose veins in your throat.
They develop when somebody has issues with their liver, most commonly something like
cirrhosis where the liver scars down and isn't able to filter blood through it as easily.
Because of that the blood backs up and increases the pressure in the main vain that supplies
the liver.
As that backs up, those blood vessels dilate and if they get too bad they can burst.
If that happens its not a good thing and you can die very quickly.
So we use propranolol to help decrease the pressure in that area and help prevent those
from getting worse.
So Propranolol was originally used to treat mostly these types of heart and blood vessel
issues, but as time has gone on, weve found that there are several other conditions that
are effectively treated.
These are actually the conditions that we tend to use this medication more commonly
for.
One of the more common reasons we use this is to treat certain types of anxiety.
It seems to be most effective in helping those who have significant anxiety with situations
like public speaking.
Just like any medication it doesn't help everybody, but many can do really well with taking a
little dose about an hour before a stressful event like public speaking.
It just slows that heart rate and shaking down enough to help somebody get through it.
We do use it occasionally for general anxiety type symptoms as well.
So those who's anxiety seems to present with more racing heart, shaking and feeling on
edge, it can be worth a try.
The next condition that we use it for is a condition called benign essential tremor.
This is a problem that tends to happen more as we get older where we can get a shaking
tremor, especially when you are trying to do things such as writing or holding things.
It's not related to conditions like parkinson's but can be quite bothersome.
We also use it to prevent frequent migraines.
We think one of the causes of migraines can be spasms of blood vessels in the brain.
In some people, propranolol can be an effective way to help prevent those spasms and decrease
how often and severe headaches are.
The last condition that I'm going to talk about is one we call hyperthyroidism.
This is when, for whatever reason, the thyroid is producing too much.
It can cause a lot of problems when it does.
It can cause you to have a very rapid heart rate and feel really on edge.
One of the medications that we will use to help protect the body from all the symptoms
of excessive thyroid is to give some propranolol.
We will often do that while we work to fix the underlying issue.
So as you can see there are many different uses of this medication and we didn't even
go over them all.
But no matter what reason you are taking this medication, the side effects and issues that
can happen with this are the same.
So let's get into some of those.
The most common issue that we see with this medication is related to its effect on the
heart and blood pressure.
The biggest thing that I warn people about when taking this medication is that it may
work too well.
Your blood pressure can go down or your heart rate can go low.
This can make you feel really sluggish and tired or even dizzy or light headed if your
blood pressure drops.
You may notice that when you stand up quick you can get that "head rush" kind of feeling.
Another group of people that need to be careful while taking propranolol are those who have
asthma.
Being a beta blocker, this medication can affect block some of receptors in the lung
and make asthma symptoms worse.
It can also counteract some of the medication that we use to treat asthma and make it less
effective.
So if you have asthma, you need to work really closely with your doctor if you are on this
medication.
Apart from those we can see side effects such as fatigue, insomnia, nausea, diarrhea, some
hairloss and occasionally some impotence.
For most of these symptoms though, they tend to be short lived and often will go away after
a few weeks or can simply be improved by a change in dose.
Of course, some may always have more significant symptoms so as with any issue with medication,
if you are having a lot of side effects, talk with your doctor about it and see what they
recommend.
More significant reactions can include worsening heart failure, very low heart rate, worsening
of asthma symptoms, allergic reactions, changes to blood counts and worsening of Raynaud symptoms
where your hands get cold, white or blue and painful often when exposed to the cold.
Propranolol does come with something called a "black box warning".
This is a special advisory about a significant concerning effect that a medication has.
The black box warning for propranolol warns against stopping this medication abruptly
in those who have underlying heart disease.
The concern is, that those who have severe underlying heart disease who stop it suddenly
can have severe worsening of chest pain that can lead to a heart attack or severe heart
arrythmias.
So what this means is, that if you are on this medication then you shouldn't stop it
all of a sudden.
When coming off of this mediation it is important that you taper down off of it over a couple
week timeframe.
Now this certainly isn't a common problem, however its important to be aware of it.
This mostly affects those who have severe underlying heart disease.
Most people know they are in this category but it is possible you can have underlying
disease and not know it yet.
For that reason we just recommend that everybody who is on it taper down off of it slowly if
they need to stop it.
So Propanolol can be an effective medication for several different things.
It can be used to treat high blood pressure and different heart conditions however, now
days, it is used most commonly to prevent migraines, treat symptoms of anxiety, tremors
or symptoms related to high thyroid.
It can be an effective tool when used under the close care of a doctor.
It is important though, to know what to watch out for while taking it.
So hopefully though this you've been able to understand a little more about this medication
and feel comfortable taking it under the recommendation of your doctor.
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