β-blockers

SDN Members don't see this ad. (About Ads)

Other thread got me thinking a little bit about this. In those pretty rare circumstances where you prescribe them for anxiety, which one do you like best and why? It appears atenolol has a long half life (Inderal a short one) but metoprolol has β1 selectivity and therefore better for anxiety. I am only a student so I am just curious.

Originally Posted by quickfeet

Other thread got me thinking a little bit about this. In those pretty rare circumstances where you prescribe them for anxiety, which one do you like best and why? It appears atenolol has a long half life (Inderal a short one) but metoprolol has β1 selectivity and therefore better for anxiety. I am only a student so I am just curious.

Propanolol crosses the blood-brain barrier better than any of these, and such it is used most often for tx of anxiety. Metoprolol does cross significantly but not as much. It could be a reasonable option. Atenolol does not cross well at all.

Originally Posted by billypilgrim37

Propanolol crosses the blood-brain barrier better than any of these, and such it is used most often for tx of anxiety. Metoprolol does cross significantly but not as much. It could be a reasonable option. Atenolol does not cross well at all.

Does anyone use the extended release version of Metoprolol (succinate) versus the IR?

Anyone have thoughts on Bystolic (nebivolol)? Very lipophilic, and very B1 selective. Lower rates of depression and the other BB side effects than even metoprolol...

Hmm...I wonder...

Originally Posted by digitlnoize

Anyone have thoughts on Bystolic (nebivolol)? Very lipophilic, and very B1 selective. Lower rates of depression and the other BB side effects than even metoprolol...

Hmm...I wonder...

Isn't that stuff expensive, though? Virtually all the others are dirt cheap.

Originally Posted by cbrons

Isn't that stuff expensive, though? Virtually all the others are dirt cheap.

It is more expensive yes. Most people with insurance are in the $30/month range or so, but a few companies have it at $10! Just have to check.

Hey, if it works better and doesn't cause the BB depression and impotence, I think most people with a bit of money would be happy to spring for it.

Originally Posted by digitlnoize

It is more expensive yes. Most people with insurance are in the $30/month range or so, but a few companies have it at $10! Just have to check.

Hey, if it works better and doesn't cause the BB depression and impotence, I think most people with a bit of money would be happy to spring for it.

Who says it does?

I thought it was Inderal that is the worst in terms of mood.

Originally Posted by cbrons

Who says it does?

I thought it was Inderal that is the worst in terms of mood.

Well, the decreased incidence of side effects is pretty well documented in the literature. Not statistically different than placebo.

I'm only hypothesizing that it might work well for anxiety since its highly lipophilic. I don't know of any data, but haven't looked either. It's probably too new and expensive (and doing very well among the HTN crowd) for them to pursue off-label or secondary indication hunches.

Still...I wonder.

Originally Posted by digitlnoize

Well, the decreased incidence of side effects is pretty well documented in the literature. Not statistically different than placebo.

I'm only hypothesizing that it might work well for anxiety since its highly lipophilic. I don't know of any data, but haven't looked either. It's probably too new and expensive (and doing very well among the HTN crowd) for them to pursue off-label or secondary indication hunches.

Still...I wonder.

What is the plasma
halflife of Bystolic?

I know Inderal is super short, Lopressor not far behind.

Originally Posted by cbrons

What is the plasma
halflife of Bystolic?

I know Inderal is super short, Lopressor not far behind.

Around 12 hours. Most people take 1 qd for their BP.

Originally Posted by digitlnoize

Anyone have thoughts on Bystolic (nebivolol)? Very lipophilic, and very B1 selective. Lower rates of depression and the other BB side effects than even metoprolol...

Hmm...I wonder...

I would be interested to hear responses to this. I've been looking into Bystolic (Nebivolol) lately for anxiety cases.

Originally Posted by cbrons

I would be interested to hear responses to this. I've been looking into Bystolic (Nebivolol) lately for anxiety cases.

I haven't heard of anything. I did a pretty thorough lit search and didn't find anything. Going to ask around at my program and see if anyone has thoughts...

Maybe I found my first research topic. I call dibs. Hands off.

Originally Posted by digitlnoize

I haven't heard of anything. I did a pretty thorough lit search and didn't find anything. Going to ask around at my program and see if anyone has thoughts...

Maybe I found my first research topic. I call dibs. Hands off.

One thing I also realized, and that a physician pointed out to me, is because of Nebivolol's unique NO-potentiating vasodilation, it could be helpful in panic disorder patient who "over-somaticize" about things related to peripheral pulse pressure (feeling heart pounding in arms/legs). Just something I've been thinking about...

Originally Posted by cbrons

One thing I also realized, and that a physician pointed out to me, is because of Nebivolol's unique NO-potentiating vasodilation, it could be helpful in panic disorder patient who "over-somaticize" about things related to peripheral pulse pressure (feeling heart pounding in arms/legs). Just something I've been thinking about...

hehehe......

you guys are seriously overthinking this.

low dose beta blockers are fairly harmless and so that's why they are occasionally prescribed for performance anxiety, but they arent particularly effective.....we could debate whether the placebo benefit of throwing another anxiety med at a pt is worth continuing to reinforce the concept that pill=anxiety relief to pts, but anyone who spends more than 5 seconds wondering about kinetics and mechanisms of beta blockers in the use of anxiety disorders is wasting their time.

imo, depends on the pt.

Originally Posted by vistaril

hehehe......

you guys are seriously overthinking this.

low dose beta blockers are fairly harmless and so that's why they are occasionally prescribed for performance anxiety, but they arent particularly effective.....we could debate whether the placebo benefit of throwing another anxiety med at a pt is worth continuing to reinforce the concept that pill=anxiety relief to pts, but anyone who spends more than 5 seconds wondering about kinetics and mechanisms of beta blockers in the use of anxiety disorders is wasting their time.

imo, depends on the pt.

Hehe... well yeah I suppose I might be overthinking it a little bit.