Propanolol vs Toprol XL for Tremor

[TheCritic]

Hi,

I was just curious if anyone has any thoughts on this. I read a study that says Toprol is just as effective in treating ET at higher doses (100-150mg) due to loss of cardioselectivity at these doses. Any thoughts from experience in treating.

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[deleted87716]

I was just curious if anyone has any thoughts on this. I read a study that says Toprol is just as effective in treating ET at higher doses (100-150mg) due to loss of cardioselectivity at these doses. Any thoughts from experience in treating.

I'll usually start with Inderal LA (propranolol), and switch to Toprol XL (metoprolol) if the patient complains of excessive fatigue. Once-a-day dosing is helpful for compliance, which is why I prefer the sustained-release versions of these drugs. Reducing the dose can sometimes help with side effects, but possibly at the expense of efficacy. Metoprolol is more selective for beta-1 receptors, and some studies (like this one) have shown it to be less effective for essential tremor compared to propranolol.

Edit: Some national guidelines ( http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7421&nbr=4380 ) also put metoprolol in the "considered, but not recommended" category.

I should add that patients are more apt to develop bradycardia and/or hypotension with high-dose beta-blockers, particular those without significant underlying hypertension. You also have to caution them about abrupt discontinuation or missed doses, as rebound hypertension can result. Fatigue is also much more likely to occur. In men, you also have to expect some erectile dysfunction.

 

[oregonbigc]

One problem I have faced is that most of my essential tremor patients are elderly and have COPD, which means high dose Metoprolol is out.

 

[McDoctor]

Hi,

I was just curious if anyone has any thoughts on this. I read a study that says Toprol is just as effective in treating ET at higher doses (100-150mg) due to loss of cardioselectivity at these doses. Any thoughts from experience in treating.

If you are losing your cardioselectivity, then what's the point of using a more expensive drug, (whose main pharmacologic advantage over existing generics is cardioselectivity) when cheaper alternatives are available? Unless, of course, you're a spineless pharmaceutical shill...err...I mean... "consultant" for Astra-Zeneca.

 

[Doctor M]

generic toprol xl is out, so ins should give these pts a break🙂