Britt Talley Daniel M.D.

7777 Forest Lane  Suite B-220

Dallas, Texas

(972) 566-4556

BETABLOCKERS

Betablockers are “Vasonormalizers” which prevent dilation and constriction of arteries. Adrenaline is made in two varieties: Alpha—which works on the lungs, and Beta—which works on arteries, thus, the name betablocker.  The archetype betablocker drug is Inderal, known generically as propanolol.  This drug works to block some of the effects of adrenaline on arteries. Other Betablockers that may be used are:  Corgard (naldolol) and Tenormin (atenolol).

Indication:

Inderal has been approved by the Federal Drug Administration for the treatment of a large variety of medical problems which includes:  Migraine, Benign Essential Tremor or Familial Tremor, Hypertension, Angina (the chest pain heart patients with coronary artery disease get), Cardiac Arrhythmias.

Dosing

Inderal comes in a short term (4 hour lasting) dose usally given 3 or 4 times a day or in LA (long acting-24 hour) once a day form.  Common doses are 80-320 mg/day.  For younger patients with migraine or tremor the dose may be discontinued safely at a low dose such as 80 mg/day, while older patients with heart disease and higher doses should have the dose tapered slowly.

Side Effects

Inderal is usually well tolerated and has few side effects, although like all drugs it has two pages of small print listing possible side effects.  One potential side effect is that a small number of patients may develop the so called “Inderal tired syndrome” after they start the drug, usually in the first week.  If this symptom develops, then the drug should be stopped and another betablocker selected. Betablockers may worsen depression or asthma and should be used with caution with these medical conditions

Duration of therapy

How long the drug has to be given is not known at the beginning and depends on the clinical indications.  For tremor Inderal is usually given long term for years or life.  For migraine I commonly encourage the patient to consider using the drug for 3-6 months at first and then reassess on follow up.  Daily preventive drugs like betablockers may be offered to migraine patients if they are experiencing at least 3-4 migraines a month.  The general effectiveness for migraine prevention is reduction in number of migraines by 50%.  Many patients are able to get off the drug if their headache diaries show that their number of events is low, although some patients with bad migraine should continue.

Treatment strategy

Inderal (propranalol) would be a good preventive drug choice for a patient with both migraine and essential tremor, but a poor choice for the patient with migraine and depression.

BTD 10/12/09