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

Britt Talley Daniel MD

7777 Forest Lane, Suite B-220

Dallas, Texas  75230

(972) 566-4556

RISK  FACTORS  FOR  ATHEROSCLEROSIS

From the American Heart Association

1)  Genetics – your own family’s history of heart disease/stroke.

2)  Obesity.

3)  Cholesterol Level – less than 200 in general; also LDL cholesterol, homocysteine, fibrinogen, low-density lipoprotein, and C reactive protein.

4)  Hypertension-a blood pressure over 130 systolic or 90 diastolic.

5)  Smoking.

6)  Diabetes.

7)  Level of Activity – all persons should do 20 minutes of Aerobic Exercise three times a week.  Aerobic exercise is defined by the heart rate.  There are published tables for desired heart rates for different ages of life.  If you do an activity that gets your heart rate in the target area, then that is aerobic exercise.  Common  types of aerobic exercise are jogging, Jane Fonda type exercises, a rowing machine, treadmill, stepper, cardioglide machine, cross country skier machine.  Walking, playing golf or tennis, even racquetball are not aerobic exercise, because the heart rate doesn’t get high enough.

Athero (fat), sclerosis (hardening) means hardening of the arteries and is a generalized disease process affecting all the major arteries in the body, mainly the heart and arteries to the brain.  Atherosclerosis is a complex, multifactorial disease process with genetic and environmental factors. In the United States the number one cause of death over age 50 is heart disease from atherosclerosis.  The number three cause of death is stroke, again from atherosclerosis.  There are no “chemical roto-rooters” to open up arteries.  Surgeons and cardiologists may do this in selected cases if the disease process is focally present in one area, like the carotid artery going to the brain, or a coronary artery supplying the heart.  The idea is to try to live a type of life that reduces the risk factors of atherosclerosis–quit smoking, lose weight, treat hypertension, care for your diabetes, watch your cholesterol, and exercise aerobically.

A research report studying 40,000 patients for 40 years showed that persons who exercised lived two years longer than persons who did not.  This was at Framingham, Massachusetts, the oldest heart disease study group in America.

Exercise may be considered to be like a drug.  It promotes the relaxing response, helps reduce tension, and increases endorphins which are internal brain chemicals that decrease pain.  Exercise may help migraine, tension type headache, anxiety, panic disorder, insomnia, and depression.

BTD 10/2/09.