Beta blockers, also known as beta antagonists, are a s class of drugs that were first developed for the treatment of certain heart conditions and hypertension. Later, beta blockers were also found to be useful in glaucoma, migraine, and some psychiatric disorders such as performance anxiety, tremors secondary to lithium, and movement disorders that are caused by some drugs used in the treatment of psychosis. In the United States, the most commonly used beta blocker used in psychiatric practice is propranolol (Inderal). Nadolol (Corgard), metoprolol (Lopressor), and atenolol (Tenormin) are also used in psychiatric practice but to a lesser degree.
Beta blockers are proven effective in the treatment of performance anxiety, lithium-induced tremor, and neu-roleptic-induced akathisia (a physical condition caused by certain antipsychotic drugs). Beta blockers have sometimes been used with benzodiazepines in treating alcohol withdrawal.
Beta blockers act on that part of the central nervous system that controls mental alertness, lung function, heart rate, and blood vessels. Although there is more than one mechanism by which beta blockers work in anxiety states, the most beneficial result probably arises from the fact that beta blockers slow the heart to a normal rate and rhythm. Therefore, persons with performance anxiety do not experience the usual chest tightness and rapid heart rate that is associated with such acts as public speaking or acting.
Certain antipsychotic medications known as neu-roleptics can cause an unwanted effect called akathisia, which is the inability to sit, stand still, or remain inactive. Patients are restless, and in severe cases, may pace constantly and forcefully and repeatedly stomp their feet. Beta blockers can sometimes treat this condition with a lower incidence of side effects than any other drugs used to treat this condition.
Propranolol is available in 10- to 90-mg tablets. Nadolol is available in 20-, 40-, 80-, 120-, and 160-mg tablets. Atenolol is available in 50- and 100-mg tablets. Metoprolol is available in 50- and 100-mg tablets.
For the treatment of performance anxiety, sometimes called stage fright, a single dose of propranolol ranging
2 Akathisia—Agitated or restless movement, usually oa affecting the legs. Movement is accompanied by a sense of discomfort and an inability to sit, stand still, or remain inactive for periods of time. Akathisia is a common side effect of some neuroleptic (antipsychotic) medications.
Benzodiazepines—A group of central nervous system depressants used to relieve anxiety or to induce sleep.
Tremor—Involuntary shaking of the hands and arms.
from 10-40 mg is given 20-30 minutes before the event causing the unwanted reactions.
For lithium-induced tremors that cannot be controlled by reducing caffeine intake or administering the dosage of lithium at bedtime, propranolol at a dose of 20-160 mg daily can be given in two or three evenly divided doses.
For akathisia caused by antipsychotic medications, propranolol can be administered at doses of 10-30 mg three times daily.
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