Transcript Clinical use of propranolol in schizophrenia

Clinical use of propranolol in
psychiatric
93.11.04
楊依蓉
Propranolol use in schizophrenia
• Propranolol may be useful in the treatment
of schizophrenia ;however ,results from
clinical studies have been conflicting
• Propranolol in combination with a
neuroleptic agent may be beneficial ,
especially in patients resistant to
neuroleptics alone
Propranolol use
• ANXIETY
a. chlordiazepoxide b. diazepam
• AKATHISIA
a.cyproheptadine
• ESSENTIAL TREMOR
a.primidone
ANXIETY
a. chlordiazepoxide
Propranolol was as effective as
chlordiazepoxide for treating anxiety. Final
doses of propranolol 320 mg/day relieved
symptoms of anxiety, as rated by various
evaluation scales, with similar efficacy as
chlordiazepoxide 75 mg/day. Propranolol was
considered to have as good or better adverse
effects profile as chlordiazepoxide (Meibach et al,
1987; Meibach et al, 1987a).
ANXIETY
b. DIAZEPAM
Diazepam was found to be more effective than
propranolol in the treatment of the somatic
symptoms of chronic anxiety (Hallstrom et al,
1981). However, the combination of diazepam
and propranolol was more effective than either
drug alone.
AKATHISIA
a.CYPROHEPTADINE
Propranolol and cyproheptadine appear to be
equally effective in the treatment of
NEUROLEPTIC-INDUCED AKATHISIA (NIA). In
a double-blind trial, 30 schizophrenic patients
were administered either cyproheptadine 16
milligrams (mg) daily or propranolol 80 mg daily
for 4 days. Both drugs significantly and similarly
reduced the severity of NIA (Fischel et al, 2001).
ESSENTIAL TREMOR
a. PRIMIDONE
Propranolol in maximum doses of 40 mg three
times daily was reported as effective as
primidone (maximum doses, 250 mg orally three
times daily) in the treatment of essential tremor
in a controlled, crossover study involving 14
patients. Primidone is suggested as an
alternative to propranolol in patients unable to
receive beta-blocking agents (Gorman et al,
1986).
USE DOSE
• Anxiety:40-320 mg/day(in divided doses)
• Essential tremor: initial, 40 mg ORALLY
twice daily
maintenance, 60-320 mg ORALLY daily (in
divided doses)
• Neuroleptic-induced akathisia: 20-100 mg
ORALLY daily (in divided doses)