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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by partlycloudy on March 16, 2005, at 15:23:23
I'm taking 20mg of propanolol (Inderal) to normalize my blood pressure which is high due to taking 30mg Cymbalta - and probably also due to the birth control pill I'm on, too.
Problem is, my blood pressure isn't back to normal. It hovers between 145/99 and 130/84 and only gets to the lower number by my doing deep breathing, and resting for about 5 minutes. If I take at any time during my work day or even in the evening, it's the higher number - always.
Question - is the propanolol dosage high enough to be effective? and
Is having a BP like this cause for immediate concern? - like a trip to the ER?I do not consume caffeine, and haven't had alcohol for a couple of weeks. I exercise 3 x a week. My other med is Klonopin .5mg every night (just added to replace Xanax .25mg as needed). Also, the Klonopin isn't doing a thing for my anxiety!!!!!!!
Posted by ed_uk on March 16, 2005, at 15:46:48
In reply to Inderal (propanolol) question, posted by partlycloudy on March 16, 2005, at 15:23:23
Hello!
>Question - is the propanolol dosage high enough to be effective?
You'll probably need a minimum of 40mg twice daily, the dose must be individualised. A 'standard' dose for hypertension would be 80mg twice daily, most people take 120-240mg/day in two or three divided doses.
The dose you are taking is within the range normally used to treat anxiety, your pdoc is probably not used to prescribing higher doses.
>Is having a BP like this cause for immediate concern? - like a trip to the ER?
No, it isn't an emergency :-)
Regards,
Ed.
Posted by B2chica on March 16, 2005, at 16:02:01
In reply to Inderal (propanolol) question, posted by partlycloudy on March 16, 2005, at 15:23:23
hey pc!
suprised to see this med mentioned here. i just was put on this about three weeks ago for racing heartbeat. i'm only on 10mg. i checked it out a little and depending why you are on this medication it goes up pretty high for dosages (compared to what i'm on)
i would Definately make a phone call as soon as you can to your Rx physician telling them your BP's, they may bump you up. i think overall 20mg is pretty low.
if i remember right i thought i saw for hypertension the average dose around 150mg??
-but certainly don't take that as 'gospel'. i know for what i'm on it for they say 10-30mg up to 3x daily, which is right where i'm at.
I say it is better to start low and work your way up rather than over medicate. But it sounds like no matter what, it needs to be addressed sooner rather than later.here's a neat little site with some info on Beta Blockers.
http://www.tmc.edu/thi/betameds.htmltake care.
b2c.
> I'm taking 20mg of propanolol (Inderal) to normalize my blood pressure which is high due to taking 30mg Cymbalta - and probably also due to the birth control pill I'm on, too.
>
> Problem is, my blood pressure isn't back to normal. It hovers between 145/99 and 130/84 and only gets to the lower number by my doing deep breathing, and resting for about 5 minutes. If I take at any time during my work day or even in the evening, it's the higher number - always.
>
> Question - is the propanolol dosage high enough to be effective? and
> Is having a BP like this cause for immediate concern? - like a trip to the ER?
>
> I do not consume caffeine, and haven't had alcohol for a couple of weeks. I exercise 3 x a week. My other med is Klonopin .5mg every night (just added to replace Xanax .25mg as needed). Also, the Klonopin isn't doing a thing for my anxiety!!!!!!!
Posted by Spriggy on March 16, 2005, at 16:44:45
In reply to Re: Inderal (propanolol) question » partlycloudy, posted by B2chica on March 16, 2005, at 16:02:01
How long have you been on the Klonopin??
It is a different type of Benzo then Xanex in that it doesn't hit you quickly nor leave you quickly like Xanex.
You might need to take a morning dose (but lessen it so you won't be so sleepy) to keep you more stabilized with anxiety.
I have anxiety and have had some panic attacks.
I take Klonopin twice a day ( a morning dose and a night dose). The doctor said keeping your blood without it leaving, is the key to being stabilized with the anxiety.
So maybe just once a day isn't good enough for you.
Posted by partlycloudy on March 16, 2005, at 16:50:21
In reply to about Klonopin, posted by Spriggy on March 16, 2005, at 16:44:45
I just started the Klonopin a week ago, because my anxiety is pretty much a constant state for me, and xanax lets you down with such a "bump" . I take it at night, and my anxiety is worse while I'm at work and driving there and back. Oh, and at the grocery store. Oh, and in elevators. You get the gist. I see my p-doc In Person in a week so we'll address it then.
Thanks for your input!
Posted by partlycloudy on March 16, 2005, at 16:54:00
In reply to Re: Inderal (propanolol) question » partlycloudy, posted by ed_uk on March 16, 2005, at 15:46:48
thanks! I am going to check with my GP about the dosage for blood pressure treatment for me. I'd been on this med an epoch ago for BP and have no clue what dose it was then.
youse guys are the bestest.
Posted by Colleen D. on March 16, 2005, at 20:03:28
In reply to Re: about Klonopin » Spriggy, posted by partlycloudy on March 16, 2005, at 16:50:21
Hi PC!
I agree with Spriggy; one .5 mg dose at night of the Klonopin will probably not work very well. My doc suggests 2 or 3 doses. I take .5 mg in the morning, .5 mg about 3 p.m. and then .25 mg at bedtime so I get a good steady level in me to get relief from anxiety. I hope you can get it worked out soon! It really is a very good med (for me anyway) for anxiety.
:-) Colleen
Posted by Phillipa on March 16, 2005, at 20:45:09
In reply to Re: about Klonopin » partlycloudy, posted by Colleen D. on March 16, 2005, at 20:03:28
Posted by Bill LL on March 17, 2005, at 8:55:33
In reply to Inderal (propanolol) question, posted by partlycloudy on March 16, 2005, at 15:23:23
Here's my 2 cents. First of all, as someone has already mentioned in their response, your bp is definitely not high enough to be an emergency.
I can see the following options:
1) Are you depressed? If so, increase the Cymbalta. Your 30 mg dose is relatively low. Even if you are not depressed, an increase could help with your anxiety. (I guess it could also raise your bp even more).
2) As people have already mentioned, you probably need an increase in inderal. the increase in Inderal, in addition to lowering your bp, might also lessen your anxiety. Inderal helps with the physical symptoms of anxiety, but usually doesn't stop the worrying part.
It's a good idea to remind doctors that you are on a bc pill if there is to be a medication change since some drugs make them less effective.
I can strongly identify with your situation. I am on 60 mg Cymbalta. It has been very effective for both my anxiety and depression as well as ADD. But it increased my bp. My readings were similar to yours until last week. Just before I went to my doc appt, I had had 2 weeks in a row with readings of 145/100.
I was already on HCTZ (diuretic) and Altace for bp. So he added Norvasc (a calcium channel blocker). Yesterday, 5 days after starting the Norvasc, I did have a better reading of 130/85. BUT- it became obvious real fast that the Norvasc is causing sexual side effects.
If that continues, I will ask him to switch me to a beta blocker such as pindolol or inderal. I read that just about all bp drugs can cause sexual side effects in some people and not in others.
> I'm taking 20mg of propanolol (Inderal) to normalize my blood pressure which is high due to taking 30mg Cymbalta - and probably also due to the birth control pill I'm on, too.
>
> Problem is, my blood pressure isn't back to normal. It hovers between 145/99 and 130/84 and only gets to the lower number by my doing deep breathing, and resting for about 5 minutes. If I take at any time during my work day or even in the evening, it's the higher number - always.
>
> Question - is the propanolol dosage high enough to be effective? and
> Is having a BP like this cause for immediate concern? - like a trip to the ER?
>
> I do not consume caffeine, and haven't had alcohol for a couple of weeks. I exercise 3 x a week. My other med is Klonopin .5mg every night (just added to replace Xanax .25mg as needed). Also, the Klonopin isn't doing a thing for my anxiety!!!!!!!
Posted by partlycloudy on March 17, 2005, at 9:37:58
In reply to Re: Inderal (propanolol) question, posted by Bill LL on March 17, 2005, at 8:55:33
Unfortunately, I can't tolerate a higher dosage of Cymbalta without my blood pressure going higher. I'd been up to 90mg when I mentioned that my head was constantly pounding with the rhythm of my blood! and that's when the blood pressure problem was discovered. The same thing happened with effexor.
My depression hasn't been as much of a problem lately (OK, so I sobbed yesterday and screamed a bit, but it was mostly in frustration.)
pc
Posted by awatts on March 17, 2005, at 9:56:30
In reply to Re: about Klonopin » partlycloudy, posted by Colleen D. on March 16, 2005, at 20:03:28
> Hi PC!
>
> I agree with Spriggy; one .5 mg dose at night of the Klonopin will probably not work very well. My doc suggests 2 or 3 doses. I take .5 mg in the morning, .5 mg about 3 p.m. and then .25 mg at bedtime so I get a good steady level in me to get relief from anxiety. I hope you can get it worked out soon! It really is a very good med (for me anyway) for anxiety.
>
> :-) ColleenI also agree. Once a day Klonopin dosing did not work for me, expecially if I took it only at night. I have been on much higher doses in the past, but now I take 0.25 mg morning and night.
Posted by ed_uk on March 17, 2005, at 12:49:32
In reply to Re: Inderal (propanolol) question - B2C and » ed_uk, posted by partlycloudy on March 16, 2005, at 16:54:00
Hi Partly!
High doses of Inderal can sometimes cause quite a lot of side effects. Perhaps you would prefer atenolol, the 'usual' dose for hypertension is 50mg. It doesn't have as much effect on anxiety as propranolol though.
Ed.
Posted by Racer on March 17, 2005, at 15:07:11
In reply to Re: Inderal (propanolol) question » partlycloudy, posted by ed_uk on March 16, 2005, at 15:46:48
My BP is up, too, on 30mg Cymbalta, which I'm going to discuss with Dr CattleProd next time I see him. Since my BP is usually low enough that whoever takes it wants to help me out of the chair, that's a real shocker to me. And we stopped my propranalol because I was so ... well, it goes beyond lethargic. I had plenty of energy, and if I once got moving I could keep moving -- but...
By the way, did you get an email from me a little while ago? I'm having trouble with emails not getting through either direction lately? Wondering if you think I've ignored you?
xoxo
Posted by partlycloudy on March 17, 2005, at 15:45:11
In reply to Re: Inderal (propanolol) question, posted by Racer on March 17, 2005, at 15:07:11
I did get your email, Racer - thanks. I'm not so good at writing back, as you can see! I think the propanolol is making me a bit depressed, but I'm my usual loaf-y self as far as energy goes.
I am going to see my GP about the blood pressure since I think my p-doc is trying to tell me in a round about way that it's not her area of expertise. If I can get that under control, maybe I could take a high enough dose of Cymbalta for it to work on the anxiety.
It's getting rather complicated.
Posted by partlycloudy on March 18, 2005, at 7:04:04
In reply to Re: about Klonopin, posted by awatts on March 17, 2005, at 9:56:30
That's a good idea. I split last night's pill in half and took the other one this morning and feel pretty good so far.
pc
This is the end of the thread.
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