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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by halcyondaze on February 6, 2007, at 12:25:05
I've been taking 10 mg three times a day of Propanolol to reduce the akathisia caused by Parnate. It's been helping tremendously but on the second day I noticed I was having this visual hallucination-like experience, where I was seeing "trails" when an object would pass in front of my or little black objects swarming in the corner of my eyes. It's almost like when you take LSD and begin to feel the initial onset of the drug.
My doctor reduced the Propanolol to 10 mg twice a day so hopefully that helps but I was wondering if this has happened to anyone? And does it indicate some kind of neuropharmacotoxicity?
Posted by dbc on February 6, 2007, at 14:05:24
In reply to Propranolol and hallucinations?, posted by halcyondaze on February 6, 2007, at 12:25:05
That definetly shouldnt be happening. I've taken propanolol at decent doses at atenolol at 100mg daily for blood pressure. Its got to be the parnate, i've never heard of a beta blocker causing any sort of effect as you're describing.
Or rather maybe its the parnate + beta blocker combo causing it. Either way thats very strange.
Posted by halcyondaze on February 6, 2007, at 15:38:26
In reply to Re: Propranolol and hallucinations?, posted by dbc on February 6, 2007, at 14:05:24
There are actually several reports in the literature about this:
<< http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7065308&dopt=Citation >>
<< http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=5781495&dopt=Citation >>
<< http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=638680&dopt=Citation >>
Posted by yxibow on February 6, 2007, at 20:05:40
In reply to Re: Propranolol and hallucinations?, posted by halcyondaze on February 6, 2007, at 15:38:26
> There are actually several reports in the literature about this:
>
> << http://www.jonmd.com/pt/re/jnmd/abstract.00005053-199803000-00010.htm;jsessionid=FL0KWhXPNrlfqWRnxg1hCbnztqJQpQzNqFnSrLqzvrRzZv1fZLtL!1538755720!-949856144!8091!-1 >>
>
> << http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7065308&dopt=Citation >>
>
> << http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=5781495&dopt=Citation >>
>
> << http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=6745087 >>
>
> << http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=638680&dopt=CitationThis study appears to associate it mostly with hypnaegogic / hypnapompic wake to state situations, especially in conjunction with alcohol.
>
> << http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=1120173 >>
>
> << http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=638680 >>
All of the other studies were far to old to draw anything other than summary, and all were case reports. It is a rarity I would have to conclude.And at 30mg slightly above the noise level in the one study that could be drawn out.
That doesn't mean that you are a case report of visual hallucinations but it may be a reaction with other medications.
You could ask your psychiatrist to switch you to pindolol or another non-cardioselective beta blocker to see if it disappears.
As far as akathisia, racing pulse, or especially pseudoparkinsonism, I've generally not seen any results until 80mg, but my liver seems to eat medications for breakfast. Who knows, I'm probably a fast metabolizer.
Anticholinergics are generally better for central movement conditions but I would try some of the other beta blockers if your doctor is up to it. Anticholinergics will almost always have some visual effects, though, caused by the atropine like alkaloids -- usually mild, but depends on the person, a general sense of brightness due to dilated pupils.
Sorry to hear that your trial with propranolol has gone a bit awry. But it should dissipate with discontinuation -- some of the subjects in the study that I was able to read did associate the hallucinations with fear but I don't think that it is something that one should worry in the long term at a low dose such as that.The trails, you're seeing are palinopsia.
Hope that helps-- Jay
Posted by Chairman_MAO on February 7, 2007, at 11:39:06
In reply to Propranolol and hallucinations?, posted by halcyondaze on February 6, 2007, at 12:25:05
This is probably not a sign of toxicity. However, I believe drugs which block 5ht2 receptors can cause this sort of experience, which IIRC propranolol does, although I'm not exactly sure. I am not really offering you much of an explanation, but I can tell you that I have noticed some 5ht2 antagonists that I've taken cause this effect.
Can you get a benzodiazepine or a dopaminergic drug for the akathesia instead? Beta blockers are not good to take unless you have to, IMHO, because they muck around too much with the cardiovascular system. Running on beta-blockers is no fun (is it ever?). ;)
Posted by yxibow on February 8, 2007, at 13:20:03
In reply to Re: Propranolol and hallucinations? » halcyondaze, posted by Chairman_MAO on February 7, 2007, at 11:39:06
> This is probably not a sign of toxicity. However, I believe drugs which block 5ht2 receptors can cause this sort of experience, which IIRC propranolol does, although I'm not exactly sure. I am not really offering you much of an explanation, but I can tell you that I have noticed some 5ht2 antagonists that I've taken cause this effect.
>
> Can you get a benzodiazepine or a dopaminergic drug for the akathesia instead? Beta blockers are not good to take unless you have to, IMHO, because they muck around too much with the cardiovascular system. Running on beta-blockers is no fun (is it ever?). ;)
>That's why one takes non-cardioselective so that rebound blood pressure if one stops "cold turkey" isn't as dangerous as say, with newer ones like metoprolol and the peripherals are activated. But you're right, it is an issue.
I wouldn't personally fuss with things like levodopa and the like, they can cause hallucinations as well. No, akathisia is a time tested unfortunate side effect of medications that usually is solved by a) anticholinergics, b) benzodiazepines and sometimes c) beta blockers.
Posted by munificentexegete on February 8, 2007, at 21:27:21
In reply to Propranolol and hallucinations?, posted by halcyondaze on February 6, 2007, at 12:25:05
anticholinergics rubbish, cause psychosis and hallucinations, not cure for akathisia google that.
Posted by yxibow on February 9, 2007, at 2:51:21
In reply to Re: Propranolol and hallucinations?, posted by munificentexegete on February 8, 2007, at 21:27:21
> anticholinergics rubbish, cause psychosis and hallucinations, not cure for akathisia google that.
Anticholinergics can cause psychosis at doses greater than the minimum effective dose. And yes, they can cause it also even at an effective dose. It depends on the person, and that is a broad generalization and I feel is not helpful for those who do take anticholinergics for a variety of things, including real parkinsons, pseudoparkinsonism, akathisia, and other EPS.
The rough order of increasing atropine like side effects would probably be Akineton (discontinued just about everywhere I think) -> Artane -> Cogentin / Benadryl. Can't tell you about procyclidine.
The psychosis caused isn't particularly violent catatonic psychosis that one associates with someone who has a psychotic disorder. Its more like chewing belladonna, because essentially they were all derived from that source originally.
One's cholinergic system (a core body component) is interrupted -- chills (or sometimes fever) can occur -- which is why if one is on them for an extended period of time they shouldn't excercise outdoors in the summer or in any area that could cause heat stroke when a heat wave hits.
Mostly the side effects are visual (real), dilated pupils ; it is contraindicated generally with people who have glaucoma, so that's something to ask one's doctor. Also antihistamine and drying effects will occur with some, this is why Artane is vital for my occasional sialorrhea due to unknown reasons, medication induced or symptom.
IV Benadryl is the fastest arrestor for akathisia in a hospital setting. I can tell you that first hand, when I took a phenothiazine (Compazine) in the ER for high fever and unstoppable vomiting from influenza. It started working and then akathisia hit, and I hit the nurse button immediately. Unfortunately they didn't give me a second dose for my ride home and I was having trouble telling the taxi driver how to get back to my apartment in college. But of course, as they say, you go to an ER and end up worse than you started sometimes (humour -- if you need an ER, use it please.)
A prudent regime of an anticholinergic, if it is not uncomfortable to the patient, I do believe is overblown from that description. And parkinsons patients, for whom they were originally developed for, who take larger doses, ramp up to them in a slow and orderly fashion so all said comments don't occur.
But, sure, its not the only choice for akathisia -- some people will respond to propranolol, some people will respond to benzodiazepines, theoretically I guess you could even respond to clonidine, but for some anticholinergics are the only choice.-- tidings
Jay
This is the end of the thread.
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