Help with coming off propranolol, starting St John's Wort and related questions

[fatoneatthegym]

For the last few weeks I've been taking propranolol, a 10mg tablet twice a day. I know that's a really low dose but it's really helped. I'm also talking supplement tablets of Magnesium, Vitamin D, and Vitamin B12.

Saw my GP again and mentioned I've been feeling dizzy and like the floor is leaning and not straight, which I thought might be a symptom of anxiety but she said it's actually more likely to be due to low blood pressure caused by taking propranolol, which is after all how it works. So she advised me to cut down to once day.

I also asked if it was safe to take St John's Wort at the same time, which I've taken in the past. She said it should probably be okay, but she didn't know the official information as it's not a prescription drug so she can't answer officially.

So I bought some St John's Wort and the leaflet says "This product is not suitable if you are taking any medicines for anxiety or depression. This includes lithium". But I don't know if this includes beta blockers or not as they're not officially antidepressants. Does anyone know?

Also I tried to cut down on propranolol but didn't succeed. I tried missing my evening dose but I was buzzing wide awake, no idea if it was a coincidence or not but I gave in at midnight and took the tablet. So I tried missing a morning dose but by midday my neck and head were aching, so I gave in again and took my tablet.

The only other option I can think of is that I have a pill cutter so I could try cutting them in half. Would this be a better idea? I know I'm on such a low dose but I'm obviously sensitive. I was hoping to swap over to taking St John's Wort instead so now I know know what to do.

All advice gratefully received.

You're fine to take St John's Wort and propanolol at the same time. Although it's used to treat anxiety, that's not its main function. The leaflet is referring to the benzodiazepines (valium/diazepam etc).

However you must not take the SJW with antidepressants. Mixing them can lead to a nasty (and potentially fatal) condition called serotonin syndrome. it would also be a good idea to start with low doses of SJW and build up, since it can cause side effects including anxiety.

After a few weeks on propanolol you will need to taper them rather than just stopping or cutting down drastically. Ideally it would be two a day for two days, one on the third day (at night) and after three rounds of that, cut it to two on one day and one on the other two for another three rounds, then go to one a day for a few days. If you still need to reduce it, repeat the pattern above but with one tablet and half a tablet instead of two tablets then one.

Have you thought of looking at the herbs which help calm anxiety? Valerian (no relation to valium) is the best known one, but I like passiflora (passionflower) and lemon balm (melissa officinalis). Valerian can cause anxiety in what's called a paradoxical reaction, and I'm one of the ones that happens to, so I can't take it.

Cutting in half sounds like a good idea. I would go and ask a pharmacist for advice about the St John's Wort. They usually have a private room or sectioned off area to talk to patients one to one. If you'd rather discuss it privately. Just ask to speak in private. Boots definitely have them.

Pharmacists are more knowledgeable about contraindications etc so although St John's Wort is a herbal medicine they might be more likely to know.

Well done for taking charge of your anxiety, hope that doesn't sound patronising! I just know how difficult it can be and you sound like you're making good progress. Good luck.

Actually that's a good point about speaking to the pharmacist. I'm going to pick up a repeat prescription this week so I'll speak to them then. Thank you for the suggestion.

Propanolol can keep you awake at night so take it early evening or earlier in the day.
Magnesium and melatonin also helps.

I take it between 7-8am and pm which seems fine.

If your propanalol pills have a indentation line down the middle of them, you can cut them in half. I would suggest you then take 1 pill at night and a half pill in the morning for a week. Then go half in the evening as well for a week. You might find that that dose works for you. If not, then cut out the morning one all together and then the evening one.

Yes I can cut them in half. That's a good point about just halving the morning dose and keeping a full evening one to see how that goes.

Read up about photosensitivity and st johns wort and protect your skin and eyes in sunlight. I do find it helpful but get brown marks on my neck and increased light sensitivity.

I'm going to try cutting down from tomorrow onwards, after I've spoken to the pharmacist.

Okay so I have failed to today.

I cut my pill in half this morning and it worked but I was aching a bit, which I thought I'd just get through and deal with it. But by lunchtime I was feeling anxious again and I eventually had to give in and take the other half. It's a bit better now but I'm worried I've become addicted to the tablets.

I'm going to lie down for a bit longer and then go out again to the pharmacy. It's an independent local one where they know me.

Please tell me this gets better...

Please be careful about St Johns wort, it’s actually quite a powerful medicine and can have side effects.

Okay so I went to the pharmacy. He said I can take St John's Wort at the same time if I really want, but it's not ideal. So instead, I've bought some Kalms tablets which I think contain Valerian which someone mentioned further up.

I'm worried I can't come off the Propranolol though. What if I've become addicted to it? I didn't cope with what happened this morning.

Please tell me this'll be over at some point.

I'll also keep taking the magnesium. But I'm really not feeling very hopeful at the moment.

I don't know what to do. I really thought I was getting better but now it's all getting worse again. What shall I do?

OP it's still very very early days. You are not going to magically get better from anxiety in this space of time regardless of what medication you are taking.
Give yourself some time and stop putting pressure on yourself to come off propranolol. Your GP has given you it for a reason, you may need to be on it for a while.

Have you looked at CBT? If you can have some therapy for the anxiety in conjunction with the medication then you stand a much better chance of coming off the propranolol or only having it when your anxiety is particularly bad.

The more pressure you out on yourself to "get better" and come off tablets then the worse your anxiety is going to get. You are giving yourself more anxiety by being anxious about your anxiety. It's a very vicious circle!

Also not sure if you are aware but SJW interferes with oral contraceptives so be careful if you are on the pill!

I've been going to counselling for at least a couple of years now because of something that happened a few years ago. But a few years before that I was offered CBT and I found it really unhelpful and pointless.

I don't know if I should start taking the St John's Wort or not.

I'm not on the pill.

You can't get addicted to propranolol

Why do you want to come off it and go on SJW? Is it because the side effects of PP?

Can you distract yourself when you think you need the 2 10mg? Like a fast paced walk for 10mins?

There is no physical dependency taking PP.

If you are depressed why is your GP not prescribing an AD like citilopram or sertraline

All PP does is bring your blood pressure down.

This was a random medical discovery that is now used for the symptoms of anxiety.

My GP originally said I should take anti-depressants but I didn't want them as I've taken them in the past and found them horrible. I can't deal with them again. So I asked for beta blockers instead. It's for anxiety rather than depression.

I take 180mg of slow release propranolol. 2 90mg tablets a day, plus dolsupin, buspirone and lyrica for anxiety and depression daily, after losing my daughter to cancer. Have been on some of these for 20 years. And Diazepam too.

Weening yourself off any of these drugs is the way, slowly, slowly. I used to be on 600mg of lyrica but have weaned myself down to 300mg, with my psychiatrists guidance. They were giving me really unpleasant side effects. I aim to come off them completely this year. Each time I drop 100mg, I feel edgy and fidgety for a while. It's not pleasant but it lasts about a week. I was hallucinating on the lyrica (pregabalin).

Propranolol were the game changers for me. I'd get a lot of vertigo with anxiety which propranolol helped with but also, they stopped my panic attacks completely. They were debilitating. I still have crippling anxiety, but I'm so thankful the panic attacks have gone.

Good luck op 💐

What's the issue with just taking the 2x 10mg a day?

PP game changer for me too.

Because they're making me feel dizzy.