AIBU to think propranolol increase is causing this exhaustion?

[OnNaturesCourse]

have a GP appointment booked but just reaching out to see if I’m on my own with this.

I’ve been put on beta blockers for anxiety surrounding dizziness and at first I was just exhausted and sleeping within a hour or so of taking them. Thankfully I seemed to get used to them. My dose has been doubled with half in am and again in pm. I now feel like I’m trudging through mud all day and it’s like a fight to keep my head up. Exhausted doesn’t cover it. I’m okish if I’m sat or lay down but the rest of the time I just want to lend , hold on , rest etc. I now feel I’m more anxious about the beta blocker symptoms than the original issue of possible BPPV / dizziness as I’m now scared of passing out the exhaustion feels so intense.

my BP before this was a approx average of 125-135 / 75-90 with a HR around 80. It came down a little bit with the first dosage of 40mg but not majorly.

it’s now averaging 95-105 / 60-70 with a HR of 65. My lowest has been 90/59 with a HR of 58 in the AM.

everywhere I look says this is not drastically low but I’m wondering if the drop from my old average to new could be causing the sheer exhaustion and if so , will my body adjust to it ? I seem to have got a much bigger drop increasing the dose than from when I first started it. My GP has intentions of my dose increasing again in a month and I’m reluctant. I started on 40mg and I’m now on 80mg with intentions of going to 120mg propranolol.

Drop the dose back down a tiny bit?
Or can you take the whole thing just at night?

i possibly could but I was to take it this way so it’s always in my system as it’s working time is about 12hrs. Taking it all in the PM wasn’t working well as I’d be getting anxious mid day. I may question trying to get 20mg tablets to take morning and night instead of the 40s

They are massive increases to take. Can you ask your gp to increase more slowly? I take propranolol for anxiety and have 10mg tablets. I'm managing at the moment with 1 10mg in a morning and another one very occasionally if I'm having a bad day, but yes I am always tired. Hadn't connected the tiredness with the propranolol but the timings match.

I'm unsure as to why you're taking it, as you mention blood pressure readings? Is it solely for anxiety or do you have high blood pressure too? If just for anxiety, you can take it as and when you like and at a dosage that works for you - anything from 10 mg right up to maximum recommended dosage. Most people with chronic anxiety will need a minimum of 40 mg to get any type of positive effect, but we're all different.

Yes and the heat. I'm on 120 daily. Mg not tablets.

Edit: but still, your dose was doubled. You might well have wiggle room, maybe hold back 1/4 of the daily total as an experiment.

Ah, of course. Yes, maybe much smaller units so you can experiment with the time it’s ingested. (For now, can you cut the pills in half? )
I take a medication thrice daily, in 100mg capsules. It’s taken quite a long time to get to the optimal timetable for that 300mg daily total!

It’s for anxiety only.

I have 40mg tablets and take one at night and one in the morning.

Babes these doctors seem to give out propanolol like it's sweeties.

I (and my big DH) can only tolerate 10mg doses.

Drop yourself right down (cut the tablets for now) and see if it helps.

lol @ sweeties. GP told me there was no point in the tablets lower than 40mg as they were ‘like sweets’ and wouldn’t help.

I’ll maybe try 40 in pm like I’ve been on a while and a twenty in the am

That's total nonsense. 10mg is very effective for me and for my husband and we both suffer with anxiety and sometimes panic attacks. 10mg stops a panic attack within 30 minutes for me.

I didn’t know they could be taken like that

Yes, I only take one when I feel anxiety or a panic attack building beyond where I can control it. It works within 30 minutes.

Purely ad-hoc use. You do not need to take them constantly if you dont want to.

I’ll speak to my GP as I’m not sure that would work best for me but I do like the idea of being able to take an additional 10mg if and when needed. I had a major panic attack the other day that took over a hour to peak and start getting better.

I think there has been some miscommunication between you and your gp. Beta blockers don't buil up in your system like other meds. For anxiety, they can either be used regularly as a preventative measure or as and when you feel a panic attack coming on. You can easily find a dose that works for you by simply experimenting! If 10 mg does the trick, stop at that. If not, increase.

Op, has the GP discussed other options with you?

Propanolol only helps the physical side of anxiety. Have you considered a low dose of an SNRI? I take 25mg sertraline which has stopped the constant anxiety in its tracks. And now I occasionally just pop a propanolol for extreme situations.

I'm not particularly confident your speaking to the right doctor. Do you have a mental health nurse at your practice? Or can you ask for a doctor who specialises in mental health?

It’s just my GP and was over the phone.

phoned to say I’d been getting panic attacks again (had them when younger briefly ) and was instantly offered beta blockers. Brief discussion about other options should they not work - I was happy to do the beta blockers due to family medical history being a bit restrictive with alternatives I can take / would be happy to.

Told anything less than 40mg daily is pointless and that the long goal is 120mg. Advised to do it in stages to reduce side effects.

That always about two months or so ago. I phoned to get the prescription again and was advised to start increasing the dose by taking the morning tablet too.

They seem very calm and easy about dishing this out especially when the side effects can be horrible from what I read.

Wow. Your GP seems very free and easy on dishing out a medication that is designed to slow your heart rate!

Propanolol can be used for a few different things, with different strengths recommended for each. I have never heard of anyone with anxiety being asked to aim for 120mg!

Beta blockers are to manage physical symptoms in the short term, like shaking and fast heart rate as it blocks adrenaline and cortisol that causes those symptoms.

I really think you need to speak to a different doctor.

NHS advice for Generalised Anxiety Disorder

I take 3 x 40mg a day for anxiety. Have done for some years. I don’t think I’d be here without it.

I take propranolol for essential tremor. The individual normal tablets had me sleeping at 7pm and awake at 1. So I prefer the slow release ones, taken at bedtime, nice steady stream through your system all day instead of the big crashes.

i am on 80mg too, for anxiety which was giving me near faints/breathless/chest pain
my worst side effect is insomnia, I’m SO TIRED

less than 40mg does nothing for me. I use them for anxiety attacks and take them as and when now when I started I was on 40mg in the morning and 40mg in the evening if needed. I take 40mg now when I feel it starting and it helps.

I genuinely forgot my tablets yesterday and I woke up in such a better state today - could be related , maybe it’s not. I knew I was going out this afternoon so I held off my morning dose and took it when I had to leave the house (felt the panic starting) Srill took a panic attack when I got to where I was going but was able to ride it out without fleeing or externally panicking. It seemed to pass quicker too. I took 20mg at night (half tablet) tonight as it was closer than usual in my dosage times.

interestingly my blood pressure has slightly increased to 110/65 tonight with a Hr of 77. Was about the same this morning too. I am wondering if my numbers increasing here are helping how I feel overall. Yes I still took the panic attack but I did not spend all day feeling like I was dragging myself through the mud just doing basic things. Tired yeh but no where near as bad. I mean it’s a very slight increase but the HR is more stable between AM and PM.