Propranolol

They're like, you're going to pass out up there, Nicole.

No, I love a good 80 milligrams of Propanolol.

Oh,

exactly.

Then we have propranolol.

So this, again, a lot of women listening to the podcast might be taking this currently or have taken it in the past.

Propranolol is sort of one of the first line migraine preventative medications.

It's a beta blocker.

It's one of the standard medications prescribed to prevent migraines.

Joining us are two of the authors of this article, Dr. Tracey G. Simon, who's a hepatologist at MGH, and Dr. Joshua Lin, who is a pharmacoepidemiologist at Harvard.

I believe that this discussion will help you better understand what Carvedilol is doing that is different from Propranolol and Natilol and why the guidelines now recommend that particular beta blocker.

Well, Joshua and Tracy, thank you much for joining us on the podcast.

I was very excited to read your article and to talk about it because This has been a big change in the management of cirrhosis to use carvedilol as opposed to natilol and propranolol.

And that would be very tough to do in a randomized trial of patients with cirrhosis.

It would require a really big population, quite a bit of follow-up, and it would be very resource intensive.

And so we were eager to try and compare these three drugs, Carvedilol, Natilol, and Propranolol, so the three sort of leading most commonly prescribed non-selective beta blockers in patients with cirrhosis in the best way, the best and most feasible way possible given sort of the constraints of a randomized trial using real world evidence.

So why don't we talk about the process of the study? We need to make sure that everybody listening understands what the data were and how you did the comparisons.

So we did not put him on Ritalin.

We put him on Propanolol, which is the treatment for PTSD and it calmed him down pretty nicely.

So this is why it's important to have a bigger canvas available to you.

So you would never, if you were just giving him Ritalin, he could have been on Ritalin for years, that wouldn't have addressed the underlying problem at all.

The preferred agents are beta1-selective blockers such as metoprolol and bisoprolol and labetalol for hypertension.

Propranolol has a long safety record and is often used for long QT syndrome.

Beta blockers may be associated with a modest reduction in fetal growth, so serial growth scans are recommended, and newborns should be observed for twenty-four to forty-eight hours for bradycardia, hypoglycemia, and low blood pressure.

Atenolol is the exception, best avoided because of the stronger association with growth restriction.

Anyway, so this beta blocker drug was gonna revolutionize the heart business, blah, blah, blah, blah, blah, blah.

And so it was an hour-long movie, and the first 15 minutes was about how wonderful this new beta blocker drug, it was called Inderal, which we know today as Propranolol.

It was about, first 15 minutes was some lady, or, or was some, you know, talking about how great this drug was, and the last 45 minutes of this hour-long movie was some lady reading the side effects.

And she was reading them pretty fast, too, by the way.

That's a, a, that's a chemical response to anxiety, right? Cortisol dump, norepi dump.

Those stress hormones, right? Propranolol just cuts the system apart.

So you have physiologic response-

What's this, what is this called?

Propranolol.

It is old-

Where do I get it?

You probably have altered mental status, and depending on the specific beta blocker, you may see additional effects.

Propranolol, for example, very common, has, uh, sodium channel blocking properties and can produce seizures and ventricular dysrhythmias if it is a significant toxicity.

Some beta blockers can also affect glucose regulation, fun fact.

So glucose belongs in your assessment here.

Now we go to the preventatives.

In her words, "I've been on every preventative, literally every single one." Propranolol, a beta blocker.

It made her so tired she could hardly get through the day.

Remember, her work is a very physically demanding job.