Propranolol Clonidine

Phentolamine (5 mg IV or IM, 1 to 2 hours before surgery) is indicated in prevention or control of hypertensive episodes that may occur in a patient with pheo-chromocytoma as a result of stress or manipulation during preoperative preparation and surgical excision and in prevention and treatment of dermal necrosis and sloughing following IV administration or extravasation of norepinephrine or dopamine. Phentolamine has been used to treat hypertensive crisis secondary to MAO inhibitors/sympathomimetic amine interactions and rebound hypertension on withdrawal of clonidine, propranolol, or other antihypertensives. It has also been used in combination with papaverine as an intracavern-ous injection for impotence. 

In a study with 3427 male and female patients having DBP of 95—109 mm Hg (12—15 Pa), and no clinical evidence of cardiovascular diseases, half of the patients were placebo-treated and half were SC antihypertensive dmg-treated, ie, step 1, chlorothiazide step 2, methyldopa, propranolol [525-66-6], or pindolol [13523-86-9], and step 3, hydralazine, or clonidine [4205-90-7] (86). Overall, when the DBP was reduced below 100 mm Hg (13 Pa), there were more deaths in the dmg-treated group than in the placebo group. The data suggest reduction of blood pressure by antihypertensive dmg treatment that includes a diuretic is accompanied by increased cardiovascular risks. 

Roehrich H, Gold MS Propranolol as adjunct to clonidine in opiate detoxification. 

Because of their reflex cardiac effect, vasodilators, if used alone in the treatment of hypertension, have not been a successful therapeutic tool. However, the reflex tachycardia and increase in cardiac output can be effectively blocked by the therapeutic association with a sympathetic blocker guanethidine, reserpine, methyldopa, or clonidine. More specifically, blockade of the cardiac beta-adrenergic receptors will also prevent the cardiac response to hydralazine. Thus, the therapeutic combination of hydralazine and propranolol can be successfully employed for effective blood pressure reduction(11). 

Antihypertensive Alpha methyldopa Clonidine Guanethidine Propranolol Reserpine... 

A host of medications have been nsed to treat TD including medications that block norepinephrine activity (clonidine and propranolol), dopamine-activating medications (bromocriptine), benzodiazepines, acetylcholine-activating medications, calcium channel blockers, and monoamine oxidase inhibitors. In addition, vitamin E supplementation and atypical antipsychotics including clozapine have been used to treat TD. 

Beta-biockers/Other sympathetic nervous system suppressants - When beginning therapy, the -blocker dosage should be equal to 80 to 160 mg/day propranolol in divided doses. If -blockers are contraindicated, use methyidopa 250 to 750 mg twice daily give for at least 24 hours before starting minoxidil due to delay in onset. Clonidine may also be used to prevent tachycardia induced by minoxidil usual dosage is 0.1 to 0.2 mg twice daily. 

Antihypertensives typically used in child psychiatry include a agonists (clonidine, guanfacine) and beta-blockers (propranolol, nadolol). 

Clonidine. As with the rationale for P-blockers in the treatment of social phobia, clonidine hydrochloride, an a-adrenergic agonist, has been used in an attempt to target the physiological symptoms of the disorder. In a case report by Goldstein [1987], one subject with social phobia who experienced a primary symptom of blushing was treated with clonidine 0.1 mg twice a day after trials with alprazolam, phenelzine, and propranolol failed to provide symptom relief. The patient reported a dramatic decrease in the frequency and intensity of blushing episodes after 1 week of treatment. At 4-month follow-up, his symptoms remained well controlled and he denied any side effects. 

Although behavioral treatments for social phobia have been well studied, there are very limited data on its pharmacological management, b- Blockers (propranolol, atenolol) have been recommended, but available evidence indicates their effect may be no different than that of placebo ( 78). In a controlled study, the monoamine oxidase inhibitor (MAOl) phenelzine has been shown to be more effective than placebo (78, 79). Anecdotal reports have also described efficacy with alprazolam, clonidine, and fluoxetine, but systematic data are lacking (80, 81, 82 and 83). 

Several drugs that interfere with the sympathetic nervous system inhibit the secretion of renin. Examples are clonidine and propranolol. Clonidine inhibits renin secretion by causing a centrally mediated reduction in renal sympathetic nerve activity, and it may also exert a direct intrarenal action. Propranolol and other 13-adrenoceptor-blocking drugs act by blocking the intrarenal and extrarenal 3 receptors involved in the neural control of renin secretion. 

Clonidine [NE] Hypertensive reaction if clonidine is withdrawn while patient is taking propranolol. 

Treatment of PTSD has largely been dependent on antidepressants (TCAs, MAOs and more recently the SSRIs) but other approaches have been to use anti-adrenergic drugs (such as propranolol and clonidine), carbamazepine (to reduce anger and aggressive outbursts) and lithium. However, the evidence for the efficacy of such drugs is largely based on... 

Clinically important, potentially hazardous interactions with albuterol, alcohol, clonidine, corticosteroids, danazol, diuretics, epinephrine, estrogens, isoniazid, lithium, oral contraceptives, pentamidine, phenothiazines, propranolol, somatropin, terbutaline, thyroid... 

Solutions of drugs were prepared in 145 mM aqueous NaCl, from which a dose series was prepared. dl-Octopamine, dl-synephrine, dopamine, tolazoline, clonidine, yohimbine, cyproheptadine, gramine, chlorpromazine, promethazine, propranolol, metoclopramide, and 3-isobutyl-l-methylxanthine were obtained from Sigma Chemical Co. naphazoline from Aldrich Chemical Co. chlordimeform and phentolamine from Ciba Geigy mianserin from Research Biochemicals Inc. and lofexidine, XAMI, and tramazoline were gifts from Dr. R. Hollingworth, Purdue Univ. 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, amitriptyline, amobarbital, amoxapine, antipsrrine, atenolol, atropine, azata-dine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorqyclizine, chlordiazepoxide, chlormezanone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazepam, clonidine, clozapine, cocaine, codeine, colchicine, qyclizine, (yclo-benzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem, diphenhydramine, diphenidol, dipheno late, dipyridamole, disopyramide, dobutamine, doxapram, doxepin, droperidol, encainide, ethidium bromide, ethopropazine, fenoprofen, fentanyl, flavoxate, fluoxetine, fluphenazine, flurazepam, flurbiprofen, fluvoxamine, fii-rosemide, glutethimide, glyburide, guaifenesin, haloperidol, homatropine, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, hydro g chloroquine, hydroxyzine, ibuprofen, imipramine, indomethacin, ketoconazole, ketoprofen, ketorolac, labetalol, le-vorphanol, lidocaine, loratadine, lorazepam, lovastatin, loxapine, mazindol, mefenamic acid, meperidine, mephenytoin, mepivacaine, mesoridazine, metaproterenol, methadone, methdilazine, methocarbamol, methotrexate, methotrimeprazine, methoxamine, methyl-dopa, methylphenidate, metoclopramide, metolazone, metoprolol, metronidazole, midazolam, moclobemide, morphine, nadolol, nalbuphine, naloxone, naphazoline, naproxen, nifedipine, nizatidine, norepinephrine, nortriptyline, oxazepam, oxycodone, oxymetazo-line, paroxetine, pemoline, pentazocine, pentobarbital, pentoxifylline, perphenazine, pheniramine, phenobarbital, phenol, phenolphthalein, phentolamine, phenylbutazone, phenyltoloxamine, phenytoin, pimozide, pindolol, piroxicam, pramoxine, prazepam, prazosin, probenecid, procainamide, procaine, prochlorperazine, procyclidine, promazine, promethazine, propafenone, propantheline, propiomazine, propofol, propranolol, protriptyline, quazepam, quinidine, quinine, racemethorphan, ranitidine, remoxipride, risperidone, salicylic acid, scopolamine, secobarbital, sertraline, sotalol, spironolactone, sulfinpyrazone, sulindac, temazepam, terbutaline, terfenadine, tetracaine, theophylline, thiethyl-perazine, thiopental, thioridazine, thiothixene, timolol, tocainide, tolbutamide, tolmetin, trazodone, triamterene, triazolam, trifluoperazine, triflupromazine, trimeprazine, trimethoprim, trimipramine, verapamil, warfarin, xylometazoline, yohimbine, zopiclone... 

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