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Suggest Remedy For Anxiety, Slurred Speech And Tremors When On Propranolol
Question: I have recently resorted to using propanolol for hypertension after a long list of other antihypertensives. It worked beautifully with hctz, but as I had to stop the hctz due to electrolyte imbalance, I have had to increase to 40 mb bid and it does work. However, with that comes a mild ataxia (mostly slower ambulation) and more importantly slurred speech. As a result I have been thought to be under the influence. This concerns me and I have found articles where this side effect can be good for tremor (as my father had parkinsons) and those with speech anxiety. Is this a fairly common side effect. One site shows the incidence of slurred speeck to be worse after age 60. I am 62 years old and active. What can you contribute? Thanks, Dr W Earnest
Brief Answer:
I would suggests some key points to consider.
Detailed Answer:
Hello dear Dr. W Earnest!
Thank you for your presence on HCM!
Facing your long attempted antihypertensives list, I would not be too insistent to advice you any other antihypertensives schemes (though the above combination of a beta-blocker with a diuretics is not such an optimal choice, due to the risk of diabetes predisposition).
Instead, I would suggest some points to consider for you:
(1) The above mentioned phenomena (mild ataxia and slurred speech) are among the possible side effects of beta-blockers. They do occur in clinical practice, even with other additional side effects manifestations, especially associated with increased doses of the beta-blockers. These unpleasant effects are more prominent with lipophilic beta-blockers, like propranolol, metoprolol, etc (as they cross better hematoencephalic barrier, reaching higher concentrations in the brain).
At this point, I would suggest you, first to reduce the dose of propranolol (you can add any potassium sparing diuretics to counteract its loss by HCTZ use).
Better to change for any hydrophilic beta-blockers, like atenolol, nadolol, etc as they have fewer CNS side effects.
(2) The second point to emphasize, is the fact that your father suffers from Parkinsons; and in fact, there is a genetically predisposition in development of this disorder.
If after applying the above advices, those unpleasant clinical signs persist; then you should consider another medical explanation, facing their occurrence. Mild ataxia and slurred speech (dysartria) may be the prodromal signs of an insidious Parkinsons onset.
At that point, I would recommend you to consult a neurologist for a comprehensive neurological status evaluation (to rule out Parkinson), and if suspicions are raised to proceed with more specific tests, like DOPA PET scan, etc.
Hope to have been helpful to you.
Feel free to ask me whenever you need.
My Best Regards! Dr. Iliri
I would suggests some key points to consider.
Detailed Answer:
Hello dear Dr. W Earnest!
Thank you for your presence on HCM!
Facing your long attempted antihypertensives list, I would not be too insistent to advice you any other antihypertensives schemes (though the above combination of a beta-blocker with a diuretics is not such an optimal choice, due to the risk of diabetes predisposition).
Instead, I would suggest some points to consider for you:
(1) The above mentioned phenomena (mild ataxia and slurred speech) are among the possible side effects of beta-blockers. They do occur in clinical practice, even with other additional side effects manifestations, especially associated with increased doses of the beta-blockers. These unpleasant effects are more prominent with lipophilic beta-blockers, like propranolol, metoprolol, etc (as they cross better hematoencephalic barrier, reaching higher concentrations in the brain).
At this point, I would suggest you, first to reduce the dose of propranolol (you can add any potassium sparing diuretics to counteract its loss by HCTZ use).
Better to change for any hydrophilic beta-blockers, like atenolol, nadolol, etc as they have fewer CNS side effects.
(2) The second point to emphasize, is the fact that your father suffers from Parkinsons; and in fact, there is a genetically predisposition in development of this disorder.
If after applying the above advices, those unpleasant clinical signs persist; then you should consider another medical explanation, facing their occurrence. Mild ataxia and slurred speech (dysartria) may be the prodromal signs of an insidious Parkinsons onset.
At that point, I would recommend you to consult a neurologist for a comprehensive neurological status evaluation (to rule out Parkinson), and if suspicions are raised to proceed with more specific tests, like DOPA PET scan, etc.
Hope to have been helpful to you.
Feel free to ask me whenever you need.
My Best Regards! Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Answered by
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