Essential tremors

[KarenRB53]

I don't know if this is the right thread to be posting this, hope so. My doctor has just prescribed Propranolol LA for my Essential Tremor. I've had it for quite a while and its getting worse. I'm concerned because of other meds I take, that I'll be overmedicated. I take Ativan, Prozac, WellbutrinSR as well as meds for other medical problems...high blood pressure,high cholesterol etc. Has anyone had any experience with the propranolol long acting?

Thanks, Karen

 

[David Baxter PhD]

I'll move this to "medications" where Steve is more likely to notice it.

 

[KarenRB53]

Thanks.

 

[Retired]

You may wish to read the article on Essential Tremor on the Mayo Clinic site. See the page on Treatment

According to their information, beta blockers such as propranolol are the first line therapy for essential tremor.

Your concern about medications would then directed toward potential drug interactions.

I performed a search for potential drug interactions for the medication list you provided and got this result:

Patient Regimen

ATIVAN ORAL
WELLBUTRIN SR ORAL
PROPRANOLOL ORAL
PROZAC ORAL


Interactions

Moderate Interaction
BUPROPION/ANTIDEPRESSANTS
Wellbutrin SR Oral and Prozac Oral may interact based on the potential interaction between BUPROPION and ANTIDEPRESSANTS.

Bupropion/Antidepressants

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

MONOGRAPH TITLE: Bupropion/Antidepressants

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Both bupropion and antidepressants are known to lower the seizure threshold.(1) Bupropion may inhibit the metabolism of desipramine by CYP P-450-2D6.(1)

CLINICAL EFFECTS: Concurrent use of bupropion and an antidepressant may result in additive effects on the seizure threshold, increasing the risk of seizures.(1) Concurrent use may increase levels of and side effects from desipramine.(1)

PREDISPOSING FACTORS: The risk of seizures may be increased in patients with a history of head trauma or prior seizure; CNS tumor; severe hepatic cirrhosis; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; use of over-the-counter stimulants an anorectics; a total daily dose of bupropion greater than 450 mg or single doses greater than 150 mg; rapid escalation of bupropion dosage; diabetics treated with oral hypoglycemics or insulin; or with concomitant medications known to lower seizure threshold (antipsychotics, theophylline, systemic steroids). (1)

PATIENT MANAGEMENT: The concurrent use of bupropion and antidepressants should be undertaken only with extreme caution and with low initial bupropion dosing and small gradual dosage increases.(1)

DISCUSSION: Because of the risk of seizure from concurrent bupropion and other agents that lower seizure threshold, the manufacturer of bupropion states that the concurrent use of bupropion and antidepressants should be undertaken only with extreme caution and with low initial bupropion dosing and small gradual dosage increases.(1)

In a study in 15 male subjects were extensive metabolizers of CYP P-450-2D6, bupropion (150 mg twice daily) increased the maximum concentration (Cmax), area-under-curve (AUC), and half-life (T1/2) of a single dose of desipramine (50 mg) by 2-fold, 5-fold, and 2-fold, respectively.(1)

REFERENCE:
1.Wellbutrin (bupropion hydrochloride) US prescribing information. GlaxoSmithKline August, 2007.

Source Medscape Interaction Checker


You may wish to print this out and discuss it with your doctor. Your doctor can help you assess the benefits vs risks in your particular case, based on your personal medical history.

You may wish to ask your doctor about other medications both prescribed and over the counter that may be implicated in the cytochrome p-450 interaction site that you need to be aware of. (see Mechanism of Action above)

 

[KarenRB53]

Thanks so much for the information.

Karen

 

[David Baxter PhD]

Just a note: Wellbutrin is commonly used to augment SSRIs. For most people at commonly used doses, this is not a problem.