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Marti HP, Pavía López AA, Schwartzmann P. Safety and tolerability of β-blockers: importance of cardioselectivity. Curr Med Res Opin 2024; 40:55-62. [PMID: 38597063 DOI: 10.1080/03007995.2024.2317433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 04/11/2024]
Abstract
Cardioselective β-blockade is generally well tolerated in practice and contraindications to this therapy are uncommon. β-blockers are a diverse therapeutic class, and their individual tolerability profiles are influenced strongly by their pharmacodynamic effects across different adrenergic receptors. Bisoprolol, probably the β-blocker with the highest selectivity for blockade of β1- vs. β2-adrenoceptors, does not block β2-adrenoceptors to an appreciable extent at doses in therapeutic use. Side-effects often attributed to β-blockers, such as erectile dysfunction and adverse metabolic effects are uncommon with bisoprolol and other β-blockers used at doses which only block β1-adrenoceptors. Cautious use of a cardioselective β-blocker is not contraindicated in people with chronic obstructive pulmonary disease or asthma and the outcomes benefits of β-blockers in patients with coronary heart disease or heart failure are also apparent in patients with concurrent COPD. Starting with a low dose and titrating upwards carefully is important for optimising the tolerability of a β-blocker. Most people with hypertension will receive combination antihypertensive therapy in practice, and the low-dose combination therapy approach provides a useful strategy for optimising the efficacy and tolerability of a regimen that includes a β-blocker, compared with up-titrating an existing monotherapy.
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Affiliation(s)
- Hans-Peter Marti
- Nephrology Section, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Pedro Schwartzmann
- Advanced Research Center - CAPED, Cardiology Unit, Unimed Hospital, Ribeirão Preto, Brazil
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Beversdorf DQ, Ferguson B, Hunter S, Hirst K, Lolli B, Bellesheim KR, Barton AU, Muckerman J, Takahashi N, Selders K, Holem R, Sohl K, Dyke P, Stichter J, Mazurek M, Kanne S. Randomized controlled trial of propranolol on social communication and anxiety in children and young adults with autism spectrum disorder. Psychopharmacology (Berl) 2024; 241:19-32. [PMID: 38086927 DOI: 10.1007/s00213-023-06452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/18/2023] [Indexed: 01/09/2024]
Abstract
RATIONALE Autism spectrum disorder (ASD) is characterized by impaired social communication and is also frequently characterized by co-occurring anxiety. Propranolol is widely utilized to treat performance and public speaking anxiety. Single-dose psychopharmacological challenge studies suggested benefits using propranolol for verbal tasks and social interaction. OBJECTIVE We conducted a double-blinded, placebo-controlled trial of the β-adrenergic antagonist propranolol in ASD for social interaction, anxiety, and language. METHODS Seventy-four participants with ASD, age 7-24 years, were enrolled and randomized to a 12-week course of propranolol or placebo, with blinded assessments at baseline, 6 weeks, and 12 weeks. The primary outcome was the General Social Outcome Measure-2 (GSOM-2) for social interaction, and secondary outcomes were the Clinician Global Clinical Impression-Improvement (CGI-I) ratings independently conducted for social interaction, anxiety, and language at 6 weeks and 12 weeks. RESULTS Sixty-nine participants completed the 12-week visit. No significant effect of drug was found for the GSOM-2 or the CGI-I for social interaction or language. CGI-I for anxiety showed greater improvement with propranolol at the 12-week time point (p = 0.045, odds ratio = 2.58 (95% CI = 1.02-6.52). Expected decreases in heart rate and blood pressure were observed with propranolol, and side effects were uncommon. CONCLUSIONS Propranolol did not impact social interaction measures or language, but there were indications of a beneficial effect for anxiety. This will need confirmation in a larger multicenter trial, monitoring markers or characteristics to identify those participants most likely to respond to propranolol for anxiety, and determine whether there is a subset of participants that are responsive for other previously reported outcomes.
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Affiliation(s)
- David Q Beversdorf
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA.
- Departments of Radiology, Neurology, and Psychological Sciences, University of Missouri, Columbia, USA.
- William and Nancy Thompson Endowed Chair in Radiology, University of Missouri, Columbia, USA.
| | - Bradley Ferguson
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
- Department of Neurology, University of Missouri, Columbia, USA
| | - Samantha Hunter
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Kathy Hirst
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Bridget Lolli
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | | | - Amy U Barton
- Northwest Missouri State University, Maryville, USA
| | - Julie Muckerman
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Nicole Takahashi
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Kimberly Selders
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
| | - Ryan Holem
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, One Hospital Drive, Columbia, MO, DC069.1065212, USA
- University of Missouri School of Medicine, Columbia, USA
| | - Kristin Sohl
- Deparment of Child Health, University of Missouri, Columbia, USA
| | - Peter Dyke
- Deparment of Child Health, University of Missouri, Columbia, USA
| | - Janine Stichter
- Department of Special Education, University of Missouri, Columbia, USA
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