The beta-blockers nadolol and propranolol have been used to treat aggression in people with developmental disabilities. Both medications decrease hyperarousal, restlessness, and tension. They decrease anxiety and cause little cognitive compromise, so patients with mental retardation may be more able to integrate different elements in their environment and to shift cognitive sets. Nadolol works peripherally, whereas propranolol is more lipophilic and exerts more central nervous system effects.32
Both medicationsóbut especially propranololómay require titration to obtain an effective dosage. Hypotension and bradycardia limit utility. These agents are contraindicated in asthmatic patients and in those with Raynaudís disease.32 Depression is a rare side effect of propranolol.31,32
Propranolol is metabolized via the cytochromes 1A2, 2D6, and 2C19, so it may interact with psychotropic agents. Propranolol may increase the serum level of thioridazine significantly, so it should not be combined with that medication.31 SSRIs may increase serum levels of beta-blockers, whereas carbamazepine may have the opposite effect.32
Reviewed and revised June 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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