Hi
I was with my GP this morning and was asking his opinion about increasing my Venlafaxine upwards from 75mg and perhaps adding in another med to see if I could get better symptom control. We agreed that for now I will increase Ven but we chatted about Propanolol as a possible add in at a future date. Early on I had tried Propanolol immediate release but I was getting random big dips in my already low blood pressure and so I stopped it. He told me that Propanolol has recently been removed from the guidelines for treating high blood pressure because it does not lower the blood pressure enough, he also told me that the extended release version (1 x80mg typical starting dose for migraine) is much more tolerable. I found this very interesting and reassuring because even though it is a 1st line agent in migraine prophylaxis, many people incl myself who already have low blood pressure are very reluctant to try Propanolol. So I am now prepared to consider the XR version as an option for the future if Ven doesn’t get me where I need to be whereas before the conversation I would have been very dubious about putting Propanolol back on the table.
Hope this helps someone out there, who, like me, has already tried a number of drug options and is trying to find something that might work but was worried about the BP lowering effects of Propanolol.
You should feel confident in that the extended release will be much more tolerable if you decide to end up trying that. I suffer from bp and heart rate fluctuations in addition to the migraines, and initially when I began verapamil immediate release my bp would drop really low. Since then I’ve switched to extended release and even doubled the dose and have almost no problems. The way my pharmacist described it was the the immediate release will give you higher highs and lower lows in its action, whereas extended will be a more balanced effect
Thanks jumpmax, that’s a really good way to describe what happened to me…you would have to wonder why docs would ever prescribe the immediate release version when quite clearly the extended release has a more balanced effect…Propanolol was the first med I tried over 2.5yrs ago, it makes me wonder now had I been put on the extended release version back then perhaps it would have been successful and I wouldn’t have had to endure this living hell for so long.
For now, I am going to just keep increasing the Ven till I get to 150mg if necessary and if I am not back to normal at that point I will then add in the propranolol
The principle of Extended Release is relatively modern invention. Propranolol is an old drug (1964 I think) and was originally immediate release. Prescribed in order that people could take tiny doses/tirate up successfully. Even now I don’t think it’s available in all strengths as Extended Release.
Very interesting snippet though. It’s people posting such that will help this site continue to be such a resource of MAV information. I didn’t realise it’s been downgraded for BP. Some people, like @jojo65 I know experienced a sudden drop in BP on remarkably low dose. I have BP pushing high and it hasn’t brought mine down but then the dose for BP starts at the maximum UK dose for migraine, ie 160mg. Some people do find it causes their BP to drop like a stone. All so individual.
Dr Hain speaks highly of a combination of Propranolol and Venlafaxine. Most UK Headache Clinics recommend the Extended Release version. I take immediate release, always have. My GP wouldn’t change it over so she must think they are very different which seems strange in a way. Just as well really for me as all Extended Release Propranolol in capsule form and I cannot take the gelatine coatings. Helen
Beta blockers can also mess with your metabolism and cause type 2 diabetes. Also beta blockers can also cause withdrawal symptoms such as palpitations and rapid heart rate. They are not as benign as they appear.
@methanol This is true. Had perfect blood sugar until being on propranolol. Now its creeping up into the pre diabetic range. No one in my family has diabetes or pre diabetes, so I suspect the propranolol. I’ve also tried to come off it, weaning down. But I have tachycardia when I go below a certain point. It can be hard to discontinue! I will see what endocrinologist wants me to do when I consult next month. Also, exercise is more difficult on propranolol- my Dr said this is a known effect.
Yes, exercise intolerance is a well known side effect of beta blockers.