Diazepam and Propranolol

Diazepam and Propranolol

Diazepam and propranolol are two different drugs that can be used for the same purpose which is treating anxiety.

They are also used for other reasons.

Diazepam and propranolol can be used individually and in combination with each other.

Using them in combination increases the effect of diazepam being more effective in treating anxiety than diazepam on its own.

So, let’s get to know diazepam and propranolol.

Family, uses, and indications:

Propranolol is from a drug family called beta-blockers, which are usually used to treat hypertension (high blood pressure) and heart problems, and used off-label in treating anxiety, and diazepam belongs to a drug family called benzodiazepines, a family used to treat anxiety.

So, diazepam and propranolol are common in treating anxiety.

Propranolol and beta-blockers are used for the physical symptoms (symptoms occurring to the body) of anxiety-like fast heart rate, chest tightness, and sweating, they are not related to the psychological and emotional symptoms like worrying and stress feeling.

Diazepam and benzodiazepines cause sedation, but they can be taken during acute bouts of anxiety and panic attacks, relieving stress and worry.

 

How do diazepam and propranolol work?

Beta-blockers and propranolol block certain neurotransmitters called epinephrine and norepinephrine, which help in dilating blood vessels, and decreasing heart rate and blood pressure.

Benzodiazepines and diazepam work by enhancing the activity of certain neurotransmitters called GABA (Gama Amino-butyric acid) that produces a calming effect on the brain and nerves.

Side effects:

There are common side effects between diazepam and propranolol and uncommon ones.

Common side effects are diarrhea, rash, blurred vision, diplopia (double vision), insomnia (sleeping problem), muscle spasms and stiffness, and fatigue.

The uncommon side effects of propranolol different from diazepam are stomach cramps, nausea, vomiting, disorientation (loss of sense of direction), hair loss, weakness, sexual dysfunction.

Uncommon side effects of diazepam different from propranolol are drowsiness, euphoria (intense excitement and happiness), loss of balance, excitability due to paradoxical reactions, rage, confusion, and speech problems.

Withdrawal symptoms:

Diazepam and propranolol are common in another aspect, both of them should not be stopped suddenly, they must be withdrawn gradually or they may cause withdrawal symptoms.

Propranolol may cause withdrawal symptoms like heart attacks, worsened chest pain (angina), serious abnormal rhythm of the heart, or even sudden death.

Diazepam may also cause withdrawal symptoms, especially after long use, like insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, fatigue, and seizures.

Warning: Diazepam may cause dependency and addiction, especially when using high doses for a long duration, also a trigger effect when you have a history of abuse or addiction to any drugs or alcohol.

Drug-drug interactions with diazepam and propranolol:

Propranolol interactions

• Propranolol with thioridazine or chlorpromazine may cause a decrease in blood pressure (hypotension) and abnormal rhythms of the heart because they interfere with the elimination of propranolol and increase the concentration of the drug in the blood.
• Combination with clonidine may cause a dangerous increase in blood pressure, that’s why close monitoring should be done after the starting or stopping of the concurrent use of clonidine and propranolol, as stopping them suddenly may also cause an increase in blood pressure.
• Phenobarbital and similarities increase the breaking and blood levels of propranolol which may reduce the effectiveness of the drug.
• Aspirin and NSAIDs (Non-steroidal anti-inflammatory drugs) may reduce the effects of propranolol by reducing the effects of prostaglandins that help in controlling the blood pressure.
• Propranolol elongates hypoglycemia (low blood sugar) and masks the symptoms in diabetic patients.

Diazepam interactions

• CNS (Central Nervous System) depressants that cause sedation to increase the sedative effects of diazepam, alcohol can cause the same effects.
• Drugs that inhibit the liver enzymes responsible for eliminating diazepam and causing prolongation of their effects, their doses may be decreased if concomitantly used like:
• cimetidine
• ketoconazole
• itraconazole
• omeprazole
• erythromycin
• clarithromycin
• darunavir
• fluvoxamine
• fluoxetine
• On the opposite, drugs increasing the elimination of diazepam by liver enzymes and decreasing the levels of diazepam, like carbamazepine, rifampin, and St. John’s wort.

Warnings and precautions:

• Before taking propranolol, you have to tell your doctor if you have:
• Asthma
• Bradycardia (very slow heartbeats)
• Sick sinus syndrome (a serious heart condition) or another heart problem called AV block (a condition that needs a pacemaker)
• Muscle disorder
• Breathing problems like bronchitis or emphysema
• Diabetes or low blood pressure
• Congestive heart failure
• Depression
• Liver or kidney problems
• A thyroid disorder
• A condition caused by a tumor of the adrenal gland called pheochromocytoma
• Raynaud’s syndrome (circulation problem)

 

Before taking diazepam, you have to tell your doctor if you have:

• Myasthenia gravis (a condition causing weakness of muscles)
• A severe breathing problem
• Sleep apnea (breathing stops for a short period during sleep)
• Eye problems like narrow-angle glaucoma or uncontrolled open-angle glaucoma
• Severe liver diseases

The combination between diazepam and propranolol may be effective due to increasing the medical effects of diazepam but also should be taken with care as the side effects also may increase.

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