People’s Pharmacy: Taking metoprolol for stage fright

Q. I’ve read that beta blockers are being used for anxiety. I was given metoprolol for stage fright. It lasts only 12 hours and is better than atenolol, which lasts for 24 hours. I am an author. When I read or speak in public, I have terrible nerves that make my voice shake. The medicine is wonderful for me.

A. For decades, doctors prescribed anti-anxiety agents such as diazepam (Valium) or alprazolam (Xanax) to help patients overcome stage fright. But these benzodiazepines can affect behavior, and long-term use may be inappropriate.

The first beta blocker, propranolol (Inderal), was approved in 1967. It is often prescribed for high blood pressure, angina, atrial fibrillation and other heart problems.

Although other beta blockers such as atenolol and metoprolol have also been used for cardiovascular conditions, doctors sometimes prescribe such drugs off-label to allay anxiety. They work, in part, by blocking the receptors for adrenaline. That’s the compound responsible for fight-or-flight symptoms like a rapid heartbeat, increased blood pressure, cold, clammy hands, and a shaky voice.

You are right that beta blockers have become popular among performers to ease stage fright. But people with breathing problems such as asthma or COPD should avoid these drugs. Dizziness and sleep problems are also potential downsides.

Q. Our old dog has bad arthritis in his knees. The veterinarian prescribed carprofen, which I understand is a nonsteroidal anti-inflammatory drug a little like ibuprofen. It seems to help him hobble around a bit better, which is what we were hoping for. He can go up and down stairs now.

I am curious about one thing, though. The vet requires that we get a blood test periodically. We were told that kidney problems were a potential risk with carprofen and that we needed to monitor him for any red flags. If that is true for dogs, why don’t people need blood tests when they take similar drugs?

A. What a great question! That is actually a very good idea. Kidney damage is hard to detect in the early stages unless you do a blood test. People who take NSAIDs such as celecoxib, ibuprofen, meloxicam and naproxen should probably ask a physician to request such tests periodically.

Email Joe and Teresa Graedon via their website: www.PeoplesPharmacy.com.