Expert: Ivan Goldberg, M.D. - 1/22/2004

Question
Doctor:  I was wandering for my mother if the drug toprol is given to slow a faster than normal pulse what the chances of mania develpoment are?  She currently takes lithium and navane, i never heard of this before but was given some info that it can happen, she most likely would only start on the lowest dose of 25mg of toprol, can you eleaborate?  Thanks   Marc

Answer
Beta-blockers have not generally been thought of as drugs that destabilize people with bipolar disorder. There are a few reposts of pindolol, a beta-blocker used to potentiate antidepressants inducing mania when taken with antidepressants. Also mania following the discontinuation of propranolol has been reported. BUT, in my experience of treating many older people with both bipolar disorder and cardiovascular disease, I have not seen any detrimental effects from beta-blockers other than the occasional induction of fatigue and/or depression.

Best regards . . .

Ivan
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