Sertraline and Propranolol (A brief guide)

In this guide, we will talk about sertraline and propranolol drug interaction, side effects and considerations.

Sertraline and Propranolol: Drug interaction

Using Sertraline and Propranolol at the same time may increase the side effects of propranolol.

It is advised to contact your doctor if you start having uneven heartbeats, shortness of breath, bluish-colored fingernails, if you feel dizzy, weak, about to faint or seizure (convulsions).

Do not stop the medication suddenly without first reaching out to your doctor.

Similarly, Setraline with Tramadol can increase your health risks.

Propanolol oral brand names and other generic formulas include:

• Betachron oral
• Hemangeol oral
• Inderal LA oral
• Inderal XL oral
• Innopran XL oral
• Lorol oral
• Procard oral
• Pronol oral

In the case of Inderal LA, rxlist.com indicated dosage and administration instructions:

“Provides propranolol hydrochloride in a sustained-release capsule for administration once daily. If patients are switched from Inderal Tablets to Inderal LA Capsules, care should be taken to assure that the desired therapeutic effect is maintained. Inderal LA should not be considered a simple mg-for-mg substitute for Inderal. Retitration may be necessary, especially to maintain effectiveness at the end of the 24-hour dosing interval.”

In addition, for the treatment of hypertension, the usual initial dose is suggested as 80 mg Inderal LA a day.

This dosage may increase to 120 mg once a day or higher until adequate blood pressure control is achieved.

The usual maintenance dosage is said to be 120 mg to 160 mg once a day. However, your doctor should provide all the instructions related to dosage.

For angina pectoris, the usual starting dose is 80 mg once a day and should be gradually increased at 3-7 day intervals until optimal response is obtained.

Although everyone reacts different in terms of responding to the treatment at different dosages, the average is said to be 160 mg a day. 

For migraine, the initial dose is said to be 80 mg once a day.

The usual effective dose can range between 160 and 240 mg once a day and the dosage may be increased gradually to achieve optimal migraine prophylaxis.

According to rxlist.com “If a satisfactory response is not obtained within four to six weeks after reaching the maximal dose, Inderal LA therapy should be discontinued.”

In contrast, Sertraline oral bran name includes Zoloft oral. According to rxlist.com, Dosage Forms And Strengths include: 

• 25 mg tablets: light green film-coated, engraved on one side with “ZOLOFT” and on the other side scored and engraved with “25 mg”
• 50 mg tablets: light blue film-coated, engraved on one side with “ZOLOFT” and on the other side scored and engraved with “50 mg”
• 100 mg tablets: light yellow film-coated, engraved on one side with “ZOLOFT” and on the other side scored and engraved with “100 mg”

Oral solution a clear, colorless solution with a menthol scent containing sertraline hydrochloride equivalent to 20 mg of sertraline per mL and 12% alcohol.

It is supplied as a 60 mL bottle with an accompanying calibrated dropper that has 25 mg and 50 mg of graduation marks.

Beta-blockers vs SSRIs

Propranolol is considered a beta-blocker, while Sertraline is classed as a Selective Serotonin Reuptake Inhibitor (SSRI).

Beta-blockers are usually prescribed to treat high blood pressure and congestive heart failure, to prevent kidney failure in patients with high blood pressure or diabetes, to reduce the risk of stroke, abnormal heart rhythms, chest pain (angina), tremors, pheochromocytoma, hypertrophic subaortic stenosis, and to prevent migraines (Medicinenet.com). 

On the other hand, SSRIs are considered a type of antidepressant used to treat depression. 

What they do have in common is that some beta-blockers and some SSRIs may be used to treat anxiety disorders.

In addition, a shared side effect would be insomnia and common side effects of beta-blockers that differ from SSRIs can include:

• Cold hands and feet
• Tiredness or depression
• Slow heartbeat
• Symptoms of asthma
• Impotence

On the other hand, some of the common side effects of SSRIs that differ from beta-blockers include:

• Headaches
• Nausea
• Vomiting
• Diarrhea
• Restlessness
• Agitation
• Sexual dysfunction
• Weight gain or loss

The main question is, what are beta-blockers and what are SSRIs?

Beta-blockers are also known as beta-adrenergic blocking agents that block norepinephrine and epinephrine (adrenaline) from binding to beta receptors or nerves.

These hormones we just mentioned, are the ones responsible for causing the symptoms related to anxiety and by blocking them, the manifestation is reduced as well as controlling some of the physical symptoms. 

In contrast, SSRIs work by increasing the amount of neurotransmitter serotonin in the brain, which can impact your mood positively.

What are the side effects of beta-blockers and SSRIs?

Every drug comes with risks of having side effects and every person reacts differently to them.

Some manifest some or all the side effects, some others don’t, it tends to vary. 

Beta-Blockers

Beta-blockers may cause:

• Diarrhea
• Stomach cramps
• Nausea
• Vomiting

Other important side effects include:

• Rash
• Blurred vision
• Disorientation
• Insomnia
• Hair loss
• Weakness
• Muscle cramps
• Fatigue

As another benefit of the treatment, they can slow heart rate and reduce blood pressure which can eventually cause heart failure or heart block in people with heart problems.  

Beta-blocker medication should not be stopped suddenly, because the withdrawal can worsen chest pain or angina and cause heart attacks, serious abnormal heart rhythms, or even sudden death. In addition, Central nervous system effects of beta-blockers include:

• Headache
• Depression
• Confusion
• Dizziness
• Nightmares
• Hallucinations

It is important to consider that Beta-blockers that block β2 receptors may cause shortness of breath in asthmatics.

And as with other drugs used for treating high blood pressure, sexual dysfunction may occur.

Beta-blockers may cause low or high blood glucose and mask the symptoms of low blood glucose (hypoglycemia) in people with diabetes.

Other serious side effects of beta-blockers include:

• Toxic epidermal necrolysis
• Raynaud’s phenomenon
• Lupus erythematosus
• Bronchospasm
• Serious allergic reactions
• Erythema multiform
• Steven Johnson Syndrome
• Toxic epidermal necrolysis

SSRIs

SSRIs can cause headaches and dose-related nausea, vomiting, and diarrhea that improve with continued treatment.

Insomnia, restlessness, agitation: Insomnia, restlessness, and agitation-which decrease over time-also are associated with SSRIs.

Insomnia can be treated with low dose (50-100 mg) trazodone (Desyrel) at bedtime and agitation may be managed by reducing the SSRI dose or treating with anti-anxiety drugs.

In addition, SSRIs have also been associated with sexual dysfunction.

Symptoms of sexual dysfunction in men may be treated with sildenafil, yohimbine (Pausinystalia Yohimbe), amantadine (Symmetrel), cyproheptadine, or neostigmine (Prostigmin).

Also, weight loss or weight gain has been associated with SSRIs in short and long term treatment.

Patients may experience weight loss initially but quickly regain the weight.

Katy’s story on taking sertraline and propranolol for anxiety

Katy’s GP diagnosed her with panic disorder and recommended to start on a low dosage of propranolol.

She was suffering from regular panic attacks and extreme anxiety.

This is what she thinks about her experience after taking both medicines. 

One of her main symptoms was heart palpitations so she stated: “The benefits of propranolol are that it stops heart palpitations, and the 10mg doses can be taken whenever you need them.”

This seems to be backed up by science with Jones and Tackett (1988)  when they studied central monoaminergic mechanisms that are believed to be involved in cardiovascular regulation. 

Specifically, this study was designed to evaluate the involvement of central serotoninergic pathways (regulation of blood pressure) in the antihypertensive action of propranolol.

They found a decreased serotonin turnover and a significant reduction in mean arterial pressure and heart rate.  

In contrast, there are some side effects and she thinks through her experience that “The negatives of taking propranolol are that you can build up a resistance to it, making it gradually less effective, and when you first start taking them you can feel really sick. I have not found them effective for reducing the psychological effects of anxiety and depression, so I am also taking sertraline alongside it for this side of things.”

She adds how, “Changing medication can be scary, especially when you don’t know what the consequences will be. When I started taking sertraline along with the propranolol, I became very tired and my mood became slightly erratic.”

It is important to ask your doctor as many questions as possible to understand and weigh the benefits and side effects of the medication, especially when you are taking more than one drug at a time. 

Why is this blog about Sertraline and Propanolol important?

When considering combining Sertraline and Propranolol, it is important to do it under medical supervision and after being informed of all the possible benefits but also the side effects.

Each drug belongs to a different class of drug, for instance, sertraline is classed as an SSRI and propranolol are considered a beta-blocker. 

Sertraline would be in charge of increasing the serotonin levels and stabilizing mood and propranolol can help to reduce and to control the physical symptoms of anxiety, which can be really beneficial when suffering from an anxiety disorder.

However, we are not encouraging the intake or combination of these medicines.

This should be done under medical supervision and instructions. 

Please feel free to comment in the comments section below. 

Frequently Asked Questions (FAQs) about Sertraline and Propanolol

Recommended reading

• The Effect of Chronic Treatment With Propranolol Or Timolol on the Cardiovascular System of the Rat
• Propranolol Hydrochloride; A Clear and Concise Reference
• Sertraline: What No One Will Tell You About
• Coming of Age on Zoloft: How Antidepressants Cheered Us Up, Let Us Down, and Changed Who We Are
• The Zoloft Treatment – A Guide to the Antidepressant Sertraline