Is it safe to take sertraline with propranolol? (Yes or No)

In this blog post, we will try to answer the question ‘is it safe to take sertraline with propranolol?’ We will also look at the different uses and side effects of sertraline and propranolol. 

Is it safe to take sertraline with propranolol?

Yes, it is safe to take sertraline with propranolol. 

The interaction of sertraline with propranolol is usually used to treat anxiety, panic attacks, and other anxiety-related disorders. Using propranolol together with sertraline may increase the effects of propranolol. 

Sertraline is a selective serotonin reuptake inhibitors (SSRIs), whereas propranolol is a beta-blocker. 

Both Sertraline and Propranolol are metabolized through the same pathway in the liver. Sertraline reduces the metabolism of Propranolol resulting in higher levels of Propranolol in the body. Therefore, this means that you should the dose of Propranolol while you take Sertraline. Otherwise, you will be at risk of hypotension, heart block, and other complications.

Remember you cannot just discontinue either of these medications both Sertraline and Propranolol should be tapered off under a physician’s supervision.

The side effect of this interaction could be that the individual starts to experience uneven heartbeats, shortness of breath, bluish-colored fingernails, dizziness, weakness, fainting, or seizure. 

If you do experience any inconvenience caused after the intake of sertraline with propranolol, visit your doctor immediately. Your doctor will adjust the doses accordingly. 

Now that we have understood the interaction of the two can be used for anxiety and related disorders. Let us understand each medication separately. 

Sertraline – an SSRI

Sertraline belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It is sold under the brand name Zoloft. 

How does it work? 

Sertraline has the same mechanism as other SSRIs. It works by increasing the amount of serotonin that is available in the brain. Serotonin is a neurotransmitter or chemical messenger, that is involved in regulating many elements of a person’s daily life, including mood, sleep, rewards, learning, and memory. Sertraline increases the amount of serotonin present in the brain, helping to reduce chemical imbalances and improve a person’s overall mood.

Uses of Sertraline 

The Food and Drug Administration (FDA) has approved the use of sertraline to treat depression, anxiety, and other mood disorders.

The main use of sertraline is to treat depression, though healthcare professionals also prescribe this drug to help treat other conditions, including:

  • obsessive-compulsive disorder, or OCD
  • panic disorder
  • social anxiety disorder
  • post-traumatic stress disorder, or PTSD
  • premenstrual dysphoric disorder — to reduce bloating, mood swings, irritability, and breast tenderness

What is the dosage for Sertraline?

The recommended dose of sertraline is 25-200 mg once daily. Treatment of depression, OCD, panic disorder, PTSD, and social anxiety disorder is initiated at 25-50 mg once daily. Doses are increased at weekly intervals until the desired response is seen. The recommended dose for PMDD is 50-150 mg every day of the menstrual cycle or for 14 days before menstruation.

Sertraline may be taken with or without food.

Side effects of Sertraline. 

Like any other SSRI, Sertraline too has various side effects on the human body. They vary from common to severe. 

Common side effects of sertraline include:

  • nausea
  • diarrhea
  • headache
  • dry mouth
  • sweating
  • nervousness
  • feeling restless
  • fatigue
  • trouble sleeping
  • sexual dysfunction

These side effects usually disappear after the first two weeks. 

Other severe side effects of sertraline may include: 

  • serotonin syndrome
  • low sodium levels
  • eye problems such as angle-closure glaucoma
  • increased risk of bleeding, especially when a person is also taking blood thinners or nonsteroidal anti-inflammatory drugs

Make sure to consult your doctor if you ever experience such side effects. 

Side Note: I have tried and tested various products and services to help with my anxiety and depression. See my top recommendations here, as well as a full list of all products and services our team has tested for various mental health conditions and general wellness.

Propranolol – A beta-blocker. 

Propranolol is a generic medication sold under the brand-name Inderal LA, Inderal XL, InnoPran XL, and Hemangeol. It belongs to the beta-adrenergic blocking agents or beta-blockers drug class. 

How does it work? 

Beta-blockers, also known as beta-adrenergic blocking agents, block norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves. These hormones are what cause the physical symptoms of anxiety and blocking them reduces these effects, helping control some of the physical symptoms of anxiety. This also helps reduce heart rate and lower blood pressure.

Uses of propranolol 

Here are some of the health conditions that the Food and Drug Administration (FDA) has approved propranolol to treat:   

  • Arrhythmia: An irregular heartbeat that’s too slow or too fast.  
  • Angina: Chest pain that occurs when blood isn’t properly flowing to the heart.
  • Tremors: Involuntary and rhythmic movement of the limbs, face, vocal cords, or head.
  • Hypertension: High blood pressure due to the force of blood against artery walls being too high. High blood pressure levels are anything above 140/90. Propranolol-HCTZ, a drug that combines propranolol with a diuretic, treats hypertension.
  • Heart attacks: A heart attack (myocardial infarction) happens when blood flow to the heart is blocked. Propranolol can help prevent and treat heart attacks.  
  • Migraine headaches: Migraines are extreme headaches that propranolol can help prevent. Researchers think that propranolol is good for migraines because it blocks the hormone adrenaline from causing a stress response in the body.   
  • Infantile hemangioma: A benign blood vessel tumor that can affect infants up to 5 months old.  

Propranolol may treat other conditions, such as anxiety and panic attacks, on a case by case basis.

Common side effects of propranolol

As with any medication, there’s always the potential for side effects. Here are some common side effects of propranolol: 

  • Dizziness
  • Lightheadedness
  • Tiredness 
  • Decreased sex drive
  • Nausea
  • Stomach pain
  • Diarrhea
  • Constipation

Serious side effects of propranolol

Taking propranolol may cause severe side effects. Here are some of the severe and potentially long-term side effects to be aware of when considering or taking propranolol:

  • Hallucinations 
  • Cold hands or feet
  • Muscle weakness
  • Muscle cramps
  • Shortness of breath 
  • Memory loss 
  • Fluid retention 
  • Blood sugar changes
  • Insomnia and nightmares 
  • Allergic reaction
  • Vomiting
  • Shakiness
  • Weight gain
  • Skin rash 

Side effects of propranolol can last anywhere from days to weeks. Most side effects will go away within a few days as the body adjusts to the medication. 

One similarity between some beta-blockers and some SSRIs may be used to treat anxiety.

How do beta-blockers help in the treatment of anxiety? 

Beta-blockers won’t treat the underlying psychological causes of anxiety, but they can help you manage some of your body’s physical reactions to anxiety, such as:

  • a fast heart rate
  • shaky voice and hands
  • sweating
  • dizziness
  • By decreasing your body’s physical reactions to stress, you may feel less anxious during stressful times.

Beta-blockers work best for managing short-term anxiety about specific events, rather than long-term anxiety. For example, you can take a beta-blocker before giving a public speech if that’s something that makes you feel anxious.

How do SSRIs help in the treatment of anxiety? 

Unlike the beta-blockers, SSRIs try to reduce the cause of anxiety and other related disorders. 

Listed below are common ways in which SSRIs are used in the treatment of anxiety and other related disorder.

Symptom Reduction

By and large, a person with anxiety and related disorder is prescribed SSRIs to assist in decreasing troublesome symptoms. SSRIs have been found to decrease the frequency and intensity of panic attacks they are used in reducing the severity of attacks, relieve the fear associated with future attacks. SSRIs can make a huge difference for a person who has become afraid of leaving the home or is having difficulties engaging in other necessary activities.

Skill-Building

Participating in therapy and self-help activities is an important part of the recovery process. Self-help strategies include breathing exercises and relaxation skills. A qualified therapist can provide cognitive behavioral therapy (CBT), which involves developing new ways of thinking and behaving in order to cope with anxiety and related disorders.

Studies indicate that CBT alone is not as beneficial without SSRIs. CBT is a long-lasting aid in managing symptoms, but medication can assist in rapidly reducing symptoms, allowing for a greater ability to participate and benefit from psychotherapy techniques. When symptoms are under control, one may feel ready to practice exposure therapy, the gradual introduction of phobic situations to slowly build up a sense of confidence when faced with fear. For many people with panic disorder, exposure therapy is only possible with the support that SSRIs provide.

Treating Co-Occurring Issues

SSRIs can not only serve to combat the symptoms of anxiety disorder but can also alleviate coexisting issues. Other mental health issues, such as depression or other forms of anxiety are also treated.  Indicators of a mood disorder include such symptoms as fatigue, sadness, and diminished interest in previously pleasurable activities.

Substance abuse issues are also related to anxiety disorder. SSRIs can be safely prescribed in such instances. Unlike sedatives, SSRIs are non-addictive. Since dependence is not an issue, SSRIs are prescribed for longer durations of time, increasing the chances of improvement.

Hence we can see that both sertraline and propranolol are used in the treatment of anxiety and other related disorders in their own ways. When taken together they enhance each other and lead to a better outcome 

However, these medications are to be taken under a doctor’s administration, given their risk for side effects. Further, these medications are to be taken in the prescribed quantity, if not would lead to added complications. 

It is also very important to keep your doctor in the loop of your medical history, as these medications may not be good when it comes to people suffering from heart diseases, respiratory issues, diabetes, hypertension, etc. 

Conclusion 

In this blog post, we have  tried  to answer the question ‘is it safe to take sertraline with propranolol?’ We have also looked at the different uses and side effects of sertraline and propranolol. 

FAQs: Is it safe to take sertraline with propranolol?

Does propranolol affect serotonin?

Evidence suggests that propranolol is a weak antagonist of certain serotonin receptors, namely the 5-HT1A, 5-HT1B, and 5-HT2B receptors.  This means that propranolol does not inhibit the secretion of serotonin in the neurons. 

How quickly does propranolol work for anxiety?

It takes 30-60 minutes for the effects of propranolol to become noticeable. Most people who take propranolol to treat performance anxiety use the medication about one hour before any stress-inducing events

Can you overdose on propranolol and die?

Propranolol overdose would produce a very similar ECG pattern, albeit with a slower ventricular rate. Any ingested dose of propranolol > 1 g is considered to be potentially lethal.

Why should you not take sertraline at night?

Many people experiencing nausea and other side effects from sertraline prefer to take it at night in order to limit the side effects. Although sertraline is also known to interfere with sleep in a small percentage of users. Hence many people also opt to take sertraline in the morning.

Does sertraline weaken the immune system?

Sertraline does have an effect on the immune system. Not only do SSRIs affect the function of healthy lymphocytes, but they are also capable of reducing the viability of several cancerous immune cells.

What we recommend for depression

Professional counselling

If you are suffering from depression then ongoing professional counselling may be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.

References 

https://www.medicalnewstoday.com/articles/325632#drug-interactions

https://www.medicinenet.com/beta-blockers_vs_ssris/article.htm#what_are_the_different_beta_blockers_and_ssris_available

https://www.healthline.com/health/propranolol-oral-tablet#alternatives

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