I'd first like to thank Isis for recently posting her friend's core PD drug regime which includes Propranolol. I had taken the beta blocker for six years to treat a tremor in my right hand (diagnosed as Essential Tremor) until 2008 when my neuros upgraded me to PD. I had a fairly new prescription of it in my cabinet as my doctor told me earlier this year that it was likely I had both ET and PD, so I could try the Propranolol. I figured why bother it's just another pill to take and Sinemet erases all evidence of tremor?
After reading Isis's post, I thought, whoa. I am already maxed out on Sinemet, tremor is my most prominent and disabling symptom (happens to be in my dominant right hand), my new neuro is telling me brain surgery is just around the corner. Why not give it a try? At worst, it will make me drowsy and since we have a snow day in Michigan, I can stay in my PJ's and snuggle with my little guy for a nap. I took 10 mg after breakfast around the time of my second dose of PD meds at 9 am or so. I have gone the entire day, over 8 hours, free of any breakthrough tremor!!!
Yes, my PD meds wear off, but the most obvious and immediate symptom I have; the one that leaves me feeling like Flipper and near useless until back on...has essentially disappeared. I'm stunned. Cautiously ecstatic if this means I can somehow lower my Sinemet dosage or at least not worry so much about dose overlapping to stay "on" all the time. This could mean a reduction in dyskinesia and a better quality of life. I don't know that this will last or what is going on entirely, but for now I'll take it.
In researching tremor, I learned that the pathophysiology underlying PD tremor has not yet even been definitively identified; there are theories, but they do not know what is going on for sure. In addition, research going back to 1967 shows potential for Propranolol in treating PD...later clinical studies through the 90's show that people did indeed benefit from it. That being said, how in the world, can they tell us that only two drugs may possibly work? Clearly my new brash, young, DBS obsessed, neurologist needs to dust off the old leather bound journals in the library and kick it "old school" for a little while I'd say.
A few facts about Propranolol:
It has been around since the 1950's and is one of the most important pharmacological inventions of the century. The Scotsman who created it was later awarded the Nobel Prize in Medicine. In other words, to me this means safety- it has been around a long time and no urges to gamble, withdrawal syndrome, etc. mar its potential benefit.
It is a beta-blocker that blocks the action of norepinephrine on our beta-1 and beta-2 adrenergic receptors.
It is long acting with a 5-7 hour half life and real life benefit of up to 12 hours.
We know that with our loss of dopamine our other neurotransmitters are impacted too and cause many of our symptoms. I thought that tremor was mainly due to an increase in acetylcholine, but perhaps our tremors originate differently depending on how we are individually affected by PD?
I know it's only been one day and this may be premature, in someone who is used to a tremor emergence every three hours, this is a dramatic difference. I can't help but share my potential "find" here with everyone. Has anyone else ever tried Propranolol for PD tremor? Has your doctor even suggested it?
Anyway, I am now happy but thoroughly confused. Propranolol is widely used and seen as effective in treating Essential Tremor. It controlled my tremor well until the tremor started looking more like PD. Given my very brief honeymoon with Sinemet, I am grateful the Propranolol still helps for me. I have an atyical PD tremor, so I don't know what this all means. Merely wanted to put out feelers to see if anyone else has experience with this and relay the info that if you have an atypical tremor or do not respond to Artane or Amantadine, then you might explore Propranolol as a potential treatment with your neuro.
Laura