February 2022 – Our old friend, propranolol
Propranolol is effective in palliating panic/anxiety in elders who are sensitive to the sedation and delirium side effects of benzodiazepines.
Consider Mrs. Li:
She has moderate dementia and is struggling with the recent death of her husband. She has bouts of panic and becomes fearful, breathless, tremulous, and agitated. Her BP is 130/80 without orthostasis.
Because it crosses the blood-brain barrier, propranolol 10 mg twice a day can reduce anxiety spirals and limit the use of other more sedating anxiolytics.