propranololAdjunctive therapyBrands: INDERAL, INDERAL LA | Hypertension; angina pectoris; atrial fibrillation ventricular rate control; post-MI mortality reduction; migraine prophylaxis; essential tremor; hypertrophic subaortic stenosis; pheochromocytoma adjunct (label). View labelExact | Label dosing varies widely by indication (hypertension, arrhythmias, migraine prophylaxis). In psychiatric use, dose selection should be tied to the specific target symptom and the patient’s cardiopulmonary risk.
Performance anxiety (off label): low single doses taken before a time-limited event are common; start low and confirm tolerability with a trial dose (monitor heart rate, blood pressure, and dizziness). | Nonselective beta-adrenergic receptor blocker (beta-1/beta-2 antagonism). | CYP2D6, CYP1A2, CYP2C19, Glucuronidation | Single-dose range 3–6 h | No | — | - Check baseline heart rate, blood pressure, and asthma/COPD history before starting.
- Monitor bradycardia, hypotension, dizziness, and fatigue after dose changes.
- Reassess mood and sleep after initiation; discontinue or adjust if adverse effects outweigh benefit.
- Taper rather than stopping abruptly after sustained use, especially in coronary disease risk.
| No | 2025-12-29 |
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| Anxiety symptoms (label); pruritus; pre/postoperative sedation (label varies by product). View labelExact | Anxiety/acute distress (off label patterns vary): 25–50 mg every 6–8 hours as needed; consider 10–25 mg starting doses in older adults or high fall risk. | First-generation antihistamine (H1 antagonist) with sedating and anxiolytic effects; anticholinergic/antiemetic properties. | Hepatic | No | | - Sedation, falls, and driving impairment are often reassessed after initiation and during dose changes—especially in older adults.
- Anticholinergic effects (constipation, urinary retention, confusion) are commonly monitored; total anticholinergic burden is minimized when possible.
- QT risk: QT-prolonging co-medications and electrolytes are typically reviewed, and baseline ECGs are often considered when risk factors stack.
- If use becomes frequent, the diagnosis is often revisited and plans may shift toward long-term anxiety treatment rather than continued PRN escalation.
| No | 2025-12-28 |
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| Anxiety disorders or short-term relief of anxiety symptoms (label). View labelExact | Start 7.5 mg twice daily (or 5 mg three times daily); increase by ~5 mg/day every 2–3 days as tolerated. | Non-benzodiazepine anxiolytic; 5-HT1A partial agonist (azapirone). | CYP3A4 | Single-dose range 2–3 h | No | — | - Follow-up within 2–4 weeks is commonly used to assess adherence, side effects, and whether anxiety symptoms are trending in the right direction.
- Dizziness and activation are commonly tracked during titration; slower titration can help if patients feel “wired” or unsteady.
- Interacting medications (CYP3A4 inhibitors/inducers) and food consistency (grapefruit) are worth reviewing when response changes.
- If no meaningful benefit after an adequate trial, stopping and switching or augmenting is common rather than continuing indefinitely.
| No | 2025-12-28 |
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lorazepamAdjunctive therapyBrands: ATIVAN, LOREEV XR | Anxiety disorders; insomnia due to anxiety/stress (label varies by product). View labelExact | Anxiety (label ranges vary): typically 1–3 mg/day in divided doses; titration is typically cautious based on sedation and fall risk. | Benzodiazepine; positive allosteric modulator of GABA-A receptors. | Glucuronidation | Single-dose mean 12 h | No | | - Functional benefit and safety are reassessed at each renewal; open-ended continuation without documented goals is generally avoided.
- Sedation, falls, and driving impairment are monitored—especially in older adults and when other CNS depressants are present.
- For catatonia, follow-up is often frequent, with coordinated escalation pathways (medical evaluation and ECT readiness when response is incomplete).
- If discontinuing after more than brief use, gradual tapering and monitoring for withdrawal symptoms and rebound anxiety are typical.
| No | 2026-02-20 |
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