Has Anyone Had Experience With Labetalol?

[jangle]

Thinking about trying this medication. Propanolol took my HR down, but only seemed to make presyncope and SOB a little bit worse.

Just wondering if anyone has had experience with this drug and if it has been positive.

[HyperPOTS8]

Jangle, labetolol is a mixed alpha and beta adrenergic receptor blocker. Propranolol is just a beta blocker, ie it will have some BP lowering effect but the HR slowing effect is much stronger. The alpha receptor blocking effect present in labetolol (in addition to the beta blocking effect) causes vasodilatation and will have a much greater BP lowering effect. So labetolol and carvedilol (coreg) are mainly used for hyperadrenergic POTS pts who have hypertension.

[jangle]

Jangle, labetolol is a mixed alpha and beta adrenergic receptor blocker. Propranolol is just a beta blocker, ie it will have some BP lowering effect but the HR slowing effect is much stronger. The alpha receptor blocking effect present in labetolol (in addition to the beta blocking effect) causes vasodilatation and will have a much greater BP lowering effect. So labetolol and carvedilol (coreg) are mainly used for hyperadrenergic POTS pts who have hypertension.

Have you tried the medication? Did it help your symptoms?

I believe I have hyperadrenergic POTS (low NET)

-hand tremors

-cold sweaty hands

-Raynauds

-mild hypertension (but I'm young)

-anxiety

-bronchospasm under stress

-panic attacks (NE dumps)

-excessive sweat in response to light exercise

Of course I'll not get "officially" diagnosed because all the POTS specialists are booked 1 year out.

[arizona girl]

Hey Jangle, Labetalol is the medication Dr. Grubb prescibed me after seeing him and he did diagnosis me with hyperadregenic pots. I have found it to work. It is short acting which is good because my bp and hr would drop during sleep into hypotension. If I was having a real active or stimulating day I would take more of it. Rarely am I even taking 200 mg. Mostly just 50 which is 1/2 of 100 mg pill.

I don't get all the symptoms you do, but they sure sound like what dr. grubb describes as hypo pots. Since you can travel maybe try to get in with him, even if it takes a while. He and my neuro Dr. Levine here in phoenix really got me on the right track, he also agreed with Dr. Levine's diagnosis of mine being autoimmune. Which we now no is true as the autoimmune disease finally presented.

It really sounds like you've been having a hard time getting a doc to see and/or hear you. I've been there and know how tough that is. I did finally hire a patient advocate to help me.

Take care kiddo!

[jangle]

Hey Jangle, Labetalol is the medication Dr. Grubb prescibed me after seeing him and he did diagnosis me with hyperadregenic pots. I have found it to work. It is short acting which is good because my bp and hr would drop during sleep into hypotension. If I was having a real active or stimulating day I would take more of it. Rarely am I even taking 200 mg. Mostly just 50 which is 1/2 of 100 mg pill.

I don't get all the symptoms you do, but they sure sound like what dr. grubb describes as hypo pots. Since you can travel maybe try to get in with him, even if it takes a while. He and my neuro Dr. Levine here in phoenix really got me on the right track, he also agreed with Dr. Levine's diagnosis of mine being autoimmune. Which we now no is true as the autoimmune disease finally presented.

It really sounds like you've been having a hard time getting a doc to see and/or hear you. I've been there and know how tough that is. I did finally hire a patient advocate to help me.

Take care kiddo!

arizona did it help anxiety symptoms?

I would love to get with Dr. Grubb, the only thing is I have important things coming up in about two months and Dr. Grubb is booked until past next year.

I'm going to talk with an AOA cardiologist, he point blank told me he's willing to read any research I bring to him and will help me out. So I figure I might try labetalol or I might try prazosin. The major symptom I want to get rid of is the bronchospasm during NE dumps. It makes it so I can barely talk.

[arizona girl]

Well I don't get anxiety or symptoms like your describing. I can get over stim in animated environments. Laying down is always my best medicine, but that is hard to do when your out and about. That being said I haven't had any problems with labetalol at the dosing I'm on and it does work for me.

Print a copy of one of grubbs articles where he states he uses labetalol for hyper pots and show that to your doc. I'd don't think it would hurt to give the labetalol a try. I had issues with propanol too. Actually, most of the bp meds I tried before I found out that I had pots didn't control my bp when I was up right. I went through about 8 of them. I can still break through even with labetalol. If that happens though I just take some more and I do okay, because it is short acting. So you might have to play around with the dosing. I would start low though, we don't need the high dosing that is given for essential hypertension.

Have you tried a suda phed when your having the breathing issues? I also use benedryl, but that is better at night as it makes you tired. I sometimes feel like I can't get enough air in my lungs, and have found those seem to help. I have also used guifasen, because my mucus tissues are so dry. I don't cough or anything, but when I take that things loosen up and I breath better.

I'm guessing your docs have already tried to put you on the ssi's, or tried to treat you for anxiety did any of those work? Dr. Grubb has used effexor and his recent study showed some patients using adderall did well with that.

Grubb had my cardio do the standing and supine catechcolamine test, which showed my rise on norepi on standing. Have you had that test done yet? If not see if you can get your cardio to do it. My epi was elevated supine and stayed the same on standing which then was in the normal range.

What your describing happening to you does sound very hard to deal with, I'm so sorry that it is that bad. All we can do is keep trying until we find something that works. I still think it wouldn't be a bad idea to get in with levine for a skin biopsy to see if your symptoms are the result of small fiber autonomic neuropathy. Your symptoms do seem to fit that. Levine would also test you for a bunch of things to rule out cause. He also sent me to a good pulmonologist, to make sure there wasn't a problem with my lungs.

Here to help, you just let me know what you need. Take care!

[HyperPOTS8]

Jangle,

Yes I have all the hyperadrenergic sxs (but not bronchospasm) and very high NE levels 900 to 1800 supine and 3300 upright. I have tried labetolol, but clonidine is a much more effective drug for me. Keep in mind that beta blockers can cause bronchospasm.

[jangle]

Well I don't get anxiety or symptoms like your describing. I can get over stim in animated environments. Laying down is always my best medicine, but that is hard to do when your out and about. That being said I haven't had any problems with labetalol at the dosing I'm on and it does work for me.

Print a copy of one of grubbs articles where he states he uses labetalol for hyper pots and show that to your doc. I'd don't think it would hurt to give the labetalol a try. I had issues with propanol too. Actually, most of the bp meds I tried before I found out that I had pots didn't control my bp when I was up right. I went through about 8 of them. I can still break through even with labetalol. If that happens though I just take some more and I do okay, because it is short acting. So you might have to play around with the dosing. I would start low though, we don't need the high dosing that is given for essential hypertension.

Have you tried a suda phed when your having the breathing issues? I also use benedryl, but that is better at night as it makes you tired. I sometimes feel like I can't get enough air in my lungs, and have found those seem to help. I have also used guifasen, because my mucus tissues are so dry. I don't cough or anything, but when I take that things loosen up and I breath better.

I'm guessing your docs have already tried to put you on the ssi's, or tried to treat you for anxiety did any of those work? Dr. Grubb has used effexor and his recent study showed some patients using adderall did well with that.

Grubb had my cardio do the standing and supine catechcolamine test, which showed my rise on norepi on standing. Have you had that test done yet? If not see if you can get your cardio to do it. My epi was elevated supine and stayed the same on standing which then was in the normal range.

What your describing happening to you does sound very hard to deal with, I'm so sorry that it is that bad. All we can do is keep trying until we find something that works. I still think it wouldn't be a bad idea to get in with levine for a skin biopsy to see if your symptoms are the result of small fiber autonomic neuropathy. Your symptoms do seem to fit that. Levine would also test you for a bunch of things to rule out cause. He also sent me to a good pulmonologist, to make sure there wasn't a problem with my lungs.

Here to help, you just let me know what you need. Take care!

That sounds like a good idea with seeing Dr. Levine and getting tested for small fiber autonomic neuropathy. Keep in mind I did have a QSART that was negative that I believe tends to rule out small fiber neuropathy.

Pretty much my worst symptom is the bronchospasm, it's so painful that it really is what causes my anxiety. (I think most people would feel anxious if they feel like they're suffocating.)

[kayjay]

I was given labetalol before I was diagnosed hyper pots. At the time i was misdiagnosed with a pheo by doctors at Johns Hopkins. Now I am on nadolol ( mayo clinic rochester). Nadolol is much better for me.

[jangle]

Kayjay, I'm looking not for a medicine that I'll take regularly, but a medicine that will prevent a panic attack (my norepinephrine surges) during performance situations so I can talk/function.

I'm guessing labetalol will pretty much prevent you from getting a panic attack. I can't find any studies with it used in panic disorder but it seems to do everything to inhibit norepinephrine.

Benzodiazepines do not help. They make me feel less anxious, but the noradrenaline is still shutting my lungs off which is really the problem.

[arizona girl]

Well Levine actually does both the biopsy and qsart, as he feels there is a better chance of catching it, as it can be spotty. The other thing is you are still pretty young and it might not be bad enough yet at the skin level. A lot of the research states the peripherial locations feet and fingers is where it shows first, but I think my autonomic areas are where it showed first with me.

I so understand how not being able to breath then causes the panicky feeling. It is scary when you can't get air in your lungs. Have you been to a good pulmonogist yet, since that is your worst symptom? Maybe you has some kind of weird asthma. Have you tried to pay attention to what you were doing and or ate in the hours before it happens? You may need something that relaxes your lungs when this is happening. I wouldn't try anything without a pulmonologist on board though.

Sometimes ratemds.com can help you find a good doctor, I've found it to be useful, accurate and reflected my experience with the doctors I saw. I just wish more people used the opportunity to rate their docs on there.

[corina]

Jangle I've been on labetalol for just one day as I got so weak and feeling sick (nausea and extremely tired) that I couldn't get out of bed. I'm low flow POTS, pooling in stomach and legs which might explain why I reacted so badlly (not that I knew that at the time). So labetalol wasn't for me at all. Hope you'll find something that will work for you!

[HyperPOTS8]

Jangle, propranolol is the classic beta blocker used for stage fright, panic, etc because it is centrally acting and has a short half life so has a rapid onset. Since it made you more SOB it may cause bronchospasm in your case and all beta blockers may do that. Since benzos haven't worked and you feel it is catecholamine-mediated you could consider discussing oral clonidine as needed with your MD.

Edited July 29, 2012 by corina
medical advice

[julieph85]

Jangle, I've done both labetolol and propranalol. Labetolol helped with the tachy episodes and it significantly lowered my Bp. (I was hypertensive at the time). I noticed an improvement in the hyperandrenergic part of my pots. I imagine it would block some anxiety symptoms as well because in my case, it made me pretty zombie like. I remember sitting staring at the tv with my mouth hanging open, lol. It was like being in a constant daze. The biggest thing I didn't like about it was it made my scalp tingle really bad, which was annoying and is a common side effect. It also worked synergistically with my ANS in the sense that when I would get more vagal at night my HR would drop into the low 50's and would make me feel really sick and lethargic. The propranalol was terrible for me. It severely dampened my body's compensatory HR increase which made my pooling worse, which of coarse made my dizziness and shortness of breath worse. I remember being so dizzy and short of breath on that medicine I couldn't stand for more than 1 to 2 minutes at a time. Being on propranalol was the worst my pots has ever been. Makes me shudder remembering it. Labetalol did a little of the same thing but not as bad. I would never take any alpha or beta blocker again because it only makes my underlying issue worse- the pooling and vasodilation. If your getting bronchi spasm during an attack, have you ever had a 24 hour urine histamine done? If your having mast cell issues it could cause hyper pots symptoms. I was sure my mast cells were ok and then I had that test. My histamine is 6 times normal limit. No wonder I'm so dilated! In my opinion, a trial of clarinex plus Pepcid is worth it to see if it helps with the hyper symptoms, which would definitely point to mast cell.

[jangle]

Julie were you taking high dosages of these medications? Typically for anxiolytic effects one just has to take low dose - like for propanolol I think it's 10-30 mg. I tolerated 10 mg propanolol ok. 20 mg was a little too much as I remember.

I'm not looking for a long term treatment as my POTS in non-stressful situations isn't that bad with exercise + salt. I just need something to keep the anxiety attacks down during performances.

[RichGotsPots]

Jangle- What you are describing is exactly 110% what happens to me, only mine has progressed since I first got in 2006. I used to get these breathing issues when I would be very hot and sweat or exercise.. Now it I have so many more triggers; heat, sweat, exercise, walking to far, walking without compressions socks, standing too long, when standing too long that my heels hurt (5 min usually), standing in a warm shower, cold air, eating carbs, and a few more...

I'v run the gamut of tests for asthma, lung scarring, COPD, large cell lung cancer, blood clots, blood clots in the lungs, tried all different asthma and copd meds..

Finally I started getting some answers. The 2nd time I was in the hospital on Nov 2011 my BP was a little high around 165/115. But my pulm doc did a pulmonary exercise walking test. This was the 1st time I found out that my BP drops lower when I walk... Then on my recent TTT (2nd one) my BP went up on tilt to 144/105 then after 5 minutes it dropped to 95/65..

In other word my BP is all over the place, not just high like you might suspect yours is Jangles. I read that most of the pots people have the crash in BP only after 10-20 minutes of the tilt. So you may think yours is High like I did when I was in the hospital but it's also crashing, upright.

My NE levels were 634 upright which wasn't that bad, but Jangle I get the same panic that you do when I can't breath and I can feel the surge and I get all warm for a minute then all my limbs go called and breathing gets even harder like I could pass out from not breathing. It's a cascade...

Tonight I had a bad episode thought I would have to go to the ER. I think it was from eating a piza bagel then driving at night which gets me fatigued and opens up the door... It's the worst feeling in the world! When I got home I checked my BP and it was 108/35 (never had such a low dystolic before) then 5 minutes later it was 144/65 and after 30 minutes laying and drinking water it normalized... I think water helps clear the adrenaline..

[julieph85]

I was on super low doses of both. I think it was just really making the underlying cause worse