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Anxiety and Stress Disorders

Test taking anxiety and the best beta blocker

04/21/2009

Question:

I am going to be taking a licensing oral board exam in the coming month and have a history of having anxiety melt downs before a significant exam, ie, USMLE step one, Radiology Physics exam, etc. My melt down involved GI symptoms with vasovagal reactions that last for about an hour until I take antispasmotics, which make me sleepy. I have tried metroprolol half dose, and it gave me stomach cramps, diarrhea and bradycardia. Is there a certain drug that is better than others? I am currently on wellbutrin for post partum depression, and have been on it for 17 months, 200mg per day.

Answer:

One of the unknown bits of information on bupropion is that it inhibits the metabolism of many drugs.(metoprolol) I would test the benefit of a different beta-blocker propranolol at a smaller dose that might minimize the GI difficulties and and not have concentrations increased by bupropion. Try this 1-2 times well before important testing.

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Response by:

Nicholas A Votolato, RPh BCPP Nicholas A Votolato, RPh BCPP
Assistant Professor of Pharmacy
College of Pharmacy
Assistant Professor of Psychiatry, Emeritus
College of Medicine
The Ohio State University