2126 – How Low Dose Of Propranolol Can Induce a Manic Episode? Case Report Of An Unexpected Side Effect

Abstract

Introduction

Propranolol prescribed by physicians in various fields. The extensive use of beta adrenergic antagonists are their various side effects such as nausea, vomiting, diarrhea, constipation, agitation and confusion, Sleep disorders, nightmares, depression and anxiety auditory hallucination. Also a case of induction of mania phase due to discontinuing propranolol has been reported.

Case report

A 11 year old boy was admitted with the diagnosis of Bipolar I disorder. Patient was started on 200 milligrams of Sodium Valproate twice daily and 1 miligram of Respridone twice daily. During the next 2-3 weeks his symptoms were gradually relieving and after 1 month patient left the psychiatric ward symptom free. At the one-month follow-up patient was still without any symptoms but had developed mild tremor and 10 milligrams of Propranolol was prescribed.

A week later patient accompanied by euphoria, restlessness, insomnia and increased energy after discontinuing it the symptoms had waned. He toke propranolol again but in a lower dose of 10 milligrams. Interestingly after taking a single dose of 10 milligrams propranolol patient developed the same symptoms. The symptoms were relieved by discontinuing the medication. Low doses of potent benzodiazepines were used to control tremor, which was a successful strategy.

Discussion

The patient with the diagnosis of BMD, who contrary to our expectations developed symptoms of manic episode after taking low doses of Propranolol.

We propose that clinicians take into consideration proper percussions before prescribing this drug to patients with mood disorders.