Cardiovascular Medications

Beta-Blockers

It has been suggested that beta-blockers may improve agitation, anxiety and aggressive symptoms following brain injury, and reduce restlessness. Often the dosage is high, leaving patients susceptible to adverse effects such as sedation, depression and lethargy (Levy et al. 2005).

Pindolol

Pindolol is a beta-blocker unlike many others in that it exerts a partial agonist effect, providing only a slight stimulation of the blocked receptor and maintaining a better resting sympathetic tone.

Table: Effects of Pindolol on Behaviour

Discussion

Greendyke and Kantor (1986) investigated the effectiveness of a beta-blocker, pindolol, for the improvement of behavioural disturbances post ABI. A significant reduction in behaviours that led to assaults was demonstrated during treatment with pindolol, with the authors stating the optimal dose ranged between 40-60 mg per day. No therapeutic advantage was gained with doses beyond that but rather it led to adverse events (Greendyke & Kanter 1986). Although the frequency of supplemented psychotropic medications was reduced in the pindolol group, these medications were still given and may have attributed to the reduction in assaultive episodes.

Conclusion

Based on a single RCT, there is Level 1b evidence that pindolol decreases aggression following brain injury.

 

Pindolol can decrease aggressive behaviour following brain injury.

 

Propranolol

Propranolol is a non-selective beta-blocker and has been used for the reduction of aggressive behaviours associated with compromised brain function. It is not known how this drug works to affect behaviour, however it appears to lack serious cognitive and affective side effects of other medications or physical restraints used to treat agitation post injury (Levy et al. 2005).

Table: Effects of Propranolol on Behaviour

Discussion

Greendyke et al. (1986) investigated the effectiveness of a beta-blocker, propranolol, for the improvement of behaviour associated with brain disease in a randomized, crossover trial. Significantly fewer assaults and attempted assaults occurred during the 11-week propranolol treatment as compared to the placebo group. Of the nine patients, five showed marked improvement, two demonstrated moderate improvement, and two showed little or no improvement in assaultive behaviour. It should be noted that the participants also had severe dementia; therefore, this study was not used to draw conclusions for an ABI population as a whole. A later study by Brooke et al. (1992) found that propranolol was effective in reducing the intensity of the agitation but was not significantly more effective in reducing the number of episodes compared to a placebo. 

Conclusion

There is Level 1b evidence that propranolol reduces the intensity of agitated symptoms following brain injury.

 

Propranolol reduces aggressive and agitated symptoms following brain injury.