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Propranolol for Marijuana-induced Palpitations
25th Apr

2017

Propranolol as a Treatment for Medical Marijuana-induced Palpitations

Propranolol, palpitations, marijuana

Propranolol’s main site of action is on the cardiac beta-blockers, where it functions as an antagonist to lower heart rate and contractility.

Introduction

Propranolol is a beta-blocker with anxiolytic effects classically used before a public speech to squelch stage-fright. Its negative inotropic effect results in a sympathetic blockade most suitable for patients experiencing uncomfortable side effects of palpitations following inhalation.

Indications

In my experience caring for patients with cannabis-induced palpitations, especially the ones who are naive to the effects of marijuana, I find that their palpitations often result in immediate concern for their own health. Add to this the common side-effect of paranoia, and a full-blown panic attack often ensues. Thus, the anxiolytic effects of propranolol – relative to other drugs in its class – are independently therapeutic to patients with a propensity for cannabis-induced anxiety as well as in combination with those with paranoia caused by the experience of palpitations from marijuana’s acute effect on the heart.

I’ve had great success using this medication to treat these side-effects since 2015, when I started my work integrating medical marijuana and primary care at Nature’s Way Medicine. This pharmacological approach is an example of allopathic marijuana clinical practices being developed from this work.

Dosing

Patients can receive a starting dose of,

10mg PO BID PRN one hour prior to cannabis consumption.

I have not found a patient requiring higher doses than this as of yet. Smaller doses can be attempted for individuals with low body weight, like those being treated for cachexia and failure to thrive.

Contraindications

Naturally, any prior hx of arrhythmias needs to be taken into consideration. Most concerning would be sick sinus syndrome, bradycardias, and WPW syndrome, which could result in vtach in the setting of afib. Concomitant use of antiarrhythmics should be taken into careful consideration prior to treatment. Current beta-blocker use negates the utility of propranolol completely, though patients already on these drugs are less prone to cannabis-induced palpitations in my experience.

Of course, blood pressure should be checked since a hypotension is an occasional side-effect of any beta-blocker. Marijuana has been shown to decrease peripheral resistance so a history of syncope, including vasovagal, must be screened for. Ensure a complete physical exam is performed with a close focus on heart rate and cardiac rhythm. An EKG may be performed at the physician’s discretion. Screen for allergies or intolerances and check the current medications for possible interactions.


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