Investigations into the use of noradrenergic agents as anxiolytics were first directed toward their use in anxious musical performers. B-Blockers such as propranolol were found to be useful in alleviating symptoms of anxiety (e.g., palpitations, sweating). Years later, clonidine was shown by Gold et al. (1978) to be effective in blocking physiological symptoms associated with opioid withdrawal. Although not found to be effective in blocking panic, agents such as propranolol, atenolol, and nadolol have been found to be useful when used adjunctively with other agents in reducing symptoms of autonomic arousal associated with panic and social anxiety (Rosenbaum et al. 1998). Importantly, propranolol is metabolized primarily by CYP2D6 and should probably be used in lower dosages in Asians who are slower metabolizers of CYP2D6 substrates.
In addition to pharmacokinetics, differences in receptor sensitivity between Asians and Caucasians also have been demonstrated, rendering the former even more susceptible to the side effects of propranolol (Zhou et al. 1992).
Handbook of Experimental Pharmacology, Vol. 169
Anxiety and Anxiolytic Drugs (2004)
