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Dr. Kaushik
Dr. Kaushik, Doctor
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Experience:  Doctor ( General Medicine)
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My Husband is usually very back but when faced with any

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My Husband is usually very laid back but when faced with any medical procedure, he has severe anxiety attacks. For example; he has osteoarthritis in his shoulder and so far has had 2 x steroid injections. At each visit he has had severe anxiety attacks, his blood pressure goes sky high, his heart rate is rapid, he is sweaty and clammy. It's very frightening to witness and he is unable to control it. He is already taking Ramipril 5mg per day for high blood pressure and his blood pressure is usually ok except when he is faced with a medical procedure! He is due to have a lump removed from his arm next week (local anaesthetic) and I am concerned that he will have another anxiety attack. Is there anything we can ask our GP to prescribe that will help? I have heard that beta blockers may help? Many Thanks Jan XXXX

Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Kaushik replied 2 years ago.
Greetings.Welcome to the site.Well, it seems like your husband develops what are described as Panic attacks, which are actually anxiety attacks, that may or may not be preceded by any stressful event or situations ( in your husband's case these panic attacks are preceded by any sort of medical procedure which constitute the stress factor in his case ).So, while beta blockers like propanolol in the dose range of 20-40 mg / day have been found to be reasonably effective in managing the panic attacks, but this genre of drug may not only compromise his blood pressure readings and pull the blood pressure way down below the lower limit of normal range blood pressure owing to the interaction between an already in use anti hypertensive ramipril with beta blocker which also is used for the same purpose of managing high blood pressure, so their concomitant use may actually bring his blood pressure too low for his own comfort and health. Plus beta blocker is not considered to the first line drug for managing panic attacks. So in order to calm his nerves and make him more relaxed in medical procedures without throwing a panic attack, you can ask your GP to start him on a combination of an 1) SSRI class anti depressant such as escitalopram at dose of 10-20 mg/ day or sertraline at dose of 25-100 mg/ day and a 2) Benzodiazepine anti anxiety agent such as clonazepam at dose of 0.5-2 mg/ day, to be taken in 2 divided doses or lorazepam at dose of 0.5-2 mg / day to be taken in 2 divided doses. While the SSRI anti depressant will help him in the long run by overcoming anxiety in such situations by working slowly but firmly over the course of 2-3 weeks, on the other hand the benzodiazepine is a quick fix option for him for now when he goes for next procedure since this category of drug acts very fast in alleviating the anxiety attacks, however, their use shall not be exceeded beyond 8 weeks and therafter only used PRN basis that is as per the need only.So kindly discuss this with his GP and decide on the drug regime.I hope this helps.Wish you all the best.Please kindly leave a Positive rating if you are satisfied with the answer.Regards
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