Alprazolam and Palpitations - A Quick Question

[isthastuff]

Hey Bluelighters,

As brevity is not my forte, I will do my best to provide background and get to the point as quickly as possible. I have been prescribed 2-4mg Alprazolam PRN since August for the treatment of (conclusively) anxiety related chest pains otherwise unresponsive to varying therapies including beta blockers (nadolol, nebivolol), an ACE inhibitor (lisinopril), and a CCB (verapamil). I have diagnosed ADHD, anxiety/panic disorder (NOS), and non-structural tachycardia and hypertension. At the time, however,I was (ab)using Focalin rather heavily and this was, retrospectively, much to blame for the palpitations and chest pain I sought treatment for. After I ceased stimulant abuse in the late Fall, the persistent chest pains and palpitations I had been experiencing also largely and accordingly decreased to a much more occasional occurrence in situations of truer (and otherwise pharmacologically unprovoked) anxiety. I have since (with my doctors) reduced my regimen to 10mg Bystolic q.a.m. and ~2mg Xanax q.h.s. for my lingering insomnia. I'm soon to be working with my doctor to switch to a more direct sleep therapy, most probably Trazodone, with which I've had very good results in the past. Anyway, to the issue: I've noticed that ~15-20 after taking my Xanax at bedtime where I had not previously been experiencing any perception of palpitation, I have on numerous occasions began to experience mild-to-moderate heart palpitations without an accompanying increase in heart rate. It is my (admittedly limited) understanding, and please correct me if I'm wrong, that benzodiazepine drugs facilitate neural inhibition by GABA modulation of the efficiency wherewith Cl- ions are able to cross cell membranes..Soo...given that Chloride is one of the electrolytes responsible for electrical signal conductance within heart tissues, my question is this: is it at all possible that my incident palpitations are in any way caused by alprazolam's secondary increase in ionic chloride transfusion within my cardiac tissue?? As always, Bluelighters, your input is greatly appreciated!!

 

[effie]

I apologise for the delay in getting back to you - this isn't the sort of question we usually get in BDD!

What precisely do you mean by palpitations? The word means different things to different people; an abnormal awareness of heartrate, a racing heart (obv not as you say no increase in heart rate) or an irregular heart rate. I presume you mean an irregular heart rate seeing as you go on to discuss arrhythmias? If so, this is something you should definitely bring up with your physician. A large portion of the population experience episodes of palpitations caued by tachycardia (paroxysmal supraventricular tachycardia to be exact) which is self-limiting, common and nothing to be concerned about unless it is giving you other symptoms or the episode does not self-terminate; but an irregular heart rate needs investigating.

It is very possible that this is either residual effects from the medications you are on, PSVT as mentioned above, or psychogenic - you are aware and concernd about palpitations, therefore you are anxious, increasing your sympathetic drive and causing palpitations.

However, back to your original question - this is beyond my biochemical knowledge I am afraid, and is definitely not BDD territory. Chloride ions do have a role in arrhythmogenesis, but less so than other ions (interesting article here) but I have no idea if a) you are correct about how benzodiazepines exert their GABAergic effects and b) if that would translate to cardiac myocytes (but I have to say I suspect not.) I too would be interested in knowing however!

The only place I can think of that may be able to help is Advanced Drug Discussion, where the smartest BLers reside

I am pretty sure they can answer a); I don't know if there is anyone there with knowledge on cardiac arrhythmogenicity and/or the liklihood of alprazolam affecting chloride ion membrane transport in cardiac myocytes however so b) may not be answered. But we'll give it a try

BDD > ADD

 

[negrogesic]

A lack of brevity is fine, but please use multiple paragraphs......

Now, I may have missed this, but were you taking/abusing focalin while undergoing diagnostics? What I am getting at, were you snorting focalin while wearing a holter/prior to stress-tests, etc? Or did you undergo diagnostics after said abuse? If you know, what were the diagnostics performed, and what were the findings? You mention hypertension; to what degree/class of hypertension do you experience at rest? Do you monitor at home, and if so, what sort of numbers are you getting (assuming the basic store-bought wrist monitor).

As effie elaborated (above), symptoms of PSVT may be psychogenic in nature, particularly in those with diagnosed anxiety disorders. To confuse the matter, you may be falsely attributing these symptoms to a drug being utilized to reduce the incidence of this phenomena (two layers of psychogenic origin, so to speak).

Now, you are not entirely off-based in respect to the chloride-dependent conflicts, but before an elaboration to that effect, please fill in the facts regarding the actual metrics we are dealing with (BP, HR, Dx's etc).

 

[isthastuff]

Thank you for responding, effie and negrogesic!! How very fitting my discussion would be moved to a forum named ADD

First off: By palpitations I mean an awareness of my heartbeat where I'm otherwise unaware thereof. I have neither a) an arrhythmia of any sort nor b) any documentation of such, and I have had at least a dozen EKG's done (about triannually) since my diagnosis of tachycardia/hypertension in 2008. All of these have yielded nothing beyond confirmation of elevated heart rate and blood pressure. For most of my life, even while off the medication at the time of measurement, my resting heart rate has hovered just around 100. While medicated, it usually hovered at or around 115, spiking easily and far past 150 with anything more than walking from one room to another. It should be noted that even prior to these diagnoses, I had always had a fast heart rate and elevated blood pressure but this had theretofore been written off as a symptom of the stimulant therapy I had received from ages 5-18. Save for Desoxyn (which, knowing myself well enough, I purposefully never pursued) these therapies included every other legal stimulant, and in therapeutically-necessitated high doses: Adderall, Adderall XR, Dexedrine/Dextrostat, Dexedrine Spansules, Mixed Amphetamine Salts, Vyvanse, Ritalin, Ritalin LA, Ritalin SR, Concerta, Daytrana Patches, Focalin, Focalin XR, as well as the non-stimulants Strattera and Intuniv.

Diagnostically speaking, I had been working with psychiatrists for the majority of the period of my treatment, and as such and given the office-setting was hardly (if ever) checked for tachycardiac/hypertensive symptoms, mostly because I had spent virtually all of my conscious existence unquestioningly assuming that my heart rate, chest palpitations, excessive sweating and jitters were just something that came with the disease, much less its attendant treatment - of which the realization of the latter being the true(r) cause of my symptoms didn't hit me until I briefly ceased treatment during my freshman year of college in 2009.

Since I wasn't at the point of abuse upon my initial diagnosis, I was, on average, recorded with blood pressures around 150-160/90-110. Throughout the years, these numbers rose and fell depending upon which treatment I was undergoing at the time. However, even when I eventually began abuse, these numbers stayed virtually the same, with relative increases based upon activity (e.g., biking to their office). I've had EKG's done both on and off the medications, and neither of the most recent instances of both medicated and unmedicated measurement yielded anything of concern (at least to my doctors) beyond numerical elevation (i.e., zero arrhythmic activity, as well as zero structural deformity, as demonstrated by echocardiograms and MRIs). The truth of the matter is, since I've been on beta-blocker therapy since 2009, I don't even know if my true/unmedicated values would still affirm the diagnoses of remnant tachycardia/hypertension, as I've since November been completely off of any stimulants beyond a cup of coffee once a week. Either way, with 10mg Bystolic q.a.m., my blood pressure now averages 125-130/70-80 and my heart rate 70-90 (at rest). I do not monitor my blood pressure at home as I've never been instructed to do so nor told that this was a medical necessity of mine.

Literally upon this moment (and I don't know why it's taken me this long), I'm realizing that there's a great possibility that the diagnoses of tachycardia/hypertension may very well have been symptomatic diagnoses; I cannot say, as I'm off the stimulants yet still undergoing BB therapy that itself would take some considerable time to come off of (I rebound very easily upon even the gentlest BB down-titration, that my so-called 'tachycardia/hypertension' was ever anything more than a symptom of treatment and attendant anxiety thereabout. Technically speaking, my current BP and HR do not reflect either condition; however, I'm not sure how much of this is a product of my BB therapy or actually a reflection of healthy cardiac activity following stimulant cessation.

I apologize for the probable disorganization of my response - the holidays have been a stressful time for me. I hope that this is sufficient to progress the discussion, and if not, please do inquire further and I will respond promptly with any and all requests for more information! thanks again guys!!

Edit: As well, I've noticed that this breed of 'un-stimulated palpitations,' as they were, are notably more pronounced while I'm lying on my left side than they are when I flip onto my back or right side. In addition to my primary biochemical question, I want to ask if there's any significance/bearing to this positional phenomenon? Also, I think I should mention that I've recently been diagnosed with GERD, and although I've yet to have a esophagogastroduodenoscopy, I suspect highly from my reflux symptoms that I may have a hiatal hernia - could this be contributing to the problem?

 

[BananasAndOranges]

If im nervous on xanax I can still get palps sometimes xanax can make me nervous. it depends on my mood?