What medications can treat hyperadrenergic state (excessive adrenaline), also known as hyperadrenergic syndrome?

From the Guidelines

Labetalol is the most effective medication for treating hyperadrenergic state, as it provides comprehensive blockade of adrenergic receptors, and its use is especially useful in hyperadrenergic syndromes 1.

Medication Options

The treatment of hyperadrenergic state involves the use of various medications that can help manage the symptoms associated with excessive adrenaline. The choice of medication depends on the specific symptoms, underlying cause, and any coexisting medical conditions.

• Beta-blockers: These medications block the effects of excess adrenaline on the heart and blood vessels, reducing symptoms like rapid heart rate, high blood pressure, and anxiety.
• Alpha-blockers: These medications control blood pressure further by relaxing blood vessels.
• Clonidine: This medication reduces central sympathetic outflow from the brain and can be effective in managing hyperadrenergic state.
• Combined alpha-beta blockers: These medications, such as labetalol, provide comprehensive blockade of adrenergic receptors and are especially useful in hyperadrenergic syndromes.

Dosage and Administration

The dosage and administration of these medications vary depending on the specific medication and the individual patient's needs.

• Labetalol: The initial dose is 0.3–1.0-mg/kg dose (maximum 20 mg) slow IV injection every 10 min or 0.4–1.0-mg/kg/h IV infusion up to 3 mg/kg/h 1.
• Phentolamine: The dose is 5 mg IV bolus, with additional bolus doses every 10 min as needed to lower BP to target 1.
• Nicardipine: The initial dose is 5 mg/h, increasing every 5 min by 2.5 mg/h to maximum 15 mg/h 1.

Considerations

When treating hyperadrenergic state, it is essential to consider the underlying cause and any coexisting medical conditions.

• Patients with autonomic hyper-reactivity due to suspected (meth)-amphetamine or cocaine intoxication should be treated with benzodiazepines first, followed by phentolamine, nicardipine, or nitroprusside if needed 1.
• Patients with pheochromocytoma should be treated with phentolamine, nitroprusside, or urapidil, as labetalol has been associated with acceleration of hypertension in individual cases 1.

From the FDA Drug Label

PHARMACODYNAMICS AND CLINICAL EFFECTS Hypertension: In a retrospective, uncontrolled study, 107 patients with diastolic blood pressure 110 to 150 mmHg received propranolol 120 mg t.i. d. for at least 6 months, in addition to diuretics and potassium, but with no other hypertensive agent. Migraine: In a 34-week, placebo-controlled, 4-period, dose-finding crossover study with a double-blind randomized treatment sequence, 62 patients with migraine received propranolol 20 to 80 mg 3 or 4 times daily Hypertrophic Subaortic Stenosis: In an uncontrolled series of 13 patients with New York Heart Association (NYHA) class 2 or 3 symptoms and hypertrophic subaortic stenosis diagnosed at cardiac catheterization, oral propranolol 40 to 80 mg t.i.d. was administered and patients were followed for up to 17 months.

Propranolol can be used to treat conditions associated with excessive adrenaline, such as hypertension, migraine, and hypertrophic subaortic stenosis. The medication works by blocking beta receptors, which helps to reduce the effects of adrenaline in the body. Key points about propranolol include:

• It can be used to control diastolic blood pressure in patients with hypertension
• It can reduce the frequency and severity of migraine headaches
• It can improve symptoms in patients with hypertrophic subaortic stenosis 2

From the Research

Medications for Hyperadrenergic State

Medications that can treat hyperadrenergic state, also known as hyperadrenergic syndrome, include:

• Beta-blockers, such as propranolol, which have been shown to be effective in treating anxiety disorders accompanied by physical symptoms, especially cardiovascular complaints 3, 4, 5, 6
• Beta-adrenergic blocking drugs, which have been demonstrated to have an antianxiety effect in patients with anxiety 5

Beta-Blockers

Beta-blockers, such as propranolol, can provide symptomatic relief in some patients with residual somatic complaints, such as palpitations and tachycardia, when combined with the patient's ongoing drug regimen 4

• They may be effective in treating benign essential tremor and the prevention of recurrent migraine attacks 6
• They also have a useful role to play in the treatment of anxiety and alcohol withdrawal states 6

Limitations and Precautions

• Beta-blockers may not be effective in treating generalized anxiety disorder or panic disorder 4
• They may induce depression, and should be used cautiously in patients with concurrent depressive illness 4
• The use of beta-blockers in the treatment of psychosis remains controversial, and current evidence does not support their use in schizophrenia 6