The beta-blockers nadolol and propranolol have been used to treat aggression in people with developmental disabilities. Both medications decrease hyperarousal, restlessness, and tension. They decrease anxiety and cause little cognitive compromise, so patients with mental retardation may be more able to integrate different elements in their environment and to shift cognitive sets. Nadolol works peripherally, whereas propranolol is more lipophilic and exerts more central nervous system effects.32

Both medications—but especially propranolol—may require titration to obtain an effective dosage. Hypotension and bradycardia limit utility. These agents are contraindicated in asthmatic patients and in those with Raynaud's disease.32 Depression is a rare side effect of propranolol.31,32

Propranolol has been noted to be associated with seizure activity in overdosage.108 In some animal models, however, it appears to increase the seizure threshold.109–111

Propranolol is metabolized via the cytochromes 1A2, 2D6, and 2C19, so it may interact with psychotropic agents. Propranolol may increase the serum level of thioridazine significantly, so it should not be combined with that medication.31 SSRIs may increase serum levels of beta-blockers, whereas carbamazepine may have the opposite effect.32

Adapted from: Barry JJ and Huynh N. Psychotropic drug use in patients with epilepsy and developmental disabilities. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;205–217. With permission from Elsevier (

Authored By: 
John J. Barry MD
Nga Huynh PharmD
Reviewed By: 
Steven C. Schachter MD
Monday, May 31, 2004