Re: just how sweaty was GG?

[Kristen Immoor <kimmoor@mindspring.com>]

At 3:28 AM -0500 3/17/98, pbm972+@pitt.edu wrote:
>i remember reading in one of THE books that GG took, in addition to the
>usual plethora of pills, a medication to suppress or reduce perspiration
>before/during his live performances.
>does anyone know what the name of the medication was?
>could it have been Inderal(propranolol)?
>i, and my psychiatrist, would be interested in knowing the answer.
>
>let me know......
>
>sean malley

This runs a but long...
Inderal-LA is a special formulation of propranolol hydrochloride consisting
of capsules filled with pheroids of the active drug that have a
sustained-release coating. One of the pharmacological actions of INDERAL LA
is to reduce heart rate, which may have made him less nervous and less
sweaty (to leap to the simplest affect) but the main indications was prolly
to keep his blood pressure down. The following list of indications and
harrowing side affects might be of interest to you. If not, pardon my
medical spam. ;-)

Indications of Inderal:
Hypertension:
It is usually used in combination with other drugs, particularly a thiazide
diuretic. Propranolol can, however, in certain patients, be used alone or
as an initial agent in patients in whom, in the judgment of the physician,
treatment should be started with a beta-blocker rather than a diuretic. The
combination of
propranolol with thiazide-like diuretics and/or peripheral vasodilators has
been shown to be compatible and generally more effective than propranolol
alone.
Experience with most commonly used antihypertensive agents has not
suggested evidence of incompatibility.

Propranolol by itself is not recommended for the emergency treatment of
hypertensive crisis. It is, however, sometimes used as an adjunct to
counteract the unwanted effect (tachycardia) of the primary agents used in
these situations.

Angina Pectoris:
For the prophylaxis of angina pectoris.

Cardiac Arrhythmias:
Supraventricular arrhythmias:
A) paroxysmal atrial tachycardias, particularly those arrhythmias induced
by catecholamines or digitalis or associated with Wolff-Parkinson-White
syndrome (see Warnings); b) persistent sinus tachycardia which is
noncompensatory and impairs the well-being of the patient; c) tachycardias
and arrhythmias due to thyrotoxicosis when causing distress or increased
hazard and when immediate effect is necessary as adjunctive, short-term (2
to 4 weeks) therapy. May be used with, but not in place of, specific
therapy (see Warnings); d) persistent atrial extrasystoles which impair the
well-being of the patient and do not respond to conventional measures; e)
atrial flutter and fibrillation when ventricular rate cannot be controlled
by digitalis alone, or when digitalis is contraindicated.

Ventricular tachycardia:
Ventricular arrhythmias do not respond to propranolol as predictably as do
the supraventricular arrhythmias; a) with the exception of ventricular
tachycardia induced by catecholamines or digitalis, propranolol is not the
drug of first choice. In critical situations when cardioversion techniques
or other drugs are not indicated or are not effective, propranolol may be
considered. If, after consideration of the risks involved, propranolol is
used, it should be given i.v. in low dosage and very slowly (see Dosage);
b) persistent premature ventricular extrasystoles which do not respond to
conventional measures and impair the well being of the patient.

Tachyarrhythmias of digitalis intoxication:
If digitalis induced tachyarrhythmias persist following discontinuance of
digitalis and correction of electrolyte abnormalities, they may be
reversible with oral propranolol. Severe bradycardia may occur (see
Symptoms and Treatment of Overdose).

I.V. propranolol is reserved for life-threatening arrhythmias. Temporary
maintenance with oral therapy may be indicated (see Dosage).

Resistant tachyarrhythmias due to excessive catecholamine action during
anesthesia.

Tachyarrhythmias due to excessive catecholamine action during anesthesia
may sometimes arise because of release of endogenous catecholamines or
administration of catecholamines. When usual measures fail in such
arrhythmias, propranolol may be given i.v. to abolish them. All general
inhalation anesthetics produce some degree of myocardial depression.
Therefore, when propranolol is used to treat arrhythmias during anesthesia,
it should be used with extreme caution and constant ECG and central venous
pressure monitoring. In patients during anesthesia with agents that require
catecholamine release for maintenance of adequate cardiac function,
beta-blockade will impair the desired inotropic effect. Therefore,
propranolol should be titrated carefully when administered for arrhythmias
occurring during anesthesia.

Post-myocardial Infarction:
For the reduction of cardiovascular mortality in patients who have survived
the acute phase of a myocardial infarction and who are clinically stable.
In the study which showed this benefit, treatment with propranolol began
between 5 and 21 days after the acute phase. Data are not available as to
whether benefit would ensue if the therapy were initiated later.

Migraine:
The prophylaxis of migraine headache. It is not indicated for the treatment
of acute migraine attacks.

Essential Tremor:
The management of essential tremor.

Hypertrophic Subaortic Stenosis:
The management of hypertrophic subaortic stenosis, especially for treatment
of exertional or other stress induced angina, palpitations, and syncope.
Propranolol may also improve exercise performance. The effectiveness of
propranolol in this disease appears to be due to a reduction of the
elevated outflow pressure gradient which is exacerbated by beta-adrenergic
receptor stimulation. Clinical improvement may be temporary.

Pheochromocytoma:
After primary treatment with an alpha-adrenergic blocking agent has been
instituted, propranolol may be useful as adjunctive therapy if the control
of tachycardia becomes necessary before or during surgery.

It is hazardous to use propranolol unless alpha-adrenergic blocking drugs
are already in use, since this would predispose to serious blood pressure
rise.
Blocking only the peripheral dilator (beta) action of epinephrine leaves
its constrictor (alpha) action unopposed. In the event of hemorrhage or
shock, producing both beta- and alpha-blockade is contraindicated since the
combination prevents the increase in heart rate and peripheral
vasoconstriction needed to maintain blood pressure.

In inoperable or metastatic pheochromocytoma, propranolol may be useful as
an adjunct to the management of symptoms due to excessive beta-adrenergic
receptor stimulation.

Inderal-LA:
For maintenance therapy in the treatment of hypertension and prophylaxis of
angina pectoris.

As for Inderal, the combination of Inderal-LA with thiazide-like diuretics
and/or peripheral vasodilators has been shown to be compatible and
generally more effective than Inderal-LA alone. Experience with most
commonly used antihypertensive agents has not suggested evidence of
incompatibility.

Treatment must always be initiated and individual titration of dosage
carried out using the conventional tablets. The long-acting formulation may
be used for maintenance provided the dosage requirement is suitable.

Not indicated for the emergency treatment of hypertensive crises.

DOSAGE AND DIRECTIONS FOR USE
Hypertension
The starting dose is one INDERAL LA 160 capsule or two INDERAL LA 80
capsules taken either in the morning or evening according to patient
convenience. An adequate response is seen in most patients at this dosage.
If necessary, it can be increased to two INDERAL LA 160 capsules and a
further reduction of blood pressure can be obtained if a diuretic or other
anti-hypertensive agent is given in addition to INDERAL LA 160. One INDERAL
LA 80 capsule is unlikely on its own to be sufficient to treat hypertension
but it may be used as a starting dose in appropriate patients (e.g. the
elderly), or supplementary to INDERAL LA 160.

Angina
One INDERAL LA 80 capsule daily may be sufficient to provide adequate
control in many patients. If necessary the dose may be increased to one
INDERAL LA 160 capsule per day and an additional INDERAL LA 80 increment
may be given.

Anxiety related autonomic symptoms and essential tremor. An adequate
response is usually obtained with one INDERAL LA 80 capsule daily, taken
either in the morning or evening according to patient convenience. If
necessary the dose may be increased to one INDERAL LA 160 capsule daily.

INDERAL LA may exacerbate the rebound hypertension which may follow the
withdrawal of clonidine. If the two drugs are co-administered, INDERAL LA
should be withdrawn several days before discontinuing clonidine. If
replacing clonidine by INDERAL LA therapy, the introduction of INDERAL LA
should be delayed for several days after clonidine administration has
stopped.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS
Side-effects
Cold extremities, nausea, vomiting, diarrhoea and other gastrointestinal
disturbances, lassitude, dizziness, fatigue, vivid dreams, nightmares, and
other sleep disturbances, visual disturbances,
overt psychosis, depression, confusion, hallucinations, Raynaud's phenomenon.
Deterioration of heart failure, mood changes, alopecia, thrombocytopenia,
psoriasiform skin reactions, exacerbation of psoriasis, heart block, and
postural hypotension which may be associated with syncope.
There have been reports of skin rashes and/or dry eyes associated with the
use of INDERAL LA.
Congestive cardiac failure and bradycardia may occur. In the event of
intolerance to INDERAL LA manifested as bradycardia and hypotension, the
medicine should be withdrawn and, if necessary, treatment instituted as
stated below. Cases of purpura, erythematous rash and paraesthesia of the
hands have been reported.
Intermittent claudication may be increased if already present.
Bronchospasm can occur in patients with bronchial asthma or a history of
asthmatic complaints, sometimes with a fatal outcome.
An increase in ANA (Antinuclear Antibodies) has been observed, however the
clinical relevance of this is not clear.

Special precautions
Care should be taken when using anaesthetic agents in patients taking
INDERAL LA 160 or INDERAL LA 80. The anaesthetist should be informed and
the choice of the anaesthetic should be an agent with as little negative
inotropic activity as possible. Use of beta-blockers with anaesthetic drugs
may result in attenuation of the reflex tachycardia and increase the risk
of hypotension. Anaesthetic agents causing myocardial depression are best
avoided.
Care should be taken when using INDERAL LA with ergotamine,
dihydroergotamine or related compounds.
Concomitant use of prostaglandin synthetase inhibiting drugs e.g. ibuprofen
and indomethacin may reduce the antihypertensive effect of INDERAL LA.
Concomitant therapy with dihydropyridines e.g. nifedipine, may increase the
risk of hypotension. In patients with latent cardiac insufficiency,
treatment with beta-blocking agents may lead to cardiac failure.
The concomitant administration of INDERAL LA and chlorpromazine may result
in an increase in plasma levels of both drugs.
Cimetidine and hydralazine increase and alcohol decreases the plasma levels
of hepatically metabolised beta-blockers.
It can be dangerous to administer INDERAL LA concomitantly with the
following medicines: hypoglycaemic agents, phenothiazines and Class I
anti-arrhythmic agents such as disopyramide.
N.B. Such drug-drug interactions can have life-threatening consequences.
Digitalis glycosides in association with beta-blockers may increase
atrioventricular conduction time.
Special Note: Digitalisation of certain patients receiving long-term
INDERAL LA therapy may be necessary if congestive cardiac failure is likely
to develop. This combination can be considered despite the potentiation of
the negative chronotropic effect of the two medicines. Careful control of
dosages and of the individual patient's response and notably the pulse rate
is essential in this situation.
With calcium channel blockers with negative inotropic effects e.g.
verapamil and diltiazem as this can lead to an exaggeration of these
effects, particularly in patients with impaired ventricular function and/or
SA or AV conduction abnormalities. Neither drug should be administered
intravenously within 48 hours of discontinuing the other.
INDERAL LA 160 and INDERAL LA 80 mask the symptoms of hypoglycaemia.
Caution should be exercised in the concurrent use of INDERAL LA 160 or
INDERAL LA 80 and hypoglycaemic therapy in diabetic patients. INDERAL LA
may prolong the hypoglycaemic response to insulin.
Bronchoconstriction may occur in patients suffering from asthma, bronchitis
and other chronic pulmonary diseases when INDERAL LA is administered.
Treatment with INDERAL LA may be associated with exacerbation of peripheral
vascular disease, or with the development of Raynaud's phenomenon (due to
unopposed arteriolar alpha-sympathetic activity) and sexual impotence.
Severe peripheral vascular disease and even peripheral gangrene may be
precipitated.
Abrupt discontinuation of therapy with INDERAL LA may cause exacerbation of
angina pectoris in patients suffering from ischaemic heart disease.
Discontinuation of therapy with INDERAL LA should be gradual rather than
abrupt and patients should be advised to limit the extent of their physical
activity during the period that the medicine is being discontinued.

Note: Adverse reactions are more common in elderly patients, in patients
with renal decompensation, and in patients who receive the drug
intravenously.

Patients with a phaeochromocytoma require concomitant treatment with an
alpha-adrenergic blocker.
Care should be taken in the parenteral administration of preparations
containing adrenaline to patients taking INDERAL LA.
The combination of INDERAL LA and lignocaine (given intravenously) should
be avoided.
INDERAL LA 160 and INDERAL LA 80 should be used with caution in patients
with decompensated cirrhosis.
One of the pharmacological actions of INDERAL LA is to reduce heart rate.
When symptoms are attributable to a slow heart rate, the dose may be
reduced.
Heart failure following myocardial infarction must have been controlled
before treatment with INDERAL LA is started.

If INDERAL LA and clonidine are given concurrently the clonidine should not
be discontinued until several days after the withdrawal of the INDERAL LA
as severe rebound hypertension
may occur.

Effect on ability to drive or operate machinery
INDERAL LA may have an effect on the ability to drive or operate machinery
and caution must therefore be taken.

Nothing about sweating.

Cheers,
Kristen

______________________________________________________________________________

"Those are terrible people who don't like Glenn Gould. 
...I will have nothing to do with such people, they are dangerous people."

                                  -- Thomas Bernhard