Question:
Male, 25-years-old, unknown subtype
Son, aged 25, was previously taking Propranol for blood pressure and anxiety. We were noticing increased anxiety and PCP just switched him to Lisinopril and Venlafax ER 75. Are these 2 meds found to be safe for patients with PWS??
Nurse Lynn’s Response:
Unfortunately, your question is more complicated than a simple yes or no. We really need to understand his pharmacogenomics, which is how an individual’s genetic attributes affect the likely response to therapeutic drugs. You can ask your provider if GeneSight testing is available which can be helpful for the prescriber. Both propranol and venlafaxine are metabolized through 2D6, which is likely to be impaired in PWS (see linked article). Lisinopril typically treats high blood pressure not anxiety and is excreted through the kidneys. Your provider will be checking lab values to make sure that the values are within normal limits.
When you talk about increased anxiety, there is a lot to unpack there. We should attempt to understand the cause for this increase. Often a combination of things is the cause, change in routines, hormonal changes, seasonal changes and so on. It can be difficult for individuals with PWS to have the insight into their own behavior. Behavioral interventions should take a systemic perspective that seeks to understand the inter-relationships between developmental, biological, psychological and social factors.
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Jennifer Bolander has been serving as a Special Education Specialist for PWSA (USA) since October of 2015. She is a graduate of John Carroll University and lives in Ohio with her husband Brad and daughters Kate (17), and Sophia (13) who was born with PWS.
Perry A. Zirkel has written more than 1,500 publications on various aspects of school law, with an emphasis on legal issues in special education. He writes a regular column for NAESP’s Principal magazine and NASP’s Communiqué newsletter, and he did so previously for Phi Delta Kappan and Teaching Exceptional Children.
Evan has worked with the Prader-Willi Syndrome Association (USA) since 2007 primarily as a Crisis Intervention and Family Support Counselor. Evans works with parents and schools to foster strong collaborative relationships and appropriate educational environments for students with PWS.
Dr. Amy McTighe is the PWS Program Manager and Inpatient Teacher at the Center for Prader-Willi Syndrome at the Children’s Institute of Pittsburgh. She graduated from Duquesne University receiving her Bachelor’s and Master’s degree in Education with a focus on elementary education, special education, and language arts.
Staci Zimmerman works for Prader-Willi Syndrome Association of Colorado as an Individualized Education Program (IEP) consultant. Staci collaborates with the PWS multi-disciplinary clinic at the Children’s Hospital in Denver supporting families and school districts around the United States with their child’s Individual Educational Plan.
Founded in 2001, SDLC is a non-profit legal services organization dedicated to protecting and advancing the legal rights of people with disabilities throughout the South. It partners with the Southern Poverty Law Center, Protection and Advocacy (P&A) programs, Legal Services Corporations (LSC) and disability organizations on major, systemic disability rights issues involving the Individuals with Disabilities Education Act (IDEA), Americans with Disabilities Act (ADA), and the federal Medicaid Act. Recently in November 2014, Jim retired.