Table 2.

Recommended approach of combined alpha- and beta-adrenergic blockade for PCCs and PGLs to maintain blood pressure at ≤120/80 mmHg and heart rate <100 bpm prior to initiating PRRT.

Blockade Strategy	Examples of Medications Used
(1) Alpha-adrenergic blockade	-Selective alpha-1-adrenergic blockers: prazosin, terazosin, doxazosin -Phenoxybenzamine is often used preoperatively, but is not preferred for longer term use
(2) Beta-adrenergic blockade	-Metoprolol, propranolol, atenolol *
(3) Calcium channel blockade	-Amlodipine, nicardipine This class of drugs is often used to augment blood pressure control with combined alpha- and beta-adrenergic blockade

NOTE: Metyrosine is another agent typically used perioperatively, but we would not recommend this given that PRRT is not limited to one cycle. Long-term use of metyrosine can result in side effects, such as sedation, anxiety, depression and extrapyramidal signs. * Beta-blockers should be started only after alpha-blockers to prevent unopposed alpha-adrenergic receptor stimulation, which could lead to increased blood pressure.