Propranolol is contraindicated in asthma

Abstract

EDITOR,-The datasheet for Inderal (propranolol) states specifically that the drug is contraindicated in patients with asthma or a history of bronchospasm. Despite this, and despite the well known risks of non-selective I blockers in patients with asthma, over the past few years Zeneca has received a number of reports of cases in which an asthmatic patient died as a result of being prescribed propranolol.Since propranolol was first marketed in 1965 the estimated exposure to it has been about 56 million patient years. The Medicines Control Agency has 51 reports of bronchospasm in its database of reports of adverse reactions to propranolol; 13 of the cases are recorded as having been fatal. Of more interest, however, are six reports in which it is stated that the patient had a history of asthma, bronchospasm, or wheeze; five of these cases were fatal. To help prevent further occurrences of this sort in asthmatic patients who might be prescribed propranolol erroneously, Zeneca has decided to highlight the warnings concerning asthma in the patient information leaflet for Inderal and related products. Pack labels will also carry warnings. Doctors should prescribe original packs so that a last line of defence against incorrect prescribing is not breached.Current We looked for a possible regional effect in a cohort of 7400 babies from West Sussex, who were measured between birth and 35 weeks (courtesy of Dr Ann Wallace). As in Newcastle, there was no sex difference in the standard deviation score for weight at birth, but thereafter the boys' weight centiles tended to exceed the girls' (by a mean score of 0.31, compared with 0.41 in the authors' study). Thus regional differences alone are unlikely to explain the finding, and a bias in the growth reference must exist. We believe that this bias arose during the fitting process, when several datasets were merged after adjustment for regional imbalances and secular trends. This process distorted the relation between the sexes, particularly in infancy.We have now eliminated the bias by modifying the fitting process.3 We have also added data on a nationally representative sample of 1.5-4.5 year old children to the reference dataset.4 Compared with the original reference, the revised median weight for girls is reduced by a standard deviation score of up to 0.2 (180 g) at 9 months, while that for boys is unchanged. The line indicating a standard deviation score of -2.0 for girls (close to the third centile used by Wright and colleagues) is reduced by up to 0.3 (200 g), while that for boys is reduced by 0.07 (40 g), a net difference of 0.24. This accounts for about three fifths of the sex discrepancy in Newcastle and rather more in West Sussex. We are confident that the remainder is a genuine regional difference.Wright and colleagues point out that the same imbalance between the sexes occurred with the 1966 British standards. The same is true of the 1980 Dutch standards,5 which were based on a large sample (n = 8301). This emphasises the variable nature of the sex difference in w...

Computational determination the reactivity of salbutamol and propranolol drugs

“…(SAL and PRO) are two drugs not commonly used, since PRO is used alone not with a cardioselctive beta-blocking agent and it is not possible to be used with SAL because the risk was higher, can outweigh the benefits for asthma patients, and should be prevented or monitored by a doctor [9][10][11]. In previous literature was motioned that some patients symptomatic affected by an overdose of SAL.…”

An Unusual Death in an Asthmatic Patient

“…Six of the reports describe a patient with a clinical diagnosis of asthma, and 5 of them involve fatalities. 5 In 1984, at the annual meeting of the American Academy of Forensic Sciences, Shaffer et al 6 presented 3 cases of fatal bronchospasm, each caused by a single dose of a ␤-adrenergic blocking agent. A study by Foresi et al 7 found that inhaled propranolol caused dose-dependent bronchoconstriction in asthmatic patients by a mechanism that was not fully understood.…”

Propranolol treatment for infantile hemangioma does not increase risk of childhood wheezing

“…It is widely accepted that propranolol is contraindicated in asthma . Several cases of fatal adverse reactions with propranolol in asthmatic adults were described . However, there are no similar reports in children .…”

“…Nevertheless, non‐selective beta‐blockers are contraindicated in patients with asthma. β 2 ‐receptors in the bronchioles are innervated by sympathetic nerves promoting bronchodilation and their blockade can lead to bronchoconstriction . Respiratory episodes including cough and wheezing in infants and young children may be different.…”