Propranolol-Withdrawal Rebound Phenomenon

Miller, Richard R.; Olson, Harold G.; Amsterdam, E. A.; Mason, Dean T.

doi:10.1097/00132586-197608000-00007

Cited by 15 publications

(16 citation statements)

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“…An exacerbation of a preexisting coronary artery disease was described by Miller, Olson, Amsterdam & Mason (1975) whereas a more benign syndrome of sympathetic hyperactivity including an abrupt rise in standingblood pressure was reported by Lederballe-Pedersen, Mikkelsen, Lanng-Nielsen & Christensen (1979). In our patients, withdrawal of penbutolol did not elicit any such symptom.…”

Section: Discussionmentioning

confidence: 38%

Penbutolol or hydrochlorothiazide once a day in hypertension. A controlled study with home measurements.

Plaen¹,

E²,

Strihou³

1981

Brit J Clinical Pharma

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1 The hypotensive effect of single daily dosing with 80mg penbutolol was compared to 100mg hydrochlorothiazide and placebo in a double-blind cross-over controlled trial with daily home measurements in ten hypertensive patients.2 Penbutolol, 80 mg once a day, reduced significantly the supine and standing blood pressure. 3 This hypotensive effect was more potent than hydrochlorothiazide 100mg particularly in the evening. 4 The hypotensive effect remained for 24 h as shown by the evening (14 h after dose) and morning (24 h after dose) blood pressure readings. 5 No relevant subjective or physical side effects were recorded. There was no significant change nor individual noticeable variation in biochemical data during penbutolol treatment. However, during hydrochlorothiazide treatment, the expected electrolyte changes were observed (symptom-free hypokalemia and hyperuricemia). 6 Penbutolol serum concentration showed no cumilation after one month of treatment. 7 Sudden withdrawal of penbutolol after 1 month of therapy resulted in a slow return to baseline blood pressures over a 2-week period without rebound.

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Section: Discussionmentioning

confidence: 38%

Penbutolol or hydrochlorothiazide once a day in hypertension. A controlled study with home measurements.

Plaen¹,

E²,

Strihou³

1981

Brit J Clinical Pharma

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show abstract

“…The 1-BL tion to either hyaluronidase or placebo. Adverse clinical criteria dictating assignment to group B included (1) a heart rate less than 55 beats/min at the time of randomization or less than 40 beats/min before randomization, (2) a systolic arterial pressure less than 100 mm Hg at randomization, one that had fallen more than 50 mm Hg from previous levels, or one that even temporarily was less than 70 mm Hg, (3) moist rales over one-third or more of the lung fields, (4) the presence of atrioventricular block, (5) a history of asthma, (6) wheezes on physical examination, (7) pulmonary edema, or (8) administration of verapamil within the previous 6 hr. 30 The 326 patients in this study were divided into four groups (figure 1).…”

Section: Methodsmentioning

confidence: 99%

Abrupt withdrawal of beta-blockade therapy in patients with myocardial infarction: effects on infarct size, left ventricular function, and hospital course.

et al. 1986

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The effects of abrupt withdrawal or continuation of fl-blockade therapy during acute myocardial infarction were evaluated in 326 patients participating in the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Thirty-nine patients previously receiving a f8-blocker and randomly selected for withdrawal of fl-blockers and placebo treatment during infarction (group 1) were compared with 272 patients previously untreated with fl-blockers who were also randomly assigned to placebo therapy (group 2). There were no significant differences between the two groups in MB creatine kinase isoenzyme (15.8 10.9 vs 18.2 + 14.4 g-eq/m2, respectively) estimates of infarct size, radionuclide-determined left ventricular ejection fractions within 18 hr of infarction (0.44 0.15 vs 0.47 0.16) or 10 days later (0.42 0.14 vs 0.47 0.16), creatine kinase-determined incidence of infarct extension (13% vs 6%), congestive heart failure (43% vs 37%), nonfatal ventricular fibrillation (5% vs 7%), or in-hospital mortality (13% vs 9%). Patients in group 1 had more recurrent ischemic chest pain (p = .002) within the first 24 hr after infarction, but not thereafter. However, this did not appear to be related to a rebound increase in systolic blood pressure, heart rate, or double product. In a separate analysis, 20 propranolol-eligible group 1 patients randomly selected for withdrawal of fl-blockade (group 3) were compared with 15 patients randomly selected for continuation of prior fiblockade therapy (group 4). This comparison yielded similar results. These data indicate that the ,f-blockade withdrawal phenomenon is not a major clinical problem in patients with acute myocardial infarction. f-Blockade therapy can be discontinued abruptly during acute myocardial infarction if clinically indicated.

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“…In the New England Journal of Medicine, Miller et al (1975) reported a series of 20 patients with angina treated with propranolol who subsequently stopped treatment (Miller et al, 1975). Six of these patients had serious myocardial events, one died suddenly, another suffered a myocardial infarction, another developed ventricular tachycardia and three developed coronary insufficiency.…”

Section: Cardiac Side-effectsmentioning

confidence: 99%

“…There have also been reports that rebound cardiac arrhythmias may follow abrupt withdrawal of P-adrenoceptorblockers with weak or absent ISA (Miller et al, 1975;Ross et al, 1981). Because they block catecholamine effects on the heart, most 3-adrenoceptor-blocking drugs including those with ISA are negative inotropic agents.…”

Section: Introductionmentioning

confidence: 99%

Beta‐adrenoceptor blocking drugs: the relevance of intrinsic sympathomimetic activity.

Wj¹,

McNeil²

1982

Brit J Clinical Pharma

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Propranolol-Withdrawal Rebound Phenomenon

Cited by 15 publications

References 0 publications

Penbutolol or hydrochlorothiazide once a day in hypertension. A controlled study with home measurements.

Penbutolol or hydrochlorothiazide once a day in hypertension. A controlled study with home measurements.

Abrupt withdrawal of beta-blockade therapy in patients with myocardial infarction: effects on infarct size, left ventricular function, and hospital course.

Beta‐adrenoceptor blocking drugs: the relevance of intrinsic sympathomimetic activity.

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