Skip to main content
Log in

The phenomenon of β-adrenergic hypersensitivity following propranolol withdrawal studied in normal subjects

  • Originals
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Summary

A study was carried out to determine whether beta-adrenergic hypersensitivity occurs in normal subjects following the abrupt withdrawal of the beta-adrenoceptor antagonist propranolol. Sixteen normal subjects took propranolol, orally, 120 mg twice daily for one week. Heart rate and blood pressure were measured supine and standing as well as during exercise. Heart rate was measured during and following the Valsalva manoeuvre. Measurements were made on the last day of the treatment period and on two occasions during the six days following withdrawal. Three subjects were removed from the analysis because of failure to take medication and one more was excluded because of protocol variation. In the remaining twelve, propranolol treatment reduced all parameters measured. Following abrupt withdrawal of the drug, there was no measurable increase in any of the parameters above baseline or placebo values within six days of the withdrawal. These findings, from normal subjects, do not support the phenomenon of beta-adrenergic hypersensitivity following propranolol withdrawal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Alderman EL, Coltart DJ, Wettach GE, Harrison DC (1974) Coronary artery syndromes after sudden propranolol withdrawal. Ann Intern Med 81: 625–627

    Google Scholar 

  • Baldwa VS, Ewing D (1977) Heart rate response to Valsalva manoeuvre. Reproducibility in normals, and relation to variation in resting heart rate in diabetics. Br Heart J 39: 641–644

    Google Scholar 

  • Boudoulas H, Lewis RP, Kates RE, Dalamangas G (1977) Hypersensitivity to adrenergic stimulation after propranolol withdrawal in normal subjects. Ann Int Med 87: 433–436

    Google Scholar 

  • Diaz RG, Somberg J, Freeman E, Levitt B (1974) Myocardial infarction after propranolol withdrawal. Am Heart J 88: 257–258

    Google Scholar 

  • Eggleston PA, Rosenthal RR, Anderson SD, Anderton R, Bierman CW, Bleecker ER, Chai H, Cropp GJA, Johnson JD, Konig P, Morse J, Smith LJ, Summers RJ, Trautlien JJ (1979) Guidelines for methodology of exercise challenge testing of asthmatics. J Allergy Clin Immunol 64: 642–645

    Google Scholar 

  • Frishman WH, Klein N, Strom J, Cohen MN, Shamoon H, Willens H, Klein P, Roth S, Iorio L, LeJemtel T, Pollack S, Sonnenblick EH (1982) Comparative effects of abrupt withdrawal of propranolol and verapamil in angina patients. Am J Cardiol 50: 1191–1195

    Google Scholar 

  • Grizzle JE (1965) The two-period change-over design and its use in clinical trials. Biometrics 21: 467–480

    Google Scholar 

  • Hills M, Armitage P (1979) The two-period cross-over clinical trial. Br J Clin Pharmacol 8: 7–20

    Google Scholar 

  • Kiyingi KS, Shaw J (1984) Propranolol withdrawal hypersensitivity: not enough evidence. Clin Exp Pharmacol Physiol (in press)

  • Miller RR, Oslon HG, Amsterdam EA, Mason DT (1975) Propranolol withdrawal rebound phenomenon. N Eng J Med 293: 416–418

    Google Scholar 

  • Mizgalla HF, Counsell J (1976) Acute coronary syndromes following abrupt cessation of oral propranolol therapy. Can Med Assoc J 114: 1123–1126

    Google Scholar 

  • Myers JH, Horwitz LD (1978) Hemodynamic and metabolic response after abrupt withdrawal of long-term propranolol. Circulation 58: 196–201

    Google Scholar 

  • Myers MG, Wisenberg G (1977) Sudden withdrawal of propranolol in patients with angina pectoris. Chest 71: 24–26

    Google Scholar 

  • Myers MG, Freeman MR, Juma ZA, Wisenberg G (1979) Propranolol withdrawal in angina pectoris: a prospective study. Am Heart J 97: 298–302

    Google Scholar 

  • Nattel S, Rangno RE, Van Loon G (1979) Mechanism of propranolol withdrawal phenomena. Circulation 59: 1158–1164

    Google Scholar 

  • Prichard BNC, Walden RJ (1982) The syndrome associated with the withdrawal of β-adrenergic receptor blocking drugs. Br J Clin Pharmacol 13: 337S–343S

    Google Scholar 

  • Prichard BNC, Tomlinson B, Walden RJ, Bhattacharjee P (1983) The β-adrenergic blockade withdrawal phenomenon. J Cardiovasc Pharmacol 5: S56–S62

    Google Scholar 

  • Raabe DS, Meengs WL, Crary JL, Sorkin RP, Gregory JM, Walton JA (1975) Risk of suddenly discontinuing propranolol therapy before coronary arteriography. Circulation 52 [Suppl II]: 12

    Google Scholar 

  • Rangno RE, Langlois S (1982) Comparison of withdrawal phenomena after propranolol, metoprolol and pindolol. J Clin Pharmacol 13: 345S–351S

    Google Scholar 

  • Ross PJ, Lewis MJ, Sheridan DJ, Henderson AH (1981) Adrenergic hypersensitivity after beta-blocker withdrawal. Br Heart J 45: 637–642

    Google Scholar 

  • Shiroff RA, Mathis J, Zelis R, Schneck DW, Babb JD, Leaman DM, Hayes AH Jr (1978) Propranolol rebound — A retrospective study. Am J Cardiol 41: 778–780

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kiyingi, K.S., Shaw, J. The phenomenon of β-adrenergic hypersensitivity following propranolol withdrawal studied in normal subjects. Eur J Clin Pharmacol 27, 423–428 (1984). https://doi.org/10.1007/BF00549589

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00549589

Key words

Navigation