Comparison of withdrawal phenomena after propranolol, metoprolol and pindolol

Br J Clin Pharmacol. 1982;13(Suppl 2):345S-351S. doi: 10.1111/j.1365-2125.1982.tb01939.x.

Abstract

1 After abrupt propranolol withdrawal a rebound increase in cardiac sensitivity to isoprenaline occurred in 9/9 patients and persisted up to 14 days. A mild brief rebound in resting heart rate occurred in 4/9 patients and a rebound in blood pressure occurred in 6/9 patients. These withdrawal phenomena were prevented by gradual withdrawal on a prolonged small dose of propranolol. 2 After abrupt metoprolol withdrawal a rebound increase in cardiac sensitivity to isoprenaline occurred in 8/8 patients but had resolved by 8 days. A marked persistent rebound in resting heart rate occurred in 8/8 patients while a small brief rebound in blood pressure occurred in only one patient. These withdrawal phenomena were largely prevented by gradual withdrawal on a prolonged small dose of metoprolol. 3 After abrupt pindolol withdrawal there was no rebound in isoprenaline sensitivity but a mild brief rebound in resting heart rate occurred in 9/10 patients. There was no rebound in blood pressure. 4 The type, magnitude and frequency of withdrawal phenomena after various beta-adrenergic receptor blockers probably reflects substantial differences in their basic pharmacological characteristics. 5 Caution must be exercised when withdrawing any patient from any beta-adrenoceptor blocker since an adverse cardiac event is unpredictable.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects*
  • Adult
  • Aged
  • Blood Pressure / drug effects
  • Heart Rate / drug effects
  • Humans
  • Metoprolol / adverse effects
  • Middle Aged
  • Pindolol / adverse effects
  • Propranolol / adverse effects
  • Substance Withdrawal Syndrome / physiopathology*
  • Time Factors

Substances

  • Adrenergic beta-Antagonists
  • Propranolol
  • Pindolol
  • Metoprolol