Comparison of withdrawal phenomena after propranolol, metoprolol and pindolol.
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.
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008790:Metoprolol / Q000009:adverse effects; D008875:Middle Aged; D010869:Pindolol / Q000009:adverse effects; D011433:Propranolol / Q000009:adverse effects; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D011433:Propranolol; D010869:Pindolol; D008790:Metoprolol