A Clinical-Epidemiological Study on Beta-Blocker Poisonings Based on the Type of Drug Overdose

Abstract

Background. Beta‐blockers carry a high risk of potentially causing fatal poisoning if overdosed. We aimed to assess the clinical and epidemiological characteristics of patients with beta-blocker poisoning. Methods. Patients were categorized based on the type of drug poisoning into propranolol, other beta-blockers, and the combination of beta-blocker groups, respectively. Demographic data, drug toxicity, and clinical, laboratory, and treatment information of different groups were compared. Results. During the study period, 5086 poisoned patients were hospitalized, of whom 255 (5.1%) had beta-blocker poisoning. Most patients were women (80.8%), married (50.6%), with a history of psychiatric disorders (36.5%), previous suicide attempts (34.6%), and intentional type of exposure (95.3%). The mean ± SD age of the patients was 28.94 ± 11.08 years. Propranolol toxicity was the most common among different beta-blockers (84.4%). There was a significant difference in age, occupation, education level, and history of psychiatric diseases with respect to the type of beta-blocker poisoning ( P < 0.05 ). We observed changes in the consciousness level and need for endotracheal intubation only in the third group (combination of beta-blockers). Only 1 (0.4%) patient had a fatal outcome in toxicity with the combination of beta-blockers. Conclusion. Beta-blocker poisoning is not common in our poisoning referral center. Propranolol toxicity was most common among different beta-blockers. Although symptoms are not different among defined beta‐blocker groups, more severe symptoms are observed in the combination of the beta-blocker group. Only one patient had a fatal outcome in the toxicity with the combination of the beta-blocker group. Therefore, poisoning circumstances have to investigate thoroughly to screen coexposure with combined drugs.

Involvement of propranolol in suicides: cross-sectional study using coroner-reported data

“…19 In a study of beta-blocker poisoning in people in an Iranian hospital, 84.4% of the 255 poisonings involved propranolol alone or in combination. 23 A Finnish study compared propranolol and metoprolol at post-mortem between 2016–2018. 24 Although metoprolol ( n = 416) was detected in more cases than propranolol ( n = 179), deaths involving propranolol were more often intentional self-poisoning, and benzodiazepines, antidepressants and antipsychotics were more often co-detected.…”

“…2 According to open-access UK prescribing data, almost 600 000 prescriptions of propranolol are dispensed monthly. 3 The prevalence of propranolol prescribed for patients with anxiety recorded in general practice more than doubled from 3.8/1000 person-years at risk in 2008 to 8.7/1000 person-years at risk in 2018, and the most substantial increase in prescribing was in young adults (age [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. 4 Reasons for this rise could include: general practitioners (GPs) prescribing propranolol more readily than other medications as they describe propranolol as non-addictive; 5 a reduction in incident benzodiazepine prescribing in alignment with national guidance; 4 and GPs wanting to 'do something' while waiting for referral to psychological therapies, as has been reported for antidepressant prescribing in depression.…”

Excessively High Chronic Propranolol Overdose in Infantile Hemangioma: A Case Report

“…Around 8761 (79.7%) of these exposures were unintentional [ 1 ]. From a retrospective study involving 5086 hospitalized poisoned patients, beta-blocker poisoning was identified in 5.1% of cases, and propranolol toxicity was the predominant presentation, accounting for 84.4% of beta-blocker poisonings [ 2 ].…”