Metoprolol withdrawal phenomena: Mechanism and prevention

Rangno, Robert E.; Langlois, Simon; Lutterodt, Alfred

doi:10.1038/clpt.1982.2

Cited by 45 publications

(16 citation statements)

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“…The majority of case reports and formal studies concern withdrawal from propranolol, but other ,B-adrenoceptor blockers may 0306-5251/82/130 345-07 $01.00 also be implicated. Indeed, a few reports suggest withdrawal features after metoprolol (Lederballe Pedersen, 1976;Rangno et al, 1982a), practolol (Nellen, 1969), oxprenolol (Nellen, 1969), and atenolol (Jackson et al, 1979). It is unknown whether any difference in frequency or severity of the withdrawal phenomena is due to limited experience with other ,B-adrenoceptor blockers or to real differences in their pharmacology.…”

Section: Introductionmentioning

confidence: 99%

Comparison of withdrawal phenomena after propranolol, metoprolol and pindolol.

Rangno¹,

Langlois²

1982

Brit J Clinical Pharma

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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.

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Section: Introductionmentioning

confidence: 99%

Comparison of withdrawal phenomena after propranolol, metoprolol and pindolol.

Rangno¹,

Langlois²

1982

Brit J Clinical Pharma

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“…While one patient had a transient increase in blood pressure and three reported withdrawal-like symptoms, there were no meaningful changes in plasma norepinephrine, epinephrine, thyroxine, or triiodothyronine. 38 In a review of {3-blockers with intrinsic sympathomimetic activity, Reale and Motolese suggest that no rebound nor withdrawal effects have been associated with such agents. 50 More recently, Rangno et al evaluated the potential for withdrawal phenomena, in ten hypertensive patients, following abrupt discontinuation of pindolol, an agent with intrinsic sympathomimetic activity.…”

Section: Implicated Drugsmentioning

confidence: 98%

Antihypertensive Drug Withdrawal Syndrome

Cummings¹,

Vlasses²

1982

Drug Intelligence & Clinical Pharmacy

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After discontinuation of antihypertensive medications, patients may experience symptoms associated with catecholamine excess, with or without a rapid rise in blood pressure; this is referred to as antihypertensive drug withdrawal syndrome. Though most often associated with the discontinuation of clonidine, this syndrome has been reported to follow the withdrawal of many other antihypertensives. Proposed mechanisms for the syndrome, depending on the drug involved, include enhanced activity of (1) the sympathoadrenal system, (2) the renin-angiotensin-aldosterone system, and (3) the thyroid hormones. The typical patient at risk is a younger person with severe hypertension, who has been on multiple drugs in high doses for a long period. Guidelines are provided for minimizing the occurrence of the syndrome and for treating the reaction, should it occur.

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“…Abrupt discontinuation of propranolol (Garbus et al, 1979) and metoprolol (Rangno et al, 1982) treatment have been associated with withdrawal symptoms. In this study 1 week after withdrawal of the drugs, such effects were not noticed with either of the drugs.…”

Section: Discussionmentioning

confidence: 99%

A comparison of a combination of penbutolol and frusemide with the two compounds individually in the treatment of hypertension.

Chadha¹,

Houtzagers²

1983

Brit J Clinical Pharma

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Forty-one patients completed a randomized, double-blind, between-group comparison of a combination of penbutolol and frusemide, with penbutolol alone, and frusemide alone in the management of mild to moderate essential hypertension. The results suggest that the combination caused a superior reduction in systolic and diastolic pressure compared with penbutolol and a superior reduction in systolic blood pressure compared with frusemide.

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Metoprolol withdrawal phenomena: Mechanism and prevention

Cited by 45 publications

References 0 publications

Comparison of withdrawal phenomena after propranolol, metoprolol and pindolol.

Comparison of withdrawal phenomena after propranolol, metoprolol and pindolol.

Antihypertensive Drug Withdrawal Syndrome

A comparison of a combination of penbutolol and frusemide with the two compounds individually in the treatment of hypertension.

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