Caution in Propranolol Withdrawal

There have been warnings that abrupt withdrawal of propranolol hydrochloride therapy in patients with or without coronary heart disease may be hazardous. This happens more often in patients treated for severe angina, especially those with unstable disease. Slome¹ reported that sudden withdrawal of propranolol therapy was often followed by myocardial infarction, and Olson et al² described acute and catastrophic exacerbation of symptoms following the abrupt cessation of treatment with large doses of propranolol in patients with coronary artery disease.

The latest warning comes from Mizgala and Counsell,³ who observed 15 acute coronary episodes in 14 patients with severe angina who had been receiving propranolol hydrochloride in daily doses of 80 to 400 mg for periods of seven days to six years. Abrupt cessation of propranolol therapy in these patients produced severe, sudden, acute coronary syndromes. Cessation was followed by rapid worsening of symptoms in 11 of 15