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

Area of Science:

• Forensic Toxicology
• Cardiovascular Pharmacology
• Public Health Surveillance

Background:

• Propranolol, a beta-blocker, is increasingly prescribed in the UK for cardiac and anxiety conditions.
• Concerns exist regarding propranolol's role in intentional poisonings, yet these are underreported.
• Utilizing coroner and toxicology data offers a unique method to assess propranolol's involvement in suicides.

Purpose of the Study:

• To quantify the involvement of propranolol in suicides.
• To analyze temporal trends in propranolol-related suicides.
• To compare demographic and clinical characteristics of individuals in propranolol suicides versus other suicides.

Main Methods:

• Data sourced from the National Programme on Substance Use Mortality (NPSUM).
• Included all suicides and deaths of undetermined intent in England, Wales, and Northern Ireland (2010-2021).
• Identified a subset of deaths where propranolol was implicated.

Main Results:

• Propranolol was involved in 6.6% of 4473 suicides, with its proportion quadrupling from 3.4% to 12.3% over the study period.
• Propranolol suicides were more prevalent in women (56.6%) and individuals with depression (39.1%) or anxiety (22.2%) diagnoses compared to other suicides.
• Antidepressants, particularly SSRIs (51.5%) like citalopram (24.6%), were detected in 81.8% of propranolol-involved suicides.

Conclusions:

• While a small proportion, the percentage of suicides involving propranolol is rising.
• Increased vigilance regarding the combined toxicity of medications used with propranolol is recommended.