The problem of propranolol poisoning

Propranolol is licensed in the UK and elsewhere to relieve symptoms of anxiety. In overdose, propranolol poisoning can be serious, difficult to treat and potentially fatal. This paper describes cases of intentional propranolol overdose reported to the UK National Poisons Information Service in order to raise awareness of the risk of harm following propranolol overdose and support safer prescribing.

This study reviews enquiries to UK Poison Centres involving intentional overdoses of propranolol requiring hospital attendance and reported between 1 January 2022 and 31 December 2023.

There were 444 enquiries about 363 intentional propranolol overdoses in 359 different patients (248 [69%] women). Median age [interquartile range, IQR] was 32 [22-45] years (n = 355); 52 (14%) patients were <18 years old. The indication was known in 121 (33%) cases, and was anxiety in 111. In 43/61 cases where propranolol and an antidepressant were co-prescribed, patients took both in overdose. The outcome was confirmed in 159 (44%) exposures; 110 patients recovered completely, 13 had ongoing features, one had permanent sequelae, and 35 died.

Overdose patients were often prescribed propranolol for anxiety, and many developed systemic toxicity. Despite intensive treatment, many patients still die from poisoning with propranolol alone or in combination with other agents. Given the dangers of propranolol in overdose, prescribers based in primary care settings should recognize that using propranolol to manage anxiety can be dangerous.