The Cardiac Safety of High-Dose Propranolol Used to Treat Severe Behaviors With Autism Spectrum Disorders

Aggression and self-abusive behaviors are serious problems in the developmentally disabled. Several medications have shown efficacy, but many individuals remain inadequately treated or intolerant of the side effects of various medications. High-dose propranolol has been shown to be effective for some individuals with various diagnoses. Clinicians' use of high-dose propranolol has been limited by a lack of evidence of cardiac safety. We are presenting a retrospective review of the cardiologic workup of 52 cases of the use of high-dose propranolol for individuals with autism spectrum and related disorders.

We report the results of electrocardiogram, Holter monitor, blood pressure, heart rate, and echocardiography in this cohort who were on doses of propranolol up to 1200 mg per day with a mean dose of 496.6 mg per day. The ages ranged from 12 to 49 years with a mean of 21.6 years.

Clinically, there were no serious adverse events over the 8 years of accumulated data on this cohort. Three of the 52 cases were discontinued from propranolol due to side effects of bradycardia and or hypotension. There were no adverse effects noted on the Holter monitor or the echocardiography. There was a correlation between heart rate and blood pressure, but for the vast majority, these were not clinically significant.

In our population, high-dose propranolol appeared to be safe from a cardiologic perspective. Our population skewed toward young individuals without preexisting heart pathology. We recommend its use with appropriate caution for any given individual.