Importance of membrane stabilizing effect in massive overdose of propranolol: plasma level study in a fatal case

Plasma propranolol levels were measured in a woman who took 3120 mg of propranolol in a suicide attempt. Highest plasma level, measured at the 12th hour, was 1475 ng/ml. Elimination half life was prolonged to 13.8 h. She suffered from coma and profound hypotension, then died on the 20th day. By estimating brain propranolol concentration from the plasma level, and reviewing the clinical pictures of previously reported cases, we propose that central nervous suppression by propranolol, with membrane stabilizing effect as its pharmacological basis, may cause life threatening abnormalities in patients with massive overdose of propranolol.