Abstract
Beta-adrenergic receptor antagonists potentially risk causing fatal poisoning when taken over the daily recommended doses. The aim of this study is to investigate the differences and potential dose-related effects of propranolol and metoprolol toxicity depending on their selectivity. This 7-year-long retrospective cohort study was conducted among on 43 adult patients who received overdose propranolol (n= 22) and metoprolol (n= 21). Patients were divided into groups, with a daily overdose ≥ 240 mg/day for propranolol, ≥ 200 mg/day for metoprolol, and toxic dose ≥ 400 mg/day for both drugs. The groups were compared in terms of admission symptoms, heart rate, blood pressure, electrocardiography findings, cardiovascular effects, toxicity severity scores, treatment, follow-up times, and outcomes. Thirty-four (79.1%) of the patients who exceeded the daily dose were female, and there were no statistically significant differences between the groups in terms of gender (p= 0,281). The mean age was 29 (18-72) years, and there were no statistically significant differences between groups in terms of mean age (p= 0,192). When the vitals of the patients who exceeded the daily dose was examined, it was found that 23 (54.8%) patients had bradycardia, and 20 (46.5%) patients had hypotension. 65.2% of the bradycardia patients and 70% of the hypotensive patients were in the propranolol overdose group (p= 0,030 p= 0,021, respectively). Mean dose of symptomatic propranolol overdose patients (n= 12) was found as 1256 (280-2000) mg, mean dose of symptomatic metoprolol overdose patients (n= 11) was found as 559 (250-1000) mg. When toxic dose (≥ 400 mg) intakes were compared, more cardiovascular effects were observed in the propranolol group (p= 0,014). As a result, it was determined that Propranolol overdose has more cardiovascular effects than metoprolol overdose and there is a linear dose-symptom relationship for Propranolol.
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References
- Reith DM, Dawson AH, Whyte IM, Buckley NA, Sayer GP. Relative Toxicity of Beta Blockers in Overdose. Journal of Toxicology: Clinical Toxicology. 1996; 34(3):273–8.
- Metra M, Cas LD, Cleland JGF. Pharmacokinetic and Pharmacodynamic Characteristics of β-Blockers: When Differences May Matter. Journal of Cardiac Failure. 2006; 12(3):177–81.
- Love JN, Howell JM, Litovitz TL, Klein-Schwartz W. Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity. J Toxicol Clin Toxicol. 2000; 38(3):275–81.
- Jaillon P. Relevance of intrinsic sympathomimetic activity for beta blockers. Am J Cardiol. 1990; 66(9):21C-23C.
- Bylund DB, Gruetter CA. Propranolol. xPharm: The Comprehensive Pharmacology Reference. 2007, p. 1–9.
- Gruetter CA. Metoprolol. In: xPharm: The Comprehensive Pharmacology Reference. 2007, p. 1–7.
- Ulusal Zehir Danışma Merkezi (UZEM) Ayrıntılı Faaliyet Raporları 2014-2020 Yılları. TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü [Internet]. 2021; Available from: https://hsgm.saglik.gov.tr/depo/kurumsal/yayinlarimiz/Raporlar/Uzem/uzem_raporlari_2014-2020.pdf
- Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, et al. 2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021; 59(12):1282–501.
- Lauterbach M. Clinical toxicology of beta-blocker overdose in adults. Basic Clin Pharmacol Toxicol. 2019; 125(2):178–86.
- Kriikku P, Pelkonen S, Kaukonen M, Ojanperä I. Propranolol and metoprolol: Two comparable drugs with very different post-mortem toxicological profiles. Forensic Science International. 2021; 327:110978.
- Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. In Treasure Island (FL); StatPearls Publishing; July 26, 2021.
- Love JN, Enlow B, Howell JM, Klein-Schwartz W, Litovitz TL. Electrocardiographic changes associated with β-blocker toxicity. Annals of Emergency Medicine. 2002; 40(6):603–10.
- Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, et al. Treatment for beta-blocker poisoning: a systematic review. Clinical Toxicology. 2020;58(10):943–83.
Abstract
References
- Reith DM, Dawson AH, Whyte IM, Buckley NA, Sayer GP. Relative Toxicity of Beta Blockers in Overdose. Journal of Toxicology: Clinical Toxicology. 1996; 34(3):273–8.
- Metra M, Cas LD, Cleland JGF. Pharmacokinetic and Pharmacodynamic Characteristics of β-Blockers: When Differences May Matter. Journal of Cardiac Failure. 2006; 12(3):177–81.
- Love JN, Howell JM, Litovitz TL, Klein-Schwartz W. Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity. J Toxicol Clin Toxicol. 2000; 38(3):275–81.
- Jaillon P. Relevance of intrinsic sympathomimetic activity for beta blockers. Am J Cardiol. 1990; 66(9):21C-23C.
- Bylund DB, Gruetter CA. Propranolol. xPharm: The Comprehensive Pharmacology Reference. 2007, p. 1–9.
- Gruetter CA. Metoprolol. In: xPharm: The Comprehensive Pharmacology Reference. 2007, p. 1–7.
- Ulusal Zehir Danışma Merkezi (UZEM) Ayrıntılı Faaliyet Raporları 2014-2020 Yılları. TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü [Internet]. 2021; Available from: https://hsgm.saglik.gov.tr/depo/kurumsal/yayinlarimiz/Raporlar/Uzem/uzem_raporlari_2014-2020.pdf
- Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, et al. 2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021; 59(12):1282–501.
- Lauterbach M. Clinical toxicology of beta-blocker overdose in adults. Basic Clin Pharmacol Toxicol. 2019; 125(2):178–86.
- Kriikku P, Pelkonen S, Kaukonen M, Ojanperä I. Propranolol and metoprolol: Two comparable drugs with very different post-mortem toxicological profiles. Forensic Science International. 2021; 327:110978.
- Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. In Treasure Island (FL); StatPearls Publishing; July 26, 2021.
- Love JN, Enlow B, Howell JM, Klein-Schwartz W, Litovitz TL. Electrocardiographic changes associated with β-blocker toxicity. Annals of Emergency Medicine. 2002; 40(6):603–10.
- Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, et al. Treatment for beta-blocker poisoning: a systematic review. Clinical Toxicology. 2020;58(10):943–83.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Clinical Research |
| Authors | |
| Publication Date | October 29, 2022 |
| Submission Date | May 13, 2022 |
| Acceptance Date | June 30, 2022 |
| Published in Issue | Year 2022 Volume: 39 Issue: 4 |
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