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Letters

Propranolol is contraindicated in asthma

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7070.1486 (Published 07 December 1996) Cite this as: BMJ 1996;313:1486
  1. J M Fallowfield,
  2. H F Marlow
  1. Medical adviser, product safety group Senior medical adviser, clinical research group Zeneca Pharmaceuticals, Macclesfield SK10 4TG

    EDITOR,—The datasheet for Inderal (propranolol) states specifically that the drug is contraindicated in patients with asthma or a history of bronchospasm. Despite this, and despite the well known risks of non-selective ß blockers in patients with asthma, over the past few years Zeneca has received a number of reports of cases in which an asthmatic patient died as a result of being prescribed propranolol.

    Since propranolol was first marketed in 1965 the estimated exposure to it has been about 56 million patient years. The Medicines Control Agency has 51 reports of bronchospasm in its database of reports of adverse reactions to propranolol; 13 of the cases are recorded as having been fatal. Of more interest, however, are six reports in which it is stated that the patient had a history of asthma, bronchospasm, or wheeze; five of these cases were fatal. To help prevent further occurrences of this sort in asthmatic patients who might be prescribed propranolol erroneously, Zeneca has decided to highlight the warnings concerning asthma in the patient information leaflet for Inderal and related products. Pack labels will also carry warnings. Doctors should prescribe original packs so that a last line of defence against incorrect prescribing is not breached.

    Current advice in the prescribing information for Inderal recommends that bronchospasm can usually be reversed with a ß2 agonist bronchodilator such as salbutamol, although large doses may be required and the dose should be titrated according to the clinical response. As ß2 adrenoceptors are blocked by propranolol the advice will now be augmented by the statement that ipratropium and intravenous aminophylline may also be indicated.

    We thank the Committee on Safety of Medicines for providing us with its information.

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