Can Propranolol, a beta-blocker, trigger asthma?

Question

Hi doctor,

I am a senior year medical student, and I would like to ask you a question about my mother. She had a history of hyper/hypothyroidism about 10 years ago, but in the last two years, her thyroid has been managed, and she stopped taking T4. Her cardiologist told her about 10 years ago to start taking Inderal (Propranolol 20 mg per day divided into two doses) because she had palpitations and some arrhythmias. She had an echo/ECG about a year ago, and her heart was fine, and her cardiologist suggested stopping Inderal. But being a very anxious person and having frequent anxiety tachycardias, she did not stop it, which brings me to the present, having been diagnosed the past six months by her pulmonologist with allergic rhinitis/asthma and having frequent wheezing episodes, even though she takes antihistamines when the episodes occur. Shouldn't she change her beta-blocker to a cardio-selective one? She finds herself not being able to breathe while on Inderal, but the symptoms reappear when she takes it. What would you recommend as a cardioselective beta-blocker? Would it be safe to change from Inderal to, let us say, Atenolol? If yes, how would she do it?

Kindly guide.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through the history you have described for your mother. I really appreciate the way you have presented it with all the details. It is very important to know the reason for starting the tablet Inderal at the first point. What kind of arrhythmia was it, and all? In order to evaluate, does she really need to continue any beta blocker? Your cardiologist, a year ago, after cardiac evaluation, did not find any reason to continue the medication as per your history. As we see in day-to-day practice, in patients with palpitations just due to anxiety or stress and without any cardiac issue, non-selective beta-blockers would definitely aggravate her symptoms.

The BP (blood pressure) looks normal to me. For the time being, you can change the beta blocker to a selective beta-blocker like Metaprolol (12.5 mg), Nebivolol (2.5 mg), or Atenelol (25 mg)on a very low dose. Get her evaluated again with her cardiac reports whenever possible, and if not required, it is better to slowly taper her beta blocker medication and stop as well. Because cardioselective beta-blockers have some or minimal effect on beta 2 receptors as well, I would even advise her to start meditation and yoga to overcome her anxiety issue, which will help her control palpitations if they are related. I would like to review all her previous and recent cardiac records to discuss and clarify the management strategy further.

I hope this helps.

Thank you.