Will Inderal provoke wheezing and allergic episodes in cardiac patients?

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 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 in a two time dose) 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 frequently 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?

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 details. It is very important to know the reason to start tablet Inderal at first point. What kind of arrhythmia it was and all in order to evaluate does she really need to continue any beta blocker. As your Cardiologist year ago after cardiac evaluation did not find any reason to continue the medication as per your history. As we see in a day to day practice patients with palpitations just due to anxiety or stress and without any cardiac issue, non-selective beta blockers would definitely aggravate her symptoms. BP (blood pressure) you have mentioned in your description is wrong I guess. As it appears to be 12/20 something, might be a type error but looks normal to me. For time being you can change the beta blocker to a selective beta blocker like Metaprolol (12.5 mg) or 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 better to slowly taper her beta blocker medication and stop as well. Because though cardioselective beta blockers has some or minimal effect on beta 2 receptors as well. Even I would advise to start meditation and yoga to overcome her anxiety issue, that will help her in controlling palpitations if they are related. Would like to review her all previous and recent cardiac records to further discuss and clarify management strategy.

Will Inderal provoke wheezing and allergic episodes in cardiac patients?

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