Beta-blockade disappearance rate predicts beta-adrenergic hypersensitivity

Clin Pharmacol Ther. 1989 Sep;46(3):279-90. doi: 10.1038/clpt.1989.139.

Abstract

We determined whether the beta-blockade disappearance rate would determine the degree of subsequent transient beta-adrenoceptor hyperresponsiveness after abrupt withdrawal of a beta-adrenoceptor drug. In a single-blind randomized study, 10 healthy men took a placebo for 1 week and then took nadolol one time a day (t1/2, 18 to 24 hours) or propranolol three times a day (t1/2, 4 to 6 hours) in doses that were increased weekly for 4 weeks to reach 240 mg per day. beta-Receptor responsiveness was assessed before and repeatedly after abrupt drug withdrawal by infusion of isoproterenol and epinephrine and by ergometer exercise. In the 13 days after drug discontinuation, peak beta-receptor sensitivity correlated (p less than 0.05) with the disappearance rate of beta-blockade as assessed by heart rate responses to isoproterenol (r = 0.68) and to submaximal exercise (r = 0.62) and by diastolic blood pressure responses to isoproterenol (r = 0.86) and epinephrine (r = 0.86). Plasma catecholamine levels and renin activity showed no overshoot. beta-Blockers with long plasma t1/2 values may prevent beta-blocker withdrawal syndromes by means of "self-tapering."

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Trials as Topic
  • Hemodynamics / drug effects
  • Humans
  • Isoproterenol / administration & dosage
  • Male
  • Nadolol / adverse effects
  • Nadolol / pharmacokinetics*
  • Propranolol / adverse effects
  • Propranolol / pharmacokinetics*
  • Random Allocation
  • Receptors, Adrenergic, beta / drug effects
  • Substance Withdrawal Syndrome / metabolism*

Substances

  • Receptors, Adrenergic, beta
  • Nadolol
  • Propranolol
  • Isoproterenol