Comparative effects of abrupt withdrawal of propranolol and verapamil in angina pectoris

William H. Frishman, Neal Klein, Joel Strom, Martin N. Cohen, Harry Shamoon, Howard Willens, Philip Klein, Steven Roth, Louis Iorio, Thierry LeJemtel, Simcha Pollack, Edmund H. Sonnenblick

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24 Scopus citations

Abstract

The potential hazards of abrupt withdrawal of propranolol have been described in patients with angina pectoris; however, the effects of abrupt withdrawal from long-term therapy with verapamil have not previously been investigated. The comparative effects of withdrawal from long-term treatment with propranolol and verapamil were assessed in a placebo-controlled double-blind randomized crossover study of 20 patients with stable angina pectoris. Patients received placebo for 2 weeks, then increasing doses of propranolol (60 to 320 mg/day) or verapamil (240 to 480 mg/day) for 3 weeks. Patients were then abruptly withdrawn from drug onto placebo for 1 week, followed by crossover to the other drug treatment and a second withdrawal period. All 20 patients were withdrawn from verapamil without evidence of a rebound increase in frequency of anginal attacks, blood pressure, heart rate, or rate-pressure product and without a rebound deterioration in exercise tolerance. In contrast, with propranolol withdrawal, 2 patients (with the highest baseline angina attack rate) had a severe exacerbation of their anginal syndrome and could not undergo formal exercise testing; the other 18 patients were withdrawn from propranolol without Incident. Plasma catecholamlnes were increased during exercise compared with rest during all treatments; however, the levels of catecholamines during exercise were significantly higher with propranolol than with verapamil and placebo (p < 0.05). Levels of exercise catecholamines returned to placebo baseline values after withdrawal of propranolol.

Original languageEnglish (US)
Pages (from-to)1191-1195
Number of pages5
JournalThe American Journal of Cardiology
Volume50
Issue number5
DOIs
StatePublished - Nov 1982

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Frishman, W. H., Klein, N., Strom, J., Cohen, M. N., Shamoon, H., Willens, H., Klein, P., Roth, S., Iorio, L., LeJemtel, T., Pollack, S., & Sonnenblick, E. H. (1982). Comparative effects of abrupt withdrawal of propranolol and verapamil in angina pectoris. The American Journal of Cardiology, 50(5), 1191-1195. https://doi.org/10.1016/0002-9149(82)90442-8