Propranolol Withdrawal

The propranolol withdrawal syndrome is postulated to be a complication in the postoperative course in two patients described by Goldman in this issue (see p 193). The timing and nature of the adverse events were in keeping with our observations of exaggerated cardiac β-adrenergic responsiveness after abrupt propranolol hydrochloride withdrawal.¹ The controversy that tends to downplay the frequency and severity of propranolol withdrawal phenomena may have two explanations. First, the withdrawal features are usually mild and probably only adversely affect a few predisposed patients with overt or undetected ischemic heart disease. Second, the symptoms of the propranolol withdrawal syndrome are similar to and, therefore, may be erroneously attributed to the underlying disease. It is difficult to predict who will be at risk of an adverse event after propranolol withdrawal; therefore, a pragmatic preventive approach seems justified. If a patient's angina or hypertension is well controlled with propranolol, it would