Clinical experiences with propranolol

ADRENERGIC beta-receptors are responsible for the cardiac effects of the sympathetic nervous system (Ahlquist, 1948). Pronethalol (Black and Stephenson, 1962) first proved to be an effective beta-receptor blocking agent with little sympathomimetic activity. Limited clinical trials suggested that pronethalol was of value in angina (Dornhorst and Robinson, 1962; Alleyne and colleagues, 1963; Barnett and Brandstater, 1964), in arrhythmias including those attributed to digitalis (Stock and Dale, 1963) and those occurring during anaesthesia (Payne and Senfield 1964; Johnstone, 1964). The drug was also used in phaeochromocytoma (Dornhorst and Laurence, 1963), in hypertrophic obstructive cardiomyopathy (Harrison, Ross, Chidsey and Braunwald, 1963; Cohen, Effat, Goodwin, Oakley and Steiner, 1964), in hypertension (Prichard, 1964), in Parkinsonian tremor (Herring, 1964), and in metaraminol-treated hypotension (Luria, Miller and Kaplan, 1964). However, the clinical use of pronethalol has been limited by its side-effects in man and by its toxic properties in mice (Paget, 1963). A further analogue, propranolol (I.C.I. 45520; Inderal) (Black, Crowther, Shanks, Smith and Dorhorst, 1964) did not appear to have these undesirable properties. We are reporting our experiences with the clinical use of propranolol with particular reference to its use in arrhythmias, in angina pectoris and during anesthesia, and to its effect on the blood lipid picture and its toxicity.