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Propranolol Dosage in Thyrotoxicosis

Departments of Pharmacology and Therapeutics Dundee, Scotland
Anaesthesia Dundee, Scotland
Surgery (A.G.), University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland

Address all correspondence to: Dr. John Feely, Division of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee 37232.

Address requests for reprints to: Prof. J. Crooks, Department of Pharmacology and Therapeutics, Dundee, Scotland.

Eighteen thyrotoxic patients receiving chronic treatment with propranolol (160 mg/day) were studied to determine the relationship between plasma propranolol concentration and drug effect. There was a considerable interindividual variability in both the plasma propranolol steady state concentration and the degree of β-adrenergic blockade. The plasma propranolol steady state concentration correlated significantly with both β-adrenergic blockade and weight change but not with the degree of subjective improvement.

In a group of 40 patients, including 10 severely thyrotoxic patients, who had the dosage of propranolol titrated objectively preoperatively to bring about a greater than 25.. reduction in exercise heart rate at the end of a dosage interval, no case of thyroid storm was encountered. Many patients, the younger and severely thyrotoxic in particular, require doses in excess of 160 mg/day to achieve this degree of β-adrenergic blockade.

^* National University of Ireland Travelling Student in Pharmacology.

Received February 5, 1980.

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