Can a patient with stress, Autism Spectrum Disorder (ASD), and Obsessive-Compulsive Disorder (OCD) experience wheezing as a reaction to propranolol (propranolol)?

From the Guidelines

Yes, a patient with stress, Autism Spectrum Disorder (ASD), and Obsessive-Compulsive Disorder (OCD) can experience wheezing as a reaction to propranolol. Propranolol is a non-selective beta-blocker that can cause bronchospasm, particularly in patients with underlying respiratory conditions like asthma or COPD, as noted in a clinical practice guideline for the management of infantile hemangiomas 1. This occurs because propranolol blocks beta-2 receptors in the lungs, which normally help keep airways open when stimulated. When these receptors are blocked, airways can constrict, leading to symptoms like wheezing, shortness of breath, or chest tightness.

Key Points to Consider

• The reaction can happen regardless of the psychiatric conditions the patient has, though stress might potentially exacerbate respiratory symptoms.
• If a patient experiences wheezing after taking propranolol, they should seek medical attention immediately.
• Their healthcare provider may need to discontinue propranolol and consider alternative medications like selective beta-blockers (such as metoprolol) or different classes of medications entirely, depending on what condition the propranolol was prescribed to treat.
• It's also important to note that while propranolol can have adverse effects, the benefits of its use can outweigh the harms in certain conditions, as seen in the management of infantile hemangiomas 1.
• However, the primary concern in this scenario is the potential for bronchospasm and the need for careful monitoring and alternative treatment options if necessary.

Additional Considerations

• The patient's psychiatric conditions, including ASD and OCD, should be managed appropriately with evidence-based treatments, such as SSRIs for OCD, as recommended in the literature 1.
• The use of propranolol or any other medication should be carefully considered in the context of the patient's overall health and potential interactions with other medications.
• Recent studies, such as the one published in 2021 on extracorporeal treatment for poisoning to beta-adrenergic antagonists, highlight the importance of being aware of the potential toxicity of beta-blockers like propranolol 1.

From the FDA Drug Label

ADVERSE REACTIONS ... Respiratory: Bronchospasm. Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions; ... respiratory distress. The patient with stress, Autism Spectrum Disorder (ASD), and Obsessive-Compulsive Disorder (OCD) could react with wheezing to propranolol, as the drug label lists bronchospasm and respiratory distress as possible adverse reactions 2.

• Bronchospasm can cause wheezing.
• The presence of stress, ASD, and OCD does not directly influence the likelihood of wheezing as per the provided drug label.

From the Research

Potential Reaction to Propranolol

• The provided studies do not directly address the potential for a patient with stress, Autism Spectrum Disorder (ASD), and Obsessive-Compulsive Disorder (OCD) to experience wheezing as a reaction to propranolol 3, 4, 5, 6, 7.
• Propranolol is a beta-adrenergic antagonist that can cause bronchospasm, which may lead to wheezing in some individuals, particularly those with pre-existing respiratory conditions 3.
• However, the studies focused on the effects of propranolol on social communication, anxiety, and cognitive performance in individuals with ASD, and did not report wheezing as a common side effect 3, 4, 6, 7.
• One study noted that propranolol was well-tolerated, with expected decreases in heart rate and blood pressure, and uncommon side effects 3.
• Another study compared propranolol to atenolol, another beta-blocker, and found that atenolol may be better tolerated and more effective for anxiety disorders, but did not mention wheezing as a side effect 5.

Autonomic and Anxiety Effects

• Some studies suggest that propranolol may improve anxiety and autonomic functioning in individuals with ASD, which could potentially impact the risk of wheezing 4, 6, 7.
• However, the relationship between propranolol, anxiety, and autonomic functioning is complex, and more research is needed to fully understand the potential effects on respiratory function 6, 7.

Conclusion Not Provided

As per the instructions, no conclusion will be drawn from the available evidence. The information provided is based on the studies cited, and it is essential to consult with a healthcare professional for personalized advice on using propranolol, especially in patients with complex conditions like ASD and OCD.