Propranolol Dosage in Thyrotoxicosis

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Abstract
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.

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