Abrupt discontinuation of some beta-blocker agents after long term therapy can result in a withdrawal syndrome.
Patient selection:
(1) long term therapy with beta-adrenergic receptor antagonist
(2) abrupt discontinuation without substitution of an alternative beta-blocking agent
Features of the withdrawal reaction:
(1) worsening of anginal symptoms, sometimes with myocardial infarction
(2) enhanced sensitivity to beta-adrenergic agonists
(3) exacerbation of ventricular arrhythmias
(4) risk of sudden death
(5) transient symptoms of sweating, palpitations, headache, malaise and tremulousness
(6) rebound hypertension
The features may last up to 2 weeks depending on the patient, specific agent, dose and duration of therapy.
The syndrome is prevented by:
(1) slowly decreasing the dose of the beta-blocker over a few weeks
(2) using beta-blocker agents with longer half lives
(2) restricting exercise during the period to minimize overexertion
(4) avoid beta-adrenergic stimulation
