What can pharmacists learn from this tragic propranolol overdose?

Pharmacy In Practice Podcast

Emma was a 24-year-old pharmacy graduate. She had two degrees, was a high achiever and was making the most of her life.

Sadly Emma took an overdose of both propranolol and citalopram.

Emma called an ambulance, but her condition quickly worsened. Despite resuscitation efforts from both paramedics and medical staff in the hospital she was transferred to, Emma sadly died.

The purpose of this podcast was to highlight the findings of the report written as a result of the investigation undertaken by the Healthcare Safety Investigation Branch (HSIB). We were fortunate to be joined by Deinniol Owens a National Investigator at the HSIB. Deinniol and I had a chat about the aspects of the investigation that are pertinent to pharmacists.

The report makes a number of recommendations but also emphasises that there is a link between anxiety, depression and migraine and that more research is needed to understand the interactions between antidepressants and propranolol in overdose.

The safety recommendations focused on the following:

• Updating clinical guidance (NICE) and the UK’s pharmaceutical reference source (the British National Formulary) on use of propranolol and highlighting the toxicity in overdose.
• National organisations supporting their staff members to understand the risks when prescribing propranolol to certain patients.
• Improving the clinical oversight in ambulance control rooms and the treatment/transfer guidance for ambulance staff for propranolol/beta-blocker overdose.