Involvement of propranolol in suicides: cross-sectional study using coroner-reported data

Gorton, Hayley C.; Archer, Charlotte; Algahtani, Thikra; Mughal, Faraz; Copeland, Caroline S.

Abstract

Background
Propranolol is a beta-blocker medication indicated mostly for heart rhythm conditions and for physical symptoms of anxiety. Prescriptions for propranolol in the UK have increased since 2008. Recently, there have been concerns about the involvement of propranolol in intentional poisonings, but such deaths are not routinely reported. Therefore, use of coroner-reported and toxicology data enables unique investigation into the scale of involvement of propranolol in suicide.

Aims
To describe the extent to which propranolol is involved in suicides, including patterns over time and characteristics of people whose suicide involved propranolol compared with other suicides.

Method
Data were derived from the National Programme on Substance Use Mortality (NPSUM). All suicides and deaths of undetermined intent between 2010 and 2021 in England, Wales and Northern Ireland were extracted, and a subset was identified where propranolol was involved in death.

Results
There were 4473 suicides of which 297 (6.6%) involved propranolol, with the proportion involving propranolol nearly quadrupling during the study period (3.4% v. 12.3%). Compared with all other suicides, a greater proportion of propranolol suicides were in women (56.6% v. 37.1%) and in people with diagnoses of depression (39.1% v. 27.1%) and anxiety (22.2% v. 8.6%). When suicide involved propranolol, an antidepressant was detected at post-mortem in 81.8% of deaths, most commonly a selective serotonin reuptake inhibitor (SSRIs) (51.5%), and most often citalopram (24.6%).

Conclusions
A small number, but increasing proportion, of suicides reported to the NPSUM involve propranolol. Vigilance to the combined toxicity profile of medicines used alongside propranolol may be pertinent.

Citation

Gorton, H. C., Archer, C., Algahtani, T., Mughal, F., & Copeland, C. S. (2024). Involvement of propranolol in suicides: cross-sectional study using coroner-reported data. BJPsych Open, 10(4), Article e127. https://doi.org/10.1192/bjo.2024.714

• Journal Article Type: Article
• Acceptance Date: Apr 23, 2024
• Online Publication Date: Jun 3, 2024
• Publication Date: 2024-07
• Deposit Date: Jun 21, 2024
• Journal: BJPsych Open
• Print ISSN: 2056-4724
• Publisher: Cambridge University Press
• Peer Reviewed: Peer Reviewed
• Volume: 10
• Issue: 4
• Article Number: e127
• DOI: https://doi.org/10.1192/bjo.2024.714
• Keywords: Suicide; primary care; epidemiology; antidepressants; propranolol
• Public URL: https://keele-repository.worktribe.com/output/856618
• Additional Information: Copyright: Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists; License: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.; Free to read: This content has been made available to all.