What is the role of antiadrenergic drugs (propranolol) in thyroid storm treatment?

Updated: Mar 16, 2020
  • Author: Madhusmita Misra, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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Antiadrenergic drugs

Promptly administer antiadrenergic drugs (eg, propranolol) to minimize sympathomimetic symptoms. Propranolol is administered orally or via nasogastric tube at a dose of 60-80 mg every 4-6 hours and the dose adjusted based on heart rate and blood pressure. It may also be given intravenously when necessary for rapid onset of action (0.5-1 mg over 10 min followed by 1-2 mg over 10 min every few hours, adjusted based on vital signs). It is important to avoid propranolol in conditions such as asthma, chronic obstructive pulmonary disease, peripheral vascular disease, or decompensated heart failure. Cardioselective beta blockers such as atenolol or metoprolol may be administered in patients with reactive airway disease, and calcium channel blockers may be used when beta blockers are contraindicated. The use of intravenous short acting beta-1 blockers, such as esmolol (loading dose of 250-500 mcg/kg, followed by an infusion of 50-100 mcg/kg per minute), allows quick dose titration with minimization of side effects.

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