Overview:
Propranolol is a non-selective beta-blocker. When used with local anesthetics containing epinephrine, it may increase the risk of hypertension and cardiac complications.
Mechanism:
- Propranolol blocks β1 and β2 receptors.
- Epinephrine’s α-adrenergic vasoconstrictor effect becomes unopposed.
- This can lead to marked vasoconstriction and elevated blood pressure.
Clinical Significance:
- Most patients tolerate small dental doses of epinephrine.
- Rarely, severe hypertensive reactions, reflex bradycardia, or cardiac events may occur.
- Risk increases with larger doses of epinephrine.
Precautions:
- Inform the dentist/physician about propranolol use.
- Use the lowest effective dose of epinephrine or consider a plain local anesthetic when appropriate.
- Do not discontinue propranolol abruptly, as this may precipitate angina, arrhythmias, or myocardial infarction.
MBH/PS