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- Title
Rectal Propranolol Controls Paroxysmal Sympathetic Hyperactivity: A Case Report.
- Authors
May, Casey C.; Oyler, Douglas R.; Parli, Sara E.; Talley, Cynthia L.
- Abstract
Paroxysmal sympathetic hyperactivity ( PSH) affects approximately 10% of survivors of acquired brain injury and is associated with substantial morbidity. The most effective maintenance therapies include oral β-blockers and α-2 antagonists. We report the use of rectal propranolol for symptomatic control of PSH in a critically ill patient with an altered gastrointestinal tract for whom oral intake was contraindicated. A 15-year-old Caucasian male with no past medical history was admitted status post all-terrain vehicle rollover with multiple intra-abdominal injuries. On hospital day 40, the patient experienced cardiac arrest with a subsequent anoxic brain injury, which was complicated by the development of PSH on post-arrest day 1. Because of his altered gastrointestinal tract, he was symptomatically managed with propranolol 40 mg per rectum every 6 hours in the form of specially prepared suppositories, intravenously infused morphine and dexmedetomidine, and a transdermal clonidine patch. The patient improved clinically during this treatment and was transferred to a rehabilitation facility. This is the first case report to describe successful use of propranolol suppositories in a clinical environment. This case supports the use of propranolol suppositories as a potential alternative route when oral administration is not possible.
- Subjects
PROPRANOLOL; PAROXYSMAL sympathetic hyperactivity; ABDOMINAL injuries; PERFORMANCE-enhancing drugs; ANATOMY; PATIENTS
- Publication
Pharmacotherapy, 2015, Vol 35, Issue 4, pe27
- ISSN
0277-0008
- Publication type
Article
- DOI
10.1002/phar.1568