A coroner has warned GPs of the risk of propranolol overdose following the death of a man who took a “significant amount” of the drug.
According to a prevention of future deaths report sent to the Royal College of General Practitioners (RCGP) and published last month, Lee Adams died in July 2020 at the age of 36 after ingesting an “excessive number of propranolol tablets, intending to take his own life”.
An inquest into the death found that Adams was “suffering from a long-term depressive illness” and “also partook in online gambling”.
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The report said that during the Covid lockdown, Adams “had become increasingly reliant [on] and involved with gambling”.
It added that Adams was contacted in March 2020 about his deposits and “had stated he was fine”.
He “continued to gamble”, the report noted, and “was not identified as being at increased risk”.
“Outcome was inevitable”
The coroner behind the report, Julian Morris, said Adams “was at home alone and had been gambling extensively” over the night before and the early morning of the day of his death.
Morris said Adams “called 999 in the early hours, saying he had taken some tablets of unknown origin”.
“The last time propranolol had been given by prescription was in 2017,” he said. “It was not clear where [Adams] had obtained the medication.”
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Morris noted that Adams’ condition “had deteriorated significantly” by the time paramedics entered his home and began administering CPR.
“At this stage, the tableted medication was still unknown,” he added. “Naloxone was given once, to no effect. Sadly, he was pronounced dead at 03.39.”
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Morris said a subsequent post-mortem and toxicology revealed “the presence of propranolol” in Adams’ stomach and blood.
“Expert evidence provided to the court was that once the significant amount of [propranolol] had been taken, the outcome was inevitable; there being no opportunity to save his life,” he added.
And he concluded that Adams’ “medical cause of death” was cardiac arrhythmia, propranolol overdose, gambling disorder and depressive illness.
“GPs should be aware”
The coroner said the inquest revealed “matters giving rise to concern” and there “is a risk that future deaths could occur unless action is taken”.
He noted that propranolol “is absorbed quickly” - and that while it is “very effective” at treating the conditions it is prescribed for, it is “highly toxic at even small doses”.
“There is no specific antidote to a propranolol overdose; the only form of treatment is supportive and therefore hospital-based,” he said.
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He added that GPs “should be aware of the consequences, at relatively small doses, of excess propranolol ingestion”, particularly as there “is no specific antidote and treatment is restricted to supportive measures only”.
And he said GPs “should be reminded to ask individuals about their gambling habits in the same way that they ask about smoking and alcohol”.
The coroner concluded that he believed “action should be taken to prevent future deaths” and that the RCGP has “the power to take such action”.
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