Abstract
In Reply.— As Dr Stotter has indicated, a drug interaction between propranolol and epinephrine can occur. Increases in blood pressure (BP) and bradycardia have been described in patients receiving propranolol after receiving intravenous epinephrine 1 and after insulin-induced hypoglycemia. 2 In the latter instance, endogenous epinephrine secreted in response to the hypoglycemia is thought to be responsible for provoking the hypertension. Dr Stotter indicates the postulated mechanism. Therapy for anaphylaxis is generally directed at reversing bronchoconstriction and supporting the BP. Usually, both epinephrine and fluids are administered to reverse the hypotension. However, careful titration of the BP in this emergency situation is difficult. While patients receiving propranolol might be more sensitive to the pressor effects of epinephrine, I expect that the BP could be maintained at safe levels by adjusting the rate of fluid administration.
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