Abstract
Primum nil nocere is a principle to be kept in mind not only when therapy is initiated, but also when it is terminated. There may be iatrogenic hazard in abrupt withdrawal of a drug. A recent example of such a hazard is the severe angina, myocardial infarction, and death that can occur in patients with coronary artery disease when therapy with propranolol is suddenly discontinued ( JAMA 237:53, 1977). Sudden discontinuance of therapy with propranolol may also precipitate acute thyrotoxicosis in persons whose hyperthyroid condition had been disguised by use of the drug. Shenkman et al 1 reported on three patients in whom florid clinical manifestations of hyperthyroidism on abrupt withdrawal of propranolol led to the unsuspected diagnosis. The threat of a superimposed acute thyrotoxic state to a heart already damaged by ischemic or hypertensive disease cannot be overemphasized. Equally florid, albeit more transient than the acute thyrotoxicosis of propranolol withdrawal,
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