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Is there still a place for practolol?

Abstract

Practolol (Eraldin - ICI) has been used in Britain for over 6 years. It is a cardioselective β-blocker with intrinsic sympathomimetic action but no quinidine-like action and until last year appeared to have few unwanted effects; this combination of properties made practolol the drug of choice for patients who required β-blockade but who had asthma or impaired cardiac function.1 It is now clear however that practolol can cause numerous unwanted effects, some of which were described in a warning circulated by the Committee on Safety of Medicines.2 The effects include arthritis and rashes,3 sclerosing peritonitis,4 keratoconjunctivitis sicca, conjunctival scarring leading to blindness, secretory otitis media and cochlear nerve damage5 and systemic lupus erythematosus.6 In general these effects have developed after prolonged use although occasionally they have occurred after only 2–3 weeks.3 In most instances they regressed when practolol was stopped; sometimes however the damage has been permanent, particularly when treatment has been continued after the onset of symptoms. The symptoms of sclerosing peritonitis may develop several months after stopping the drug. These various effects are uncommon but are sufficiently severe for the indications for the use of practolol to be reviewed. The manufacturer’s recommendations for the use of practolol have already been modified, and from October 1st the tablets will be available only from hospital pharmacies.

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