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Samuel Vaisrub, MD

JAMA. 1978;239(21):2277.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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 al¹ 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, . . . [Full Text PDF of this Article]

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