Adrenaline vs Beta blockers

adrenaline adrenaline in anaphylaxis beta blockers Jun 05, 2025

Battle of the beasts – beta blockers vs adrenaline 💉🆚

Adrenaline is the one and only drug of choice for anaphylaxis management, but what happens when it comes up against a formidable opponent?

Patients who are taking beta blockers, particularly noncardioselective ones such as propranolol and sotalol, will likely have a diminished response to adrenaline due to the antagonistic effects of beta blockers on beta 1 receptors ❤️ and beta 2 receptors in the lungs 🫁.

What does this mean?

🔸 The cardio-stimulatory effects of adrenaline are far less apparent in patients on beta blockers, leading to prolonged periods and difficult management of hypotension
🔸 Noncardioselective beta blockers can inhibit the bronchodilatory effects of adrenaline in the smooth muscle of the bronchial tree, impacting on the management of bronchospasm
🔸 Some research has suggested that beta blocker use has contributed to a higher incidence and severity of anaphylaxis, but the jury is still out on this one

Impacts on anaphylaxis management:

🔹 Adrenaline is still the drug of choice for anaphylaxis management, however extreme caution and even closer monitoring is advised in patients who are taking beta blockers
🔹 In patients with ongoing hypotension not responsive to adrenaline, glucagon can be given to reverse the effects of beta blockers 💊
🔹 For resistant bronchospasm, intravenous salbutamol can be used
🔹 For patients with identified anaphylaxis who may use an Epi-pen in the community, consideration should be given to ongoing beta-blocker therapy and whether there is a safer, suitable alternative
🔹 In any event, adrenaline remains the first-line treatment for anaphylaxis for all patients

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References:

Ledford, D. (2021) Epinephrine (adrenaline) therapy in patients receiving beta blocker treatment. American academy of allergy, asthma and immunology. https://www.aaaai.org/allergist-resources/ask-the-expert/answers/old-ask-the-experts/epi#:~:text=Beta%2Dblockers%20may%20attenuate%20the,muscles%20of%20the%20bronchial%20tree.

Yim, R. (2016) An update on perioperative anaphylaxis. WFSA. https://resources.wfsahq.org/atotw/an-update-on-perioperative-anaphylaxis/

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