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A coroner has given the Medicines and Healthcare products Regulatory Agency chief executive Lawrence Tallon until next month to set out how prescribers’ awareness of excess propranolol ingestion can be improved and when an antidote to an overdose will be available in community settings.  

The senior coroner for London Inner South Julian Morris warned propranolol is “highly toxic at even small doses” as he examined the circumstances surrounding the death of Lee Derek Jamie Adams, 36.

Morris said there is “no specific antidote” to an overdose of the drug and warned “the only form of treatment is supportive and hospital-based”.

An inquest heard Adams was at home alone and had been “gambling extensively” on the evening of July 23, 2020 and into the early hours of the following morning when he called 999 to say he had taken a number of tablets. The inquest heard he had attempted to take his own life.

When an ambulance arrived, he was unable to let them in and by the time police gained entry to his property, the inquest heard, Adams “had deteriorated significantly, seizing and with shallow breathing”. He was given CPR but at that stage, it was not known what medication he had taken and naloxone was administered but to no effect. Adams died shortly after.

A post-mortem and toxicology test found propranolol in his stomach and blood. The drug is used to treat high blood pressure, angina, irregular heartbeats, tremors, migraines and physical anxiety symptoms.

In his report, Morris said Adams’ cause of death was cardiac arrhythmia, propranolol overdose, gambling disorder and depressive illness.

Long-term depressive illness 

The inquest heard the last time Adams, who suffered from a “long-term depressive illness”, was given propranolol on prescription was in 2017 but it was unclear where he obtained the medication.

His online gambling increased during the Covid lockdown but the coroner noted he was not “identified as being at increased risk”. The inquest heard expert evidence that “once the significant amount” of propranolol had been taken, “the outcome was inevitable – there being no opportunity to save his life”.

The court was told propranolol is absorbed quickly, within 30 to 60 minutes of ingestion, and although it is “very effective in what it is prescribed for…it is highly toxic at even small doses”. Warning more deaths could occur unless action is taken, Morris gave Tallon until May 15 to respond to the report’s findings.

“Doctors and specifically GPs should be aware of the consequences, at relatively small doses, of excess propranolol ingestion,” it said, “especially when there is no specific antidote and treatment is restricted to supportive measures only.”