Advertisement

Beta blockers and intravenous roentgen contrast materials: Which risks do exist?

Published:August 13, 2016DOI:https://doi.org/10.1016/j.ejim.2016.08.003
      Currently, beta blockers (e.g. metoprolol, atenolol, bisoprolol, esmolol, nebivolol, propranolol, pindolol) are broadly used to treat diseases like hypertension, tachycardia, cardiac arrhythmia, congestive heart failure, essential tremor, migraine prophylaxis, and myocardial infarction for example. Both beta blockers and iodinated radio-contrast media (ICM) are frequently used, so that a relevant proportion of patients undergoing ICM-enhanced computed tomography (CT) or other X-ray-related imaging procedures can be estimated to be under treatment with beta blockers. Usually, ICM are well tolerated and safe. However, adverse events (AEs) and hypersensitivity reactions (HSRs) still occur in a small percentage of patients. Especially, patients at risk will acquire AEs/HSRs. Therefore, the identification of risks is mandatory to efficiently avoid ICM side effects. While a history of a previous ICM reaction/allergy is a well-known risk and a clear indication for a prophylactic task, other risks such as intake of beta-blockers are less clear and, therefore, still a matter of debate. Since GPs should be involved in the decision process to safely manage the application of ICM, we summarized the current knowledge concerning beta-blocker medication while undergoing ICM-enhanced radiological imaging procedure.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lang D.M.
        • Alpern M.B.
        • Visintainer P.F.
        • Smith S.T.
        Elevated risk of anaphylactoid reaction from radiographic contrast media is associated with both beta-blocker exposure and cardiovascular disorders.
        Arch Intern Med. 1993; 153: 2033-2040
        • Hamilton G.
        Severe adverse reaction to urography in patients taking beta-adrenergic blocking agents.
        CMAJ. 1985; 133: 122
        • Lee S.
        • Hess E.P.
        • Nestler D.M.
        • Bellamkonda Athmaram V.R.
        • Bellolio M.F.
        • Decker W.W.
        • et al.
        Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis.
        J Allergy Clin Immunol. 2013; 131: 1103-1108
        • Lieberman P.
        • Simons F.E.
        Anaphylaxis and cardiovascular disease: therapeutic dilemmas.
        Clin Exp Allergy. 2015; 45: 1288-1295
        • Mannaioni P.F.
        • Mastroianni R.
        • Mastrangelo D.
        Adrenaline inhibits the immunological activation of human basophils at pharmacological and ultra-low doses.
        Med Sci Monit. 2010; 16: BR227-BR232
        • Wang X.S.
        • Lau H.Y.
        Beta-adrenoceptor-mediated inhibition of mediator release from human peripheral blood-derived mast cells.
        Clin Exp Pharmacol Physiol. 2006; 33: 746-750
        • Kassamali R.H.
        • Kim D.H.
        • Patel H.
        • Raichura N.
        • Hoey E.T.
        • Hodson J.
        • et al.
        Safety of an i.v. β-adrenergic blockade protocol for heart rate optimization before coronary CT angiography.
        AJR Am J Roentgenol. 2014; 203: 759-762
        • Ndrepepa G.
        • Kastrati A.
        Intravenous β-blockers in primary percutaneous coronary intervention: new hope for an old therapy.
        Circulation. 2013; 128: 1487-1489
        • Aggarwal A.
        • Smith J.L.
        • Chinnaiyan K.M.
        • Mehta N.
        • Boura J.
        • Khoury Abdulla R.
        • et al.
        β-Blocker premedication does not increase the frequency of allergic reactions from coronary CT angiography: results from the Advanced Cardiovascular Imaging Consortium.
        J Cardiovasc Comput Tomogr. 2015; 9: 270-277
        • Aran S.
        • Shaqdan K.W1.
        • Abujudeh H.H.
        Adverse allergic reactions to linear ionic gadolinium-based contrast agents: experience with 194,400 injections.
        Clin Radiol. 2015; 70: 466-475
        • Lang D.M.
        Do beta-blockers really enhance the risk of anaphylaxis during immunotherapy?.
        Curr Allergy Asthma Rep. 2008; 8: 37-44