Propranolol kinetics in plasma from severely burned adults

Objectives The aim of this study was to determine the appropriate propranolol dosing strategy for reducing heart rate in severely burned adults. Methods A total of 26 patients (≥18 years) with burns covering ≥30% of the total body surface area were included in this IRB-approved study. Plasma propranolol concentrations were determined in a placebo group (n = 10) or following one of three dosing strategies: Q6 (n = 4), Q8 (n = 6), and Q24 (n = 6). Blood was collected just before dosing and at regular intervals over two dosing periods with corresponding heart rate and blood pressure recordings. Statistical significance was determined by one-way ANOVA followed by the appropriate post-hoc test. Results Heart rate was 86 ± 2 bpm for Q6, 93 ± 3 bpm for Q8, and 90 ± 4 bpm for Q24. The Q8 group had a significantly higher heart rate than the Q6 group (p = 0.0001). Plasma propranolol concentrations were significantly higher in the Q6 dosing strategy than in the Q8 dosing strategy (p = 0.02). Conclusions Heart rate can be decreased to a similar degree with Q6 and Q24 dosing strategies, with the Q8 dosing strategy being less effective. Q6 dosing is recommended to maintain reduced heart rate throughout dosing periods.