Rectal propranolol controls paroxysmal sympathetic hyperactivity: A case report

Casey C. May, Douglas R. Oyler, Sara E. Parli, Cynthia L. Talley

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Paroxysmal sympathetic hyperactivity (PSH) affects approximately 10% of survivors of acquired brain injury and is associated with substantial morbidity. The most effective maintenance therapies include oral β-blockers and α-2 antagonists. We report the use of rectal propranolol for symptomatic control of PSH in a critically ill patient with an altered gastrointestinal tract for whom oral intake was contraindicated. A 15-year-old Caucasian male with no past medical history was admitted status post all-terrain vehicle rollover with multiple intra-abdominal injuries. On hospital day 40, the patient experienced cardiac arrest with a subsequent anoxic brain injury, which was complicated by the development of PSH on post-arrest day 1. Because of his altered gastrointestinal tract, he was symptomatically managed with propranolol 40 mg per rectum every 6 hours in the form of specially prepared suppositories, intravenously infused morphine and dexmedetomidine, and a transdermal clonidine patch. The patient improved clinically during this treatment and was transferred to a rehabilitation facility. This is the first case report to describe successful use of propranolol suppositories in a clinical environment. This case supports the use of propranolol suppositories as a potential alternative route when oral administration is not possible.

Original languageEnglish
Pages (from-to)e27-e31
Issue number4
StatePublished - Apr 1 2015

Bibliographical note

Publisher Copyright:
© 2015 Pharmacotherapy Publications, Inc.


  • paroxysmal sympathetic hyperactivity
  • pharmacokinetics
  • rectal propranolol

ASJC Scopus subject areas

  • Pharmacology (medical)


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