The General Pharmaceutical Council (GPhC), the Patient Safety Commissioner for England, the Royal College of Pharmacy and the College of Mental Health Pharmacy have jointly written to the National Institute for Health and Care Excellence (NICE) to request a review of its guideline on the treatment of generalised anxiety disorder and panic disorder in adults.
The letter, coordinated by the GPhC, follows ongoing patient safety concerns associated with propranolol, identified through regulatory work and patient safety intelligence, including fatal overdoses highlighted through Prevention of Future Deaths reports.
Propranolol is not currently recommended or mentioned within NICE guideline CG113, but the letter said, "it continues to be commonly prescribed for anxiety disorders, particularly in primary care, as it remains a licensed treatment option."
"This is despite limited evidence supporting efficacy for anxiety disorders and the potential for significant harm. Propranolol is more lipophilic than other beta-blockers and readily crosses the blood brain barrier, so in overdose, it carries a higher risk of convulsions in addition to cardiovascular collapse," the letter added.
The organisations are asking NICE to review the guideline and make clear that propranolol is not recommended by NICE for the management of anxiety disorders and to highlight the risks associated with overdose.
The organisations also ask NICE to consider providing appropriate prescribing and safety advice for circumstances where propranolol is prescribed for anxiety in line with clinical judgement.
The signatories include Dr Roz Gittins, Chief Pharmacy Officer at the GPhC; Professor Henrietta Hughes, Patient Safety Commissioner for England; Dr Emily Kennedy, Head of Professional Standards, Guidance and Patient Safety at the Royal College of Pharmacy; and Nicola Greenhalgh, President of the College of Mental Health Pharmacy.
