{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T22:36:47Z","timestamp":1784932607578,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Scientic Foundation-Flanders","award":["1120623"],"award-info":[{"award-number":["1120623"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: The issue of beta blocker poisoning has received little attention, despite the widespread use of these compounds in cardiac and neuropsychiatric care. Safety profiles differ, and some beta blockers appear in poisonings far beyond what their usage rates imply. This study characterizes beta blocker intoxication patterns in Belgium, focusing on propranolol, by integrating national prescription data, poisoning reports, and adverse drug reaction records. Methods: Belgian prescription data, poison centre reports, and European ADR databases were analysed to identify intoxication patterns and demographic or clinical characteristics associated with these events. Results: Poisoning data revealed propranolol as markedly overrepresented compared to prescription rates and was the primary beta blocker implicated in self-harm-related overdoses. These cases occurred mainly in women, younger individuals, and patients with psychiatric or cardiovascular comorbidities. Co-exposures with benzodiazepines, antidepressants, and other psychoactive agents were frequent, and propranolol was linked to more complex intoxication patterns than other beta blockers. Conclusions: Propranolol shows a distinct toxicological profile and is disproportionately involved in intoxications, especially in vulnerable groups and in combination with psychoactive drugs. These findings highlight the need for greater awareness, targeted prevention, and careful monitoring.<\/jats:p>","DOI":"10.3390\/pharmacy14020043","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T15:01:07Z","timestamp":1772636467000},"page":"43","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beta Blocker Intoxications in Belgium: A Data Analysis with Focus on Propranolol"],"prefix":"10.3390","volume":"14","author":[{"given":"Brechje","family":"van den Boogaard","sequence":"first","affiliation":[{"name":"Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"van de Lavoir","sequence":"additional","affiliation":[{"name":"Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-3490","authenticated-orcid":false,"given":"Rani","family":"Robeyns","sequence":"additional","affiliation":[{"name":"Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celine","family":"Gys","sequence":"additional","affiliation":[{"name":"Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0527-1136","authenticated-orcid":false,"given":"Adrian","family":"Covaci","sequence":"additional","affiliation":[{"name":"Toxicological Centre, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4488-551X","authenticated-orcid":false,"given":"Hans","family":"De Loof","sequence":"additional","affiliation":[{"name":"Laboratory of Physiopharmacology, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/aian.AIAN_201_18","article-title":"Propranolol: A 50-Year Historical Perspective","volume":"22","author":"Srinivasan","year":"2019","journal-title":"Ann. Indian Acad. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.recesp.2019.02.023","article-title":"Beta-blockers: Historical Perspective and Mechanisms of Action","volume":"72","author":"Oliver","year":"2019","journal-title":"Rev. Esp. Cardiol. (Engl. Ed.)"},{"key":"ref_3","unstructured":"(2024, May 12). WHO EML 23rd List (2023) 2023. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-MHP-HPS-EML-2023.02."},{"key":"ref_4","first-page":"247","article-title":"Beta-blocker and calcium-channel blocker toxicity: Current evidence on evaluation and management","volume":"13","author":"Goldfine","year":"2024","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_5","unstructured":"(2024, May 13). Beta Blocker Poisoning\u2014UpToDate. Available online: https:\/\/www.uptodate.com\/contents\/beta-blocker-poisoning."},{"key":"ref_6","unstructured":"(2024, May 12). B\u00e8ta-Blokkers. Available online: https:\/\/toxicologie.org\/beta-blokkers\/."},{"key":"ref_7","unstructured":"(2024, November 19). Vergiftigingen.info\u2014Home. Available online: https:\/\/www.vergiftigingen.info\/."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Giakas, A., Mangold, K., Androulakis, A., Hyduke, N., Galynker, I., Thiam, M., Cai, G., and Androulakis, X.M. (2023). Risks of suicide in migraine, non-migraine headache, back, and neck pain: A systematic review and meta-analysis. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1160204"},{"key":"ref_9","unstructured":"Nelson, L.S., Howland, M.A., Lewin, N.A., Smith, S.W., Goldfrank, L.R., and Flomenbaum, N.E. (2019). Goldfrank\u2019s Toxicologic Emergencies, McGraw-Hill. [11th ed.]."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"516","DOI":"10.3399\/bjgp24X739881","article-title":"Propranolol in anxiety: Poor evidence for efficacy and toxicity in overdose","volume":"74","author":"Phelan","year":"2024","journal-title":"Br. J. Gen. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s13181-025-01088-3","article-title":"Variable Toxicity by \u03b2-Blocker Class in Intentional Overdoses Reported to U.S. Poison Centers","volume":"21","author":"Watson","year":"2025","journal-title":"J. Med. Toxicol."},{"key":"ref_12","first-page":"87","article-title":"Presented at the North American Congress of Clinical Toxicology 2023-Montreal","volume":"61","author":"Rianprakaisang","year":"2023","journal-title":"Can. Publ. Clin. Toxicol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"11795476221126981","DOI":"10.1177\/11795476221126981","article-title":"Seizures and Irreversible Cardiogenic Shock Following Propranolol Poisoning: Report of 2 Cases and Literature Review","volume":"15","author":"Sharifpour","year":"2022","journal-title":"Clin. Med. Insights Case Rep."},{"key":"ref_14","unstructured":"Barahona, G.C., Ali, R., Giron, C.O., Ng, W., Bobrysheva, H., Martinez, E.C., Azhar, M., Htoo, M., and Atrash, A. (2026, February 22). Beta-Blocked: A Severe Propranolol Overdose Case Report. Available online: https:\/\/www.atsjournals.org\/doi\/pdf\/10.1164\/ajrccm-conference.2024.209.1_MeetingAbstracts.A5699."},{"key":"ref_15","first-page":"1","article-title":"Physicians\u2019 Psychosocial Work Conditions and Quality of Care: A Literature Review","volume":"5","author":"Angerer","year":"2015","journal-title":"Prof. Prof."},{"key":"ref_16","unstructured":"(2024, November 27). Patient Safety Spotlight: The Under-Recognised Risk of Toxicity of Propranolol in Overdose|General Pharmaceutical Council. Available online: https:\/\/www.pharmacyregulation.org\/about-us\/news-and-updates\/regulate\/patient-safety-spotlight-under-recognised-risk-toxicity-propranolol-overdose."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1192\/bjo.2024.714","article-title":"Involvement of propranolol in suicides: Cross-sectional study using coroner-reported data","volume":"10","author":"Gorton","year":"2024","journal-title":"BJPsych Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3114","DOI":"10.1002\/bcp.70147","article-title":"The problem of propranolol poisoning","volume":"91","author":"Williams","year":"2025","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_19","unstructured":"(2026, February 25). Potential Under-Recognised Risk of Harm from the Use of Propranolol. Available online: https:\/\/www.hssib.org.uk\/patient-safety-investigations\/potential-under-recognised-risk-of-harm-from-the-use-of-propranolol\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1161\/HYPERTENSIONAHA.120.16590","article-title":"Do \u03b2-Blockers Cause Depression?: Systematic Review and Meta-Analysis of Psychiatric Adverse Events During \u03b2-Blocker Therapy","volume":"77","author":"Riemer","year":"2021","journal-title":"Hypertension"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s40264-021-01140-5","article-title":"\u03b2-Blockers and the Risk of Depression: A Matched Case\u2013Control Study","volume":"45","author":"Bornand","year":"2022","journal-title":"Drug Saf."},{"key":"ref_22","unstructured":"(2024, July 02). Statistieken over Geneesmiddelen Afgeleverd in Openbare Apotheken (Farmanet)|RIZIV. Available online: https:\/\/www.riziv.fgov.be\/nl\/statistieken\/statistieken-van-geneesmiddelen\/statistieken-over-geneesmiddelen-afgeleverd-in-openbare-apotheken-farmanet."},{"key":"ref_23","unstructured":"(2024, July 02). Defined Daily Dose (DDD). Available online: https:\/\/www.who.int\/tools\/atc-ddd-toolkit\/about-ddd."},{"key":"ref_24","unstructured":"Python Software Foundation (2024, May 12). Python Language Reference, Version 3.8. Available online: https:\/\/www.python.org."},{"key":"ref_25","unstructured":"Kendall, M.G. (1970). Rank Correlation Methods, Charles Griffin. [4th ed.]."},{"key":"ref_26","unstructured":"(2024, October 09). Over Ons|Belgisch Antigifcentrum. Available online: https:\/\/www.antigifcentrum.be\/over-ons."},{"key":"ref_27","unstructured":"(2024, November 07). Europese Database van Rapporten over Vermoedelijke Bijwerkingen van Geneesmiddelen\u2014Gegevensbron. Available online: https:\/\/www.adrreports.eu\/nl\/data_source.html."},{"key":"ref_28","unstructured":"(2025, December 15). BCFI|Folia|Nieuwigheden Geneesmiddelen Februari 2023. Available online: https:\/\/www.bcfi.be\/nl\/articles\/4011?folia=4002&matches=acebutolol%7CAcebutolol."},{"key":"ref_29","unstructured":"(2024, October 20). Europese Database van Rapporten over Vermoedelijke Bijwerkingen van Geneesmiddelen\u2014Een Webrapport Bekijken. Available online: https:\/\/www.adrreports.eu\/nl\/viewing_reports.html."},{"key":"ref_30","unstructured":"Baselt, R.C. (2020). Disposition of Toxic Drugs and Chemicals in Man, Biomedical Publications. [12th ed.]."},{"key":"ref_31","unstructured":"(2024, November 21). Plaats van B\u00e8tablokkers Volgens de Nieuwe Richtlijnen van de ESH 2023|Tijdschrift voor Cardiologie. Available online: https:\/\/www.tvcjdc.be\/nl\/article\/13505007\/."},{"key":"ref_32","unstructured":"(2026, January 14). Do Antihypertensive Medicines Increase the Risk of Depression?\u2014The Pharmaceutical Journal. Available online: https:\/\/pharmaceutical-journal.com\/article\/research\/do-antihypertensive-medicines-increase-the-risk-of-depression."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"337","DOI":"10.5694\/mja2.52631","article-title":"Strong medication overdose data, but we need to consider both toxicity and therapeutic need when prescribing","volume":"222","author":"Chiew","year":"2025","journal-title":"Med. J. Aust."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"339","DOI":"10.5694\/mja2.52638","article-title":"The relative toxicity of medicines detected after poisoning suicide deaths in Australia, 2013\u20132019: A data linkage case series study","volume":"222","author":"Lim","year":"2025","journal-title":"Med. J. Aust."},{"key":"ref_35","unstructured":"(2026, February 25). The Dangers of Propranolol for Anxiety\u2014The Pharmaceutical Journal. Available online: https:\/\/pharmaceutical-journal.com\/article\/feature\/the-dangers-of-propranolol-for-anxiety."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s11096-023-01648-z","article-title":"A quality improvement study of the implementation and initial results of a pragmatic clinical decision support system in the community pharmacy setting","volume":"46","author":"Bogaerts","year":"2024","journal-title":"Int. J. Clin. 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