BB to cause toxic epidermal necrolysis

Q: Which beta-blockers (BB) can cause toxic epidermal necrolysis, even at therapeutic levels. - Select one

A) Acebutolol

B) Sotalol 

C) Carvedilol

D) propranolol

E) Atenolol

Answer: C

The toxicity of BB occurs either due to its excessive response to beta-adrenergic blockade or sometimes due to its proarrhythmic, i.e., membrane-stabilizing activity (MSA) on cardiac conduction. Out of these two, MSA has the most significant impact. The BBs that may cause the most MSA are propranolol (choice D), acebutolol (choice A), betaxolol, and οхрrеnоlοl.

Sotalol (choice C) is more prone to cause  Torsades de Pointes.

The only BB, so far reported to cause toxic epidermal necrolysis even at the therapeutic level, is Carvedilol (Choice C).

#toxicity

#cardiology

References:

1. Vlahovic-Palcevski V, Milic S, Hauser G, et al. Toxic epidermal necrolysis associated with carvedilol treatment. Int J Clin Pharmacol Ther 2010; 48:549.

2. Love JN, Howell JM, Litovitz TL, Klein-Schwartz W. Acute beta blocker overdose: factors associated with the development of cardiovascular morbidity. J Toxicol Clin Toxicol 2000; 38:275.